智利健康保险制度改革分析

本文介绍了智利健康保险制度改革后的基本框架，分析了其运行过程中出现的问题及原因，指出无论是从公平还是从效率的角度看，智利的模式都很难说是成功的。从全球范围来看，面对实践的挑战，健康保险的理论研究仍旧任重而道远。     

Social Risk in Health Insurance: A Reflection on the Economies of Scale and Scope in Health Insurance

Social risk causes distortion in the health insurance market. In the presence of social risk, health insurance must be inflated with a safety loading. This implies that policyholder will choose incomplete risk transformation and that health insurers have to build up large capital reserves. By using cross-diversification and enlarging the insurance pool with other kinds of risk (utilising economies of scope in addition to scale production), the problem of social risk will reduce. It is shown how this is possible by using the capital market as a diversification pool     

我国商业健康保险发展的制度分析

我国商业健康保险的发展严重滞后于经济和社会发展的需要,医疗保障制度供求失衡为商业健康保险制度创新提供了动力机制。从商业健康保险制度创新所要求的制度环境看,在我国现阶段还存在诸多不利于商业健康保险制度创新的体制性和机制性障碍。应统筹考虑医疗社会保险和商业健康保险的协调发展,建立市场退出机制,促使保险企业成为合格的产品供给主体,加快保险消费文化与消费意识转型,引导消费者成为理性消费群体。     

农民的疾病风险与医疗保障:一个实证分析

农民的疾病风险与医疗保障是“三农”研究中一个不能回避的问题。在调查数据基础上，本文通过提出假设并建立回归模型进行检验的实证研究发现，在大多数农民已解决温饱的今天，疾病风险已是农民所面临的诸多现实威胁中最普遍的一种，对于身体状况不太好和家庭有惠重病成员的农民来说尤为如此。本研究认为，建立与完善农民的疾病医疗保障制度已是当务之急，应充分注重提高农村医疗的可及性，加快农村基层医疗体系建设，为农民提供方便、高质量的医疗服务。     

Income and Health Concentration in Australia

This paper measures the concentration of ill-health among income groups in Australia using health survey data from 1989–90 ( Australian Bureau of Statistics 1991 ) and 1995 ( Australian Bureau of Statistics 1997 ), which contain responses on self-assessed health status and gross personal income. The technique of direct standardisation is used to control for the influence on health status of gender and age. Comparisons of the concentration of ill-health over time and between males and females and persons living in rural and urban areas are reported. For both surveys and all groups, we find that ill-health is concentrated among lower income groups. Concentration measures of ill-health are higher (in absolute terms) for men than for women. In all categories apart from women, the concentration measures fell between 1989–90 and 1995 surveys.     

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。     

A Critique of the Private Health Insurance Regulations

The private health insurance sector is one of the most regulated sectors in Australia. The Private Health Insurance Incentives Scheme, along with community rating, is intended to make private insurance equitable, profitable and popular. We argue that the subsidy to health insurance ought to be a very effective tool for increasing insurance–but it was ineffective because community rating was ineffective. Using data from the Household Expenditure Survey we find that despite community rating rules which prohibit age‐adjusted premiums, young adults paid considerably less for their insurance than older adults. We conclude that insurers circumvented community rating through plan design, screening older consumers into more expensive plans. We also find that the penalty of 2 per cent per year for delaying insurance, introduced as part of the lifetime cover plan, is too low to be effective. We reflect on the New Zealand experience, where a completely deregulated insurance industry continues to be profitable and enjoys similar rates of coverage to those of Australia, and we ask whether Australia too could not benefit from complete deregulation.     

Why Subsidise Private Health Insurance?

What are the economic rationales for the public subsidy of private health insurance? Inducing more people to purchase private cover has the potential to create a positive fiscal externality, as it frees up the limited public beds and other public resources for people who cannot afford private health insurance. Investigating this quantitatively, based on short‐run demand estimates, we find that the subsidy cannot be justified on the basis of this externality effect alone. We estimate that the optimal subsidy is actually negative, that is, a tax on private health insurance premiums. On the other hand, the externality does finance some of the costs. We then consider a long‐run dynamic version, consistent with the government's stated rationales for the reforms. In this context, the subsidy might be justified, or at least largely offset, by the fiscal externality. We then discuss other rationales for a subsidy and implementation issues.     

Health,Social Insurance and Income

Health, a form of human capital, can be defined by longevity and physical wellbeing. Social policy decisions require an understanding of the factors that contribute to the creation of health inequalities. To learn more about socioeconomic variables and health capital, this paper examines the relationship between three key variables: health, social insurance, and income, for the Swedish population. Using a randomized research survey design, data from 3,600 participants of a larger Swedish study, conducted in 2005, was analyzed. A linear model of Three Stage Least Squares was chosen to correct for simultaneous bias in the Health, Social Insurance, and Income (HSI) Model. Findings confirm the importance of socioeconomic, behavioral and environmental factors in explaining health inequalities. The results clearly show men, educated people, nonsmokers, individuals that exercise and youngsters possess higher health status than other people. The dependency on social insurance is mainly caused by poor health; a higher degree of social insurance dependency was offset by income increases due to age and higher professional level.      

Health Insurance, Liquidity and Growth

Within the context of an endogenous growth model, it is shown that in the presence of health risks which influence household income, the introduction of a private insurance company increases the long-term economic growth rate. The introduction of such an institution has two effects on savings: a level effect and a composition effect. Although the presence of this risk-reducing institution induces a decrease in the level of total savings, as suggested in earlier papers, the rate of illiquid savings, which contribute to growth, increases.
JEL Classification E 1; G 2; O 1; O 4     

Transferable Ageing Provisions in Individual Health Insurance Contracts

Abstract. We consider lifetime health insurance contracts in which ageing provisions are used to smooth the premium profile. The capital stock accumulated for each individual can be decomposed into two parts: a premium insurance and an annuitized life insurance, only the latter being transferable between insurers without triggering premium changes through risk segmentation. In a simulation based on German data, the transferable share declines in age and falls with an increasing age of entry into the contract. In spite of different benefit profiles, it is almost identical for women and men.     

论我国商业健康保险的发展

入世以来，世界经济全球化的趋势给我国的保险带来前所未有的发展和变化。随着医疗保险制度改革的逐步深化，花钱看病、投保买健康的观念将逐渐被人们所接受，这样商业健康保险的发展将有广阔的市场。但是目前，我国健康保险的发展还很落后，并且其发展还处于“小马过河”的阶段，所以商业健康保险亟待完善。本文在讨论商业健康保险发展问题的同时，阐述了商业健康保险的发展对策。     

Estimating the Percentage of the US Population without Health Insurance: An Ecological Approach

This ecological study identifies factors that affect the percentage of a state’s population without health insurance. Even with the Medicaid program, over 15% of the US population is without health insurance and understanding reasons why people are uninsured is an important first step in remedying this problem. Results presented here indicate an income policy or a piecemeal approach to the problem will probably be unsuccessful.      

Efficient Transfer of Aging Provisions in Private Health Insurance

In German-style private health insurance contracts, aging provisions are used to flatten premium profiles. An individual would like to change insurer if she perceives a low service quality. The first-best optimum is characterized by provision transfers upon insurer changes which are higher for high risks and may be negative for low risks. Should the actual risk status not be verifiable, provision transfers have to be uniform. Efficient transfers will equalize consumption across periods and states if high risks are deterred from switching. Otherwise, the optimum transfer balances the distortion of incentives for high-risk and low-risk individuals.     

Intergenerational Risk Sharing and Health Insurance Financing

When medical care prices and individual health needs follow stochastic processes with non-zero trends. community rating facilitates lifetime insurance and intergenerational risk sharing. While such a policy is unsustainable in competitive private insurance markets. it provides the basis for the financing of public health systems designed to spread risks efficiently.     

The Macroeconomic Consequences of Financing Health Insurance

Employer-financed health insurance systems like those used in the United States distort firms’ labor demand and adversely affect the economy. Since such costs vary with employment rather than hours worked, firms have an incentive to increase output by increasing worker hours rather than employment. Given that the returns to employment exceed the returns to hours worked, this results in lower levels of employment and output. In this paper, we construct a heterogeneous agent general equilibrium model where individuals differ with respect to their productivity and employment opportunities. Calibrating the model to the U.S. economy, we generate steady state results for several alternative models for financing health insurance: one in which health insurance is financed primarily through employer contributions that vary with employment, a second where insurance is funded through a non-distortionary, lump-sum tax, and a third where insurance is funded by a payroll tax. We measure the effects of each of the alternatives on output, employment, hours worked, and wages.     

医疗保险与城乡反贫困:1989-2006

文章利用中国健康与营养调查(CHNS)数据,估计了1989-2006年医疗保险对中国城乡家庭的反贫困效应。结果发现:发生灾难性卫生支出的城乡家庭比例较高,最穷的群体其医疗费用超过收入的比例增加,医疗保险对减少收入不平等只起到微弱作用。TIP贫困曲线表明,近几年,医疗保险补偿后,城乡患病家庭的贫困并没有减轻,医疗保险在减少贫困上的作用很小。分析贫困特征的多元回归模型显示,家庭成员数量、教育程度、抚养比率、参保人数等都影响了贫困,而条件多元回归模型则显示,医疗保险对贫困的变动没有影响。     

澳大利亚的科技研究绩效评估体系

澳大利亚重视对科研活动的支持和引导,通过不同方式对科研机构和科研活动进行定期的绩效考核与评估,以促进科研投入更好地发挥作用,不断提高科研机构和研究人员的工作效率。本文较详细地报告了澳大利亚的研究绩效评估体系,介绍了研究评估的目的、方法、标准及评估结果的用途等,概述了研究绩效影响的评估做法,供参考。     

论我国循环经济法律制度框架的创建

循环经济本质上是一种生态经济,它要求把经济活动组成一个"资源-产品-再生资源"的反馈式流程.因此,通过立法促进废弃物的回收和综合利用,以法律的形式规定循环经济制度,是此项制度发展的必然趋势.我国应吸收、借鉴国外先进立法经验,将发展循环经济、走生态经济道路的内容写入国家宪法,制定专门的《循环经济法》和相关法律,调整、修订相关法律、法规和政策,创建我国的循环经济法律体系,使我国的经济走生态化发展的道路,实现可持续发展.