借鉴日本护理保险制度 构建我国护理保险体系

护理保险是应对人口老龄化带来的社会问题的一种有效途径。日本的护理保险制度具有护理保险法律法规健全、内容细致多样化及具有专业的护理人员等特点,这种制度为日本老年人提供了很好的护理保障。我国在未来要面临更加严重的人口老龄化问题,我国可以借鉴日本的发展经验,构建我国护理保险体系。在发展我国护理保险体系时,我国应确定社会保险和商业保险相结合的模式;注重法律法规的建设;创新护理保险产品种类;加强人才的培养。     

Substitutional effect of long-term care to hospital inpatient care?

In China, many of the top- and second-tier hospitals are overcrowded, this is partly due to the fact they are providing services which can provided by other medical facilities such as long-term care. The implementation of the Qingdao Long-term Care Medical Insurance (LTCMI) which began as a pilot in Qingdao in 2012 may alleviate the burden of overcrowding in these hospitals. In this pilot, the Qingdao government shifted patients who did not require hospital inpatient care from top- and second-tier hospitals to lower tier facilities, care homes and home care to i) reduce the expenditure of patients, ii) reduce the burden on the top- and second-tier hospitals and iii) improve delivery (from a time and geographic perspective) of long term care to those that need such attention.The purpose of this paper is to assess the impact of this policy from a burden and cost perspective. Our finding suggests that there is a reduction in costs to all stakeholders. The total cost to the government-subsidized medical insurance decreases by around $7918 RMB per recipient. The cost to the individual decreases by around $2324 RMB per recipient. Thus, netting a decrease of $10,242 RMB in total expenditure. Furthermore, we find that there is a 12% reduction in inpatient service after a recipient participates in the pilot. Given the reduction in costs and admissions, this does indicate some level of success with the program. This paper concludes by examining the policy implications of these results.     

Supplier density and at-home care use in Japan: Evidence from a micro-level survey on long-term care receivers

Following the introduction of the long-term care insurance scheme and deregulation of the market for at-home care services, Japan experienced a substantial increase in expenditure on care for the elderly. Using household-level survey data, we empirically examine whether the increase in care expenditure is associated with supplier density springing from the rise in the number of care providers following deregulation. We provide weak evidence that supplier density in the at-home care market is positively correlated with probability to use care or expenditure on care. Moreover, we find no link between the share of for-profit providers and the demand for at-home care services.     

Social capital as correlate,antecedent, and consequence of health service demand in China

Amid increasing interest in how social relationships play an important role in health and health behavior, it remains unclear whether social activities and social capital in general benefit individuals' health literacy and in turn affect their health care consumption. More specifically, this article proposes a research hypothesis to address the question: Do individuals who are strongly tied to other individuals within the social networks become more health conscious or literate and hence use more health services? This paper extends prior research on social support, health literacy and health care utilization to investigate the association between social interaction and health service demand. Using the China Health and Nutrition Survey, the paper provides cross-sectional evidence that people who are socially active and connected with their friends made more visits to health care providers. It also finds that people of male gender, being single, having more years of education, and no health insurance coverage tend to avoid seeking health services. The quasi-experimental study, which examines the events that exogenously intensified social interactions in some but not all Chinese provinces, indicates that social capital is more an antecedent than a consequence of health service needs.     

政府补助、保险支付与老年临终照料成本——基于2002-2014年CLHLS死亡人口追踪数据的分析

为应对日益增大的老年人照料压力,我国各地试点通过政府补助或社会保险支付的方式满足老人的照料需求。基于2002-2014年CLHLS死亡人口追踪数据,文章用两部分模型、Heckman选择模型和结构方程模型,分析了政府补助、保险支付对老年临终照料直接成本和总成本的影响及其中介机制。研究发现,老年临终照料服务由保险支付的直接成本和总成本都比家庭支付明显更高,政府补助的直接成本比家庭支付更高,保险支付的直接成本比政府补助更高。保险支付和政府补助对照料成本影响的机制存在差异,保险支付主要通过收入效应对照料成本产生显著影响,但替代效应也发挥了中介作用,政府补助则主要通过替代效应对照料成本产生显著影响。文章的研究结论具有重要的政策含义。我国发展长期护理保险,应合理界定政府、市场、社会和家庭对老年人的照料责任,并明确长期护理保险的有限责任,尽量降低可能的收入效应和替代效应对照料成本的影响。     

社会保险筹资方式的影响因素及国际比较

对社会保险筹资方式的选择不仅仅是一个筹资问题,也关系到社会保险基金的管理、支付方式,甚至决定着整个社会保险制度的运行过程。本文从理论上分析了社会保险筹资方式的类型,探讨了社会保险筹资方式的影响因素,并力图通过负担水平、管理模式、制度公平性、政府责任等方面的比较,实现对社会保险税和社会保险费的理性认识。     

新农保保障水平的实效分析及提高机制

现试行的新农保试点政策的保障水平不高影响了其作为一项养老政策功能的实现,通过科学制定新农保养老金的目标替代率,重新界定各缴费主体的缴费责任,可使新农保的目标替代率达到40%,且具有财政上的可持续性,为新农保政策由试点走向常态化提供了理论和实践的支持。     

Quality and efficiency of home help elderly care in Japan: Evidence from micro-level data

With the introduction of public long-term care insurance in the spring of 2000, for-profit enterprises were allowed to enter the home help elderly care market in Japan for the first time. We take advantage of data from a unique, self-conducted survey to compare the efficiency and quality of service offered by providers with different types of ownership and different lengths of operation. We present two major findings. First, contrary to the prevailing perception, we find no significant difference in the quality of service between for-profit and nonprofit providers. Although the nonprofits are able to offer more qualified and experienced staff, the quality of services provided by nonprofits is worse in some aspects than that of their for-profit counterparts. Second, our estimates of a quality-adjusted cost function demonstrate that the management of newer providers is more efficient than that of older providers. Our results show that the competition mechanism works effectively in the home help care market, and that there is no reason to believe that the for-profit providers are behaving opportunistically. Thus, this study justifies the belief that free-market policy contributes significantly toward improving the quality and the efficiency of home help long-term care in Japan. J. Japanese Int. Economies 21 (2) (2007) 287–301.     

中国农村社会养老保险养老待遇的实证性研究

农村社会养老保险养老待遇较低已经是不争的事实,但是到底低到什么程度?随着新型农村社会养老保险工作在全国范围内的试点,参保农民养老待遇普遍较低的问题能否得到改善?本文根据江苏省阜宁县沟墩镇农保所的参保数据,在新老农村社会养老保险制度的前提下,探讨我国农村社会养老保险养老待遇问题,由此给出"两提高"的政策建议,即:一方面,进一步提高个人帐户给付利率;另一方面,进一步提高地方政府财政补贴。同时,将鼓励村和集体单位给予补助、建立农村养老待遇调整机制作为地方辅助性政策。     

Small business service firms and the 1990s recession in the United Kingdom: Implications for local economic development

During the 1990s recession, the UK experienced a dramatic growth in employment in information-intensive business firms. This paper explores this growth with reference to small management consultancy and market research firms. Business service firms continued to be established and to grow during the recession because of three related attributes: professional expertise, an existing reputation and a network of client contacts. These attributes are related to the theoretical work of Granovetter (1973; 1982; 1985) who argues that “weak ties” operate to connect different groups of people together. The implications of these attributes for local economic development are considered. Success for all companies at the level of the local economy will be partially dependent on efficient and effective use of available business service expertise. The three attributes make it impossible to develop successful mechanisms to encourage the formation of business service companies in areas with underdeveloped service infrastructure. Mechanisms, however, may be developed at the local level to encourage the establishment of “weak ties” between local companies and regional and national providers of business service expertise.     

Exporting against Risk? Theory and Evidence from Public Export Insurance Schemes in OECD Countries

This paper endeavours to find out in how far public export insurance schemes foster international trade. Thereto, a gravity equation is derived, which accounts for the risk of financial losses in case firms contract defaulting foreign buyers. Empirical results suggest that OECD countries issuing trade credits with generous state-guarantees did not, during the 1999 to 2005 period, witness more exports towards politically and commercially more unstable low-income countries. Rather, publicly indemnified trade finance has promoted exports, to a modest degree, towards high and middle-income countries, where financial intermediaries and markets provide viable alternatives to hedge against payment risks.     

医疗保险的福利效应

本文考察在完全信息的市场经济条件下,医疗保险的进入对于社会总福利的影响。分析表明,保险公司的进入可能使得消费者为医疗服务付出更高的代价,但是会提高医院的利润,总的来说保险公司的进入会提升社会总福利。本文还发现,由于保险公司未考虑其合约设计对医院利润的影响,市场均衡的医疗保险水平仍低于社会最优水平。这些结论有助于澄清相关文献对医疗保险的一些负面看法。     

城乡居民社会养老保险一体化模式研究——基于浙江、北京和重庆三模式的比较

浙江、北京和重庆城乡居民社会养老保险一体化都采取了统账结合模式,个人缴费、集体补贴和政府补助的资金筹集方式,及以市(区、县)级统筹试点的形式.但经济水平、收入水平及政策环境的差距,导致三地在养老金缴费标准、财政补贴及待遇方面存在不少差异.鉴于此,我国应分类推进城乡社会养老保险体系,构建养老金缴费与待遇的自动平衡机制,以及城乡统一的养老金管理模式.     

新财税政策下的职工基本养老保险最优缴费率测算研究

企业职工基本养老保险缴费率作为养老保险制度的关键性要素,受到专家学者的普遍关注,企业缴费率高、缴费压力大已成为制约企业发展的重要因素。本文综合运用灰色关联、因子分析与回归、动态调整和模拟预测的方法,构建企业基本养老保险缴费率适度水平的因子测算模型,以上海市2008—2019年的数据作为样本进行测算与预测。结果显示:缴费率的适度水平处于19%～23%;增加国有资产划转10%补充社保基金以及中央调剂金制度等参数后,模拟预测2018—2025年的缴费率适度水平在14.8%～18.6%之间,说明企业职工基本养老保险的缴费率有进一步下降的空间。     

信托业在金融促进经济发展中的作用探析

信托业作为"四大金融支柱"之一,应当在金融促进经济发展中发挥重要作用。在当前的经济金融形势以及政策环境下,信托公司可以为银行提供通道服务,放大信贷规模,满足企业融资需求;与地方政府合作,满足基础设施建设的融资需求;开发房地产信托产品,促进房地产业发展;开展股票质押融资信托业务,满足"大小非"融资需求;开展私人股权投资信托业务,满足企业股权融资需求。     

Nonprofit/for-profit status and earning differentials in the Japanese at-home elderly care industry: Evidence from micro-level data on home helpers and staff nurses

In April 2000, Japan embarked on a reform of its health care market. Along with the introduction of a long-term care insurance scheme, the government for the first time allowed for-profit operators to compete head-on with non-profit operators in the provision of at-home care services. Taking advantage of a unique and rich micro-level survey, this study is the first to examine wage differentials between the nonprofit and the for-profit sectors in Japan's nursing care industry, concentrating on home helpers and staff nurses. Controlling for nonrandom unobserved selection biases, our results show that a nonprofit wage premium exists. This finding supports the hypothesis that nonprofit providers operate under non-distributional constraints. J. Japanese Int. Economies 21 (1) (2007) 106–120.     

第三方支付企业监管差异化研究

内容2011年5月,中国人民银行第一批支付业务许可证的发放不仅预示着第三方支付企业将迎来更广阔的发展空间,也意味着我国政府将第三方支付企业纳入到正式的监管体系,对其监管将日趋规范化.第三方支付企业在规模、经营模式等方面都有所不同,如果采取“一刀切”的方法,对其进行大而统的管理,可能会影响监管效果,甚至最终影响第三方支付行业的发展.因此,通过科学的规划实现差异化监管,成为保证我国第三方支付行业健康发展的当务之急,也是本文研究的出发点.本文从分析现有监管体系的不足入手,对我国第三方支付企业的特点进行了深入分析,并在此基础上提出了对第三方支付企业实行差异化监管的具体对策建议     

对陕西省农村社会养老保险供求主体的分析与政府作用研究

陕西是西部的农业大省,农村社会养老保险制度发展缓慢,农村养老保险市场需要寻找供需双方的均衡点,政府作为制度的提供者和政策的制定者,必须在农村社会养老保险制度建立和运营中明确思路,发挥主导作用,以保证陕西省农村养老保险健康、有序地发展。     

Corporate Endowment Insurance Fee Reduction and Employee Wages: Evidence from China

To stimulate economic growth, the Chinese government implemented three consecutive policies between 2016 and 2019 to reduce the corporate endowment insurance contribution ratio (CEICR), the highest payment item for Chinese companies. Using China's CEICR reduction policies as a quasi-natural experiment, this paper evaluates the impact of corporate payment burden reduction on employee wages. Generally, reducing CEICR appears to prompt companies to increase employee wages. Corporate cash flow is a possible channel of influence. Moreover, the positive effect is found to be more pronounced in companies that are more labor intensive, performing better in labor payment compliance, and located in regions with higher pressure for elderly care. This paper offers evidence in favor of implementing CEICR reduction policies from the perspective of improving the well-being of employees.     

医保支付方式与乡村医生行为

长期以来，我国农村地区的初级医疗保健服务由乡村医生提供，然而新农合制度以按服务付费为主的支付方式导致了乡村医生供应短缺、行为扭曲等一系列供方市场问题，进而严重制约了农村地区初级医疗保健服务体系建设与社会福利提升。基于改革医保支付方式是从供方角度合理控制医疗成本的有效措施这一基本前提，文章通过构建理论模型，分析了按服务付费、按人头付费、固定工资，以及混合付费等四种支付方式下乡村医生给予不同疾病状态患者的治疗数量、治疗质量，以及职业道德的决策问题。考虑新农合与城乡居民医保制度的地区差异性、发展不均衡等特点，研究发现：（1）无论政府采用哪一种支付方式，都无法一次性将医生行为调控至最优期望目标，通过支付方式的选择与优化来调控医生行为需要与医保发展阶段相互匹配；（2）作为主要行为指标，医生给予患者的治疗数量与治疗质量之间存在反比关系，医生职业道德与患者疾病状态之间也呈现类似反比关系；（3）随着医保体系的不断完善，激励方式合理的混合支付可能是调控医生行为的一种占优选择。在城乡居民医保制度整合背景下，文章将为如何通过改革乡村医生支付方式来控制医疗成本提供一定理论支撑。