美国医疗保险扩面改革之路的里程碑

虽然美国有两大类三大层次的医疗保险体系,但没有实现如其他大多数发达国家那样的全民医保,缺乏一张覆盖全国的社会医疗网络,始终是美国近10年来备受诟病的社会问题.没有医疗保险的问题始终处于社会政策争议的前沿和核心.之前克林顿总统失败的改革方案核心就是实现全民医保,15年后,奥巴马新医改方案又明确将扩大覆盖面作为其改革的重中之重.然而,历经波折得以通过的奥巴马医改法案却依然面临诸多反对和抗议,其中最为核心的是关乎强制参险的条款.2012年6月28日,美国最高法院裁定奥巴马医疗保险改革的大部分条款合乎宪法,最具争议的强制参险也得以保留,这意味着美国在实现全民医保时代的进程中向前迈出了一大步.     

重大公共卫生危机下的健康保险应对研究

公共卫生危机对经济的影响较大,21世纪以来,面对频发的重大公共卫生危机,健康保险业如何通过科技赋能,有效参与到公共卫生安全体系建设中亟待研究对策。通过数据比较分析法、模型构建法,分析了我国商业健康保险业在防控重大疫情期间的作为、短板、机遇和挑战,并基于健康保险参与公共卫生安全体系建设的国际经验和保险科技的发展,提出了我国健康保险业应对重大公共卫生危机的一系列政策建议,以便完善现有公共卫生安全体系,助推"健康中国战略"和"可持续发展战略"的实现。     

物联网时代的健康保险与健康管理

随着我国社会发展与人们生活水平的提高,健康管理和健康保险将成为未来社会管理和保险市场需求的重要领域。目前健康保险和健康管理面临着由于信息不对称引起的道德风险的困境,同时,受到经营管理效率的制约。物联网技术的出现、发展与普及,为解决上述问题提供了可能。解决的基本思路是围绕存在的问题,有针对性地利用物联网的“更加透彻的感知...     

Citizen views about public meetings

The current study seeks to demonstrate that a citizen views about public meeting structure and related groups matter in predicting satisfaction with public engagement and willingness to attend future meetings. Public health agencies frequently use public meetings to communicate risk information, but relatively little social science research has examined how potential meeting participants view them. Using survey data (N?=?866) collected in seven US communities where health agencies were investigating possible local cancer clusters and holding public meetings to communicate with local residents, the current study replicates and extends an earlier inquiry related to citizens satisfaction with public meetings used for risk communication. Whereas previous research found that expectations, health agency credibility, and risk perceptions predicted satisfaction with public meetings, the current results did not show a significant relationship between agency credibility, risk perceptions, and satisfaction. Further, the results suggest it may make sense to consider ‘views about public meetings’ as a single measure that includes citizens’ structural expectations for meetings. Finally, the current study finds that views about public officials and views about meetings relate to individuals’ willingness to attend future meetings. Additional variable development and modeling research is suggested.     

Health information technology and patient outcomes: the role of information and labor coordination

Health information technology (IT) adoption, it is argued, will dramatically improve patient care. We study the impact of hospital IT adoption on patient outcomes focusing on the role of patient and organizational heterogeneity. We link detailed hospital discharge data on all Medicare fee‐for‐service admissions from 2002–2007 to detailed hospital‐level IT adoption information. For all IT‐sensitive conditions, we find that health IT adoption reduces mortality for the most complex patients but does not affect outcomes for the median patient. Benefits from health IT are primarily experienced by patients whose diagnoses require cross‐specialty care coordination and extensive clinical information management.     

社会医疗保险、自我保护与商业健康保险

基于消费者保险需求理论,采用中国家庭金融调查（CHFS）数据,分析了社会医疗保险、自我保护与商业健康保险之间的关系。结果表明：社会医疗保险抑制了商业健康保险的发展,显著减少了自我保护支出;自我保护促进了商业健康保险的发展。鉴于此,政府应制定合理的封顶线及报销比例以提供适度的基本医疗保险保障水平,商业保险公司应提供差异化的健康保险以补充社会医疗保险,政府及保险公司应鼓励自我保护投资以促进商业健康保险发展。     

城乡居民医保逆选择的破解——一个基于不同人口年龄需求的设计

逆选择困扰了我国城乡居民医保事业的可持续发展.在原有的大病和重病保障之外,基于不同人口年龄需求设计一个有条件、有限度和有年龄差别的特殊医保待遇方案,让参保者在没有享受到大病重病医保待遇的情况下,也可获得一些与年龄相称的医保待遇.这一设计除了能增加参保的弹性,让各年龄群体都自愿积极参保,还可增强居民的健康意识,提高居民的健康水平,减少居民和医保的医药开支.此外,它还能促进基层医疗服务业的发展.     

隔代照料对老年人健康状况的影响——基于CHARLS的实证研究

"421"型家庭结构的涌现和人口老龄化进程的加快使隔代照料成为目前我国家庭照料的一种重要形式。但是作为隔代照料提供者的老年人,他们的健康状况却经常被忽视。本文试图通过使用2013年中国健康与养老追踪调查(CHARLS)数据,运用STATA数据分析方法,研究提供隔代照料与不提供隔代照料的老年人在日常活动能力障碍、自评健康状况和心理健康状况三方面的不同。研究结果发现,提供隔代照料对老年人的日常活动能力障碍、自评健康状况、心理健康状况三方面均产生了负面影响。     

Perspectives on changing times: implications for insurance medicine

Profound changes are occurring in medicine. These changes are in both medicine itself and also in the economic and social context. The driving forces for change include health care reform, sophisticated consumers, new technology, information explosion and ethics of controlling human biology.     

新医改框架下我国商业健康保险发展策略探讨——国际经验和中国模式

我国商业健康保险市场虽饱受政府重视,但却始终发育不足。相当重要的一个原因是简单逐利,并不兼顾社会需求,忽略医疗保险源自社会互助的历史渊源,也就缺乏科学的发展模式。从国际看,在私营医疗保险发挥重要作用的国家,其私营医疗保险市场构成主体、管理费用、保险合同类型、费率设定方式、专业化程度等都与我国存在较大的差异,其背后的原因是制度所遵循的价值理念和发展方式的不同,特别是对制度目标的认识。因此,本文提出一系列方法,淡化我国商业健康保险市场的盈利动机,使其注重社会公众利益与其利润的共同实现,从而使整个市场走上科学的发展道路,更好的完成自己作为公立计划补充的角色。     

健康保险单独监管问题研究

商业健康保险最能体现保险的社会管理功能,在我国多层次医疗保障体系建设中发挥着愈加明显的重要作用。本文从促进健康保险发展的行业监管角度,提出应将商业健康保险作为与产险、寿险并列的第三领域实施单独监管。本文详细分析了健康保险的专业经营特点,阐述了对健康保险实施单独监管的必要性,明确了单独监管的基本内容并提出了相关政策建议。     

抓住机遇,开拓进取,努力开创内蒙古高校科技工作的新局面

近年来,内蒙古高校科技工作取得了显著成效:综合科技实力持续提高;教学与科研二元化发展模式基本确立;学科结构不断优化;培养出一批本土学科带头人;有效整合了创新资源。同时也面临着如下问题:高校科技工作与自治区经济社会重大需求不相适应;科技创新动力不足;科技投入力度不够;创新平台综合利用和集约化程度差;政策支撑环节仍然薄弱。因此,要努力抓好一项规划;提升两个能力;实施三大行动;在科技计划中突出六大重点,实现高效科技工作新局面。     

论互助保险公司在法国医疗保险制度中的作用

法国的医疗保险制度较好的保障了法国人民的健康状况和生活质量,在世界上享有良好的声誉。本文在介绍了法国医疗保险的财政支持的基础上,分析了互助保险公司在法国医疗保险制度运行中所发挥的重要作用,并以MGEN（法国最大的互助保险公司）为例,介绍了其建立原则、历史沿革、经济模型、覆盖的医疗服务及其发展的评估,探讨了其完善和促进法国卫生保障事业的功效,同时也缓和了社会不平等现象。基于互助保险公司非盈利、联盟和责任感的价值观,MGEN还在眼科医疗方面提供更多的服务。     

我国省际公共卫生与基本医疗服务供给状况评估

公共卫生与基本医疗作为一项保障和促进公众健康的社会公益事业,与公众的基本生命安全息息相关,是我国基本公共服务的重要内容.本文运用层次分析法,构建出公共卫生与基本医疗供给状况评估的指标体系,并对2009年我国31个省区市的供给状况进行综合评价.结果表明,我国的公共卫生与基本医疗供给状况与地区经济发展水平无严格的正相关关系,但存在一定联系,且省际间差异明显,供给状况较不平衡.未来工作重点在西部省份及个别东中部省份的状况改善.     

Consumerism and wellness: rising tide, falling cost

Annual employer-sponsored health plan cost increases have been slowing incrementally due to slowing health care utilization--a phenomenon very likely tied to the proliferation of health management activities, wellness programs and other consumerism strategies. This article describes the sharp rise in recent years of consumer-directed health plans (CDHPs) and explains what developments must happen for genuine consumer-directed health care to realize its full potential. These developments include gathering transparent health care information, increasing consumer demand for that information and creating truly intuitive data solutions that allow consumers to easily access information in order to make better health care decisions.     

Schöpft die PKV den Rahm ab? Eine spieltheoretische Analyse der Effekte der PKV auf die Medikamentenqualität

Quality of medical treatment is a major goal of Germany’s statutory health insurance system. According to our game theoretic approach, existing price-discrimination between statutory and private health insurance leads to higher quality of innovative drugs. Hence, a move into the direction of a national health service system (so-called citizen insurance) should result in a reduction of innovative drugs’ quality. Moreover and in the case of citizens insurance’s implementation, innovative drugs’ price level should increase for patients with statutory health insurance. Furthermore, a similar effect is caused by the Act on the Reform of the Market for Medicinal Products (AMNOG) which leads to reduced prospects for pricediscriminations between the statutory and private health insurance system. In summary, the existence of private health insurance in Germany does not cause unfavourable cream-skimming. Rather the split-up of the German health care sector (statutory vs. private health insurance) results in eligible higher drug quality at lower prices for patients with statutory health insurance.     

医疗保障对居民消费水平的影响——基于省级面板数据的实证研究

近年来,我国居民消费持续走低,在GDP中所占的比重持续下降,消费需求不足已经成为制约我国经济发展的重要因素之一。本文立足于保险学和消费者理论的基础,使用我国31个省、自治区、直辖市的面板数据,系统研究医疗保障体系对居民消费的影响,发现基本医疗保险和商业健康保险对于居民消费均具有明显促进作用,其中城镇居民基本医保对消费的刺激作用大于新农合医保,商业健康保险的促进作用要大于城镇职工基本医保。在此基础上,提出了相应的政策建议。     

论公共卫生最优支出策略

公共卫生支出具有极强的正外部性.如果由地方政府或私人选择公共卫生支出的水平,那么他们的最优选择是较低的公共卫生支出和较高的个人消费(内含个人医疗支出),整个社会的福利将会处于较低的水平状态.本文在一个动态的框架下分析了发生这种现象的经济学原因,说明中央政府而非地方政府或私人应该对公共卫生的建设承担更大的责任,应由中央政府负责全国公共卫生体系的建设.     

Why the Development of Health Insurance Is Regionally Imbalanced: Evidence from China

As China adopted an imbalanced development strategy to obtain rapid economic growth, it is getting more and more urgent to find out a feasible way to balanced development of social safety network. This study measures the degree of regional disparities in China’s health insurance industry and explores the rationales by a thorough examination of health insurance purchasing behavior. An empirical analysis is conducted, based on a panel data of 31 provinces from 2004 to 2014, to test the hypothesis. We find that the regional disparities would be significantly affected by the variables including age structure, education, income, availability of health resources, density of population, and substitutes.     

The impact of health information technology on hospital productivity

Health information technology (IT) has been championed as a tool that can transform health care delivery. We estimate the parameters of a value‐added hospital production function correcting for endogenous input choices to assess the private returns hospitals earn from health IT. Despite high marginal products, the total benefits from expanded IT adoption are modest. Over the span of our data, health IT inputs increased by more than 210% and contributed about 6% to the increase in value‐added. Not‐for‐profits invested more heavily and differently in IT. Finally, we find no compelling evidence of labor complementarities or network externalities from competitors' IT investment.