EFFECT OF CROSS‐BORDER HEALTH CARE ON QUALITY AND PROGRESSIVITY OF FINANCING

In this study, we examine the effect of cross‐border health care in terms of public health insurance. We consider its effect on healthcare quality and progressivity of financing. We use a two‐country Hotelling model in which consumers are divided into two groups: high and low innate‐talent consumers. Aiming to maximize social welfare, governments impose a progressive income tax on consumers to provide healthcare services. Assuming that a payment scheme for healthcare services is based on diagnosis‐related group pricing, which has been adapted in many countries, we obtain the following results. The promotion of cross‐border health care does not influence healthcare quality or the progressivity of financing in patient‐importing countries, but does reduce healthcare quality and influence the progressivity of financing in patient‐exporting countries.     

Estimating willingness to pay for medicare using a dynamic life-cycle model of demand for health insurance

Medicare is the largest health insurance program in the US. This paper uses a dynamic random utility model of demand for health insurance in a life-cycle human capital framework with endogenous production of health to calculate the individual willingness to pay (WTP) for Medicare. The model accounts for the feature that the demand for health insurance is derived through the demand for health, which is jointly determined with the production of health over the life-cycle. The WTP measure incorporates the effects of Medicare insurance on aggregate consumption through effects on medical expenditures and mortality, and consumption utility of health. The model is estimated using panel data from the Health and Retirement Study. The average WTP or change in lifetime expected utility resulting from delaying the age of eligibility to 67 is found to be $ 24,947 in 1991 dollars ($ 39,435 in 2008 dollars). However, there is considerable variation in the WTP, e.g., in 1991 dollars the WTP of individuals who have less than a high school education and are white is $ 28,347 ($ 44,810 in 2008 dollars), while the WTP of those with at least a college degree and who are neither white nor black is $ 15,584 ($ 24,635 in 2008 dollars). More generally, the less educated have a higher WTP to avoid a policy change that delays availability of Medicare benefits. Additional model simulations imply that the primary benefits of Medicare are insurance against medical expenditures with relatively smaller benefits in terms of improved health status and longevity. Medicare also leads to large increases in medical utilization due to deferring of medical care prior to eligibility.     

CPI revision provides more accuracy in the medical care services component.

This revision, as in the past, enabled the Bureau to update medical care service expenditure weights in the CPI, including a more complete allocation of health insurance premiums. Instead of keeping the portion of premiums that go to benefits under health insurance, the expenditure weight for each benefit category has been added to the appropriate out-of-pocket expense. The unpublished health insurance item represents only the retained earnings portion of premiums paid by households. The specific item categories included in medical care services have also been updated and expanded. A study conducted during the developmental phase of the revision indicated that the Bureau should expand the eligible priced rates for physicians in the CPI to include not only the "self-pay" rate, but also other categories of payment as well. Another study indicated that the direct pricing of health insurance is not feasible because of the difficulty of factoring out from premium changes the effect of utilization levels and modified coverage. In pricing medical care service items, as with other item categories in the CPI, BLS attempts to exclude from price movement the effect of quality changes. However, some quality changes are difficult to assess or are not readily identified, for example, a change in the ratio of nurses to patients, and such changes may be reflected as part of the price change movement in the CPI.     

EVA在我国保险公司绩效评价中应用的思考

我国保险市场竞争日趋激烈,各家保险公司在保费规模增长的同时,更加注重业务结构的调整和经营效益的提升。但保险公司在绩效考评等内部管理环节上存在的一些问题影响了保险公司经营绩效的真实反映,制约了保险行业的进一步发展。在保险公司实施基于EVA的绩效评价体系,有利于提高保险公司价值管理水平,增强其核心竞争能力。     

Willingness to Pay for Green Products in Air Travel: Ready for Take‐Off?

We examine the willingness to pay (WTP) for green products in air travel. Green products in aviation are supplementary services, which are sold on top of the travel service (e.g. carbon offsets, organic on‐board food). We identify a set of potential green products in aviation and report the preferences for additional airline services of 811 Swiss air travellers using an adaptive choice‐based conjoint survey. We find that 20% of those passengers who are interested in purchasing supplementary services show a considerable WTP for green products. The green segment differs from the regular segment only in terms of behavioural features, not in terms of demographic or socio‐economic characteristics. Copyright © 2015 John Wiley & Sons, Ltd and ERP Environment     

指数风险偏好下的最优保险策略

本文讨论了当投保个体和保险公司为指数风险偏好时，在保费约束下投保个体的最优保险策略问题。本文采用求解对偶优化问题的方法求解这个问题，并给出当损失服从指数分布时最优保险策略解的解析式。本文最后讨论了投保个体和保险公司风险厌恶程度以及保费预算变化对个体最优保险策略的影响。     

Do health system reforms stand a chance?

While most major reforms of health systems fail, those that succeed are motivated by politicians' quest for reducing the health burden on their budget in response to a shift in voters' preferences away from public health. An Edgeworth box is used to depict their preferences, in addition to those of (potential) patients and health‐care providers. Politicians are found to severely constrain the area of mutual advantage, suggesting that only minor reforms are possible unless they promise to lower health‐care expenditure. An efficiency‐enhancing change that would enlarge the box and hence the area of mutual advantage would be to suppress the requirement imposed on health insurers to purchase domestically, rather than being free to directly import health‐care services and drugs.     

Optimal dividend strategies with time-inconsistent preferences

This paper studies the optimal dividend strategies of an insurance company when the manager has time-inconsistent preferences. We consider the problem for a naive manager and a sophisticated manager, and analytically derive the optimal dividend strategies when claim sizes follow an exponential distribution. Our results show that the manager with time-inconsistent preferences tends to pay out dividends earlier than her time-consistent counterpart and that the sophisticated manager is more inclined to pay out dividends than the naive manager. Furthermore, we extend these results to the case with claim sizes following a mixed exponential distribution, and provide a numerical analysis to reveal the sensitivity of the optimal dividend strategies to changes in the premium, claims and surplus volatility.     

The demand for deductibles in private health insurance: A probit model with sample selection

In this paper we analyse the decision to prefer a health insurance with a deductible to one with complete coverage. We focus on health, medical consumption, and on socio-economic characteristics like age, income, education and family size. The analysis is based on a sample of 8000 privately insured families; about 60 percent of them did not wish to have a health insurance policy with a deductible. A corrective method for sample selectivity, analogous to Heckman's (1979) method, has been applied in probit analysis; the estimation results are compared with the maximum-likelihood estimates. Health, medical consumption and income are found to have a significant influence on the decision with respect to the type of insurance. Our results give an indication of the degree of adverse selection that may take place if health insurance policies are offered with the option to take a deductible in exchange of a premium reduction.     

Do quality perceptions of health and social services vary for different ethnic groups? An empirical investigation

The United States is now more ethnically diverse than any other time in its history. In 2000, minority ethnic groups comprised 26% of the US population; by 2010, they comprise 35%, and in 2080 they will form the majority of American citizens. And among these ethnic groups, African Americans (12.4%), Hispanics (15.4%) and Asians (4.4%) were the most predominant in 2000. The growth of this segment of the population is not only in terms of numbers but also in terms of economic development. Minority groups are showing marked improvement in income and education levels leading to greater purchasing power. As a result, for‐profit companies are increasingly targeting minority populations with products and promotions specifically designed for specific minority groups. Even non profit organizations such as educational programs, social service and healthcare agencies are striving to design specific services and culturally competent outreach models in order to serve this increasingly diverse marketplace. But despite the strides made by non profit agencies, several studies note the tremendous disparities between the ethnic and racial groups in the seeking and the receipt of health‐care and social services. Additionally, there is limited empirical information about the perceptions of minority consumers. In order to effectively serve minority groups, it is essential to understand their experiences with the non profit service industry and to assess their ongoing concerns. In this study, we focus on two critical components of the non profit world – healthcare and social services. We conducted a survey to compare and contrast the social service and health‐care quality perceptions of three ethnic groups: Caucasians, African‐Americans and Hispanics. Our study, undertaken in collaboration with community health centers, reveals distinct differences in perceptions between the three ethnic groups. Based on our findings, we outline a set of implementable strategies for social service and community health organizations. Copyright © 2010 John Wiley & Sons, Ltd.     

A multivariate analysis of the determinants of physician utilization

This study examines the determinants of health services utilization among 2168 households in five New York and Pennsylvania counties. The purpose is to identify sub-population groups with relatively homogeneous patterns of health service use behavior and to determine for each the relative importance of various predictors, categorized into three broad dimensions—the need for care, predisposing factors and enabling factors. A two stage approach using multivariate analysis technique is employed.Overall, the proportion of expenses paid by health insurance, Medicare, social class and the physician-population ratio in the country where health services are recieved are found to be important predictors of health services use. The significance of these and other predictors varies, however, from one subgroup to the next. The analytical strategy employed proves to be helpful both in understanding the differential patterns of health services utilization in subpopulations and in indentifying impediments to health care. Moreover, the predictive models of physician utilization are formulated.     

The role of asset testing in public health insurance reform

Starting slowly with the 1996 Welfare Reform Act and culminating in the 2010 Affordable Care Act, means-tested public health insurance eligibility expanded to include adults in low-income families regardless of their asset holdings. This paper quantifies the effects of these eligibility expansions within the context of the 2010 Affordable Care Act. I construct a dynamic stochastic general equilibrium model with indivisible labor supply expanded to include an endogenous household choice of health insurance coverage and calibrate it to U.S. data. I establish that changes in the distribution of labor and welfare associated with removal of asset testing are driven by exit of high productivity and high wealth households from the labor market. I then expand my analysis to the 2010 Affordable Care Act to demonstrate that removal of asset testing is critical to the obtained results even when combined with other provisions of the Act. Finally, I find that a simple asset test for eligibility of health insurance transfers undoes the distortion to the household labor supply decision among high productivity types. These results are robust to the introduction of employer premium contributions, an independent health insurance market, and idiosyncratic shocks to eligibility for employment-based health insurance.     

Prevention incentives in long‐term insurance contracts

Long‐term insurance contracts are widespread, particularly in public health and the labor market. Such contracts typically involve monthly or annual premia which are related to the insured's risk profile. A given profile may change, based on observed outcomes which depend on the insured's prevention efforts. The aim of this paper is to analyze the latter relationship. In a two‐period optimal insurance contract in which the insured's risk profile is partly governed by her effort on prevention, we find that both the insured's risk aversion and prudence play a crucial role. If absolute prudence is greater than twice absolute risk aversion, moral hazard justifies setting a higher premium in the first period but also greater premium discrimination in the second period. This result provides insights on the trade‐offs between long‐term insurance and the incentives arising from risk classification, as well as between inter‐ and intragenerational insurance.     

The impact of Medigap insurance on out-of-pocket health expenditures by older Americans over the 1980s

This study presents a comparative analysis of out-of-pocket health expenditures over the 1980s by older Americans with and without Medigap (supplemental) insurance. The objective is to analyze changes during the 1980s in the pattern of health expenditures and in the financing of those health expenditures by households age 65 and over. Two-stage regression analysis shows that health goods and services are normal goods. Out-of-pocket health expenditures, excluding insurance premiums, are higher for those with Medigap insurance, which may be explained by the market failures of moral hazard and adverse selection.     

Falsified or Substandard? Assessing Price and Non‐price Signals of Drug Quality

Pharmaceutical products can be of poor quality either because they contain zero correct active ingredient (referred to as “falsified”) or because they contain a nonzero but incorrect amount of the right active ingredient (referred to as “substandard”). Although both types of poor‐quality drugs can be dangerous, they differ in health consequence, price, and potential policy remedies. Assessing basic quality of 1437 samples of Ciprofloxacin from 18 low‐to‐middle‐ income countries, we aim to understand how price and nonprice signals can help distinguish between falsified, substandard, and passing drugs. Following the Global Pharma Health Fund e.V. Minilab® protocol, we find 9.88% of samples have less than 80% of the correct active ingredient and 41.5% of these failures are falsified. Falsified and substandard drugs tend to differ in two observable attributes: first, falsified drugs are more likely to mimic drugs registered with local drug safety regulators. Second, after controlling for other factors, substandard drugs are on average cheaper than passing generics in the same city but the price of falsified drugs is not significantly different from that of passing drugs on average. These data patterns suggest that careful consumers may have information to suspect a drug is substandard before purchase but substandard drugs can still exist to cater to poor and less‐educated population. In contrast, falsified drugs will be more difficult for consumers to identify ex ante because they appear similar to high‐quality, locally registered products in both price and packaging.     

强化医疗保险基金审计的监督职能——以陕西省为例

随着社会主义市场经济的不断发展以及社会保障需求的不断提高,医疗保险基金作为社会保障的重要组成部分,在维护社会稳定、提高居民身体健康水平方面起着重要作用。如果缺乏对医疗保险基金的有效监督,必将产生极大的隐患。审计作为监督的重要手段,对保障医疗保险基金的合理征缴、合规使用起着不可替代的作用。论文从陕西省医疗保险基金审计的结果出发,发现医疗保险基金管理中存在的问题,进而提出强化医疗保险基金审计监督职能的相关建议。     

医院住院费用影响因素的综合分析与预测

药品比例高居不下已成为目前我国各个医院所共同面临的难题。本文把对药品比例过高问题的研究和医院住院病人各种费用的深入分析与医院当前的医疗保险存在的问题联系起来,客观系统地分析了造成药品费用过高的原因,根据医院目前的现状,实事求是地查找医院医保费用管理中存在的问题,试图找到解决医院医保费用的有效途径。     

Dying for Money

A bstract . A major cause of spiralling health-care cost is aggressive treatment of major illnesses by health-care providers The insured patient also demands such an expensive course of action because he pays only a small portion of the cost and is not given a more attractive alternative. If the patient is offered compensation to give up his de facto right to aggressive treatment, insurance premium can be reduced. Physician-assisted death with benefit conversion is discussed as a means for such an exchange.     

Impact of treatment heterogeneity on drug resistance and supply chain costs

The efficacy of scarce drugs for many infectious diseases is threatened by the emergence and spread of resistance. Multiple studies show that available drugs should be used in a socially optimal way to contain drug resistance. This paper studies the tradeoff between risk of drug resistance and operational costs when using multiple drugs for a specific disease. Using a model for disease transmission and resistance spread, we show that treatment with multiple drugs, on a population level, results in better resistance-related health outcomes, but more interestingly, the marginal benefit decreases as the number of drugs used increases. We compare this benefit with the corresponding change in procurement and safety stock holding costs that result from higher drug variety in the supply chain. Using a large-scale simulation based on malaria transmission dynamics, we show that disease prevalence seems to be a less important factor when deciding the optimal width of drug assortment, compared to the duration of one episode of the disease and the price of the drug(s) used. Our analysis shows that under a wide variety of scenarios for disease prevalence and drug cost, it is optimal to simultaneously deploy multiple drugs in the population. If the drug price is high, large volume purchasing discounts are available, and disease prevalence is high, it may be optimal to use only one drug. Our model lends insights to policy makers into the socially optimal size of drug assortment for a given context.     

Technological change in health care: Why are opinions so divided?

This paper purports to explain the widespread scepticism towards technological change in health care in general and pharmaceutical innovation in particular in the face of very high estimated rates of social return. These estimates are based on observable market prices and quantities, which are used for measuring the additional consumer surplus induced by an innovation. They grossly overstate true surplus due to the effect of insurance, however. For true demand for health care services and hence true surplus depends on the net price a patient is willing to pay, which is a rather small fraction of observed market price. The paper also outlines the conditions under which a health insurer would welcome a pharmaceutical innovation.