中国城镇医疗体制改革前后的医疗融资比较

The health financing schemes is the foundation for the nation’s health care system, and the health insurance is a main one of some options for financing health care. This article compares two health care financing schemes in urban areas before and after the health reform, and targets at the impacts facing coverage groups, the financing methods, decision-making power or financial management (i.e. the distribution of responsibility and rights between the central government and local governments), payment arrangement and cost containment of health care financing mechanisms. Prior to reform, the equal access and universal coverage of health care services were implemented through the employment-based health insurance in a state-controlled economy with guaranteed full employment and central control in general. The decentralization reforms of fiscal system and tax sharing reforms disrupts the past economic foundation, the rebuilding health insurance system which still benefits the employed bring the limited coverage. The next trend is to make transition from health insurance covering only part of the employed population to what are in effect national health services covering the whole population in urban areas.      

养老模式对健康的影响

中国人口老龄化趋势日益明显,这给养老、医疗、社会服务带来了巨大的压力。本文从居住模式和主要经济来源两个方面来界定中国老年人的养老模式,利用经济学方法,根据2002年、2005年中国老年人口健康状况调查数据(Chinese Longitudinal Healthy Longevity Survey,CLHLS),从实证角度,讨论了中国不同养老模式如何影响老年人的健康状况,并且分析了这一关系是否存在性别差异、城乡差异和年龄段差异。研究发现,养老模式是关系到中国老年人健康的一个关键因素,经济与居住均独立的老年夫妻有最明显的健康优势和主观幸福度优势,而依靠子女供养或政府补助的个人独居养老模式是最差的。这些经验发现可以为政府改善老龄人群的健康提供可靠的政策依据。     

中国卫生筹资的再分配效应

利用2006年中国健康与营养调查(CHNS)数据和类似于税收再分配的分解方法,将卫生筹资的再分配效应分为三部分:累进效应、水平平等效应和再排序效应。卫生筹资增加了收入不平等,表现出了亲富人的再分配,主要原因在于水平不平等和再排序效应,如果相同收入的人群进行相同的卫生支付,再分配效应将会降低64%,另一原因在于卫生筹资系统的累退性。在同为从穷人到富人的再分配中,农村卫生筹资亲富人的再分配程度高于城市;农村卫生筹资的累退程度大于城市;农村卫生筹资的水平不平等小于城市。     

Ex Post Welfare under Alternative Health Care Systems

The implications of a societal aversion to inequality for the optimal structure of the health care system are studied. The agents are assumed to be ex ante identical, but to differ ex post in the state of their health. Inequality aversion is introduced by postulating a strictly concave ex post social welfare function. It is shown that the optimal public health care system allocates health care differently than would private health insurance; specifically, people who are relatively unhealthy with and without treatment receive more health care, and people who are relatively healthy with and without treatment receive less health care. The aggregate quantity of health care under the optimal public health care system can be either greater or smaller than under private health care insurance. If the public health care system is optimally designed, allowing agents to purchase supplementary private health care insurance cannot raise social welfare and is likely to decrease it.     

Evolution of the prospective payment system: implications for nursing

Many changes have occurred in the financing and organization of health care services in recent years. Medicare's prospective payment system, a major financing innovation implemented by the federal government, is continuing to evolve in response to demands that costs be controlled while quality of care and access are ensured.     

TRUE HOUSEHOLD EQUIVALENCE SCALES AND CHARACTERISTICS OF THE POOR IN THE UNITED STATES

In this paper we deal with the question of which measures of economic well-being are adequate to identify those groups of households in the U.S. whose economic conditions justify public concern and assistance. We derive a utility based measure of economic well-being from the estimation of a complete set of consumer demand equations. The demand system is Lluch's Extended Linear Expenditure System (Lluch, 1973). Household characteristics are incorporated using the scaling method proposed by Barten (1966). Using the welfare indicator derived, we study the composition of the poorest part of the population, using data from the 1972–73 Consumer Expenditure Survey. We compare our results with those obtained using various other welfare indicators, including the official U.S. poverty line. We show that using different family composition adjustments significantly and systematically affects just who are considered to be at the bottom of the welfare distribution. We finally suggest that program designers therefore can improve their target efficiency by carefully selecting from among the acceptable indices of welfare when defining program eligibility.     

A Simple Model of Health Insurance Competition

This study investigates competition between health insurance companies under different financing regulations. We consider two alternatives advanced in recent German healthcare reform discussions: competition by contribution rates (health contributions) and by fees (health premia). We find that contribution rate competition yields lower company profits and higher consumer welfare than premia competition when switching between insurance companies is costly.     

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.     

Who benefits from big government? A life satisfaction approach

Which impact does government size have on life satisfaction, and how do effects of bigger government differ between income groups in society? Previous studies typically employed country averages and thus neglected possibly heterogeneous happiness effects between income groups. This paper addresses empirically the effects of government spending on subjective well-being of individuals belonging to different income groups. Our analysis is based on individual data from 25 European countries participating in the European Social Survey. In contrast to most previous studies we take account of the endogeneity between relative income position and reported life satisfaction by an instrumental variable approach. Our results suggest, first, that most government spending categories, including social protection, are on average negatively related to individual well-being. Secondly, estimated marginal effects of health, education and social protection spending at different income levels show that spending increases always have a stronger negative effect on high income groups’ well-being than on low income groups’ life satisfaction. For all government spending categories, marginal happiness effects of higher public spending are clearly negative for income groups at the top.     

Eudaimonic well-being,inequality, and health: Recent findings and future directions

The theoretical and philosophical underpinnings of a eudaimonic model of well-being are examined, and its empirical translation into distinct dimensions of well-being is described. Empirical findings have documented aging declines in eudaimonic well-being, but there is considerable variability within age groups. Among older adults who remain purposefully engaged, health benefits (reduced morbidity, extended longevity) have been documented. Eudaimonic well-being also appears to offer a protective buffer against increased health risks among the educationally disadvantaged. Neural and genetic mechanisms that may underlie eudaimonic influences on health are briefly noted, and interventions designed to promote eudaimonic well-being are sketched. Needed future research directions include addressing problems of unjust societies wherein greed among privileged elites may be a force compromising the eudaimonic well-being of those less privileged. Alternatively, and more positive in focus, is the need to better understand the role of the arts, broadly defined, in promoting eudaimonic well-being across all segments of society.     

Fiduciary responsibility and potential liabilities in health care cost management

This article addresses the key legal issues facing ERISA welfare plan fiduciaries in health care cost management and explores the current status of a number of fiduciary obligations particularly relevant to welfare plan trustees. The authors discuss the fiduciary issues raised by the selection of a health care delivery system, plan design decision making and provider discount arrangements with health plans, and provide suggestion for administering reimbursements for health care costs from third party recoveries and addressing provider fraud.     

公立医院公益性问题研究

近年来,公众之所以会对"公立医院是否具有公益性"产生疑问,是源于社会上对"公立医院收费使它们丧失了公益性"的批评,而这种批评又混淆了公立医院提供医疗服务应不应当收费和医疗费用最终应当由谁支付这两个不同的问题。因此,文章在综合各种公益性概念并对公益性给出一个确切定义的基础上,分别梳理了目前国际上医疗费用筹措与医疗服务提供的几种主要方式,分析各自的优缺点,指出了增加公共医疗支付的必要性。文章最后提出,目前我国一些城市试行的"按病种付费"的体制,可望根据实际情况进行改进以后在更大的范围内推广。     

廉租房融资模式研究

廉租房作为一项重要的住房保障制度,福利性、公益性的特性决定了其与一般商品房的开发、运作方式的显著不同。在开发融资渠道上,政府主导财政资金供给模式使得融资渠道单一,引入房地产信托投资基金（REITs）将有助于解决廉租房融资困境。     

所得、快乐与赋税:基于黄有光快乐经济学的审视

根据黄有光的快乐经济学,人们追求的最终目的是提高福利,因而经济学探讨的中心问题是福利或快乐.由于快乐是一种主观感受,因而GDP并不是衡量福利的一个有效指标.在现代社会中,生活品质不仅与私人品的消费有关,更与公共品的质量和数量有关.因此,在未来社会中,公共开支确实会且应该不断增长.为了应对不断增加的公共支出,政府就需要提高累进税,尤其是提高钻石商品的税收.     

Microfinance and child mortality

Microfinance institutions (MFIs) offer targeted opportunities for the poor to generate additional income with a range of financial services including credit, insurance, savings accounts and money transfers. Aside from reducing poverty, microfinance can potentially improve health because it is the poor who are usually more constrained from health investments due to limited budgets. Furthermore, microfinancing specifically targets women, who are more likely to spend additional income on children’s well-being. Finally, several MFIs have also begun to offer health-related services, such as health education, health-care financing, clinical care, training community health workers, health micro-insurance and linkages to public and private health providers. Using a new data set, this article conducts the first multi-country study of the effect of microfinance on child mortality, the health outcome, which is most sensitive to the effects of absolute deprivation. Our findings confirm that an increase in the proportion of MFI clients in a country is significantly associated with lower under-five and infant mortality rates. We conclude that if MFIs’ educational and health services have indeed caused improvements in health outcomes at the community level, then it may be important for governments to complement these activities with similar campaigns, particularly in remote areas where MFI penetration is low.     

The Moral Imperative and Social Rationality of Government-Guaranteed Employment and Reskilling

Unemployment exacts a high cost to its victims, not only in lost income, but also in terms of quality of life (insecurity, depression, abandoned families, divorce, suicide and poorer health). It also exacts a high cost to society in terms of lost output, foregone tax revenue, depreciating human capital, and increased costs of welfare, crime and health care. Yet modern wealthy societies have, principally for the sake of price stability and to avoid the budget costs of a full remedy, chosen to tolerate a substantial level of permanent unemployment. This article explores the moral conditions of this social choice and its rationality in terms of social welfare. It makes and develops support for two claims: society's tolerance of involuntary unemployment is morally wrong, and it is socially and economically irrational. It concludes that government should guarantee employment by serving as employer of last resort and where appropriate provide for retraining.     

破解医改难题关键在于纠正市场与政府的双失灵——中国医疗体制改革的经济学分析

医疗卫生关系人们的生命健康,建立一个科学完善的医疗卫生体制是构建和谐社会的重要内容。目前,中国医疗卫生体制改革失败的事实要求我们深入分析其背后深层次的原因。中国医疗体制改革失败的根本原因在于市场与政府的双失灵,破解医改难题关键在于纠正市场与政府的双失灵。     

Well-being effects of extreme weather events in the United States

The increase in weather and climate disasters in recent years has prompted an interest in analyzing their consequences and the mitigation and adaptation measures that can help minimize their potentially large impacts on individuals’ welfare. We match thirty-one billion-dollar disasters with individual survey data from the Behavioral Risk Factor Surveillance System to estimate the effect of extreme weather events on the subjective well-being of U.S. residents. Our results indicate that natural disasters have a negative and robust impact on subjective well-being in the affected communities, and that, on average, this impact peaks 6 months after the event, and then decays over time. We then investigate the attenuating impact of health care access, flood insurance, and governmental assistance programs and find a partial compensating role for risk-transfer and relief measures. We also find that stronger emotional and social support mitigates the negative impact of natural disasters.     

Distress financing of out‐of‐pocket health expenditure in India

In the absence of a universal health insurance mechanism, the increasing burden of out‐of‐pocket (OOP) health expenditure has become a growing concern in India. To cope with the cost of illness, people use either their savings and income, or they have to rely upon distress means of finance such as depletion of household assets, borrowings from banks and moneylenders, and contributions from family and friends. This paper analyses the changes that have taken place in the incidence and covariates of distress financing in India by using data from National Sample Survey Organisation for the years 2004 and 2014. Results indicate that during this period the incidence of distress sources as a means to finance OOP health expenditure has hovered around 50%. Further, the results reveal a significant socioeconomic gradient in the incidence of distress financing. Socioeconomic and health‐related covariates significantly impact the likelihood of distress financing as a means to cope with OOP health expenditure. The results indicate the need for government action to formulate a comprehensive plan through an increase in public spending on health care that will improve the quantity and quality of the public health‐care system and enhance the scope of health insurance in India.     

Cost-utility analysis of the rehabilitation of patients with musculoskeletal problems

The objective of this study is to discuss the rehabilitation of patients in primary health care with problems in the musculoskeletal system from a socioeconomic perspective. A trial with coordinated rehabilitation in primary health care is compared with traditional rehabilitation. This trial, performed in Sweden in 1994, was a two-year prospective and comparative study of consecutively included patients with long-term illnesses due musculoskeletal problems (810 observations). A cost-utility analysis shows that the new rehabilitation program in primary health care is a cost-minimization program for society. There is no significant difference in the quality of life between the trial and control groups. The total cost is lower for rehabilitation in primary health care than for traditional rehabilitation (6 percent). The indirect costs are higher than the direct health care costs (60 percent), and payments from social insurance increased by 8 percent. The health economic results support rehabilitation in primary health care but also points out that this type of rehabilitation can be further improved.