Comparative analysis of health care costs in Japan and the United States: a simulation of productivity and savings behavior

Japan and the United States, though contrastive in terms of the percentage of the elderly in their population and the ratio of their health care costs to GDP, both face soaring medical expenditures. Sato et al. [Health Care Systems in Japan and the United States: A Simulation Studies and Policy Analysis. Kluwer Academic Publishers, Hingham, MA] developed a model to solve this problem by increasing the productivity of the non-health care sector. This study has applied that model to estimate national savings, and compared these savings with estimated health care costs. The results show that in order for savings to exceed expenditures the US needs to have a higher savings rate and a higher interest rate than Japan.     

Health as a consumption object: research notes and preliminary investigation

Through the processes of commodification and marketization, materials and human activities are brought within the domain of market exchange. The results of these accelerating processes are observed in the consumer culture centred on objects of consumption. We contend that, in addition to healthcare, health itself has become yet another object incorporated within consumption space. This contention is consistent with the perspective of consumption as the dominant social paradigm in the structuring of health and healthcare practices. In this paper we present the conceptual backdrop for our contentions, together with details of a heuristic study. Our findings support the view that people regard health as a consumption object. Furthermore, the evidence suggests a patterning of responses by social grade and gender. Given our wider interest in class‐based health inequalities, we use our results to comment on the broader policy debate concerning this phenomenon in relation to consumerism.     

Do physician incentives affect hospital choice? A progress report

The US health reforms of March 2010 introduced new provisions for physicians providing Medicare and Medicaid services to be given financial incentives to control costs. Physician payment mechanisms generating similar incentives are currently used by some health maintenance organizations in California. We describe an ongoing research project in which we investigate physician responses to these payment schemes. The question is whether patients whose physicians have incentives to control hospital costs are admitted to lower-priced hospitals than other patients, all else equal. We provide an initial analysis of California hospital discharge data from 2003, documenting evidence consistent with this hypothesis.     

‘Globesity’? The effects of globalization on obesity and caloric intake

We examine the effect of globalization, in its economic and social dimensions, on obesity and caloric intake, namely the so –called ‘globesity’ hypothesis. Our results suggest a robust association between globalization and both obesity and caloric intake. A one standard deviation increase in globalization is associated with a 23.8 percent increase in obese population and a 4.3 percent rise in calorie intake. The effect remains statistically significant even after using an instrumental variable strategy to correct for some possible reverse causality and ommited variable bias, a lagged structure, and corrections for panel standard errors. However, we find that the primary driver (of the ‘globesity’ phenomenon) is the ‘social’ rather than the ‘economic’ dimension of globalization, and specifically the effect of changes in ‘information flows’ and ‘social proximity’ on obesity. A one standard deviation increase in social globalization increased the percentage of obese population by 13.7 percent.     

非农就业、母亲照料与儿童健康——来自中国乡村的证据

中国农村女性参与非农就业的比例显著提高,对于增进家庭收入、减少贫困起到了积极的作用。但从女性在家庭中的双重身份——挣取收入者和照看孩子的主要人员出发,其劳动模式和供给行为的改变对于下一代福利的影响和人力资本的积累所起到的作用却是不确定的。本文通过将农村地区妇女的劳动供给状况进行区分,就其劳动参与行为对孩童健康状况的影响进行了探讨。在控制其他因素的情况下,母亲额外单位的劳动时间的增加对孩子的健康状况具有显著的负向影响,且同样的母亲非农劳动时间的增加对于孩童健康的负面影响大于农业劳动时间增加的影响程度,而母亲收入增加对孩子健康状况具有显著的正向影响;边际效果分析表明母亲收入增加对孩子健康的正向影响难以抵销劳动时间增加所带来的负面效果。孩子性别不同所受到的影响亦不同,女童相对而言处于健康的劣势地位。虽然母亲的劳动供给有助于缩小孩子营养状况的性别差距,但却是以所有儿童的健康状况下降为代价的。研究结果预期具有较强的政策含义。     

中国医疗保险体系中的自选择与医疗费用——基于灵活就业人员参保行为的研究

我国社会医疗保险已实现全覆盖,现阶段的主要问题在于医保基金能否实现可持续运行。在现行制度安排下,灵活就业群体参加城镇职工医疗保险可能存在逆选择问题,随着就业形态日趋多样化,这将加剧基金运行的不平衡。本文基于2012-2014年中国家庭追踪调查数据(CFPS),利用中国特有的制度特征,在实证上将逆选择效应同道德风险相区分,验证了选择参加城镇职工医保的人群是医疗费用较高的人群。估计表明,自愿选择参加城镇职工医保的人群医疗支出明显高于强制参保群体,大约高78%;而选择参加城镇职工医保的人群医疗支出比选择参加城乡居民医保高约45%。灵活就业人员参加城镇职工医保提升了他们的福利,但如何规避潜在的基金运行风险,是医保制度设计中不可忽视的问题。     

城镇化视角下的农村人力资本投资研究

本文在分析农村人力资本投资对城镇化的重要作用的基础上,指出了当前农村人力资本投资中存在的影响城镇化发展的种种不足.最后,在城镇化的视角下,提出了改善农村人力资本投资的建议.     

The supreme struggle: ‘Obamacare’ and the new limits of federal regulation

On June 28, 2012, the U.S. Supreme Court rejected legal challenges to the Patient Protection and Affordable Care Act, commonly known as ‘Obamacare,’ by a vote of 5-4. In National Federation of Independent Business v. Sebelius (2012), a majority of the justices affirmed Congress's power to expand Medicaid and impose an individual mandate requiring people to obtain health insurance or face increasing tax penalties. The Court's decision was widely condemned as a dramatic expansion of federal power that threatened state sovereignty and individual liberty. The Court was heavily criticized for betraying the principles of federalism and limited government in the U.S. Constitution. The harshest criticism was reserved for Chief Justice John Roberts, a Republican appointee who—though considered a conservative justice—authored the Court's opinion and cast the critical deciding vote to uphold the Act. In reality, far from dramatically expanding federal power, the Court's decision placed groundbreaking limits on Congress's power to regulate commerce and use federal funds to pressure states into doing its bidding. These aspects of the Court's decision received less attention in the popular media, but may actually prove to have a more significant impact on the scope of federal regulation in the future. This installment of Business Law & Ethics Corner explains how those aspects of the Court's decision place new limits on the nature and scope of federal regulation.