Price Indexes for US Medical Care Spending, 1980–2006

We construct price indexes for medical care spending in the US economy for the period 1980–2006. Our indexes show slower price growth than the official deflator from 1987–2001, consistent with the fact that indexes that improve on the official statistics typically find slower price growth than the official indexes. However, the result is reversed for the 2001–2006 time period. We develop a decomposition that parses out the numerical differences in these indexes into three factors that are held constant in the official price indexes but are not in our indexes: changes in the type of provider supplying care, changes in the type of insurance plan used by the patients, and changes in the bundle of procedures used to treat patients. Our results suggest that using the official price measures may provide misleading conclusions about spending trends and productivity growth in this important sector over this time period.     

What happens to social spending in IMF-supported programmes?

This article finds that education and health spending has risen during International Monetary Fund (IMF)-supported programmes at a faster pace than in developing countries as a whole. The analysis is based on the most comprehensive dataset assembled thus far for this purpose, with data covering 1985 to 2009 for 140 countries. Controlling for other determinants of education and health spending, including macroeconomic conditions, the results confirm that IMF-supported programmes have a positive and significant effect on social spending in low-income countries. Over a 5-year period with IMF-supported programmes, spending for education increases by about ¾ percentage point of Gross Domestic Product (GDP); and for health, by about 1 percentage point of GDP. IMF-supported programmes are also associated with increases in the share of government spending allocated to education and health.     

美国医疗保健模式及其改革

由于倡导自由市场经济的文化和社会背景,美国是唯一没有实行全国统一的医疗保障制度的发达国家。本文对美国医疗保险制度、美国医院的管理运行机制、美国医疗保险付费方式的沿革进行了系统的介绍,并梳理了美国医疗保健管理模式的特点与问题,结合奥巴马政府医疗保健改革要点,对我国医疗保健体系改革提出了几点建议。     

The Social Value Theory of Orthodoxy: A Review and Critique

From an institutionalist perspective, we identify five sources of policy conflict. Each may explain why policies intended to obtain particular goals for an institutionalized practice may have unintended consequences. We illustrate by analyzing attempts at introducing market-oriented reform in health care provision.     

国外政府居家养老医疗服务政策与经验借鉴

医疗服务是政府发展居家养老服务的重要内容。国外政府发展居家养老服务起步较旱,尤其在居家养老医疗服务方面具有先进的管理经验。目前,我国的居家养老医疗服务发展水平比较低,政府在医疗制度、财政投入、法律政策等方面还存在许多不足。     

过度医疗行为的理论、实证与管理式医疗制度

本文是一篇文献综述,主要回顾过度医疗行为的理论与实证研究成果;其次,阐述与分析了以该理论为基础的美国管理式医疗与支付制度。     

Do Competing Health Insurance Licensors Provide Pro-patient Effects?

This paper shows that competition among health insurance licensors has strong pro-patient effects, if inter-regulatory competition is allowed. The pro-patient effects of the competition among health insurance licensors do not depend on the need for the patients to form or exercise their political influence, such as, forming cooperatives or voting, as suggested by Backer's pressure group theory. When inter-jurisdictional transactions are allowed, endogenous policy making ensures that the health care licensors pursue public interests at no costs to patients.     

经济增长、地区收入差距与公共支出

建立包含公共基础设施的两地区内生增长模型,将公共支出政策纳入统一的分析框架,同时合并考虑政府调控的各种支出手段对区域发展的综合影响。该模型表明与转移支付和传统的区域政策相对照,旨在减少革新成本的公共支出政策能提高经济增长率,同时促进区域间平等。     

Universal Health Care and the Economics of Responsibility

In the American health care system the cost of health insurance is underwritten by all three sectors of the economy: 1) households; 2) employers; and 3) government. However, while costs are shared, responsibility is not. The retreat of private firms and government from assuming a substantial share of the burden of health care costs is based on the presumption that health care is an individual’s responsibility, while the contributions of government and the private sector are basically optional - a matter of benevolence rather than responsibility. The outcome of the current debates over health care reform will depend on this issue of responsibility. Who should pay for health care? Is it a collective responsibility or an individual one? In this paper, we explore the economics of responsibility as it applies to health care. In the institutionalist framework, any reallocation of costs must be driven by an underlying philosophy of shared responsibility.     

城镇低保户医疗服务利用和医疗保障制度设计对就医行为的影响——基于兰州、西宁和白银城镇家庭调查数据的分析

解决低保户看病难问题事关社会底线公平。文章基于2005年三个西北城市的17 690个样本对低保户就医问题展开实证研究,分析结果表明,由于中国医疗机构扭曲的激励机制和偏重住院报销的给付结构,低保户和非低保户两个群体都倾向于自己购药处理日常病患,而减少了门诊利用,经常面临生存危机的低保户由此拖延病情直至病情严重;个人账户既不能横向分散不同人群的疾病风险,也不能纵向分散个人在生命周期不同阶段的疾病风险;职工基本医疗保险能够显著增加中青年低保户对住院服务的利用,但对老龄低保户没有效果。     

The U.S. health care expenditure: evidence from 2001 to 2009

This study utilizes state-level data from 2001 to 2009 to estimate the impact of the 2007 financial crisis upon health care expenditures. Higher death rates are consistently found to have a positive and statistically significant impact on health expenditures. While mental health and COPD are not generally found to impact expenditures, increases in the percentage of the population diagnosed with cholesterol and obesity tend to increase health expenditures. Increases in health expenditures slowed considerably after the financial crisis. Even though recessions (high unemployment rates) are generally found to have a positive impact on health expenditures, the post-financial crisis time period is estimated to have much lower health expenditures than in other time periods. Our results can be used to give insight into the conditions under which the slower rate of increase in health expenditures can be expected to increase. More research will be needed to be able to more completely explore not only the reasons for these changes in health expenditures but also whether they are likely to continue into the future.     

Unmet need for health care during pregnancy: A French – Romanian comparison

ABSTRACT

Health inequalities emerge from birth, the early neonatal mortality and infant mortality rates being different between countries. These differences may be related to inequalities in use of health care during pregnancy. The aim of this research is to identify and compare the profiles of women who do not follow pregnancy health care recommendations in two European countries with different health systems and indicators: namely France and Romania. However, health care recommendations for pregnant women are free in the two countries. Firstly, unmet need for health care during pregnancy is observed. Secondly, our results reveal that there is a relationship between perinatal health care abandonment and several forms of inequalities (social, informational and psychological). Thirdly, the much higher probability of forgoing perinatal health care for Romanian women could be associated with financial or informational problems which seems counterintuitive because perinatal health care recommendations are free. Free coverage is too insufficient to ensure the efficiency of the perinatal health care system.     

Research on spending policy for university endowment funds

University endowment funds are important capitals in many universities in China today. A lot of universities target their endowment spending at a fixed spending ratio. Because of volatile inflation, it is not optimal. In this paper, the author analyzes the importance of spending policy of university endowment funds, and suggests two models in accordance with inflation-adjusted value.     

Optimal monetary–fiscal policy in the euro area liquidity crisis

We build an euro-area level DSGE model featuring a liquidity shock in the sovereign bonds market to simulate the strong contraction in economic activity observed during the 2008–2009 crisis. In the model, a sudden deterioration of the liquidity property of sovereign bonds is associated with deep recession and deflation. Against this background we characterize optimal monetary and fiscal policy with full commitment. We find that the optimal policy contains three features: (i) the policy rate is lowered until hitting the zero lower bound (ZLB) and then is kept at the ZLB for more periods; (ii) a prolonged central bank’s balance-sheet expansion aimed at restoring the liquidity deteriorated; (iii) a counter-cyclical fiscal stimulus which offsets, to a large extent, the fall in private spending caused by the liquidity shock. Policy regimes involving (i), but not (ii) and (iii), are quite weak in stabilizing output gap and inflation. Monetary policy regimes such as full inflation-targeting or nominal GDP targeting perform remarkably well insofar as they are complemented with an optimally-implemented counter-cyclical fiscal policy. Our results tend to favour the view that, in case of recession, an euro-wide coordinated fiscal policy should supplement the role of the ECB in achieving its primary objective.     

Health economics of medical devices: opportunities and challenges

Expenditure on medical devices is substantial and is expected to grow in the future. This Editorial draws attention to health economic issues surrounding medical devices. To this effect, opportunities and challenges involved in the economic analysis of the market structure of medical device sectors and in the economic evaluation of medical devices are identified.

Markets for medical devices tend to be fragmented and suffer from a lack of transparency and competition. In response to this, there is extensive government intervention in many developed countries with a view to keeping down prices, restricting public reimbursement and promoting an efficient use of medical devices. Studies are called for that evaluate and compare country approaches towards regulating medical device markets with a view to informing medical-device policies.

Whereas economic evaluation of medicines is well established, and is used to inform pricing and reimbursement decisions in many developed countries, this is less the case for medical devices. There is a need for economic evaluations of medical devices with a view to demonstrating their cost effectiveness. In addition, countries need to implement frameworks for the assessment of new and emerging medical devices with a view to taking pricing and reimbursement decisions.