Converting retirement benefit into a life care annuity with graded benefits*

This paper deals with life care annuities, i.e. bundled products comprising a life annuity and long-term care insurance. It aims to assess the cost of converting retirement benefit into a life care annuity with graded benefits using a pre-existing public pay-as-you-go pension scheme. With this objective in mind, we present an actuarial method based on array calculus for valuing this type of life care annuity. The health dynamics of the annuitant rely on a reversible illness-death multistate framework. The paper contains a numerical example in which mortality and disability assumptions are based on data from the USA and Australia, although this should be viewed simply as an illustration. In addition, in order to check the coherence of these data, we compute life expectancy for both healthy and dependent persons, and then for dependent persons in each of the states of dependence. The effect of ruling out the recovery assumption on the annuity’s cost is also assessed. The analysis provides valuable insights into how much it would cost to introduce these annuities and enables us to make some policy recommendations to help ensure that this combined pension scheme has a good actuarial design.     

番茄皮保健蛋糕的工艺研究

本文以面粉、糖、番茄皮渣粉为主要原料制作番茄皮保健蛋糕,通过正交实验得到的优化最佳工艺条件为:100 g低筋面粉中,添加鸡蛋210%,糖10%,番茄皮粉15%,搅打时间14 min。蛋糕成品表面金红、有光泽,质地松软、有弹性,口感鲜香微甜,略带番茄味。     

Ambulance response time in a Brazilian emergency medical service

Research efforts on ambulance response times for Emergency Medical Services (EMS) calls have been made for decades, especially in developed countries, using different techniques and with varying objectives. In Brazil, a developing country, the scarce scientific production on this vital indicator prioritizes scenarios for EMS in cities with more than one million inhabitants. This shows the importance of extending research to the reality of small and medium-sized cities. This paper presents SAMU, the Brazilian EMS that follows the Franco-German emergency medicine model, compiling numbers related to service at the national level. The use of quantile regression allows the identification of the RT for the EMS and helps to explain the effects of factors at the system level, at the patient level, and specific factors on response time intervals of Southwest Paraná SAMU. This specific EMS, characterized as an inter-municipal consortium of prehospital services, is responsible for prehospital emergency care for an approximate population of 635,000 inhabitants in 42 small towns in the State of Paraná in southern Brazil. From the analysis of the records of 12,050 ambulance dispatches, it was possible to identify the average ambulance response time of 14 min and 25 s. The regression model was able to explain the influence of the independent variables at the system level (presumed severity of the emergency, ambulance dispatch time, and ambulance travel time), at the patient level (age, gender, and characteristic of the emergency) and specific variables of the emergency (day of the week and time of day) on the dependent variable response time over the quantiles, showing that the dispatch time, travel time, time of day, service to male patients and critical cases influence the ambulance response time. This work contributes to deepening the understanding of the management of EMS operations in a developing country, allows the comparison of the RT identified in relation to other countries, and identifies factors that impact the RT for other actors directly or indirectly involved. The practical implications are also presented, as well as how the study impacts the decision-making and management process of the EMS in the short, medium and long term.     

Can the affordable care act provisions explain the recent wave of acquisitions in the health insurance industry?

This research shows that the ACA health insurance exchanges have generated more merger activity in the health insurance market. The impact is robust to control for an extensive set of factors suggested by both neoclassical and behavioural frameworks. The economic impact of this ACA provision is substantial with 3.8 more months of unusually high merger activity or 52 more merger bids per year.     

Economic burden associated with inadequate antidepressant medication management among patients with depression and known cardiovascular diseases: insights from a United States–based retrospective claims database analysis

Abstract

Aims: The current study examined the association between insufficient major depressive disorder (MDD) care and healthcare resource use (HCRU) and costs among patients with prior myocardial infarction (MI) or stroke.

Methods: This was a retrospective study conducted using the MarketScan Claims Database (2010–2015). The date of the first MI/stroke diagnosis was defined as the cardiovascular disease (CVD) index date and the first date of a subsequent MDD diagnosis was the index MDD date. Adequacy of MDD care was assessed during the 90 days following the index MDD date (profiling period) using 2 measures: dosage adequacy (average fluoxetine equivalent dose of ≥20?mg/day for nonelderly and ≥10?mg/day for elderly patients) and duration adequacy (measured as the proportion of days covered of 80% or higher for all MDD drugs). Study outcomes included all-cause and CVD-related HCRU and costs which were determined from the end of the profiling period until the end of study follow-up. Propensity-score adjusted generalized linear models (GLMs) were used to compare patients receiving adequate versus inadequate MDD care in terms of study outcomes.

Results: Of 1,568 CVD patients who were treated for MDD, 937 (59.8%) were categorized as receiving inadequate MDD care. Results from the GLMs suggested that patients receiving inadequate MDD care had 14% more all-cause hospitalizations, 4% more all-cause outpatient visits, 17% more CVD-related outpatient visits, 13% more CVD-related emergency room (ER) visits, higher per patient per year CVD-related hospitalization costs ($21,485 vs. $17,756), higher all-cause outpatient costs ($2,820 vs. $2,055), and higher CVD-related outpatient costs ($520 vs. $434) compared to patients receiving adequate MDD care.

Limitations: Clinical information such as depression severity and frailty, which are potential predictors of adverse CVD outcomes, could not be ascertained using administrative claims data.

Conclusions: Among post-MI and post-stroke patients, inadequate MDD care was associated with a significantly higher economic burden.     

重大突发公共卫生事件科技研发应急体系运行机制研究

在突发事件应急管理过程中,科技研发支撑作用十分关键,亟需建立突发公共卫生事件科研应急体系长效运行机制。基于科技研发应急体系的复杂性、适应性特征,从主体属性和体系架构两个层面入手,分析重大突发公共卫生事件科技研发应急体系的复杂适应系统特征,运用复杂适应系统理论模型和动态闭环螺旋模型,研究重大突发公共卫生事件科技研发应急体系运行机制。研究发现,重大突发公共卫生事件背景下,科技研发应急体系具有复杂适应系统的7个基本特征,是典型的复杂适应系统;科技研发应急体系中,科研攻关专家组、诊疗医院、科技部门等科研主体具有各自内部模型,并通过6大标识进行聚集;科技研发应急体系存在事件—需求引导、主体协同、资源交互、成果转化机制。同时,新冠病毒肺炎疫情应对实践表明,疫情防控救治进程中科技研发应急体系存在并遵循上述运行机制。     

提高出生人口素质的孕前—围孕保健模式的再讨论

随着人口再生产类型和疾病模式发生根本性的转变,我国政府已对提高出生人口素质和出生缺陷预防给予了高度重视。在过去十年中,随着对孕前保健和出生缺陷-级预防重要性认识的逐步加深,我国出生缺陷预防工作正努力从产前—围产保健模式逐步扩展到孕前—围孕保健模式。尽管如此,近几年的实践表明出生缺陷预防模式的转变依然面临诸多的挑战。对孕前—围孕保健预防模式相关的几个问题进行了讨论,包括计划怀孕的重要性、-级预防应采取何种策略、能力建设和发展。     

加速城市建设应注意的几个问题

目前,我国城市化进程不断加快,城市数量增加,规模扩大,成效显著.但是,也必须清醒地看到,城市建设工作中的短期行为和浮躁之风相当严重,应当引起人们的高度重视.本文认为,城市规模扩张必须以产业支撑为前提,不能搞空壳城市;城市公共设施建设慎向民资伸手,不能滥用市场化手段;居民区搬迁改造应多些人文关怀,不能一拆了之;应遵循城市发展的客观规律,正确处理城市建设中的几个关系问题.     

The effectiveness of government spending on education and health care in developing and transition economies

Recent studies show that corruption is associated with higher military spending [Eur. J. Polit. Econ. 17 (2001) 794] and lower government spending on education and health care [J. Publ. Econ. 69 (1998) 263]. This suggests that policies aimed at reducing corruption may lead to changes in the composition of government outlays toward more productive spending. However, little empirical evidence has been presented to support the claim that public spending improves education and health indicators in developing and transition countries. This paper uses cross-sectional data for 50 such countries to show that increased public expenditure on education and health care is associated with improvements in both access to and attainment in schools, and reduces mortality rates for infants and children. The education regressions are robust to different specifications, but the relationship between health care spending and mortality rates is weaker.     

莆田市发展“医养一体化”服务模式的对策研究

随着银色浪潮来袭,如何养老已成为我国各城市重点关注的问题。将医疗机构、养老机构、社区医疗服务中心当中的医疗资源与养老资源进行共享交流,搭建“医养一体化”平台,是我国养老服务的发展趋势。论文研究了莆田市如何突破传统养老方式的局限性,推行“医养一体化”服务模式,探讨“医养一体化”平台的搭建对策。