纵向财政失衡、FDI竞争与医疗卫生服务供给水平——兼论标尺竞争机制下地区间的策略性行为北大核心CSSCI

关于医疗卫生服务供给不足的原因一直是社会各界高度关注的重点话题,现行的财政分权制度常被认为是最主要的原因。本文尝试将表征现行财政分权制度特征的三个要素,即纵向财政失衡、地区FDI竞争和地区间竞争模仿的策略性行为,与医疗卫生服务供给水平纳入同一分析框架,在对其理论机制分析的基础上,利用2007-2018年277个地级及以上城市面板数据,实证考察它们之间的关系特征及机制路径。研究发现,纵向财政失衡与地区FDI竞争对医疗卫生服务供给水平均存在显著的抑制作用,同时,地区FDI竞争对纵向财政失衡的负向抑制作用具有正向调节效应。进一步分析发现,地方政府间的标尺竞争使其在医疗卫生服务供给行为上表现出明显的策略模仿,医疗卫生服务供给水平呈明显的空间溢出效应。异质性分析发现,发达地区医疗卫生服务供给水平受抑制的主因是FDI竞争所致,欠发达地区则主要缘于纵向财政失衡的显著影响。机制分析发现,纵向财政失衡通过作用于财政支出结构与医疗卫生支出效率两种方式实现对医疗卫生服务供给水平的抑制,而FDI竞争则主要是通过扭曲财政支出结构的方式实现其抑制作用。本文的研究丰富了医疗卫生服务供给不足制度性成因探寻的文献,对于如何全面推进新一轮财税体制改革、深化医疗卫生体制改革、优化政绩考核指标等具有借鉴意义。     

公众健康权与药品专利权:利益冲突及其政策选择

药品专利权与公众健康权的冲突由来已久,通过政府药品管制及现存法律制度提供的强制许可与平行进口路径,并不能得到有效解决冲突。政府基于责任伦理在国民收入第二次分配中的补偿机制,应当是现阶段公众健康权实现的较为可行的政策选择。     

Interpretive structural modeling of quality factors in both medical and hospitality services in the medical tourism industry

This study aims to theoretically integrate quality factors of both medical and hospitality services in medical tourism. Medical tourism comprises both medicine and tourism. Although the core product in medical tourism is medical treatment, attractive hospitality and travel options are also essential. Despite the dual nature of medical tourism, the two aspects of this concept have not been integrated in a unique framework. This study attempts to fill this gap using interpretive structural modeling (ISM). According to ISM, although factors of medical services and hospitality services are independent from each other, these factors have vital impacts on perceived value, satisfaction, and loyalty.     

Characteristics of a Medical Tourism Industry: The Case of South Korea

This study investigates the process involved in developing a medical tourism industry in South Korea as a case country, one of the fastest growing countries with strong potential in the medical tourism industry. It analyzed 252 articles on medical tourism posted on the websites of the Korean Tourism Organization and the Korean International Medical Association. Both sources are highly representative portal websites for medical tourism in the country. The article aims to enhance understanding of medical tourism as a new growth industry while identifying its key developmental characteristics and makes valuable suggestions for the industry that can be reflected to other countries. The study contributes theoretically and practically by examining the unique and updated characteristics and process of positioning of this recently emerging field in the global tourism industry.     

The main paths of medical tourism: From transplantation to beautification

Medical tourism, combining the very polarized purposes of pleasurable travel and potentially stressful health care services, is an emergent and growing business worldwide. Medical tourism patients are willing to travel abroad to seek better quality, lower cost, domestically unavailable, no wait-time destinations for non-emergency medical care. There are numerous related studies in the academic literature that are substantiated with multidisciplinary and diverse backgrounds. This study uses the main path analysis, a unique quantitative and citation-based approach, to analyze the significant development trajectories, important literature, and recent active research areas in medical tourism. We find that there are two distinctive development paths: one path focuses more on the evolution of medical tourism, the motivation factors, marketing strategies, and economic analysis; the other path emphasizes organ transplant and related issues. These two paths eventually merge to a common node in the citation network, which foretells transplantation to beautification as the future research direction trend.     

医工交叉创新成果转化中法律制度保障研究

医工交叉是医疗器械持续创新的基础动力,是我国医疗器械产业升级的关键.近年来,我国出台了一系列政策促进科技成果转化,但医工交叉领域具有周期长、多方参与、投资巨大等特点,导致其失败风险高并制约了科技成果转化的效率.本文通过分析医工交叉成果转化中存在的问题,从法律保障的视角提出能够促进科技成果转化的法律制度建议,从科研工作者...     

医患纠纷法律适用探析

近年来,对医患纠纷的法律适用问题,理论及司法实践中均存在争议,这既不利于化解日益尖锐的医患矛盾,也有碍于对医患双方利益的维护。在明确医患纠纷法律适用的前提条件、理论基础及关键的基础上,提出医患纠纷应适用《民法通则》《合同法》等民事法律规范调整;医患纠纷原则上应属于《消法》调整,但由于医疗服务的高风险性的特征,应予以区别对待。     

Rewarding the introduction of multiparty elections

Do aid donors reward the adoption of multiparty elections? Are multiparty elections rewarded in both democracies and electoral authoritarian regimes? How do the rewards for institutional reforms compare to the rewards for substantive improvements in governance and political rights? These questions are of particular interest given both the spread of democracy and the emergence of autocracies with multiparty elections for the executive and legislature as the modal form of authoritarianism. To answer these questions, we examine temporal dynamics in aid flows before and after transitions to multiparty elections and the strategic allocation of aid rewards to specific sectors depending upon electoral competition and substantive improvements in governance and political rights. We find that, in the post-Cold War era, bilateral and multilateral donors reward the adoption of multiparty elections in both democracies and electoral authoritarian regimes while also rewarding substantive improvements in governance and political rights. Sector specific analyses reveal that multiparty elections are rewarded with greater democracy aid and economic aid in both democratic and electoral authoritarian regimes. Nevertheless, the quality of elections matters: the adoption of democratic elections receives greater aid gains than the adoption of authoritarian elections.     

Economic outcomes of exenatide vs liraglutide in type 2 diabetes patients in the United States: results from a retrospective claims database analysis

Abstract

Objective:

The safety and efficacy of the GLP-1 receptor agonists exenatide BID (exenatide) and liraglutide for treating type 2 diabetes mellitus (T2DM) have been established in clinical trials. Effective treatments may lower overall treatment costs. This study examined cost offsets and medication adherence for exenatide vs liraglutide in a large, managed care population in the US.

Methods:

This was a retrospective cohort analysis comprising adult patients with T2DM who initiated exenatide or liraglutide between 1/1/2010 and 6/30/2010 and had 6 months pre-index and post-index continuous eligibility. Patients were propensity score-matched to controls for baseline differences. Medication adherence was measured by proportion of days covered (PDC). Paired t-test and McNemar’s test were used to compare outcomes.

Results:

Matched exenatide and liraglutide cohorts (n?=?1347 pairs) had similar average total 6-month follow-up costs ($6688 vs $7346). However, exenatide patients had significantly lower mean pharmacy costs ($2925 vs $3272, p?<?0.001). Among liraglutide patients, patients receiving the 1.8?mg dose had significantly higher average total costs compared to those receiving the 1.2?mg dose ($8031 vs $6536, p?=?0.026), with higher mean pharmacy costs in the 1.8?mg cohort ($3935 vs $3146, p?<?0.001). There were no significant differences in inpatient or outpatient costs or medication adherence between groups (mean PDC: exenatide 56% vs liraglutide 57%, p?=?0.088).

Limitations:

The study assumed that all information needed for case classification and matching of cohorts was present and not differential across cohorts. The study did not control for covariates that were unavailable, such as HbA1c and duration of diabetes.

Conclusions:

Patients initiating exenatide vs liraglutide for T2DM had similar medication adherence and total healthcare costs; however, exenatide patients had significantly lower total pharmacy costs. Patients prescribed 1.8?mg liraglutide had significantly higher costs compared to those on 1.2?mg.     

Globalization with a human face

This paper has six parts. The first part defines globalization. The second discusses globalization eras. The third discusses the irreversibility and inevitability of globalization. The fourth section discusses the benefits and costs of globalization. The fifth section asks what is to be done. The sixth section contains my conclusions.