公私医疗卫生支出与经济增长关系的实证分析

众所周知,医疗卫生支出不仅关系到一个国家社会福利政策的规划,还对经济增长具有不可忽略的促进作用。然而,现有文献对于医疗卫生支出与经济增长关系之间的研究结论却是众说纷纭。鉴于此,本文根据医疗卫生支出的支付主体,将其分为政府医疗卫生支出和居民医疗卫生支出,并通过建立双向固定效应模型对公私医疗卫生支出对经济增长的影响进行分析。结果显示：从全国平均水平来看,政府医疗卫生支出每增长100％,带动经济增长12．08％,居民医疗卫生支出每增长100％,带动经济增长15．85％;但与此同时,考虑到不同地区的经济发展非均衡化时,政府医疗卫生支出和居民医疗卫生支出带动经济增长的效应差异甚大,其中政府医疗卫生支出对经济增长呈现“倒U型”效应,而居民医疗卫生支出对经济增长呈现“阶梯型”效应。     

Consumer Information,Insurance, and Doctor Shopping: The Elderly Consumer's Perspective

One possible strategy to minimize costs of health care is to provide consumers with information pertaining to its relative cost. However, the effectiveness of programs to dispense information on medical services has been difficult to evaluate because very little is known about incentives for doctor shopping. The demand for medical services information (doctor shopping) among elderly consumers and the effect of health insurance purchases on shopping decisions are assessed.     

Making Health Care More Affordable Through Health Insurance Finance Reform

The way that we finance health insurance today is both unfair and inefficient. The tax code subsidizes the most expensive employment-based policies while penalizing those who buy insurance on their own or choose more basic policies. By reforming this system, we can both make health care more affordable for millions of people and get higher-value care for the money that we spend. These reforms should be coupled with policies to ensure that basic private insurance is affordable for everyone, including those with chronic health conditions or low income, and to ensure that patients and physicians have the tools that they need to make well-informed decisions. JEL Classification I11     

Disabled Elders' Out-of-Pocket Home Care Expenses: Examining Financial Burden

Questions regarding the extent to which home care expenses are financially burdensome for disabled elders and who is most at risk of financial burden were examined using data from the 1989 National Long-Term Care Survey. Three of the four definitions of financial burden (expenditures relative to ability to pay) suggest that fewer than 11.2 percent of home care users have burdensome costs. Potential public and/or private options for protecting consumers at risk of burdensome home care costs are discussed. Discussion of how to understand home care financial burden focuses on current expectations and policy issues regarding the use of household income, assets, and home equity to pay for long-term care.     

Information Technology and Consumer Search for Health Insurance

We explore the impact of information technology on the level of premiums paid for individual health insurance by asking which kinds of buyers will have larger gains from the use of new technology. We compare ‘asking price’ data posted on an electronic insurance exchange with survey data on premiums actually paid before the advent of exchange and examine whether the pattern of differences between asking prices and transactions prices can be explained using a simple search theory. We hypothesize that older consumers, expecting to pay higher premiums for a given policy, had engaged in more intensive search than younger consumers, given the same distribution of prices and search costs. Therefore, the introduction of an electronic exchange that lowers the cost of search should have a larger effect on decreasing the level of premiums paid for those who previously searched less (i.e., younger consumers). We find evidence consistent with this hypothesis.     

Health Information Technology and Financing's Next Frontier: The Potential of Medical Banking

Calls to action for widespread adoption of electronic health records have come from a broad spectrum of the private and public sectors. The problem, to date, is not that information does not exist, as much as that the data have not been organized around the patient. An integrated Personal Health Record is a patient- or family-centered technology designed to capture not only the contacts with health care providers, but also personal information on insurance, diet, and personal preferences that a physician's health record will not capture. Medical banking, based on a new technology platform called the Integrated Health Card, is emerging as a solution to the problem of collecting and combining information from the electronic health record with personal health information. It may also be the only way for fledging health savings accounts to enable the price and quality transparency of the medical market that has been called for repeatedly in this decade. In analyzing the political and patient applications of widespread adoption of this new innovation, the positive contributions to social welfare are very likely to outweigh the negative.     

PUBLIC DEBT AS PRIVATE WEALTH: SOME EQUILIBRIUM CONSIDERATIONS

Government bonds are interest‐bearing assets. Increasing public debt increases wealth, income and consumption demand. The smaller government expenditure is, the larger consumption demand must be in equilibrium, and the larger must be public debt. Conversely, lower public debt implies higher government spending and taxation. Public debt plays, thus, an important role in establishing equilibrium. It distributes output between consumers and government. In case of insufficient demand, a larger public debt entails higher private consumption and less public spending. If upper bounds on public debt are introduced (as in the Maastricht treaty), such constraints place lower bounds on taxation and public spending and may rule out macroeconomic equilibrium. As an aside, a minor flaw in Domar's (American Economic Review, 34 (4), pp. 798–827) classical analysis is corrected.     

On the relationship between public and private spending in developing and developed countries

Using annual data, the paper studies the time-series evidence regarding the effectiveness of government spending. The emphasis is on the relationship between public spending and private spending. The objective is to identify whether the effects of public spending on macro variables are reinforced or mitigated through the spillover effects on private spending. The evidence attests to the importance of stimulating private spending to maximize the positive effect of an increase in public spending on real growth. Concerns about the crowding out effects of higher public spending on private demand are more dominant in developing countries. Moreover, the scope for government spending to determine aggregate uncertainty is much larger in developing countries. Overall, the evidence attests to the importance of managing trends and variability of government spending towards maximizing the fiscal multiplier. The paper's evidence spells out potential to maximize the fiscal multiplier via private spending and concerns about the ineffectiveness of fiscal policy where crowding out concerns dominate.     

Genetic Testing and the Demand for Cancer Insurance

There has been an expansion of the availability of disease-specific insurance policies in the United States over the past decade. At the same time, recently developed medical tests are providing consumers with new information regarding their risk of contracting particularly serious diseases. This exploratory study makes use of data from two groups of women to examine the demand for one type of disease-specific policy, cancer insurance. Members of the first group have been tested for a BRCA1 gene mutation that is associated with an 88% risk of contracting breast and/or ovarian cancer by age 70. The other group consists of women from the general population who have not been tested for any BRCA1 gene mutation.The study results indicate that women who have been tested for the BRCA1 gene mutation are more likely than untested respondents to have purchased cancer insurance and to have recently thought about purchasing cancer insurance. The results also indicate that older women and women who have modest household incomes are more likely to have purchased cancer insurance. Women who have minor children, who are more highly educated, who have no health insurance, who have had cancer, or who report that they are in poor health are more likely to have recently contemplated purchasing cancer insurance. Our discussion of the findings highlights several issues that merit further consideration on the part of consumer policy makers working in the area of insurance regulation.     

The Distributional Impact of Health Financing in Europe: A Review

This article summarises, extends and updates previous empirical work on the distributional implications of alternative health care financing arrangements in a selection of European countries and the US. On the one hand, total health care payments are almost proportional to ability to pay in most countries. This is predominantly driven by a high reliance on public financing. On the other hand, private payments – out‐of‐pocket payments as well as private insurance premiums – are highly regressive. More extended reliance on private financing may therefore endanger the equitable nature of financing systems. In addition, private payments put a heavy burden on unfortunate households.     

Bending and Stretching the Health Care Cost Curve

The Patient Protection and Affordable Care Act of 2010 (PPACA) has a number of provisions that aimed at slowing the rate of growth of health care spending. This paper examines the most prominent of these provisions and finds them to be seriously flawed and unlikely to deliver savings as intended. They are either too weak or liable to compromise quality. Moreover, some of the most important drivers of health care costs, such as fee for service payments to physicians under Medicare or limitations on physician liability are not addressed adequately. Thus, it is unlikely that the PPACA in its present form will do much to reduce the growth rate of health care expenditures.     

Consumers’ attitudes,trust and willingness to pay for food information

Market failure can be corrected using different regulatory approaches ranging from high to low intervention. Recently, classic regulations have been criticized as costly and economically irrational, and thus, policy makers are giving more consideration to soft regulatory techniques such as information remedies. However, despite the plethora of food information conveyed by different media there appears to be a lack of studies exploring how consumers evaluate this information and how trust towards publishers influence their choices for food information. In order to fill such a gap, this study investigates questions related to topics that are more relevant to consumers, who should disseminate trustful food information, and how communication should be conveyed and segmented. Primary data were collected both through qualitative (in‐depth interviews and focus groups) and quantitative research (web and mail surveys). Attitudes, willingness to pay (WTP) for food information and trust towards public and private sources conveying information through a new food magazine were assessed using both multivariate statistical methods and econometric analysis. The study shows that consumer attitudes towards food information topics can be summarized along three cognitive‐affective dimensions: the agro‐food system, enjoyment and wellness. Information related to health risks caused by nutritional disorders and food safety issues caused by bacteria and chemical substances is the most important for about 90% of respondents. Food information related to regulations and traditions is also considered important for more than two‐thirds of respondents, whereas information about food production and processing techniques, lifestyle and food fads are considered less important by the majority of respondents. Trust towards food information disseminated by public bodies is higher than that observed for private bodies. This behaviour directly affects WTP for food information provided by public and private publishers when markets are shocked by a food safety incident. WTP for consumer association (€1.80) and the European Food Safety Authority (€1.30) are higher than WTP for the independent and food industry publishers that cluster around zero euro. Furthermore, trust towards the type of publisher also plays a key role in food information market segmentation together with socio‐demographic and economic variables such as gender, age, presence of children and income. These findings invite policy makers to reflect on the possibility of using information remedies conveyed using trusted sources of information to specific segments of consumers as an interesting soft alternative to the classic way of regulating modern food markets. JEL codes: D12, D18, D89, Q18.     

Analysis of free gift card program effectiveness

Retailers use various promotions, such as gift cards, to increase profits. When retailers give gift cards “free” to consumers who spend above specified thresholds in a single purchase, some consumers may buy more goods. We develop a model to derive the optimal purchase amount thresholds and gift card values. The model is developed for consumers without and then with a spending constraint. We find that the retailer's profit margin, the degree of forward buying and stockpiling, and use of gift cards in future purchases that would have been made with cash, are the most important factors in determining the profitability of gift cards. Gift cards may be very profitable for high-margin retailers who can limit the degree of forward buying and stockpiling, particularly when consumers use gift cards to buy goods they would not have bought from the retailer without gift cards. If this is how consumers use the gift cards, then consumers spending above the cards’ value at redemption can significantly increase their profitability. Without a consumer spending constraint, it is best for the retailer to offer at most one gift card at a large purchase amount. With a consumer spending constraint, it may be profitable to give gift cards at multiple purchase amount thresholds. We also show that the commonly observed policy of giving gift cards at equally spaced purchase amounts may be profitable when forward buying and stockpiling can be controlled. Moreover, we show that gift cards become more profitable when consumers are inconsistent, that is, they overestimate their probability of redeeming the gift card at purchase time. Finally, gift cards may have only a slight profit advantage over discounts if consumers are consistent. Consumer inconsistency and spending above the cards’ value increase this advantage.     

Social marketing and consumers’ experience of lipophobia

Modern societies are lipophobic: they express a deep anxiety about fat and fatness. On the other hand, the public discourses about health and well being, though biased towards lipophobia, are far from unanimous. The general question is how consumers experience and negotiate contradictory messages of hedonism and ascetics from commercial and governmental agents? This study more specifically examines the hypothesis that the governmental campaigns and official messages mediated through TV, newspapers and other media are largely failing their target, since they tend to have the biggest impact on people, that do not have a serious weight problem, but who nevertheless perceive themselves to be overweight. This is investigated through an adapted use of the Zaltman Metaphor Elicitation Technique approach with 20 younger female informants as well as a set of interviews with selected medical and political experts and representatives of consumer groups. The results provide a culturally rooted image of consumers’ fat intake and dietary practices as well as an attempt to de‐stigmatise consumers’ body imagery, informing future food policies and the food industry's satisfaction of public and private interests in consumers’ dietary patterns. This ends up in a critique of a certain approach to social marketing in the food domain. Rather than focusing on informational campaigns spreading messages that are already known to most people, more efforts should be put into the basic build‐up of a better general food culture – one that stresses quality over quantity and which is lipo‐conscious rather than lipophobic.     

Experience,change and vulnerability: consumer education for older people revisited

Everyday consumer transactions have the same potential for unexpected consequence whatever the age of the consumers involved. Young and old alike can find that products and services fail to live up to performance claims and that they are left with problems not easily resolved, or costs that are difficult to recover. While not overlooking consumer heterogeneity – especially on the basis of age – older consumers are arguably distinguishable in terms of the social and financial context in which they make decisions and attempt to redress problems. In 1988, attention was drawn to the need for consumer education to look beyond generic objectives to the specific situation of older people and their transactions. More than a decade later, in an allegedly consumer‐oriented society, the issue is revisited here to assess the argument's current relevance. Despite the increased availability of information for decisions and consumer protection, difficulties persist in the way information is presented or accessed. Chameleon‐like, old problems become manifest in new unfamiliar ways and invalidate experience. Consumer education today is as important as it was in 1988. Arguably, technological change means that the need for a better understanding of dangers, rights and redress procedures is greater than ever and the needs of older people in increasingly complex private and public sector transaction environments are all the more pressing. However, a fundamental revision of the way we approach the design of products, services and environments is needed to improve prospects for older consumers.     

Group service recovery strategies effectiveness: The moderating effects of group size and relational distance

The extant service recovery literature focuses on consumers' responses to individual failures. However, group service failures are in fact common, but they have received insufficient research attention. This study contributes to theory and practice by applying social impact theory to explain the social nature of group failures. Findings from two studies show that group size and relational distance substantially affect consumers' response to group service recovery strategies. Specifically, private economic recovery creates less consumer satisfaction as group size increases, whereas consumers with a distant social relationship are more satisfied with public recovery for both economic recovery and social recovery. However, consumers with close relationships are more satisfied with public economic recovery and private social recovery. Apart from offering practical insights, this study expands the theoretical understanding of service failures, suggesting that they occur in a complex social ecology instead of relatively simple dyadic interactions between service providers and consumers.     

The Future of Private Labels: Towards a Smart Private Label Strategy

Modern day store brands (SB) or private labels (PL), now also popularly called private brands, are brands generally owned and marketed by retailers. They have been active on the market for about 70 years. Over this time span, these brands have evolved from generic, cheap, low-quality economy or budget private labels to lower-priced-than-national brand but acceptable-quality value or standard private labels. Over time, retailers extended the value proposition to the consumer segment seeking higher quality by offering premium private labels. This strategy, called the tiered-private label, comprises offering economy PL to the price-sensitive but not quality sensitive consumers, standard PL to mainstream consumers seeking acceptable quality at lower prices, and premium PL to the quality-sensitive segment seeking value. Over the last 40 years (1980–2020), these versions of private labels have witnessed substantial growth around the world, though the growth is said to be tapering in recent times.As retailers chart the future strategy for their private labels in 2020 and beyond, a pertinent question they face is: Should they continue to offer value or even tiered PL with the same formula that brought them success in the past, or should they morph and adopt new strategies in keeping with current market trends? We support adopting a new strategy that we call the smart PL strategy. The value PL strategy and its manifestation as the tiered PL strategy cater to different consumer segments but focus primarily on price and quality as attributes of choice. In the current marketplace, consumers care not only about price and quality, but also about sustainability, ethics, social responsibility, image, so forth, perhaps more so than earlier generations. They are also more tech-savvy in using digital tools for search and purchase. Retailers, on their part, are now endowed with rich, extensive data that they can tap into to understand customers’ diverse needs, and they are able to harness technology for developing the right product and communication. Thus, the smart PL strategy is a strategy by which retailers can leverage data and technology to market private labels that meet diverse customer needs and achieve greater retail differentiation, store loyalty, margins, and profits. This thought piece provides a road map for developing such a smart PL strategy and directions for future research.     

The Affordable Care Act,the Medicaid Coverage Gap,and Hispanic Consumers: A Phenomenology of Obamacare

The historic health care reform of the Patient Protection and Affordable Care Act, commonly referred to as Obamacare, enabled more than 20 million Americans to gain health insurance and access to health care. However, the original mandate requiring states to expand Medicaid was ruled as optional in 2012 by the Supreme Court. Focusing on Hispanic consumers residing in a state that opted out of the Medicaid expansion, this study reports on the consumer experience of Obamacare. Findings show that study participants are in an unfavorable situational context, better understood when the cultural context is considered, and cultural resistance recognized. The findings also show that participants are confused, discouraged, and fearful of the continued unaffordability of health insurance and the lawful need to enroll or be penalized. For these participants, affordable health insurance has not been realized and this research gives an insight on those individuals falling through the cracks.     

Examining Antecedents of Health Insurance Literacy: The Role of Locus of Control,Cognitive Style,and Financial Knowledge

Today's consumer is expected to make health-care decisions that have serious implications for their welfare. However, a major barrier to these decisions is a basic lack of understanding of health insurance. A critical first step is to examine drivers of health insurance literacy and in turn offer interventions that can have a positive impact on consumer welfare. This article explores the relationship between relevant consumer psychographics, financial knowledge, and demographics with health insurance literacy. Results indicate that while demographics play a role, the degree to which consumers believe a situation or event is under their own control (i.e., locus of control), how they process information (i.e., cognitive style), and consumer's financial confidence (i.e., subjective knowledge) is a critical indicator of their health insurance literacy. Cluster analysis reveals three “faces” of health insurance literacy.