ILO筹资模型与核密度估计方法在社会健康保险精算的应用研究

目的探讨国际劳工组织(znteruational Labour Office,ILO)筹资模型与核密度估计方法在我国社会健康保险精算领域应用的可行性和价值。方法依据ILO筹资建模思路建立的社会健康保险短期筹资比例计算框架作为主要的精算方法 ,其中的成本估计模型采用核密度估计拟合赔付额分布来估计次均基金赔付额。结果将非参数核密度估计方法所估计出的次均保险基金赔付额应用到ILO筹资模型中,计算得到2005年成都市城镇职工住院医疗保险的筹资比例为4.7%。结论研究表明,ILO筹资结构完整、灵活,将其应用到社会健康保险精算领域是可行的;非参数核密度估计作为次均保险基金赔付额的估计方法是适合的。将ILO筹资模型与核密度估计相结合计算筹资比例的尝试为健康保险精算方法提供了一种新的思路和方法 。     

农村健康保险的精算体系

本文提出了我国农村健康保险的精算体系和测算保险费、管理费、储备金、预防保健费、保险因子、增加系数、医药费及其补偿比的实用方法。     

韩国私人健康保险的国际化比较

该文介绍韩国私人健康保险的历史和政策背景,并分析了增加私人健康保险在抵消政府融资、增加社会保障缴款、减少个人支出并帮助稳定医疗费用总支出方面的作用.该研究采用了固定效应模型评估的方法,允许误差项随时间呈序列相关,以获取私人健康保险融资与医疗卫生融资及医疗费用总支出的三个组成部分之间的关系.韩国的社会保障缴款相对有限,这意味着通过提高国民健康保险保障范围以及增加社会保障缴款,高额个人支出可能得到缓解.评估结果证实,私人健康保险的融资是不可能减少政府在医疗卫生和社会保障缴款方面的开支的.在一定程度上个人支出可以通过私人健康保险的融资而减少.但私人健康保险融资与医疗费用总支出在统计上呈显著的正相关.研究发现,几乎没有证据表明增加私人保险的举措在应对韩国国民健康保险计划的财政挑战时具有优势.进一步研究公共和私人保险公司之间的相互影响和供应商与患者的行为反应,对即定的私人-政府财政结构而言是必要的,以便使私人健康保险和政府资助的全民健康保险之间达到足够的平衡.     

对商业健康保险与社会医疗保险衔接的探讨

通过系统研究和描述商业健康保险、社会医疗保险的发展现状，论述建立商业健康保险与社会医疗保险衔接机制的必要性，剖析目前存在的问题，并结合新“医改”政策，从提高健康保险公司专业化程度及产品创新等方面提出建立合理衔接机制的政策建议。     

商业健康保险与社会医疗保险协同发展的动力机制

社会医保体系是一个远离平衡态的开放系统,保障功能的实现是其演化的序参量,决定着整个系统的演化进程与方向。只有商业健康保险与社会医疗保险实现协同发展,医保体系才能有效控制医疗风险,降低医疗费用,实现保障功能最大化。在双方的协同中,商业健康保险应专注于补充医疗保险、社会医疗保险第三方管理和健康管理等领域;社会医疗保险应积极利用商业健康保险的灵活机制,提升医保体系的整体效率。     

农村健康保险基金的筹集管理模式比较

农村健康保险基金的筹集管理模式比较张德孝（四川省卫生厅成都６１００００）蒲润林，陈德平，蔡先全，雷飞跃（四川省简阳县卫生局６４１４００）中国农村健康保险试验研究课题为探索如何筹集健康保险基金进行了研究，现将试验研究中的设计、实施、结果以及实施中存在的...     

浅析我国商业健康保险对社会医疗保险的补充作用

社会医疗保险和商业健康保险共同构成了我国的医疗保障体系,其中社会医疗保险是基础,商业健康保险是必要补充。目前,我国商业健康保险业务量小,覆盖率低,对医疗费用的分担少,因此其对社会医疗保险补充作用的发挥程度较低,这是由医疗保险所针对风险的特殊性所决定的。为了充分发挥商业健康保险对社会医疗保险的补充作用,必须加强政商合作,实行专业化经营,加强人才培养,构建有吸引力的医保合作框架,针对特殊风险进行业务创新等。     

结构方程模型中拟合指数的运用与比较

结构方程模型是一种建立、估计和检验因果关系模型的方法,近二十年来在心理学、社会学、行为科学以及医学等领域得到越来越广泛的应用,通常利用拟合指数对模型的拟合效果进行评价。然而,结构方程模型的拟合指数有40多种,不同的拟合指数反映出的拟合效果并非完全一致,因此拟合指数性能的可靠性成为应用者比较关心的话题。本文通过文献查阅,较为系统地总结了结构方程模型常用拟合指数的分类及其特征,通过对比分析发现指数NNFI和RMSEA相对值得信赖,CFI、RNI和Mc具有一定的参考价值,而在用ML或GLS法进行参数估计时SRMR则表现出了较好的效果。     

商业健康保险在我国医疗保障体系中的作用研究

本文介绍了商业健康保险的定义，讨论了商业健康保险的市场潜力和经营环境，说明了商业健康保险在完善我国医疗保障体系中的重要地位和作用，提出了商业健康保险对社会医疗保险进行补充的具体形式     

农村健康保险的综合评价指标体系及其应用

农村健康保险的综合评价指标体系及其应用王强，高晨，杨树勤（华西医科大学成都６１００００）健康保险的效果受社会经济、医疗服务，保险管理等多方面的影响，只有采用多指标的综合评价才能反映这一特点。健康保险评价重视保险的效果，采用评价手段对实现健康保险的目标...     

中国公费医疗与劳保医疗的改革

本文系统地阐述了我城镇社会医疗保险的改革与发展,以及其变革的原因.同时,介绍了即将在全国实施的城镇职工基本医疗保险的筹资和运作方式.     

关于《社会保险法》中“追偿”权行使的探讨

围绕《社会保险法》中提到的"追偿"这一词汇,就社保经办机构如何从法律实施角度对具体的对象行使"追偿"权进行梳理与解析。"追偿"在赋予社保经办机构权利的同时,也对社保经办机构提出了更高的要求,对当前社会保险工作提出了新的挑战。     

Factors Affecting the Downward Mobility of Psychiatric Patients: A Korean Study of National Health Insurance Beneficiaries

Objectives:

The purpose of this study is to examine the magnitude of and the factors associated with the downward mobility of first-episode psychiatric patients.

Methods:

This study used the claims data from the Korean Health Insurance Review and Assessment Service. The study population included 19 293 first-episode psychiatric inpatients diagnosed with alcohol use disorder (International Classification of Diseases, 10th revision [ICD-10] code F10), schizophrenia and related disorders (ICD-10 codes F20-F29), and mood disorders (ICD-10 codes F30-F33) in the first half of 2005. This study included only National Health Insurance beneficiaries in 2005. The dependent variable was the occurrence of downward mobility, which was defined as a health insurance status change from National Health Insurance to Medical Aid. Logistic regression analysis was used to assess factors associated with downward drift of first-episode psychiatric patients.

Results:

About 10% of the study population who were National Health Insurance beneficiaries in 2005 became Medical Aid recipients in 2007. The logistic regression analysis showed that age, gender, primary diagnosis, type of hospital at first admission, regular use of outpatient clinic, and long-term hospitalization are significant predictors in determining downward drift in newly diagnosed psychiatric patients.

Conclusions:

This research showed that the downward mobility of psychiatric patients is affected by long-term hospitalization and medical care utilization. The findings suggest that early intensive intervention might reduce long-term hospitalization and the downward mobility of psychiatric patients.     

我国重度残疾老年人状况及其社会保障

残疾老年人是老年人中的弱势群体,而重度残疾老年人则是弱势群体中的弱势群体.在第二次全国残疾人抽样调查数据中没有我国重残老年人的总量数字.通过测算,经国内首次研究得出:我国重度残疾老年人达到1244.42万人.规模庞大并成快速增长趋势的重度残疾老年人的经济贫困和生活长期护理问题应该引起和谐社会的高度关注,为此有必要构建面向包括此人群在内的老年社会保障体系.     

Determinants of public satisfaction with the National Health Insurance in South Korea

To explore the determinants of public satisfaction with the National Health Insurance, this study re-analyzed the 2004 public satisfaction survey with the Korean National Health Insurance (KNHI) conducted by Korean National Health Insurance Corporation (KNHIC). One thousand samples were selected with probability proportional to population size (by region/sex/age). The data collected by home-visit interview were transformed into the final data set by matching them to the insured's benefit database and the qualification database. The results showed that metropolitan residence, insured type, relationship between respondent and householder, subjective health status, benefit-cost ratio, and attitudes toward KNHI were direct determinants of satisfaction with KNHI. In addition, various demographic and socioeconomic variables and the health status of the respondent's family indirectly influenced satisfaction with KNHI. Among these variables, the attitude toward KNHI was the most vital factor to determine public satisfaction. The study results show that equity in monthly contributions and an enhanced quantity and quality of medical services are required to improve public satisfaction with KNHI. Furthermore, it is important to improve the public perception of social values and solidarity for increased public satisfaction with KNHI.     

上海城镇居民医保制度运行分析与对策建议

文章用联合国教科文组织推荐的ROCCIPI 方法,对上海城镇居民医保制度存在的部分居民未参保、大病保障水平偏低、城乡统筹需要进一步推进等问题,从规则、过程、机会、能力、交流、利益、意识7个方面进行了深入分析,寻找出解决问题的可行性方法和政策建议.     

Framing the Use of Social Media Tools in Public Health

Objective

Recent scholarship has focused on using social media (e.g., Twitter, Facebook) as a secondary data stream for disease event detection. However, reported implementations such as (4) underscore where the real value may lie in using social media for surveillance. We provide a framework to illuminate uses of social media beyond passive observation, and towards improving active responses to public health threats.

Introduction

User-generated content enabled by social media tools provide a stream of data that augment surveillance data. Current use of social media data focuses on identification of disease events. However, once identification occurs, the leveraging of social media in monitoring disease events remains unclear (2, 3). To clarify this, we constructed a framework mapped to the surveillance cycle, to understand how social media can improve public health actions.

Methods

This framework builds on extant literature on surveillance and social media found in PubMed, Science Direct, and Web of Science, using keywords: “public health”, “surveillance”, “outbreak”, and “social media”. We excluded articles on online tools that were not interactive e.g., aggregated web-search results. Of 2,064 articles, 23 articles were specifically on the use of social media in surveillance work. Our review yielded five categories of social media use within the surveillance cycle (

卫生保健领域中社会资本指标探讨

社会资本是促进人群健康和卫生行业发展的重要动力.结合我国医疗卫生国情剖析社会资本理论中信任、群众参与、社会网络、规范、互惠、能动性等指标的内涵,及其对人群健康、卫生机构乃至卫生保健全行业发展的影响,为开发和利用社会资本发展卫生事业、增进人群健康提供理论依据.