政府卫生支出健康效率测算及分析

目的：测算和分析中国1990年、2000年和2010年政府卫生支出的健康效率及其影响因素。方法：运用DEA和Tobit测算政府卫生支出的健康效率,评估效率值的影响因素。结果：政府卫生支出的健康生产效率在波动中有所提高,不同年度处于前沿面的省份基本一致,远离前沿面的省份存在较大差别;该效率在各区域间的差异较显著,东部地区政府卫生支出的健康生产效率高于中、西部地区;财政分权与政府卫生支出健康效率存在显著负相关关系。结论：财政分权制度的改革与完善是提高政府卫生支出健康效率的重要途径。     

津巴布韦国家健康保险计划问题对我国的启示

津巴布韦是经济发展水平在南部非洲仅次于南非的一个发展中国家，１９８５年为了与正在进行立法程序的社会保障制度接轨，政府探索建立“国家健康保险计划”的可能性。由于该计划存在不少问题，因此始终未能提交国会讨论。这些问题对我国医疗保健制度改革有一定参考价值。     

韩国强制性全民健康保险的特点及对我国的启示

韩国是亚洲“四小龙”之一，在其经济高速增长的30多年中，人均国民总收入（GNI）从1970年的254美元上升至2004年的14162美元．在这期间，韩国政府分阶段稳步推进了国民健康保险改革．逐步建立和完善了覆盖全体国民的健康保险系统，于2000年7月开始实施强制性的全民健康保险。     

财政视角下我国公共卫生政府投入的问题和成因分析

从财政视角分析,目前公共卫生政府投入的主要问题包括投入规模不足、地区间结构不合理和投入效率低下,主要原因是政府对公共卫生机构收费政策和预算管理制度转变、财政分权改革及公共卫生财政预算体制不完善,同时,宏观制度背景下带来的激励机制问题和公共卫生固有的绩效评估技术问题也是导致公共卫生政府投入存在问题的重要原因.     

我国商业健康保险可持续发展研究

文章介绍了我国商业健康保险的发展现状,对制约我国商业健康保险可持续发展的内在因素和外在因素进行了综合分析,提出积极改变系统的结构、加强适用性产品的开发、加强专业化经营以及积极寻求政府政策支持等对策,目的在于促进我国商业健康保险的可持续发展.     

我国商业健康保险发展趋势研究

综合十年来我国商业健康保险发展的各项相关数据,指出其发展困境所在,并结合实践探索商业健康保险的发展出路,认为参与中国基本医疗保障体系建设、发展管理式医疗和健康管理将成为我国商业健康保险发展的主要方向.     

我国商业健康保险发展影响因素实证分析

近年来我国商业健康保险市场发展迅速,但其总体水平与我国庞大的人口规模和高额的医疗费用支出相比还存在很大差距。本文首先分析了商业健康保险供给与需求的影响因素,然后从实证分析的角度出发,运用计量经济学方法和EVIEWS软件对近几年的健康保险相关数据进行了回归分析。1998—2009年的数据分析结果显示:我国城镇居民人均可支配收入和保险意识的提高显著地促进了商业健康保险的发展,短期内社会医疗保障水平的提高与商业健康保险的发展呈负相关,人均医疗卫生费用、老年人口比重及城镇人口数量对商业健康保险的发展无明显影响。     

商业健康保险与基本医疗保险融合发展的国际经验及启示

商业健康保险与基本医疗保险的融合发展对完善我国多层次医疗保障体系具有重要意义。本文梳理了国际上商业健康保险与基本医疗保险融合发展的典型模式及先进经验。结合我国实际,提出启示：加强顶层设计、完善政策体系,发挥各自优势、加快社商融合,多举措支持商业健康保险发展,加强对商业健康保险的监管力度。     

我国商业健康保险发展的现状及存在的问题

分析了在医疗卫生体制改革背景下商业健康保险的现状,指出在参与医疗市场的过程中,商业健康保险存在着角色定位模糊、医疗体制尚不完善、专业技术人才不足、风险控制力较弱等问题。通过明晰商业健康保险与社会医疗保险的关系,政府部门发挥主导作用,培养专业技术人才,提升专业经营水平和风险控制能力等方面的工作,使得商业保险能够在医疗卫生体制改革情况下有更好的发展前景。     

我国城镇商业健康保险区域发展非均衡及影响因素分析

选取2007—2016年我国东中西部地区的城镇商业健康保险收入和支出数据,利用保险密度、保险深度和Theil指数分析我国城镇商业健康保险的发展速度和非均衡程度,结果表明:三个地区城镇商业健康保险都处于增长状态,且发展速度由东向西依次递减;东部地区城镇商业健康保险非均衡程度最大,其次是西部地区,中部地区最小。利用灰色关联分析法从风险认知程度、人均地区生产总值、收入和社会保险支出等方面分别对东中西部的商业健康保险发展的影响因素进行分析,结果发现,收入和人均地区生产总值对三地区的影响程度都很大,社会保险支出对东部地区的影响比风险认知度大,而风险认知程度则对中西部地区的影响较东部地区明显。最后,针对分析结果对城镇商业健康保险的发展提出几点建议。     

Compulsory private complementary health insurance offered by employers in France: Implications and current debate

In January 2013, within the framework of a National Inter-professional Agreement (NIA), the French government required all employers (irrespective of the size of their business) to offer private complementary health insurance to their employees from January 2016. The generalization of group complementary health insurance to all employees will directly affect insurers, employers and employees, as well as individuals not directly concerned (students, retirees, unemployed and civil servants). In this paper, we present the issues raised by this regulation, the expected consequences and the current debate around this reform. In particular, we argue that this reform may have adverse effects on equity of access to complementary health insurance in France, since the risk structure of the market for individual health insurance will change, potentially increasing inequalities between wage-earners and others. Moreover, tax exemptions given to group contracts are problematic because public funds used to support these contracts can be higher at individual level for high-salary individuals than those allocated to improve access for the poorest. In response to the criticism and with the aim of ensuring equity in the system, the government decided to reconsider some of the fiscal advantages given to group contracts, to enhance programs and aids dedicated to the poorest and to redefine an overall context of incentives.     

商业医疗保险与补充保险

商业保险是补充医疗保险的主要形式之一,主要用于覆盖主体医疗保险中投保者自付部分及主体医疗保险没有覆盖的项目.由于补充医疗保险与主体医疗保险相互作用以及商业保险的特性,商业性补充医疗保险市场需要必要的政府监管.     

Private expenditure and the role of private health insurance in Greece: status quo and future trends

The health care system in Greece is financed in almost equal proportions by public and private sources. Private expenditure, consists mostly of out-of-pocket and under-the-table payments. Such payments strongly suggest dissatisfaction with the public system, due to under financing during the last 25 years. This gap has been filled rapidly by the private sector. From this point of view, one might suggest that the flourishing development of private provision may lead in turn to a corresponding growth in private health insurance (PHI). This paper aims to examine the role of PHI in Greece, to identify the factors influencing its development, and to make some suggestions about future policies and trends. In the decade of 1985–1995 PHI show increasing activity, reflecting the intention of some citizens to seek health insurance solutions in the form of supplementary cover in order to ensure faster access, better quality of services, and increased consumer choice. The benefits include programs covering hospital expenses, cash benefits, outpatient care expenses, disability income insurance, as well as limited managed care programs. However, despite recent interest, PHI coverage remains low in Greece compared to other EU countries. Economic, social and cultural factors such as low average household income, high unemployment, obligatory and full coverage by social insurance, lead to reluctance to pay for second-tier insurance. Instead, there is a preference to pay a doctor or hospital directly even in the form of under-the-table payments (which are remarkably high in Greece), when the need arises. There are also factors endogenous to the PHI industry, related to market policies, low organisational capacity, cream skimming, and the absence of insurance products meeting consumer requirements, which explain the relatively low state of development of PHI in Greece.      

Once covered,forever covered: The actuarial challenges of the Belgian private health insurance system

The Belgian Law of 20 July 2007 has drastically changed the Belgian private health insurance sector by making individual contracts lifelong with the technical basis (i.e. actuarial assumptions) fixed at policy issue. The goal of the Law is to ensure the accessibility to supplementary health coverage in order to protect policyholders from discrimination and exclusion, essentially when these operate on the basis of age. Due to the unpredictable nature of medical inflation risk and the difficulty to model future increases of health claims, the legislator introduced medical indices together with a specific updating mechanism, which aim at establishing standardized and fair premium adjustments across the sector. This paper considers two major issues of the current Belgian system. The first one is related to the transferability of the reserves, whereas the second one is related to age-discrimination. We discuss these issues and their interplay, and we address the conflict between the goal of the Law and the practical problems arising in the light of the actuarial techniques.     

Tax incentives and the demand for private health insurance

We analyze the effect of an individual insurance mandate (Medicare Levy Surcharge) on the demand for private health insurance (PHI) in Australia. With administrative income tax return data, we show that the mandate has several distinct effects on taxpayers’ behavior. First, despite the large tax penalty for not having PHI coverage relative to the cost of the cheapest eligible insurance policy, compliance with mandate is relatively low: the proportion of the population with PHI coverage increases by 6.5 percentage points (15.6%) at the income threshold where the tax penalty starts to apply. This effect is most pronounced for young taxpayers, while the middle aged seem to be least responsive to this specific tax incentive. Second, the discontinuous increase in the average tax rate at the income threshold created by the policy generates a strong incentive for tax avoidance which manifests itself through bunching in the taxable income distribution below the threshold. Finally, after imposing some plausible assumptions, we extrapolate the effect of the policy to other income levels and show that this policy has not had a significant impact on the overall demand for private health insurance in Australia.     

新医改背景下发展商业健康保险若干问题探讨

探讨了商业健康保险的政策扶持情况、其与社会保险的衔接、赔付风险控制等关键问题,建议:完善商业健康保险的法律法规建设,由政府出台相应的财税优惠政策;清晰界定社会医疗保险和商业健康保险的内容,商业健康保险公司创新产品开发并丰富保障内容;实现保险公司与医疗机构间的信息共享,建立商业保险公司与医疗机构间的合作关系,商业健康保险...     

The income distributive implications of recent private health insurance policy reforms in Australia

The Australian government implemented a series of private health insurance (PHI) policy reforms between 1997 and 2000. As a result, the proportion of the population with PHI coverage increased by more than 35%. However, this study found significant evidence that the policy reform disproportionately favours high-income earners. In particular, the 30% premium subsidy represents a windfall gain for households which would have purchased PHI even without the rebate. The amount of such gain is estimated to be around $900 million per year, a large proportion of which went to higher income households.

A model to decompose the performance of supplementary private health insurance markets

For an individual insurance firm offering supplementary private health insurance, a model is developed to decompose market performance in terms of insurer profits. For the individual contract, the model specifies the conditions under which adverse selection, cream skimming, and moral hazard occur, shows the impact of information on contracting, and the profit contribution. Contracts are determined by comparing willingness to pay for insurance with the individual's risk position, and information on both sides of the market. Finally, performance is aggregated up to the total market. The model provides a framework to explain the attractiveness of supplementary markets to insurers.     

Unwinding the State subsidisation of private health insurance in Ireland

Ireland's private health insurance market provides primarily supplementary health insurance for hospital services, operating alongside a public hospital system to which residents have universal access entitlements, subject to some copayments for those without a medical card. The State subsidises the purchase of private health insurance through measures including tax relief on premiums and not charging the full economic cost for private beds in public hospitals. Furthermore, privately insured patients occupying public beds in public hospitals did not, until 2014, incur charges for such accommodation, apart from modest statutory charges. In the Budget in October 2013, a number of measures were announced that began to unwind these subsidies. Although it was initially feared that these measures would add to premium inflation, leading in turn to further discontinuation of health insurance, the evidence suggests that premium inflation has eased and take-up has stabilised, although some of this may have been due to the introduction of lifetime community rating in May 2015. Nevertheless, it would appear that the restriction on the subsidisation of private health insurance has not had a significant adverse effect on the market, while it has reduced an inequitable cross-subsidy.     

Demand for private health insurance in Chinese urban areas

Between 1993 and 2003, the proportion of urban residents without health insurance rose from 27 to 50%. The probability of outpatient visits in the previous 2 weeks dropped from 19.9 to 11.8% in urban areas between 1993 and 2003, and from 16.0 to 13.9% in rural areas. To improve risk-pooling and risk-sharing, private health insurance should play an important role in China's health insurance system. This paper estimates the demand for private health insurance in urban areas using contingent valuation methods. Individuals were asked about their willingness-to-pay (WTP) for major catastrophic disease insurance (MCDI), inpatient expenses insurance (IEI), and outpatient expenses insurance (OEI). The study was based on a household survey conducted in four small cities in China in 2004 and included 2671 respondents. More people would like to buy IEI and MCDI (48.5 and 43.0%, respectively) than OEI (24.5%). In addition, individuals would pay a higher premium for MCDI and IEI than for OEI. The price elasticities of demand for MCDI, IEI, and OEI were -0.27, -0.34, and -0.42, respectively. The determinants of enrollment in the three private health insurance programs were similar with employment status, age, education, and income.