公私医疗卫生支出与经济增长关系的实证分析

众所周知,医疗卫生支出不仅关系到一个国家社会福利政策的规划,还对经济增长具有不可忽略的促进作用。然而,现有文献对于医疗卫生支出与经济增长关系之间的研究结论却是众说纷纭。鉴于此,本文根据医疗卫生支出的支付主体,将其分为政府医疗卫生支出和居民医疗卫生支出,并通过建立双向固定效应模型对公私医疗卫生支出对经济增长的影响进行分析。结果显示：从全国平均水平来看,政府医疗卫生支出每增长100％,带动经济增长12．08％,居民医疗卫生支出每增长100％,带动经济增长15．85％;但与此同时,考虑到不同地区的经济发展非均衡化时,政府医疗卫生支出和居民医疗卫生支出带动经济增长的效应差异甚大,其中政府医疗卫生支出对经济增长呈现“倒U型”效应,而居民医疗卫生支出对经济增长呈现“阶梯型”效应。     

Long-term care,dependence and the third sector

The demographic changes that have taken place throughout the twentieth and early twenty-first century confirm the increase in the number of older adults. More older adults implicitly entail an increase in the number of people in a situation of dependence. The issue of long-term care has economic, social and health care implications. This article addresses the characteristics of the companies involved in long-term care services and the employment generated. The database of the Spanish Directory of Companies (DIRCE) provided information on the variables used in the analysis: companies created, employment generated, companies by legal status and territorial distribution of the companies. Noteworthy findings were that the long-term care service sector contributes more to creating jobs than other economic sectors and that third sector companies are important in providing long-term care services.     

Health Systems and Health Reform in Europe

The organisation of health care differs widely across Europe. Access to services, financing schemes, incentives for better care, and administrative efficiency are challenges that are being dealt with in a variety of ways. Are insurance-based systems the best solution for balancing resources and services or are national health funds preferable? Does the introduction of competition fulfil high hopes for better service at lower costs? What are the relative advantages and drawbacks of central and local management of health care?     

The future of swiss asset management: A look in the crystal ball

Until recently, Switzerland had an unmatched reputation for the quality of its banking services. Based on a secular tradition of security and a strict banking secrecy enforced by law, Swiss banks have established themselves as leaders in discretionary asset management. Recent studies estimate that about 35 percent of the private off-shore wealth is managed in Switzerland. At the end of 1996, asset management in Switzerland represented about 2.5 trillion Swiss francs (about $2 trillion), provided 3.5 percent of the total added value in the country, and contributed 4.44 billion Swiss francs in taxes, making it one of Switzerland's major sector of activity. But the traditional paradigm on which asset management is based in Switzerland–confidentiality, conservatism, and safety–is undergoing rapid change. Have the profound changes which transformed the banking industry and its production structures over the past several years ended? This is the subject of a large study we carried out with the Institute of Banking and Financial Management at HEC-University of Lausanne. This survey provides an unbiased global reference and a neutral benchmark describing the current state of the Swiss asset management industry. It should help the assessment of specific strategies before considering implementations issues. This interview article contains part of the survey results and identifies a few factors that could prolong the industrial revolution underway. © 1999 John Wiley & Sons, Inc.     

Consumption Patterns Among the Young-Old and Old-Old

Data on 2,810 elderly households were drawn from the Bureau of Labor Statistics 1990 Consumer Expenditure Survey. Multivariate Tobit analysis was used to examine spending pattern differences between households with a reference person aged 65–74 (young-old) and households with a reference person aged 75 and older (old-old). Significant differences in spending were found for expenditures on food at home, food away from home, alcohol and tobacco, housing, apparel and apparel services, transportation, bealthcare, bentertainment, personal care, and personal insurance. The impact of socio-demographic factors on expenditures by either age group was not uniform.     

Improving Incentives in Health Care Spending

Although U.S. economic growth is likely to continue to be robust, the growth of private and public spending on health care presents long-run public policy challenges. To meet these challenges health care resources must be used more efficiently. Currently, there are few incentives to put health care dollars to the highest value use. This is true in both public and private spending. An important element of the problem lies in the tax-preferred treatment given to employer-provided insurance but not to out-of-pocket spending. The resulting bias towards first-dollar insurance coverage means that consumers are insulated from the real costs of the health care that they consume and have little reason to evaluate whether the benefits are greater than those costs. Moreover, they seldom have sufficient price and quality information to make informed decisions. Health Savings Accounts (HSAs) are a promising way to remove the tax-penalty for enrolling in catastrophic insurance and paying for routine care out of pocket. Given the information that they need, consumers would then have more choices and more control, strengthening their role in reducing waste, improving efficiency, and promoting competition. Coupled with other policies, HSAs can be a critical component in moving toward an efficient and equitable health care system. JEL Classification I11     

Financing the correct rate of growth of medical technology

This article suggests ways to preserve innovation while partially restraining the impressive growth rate in new medical technology. Health care will soon consume 12 percent of GNP. There is a wide range of opinions as to whether medical technology is a major or minor source of rising health care expenditures. Given our current fiscal problems, health care providers will be in direct competition with education and other domestic programs for a limited supply of R&D funds. More funding will have to come from the private sector. The challenge for prudent buyers of health care services is to control costs without eroding the biomedical capacity of the nation.     

Importance of the U.S. Bureau of Labor Statistics and critical issues it faces

The U.S. Bureau of Labor Statistics (BLS) provides essential, trustworthy, highly visible statistics that promote economic efficiency. However, its ability to do so is threatened by many challenges, chief among which is its funding situation. This article updates important stakeholders, such as those at NABE, on the situation at BLS. The paper reviews evidence on the vital role played by BLS products, how BLS maintains high data integrity, and evidence of users’ trust in the data. This is followed by discussion of the agency’s continuous efforts to improve efficiency. Despite the agency’s importance and efficiency, its funding has been flat in nominal terms since 2009, leading to a $90 million shortfall (15% below that needed) in real terms by FY2018. The BLS has needed to curtail spending in ways that are not sustainable, slowing modernization and raising the risk of data errors or delayed releases. With adequate funding, BLS could greatly speed modernization and better serve its customers in many ways. The paper concludes with a call to action: steps that NABE economists and other data users should take to help assure that BLS continues to provide the data that we all need in order to preserve our national vitality.     

Adoption and Diffusion of Telemedicine Technology in Health Care Organizations: A Comparative Case Study in Hong Kong

Rapidly changing dynamics and turbulence in the business environment have made technology management increasingly critical to the bottom-line survival and competitiveness of many organizations. Adoption and diffusion are 2 challenging technology management issues facing health care organizations. As health care is becoming an increasingly important sector of the national and the global economy, contemporary problems in access, equality, and costs have demanded innovativeness from health care organizations that, in response need to adopt and institutionalize appropriate technological innovations for service improvement and expansion. A case in point is telemedicine technology that has the potential to support physicians' patient care and improve health care organizations' competitiveness.     

Strengthening the voice of mental health service users and carers in Wales: a focus group study to inform future policy

Improving the mental health of the people in Wales lies at the heart of the Welsh Assembly Government's public health agenda and the current reforms of the National Health Service in Wales. However, relative to its importance as a health problem, spending on mental health is disproportionately low. Statutory authorities in Wales highlight the importance of listening to, and learning from, service users and carers. This is seen as a way of improving services within the limited funding that is available. The aims of this study were to describe the ways in which mental health service users and carers are currently involved in mental health services across Wales; and to consider the need for an all‐Wales mental health service user and carer ‘national mechanism’ to promote genuine partnership. Eight focus groups were held across Wales attended by mental health service users and carers. There is a clear picture of the level and nature of participation, evidence of good practice and user and carer based aspirations for future participation. There is an untapped source of energy and experience that could help transform mental health services for the good of all. To ignore this would be to miss an opportunity to improve the quality of care for all those dependent upon these services, both patients and carers.     

Mid-life and older workers: job displacement and health care coverage

The purpose of this study was to explore factors influencing the likelihood that workers would have health care coverage following job displacement. The sample was drawn from the Current Population Survey: Displaced Worker Supplement (January 1988) and consisted of 840 workers aged 45 years and older. The workers lost jobs because of plant closings, relocations or because of slack work At the time of the survey, 567 displaced workers indicated that they had health care coverage. Logistic analysis revealed that prior health care coverage, new earnings of males and family incomes of $20,000 or more impacted the likelihood that these displaced workers would have health care coverage. However, workers subsequently re-employed in new jobs (over 35 hours a week) were less likely to have health care coverage.     

New venture development: The costs and benefits of public sector assistance

In recent years there has been an extraordinary level of entrepreneurial activity occurring in the United States. Venture start-ups, new incorporations even bankruptcies are reaching record numbers. Concurrent with the increase in entrepreneurial activity has been an effort within the Reagan Administration to privatize public sector programs designed to aid new and small, ongoing business ventures. The premise behind this movement is that private sector initiatives can better, and more efficiently, serve the needs of entrepreneurs and small business managers and can also offer new business opportunities for some entrepreneurs. At the same time, however, privatization could reduce the assistance programs currently targeting fledgling ventures, many of which are unable to afford a private consultant.The purpose of this article is to examine the economic impact of one public sector assistance program, the Small Business Development Center (SBDC), in terms of its contributions to new venture initiation in Georgia and South Carolina. The focus on the SBDC program is appropriate since over 50% of the counseling activities of most of the centers is devoted to pre-venture clients, i.e., individuals or groups considering starting a business. This study is important and timely, not only in respect to assessing the effectiveness of public sector assistance programs for pre-ventures, but also for assessing whether it is worthwhile from an economic perspective, to offer assistance to such individuals in the first place.Although it is difficult to be precise in attributing cause to effects in dynamic business ventures, our study indicates that the Small Business Development Center's client sample experienced a greater than expected number of business starts, and a higher than expected rate of survival. The results suggest that the net taxable sales, generated by these new ventures in 1984. was approximately $20 million in Georgia and $10 million in South Carolina. Results also suggest that almost 500 new jobs were created in Georgia and 600 new jobs were created in South Carolina between 1981 and 1984 as a result of successful business starts among SBDC pre-venture clients.While such figures are impressive, the bottom line of this study is that the new tax revenues generated by client firms exceeded the cost of delivering the services. Specifically, our conservative estimates suggest a $3.80 to $1.00 and $1.50 to $1.00 benefit to cost ratio for the center's pre-venture consulting services in Georgia and South Carolina, respectively. Furthermore, the value attached to the assistance received, by the entrepreneurs themselves, closely paralleled our estimates, lending additional validity to our conclusions. Resource constrained entrepreneurs can obtain effective business assistance from the SBDC free-of-charge, and the benefits to society accruing from this service far outweigh the cost of providing them.     

Economic Perspectives on Health Information Technology

It seems paradoxical that health care spending and examples of inferior health care have been rising rapidly at the same time. An important factor is the slow pace at which the health care system has adopted information technology (IT). This paper discusses the dimensions of the problems that could be mitigated by effective use of IT in the health care system, their consequences, and their potential solutions. It also discusses the economic and institutional barriers to deploying IT and how the inherent economies of scale in IT are likely to lead to new problems of competition within the health care system. Inasmuch as this paper was based on an address followed by a question-and-answer period, it also includes an edited version of the recorded questions and answers.JEL Classification I180, I190     

Health Care Matters: Supply Chains In and Of the Health Sector

Providing health care involves a complex enterprise, and the trade‐off between quality and cost has been particularly stark compared to other industries. However, a recent focus on health sector supply networks is now producing significant innovations and improvements. This Special Topic Forum illustrates for the academic and practitioner community how health care supply chain research can benefit from our evolving understanding of supply chains and help push that understanding even further. We classify health care supply chain research into two broad categories—supply chain in health care and supply chain of health care—to set an agenda for future research.     

The labor force of the future.

In the decades ahead, the US labor force will reflect changes in the industrial structure, with declines in some manufacturing industries and expansion in service industries. The services sector is so diverse that the jobs within it cannot be categorized as either high wage or low wage. The service-producing sector employs 85% of professional specialty workers in the US. In general, information on compensation trends indicates that greater increases in compensation have occurred for workers in service-producing as opposed to goods-producing industries. The increase in service sector jobs has created opportunities for women to enter the labor force and, at present, 5 out of 6 women work in this sector compared to fewer than 2 out of 3 men. Productivity growth rates in the service-producing industries vary substantially and are strongly affected by the business cycle. Central to employment opportunities in the years ahead will be the effect of new technology. To date, the aggregate effect of new technology has been increased employment and higher living standards. Although retraining programs should be in place, the scenario of a huge technology-created labor surplus seems unlikely. In fact, a more likely problem is a shortage of labor resulting from earlier labor force withdrawal and demographic aging of the population. Those in the 25-54-year age group will represent a larger share of the labor force in the years ahead. In addition, blacks are expected to account for 20% of the labor force growth in the next decade. Finally, given increasing labor force participation rates among mothers, employers may have to provide more flexible work schedules, assistance with day care, and more attractive benefits packages.     

International Trade and Health Policy: Implications of the GATS for US Healthcare Reform

This paper examines the implications of the General Agreement on Trade in Services (GATS), the World Trade Organization’s agreement governing trade in health-related services, for health policy and healthcare reform in the United States. The paper describes the nature and scope of US obligations under the GATS, the ways in which the trade agreement intersects with domestic health policy, and the institutional factors that mediate trade-offs between health and trade policy. The analysis suggests that the GATS provisions on market access, national treatment and domestic regulation, which are designed to eliminate ‘regulatory barriers’ to global trade in health services, limit the range of options that state and federal regulators and legislative bodies can employ to regulate the health sector and implement healthcare reforms. As such, the paper identifies the broader social and ethical implications of free trade policy.     

The Payoff to America from Globalisation

This article summarizes the economic payoff to the United States from its postwar trade opening and estimates the potential future gains from more opening going forward. To quantify these gains, we survey different methodologies and estimates. We find that trade opening since World War II has added between $800 billion to $1.4 trillion to the US economy, or about $7,000 to $13,000 per household. More speculative estimates of the potential additional gains from removing the rest of US trade barriers range from $400 billion to $1.3 trillion, or about $4,000 to $12,000 per household. Since trade opening permanently raises national income, these gains are enjoyed annually. Trade opening inevitably entails adjustment costs. We estimate that the lifetime cost of all worker dislocations that have been triggered by expanded trade in the United States could be as high as $54 billion, although probably less. The permanent gains from past and potential liberalization easily swamp the modest sums necessary to alleviate the temporary pains of adjustment. In the future as in the past, free trade can significantly raise income – and quality of life – in America.     

Toward a Model of Word-of-Mouth in the Health Care Sector

An important source of health information is word of mouth (WOM). Nevertheless, a model describing WOM in the health care sector does not exist. The aim of this paper is to contribute to research by providing concrete suggestions for a model of word of mouth in the health care sector. A conceptual framework comprising the theory of cognitive dissonance, the theory of the strength of weak ties, and the theory of perceived risk are used as a theoretical anchor. In order to gain a more precise knowledge of WOM in the health care sector, a literature review of leading health care journals is conducted. The findings are summarized in the form of a model proposal describing the creation, spread, and impact of WOM in the health care sector. As the model summarizes the current WOM literature, it seems to be a good starting point for further research by scholars. The paper also helps practitioners to better understand WOM and integrate the WOM aspects described into their daily work.