The American Example in Health Care

Medical provision to British taxpayers under the National Health Service has often been favourably contrasted with the experience of American consumers. Frances Stevens who has worked in the NHS for years suggests from her observation of the American health system that the NHS can learn much from America.     

American Health Care: the Re-awakening of Competition

The market for health care in America is constantly used as an Aunt Sally by British health economists. But, Dr David Green (above), a political scientist and welfare economist at the IEA, reveals why the American system is hardly a free market and why it has misled debate in the UK.     

Health Care

A bstract . A broad rational national health care insurance policy for the United States , providing for universal financial access to health care for all citizens, has both "meaning" and "validity" in that it would address actual socioeconomic concerns and could be implemented. It is justified by theories of justice of Rawls and Donaldson as well as by Adam Smith's socioeconomic model. Social consensus in this area accepts the principle of solidarity that individual self-interests may be better served through collective action , especially if such action is tied to competitive rules. Health care, therefore, is evolving as a public or quasi public good. The basic question no longer is whether the U.S. should have universal health care insurance but what specific health care policy the country should adopt in order to strengthen the market system and to maximize social welfare as effectively as possible.     

The Demand for Health Care Services in Rural Tanzania

This paper examines the pattern of health care demand in rural Tanzania. We distinguish between hospital and clinic‐based care, in both the public and private sector using a two‐level nested multinomial logit model. Own price elasticities of demand for all health care options are high, although less so for public clinics and dispensaries than other choices. However, there is a high degree of substitution between public and private care. Consequently, price increases or user fees will result in small percentage of people opting for self‐treatment. Another important contribution of this paper is that the quality of medical care has large effects on health demand. This applies to the quality and availability of doctors/nurses, drugs and the clinic environment.     

Designing Optional No-Fault Insurance Policies for Health Care Systems

Legislation to create optional no-fault insurance (ONFL) programs has recently been enacted in Florida and Virginia. ONFI programs provide compensation to patients when certain medical complications arise, provided the patient agrees not to sue the doctor for additional damages. The optimal design of ONFI programs is explored in this paper, focusing on the incentive effects of ONFI programs. The question of whether ONFI programs should be funded entirely by participating doctors, or whether social subsidies are optimal, is examined.     

2002年美国波多里奇奖获奖组织简介(一)SSM圣玛利亚修女医疗中心(医疗卫生类)

SSM圣玛利亚修女医疗中心位于密苏里州的圣路易斯市,是一家非盈利的天主教医院.SSM来自Sisters of Sr .Mary(圣玛利亚修女)的头三个字母.它主要提供初级、第二级和第三级的医疗护理服务,在密苏里州、利利诸斯州、威斯康星州、俄克拉荷马州等,拥有21个急救中心和3个护理中心.该医院约有5000名医生和22200名员工.     

美国建筑健康管理经验分析

美国建筑健康管理已经形成了完备的管理体系,本文重点分析建筑标准体系的供应体制、构成特点以及健康理念的体现方式,这对我国建筑健康管理具有极大地借鉴意义。     

Agency in Health Care: Lessons for Economists from Sociologists

A bstract . What economists can learn from sociologists with regard to the economic theory of agency in health care is considered. Whilst the concept of agency has become widely accepted in health economics , its application to the doctor-patient relationship remains somewhat limited. Research is needed on the nature of the patient's and doctor's utility functions before an efficient outcome in health care can be achieved. Economists have much to learn from sociologists concerning the nature of patient's and doctor's utility functions. Only when economists take account of this literature will moves towards an efficient outcome in health care be achieved.     

Network Incentives in Managed Health Care

This paper introduces a theory of network incentives in managed health care. Participation in the plan's network confers an economic benefit on providers; in exchange, the plan expects compliance with its protocols. The network sets a target for the number of outpatient visits in an episode of care. A provider failing to satisfy the target may be penalized by the plan's attempt to direct patients to other providers within its network. There is an equilibrium in which every provider in the network uses the target. We test the theory by observing behavior of providers before and after the introduction of managed mental health care in a large, employed population. Managed care consisted of price reductions, utilization review, and creation of a network. Quantity per episode of care fell sharply after initiation of managed care. We identify a network effect in our empirical work. The results indicate that in this case, network incentives account for most of the quantity reduction due to managed care.     

金融企业财务诊断与保健研究

根据多数金融企业的亏损现状,本文采用拟人的手法,分析了金融企业的财务风险,介绍了掌握金融企业财务风险的应急诊断和病理分析技巧等财务保健方法,加强对有问题金融企业的处理措施,从而促进金融企业健康有序地发展。     

Coordination Mechanisms for Implementing Complex Innovations in the Health Care Sector

Abstract

Coordination is a central element in the public sector, especially for introducing complex innovations. In health care, this issue takes on great importance since many stakeholders are involved, pursuing multiple interests, and influencing the outputs and outcomes of the health care system. This paper discusses the introduction of a specific health care innovation (i.e. electronic patient records) in two Italian regions, and it aims to contribute to the debate on coordination in health care, depicting the coordination mechanisms that took place in two different contexts in order to introduce the same kind of innovation, and highlighting any potential enabling conditions.     

Public and Private Provision of Health Care

One of the mechanisms that are implemented in the cost containment movement in the health care sectors in western countries is the definition, by the third-party payer, of a set of preferred providers. The insured patients have different access rules to such providers when ill. The rules specify the copayments patients must pay when using an out-of-plan care provider. This paper studies the competitive process among providers in terms of both prices and qualities. Competition is influenced by the status of providers as in-plan or out-of-plan care providers. Also, there is a moral hazard of provider choice related to the trade-off between freedom to choose and the need to hold down costs. It is possible to achieve the first-best allocation by an appropriate definition of the reimbursement scheme when decisions on prices and qualities are taken simultaneously (as in primary health care sectors). In contrast, some type of regulation is needed to achieve the optimal solution when decisions are sequential (as in specialized health care sectors). We also derive normative conclusions on how price controls should be implemented in some European Union member states.     

Paying For Joint Costs in Health Care

The paper analyzes a regulatory game between a public and a private payer to finance hospital joint costs (mainly capital and technology expenses). The public payer (inspired by the federal Medicare program) may both directly reimburse for joint costs ("pass-through" payments) and add a margin over variable costs paid per discharge, while the private payer can only use a margin policy. The hospital chooses joint costs in response to payers' overall payment incentives. Without pass-through payments, under provision of joint costs results front free-riding behavior of payers and the first-mover advantage of the public payer. Using pass-through policy in its self-interest, the public payer actually may moderate the under provision of joint costs; under some conditions, the equilibrium allocation may be socially efficient. Our results bear directly on directly Medicare policy, which is phasing out pass-through payments.     

奥巴马政府面对医疗保健体系的挑战（英文）

美国的医疗保健危机引起了广大美国人民的关注。美国的医疗保健系统是全世界最为昂贵的,六分之一的美国人因此而不能享有医疗保健。为了能有一个广泛的,高质量的,可以为广大民众能够负担的医疗保健系统,美国人民试着发现和改变一系列现存的问题。该文章浅析了美国医疗保障体系中的种种弊端和奥巴马政府在医疗改革中的基本原则。医疗改革能否成功的关键在于是否能够克服财政,特殊利益集团和政党斗争以及民众的质疑等问题。     

Mergers and Exclusionary Practices in Health Care Markets

We evaluate the relationship between insurers (payers) and providers of health care (hospitals) when they each have a nonnegligible share of the market. We focus in particular on their incentives to merge and the existence of equilibria where payers offer preferential treatment to a subset of hospitals. We demonstrate that hospitals are more likely to merge without consolidating their capacities the less competitive they are vis-à-vis the payer's market. Payers are more likely to merge without consolidating their capacities the less competitive either the hospitals' or the payers' market is. A given payer follows an exclusionary strategy when its starting bargaining position vis-à-vis hospitals is weak. At such exclusionary equilibria, payers tend to distinguish themselves from neighboring payers by contracting with a different subset of hospitals.     

Payer Competition and Cost Shifting in Health Care

This paper studies a model in which two payers contract with one hospital. True costs per patient are not a possible basis for payment, and contracts can only be written on the basis of allocated cost. Payers choose a contract that is fully prospective or fully based on cost allocation, or a payment scheme that would give some weight to each of these two. We characterize the payers'equilibrium contracts arid show how in equilibrium hospital input decisions are distorted by the payers' incentives to engage in cost shifting. Two cost-shifting incentives work in opposite directions, and equilibrium can be characterized by too little or too much care relative to the socially efficient level.     

东北地区脑血管病的护理

结合哈医大二院神经内科具体病例的特点和脑血管病的成因,给出了东北地区脑血管病的注意事项和患者的康复护理措施,最后对医疗机构提出建立全民医疗保险的建议。     

高强度红外光的医疗系统设计理念探析

高强度红外光的医疗系统利用光波导的传输增强了红外光治疗的能力,提高整体系统的医疗功能,特殊的传导输出能力,先进的光源控制和严格的材料选用使医疗系统更加的完善和科学。