灵活就业人员医疗保险参与及受益归属——基于逆向选择和正向分配效应的双重检验

当前,灵活就业人员医疗保险发展不充分与不平衡的问题格外突出,这不仅会制约医保制度公平性与可持续能力的提高,同时会阻碍经济社会的全面、协调和可持续发展。本文运用中国劳动力动态调查数据(CLDS),研究灵活就业人员参加医保的决定因素以及受益归属,从而为新时期医保制度顶层设计提供决策依据。结果表明:一方面,无论是在参保决策还是险种决策阶段,灵活就业人员的健康风险显著正向影响参保状态,说明逆向选择效应显著存在;另一方面,低收入的参保人利用了更多优质的医疗服务,获得了更多的医保基金补偿,并显著改善了健康状况,因此医保发挥了积极的正向分配作用。但是过高的保障水平,在改善医疗可及性的同时会激发道德风险,从而加剧逆向选择问题并阻碍正向分配效应,对更加公平可持续医保制度的建立造成负面影响。     

The Economic Impact of Medical Migration: An Overview of the Literature

This paper provides an overview of the evidence and applied literature on medical migration. The economic impacts of medical migration have been little researched, causing a polarisation in the debate between its critics and its proponents. The paucity of quantitative studies may be explained by the lack of comprehensive and consistent data. Investments in statistical resources on medical migration are therefore a major priority. The available evidence suggests that particularly English‐speaking countries in Sub‐Saharan African countries and the Caribbean with relatively few health workers and a high disease burden suffer most from the medical brain drain. However, the exodus of health workers is not the main cause of the health status crisis, but rather a symptom of deeper underlying problems, which often extend beyond the health sector towards the broader economic and political environment. In such situations, medical brain drain does pose challenges for human resource management and health service delivery. The only effective and long‐term sustainable policy is one that addresses the underlying push and pull factors. Reforms have to be country‐led, but may be supported via temporary migration schemes, remittances, enhancement of diaspora networks, and financial aid for which a strong moral case exists.     

纵向财政失衡、FDI竞争与医疗卫生服务供给水平——兼论标尺竞争机制下地区间的策略性行为北大核心CSSCI

关于医疗卫生服务供给不足的原因一直是社会各界高度关注的重点话题,现行的财政分权制度常被认为是最主要的原因。本文尝试将表征现行财政分权制度特征的三个要素,即纵向财政失衡、地区FDI竞争和地区间竞争模仿的策略性行为,与医疗卫生服务供给水平纳入同一分析框架,在对其理论机制分析的基础上,利用2007-2018年277个地级及以上城市面板数据,实证考察它们之间的关系特征及机制路径。研究发现,纵向财政失衡与地区FDI竞争对医疗卫生服务供给水平均存在显著的抑制作用,同时,地区FDI竞争对纵向财政失衡的负向抑制作用具有正向调节效应。进一步分析发现,地方政府间的标尺竞争使其在医疗卫生服务供给行为上表现出明显的策略模仿,医疗卫生服务供给水平呈明显的空间溢出效应。异质性分析发现,发达地区医疗卫生服务供给水平受抑制的主因是FDI竞争所致,欠发达地区则主要缘于纵向财政失衡的显著影响。机制分析发现,纵向财政失衡通过作用于财政支出结构与医疗卫生支出效率两种方式实现对医疗卫生服务供给水平的抑制,而FDI竞争则主要是通过扭曲财政支出结构的方式实现其抑制作用。本文的研究丰富了医疗卫生服务供给不足制度性成因探寻的文献,对于如何全面推进新一轮财税体制改革、深化医疗卫生体制改革、优化政绩考核指标等具有借鉴意义。     

我国医疗旅游发展对策研究

随着体验经济时代的到来以及人们对”健康、长寿”的不懈追求。医疗旅游在世界各地已蔚然成为一股新风潮，中国也迎来了发展医疗旅游的重要机遇期。文章运用SWOT分析法，对中国发展医疗旅游的内外部条件进行分析，结果表明我国发展医疗旅游优势明显，但存在一定的限制，机遇与挑战并存，据此提出相应的发展对策。     

Financing the correct rate of growth of medical technology

This article suggests ways to preserve innovation while partially restraining the impressive growth rate in new medical technology. Health care will soon consume 12 percent of GNP. There is a wide range of opinions as to whether medical technology is a major or minor source of rising health care expenditures. Given our current fiscal problems, health care providers will be in direct competition with education and other domestic programs for a limited supply of R&D funds. More funding will have to come from the private sector. The challenge for prudent buyers of health care services is to control costs without eroding the biomedical capacity of the nation.     

中国口岸输入性医学媒介生物防控体系的建立

[目的]探讨建立科学的口岸输入性医学媒介生物防控体系的必要性,降低虫媒传染病传入风险。[方法]通过总结我国口岸输入性医学媒介生物监测及携带病原体检测研究成果,结合我国口岸卫生检疫工作需要,研究建立口岸输入性医学媒介生物防控体系的结构功能和运行模式。[结果]建立口岸局—直属局—国家质检总局输入性医学媒介生物三级专家风险评估体系模式和国家质检总局—直属局—口岸局输入性医学媒介生物三级防控处置体系模式,可分别为科学防控提供技术支持和组织保障。[讨论]建立上述三级防控体系,并保障其有效运行,对提高我国口岸输入性医学媒介生物防控工作科学水平,保障口岸卫生安全具有积极的指导意义。     

Digitalisierung im Gesundheitswesen — zwischen Datenschutz und moderner Medizinversorgung

The digital transformation of the healthcare branch is important and unstoppable. The enormous possibility of digitalisation to redesign and enhance processes has been shown in other branches. Digital technologies offer the similarly large potential to improve the quality and efficiency of healthcare services. However, in terms of digitalisation, the German health system lags behind other European countries. But given a lack of available evidence, the effects of the digitalisation of the healthcare system cannot be reliably evaluated. Digital access to patient data necessitates constructive error cultures in organisations in order to limit defensive medicine. And digital access to health information necessitates individual competence in searching and using this information for participatory decision-making. As with all technological progress, information security is very important in order to gain citizens’ confidence in a digital healthcare system. Thus, it is necessary to simultaneously pursue both enhanced privacy standards and state-of-the-art medical technology.     

美国国民健康教育中公关与广告手段的应用——以“抵御肥胖”运动为例

不健康的现代工作生活方式和饮食习惯导致了各类慢性疾病的频发,严重影响着国民的健康素质。各国政府及相关的公益组织正努力通过有效的手段和方式来说服人们进行观念上和行为上的改变。本文从健康传播的角度,分析美国政府和社会公益组织对"抵御肥胖"健康主题的信息传播与说服的手段、策略,并与我国相关主题的健康传播手段进行比较,由此提出了我国的政府及相关公益组织在进行相关信息传播时,应尽量避免呆板生硬的教科书式宣传,要从整合营销和社会营销的角度进行科学的观念推广。     

Trade in health products and population health: A long-run relation

The effect of trade on different economic outcomes has been extensively studied but the literature on the specific effects of trade on health outcomes has remained relatively scanty. Our paper fills in the gap by examining the long-run association between import expenditures on health products and longevity in a cross-country panel setting of 32 developed and 24 developing countries, covering 1990–2018. It accounts for both time-series properties and cross-country heterogeneity, while remaining robust to omitted variables and endogeneity problems, by applying panel cointegration techniques. The results reveal that per capita medical import expenditure on pharmaceuticals, aggregate medical products and medicines have contributed around 0.34, 0.35 and 0.30 percentage points, respectively to the annual increase in life expectancy for an average country in our sample. The findings suggest that higher per capita import expenditure on health products can increase longevity significantly in the long-run. The results remain robust to cross-sectional dependence, sub-samples of developed and developing countries and alternate measures of health outcomes such as adult mortality rates. These findings set the context for treating health product imports as critical for long-term improvements in population health and outlines the need for greater coordination between health and trade policymakers for improving population health.     

Hope across the seas: the role of emotions and risk propensity in medical tourism advertising

Rising US medical costs as well as more competition in the health care industry have led many Americans to pursue health care in foreign destinations. As a result, leading countries in medical tourism have begun launching international advertising campaigns. A growing trend in much of this advertising is the use of emotional appeals. The purpose of this research is to examine whether the use of emotional appeals by non-domestic health care providers contributes to more favourable evaluations of the target health care provider than rational appeals. Specifically, two experimental studies investigate the efficacy of advertisements that induce the emotion of hope to determine whether these advertisements increase trust perceptions and reduce perceived risk, given an individual's level of risk propensity. Implications for public policy makers and marketing managers who work in health care are discussed.     

Determinants of knowledge management system adoption in health care

The demand for efficient knowledge management (KM) in health care is increasing because the complexity and scale of the knowledge generated from medical research and clinical practices have resulted in challenges of information overload and medical quality. These critical issues can be improved through the adoption of knowledge management systems (KMS). However, the adoption of technological innovations in health care demands an enhanced understanding of the lagged technology adoption status in the health care sector. This study uses empirical methods to investigate the determinants of KMS adoption on the basis of a national survey. Results suggest that KMS adoption is affected by organizational characteristics, KM enablers, and KMS characteristics. We emphasize that KMS adoption in health care is considerably complex because it largely depends on KM enablers and organizational characteristics and not solely on system characteristics. The implications of the findings for research and practice are outlined in this work.     

大病保险对中老年居民医疗利用及健康的影响——基于CHARLS数据的实证检验

运用CHARLS 2011、2013、2015年三期数据,采用双重差分模型和准自然实验框架,分析城乡居民大病保险制度对中老年居民医疗服务利用和健康的影响及其作用机制,并从城乡和收入两个角度对制度实施效应的异质性进行探究。研究表明:大病保险制度实施能够显著促进中老年居民住院医疗服务及健康,增加中老年居民住院概率1.03%,提高住院次数0.022次,提高住院总费用10.4个百分点,总体健康水平提高0.023个单位;制度实施主要促进了农村和中等收入群体的住院医疗服务利用和健康水平的改善,对低收入人群住院医疗服务影响有限,且对城镇居民和高收入群体的影响并不显著;作用机制分析显示大病保险制度实施通过提高居民医疗服务利用进而起到改善其健康水平的作用。研究表明大病保险制度对中老年居民的住院服务利用和健康起到积极作用,但对于低收入群体的效应仍有待进一步改善。     

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.     

Measuring physician contribution to the healthcare safety net

There are an estimated 46 million Americans without health insurance and an even larger number for whom health insurance does not cover all needed medical services. These individuals and families have to rely more and more on government programs and physicians’ willingness to provide uncompensated services, most often described by providers as charity care. Previous studies have shown a downward trend in the percent of physicians willing or able to provide charity care. We extend this research by examining the results of the Medical Group Management Association's Cost Survey of Medical Group Practices for 2005, 2006, and 2007. It is important to examine the uncompensated care reported by medical groups because groups have policies that may govern how much, if any, charity care their physicians provide. This survey data shows that, overall, the number of medical practices providing charity care continues to decline. The results and analysis of the survey data indicate that uncompensated (charity) care is being offered by less than half of medical practices, and at less than 2% of total gross charges. We examined the results by potential explanatory variables: population density, practice size, physician practice specialty, practice ownership structure, payer mix, and practice financial performance. Results were consistent across all categories; charity care is declining. These results have major policy implications for both the federal government and all state governments, especially in light of the current recession and proposed healthcare reform legislation.     

新型农村合作医疗基金使用刍议——3县（市）新型农村合作医疗调查分析

“新农合”制度对于提高农民健康保障水平,减轻农民负担。发挥了极其重要的作用。当前,“新农合”制度还存在着筹资水平低,住院费用补助率低、受益面窄,对特殊群体的补偿比例不尽合理以及对大病补偿不足等问题。农民发生重大疾病,个人负担仍然很重,治不起病的现象仍然存在。推进“新农合”建设,需要在制度上不断完善。针对不同群体。采取相应的政策,运步增加资金投入,提高医疗费用补助率,扩大受益面,以维护参舍农民的合法权益,促进“新农合”制度的健康发展。     

人工智能在我国公共卫生建设中的应用与思考

新冠疫情的暴发以及长期防治对中国的公共卫生体系造成深远影响,给我国突发公共卫生事件应急与防控机制带来巨大的考验。在疫情防控的过程中,信息化技术为传统医疗机构带来瞩目的帮助与改变,人工智能、大数据、5G高速网络等新兴高科技的蓬勃发展在直接提升医疗水平方面表现出巨大潜力。本文就人工智能在疫情期间的医疗辅助功能展开讨论,并对未来我国公共卫生体系的建设进行了思考。     

医疗护理服务可及性对居家老人照料服务选择的影响研究——基于北京市的实证研究

利用课题组2018年在北京市的抽样调查数据,运用Logistic回归方法考察医疗护理服务可及性对居家老人照料服务选择的影响。结果发现,医疗护理服务的便捷性、可支付性与老人照料服务的选择显著相关。住所附近有医疗卫生机构、有提供上门护理服务的机构或是与家庭医生签约的老人,更倾向于选择社会照料服务;支付能力对照料服务的选择呈现"U"型效应:家庭支付能力较强或者经济自评相对不足的老人更倾向于选择社会照料服务。应通过优化医疗护理资源布局、建立并完善社会照料服务的价格机制等措施,推进高效、可持续的社会照料服务体系的构建。     

看病难，看病贵：不能解决，还是不想解决？——关于医改舍本求末、屡改屡败的沉重思考

看病难、看病贵的问题长期困扰着国民,政府主管部门采取的解决措施却是隔靴搔痒,投鼠忌器,职能部门归咎的原因讳莫如深,避实就虚。看病难、看病贵的真正原因是国家医疗卫生体制市场化改革滞后;国家医疗卫生行政部门因保护部门权益不想改革;公立医疗卫生服务行业人员因既得利益不热心改革。当前医患冲突不断升级,已经成为一个社会问题,影响社会的和谐和稳定。针对今后的医疗改革,推行医疗服务市场化是解决看病难、看病贵的根本;实施以技养医是解决看病难、看病贵的关键。     

Mistake-proofing healthcare: Why stopping processes may be a good start

Two significant concerns in healthcare are spiraling costs and medical errors. These two concerns are correlated: eliminating medical errors leads to significant cost reductions. We provide an example, ThedaCare Inc., where both problems are improved by providing mechanisms that stop healthcare processes. While businesses often view having their processes stopped as a negative, increasing the stoppages, or creating process failures, is often a precursor to improved performance. A good rule of thumb is: if in doubt, stop. This concept of creating or engineering stoppages in the processes is linked to two “lean” concepts that come from the Toyota Production System: jidoka and poka-yoke. A spectrum of methods for stopping processes is discussed, ranging from warnings in the work environment to mechanical devices designed to stop processes and empower humans to stop the process. The preliminary results achieved at ThedaCare demonstrate the financial and medical improvements that may be obtainable from utilizing these methods.