澳大利亚基本医疗保险管理体制

澳大利亚拥有世界一流的健康服务体系。国民医疗保险作为政府主导下的全民医疗保险,保障了所有澳大利亚居民都可以获得必要的和高质量的治疗、药物及医院服务。澳大利亚政府的国民服务部负责国民医疗保险的具体管理并提供服务。同时,澳大利亚政府鼓励居民在国民医疗保险之外,积极参加私人医疗保险。94%以上的澳大利亚居民对基本医疗保险满意。通过介绍澳大利亚国民医疗保险及政府对其管理的基本情况,旨在为我国医疗保险制度的改革提供参考。     

新加坡的医疗保险制度

新加坡的医疗保险制度是以个人责任为基础,政府负担部分费用并控制医疗费用增长,以保证政府和个人都能够负担的基本医疗服务。一、政府补贴及三项计划政府对全体国民的医疗保健服务给予较多的补贴（按提供的服务量拨付给医院）。病人在国立诊所接受门诊服务,只需支付５...     

医疗保险总额预付制度与医疗行为博弈相关问题研究

社会保险法的颁布实施进一步提供了法律保障,国家医改方案坚持"强基层、保基本、建机制、广覆盖、可持续的"方针,强调国家义务和政府责任,系统规划医疗保险、公共卫生服务、基本药物制度、基本医疗服务体系、公立医院改革等医疗改革发展目标,更加具体细化。建立完整的全民医保体系是初步解决十三亿国民医疗保健这一世界难题的基本方法,具有极强的历史意义。     

城镇居民医疗保险对卫生服务利用的影响——政策效应与稳健性检验

基于国家基本医疗保险调查数据,运用面板随机Probit模型,研究发现,城镇居民医疗保险显著促进了居民基本卫生服务利用,政策实施效果良好。而且,其对卫生服务利用的影响具有全面和分层次促进的特点:城镇居民医疗保险促进了全体居民进行健康体检,促进了弱势群体的门诊服务利用,显著提升了低健康群体的住院服务利用。城镇居民医疗保险制度促进了低健康群体卫生服务利用的合理增长,中高健康群体未出现过度利用医疗资源的问题,制度较好地兼顾了公平与效率。促进保健、自我诊疗与门诊利用是未来城镇居民医疗保险制度完善的优先投入方向。     

浅议我国医疗保险支付方式的改革

近些年来,随着覆盖城乡的基本医疗保障制度的建立,我国居民基本医疗保险覆盖率已超过90％。在政府不断的增加对居民医疗保险补贴的同时,城乡居民医疗消费支出不断扩大,医疗费用也在不断增长。引起医疗费用上涨和居民实际医疗的支出增加的原因之一就是第三方付费支付制度的不完善。本文认为,在我国目前情况下,医疗保险支付方式的改革,是解决医疗费用增长过快,提高医疗保险制度效率的比较有效的措施。     

试论商业医疗保险如何为国家基本医疗保险制度配套服务

商业医疗保险如何为国家基本医疗保险制度配套服务的问题,是当前商业保险市场竞争激烈、城镇职工最关心的问题.配套服务搞得不好,关系到商业医疗保险在社会医疗保险中的地位及作用,也关系到国家基本医疗保险制度的落实和社会医疗保障体系的完善.哪个商业保险公司先认识、先行动,哪个商业保险公司就先受益.本文试从商业医疗保险和国家基本医疗保险制度的关系;商业医疗保险和国家基本医疗保险制度配套服务的政策依据及必要性;商业医疗保险如何为国家基本医疗保险制度配套服务三个方面来谈谈个人的认识及意见.     

中国医疗保险对城镇居民药品经济负担影响研究

本研究利用"国务院城镇居民基本医疗保险试点评估入户调查"数据,通过最小二乘法线性回归模型,分析现有几种主要医疗保险对于城镇居民药品经济负担的影响.结果显示,无论是门诊费用还是住院费用,有医疗保险的城镇居民的药品经济负担较没有任何医疗保险的城镇居民低,其中拥有城镇职工基本医疗保险、新型农村合作医疗及其他医疗保险的人群的药品经济负担,均有不同程度缓解,且具有统计学意义.拥有城镇居民基本医疗保险的人群,其药品经济负担没有明显下降,分析原因可能是由于城镇居民基本医疗保险刚刚开始实行,参保人群的潜在需求还未充分释放出来.     

基本医疗保险资金审计管见

城镇职工基本医疗保险、新型农村合作医疗和城镇居民基本医疗保险是基本医疗保险的重要组成部分,基本医疗保险是社会保障的重要组成部分。本文主要研究基本医疗保险资金审计需关注的重点,分析了医疗保险制度执行及资金筹集、使用、管理中可能存在的问题及成因,提出了对策及建议。     

社区卫生服务与医疗保险如何结合

近年来,国家政策大力推进社区卫生服务,但是由于种种原因,社区卫生服务发展并不理想。把社区卫生服务和医疗保险制度相结合,将在很大程度上解决社区卫生服务的筹资问题,并有利于维护医疗保险基金的平稳运行和控制参保人的健康风险。本文提出了社区卫生服务纳入医疗保险支付的基本条件,以及医疗保险支付社区卫生服务的基本方式,并且认为,在目前进行社区慢性病管理是必要的也是可行的,社区卫生服务和医疗保险制度的结合可以首先在社区慢性病管理方面进行尝试。     

实行全民医疗保险的模式与思考

文章对我国医疗保障制度的现状及存在的问题进行了分析,对实行全民医疗保险模式进行了构思。指出要建立具有中国特色的覆盖城乡全体居民的全民医疗保障制度,必须坚持用以人为本的科学发展观统领医疗保险制度改革,建立统一的医疗保险制度,统一的医疗保险管理服务体系,逐步提高统筹层次,增强共济能力,让人人都能享有基本医疗保障。     

Health Policy and Equity of Health Care Financing in Australia: 1973–2010

Using data from Australian Taxation Statistics and Household Expenditure Surveys we analyze the distribution of health care financing in Australia over almost four decades. We compute Kakwani Progressivity indices for four sources of health care financing: general taxation, Medicare Levy payments, Medicare Levy Surcharge payments, and direct consumer payments, and estimate the effects of major policy changes on them. The results demonstrate that the first three of these sources of health care financing are progressive in Australia, while the distribution of direct payments is regressive. Surprisingly, we find that neither the introduction of Medicare in Australia in 1984 nor the Extended Medicare Safety Net in 2004 had significant effects on the progressivity of health care financing in Australia. By contrast, the Lifetime Cover scheme—introduced in 2000 to encourage people to buy and hold private health insurance—had a progressive effect on health care financing.     

我国基本医疗保险制度的激励与监督机制——基于道德风险的分析

逐步在我国建立公平有效的基本医疗保障制度是当前医疗体制改革的首要目标.几年来,尽管我国在这方面取得了一定成绩,但为了防范广泛存在的道德风险,政府的不恰当措施却导致我国在医疗保险体制上出现了诸如门诊负担沉重、报销水平偏低、医疗成本控制过严和医疗保险基金挪用等严重问题.如何解决这些问题是本文研究的关键.我们从分析基本医疗保险的性质出发,集中论述了由共用资源和委托代理关系所引发的道德风险以及政府所面临的两难困境.最后,我们提出了相应的政策建议:政府应在放宽对参保人和医疗机构限制的基础上,通过构建合理的激励与监督机制来健全基本医疗保险体系.     

The determinants of the demand for private health insurance under Medicare

Since the introduction of Medicare in 1984, the proportion of the Australian population with private health insurance has declined considerably. Insurance for health care consumption is compulsory for the public health sector but optional for the private health sector. In this paper, we explore a number of important issues in the demand for private health insurance in Australia. The socio-economic variables which influence demand are examined using a binary logit model. A number of simulations are performed to highlight the influence and relative importance of various characteristics such as age, income, health status and geographical location on demand. A number of important policy issues in the private health insurance market are highlighted. First, evidence is provided of adverse selection in the private health insurance pool, second, the notion of the wealthy uninsured is refuted, and finally it is confirmed that there are significant interstate differences in the demand for private health insurance.     

基于城镇医疗保险和新农合相衔接的视角探讨构建农民工医疗保险制度的定位原则

本文通过分析农民工参与医疗保险存在的问题和农民工医疗保险制度的定位,从未来城镇医疗保险和新农合相衔接的视角,探讨构建农民工医疗保险需要把握的原则。农民工医疗保险制度应该独立于现行的城乡医疗保险制度,在满足农民工基本医疗服务需求、保大病的同时要兼顾小病,只有本着低门槛、循序渐进、灵活性与可衔接性相结合等原则,才能切实保障农民工有病可医。     

What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending

We study the impact of the introduction of one of the major pillars of the social insurance system in the United States: the introduction of Medicare in 1965. Our results suggest that, in its first 10 years, the establishment of universal health insurance for the elderly had no discernible impact on elderly mortality. However, we find a substantial reduction in the elderly's exposure to out of pocket medical expenditure risk. Specifically, we estimate that the introduction of Medicare was associated with a 40% decline in out of pocket spending for the top quartile of the out of pocket spending distribution. A stylized expected utility framework suggests that the welfare gains from such reductions in risk exposure alone may be sufficient to cover almost two-fifths of the costs of Medicare. These findings underscore the importance of considering the direct insurance benefits from public health insurance programs, in addition to any indirect benefits from an effect on health.     

大学生医疗保险现状研究

随着2009年国务院颁布将大学生纳入城镇居民基本医疗保险政策,各高校陆续开始实施新的大学生医疗保险政策。从分析我国大学生医疗保险发展的历程入手,探讨了新制度中存在的问题,并提出了相应的可行性政策建设。     

人口老龄化对医疗保险制度的影响——以山西为例

针对人口老龄化对山西医疗保险制度的影响,认为应采取措施增强医疗保障基金积累功能;落实政府公共财政责任,实现医疗保障制度的可持续发展;发展以社区为中心的老年医疗保健服务体系;建立老年保健评估制度。     

Medical Expenditures and Health Status in Australia: A Story of Increasing or Decreasing Returns?

We use a three‐equation model to estimate a health production function for Australia using population data for 1996. Working at the level of the Statistical Local Area (n= 1335) we match (i) data on private practice medical services (derived from the Medicare scheme), (ii) mortality data derived from the de‐identified unit records produced by the Australian Bureau of Statistics (ABS), and (Hi) social and economic data from the Australian Census of Population and Housing (ABS 1997). We detect strong and statistically significant positive marginal effects of medical expenditure on health status as well as increasing returns. These findings are remarkably different from those of US health production studies, which have tended to lend support to the hypothesis of ‘flat‐of‐the‐curve (that is, zero marginal product) medicine’. Moreover, our conclusions are in stark contrast to those produced by Richardson and Peacock (2003, p. 6), who have argued that their econometric work indicates that ‘an increase in the [Australian] doctor supply is associated with increasing mortality’.     

城乡基本医疗保险制度一体化构想——以河北省为例

医疗保障制度设计是世界公认的民生难题,作为世界人口第一大国,中国仅用10年时间,就实现了全民基本医疗保险。但是由于二元社会经济结构的存在,以及制度在制定之初缺乏统一规划,现行基本医疗保险制度呈现多元化、碎片化的特征。这样的医疗保险制度与社会保障制度所公认的公平原则相违背,不利于劳动力在全国范围内的自由流动,不利于缓解我国日益严重的收入分配差距问题。中共十八大报告中提出了"推动城乡发展一体化"的战略部署,基本医疗保险制度的城乡一体化是其中应有之义。积极推进基本医疗保险制度的城乡一体化,有利于完善我国的基本医疗保障体系、减轻全体居民的医疗费用负担,有利于缩小收入分配差距、构建和谐社会。     

Anti-insurance: Analysing the Health Insurance System in Australia

This paper develops a model to analyse the Australian health insurance system when individuals differ in their health risk and this risk is private information. In Australia private insurance both duplicates and supplements public insurance. We show that, absent any other interventions, this results in implicit transfers of wealth from those most at risk of adverse health to those least at risk. At the social level, these transfers represent a mean preserving spread of income, creating social risk and lowering welfare – what we call anti-insurance. The recently introduced rebate on private health insurance can improve welfare by alleviating anti-insurance.