卫生服务产出的质量调整问题初探

随着医疗技术的持续进步,对卫生服务的产出进行质量调整愈发重要。目前,卫生服务产出的质量调整仍旧处在中国的国民经济核算框架之外,中国还没有卫生服务产出质量调整的理想指标。因此,如何将质量调整指标引入中国的国民经济核算还需要进一步研究。     

AN EMPIRICAL STUDY ON HEALTH IN TAIWAN AND ITS LONG‐TERM ADJUSTMENT*

This paper investigates the dynamic change of the population health status in Taiwan. Specifically, it provides insight into the empirical determinants of health production function and explores the nature of the long‐term adjustment in health performance. For these purposes, panel data are used incorporating dynamic effects as well as controls for unobservable area‐specific effect and area‐invariant time effect. The findings are consistent with the earlier research in terms of the determinants of the health production function. The result of the present paper suggests that after decades of improvement in health care, people in Taiwan have lower age‐adjusted mortality rates. Also, the decreases in mortality rates follow a rapid pace of long‐term adjustment implying that health‐care policy that focuses on the provision of medical care services substantially benefits the nation's health.     

产出损失和政策效应分化下的G20合作

在对金融危机造成的实体经济产出损失进行测算的基础上,本文着重从经济基础层面对当前G20合作的现实困境加以解释.笔者认为,金融危机对全球经济的冲击形成了G20深化合作的内在动力,但与此同时,冲击的不对称性以及政策效应的分化特征也造成了当前G20进一步深化合作的现实困难.此外,在发展中国家的内部分化特征更为显著的背景下,金融危机后全球经济格局中发达国家主导的局面不会发生根本变化,而围绕市场开放和外部经济失衡调整的利益纷争也必然会有所加剧.     

不确定性、通货膨胀与产出增长

基于中国1952—2004年的数据,通过GARCH-M模型和广义脉冲响应函数对不确定性、通货膨胀与产出增长进行实证分析。结果发现:通货膨胀不确定性与产出增长负相关;产出增长不确定性与产出增长负相关;产出增长不确定性与通货膨胀正相关;通货膨胀不确定性与通货膨胀负相关;产出增长冲击和通货膨胀冲击对产出增长不确定性和通货膨胀不确定性的影响存在滞后性和非对称性;产出增长对产出增长冲击的动态响应最大,通货膨胀对产出增长冲击的动态响应以及产出增长对通货膨胀冲击的动态响应最小,通货膨胀对通货膨胀冲击的动态响应居中。     

MUTUAL HEALTH ORGANIZATIONS AS FACILITATORS AND/OR BARRIERS TOWARDS THE SUCCESSFUL IMPLEMENTATION OF NHIS IN GHANA

There are many constraints to implementing comprehensive health insurance in the context of Sub‐Saharan Africa. Mutual health organizations are under pressure to resolve the inadequacies, accordingly. The objective of this study is to explore the extent to which the mutual health organizations constitute facilitators and/or barriers to the successful implementation of the health insurance scheme nationwide. Data were gathered through interviews and review of literature. The findings of the empirical data were analyzed using theories of health seeking behaviour and reflexive communities. The findings of the paper suggest that the mutual health organizations are beneficial to their communities as they have broadened the understanding of the community members, regarding what the concept of health insurance was in Ghana, a country where it was a relatively new concept in public health financing and delivery. However, the paper also observes that the mutual health organizations are facing problems that are likely to affect sustainability overtime under a national health insurance scheme. Therefore, the need for continuous public education to sustain the enthusiasm among community members is recommended.     

INFRASTRUCTURE,PUBLIC EDUCATION AND GROWTH WITH CONGESTION COSTS

This paper studies the implications of education quality for the optimal allocation of public expenditure in a simple endogenous growth model with mandatory schooling and infrastructure spillovers. Education quality is inversely related to the degree of congestion in schools, which is itself measured in two ways: the proportions of teachers and students in the population, and the ratio of government spending on education to teaching capacity. The balanced‐growth path is derived and the transitional dynamics associated with an increase in the degree of congestion are analysed. The growth‐maximizing share of government spending on education is shown to depend negatively on the congestion parameter. Policy implications for the ‘quantity versus quality’ debate in schooling are also discussed.     

Adjustment Costs,Inventories and Output

This paper analyzes the optimal adjustment strategy of an inventory‐holding firm facing price‐ and quantity‐adjustment costs in an inflationary environment. The model nests both the original menu‐cost model that allows production to be costlessly adjusted, and the later model that includes price‐ and quantity‐adjustment costs, but rules out inventory holdings. It is shown that the firm's optimal adjustment strategy may involve stockouts. At low inflation rates, output is inversely related to the inflation rate, and the length of time demand is satisfied increases with the demand elasticity but decreases with the storage cost and the real interest rate.     

Risk adjustment and prevention

Abstract Widespread integration of market‐based incentives into healthcare systems calls for – and has elicited – increasing adoption of risk adjustment. By deterring selection, risk adjustment helps to assure fair and efficient payments among health insurers or capitated provider groups. However, since conventional risk adjustment allocates funds among regions or insurers according to current population health status, it does not reward – indeed, it penalizes – preventive efforts that improve population health. This prevention penalty of risk adjustment represents a hidden cost of unclear magnitude, undermining provider incentives for health promotion. We develop a theoretical model of selection and prevention demonstrating this problem with conventional risk adjustment and suggesting a simple alternative: risk adjustment should be linked to pay‐for‐performance for prevention.     

相机抉择政策、经济增长与地区产出波动

本文旨在研究地方政府的相机抉择政策对经济增长和产出波动的实际影响。本文首先从预算软约束和晋升激励的角度分析这一政策的作用方式，然后用模型测度出相机抉择政策，并以2000—2013年的省际面板数据进行实证检验。研究表明，相机抉择的确刺激了地方经济增长，但却带来了明显的产出波动。不过相机抉择政策具有明显的时滞，其真实效果集中凸显在政策实施的两年后。因此，我国应加强公共财政制度的建设，使相机抉择政策在规则的框架下更为合理地使用。     

Housing price,talent movement,and innovation output: Evidence from Chinese cities

How housing costs would influence the job‐housing choice of talent and associated city‐level innovation performance is a question of interest for urban development policies. Recently, considerable attention has been paid to the influence of rising housing prices on the attraction of talent and the associated innovation output in major Chinese cities. In this paper, we use the housing price data of 51 cities from the China Real Estate Index System database and the corresponding macro data of China City Statistical Yearbooks from 2005 to 2014 to analyze this focal research question. The empirical analysis shows that the increase in city housing prices generally correlates positively with city innovation outcome and talent attraction, suggesting no crowding‐out effect on the innovative performance of the city. However, the positive association between housing prices and innovation outcome and talent attraction has started to disappear in first‐tier cities in recent years, suggesting potential crowding‐out effect if the increasing housing prices transform to bubbles. This research thus provides considerable policy implications concerning the impacts of housing prices on talent movement and innovation output.     

Institutions,quality competition and public service provision: The case of public education

This paper contributes to the literature on integovernmental competition in two ways. First, the institutional setting within which public services are delivered is analyzed with respect to the impact on the quality of services provided. Previous studies have measured competition only in terms of governmental structure, ignoring the issue of service quality and the potential for differentiating local governmental jurisdictions along quality dimensions. Second, the outcome of competition is defined in terms of service quality. Previous studies generally have measured the outcome of competition by examining the fiscal effects of fragmentation and accountability through service costs or tax revenue impacts. School districts were used to empirically test quality competition. Student academic performance was modeled as a function of control variables and the degree of competition from neighboring school districts. Academic performance in public schools was positively associated with the performance of neighboring districts, although the effect was small. These findings, however, suggest that strategies to strengthen interjurisdictional competition may be useful in enhancing public service quality.     

The political economy of public education

I study the relationship between income inequality and public spending in education in a voting model. Voters collectively choose the uniform quality level of public education, the amount of a public good, and the tax rate on labor income. Parents can decide to opt-out of the public education system by purchasing private education at the desired quality level, and children’s expected income is assumed to be increasing in the quality of education. I show that higher income inequality is associated with higher governmental spending in education if and only if the expected marginal returns to education are larger for the children of relatively low income parents. In turn, better public education tends to reduce future inequality. These results are consistent with most findings in the empirical literature about public investment in education. Lastly, I show that for other kind of publicly provided goods, such as health care, the relationship with income inequality exhibits an ambiguous or opposite sign.     

DOES SCIENTIFIC AND TECHNICAL RESEARCH REDUCE MACROECONOMIC VOLATILITY?

This paper explores whether conducting scientific and technical (S&T) research reduces the volatility of output growth. The paper finds robust evidence that output volatility is significantly lowered by a country's production of S&T publications. The results show that the effect of S&T publications on output volatility is particularly strong in middle‐income, OECD and other high‐income countries. However, for East‐Asian, low‐income and sub‐Saharan African countries the effect is either weak or absent. These results provide strong evidence that not only OECD and other high‐income countries are actively engaged in S&T research, emerging developing countries are also conducting S&T research, which is effective in reducing output volatility. The results are robust to adding a host of control variables, various subsamples and different estimation techniques.     

INEQUALITY AND POVERTY IN JAPAN*

This paper presents a brief survey of inequality and poverty in Japan. It shows empirical evidence on the extent of both inequality in income distribution and of poverty rates; the paper discusses the cause of increases in both these variables, and the implication of such trends. The paper goes on to argue the difference between inequality of opportunity and inequality of outcome and shows some related empirical evidence. Finally, the paper investigates the relationship between economic efficiency and equity, supposed to be in a trade‐off relationship, and presents my personal view of that relationship and policy recommendations.     

我国外贸出口与实际产出关系的季节单整与协整分析

本文根据Lamfalussy模型运用季节误差修正模型和季节单整与协整方法,利用1984年1季度至2004年4季度未经季节调整数据研究了我国的实际产出和出口之间的关系.实证分析表明:尽管出口对实际产出有显著的促进作用,但强度却不大,出口依存度每提高1%,实际产出增长率仅提高0.078%,其原因是我国季度实际产出和出口之间不存在(零频率上)长期协整关系,只存在π频率上短期季节协整关系.本文结果有助于消除人们对于人民币升值造成出口减少影响经济增长的顾虑.     

Investments in worker health and production: Evidence from Vietnam

In manufacturing industries, occupational health and safety measures ensure better working conditions for employees, which may influence their productivity. We study the impact of investments undertaken by small and medium enterprises in Vietnam in mitigating indoor pollution (including air quality improvements, heat and noise protection as well as lighting) on firm-level gross output and value added. We find that the amount invested by the firm in health has a significant positive effect on both outcomes. Given historically poor working conditions in Vietnam, policy implications relate to incentivizing and enabling firms to undertake such investments, on both moral and economic grounds.     

Pollution,Private Investment in Healthcare,and Environmental Policy*

In this paper, we demonstrate that, in a two‐period overlapping‐generations model, the relationship between environmental taxation and economic activity (output level and growth) has an inverted‐U shape when we take into account the detrimental impact of pollution on health and the individual decision of each working‐age agent to improve her health. We also demonstrate that the link between environmental tax and lifetime welfare also has an inverted‐U shape, and that a tighter environmental policy might enhance economic activity while reducing steady‐state lifetime welfare. Finally, we investigate the social optimum and the determinants of the optimal environmental tax.     

Transforming Malaysia's Higher Education: Policies and Progress

Malaysia's higher education sector has a substantial number and diverse types of public and private providers, which have contributed toward improving access. Over time, with improved access, there are increasing policy efforts directed toward improving the quality of higher education to meet the desired human capital needed for advancing economic development. This paper assesses three key areas that have been undertaken to improve the quality of higher education, their measurements, achievements, outstanding challenges, and ensuing implications on future policy directions. The key performance indicators used for monitoring quality improvements show that some targets have been achieved. A review of the approach used to measure performance and a consolidation of the sector are needed for further quality improvement.     

Do Education and Income Really Explain Inequalities in Health? Applying a Twin Design

We apply a twin design to examine the relationship between health and education and income. The estimated associations between health and education and income, controlling for unobserved endowments, at the twin‐pair level, are lower than estimates obtained via ordinary least‐squares (OLS) on the same sample. Thus, OLS‐based effects of education and income are biased, exaggerating the contribution of education and income to health inequality. The main part of health inequality is explained by within‐twin‐pair fixed effects, incorporating family background and genetic inheritance. It appears that education and income policies have less to offer for reducing health inequality than is usually assumed.     

Foreign aid,institutional quality and economic growth: Evidence from the developing world

This paper examines the effect of sectoral foreign aid and institutional quality on the economic growth of 74 developing countries from Africa, Asia and South America, and covers the period 1980–2016. We consider bilateral aid flows into three sectors, namely education, health and agriculture, and find that among the three types of aid, education aid is more effective for aid-receiving countries. The effect is conditional on the current level of institutional quality and varies substantially across regions. While education aid is more effective in South America, health aid is more effective in Asia and agricultural aid is more effective in Africa. As the level of institutional quality improves, the gap between the marginal effect of education, health and agricultural aids widen. Our findings have strong policy implication for donor countries and international aid organisations, which shows that it is more desirable to shift aid flows towards the education sector as the level of institutional quality improves.