Incentives and cost containment in primary care physician reimbursement

The goal of capitation is to place gatekeepers at financial risk for the services the deliver. However, third party payers should provide gatekeepers with some type of protection against random and systematic risk transfer. Gatekeeper physicians' other alternative is to reduce this risk on their own by actively marketing services to healthier individuals and creating barriers to care for their sicker patients. Thus, the proper balance of risk transfer will result in the most cost-efficient, quality gatekeeper networks. However, even with the right balance of risk transfer, capitation may provide incentive for some physicians to withhold necessary services to further increase their profit margins-making quality of care a key concern. Thus, practice guidelines should be developed to ensure quality is not affected. These guidelines afford explicit criteria on how gatekeepers should respond in specific clinical situations.     

Assuming and managing risk: Part II

Last month HCMA began to address the issue of hospitals assuming risk as they become more and more involved in managed care situations. This article continues that discussion. The focus is on capitation contracting, physician-related issues, and a final assessment of the risk that hospitals should and will acquire as they move forward in a heavily managed care environment.     

Prior health expenditures and risk sharing with insurers competing on quality

Insurers can exploit the heterogeneity within risk-adjustment classes to select the good risks because they have more information than the regulator on the expected expenditures of individual insurees. To counteract this cream skimming, mixed systems combining capitation and cost-based payments have been adopted that do not, however, generally use the past expenditures of insurees as a risk adjuster. In this article, two symmetric insurers compete for clients by differentiating the quality of service offered to them according to some private information about their risk. In our setting it is always welfare improving to use prior expenditures as a risk adjuster.     

A review and comparison of medical expenditures models: two neural networks versus two‐part models

This paper compares the two‐part model (TPM) that distinguishes between users and non‐users of health care, with two neural networks (TNN) that distinguish users by frequency. In the model comparisons using data from the National Health Research Institute (NHRI) in Taiwan, we find strong evidence in favor of the neural networks approach. This paper shows that the individuals in the self‐organizing map (SOM) network clusters can be described as several different forms of frequency distributions. The integration model of SOM and back propagation network (BPN) proposed by this paper not only permits policymakers to easily include more risk adjusters besides the demographics in the traditional capitation formula through the adaptation and calculation power of neural networks, but also reduces the incentives for cream skimming by decreasing estimation biases.     

Bürgerversicherung — Die Wirkung von Kopfprämien auf den Arbeitsmarkt

Capitation fees are considered to be an option for a change in funding principles for statutory health care insurance. This paper discusses several models of capitation fees either to be introduced for a part of the population or for all citizens. It analyses the impact of a change in financing health care on the labour market. Therefore microeconomic theory and a QUERU-model is applied. It also considers the issue of presently co-insured dependents.     

基于RBF网络的商业银行信用风险控制研究

对信用风险的有效控制与管理,在现代商业银行日常运行过程中具有举足轻重的地位。基于信用风险系统是一个高度复杂的非线性动态系统,利用神经网络的自适应学习、并行分布处理和较强的鲁棒性及容错性等特性,建立基于RBF神经网络的信用风险预测控制模型,从理论上探寻信用风险非线性智能控制。仿真试验表明,信用风险度能被控制在以最佳风险度为中心的一定范围内。因此,该预测控制系统适合于商业银行信用风险的控制。     

The Pricing of Tax-Exempt Bonds and the Miller Hypothesis

This paper reports a new test of two competing theories of the relation between tax-exempt and taxable interest rates. The Miller hypothesis predicts that the tax-exempt rate is 52 percent of the taxable rate, while the institutional demand hypothesis predicts a volatile relationship. The tests in this paper employ a random intercept model to control for the risk of average interest rates. The results favor the Miller hypothesis. Marginal tax rates are found to be close to Miller's predicted 48 percent. The relationship is not influenced by relative demand or supply and the marginal tax rate appears stable over time.     

Assessing risks due to threats to internal control in a computer‐based accounting information system: a pragmatic approach based on fuzzy set theory

A rational risk assessment model, based on the reasoning of fuzzy set theory, is presented. The model would help managers assess risk exposure due to potential threats to internal control in a computer‐based accounting information system. Such risk assessment is essential in making appropriate decisions about establishing new internal control policies and procedures that may be necessary to protect the integrity and security of the information system. Copyright © 2004 John Wiley & Sons, Ltd.     

建立我国基于风险控制的企业年金监管体系

在我国企业年金制度启动后,为防范企业年金基金管理风险,必须建立一套行之有效的监管体系和监管方法。本文提出建立我国基于风险控制的企业年金监管体系,该体系是基于风险的金融监管理论在企业年金领域的应用和实践。建立基于风险的企业年金监管体系主要包括4个方面的内容:即确定企业年金的监管架构及适合我国国情的监管模式;建立统一的风险监管平台,开发统一的企业年金风险监管系统,统一企业年金监管风险管理工具和风险指标,形成支持协同监管的技术系统平台;完善规章制度体系,奠定监管基础;切实严格执行管理机构的准入制度,形成优胜劣汰良好机制。     

A NEW MODEL FOR ESTIMATING RISK PREMIUMS (ALONG WITH SOME EVIDENCE OF THEIR DECLINE)

This article uses the Gordon growth model with a novel method for forecasting dividend growth rates to estimate the equity cost and associated risk premium for a sample of Canadian telecommunications companies. The results suggest that the Telco risk premium has declined significantly since the early 1980s. Moreover, this decline is accentuated when measured over long Canada yields, rather than over similarly taxed, longterm preferred yields.
The findings of this study also suggest that the inverse relationship between utility risk premium and market interest rates reported by studies of U.S. utilities does not hold in Canada. If anything, the Telco risk premium has tended to vary directly with the level of market interest rates, with risk premium falling along with the general decline in rates. The main reason for these results seems to be the significant increase in interest rate risk, which has caused the long Canada yield to be a very poor proxy for the longterm, riskfree rate.
One practical implication of this finding is that companies that estimate equity costs as a premium over longterm government bond yields are probably seriously overestimating the cost.     

年报风险信息披露与银行贷款利率

既有文献较少从银行视角关注年报风险信息披露的经济后果。银行更有能力解读年度风险信息,银行利益也更直接受到年报风险信息的影响,银行贷款利率更能体现年报风险信息披露的经济后果。本文基于2008-2017年单笔银行贷款利率数据的研究发现:总体上我国年报风险信息披露降低了银行贷款利率,说明我国年报风险信息披露更符合趋同观假说。中介效应检验发现:我国年报风险信息披露通过提高信息透明度,降低银行风险感知水平进而降低了银行贷款利率,即信息质量和风险是我国年报风险信息披露影响银行贷款利率的不完全中介。进一步分析发现:我国年报风险信息披露与银行贷款利率的负相关关系主要体现在货币政策紧缩组、非国有企业组以及公司治理水平较高组。本文首次研究银行贷款利率与年报风险信息披露的关系,有助于丰富风险信息披露文献和银行贷款文献。     

货币供应量、利率与银行系统性金融风险——基于CoVaR方法的实证研究

在常态化疫情防控的背景下,商业银行系统性金融风险有上升迹象,这对央行实施货币政策工具和力度的把握提出了更高要求。本文利用条件在险值模型检验了我国货币供应量、利率与银行系统性金融风险的关系。研究结果表明,货币供应量和利率与银行系统性风险之间的关系不是线性的,而是U型的,即存在最优的货币供应量和利率能够使商业银行的系统性金融风险最低。当货币供应量和利率小于这个最优组合时,增加货币供应量和提高利率能够有效降低商业银行的系统性金融风险;而当货币供应量和利率大于这个最优组合时,增加货币供应量和提高利率反而会增加银行系统性金融风险,进而降低商业银行的金融稳定性。     

A multi-factor model for the risk management of portfolios

We propose a methodology for modelling the value at risk of a complex portfolio, based on an extension of the Ho, Stapleton and Subrahmanyam technique. We model the variance-covariance structure of up to seven variables. These could represent four country indices and three exchange rates, for example. In addition, the effect of an arbitrary number of orthogonal factors can be analysed. The system is illustrated by estimating the value at risk for a portfolio of international stocks where the factors are stock market indices and exchange rates, a portfolio of international bonds where the factors are interest rates as well as exchange rates, and a portfolio of interest rate derivatives in different currencies. In this last case, we model a two-factor term structure of interest rates in each of the currencies, valuing the derivatives at a future date using these term structures and the Black model. The model is applied for different fineness of the binomial density and computational accuracy and efficiency are estimated.
G13, G15, G21     

理解现代财政:公共风险的视角

理解财政,需要转换思维.表面看,财政行为是利益的分配和转移,而从实质看,财政行为是风险的分配和转移.财政通过分配和平衡风险,避免风险在某处聚集并在风险链上放大,避免了危机的产生,这实质是化解公共风险,所以财政的本质功能是通过平衡风险化解公共风险,以维护社会共同体的生存和发展.财政的基础性作用在于,只有财政有这种平衡风险的内在功能.与社会共同体面临的公共风险治理要求相匹配,是现代财政的判断标准.如果财政能够很好地平衡风险、化解公共风险,那就是现代财政;通过改革与公共风险治理要求相匹配,就是现代财政改革.新时代的现代财政改革,要立足于以下几个方面:构建大国财政体系,应对面临的全球风险挑战;织密预算的制度笼子,完善权力的财政治理体系;建立公平与效率融合的财政制度;为形成经济双循环格局"架桥铺路".     

EQUITY AND EFFICIENCY: CLARIFYING CONFUSION FOR ENGLISH ACUTE HOSPITALS

Effective management of health care resources includes containing total costs and improving equity and efficiency. It has been argued that the only way to contain costs is by determining future finance by the principle of capitation. That principle underlies English health authorities' revenue targets which are intended to set the direction for future equitable cash allocations. A case study of an inner-city authority illustrates how its target for acute services confuses equity and efficiency. It is argued that equity is most effectively promoted not by devolving responsibility for equity to such authorities by financial targets, but by higher-level, service-based strategies. Indicators are suggested which enable distinctions to be made between equity and efficiency.     

Mortgage convexity

Most home mortgages in the United States are fixed-rate loans with an embedded prepayment option. When long-term rates decline, the effective duration of mortgage-backed securities (MBS) falls due to heightened refinancing expectations. I show that these changes in MBS duration function as large-scale shocks to the quantity of interest rate risk that must be borne by professional bond investors. I develop a simple model in which the risk tolerance of bond investors is limited in the short run, so these fluctuations in MBS duration generate significant variation in bond risk premia. Specifically, bond risk premia are high when aggregate MBS duration is high. The model offers an explanation for why long-term rates could appear to be excessively sensitive to movements in short rates and explains how changes in MBS duration act as a positive-feedback mechanism that amplifies interest rate volatility. I find strong support for these predictions in the time series of US government bond returns.     

从公司治理角度探讨国有商业银行资金管理机制再造

建立长效的资金管理机制,对于完善商业银行内部运行机制,优化商业银行公司治理结构具有重要的现实意义.本文将国有商业银行资金管理问题置于公司治理的框架下考虑,分析了我国国有商业银行存在组织架构未能理顺、管理方式和手段落后、资金风险管理水平不高和内部转移价格体制不合理等问题.据此,提出重构资金管理新机制的基本思路,即科学设计资金营运组织架构、提高风险管理水平、全面实行资金集中管理及建立完整有效的内部资金转移价格体系,并指出对于内部资金转移价格的定价可先采取实际成本率和收益率法,再过渡到半市场化法,最终实现市场化法的定价思路.     

现代商业银行信贷资产风险管理研究

风险管理是商业银行管理的核心之一。我国商业银行风险管理的现状在职能厘定、管理机制以及队伍建设等方面都有改革的必要。因此,建立完善我国现代商业银行信贷资产风险管理体系,必须着力抓好制度、文化和人三个关键要素;同时,把握先进性原则,构建以风险控制为核心的信贷风险管理文化;把握层次性原则,探索健全风险管理机制;把握动态性原则,建立和强化信贷风险预警体系;把握渐进性原则,加强信贷风险管理信息系统建设;把握应变性原则,提高风险控制能力和信贷资产质量;把握人本性原则,带好一支高水平的信贷风险管理队伍。     

Tests of the hypothesis of the existence of risk premium in the foreign exchange market

This paper tests for a risk premium in the foreign exchange market. The null hypothesis of the test is the random walk hypothesis in the foreign exchange market. The alternative hypothesis is that biases of current spot rates (or forward rates) from future spot rates are systematically related to a set of economic variables on which a risk premium may depend. This paper provides firm evidence for a risk premium in the foreign exchange market. The risk premium explains 10–20% of the total variance in future spot rates when the US dollar/mark quarterly rates are used. The magnitudes are smaller (less than 10%) for monthly rates.