补充医疗保险的需求研究

根据上海市社会基本医疗保险的框架，我们设计了与之相对应的4个补充医疗保险方案，并调查了职工以这些补充医疗保险方案的意愿支付，分别建立了需求模型。结果显示：4个补充医疗保险方案各具特性，其需求不仅取决于各个方案的属性（其所覆盖的医疗费用风险损失及其发生概率）、价格与职工家庭收入，而更重要的是取决于职工本人的保险意识、态度与信息。补充医疗保险方案需求的平均价格弹性在－0．59～－3．84之间。对补充医疗保险的政策推动与市场监管应充分考虑到不同补充医疗保险方案的本质属性。     

成都市补充医疗保险办法及职工参保情况分析

对成都市现行4种补充医疗保险办法进行比较分析,并分别比较不同社会经济状况职工的补充医疗保险参保率,为完善和发展补充医疗保险提供参考依据。     

温州市补充医疗保险的需求及其影响因素研究

根据温州市职工基本医疗保险覆盖范围 ,笔者设计了与之对应的 5个补充医疗保险方案 ,调查了职工对这些补充医疗保险方案的意愿支付情况。结果表明 :5种方案的需求价格弹性在 0 .88～ 1 .3 4之间。覆盖特需医疗服务的方案D和E需求价格弹性较大 ,覆盖大病重病的方案A接受程度最高 ,价格弹性最小 ,应优先考虑加以推广。个人经济状况、医疗服务利用及对基本医疗保险的了解程度影响补充医疗保险需求。     

黑龙江省城镇职工补充医疗保险需求调查与影响因素分析

目的:了解黑龙江省城镇职工对补充医疗保险的需要、需求及影响因素.方法:采用分层抽样法,自制问卷对黑龙江省城镇职工补充医疗保险的需求进行个人调查.结果:只有18.2%的受访者了解补充医疗保险:29.67%受访者防范未知医疗疾病风险以个人存款为主要途径,还有16.92%没有任何准备;80.4%受访者愿意参加城镇职工补充医疗保险.在补充医疗保险的举办方式上,选择社会医疗保险机构举办的自愿性补充医疗保险居多,占45.5%.结论:政府医疗保障部门和商业医疗保险机构应该关注城镇职工的补充医疗保险需求,并要参考城镇职工实际需求意愿,制定适宜的城镇职工补充医疗政策和实施方案.     

温州市高收入职工对特需服务补充医疗保险的需求分析

笔者设计了覆盖基本医疗保险药品目录以外药品费用和特需服务的补充医疗保险方案1和2,通过对温州市高收入职工的意愿参与和意愿支付调查,发现收入、保险价格、对保险的认知、职业情况、罹患慢性病及其对基本医疗保险的了解程度等是影响高收入者对这两种方案意愿参保的主要因素;需求价格弹性分别为-1.07和-1.29。覆盖特需服务的补充医疗保险应注重个性化和多样化需求,并需注意逆向选择。     

对建立企业补充医疗保险的构想

企业补充医疗保险是对基本医疗保险起补充作用的一种医疗保障制度 ,是多层次的医疗保障体系的重要组成部分。目前 ,在实施基本医疗保险制度的统筹地区 ,大都同步建立了大额医疗费用互助制度 ,逐步落实了公务员医疗补助政策 ,但在建立企业补充医疗保险方面却相对滞后 ,致使一些现有医疗消费水平较高的特定行业和企业不愿参加基本医疗保险 ,即使参保了 ,也会因当地企业补充医疗保险政策不到位而产生一些意见 ,尽快出台并实施企业补充医疗保险办法已刻不容缓。一、建立企业补充医疗保险的条件、筹资与管理１．既然是对基本医疗保险的补充 ,建立…     

基本医疗保险的延伸——大病补充医疗保险

《云南省城镇职工大病补充医疗保险暂行办法》将于２０００年推出,该办法的实施将对省内患大病的城镇职工医疗费用的筹集、支付、经办机构等有一个明确的界定,从政策上保证了患大病职工的医疗问题。按照国内有关专家的论述,补充医疗保险应是基本医疗保险的补充和延伸,根据我国的国情,补充医疗保险应为“基本补充医疗保险”。本文将对即将推出的《云南省城镇职工大病补充医疗保险暂行办法》的适用范围、基金筹集、支付办法、经办机构及具体操作中可能遇到的问题作一简要分析。１《云南省城镇职工大病补充医疗保险暂行办法》概况１－１　…     

曲靖市职工补充医疗保险暂行办法

第一条　为了妥善解决基本医疗保险范围以外的医疗费用问题,根据全国城镇职工医疗保险制度改革工作会议精神和《曲靖市职工医疗保险暂行办法》的有关规定,特制定本办法。第二条　职工补充医疗保险是多层次医疗保险的重要组成部分。凡参加曲靖市职工基本医疗保险的单位都应建立职工补充医疗保险和执行本办法。第三条　职工补充医疗保险基金由参保单位建立和负责筹集。按单位全年职工工资总额的１％～４％的比例提取（进入成本费用）,并从福利费支出科目中列支。当年应筹集的职工补充医疗保险基金,以上年单位人均工资为依据,单位上年人均…     

社会医疗保险中需方制约机制的研究

人们的卫生服务需求受多种因素的影响.对于社会医疗保险参保人,其卫生服务需求主要取决于自身的健康状况、社会医疗保险制度和卫生服务价格.通过共同承担健康责任,合理确定自负医疗费用比例,实行医疗分级付费制等措施,能有效地对需方的求医行为和医疗消费进行调控.     

关于基本医疗保险补充办法的意见

一、提高对发展和完善基本医疗保险补充办法的认识。当基本医疗保险“主体”界定后，有必要同步策划对基本医疗保险各种补充办法。这将有利于协调各方利益，减少乃至消除“后顾之忧”，以利推进和巩固基本医疗保险制度。二、加强对基本医疗保险补充办法的理论研究和实践指导。目前，有的认为应少争论，多实践，后评价，鼓励试行多种补充办法，能解决问题就好；也有的认为要吸取国际医疗保险的经验，先规范（包括立法），再实施，在实践中不断修正、完善。我们认为应坚持理论联系实际的方针，在理论的指导下实践，在实践的基础上提高到理论。…     

Switching costs in competitive health insurance markets: The role of insurers' pricing strategies

Our article deals with pricing strategies in Swiss health insurance markets and focuses on the relationship between basic and supplementary insurance. We analyzed how firms' pricing strategies (i.e., pricing of basic and supplementary products) can create switching costs in basic health insurance markets, thereby preventing competition in basic insurance from working properly. More specifically, using unique market and survey data, we investigated whether firms use bundling strategies or supplementary products as low‐price products to attract and retain basic insurance consumers. To our knowledge, this is the first paper to analyze these pricing strategies in the context of insurance/health insurance. We found no evidence of bundling in the Swiss setting. We did however observe that firms used low‐price supplementary products that contributed to lock in consumers. A majority of firms offered at least one of such product at a low price. None offered low‐price products in both basic and supplementary markets. Low‐price insurance products differed across firms. When buying a low‐price supplementary product, consumers always bought their basic contract from the same firm. Furthermore, those who opted for low‐price supplementary products were less likely to declare an intention to switch basic insurance firms in the near future. This result was true for all risk category levels.     

The effect of premiums on the decision to participate in health insurance and other fringe benefits offered by the employer: evidence from a real-world experiment

In this paper, we investigate the effect of the out-of-pocket premium on the decision to enroll in employer health insurance and other benefits plans including dental insurance, vision care, long-term care insurance, and wellness benefits. Previous estimates of the effects of premium on takeup of health insurance could be biased toward zero due to a correlation between premium and unobservable demand or plan quality. We solve this problem using data representing hypothetical choices by employees under three different price regimes, providing price variation uncorrelated with either individual-specific or plan-specific unobservables. We find that workers are insensitive to price in health insurance takeup. Workers show much greater price sensitivity to decisions about dental insurance, vision plans, long-term care insurance, and wellness benefits. We conclude that premium subsidies are unlikely to have a substantial impact on increasing insurance rates of workers already offered employer insurance.     

Health insurance take-up by the near-elderly

OBJECTIVE: To examine the effect of price on the demand for health insurance by early retirees between the ages of 55 and 64. DATA SOURCE: Administrative health plan enrollment data from a medium-sized U.S. employer. STUDY DESIGN: The analysis takes advantage of a natural experiment created by the firm's health insurance contribution policy. The amount the firm contributes toward retiree health insurance coverage depends on when a person retired and her years of service at that date. As a result of this policy, there is considerable variation in out-of-pocket premiums faced by individuals in the data. This variation is independent of the nonprice attributes of the health insurance plans offered and is plausibly exogenous to individual characteristics that are likely to affect the demand for insurance. A probit model is used to estimate the decision to take-up employer-sponsored health insurance by early retirees between the ages of 55 and 64. Demand for insurance is measured as a function of out-of-pocket premiums and a set of individual characteristics. PRINCIPAL FINDINGS: We find that price has a small but statistically significant effect on the decision to take up coverage. Estimated price elasticities range from -0.10 to -0.16, depending on the sample. CONCLUSIONS: The implied elasticities are comparable with results found in previous studies using very different data. Our estimates indicate that policy proposals for a Medicare buy-in or a nongroup tax credit will have a modest impact on take-up rates of near-elderly retirees.     

Health care plans: interfaces between the public and private system in the dental sector

The present work presents a brief history of health plans in Brazil examining the interface between the public and the private sector. The evolution and regulation of the supplementary care system is analyzed, the different care modalities are defined and the main differences between health plans and dental care insurance are pointed out. The coverage provided by the supplementary care system and its relationship with the public health system is shown on the basis of current data. On the other hand, the study focuses on the care services, health plans and the labor market in the sector correlating, also on the basis of current data, the challenges and new opportunities of the supplementary care market, mainly in the dental sector. Although the dental sector is living an extraordinary moment within the private health care system and given that ANS data are pointing to a growth of this sector of 210% over last the 7 years, the service coverage of the supplementary care sector mainly directed to medical and inpatient care does not meet the real demand for integrated health care.     

Differences in price elasticities of demand for health insurance: a systematic review

Many health insurance systems apply managed competition principles to control costs and quality of health care. Besides other factors, managed competition relies on a sufficient price-elastic demand. This paper presents a systematic review of empirical studies on price elasticity of demand for health insurance. The objective was to identify the differing international ranges of price elasticity and to find socio-economic as well as setting-oriented factors that influence price elasticity. Relevant literature for the topic was identified through a two-step identification process including a systematic search in appropriate databases and further searches within the references of the results. A total of 45 studies from countries such as the USA, Germany, the Netherlands, and Switzerland were found. Clear differences in price elasticity by countries were identified. While empirical studies showed a range between ?0.2 and ?1.0 for optional primary health insurance in the US, higher price elasticities between ?0.6 and ?4.2 for Germany and around ?2 for Switzerland were calculated for mandatory primary health insurance. Dutch studies found price elasticities below ?0.5. In consideration of all relevant studies, age and poorer health status were identified to decrease price elasticity. Other socio-economic factors had an unclear impact or too limited evidence. Premium level, range of premiums, homogeneity of benefits/coverage and degree of forced decision were found to have a major influence on price elasticity in their settings. Further influence was found from supplementary insurance and premium-dependent employer contribution.     

Consumer price sensitivity in Dutch health insurance

Aim To estimate the price sensitivity of consumer choice of health insurance firm. Method Using paneldata of the flows of insured between pairs of Dutch sickness funds during the period 1993–2002, we estimate the sensitivity of these flows to differences in insurance premium. Results The price elasticity of residual demand for health insurance was low during the period 1993–2002, confirming earlier findings based on annual changes in market share. We find small but significant elasticities for basic insurance but insignificant elasticities for supplementary insurance. Young enrollees are more price sensitive than older enrollees. Conclusion Competition was weak in the market for health insurance during the period under study. For the market-based reforms that are currently under way, this implies that measures to promote competition in the health insurance industry may be needed.      

Managed competition and consumer price sensitivity in social health insurance

This paper examines whether the introduction of managed competition in Dutch social health insurance has resulted in effective price competition among insurance funds. We find evidence of limited price competition, which may be caused by low consumer price sensitivity. Using aggregate panel data from all insurance funds over the period 1996-1998, estimated premium elasticities of market share are -0.3 for compulsory coverage and -0.8 for supplementary coverage. These elasticities are much smaller than in managed competition settings in US group insurance. This may be explained by differences in switching experience and higher search costs associated with individual insurance.     

Issues regarding health plan payments under Medicare and recommendations for reform.

The failures of the market for current Medicare health plans include poor information and price distortions and can be attributed to government policy. Reforms that could improve its structure are annual open enrollment periods, premium rebates from health management organizations (HMOs) to members, and termination of the federal government's subsidy of Medicare supplementary insurance. However, the price for a basic Medicare benefits package would still be distorted because Medicare bases its contribution on the cost of a comparable package in the fee-for-service (FFS) sector rather than on the cost of the most efficient plan available to beneficiaries in each market area. The present Medicare HMO program almost certainly increases total Medicare costs and actually discourages HMO growth by shielding beneficiaries from the true price difference between basic benefits in the HMO and FFS sectors. Lacking payment reforms, the Medicare HMO program should be terminated.     

农村医疗保险需求影响因素分析

农村医疗保险市场的发展有赖于市场需求的不断扩张，而医疗保险需求又受到医疗保险价格、消费者收入水平、疾病风险程度预期、健康状况、文化水平、消费者对政府政策稳定性预期等因素的影响。