Medical savings accounts: why do they work?

This article analyzes and reviews the cost and design characteristics of medical savings accounts (MSAs). By placing premium savings from high-deductible health insurance in medical savings accounts, individuals have an incentive to shop for medical services. A more market-oriented health insurance and delivery system results, as individuals are now both users and buyers of health care. Data show that most families would accumulate balances in their MSAs that may be used for future medical expenses or savings. Through program design, the potential problems of adverse selection and cost to risk can be greatly reduced.     

Making competition in health care work

Health care reform in the United States is on a collision course with economic reality. Most proposals focus on measures that will produce one-time cost savings by eliminating waste and inefficiency. But the right question to ask is how to achieve dramatic and sustained cost reductions over time. What will it take to foster entirely new approaches to disease prevention and treatment, whole new ways to deliver services, and more cost-effective facilities? The answer lies in the powerful lessons business has learned over the past two decades about the imperatives of competition. In industry after industry, the underlying dynamic is the same: competition compels companies to deliver constantly increasing value to customers. The fundamental driver of this continuous quality improvement and cost reduction is innovation. Without incentives to sustain innovation in health care, short-term cost savings will soon be overwhelmed by the desire to widen access, the growing health needs of an aging population, and the unwillingness of Americans to settle for anything less than the best treatments available. The misguided assumption underlying much of the debate about health care is that technology is the enemy. By assuming that technology drives up costs, reformers neglect the central importance of innovation or, worse yet, attempt to slow its pace. In fact, innovation, driven by rigorous competition, is the key to successful reform.     

Potential “Savings” of Medicare: The Analysis of Medicare Advantage and Accountable Care Organizations

Medicare faces significant financial challenges because of rising health care costs. In response, Medicare reform efforts have been testing various payment and service delivery models, including accountable care organizations (ACOs), aiming to reduce expenditures while preserving or enhancing the coordination of quality care. The idea behind ACOs is to form an organizational network to coordinate all care for Medicare beneficiaries and in so doing, at least theoretically, improve quality of care and hopefully reduce medical costs. The purpose of this research is to apply Data Envelopment Analysis (DEA) to assess the potential savings of Medicare obtainable through optimally efficient implementation of ACOs and Medicare Advantage plans. DEA comparisons across plans achieve this purpose by identifying which Medicare plans operate relatively more efficiently and which are inefficient, and additionally, for inefficient plans, the DEA analysis generates target levels of “inputs” and “outputs” required to bring the plan into efficient operation. Knowing sources of inefficiency can also provide insights into Medicare reform, such as Medicare privatization and innovation models. Our results show that Medicare Advantage plans are more efficient in reducing health expenditures but incur higher administrative costs. Health expenditure savings can also be achievable by promoting government-sponsored managed Medicare such as ACOs. Finally, compared to the profit efficiency of Medicaid managed care plans, Medicare Advantage should have the potential for more Medicare market penetration from the supply (insurer) side.     

预先医疗指示制度与临终医疗资源利用——基于RCT研究的文献综述

本研究纳入2000-2016年国际公开发表的针对临终患者的预先医疗指示(AD)制度设计的临床随机对照研究(RCTs),对ADs的临床产出及医疗资源利用情况评估文献进行系统综述,以期为我国实施终末期患者制定预设临终照顾计划(ACP)提供决策依据及路径。结果显示,鼓励临终患者及代理人就ACP进行主动沟通、签署AD,不仅可缓解患者焦虑、抑郁情绪,使患者临终意愿得到尊重,减少医疗纠纷,而且可显著减少患者临终期对住院、ICU等医疗资源的使用,减少激进治疗方案的选择,提高医疗资源利用效率并节省费用。     

The medical home bends cost curve

While the Affordable Care Act is trying to manage health insurance, as well as mandating coverage, a number of projects around the country are trying to manage the underlying cost of health care. By bringing back the concept of a true primary care physician, who provides 90% of your care and coordinates with your specialists, these programs are bending the curve of health care cost trends. Most are seeing a reduction in emergency room visits and hospital days in the double digits. Others that are taking fee-for-service insurance out of the picture altogether are experiencing even higher reduction rates. The goal is to increase patient health, which includes the patient having an active role in understanding his or her condition, treatment options and self-care strategies. It is estimated that if all Americans had access to a medical home, our nation could save $37 billion annually.     

Access to services: what are the real needs?

Adequate accessibility to managed care services is typically a key determining factor when an employer decides to implement a managed care plan. And although it can be difficult for an employer to determine what constitutes adequate accessibility, it is necessary in order for managed care utilization and associated cost savings to be maximized.     

An analysis of the Medical Savings Account as an alternative retirement savings Vehicle

Personal savings as a percentage of disposable income have dropped steadily since the early 1980s. Savings have continued to decline in 1999, as the savings rate—savings as a percentage of after-tax income—dropped to a record low of minus 0.7% in April 1999, according to the Department of Commerce. The study finds that MSA-type accounts are a viable supplement to retirement savings, but should not be used as a replacement for existing retirement alternatives given their current structure. Results show that future health care expenditures are an important factor in the success or failure of MSAs as supplemental retirement accounts. Medical Savings Accounts are currently eligible for long-term care expenses, and to the extent that such expenses occur during retirement, MSA balances could be used to pay for retirement expenses. In that respect the accounts already capture the characteristics of a retirement savings account. A comparison of the Roth IRA with the MSA as defined by the 1996 HIPAA legislation is also conducted.     

中国城镇居民医疗保险和新型农村合作医疗衔接路径探讨——基于湖北省武汉市的实证分析

中国城镇职工医疗保险、新型农村合作医疗和城镇居民医疗保险的建立标志着全民医保体系的确立,但是基本医疗卫生服务仍然表现出明显的城乡二元化特征。湖北省武汉市作为中部经济发展水平较高的大城市,在城市化和人口流动加快的背景下,迫切需要实现城乡医疗卫生资源的整合和基本医疗保险制度的衔接。首先实现城镇居民医疗保险和新农合衔接,进而探索城乡居民医疗保险和城镇职工医疗保险衔接,分两步走实现城乡三大医疗保险制度衔接。     

Will we outlive our money?

Fewer and fewer Americans retire with benefits in the form of life annuities. The author raises key issues regarding the increased importance that uncertainty plays in determining retirement income. The key issues include longevity risk and how savings withdrawals rates will be affected at varying rates of return.     

The impact of health care reform on older workers, retirees and employers

The Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 impacts everyone who uses or pays for the health care system. Among the new law's effects will be changes in older workers' health care choices as they transition from full-time employees to part-time work or other jobs and, ultimately, to retirement, and the retiree health benefit choices facing their employers. This article reviews the major issues surrounding these changes, including those affecting retiree health benefits, benefits for Medicare-eligible retirees and health care options for older Americans not yet eligible for Medicare. The authors conclude that although employers will be reacting in 2010 and 2011 with regard to some issues surrounding FASB ASC 715-60 and the early retiree reinsurance program, employers should consider waiting to make major changes until regulations are issued and the health plans for active employees have been fully vetted.     

Single payer: do government-run programs meet America's needs?

The impact of a government-run program on our current health care system is not well understood by most Americans. Californians could be in for many unpleasant surprises should the single payer ballot initiative pass this November. The author examines how a single payer program attempts to meet the goals of health care reform and why it fails in many important aspects.     

发达国家和地区空巢老年人长期照护的经验与启示

建立和完善老年人长期照护体系,是应对银色浪潮的必然选择.目前欧洲、美国、日本等发达国家以及香港、台湾等地区,老年人长期照护制度建设已比较完善,在空巢老年人长期照护体系建设方面积累了丰富的经验.目前我国空巢老年人长期照护体系建设还处于起步阶段.借鉴国内外的先进经验,我国空巢老年人长期照护体系应该是融经济供养、医疗照护、日常生活护理、精神慰藉于一体的综合服务体系.在这一体系的构建中,政府是主导,家庭、机构、社区是载体,社会服务组织是主力,专业人员是基础.只有充分发挥了这几个方面的作用,才能破解我国老年人长期照护体系建设的难题.     

Mergers and marginal costs: New evidence on hospital buyer power

We estimate the effects of hospital mergers, using detailed data containing medical supply transactions (representing 23% of operating costs) from a sample of US hospitals, 2009–2015. Pre‐merger price variation across hospitals (Gini coefficient 7%) suggests significant opportunities for cost decreases. However, we observe limited evidence of actual savings. In this retrospective study, targets realized 1.9% savings; acquirers realized no significant savings. Examining treatment effect heterogeneity to shed light on theories of “buyer power,” we find that savings, when they occur, tend to be local, and potential benefits of savings may be offset by managerial costs of merging.     

Worries and plans as individuals approach retirement

The primary objective of an employment-based retirement plan is to provide a secure and adequate income for workers throughout retirement. In the defined contribution (DC) framework, asset accumulation is a means to the end, but not the end. Drawing retirement income from savings and paying for health care expenses in retirement are the two issues that concern individuals the most as they approach retirement. This article examines the attitudes of near-retirees regarding these risks and their plans for managing them. The author discusses how DC plan design can have a major impact on how individuals convert their retirement savings to retirement income; differences in survey responses between those who have consulted a financial advisor or other financial professional and those who have not; and the role of trust in implementing advice.     

中国长期护理保险财政负担能力研究

本文通过测算城乡居民和城镇职工长期护理保险需求,构建医疗保险精算模型,对中国长期护理保险财政负担能力展开研究。结果发现:依托城乡居民医疗保险建立的长期护理保险会增加财政支出,但是支出规模在可控范围内;依托城镇职工医疗保险建立的长期护理保险会威胁职工医疗保险统筹基金的安全,因而不可持续,但是该问题可以通过改革职工医疗保险个人账户来解决;中国长期护理保险应该采用“个人缴费+医疗保险基金补助+财政补助”的模式,且个人缴费最高不超过15%;中国长期护理保险财政负担水平总体较低,财政有能力维持长期护理保险的运行。对此,我国应尽快正式建立全国性的长期护理保险制度和财政对长期护理保险的投入机制。     

External constraints and endogenous growth: Why didn't some countries benefit from capital flows?

Empirical evidence on the growth benefits of capital inflows is mixed. The growth benefits accruing from capital inflows also appear to be larger for high savings countries. We explain this phenomenon using an OLG model of endogenous growth in open economies with borrowing constraints that can generate both positive and negative growth effects of capital inflows. The amount an economy can borrow is restricted by an endogenous enforcement constraint. In our setting, with physical capital and a pay-as-you-go pensions system, the steady state is unique. However, it can either be constrained or unconstrained. In a constrained economy, opening up to equity and FDI inflows can be bad for growth because it makes the domestic interest rate too low, which endogenously tightens borrowing constraints. Agents decrease savings and investment in productivity-enhancing activities resulting in lower growth. Results are reversed in an unconstrained economy. We also provide a quantitative analysis of these constraints and some policy implications.     

日本“医养结合”社区养老模式构建及对我国的启示——基于制度分析视角

为应对2025年超老龄化社会背景下老龄群体疾病类型转变、护理需求剧增的状况,同时减轻医疗与介护保险的财政负担,自2014年起,日本在现有制度基础上进一步探索"医养结合"社区养老模式,成立了社区医疗护理综合确保基金,提出要推动"地域医疗服务体系"和"社区综合护理体系"的协同发展。本文围绕日本"医养结合"社区养老模式的历史演进、主要内容、财务机制等方面展开研究,借鉴日本经验,从制度分析视角探索"医养结合"社区养老模式在中国的发展前景,以期为我国多层次社会保障体系的未来发展以及构建居家社区机构相协调、医养康养相结合的养老服务体系提供有益参考。     

Health care challenges and opportunities in the 1990s

The 1990s offer both substantial challenges and opportunities for those involved in the delivery of health care. Increasing costs must be managed to ensure that the health of both Americans and America's economy are maintained. Managed care offers the brightest hope for effectively controlling costs while increasing the quality of care.     

论商业保险基础风险原理对建立基本医疗保障制度的适用价值

2009年新医改重大举措不断,它对于我国相对薄弱的医疗保障体系无疑是必需和及时的。本文从理论上初步论述了商业保险基础风险原理对完善建立我国全民基本医疗保障制度的适用价值。通过总结国际医疗保障制度改革及其研究的趋势,论证以医疗保险的基础风险为依据,是实现社会医疗保险预期绩效的基本保证。同时指出定性定量分析我国全民医保的基础风险,才能从根本上找到完善建立相关制度的措施和方法,促进我国医疗保障体系的进一步科学发展。     

不确定性与中国城镇居民储蓄率的实证研究

本文从不确定性收入、社会保险的参与情况对中国城镇居民面临的不确定性进行了界定,并使用2006年中国综合社会调查数据(CGSS2006)检验了不确定性对城镇居民储蓄率的影响。基于稳健OLS和可行广义最小二乘法(FGLS)的估计结果表明:不确定性收入与城镇居民储蓄率之间存在着显著的正相关关系,参加养老保险和医疗保险可以显著降低城镇居民的储蓄率。分位数回归的结果进一步显示:在各分位处,不确定性收入均对城镇居民储蓄率产生了显著的正向影响,并且影响强度随着储蓄率分位的上升而下降;而在储蓄率分布的0.5及以上中高分位处,参加养老保险可以显著降低城镇家庭的储蓄率;在储蓄率分布的顶端,参加医疗保险也与城镇居民储蓄率之间表现出显著的负相关关系。