成都市补充医疗保险需求的影响因素研究

根据成都市补充医疗保险实施的现状,对其4种补充医疗保险办法分别建立了需求模型.结果显示:对于补充医疗保险的需求不仅取决于其属性即其所覆盖的医疗费用风险损失及其发生概率以及价格,而且也取决于职工本人的社会经济特征及其保险意识.4种补充医疗保险办法的平均价格弹性在-4.67～-18.70之间.补充医疗保险的完善和发展应充分考虑到补充医疗保险方案的本质属性.     

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。     

城镇职工补充医疗保险的组织与筹资研究

目的探索市场经济条件下我国城镇职工补充医疗保险适宜的组织与筹资模式。方法通过在上海、温州和成都三地对补充医疗保险的参加意愿、支付意愿和实际参保情况进行调查,对国内不同运作模式进行总结与比较分析,以期对可行的补充医疗保险覆盖范围及其组织运作进行前瞻性分析。结果获得了职工对不同补充医疗保险方案的需求特征,提出了补充医疗保险适宜的覆盖范围及其组织运作模式。结论建议要明确界定政府在补充医疗保险发展中的职能定位,要依靠政策扶持与引导,推进补充医疗保险的发展;要加强对补充医疗保险的监管等。     

中国城镇医疗保险制度应对人口老龄化问题与解决路径

中国已进入老龄化社会，这将给医疗保险基金的收支平衡、医疗保险制度的顺利实施带来不小的压力。面对严峻的老龄化趋势，必须提前准备，采取以下措施加以应对：1．扩大医保覆盖面；2．大力推进和完善补充医疗保险：3.制定科学合理的结算政策，促使医院加强管理，因病施治，合理用药，提高基金使用效益；4．增强服务意识，注重健康导向的预防性医疗服务；5.加大医疗知识宣传力度，树立职工健康理念，抑制疏导参保职工不正确的医疗需求；6．实现医疗保险资金来源多样化。     

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。     

上海市非社会医疗保险的实施情况

为了建立以职工社会医疗保险为主体，附加保险和医疗救济为补充的覆盖全体城镇职工的医疗保障体系，形成与社会主义币场经济体制相适应的，保障主体多元化（国家、社会、单位、个人）、资金来源多渠道、保障方式多层次的医疗保险新格局，笔者对上海市现行的非社会医疗保险的形式进行了调研，为领导部门制定政策提供依据。1企业单位内部补充医疗保险1．1重病帮困基金由企业、工会及职工三方筹集资金，旨在缓解现阶段职工患特殊重病医疗难的矛盾，切实为职工解决实际困难。如上海铁路分局设立的“职工特殊重病友爱基金”来源于三个方面：一是…     

城镇职工医疗保险需求的logistic回归分析

内蒙古城镇职工基本医疗保险制度已于 2 0 0 0年1月开始启动 ,城镇职工的医疗保险需求及医疗保健服务的需求和利用随之发生了显著的变化。截止到2 0 0 0年底 ,内蒙古城镇职工人数达 32 3.9万人 ,全自治区 94个统筹地区有 85个已经开始施行社会医疗保险 ,但从运行情况来看 ,其社会覆盖面并不够大 ,存在的问题亟待解决。商业医疗保险作为一种重要的补充医疗保险方式 ,也未能得到很好的发展。基于上述原因 ,笔者在 2 0 0 1年春季对内蒙古城镇职工进行了医疗保险需求状况的调查 ,以期在对影响内蒙古城镇职工医疗保险需求的因素进行分析的基础上 …     

浅谈建立职工补充医疗保险

我国基本医疗保险制度建立的初衷是本着“低水平、广覆盖”的原则，仅仅是保障参保人员的基本医疗需求。基本医疗保险的政策定位，限定了其保险水平只能根据社会生产力发展水平，而非职工的实际医疗消费需求来确定其缴费标准和支付标准。这种低水平、有限的、普遍享受的医疗保障，难以满足不同人群的医疗消费需求。要在基本医疗保险之外，根据不同医疗消费承受能力，满足不同层次医疗消费需求，发展补充医疗保险。     

温州市不同社会经济特征职工对补充医保的意愿参保分析

根据温州市基本医疗保险覆盖范围,该文设计了与之对应的5个补充医疗保险方案,并测算了不同社会经济特征职工对不同方案的意愿参保情况.结果发现,职工对方案A和方案B的意愿参保率较高;高年龄者对所有方案的参保率较低;文化程度较高者和高收入者对所有方案的意愿参保率较高.自认健康状况差的职工关注大病重病费用风险,对方案A意愿参保率较高.     

厦门市职工补充医疗保险的做法及体会

我市职工补充医疗保险已伴随着职工基本医疗保险走过了两个医保年度。在这两个医保年度中,补充医疗保险发挥了积极的作用,深得广大参保单位和参保职工的欢迎,得到了国务院领导和国家医改办的肯定,切实解决了职工大病再治疗问题。职工补充医疗保险是职工基本医疗保险的延续和发展,是职工基本医疗保险制度改革的一种新尝试。但是,职工补充医疗保险在执行过程中仍存在着许多问题和不足,有待今后改革中不断完善。一、我市医保第一个年度的基本情况１、职工投保情况１９９７年７月１日～１９９８年６月３０日,全市参保单位３３９９个,总…     

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.     

基于TOPSIS法的江苏省A市职工自费医疗补充保险补偿水平评价

[目的]对江苏省A市自费医疗补充保险补偿水平进行评价,以期为我国自费医疗补充保险的补偿水平方案设计提供参考.[方法]通过文献研究得到补偿水平设置和评价的方法与指标,基于江苏省A市医保结算明细数据得到不同的方案和指标值,采用TOPSIS法评选最优补偿水平方案,通过最优补偿水平方案与江苏省A市现有补偿水平的比较进而评价A市...     

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。     

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.     

More than half of individual health plans offer coverage that falls short of what can be sold through exchanges as of 2014

The Affordable Care Act creates state-based health exchanges that will begin acting as a market place for health insurance plans and consumers in 2014. This paper compares the financial protection offered by today's group and individual plans with the standards that will apply to insurance sold in state-based exchanges. Some states may apply these standards to all health insurance sold within the state. More than half of Americans who had individual insurance in 2010 were enrolled in plans that would not qualify as providing essential coverage under the rules of the exchanges in 2014. These people were enrolled in plans with an actuarial value below 60 percent, which means that the plans covered less than that proportion of the enrollees' health expenses. Many of today's individual health plans are below the "bronze" level, the lowest level of plan that can be sold through exchanges. In contrast, most group plans in 2010 had an actuarial benefit of 80-89 percent and would qualify as highly rated "gold" plans in the exchanges. To sell to ten million new buyers on the exchanges, insurers will need to redesign benefit packages. Combined with a ban on medical underwriting, the individual insurance market in a post-health reform world will sharply contrast with the market of past decades.     

The current situation of the private health plans and insurance market in Brazil and trends for the future

This paper presents an overview of the Brazilian private health plan market over the period 2000-2006. The current situation is analyzed with respect to the profile of private insurance companies, health plans and beneficiaries and some possible trends that were identified in the study are emphasized. The increase of employer group-plans as a work-related benefit and the reduction of individual plans are discussed. Although the market is restricted to only a few companies, there are more people covered by local plans than by plans offering coverage on a national basis. Finally, the paper approaches aspects related to the financial resources, among them the governmental incentive for the health area, and points to the need of further studies for a better understanding of the supplementary healthcare market.     

城镇医疗保障制度改革对单病种住院费用的影响研究

控制医药费用不合理增长是城镇医疗保障制度改革的目标之一.该文采用病历回顾的方法,选取急性阑尾炎和住院分娩两种健康状况作为指示病例,分析了不同医疗保险改革模式与医药费用变化的关系.基本结论是,医疗保障制度改革与医药费用控制关系密切,医疗保障制度是影响医药费用水平的主要因素,在尚未完全建立新型的医疗保险模式的地区,两个病种的医药费用攀升速度较快,费用上升速度总体上是实施新型医疗保险比较成熟地区的一倍多.医疗保障制度改革方案的合理设计和有效实施对于控制医药费用过快增长意义重大.     

多层次医疗保障体系视角下普惠型商业健康补充保险发展路径分析

目的:探究在多层次医疗保障体系视角下,提出优化我国普惠型商业健康补充保险发展路径的措施.方法:通过分析我国普惠型商业健康补充保险发展情况,梳理其产品、保险公司以及第三方管理平台情况;并基于典型地区的实践经验,剖析现存的问题.结果:目前我国普惠型商业健康补充保险正处于"井喷式"发展阶段,然而发展路径尚未成熟,仍旧存在产品...     

据管理方意向分析医改对职工卫生服务需求行为的影响

通过分析医保管理机构管理者和医疗机构医保管理者对医改前后职工卫生需求行为的变化及其相关影响因素显示,现行的医保政策有利于控制医疗费用的过快增长,医改政策实施后,职工的卫生服务需求行为趋向合理化,但对供方行没有显著影响,从而影响了需方行为和费用控制效果,管理方不规范操作作对职工卫生服务需求行为也有显著影响。