Health care cost of floods: Evidence from Typhoon Morakot in Taiwan

Using the difference-in-difference (DID) method, this study uses Typhoon Morakot, which occurred in August 2009, as an example to estimate the effect of flooding on health care cost burden. The main data source is the medical claims records of a cohort of three million patients in Taiwan’s National Health Insurance system. By examining flood-related physiological diseases and disaster-related mental illnesses, our results indicate that the increase in outpatient health care costs resulting from the flood caused by the typhoon is approximately NTD 8.95 billion (USD 280 million), equivalent to approximately 69% of the annual special budget for flooding prevention during the period 2006–2019 in Taiwan. Moreover, the increase in outpatient expenditure for mental illnesses is nearly 10 times that of physiological diseases. An important implication of our findings is that the cost of preventing natural disasters, such as floods, can be offset by saving health care costs, particularly for mental illnesses. Our results also suggest that in addition to providing safe drinking water and indoor residual spraying, offering continuous post-disaster mental health services can further save health care expenditures caused by natural disasters.     

Factors Influencing the use of Preventive Medical Care in Malaysia: Evidence from National Health and Morbidity Survey Data

An increase in the prevalence of modifiable health risk factors, such as diabetes, hypertension and hypercholesterolemia, has become a serious public health issue in developed and developing countries. It is the main contributing factor to the rise in non‐communicable diseases (NCD). The use of preventive medical care remains the best method to prevent NCD. The objective of the present study is to examine the factors affecting the decisions of people to use preventive medical care (e.g. blood glucose tests, blood cholesterol tests and blood pressure test). An ordered logit model is estimated based on a nationally representative sample. The present study finds that income, age, education, ethnicity, employment status, health insurance and smoking are significantly associated with the use of preventive medical care. As a measure towards increasing the prevalence of the preventive medical care usage, the government should pay special attention to low income earners, the young and the elderly, the less‐educated, the ethnic minorities, employed individuals, individuals whose medical expenses are not paid by insurance carriers, as well as smokers.     

农村合作医疗制度研究综述

新型农村合作医疗制度(以下简称"新农合")建设是关系到农村医疗卫生保障可持续发展的重大问题,文章简要回顾了试点以来新农合制度建设理论研究及实践的进展,归纳了理论界在新农合制度建设的必要性研究、新农合制度的现状及存的问题、农民参合意愿影响因素研究、新农合制度建设的路径研究和农村合作医疗制度建设的国际经验研究等五个方面的研究进展,并对这些研究做了简要的评述,指出农民参合意愿是新农合制度可持续发展的关键,也是新农合制度效率的最好反映。     

FDI对国内企业研发行为的影响——理论模型与中国的经验

文章分析了外商直接投资对内资企业研发支出影响的作用机理,理论分析表明,当外资企业采用FDI模式的成本较低时,外商直接投资会导致国内企业的研发支出水平下降;当FDI成本较高时,FDI是促进还是抑制本土企业的研发支出由经济系统其他参数决定。在理论分析基础上,文章采用中国1998～2006年工业部门的37个行业面板数据来验证FDI在我国对内资企业研发行为的影响,实证检验结果表明,在过去的几年中FDI促进了我国内资企业对研发投入的增加。     

Health insurance generosity and conditional coverage: Evidence from medicaid managed care in Kentucky

This article estimates the impact of the introduction of Medicaid managed care (MMC) on the formal Medicaid participation of children. We employ a quasi‐experimental approach exploiting the location‐specific timing of MMC implementation in Kentucky. Using data from the March Current Population Survey from 1995 to 2003, our findings suggest that the introduction of MMC increases the likelihood of being uninsured and decreases formal Medicaid participation. This finding is consistent with an increase in “conditional coverage,” waiting until medical care is needed to sign up or re‐enroll in Medicaid. These effects are concentrated among low‐income children and absent for high‐income children. We find no evidence of “crowd‐in,” substituting private coverage for Medicaid. These results are robust to multiple placebo tests and imply the potential for less formal participation (i.e., more conditional coverage) among the Affordable Care Act‐Medicaid expansion population (which is likely to be primarily covered under MMC) than is typically predicted.     

低碳下带时间窗的冷藏药品路径优化

针对城市中冷藏药品的车辆调度与路径规划问题,从节能减排的新视角,提出以降低药品配送成本为目标,以客户服务时间窗为约束的低碳下带时间窗的冷藏药品非线性路径优化模型。以上海市敬谊物流公司药品配送为实例,并采用lingo11.0编码求解,验证了模型的有效性和可行性。结果表明：在考虑碳排放因素下合理规划冷藏药品的配送路径,使企业可同时兼顾经济效益和环境效益,因而企业社会总成本会有所降低。     

Assessing Consumer Gains from a Drug Price Control Policy in the United States

We use national data from 1960 to 2000 to estimate the demand for pharmaceuticals in the United States. We then simulate consumer surplus gains from a hypothetical drug price control policy that would have limited drug price increases to the rate of inflation from 1981 to 2000. Using a range of values for the real interest rate, coinsurance rate, and own-price elasticity of demand, we find that the consumer surplus gains from this policy equal $472 billion by the end of 2000. According to a recent study, that same policy would have led to 198 fewer new drugs being brought to the U.S. market. Therefore, the average social opportunity cost per drug developed during this period was approximately $2.4 billion. Research on the value of pharmaceuticals suggests that the social benefits of a new drug are far greater than this estimate. Hence, drug price controls could do more harm than good.     

Short‐run marginal medical costs from booze and butts: Evidence from the states

This article uses a panel data set of U.S. states over the 1980 to 2007 period to estimate the demands for medical care, cigarettes, and beer. The estimation process generates own‐price, income, and cross‐price elasticities for all three goods. Implied per capita beer and cigarette consumption elasticities of per capita health care expenditures, suggested by our baseline estimates, are 0.83 and 0.14, respectively. These results are robust to a number of specification tests. Simulations suggest that yearly marginal medical costs amount to approximately $12 per bottle and 27 cents per cigarette in the short run (in 2012 dollars). These results are likely to be driven by the much larger corresponding increases in the consumption of binge drinkers and heavy smokers.

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Drug selection: Mozambique

Whereas a few hundred generic drugs are essential for health care, the international and many national markets are flooded with tens of thousands of brand-name preparations. This numerical difference is because of the many imitative products, drug combinations, brandname duplications, and drugs with low therapeutic value and/or unacceptable adverse effects. Since independence Mozambique has reduced the number of registered products, including those for retail pharmacy sale, from some 26,000 to about 1200. An effective national formulary has been introduced for health service use and now contains only 343 distinct therapeutic substances. The formulary uses only international non-proprietary names, and has been used to rationalize state pharmaceutical procurement with cost savings and to improve drug information and use.     

新型农村合作医疗中政府角色分析——一种角色理论视野下的阐释

农村合作医疗本身具有的公共物品属性决定了政府在农村合作医疗中作用的不可替代性。新型农村合作医疗的实施和发展离不开各方政府的大力支持,因此文章利用角色理论对新型农村合作医疗中政府的角色冲突、角色义务问题进行分析,探讨政府由权威型管理型政府向服务型政府转换的最佳途径。     

山东省城乡居民基本医疗保险水平区域差异因子分析

基于山东省各地市的统计数据,运用SPSS17.0对山东省城乡居民基本医疗保险水平区域差异进行因子分析,结果表明山东省17地市的城乡居民基本医疗保险水平存在较为明显的差异,这与各地市的人口与医疗保障水平情况、社会经济发展情况有着密切联系。对此,提出了加快各地区经济发展、实行医疗保障服务的差别性支持、完善制度设计的建议。     

公立医院 “成本病” 与医疗负担——兼论 “药品零加成” 政策的影响

公立医院是我国医疗卫生体系的主体,是新医改成功的关键,但多年来缺乏完善的成本核算体系,也加重了患者和政府的医疗负担。文章利用2013-2018年中部某省658家公立医院数据,基于Baumol"成本病"理论,构造新的"调整的鲍莫尔变量",首次从微观视角检验公立医院"成本病"的存在性,并考察了"成本病"是否加重了患者和政府负担;进一步结合"药品零加成"政策的实施,探究了其对公立医院"成本病"效应的影响。研究发现,我国公立医院系统同样存在"成本病"现象,且是加重患者与政府医疗负担的重要原因;"成本病"对患者医疗负担的影响并无医院等级差异,对政府医疗支出的影响在二级医院更为明显。结合样本期内"药品零加成"政策的实施发现,政策有效降低了患者负担,但加重了政府医疗支出,也未能缓解公立医院的"成本病"问题,但有助于医技成本支出的降低。研究具有重要的政策启示:"成本病"已经成为制约公立医院可持续发展的重要影响因素,亟需建立有效的成本核算管理工具和机制,健全公立医院薪酬制度,促进公立医院管理向精细化、规范化转型,抑制"成本病"问题,保障公立医院健康、可持续发展。     

Does Increased Funding for Homeless Programs Reduce Chronic Homelessness?

This article tests whether programs that provide housing assistance to homeless people can reduce chronic homelessness. I analyze data from the Department of Housing and Urban Development for 130 communities across the United States over the period 2005 to 2007. Because the amount of federal money allocated to a community to combat homelessness may depend on unobserved characteristics of that community, I estimate a fixed‐effects model that estimates the effect of new federal homeless funding on chronic homelessness. I find that the first‐year cost of moving one chronically homeless person into permanent supportive housing is $55,600. An analysis of new funding to specific types of homeless programs indicates that programs that provide long‐term housing and services to homeless people with disabilities drives this relationship.     

DEA APPLIED TO A GAUTENG SAMPLE OF PUBLIC HOSPITALS1

The research presented in this paper provides an analysis of the delivery of a few health care services by the public sector in Gauteng, South Africa. The data for the study was especially difficult to collect, suggesting the need for hospital level data information systems, as well as staff who are trained to analyze the information collected. The empirical results from the analysis suggest that services provided by small‐scale medical facilities waste fewer resources, while medical centres offering more technical services, such as surgeries, also appear to deliver medical services more efficiently.     

药品暴利的成因与制度对策

在中国,由于政府对医疗卫生领域的管制,以及医院对处方药销售权的垄断,使得真正的市场作用,在医药零售领域严重缺失,看病难、看病贵的问题越发突出,医疗体制改革积重难返。本文通过对医药行业的特殊属性、行业乱象进行分析,探究解决药品暴利问题的制度对策,认为政府在医疗体制改革的问题上,必须尊重市场,按照市场规律办事,放开对医疗领域的严格管制;在法治化的条件下,适当地对医疗市场失灵进行调节,从而使中国药品市场走上更加充分、有序、福利最大化的市场竞争之路。     

交易成本与新型农村合作医疗制度可持续发展

新型农村合作医疗制度的试点极大地推进了我国农村医疗保障制度的构建过程,但是该项制度推进并不顺利。本文试从交易成本理论视角,分析当前新农合制度存在较高的交易成本导致制度创新不足。在此基础上,本文提出要使新农合制度可持续发展,政府必须从制度完善和机制创新两个方面降低交易成本,以提高新农合制度绩效。     

以腹腔镜为例分析我国医疗器械再制造特点

首先，概括了2001-2015年中国以及全球医疗器械的市场销售情况，分析了国内外医疗器械行业及其再制造特点，得出国内外医疗器械再制造市场前景可观的趋势。其次，以腹腔镜医疗设备作为范例，通过层次分析法 (AHP) 科学论证了腹腔镜医疗设备各运行成本的权重，结果表明医疗器械设备折旧费所占的比重最大，医疗器械再制造能够节约较大成本。最后，以腹腔镜医疗器械再制造的流程图为基础，总结出适合医疗器械再制造的流程框架。首次系统分析了医疗器械再制造特点，为我国医疗器械再制造行业提供了一定理论基础。