Reforming health insurance in Argentina and Chile

The paper examines the recent reforms of health insurance in Chile and Argentina. These partially replace social health insurance with individual insurance administered through the private sector. In Chile, reforms in the early 1980s allowed private health insurance funds to compete for affiliates with the social health insurance system. In Argentina, reforms in the 1990s aim to open up the union-administered social insurance system to competition both internally and from private insurers. The paper outlines the specific articulation of social and individual health insurance produced by these reforms, and discusses the implications for health insurance coverage, inequalities in access to healthcare, and health expenditures.     

美国医保DRG支付方式对我国医保支付方式选择的启示

通过对美国医疗保险DRG支付方式的分析和评价 ,不仅指出了美国医疗保险DRG支付方式的核心支撑体系是价格 ,是从医疗保险角度所设立的“医疗保险价格”的新理念 ,而且还指出了我国医疗保险支付方式选择的思路 :以总额预付制为基础 ,进行预付制与后付制的有机组合 ;根据医疗服务的多样性应用多种支付方式 ;建立医疗保险价格体系 ;建立质量评估监测体系 ,结合质量校正系数调整给付费用。     

我国城镇未成年人医疗保障制度比较研究

未成年人是我国城镇居民基本医疗保险中的重点对象,未成年人医疗保障是社会保障体系的重要组成部分。通过对我国城镇未成年人医疗保障的现有形式进行回顾,并着重通过对国内部分城市实施的未成年人医疗保障制度进行比较和分析,为改进和提高城镇居民基本医疗保险制度对未成年人的保障水平提供了参考。     

The effects of public health insurance expansion on private health insurance in urban China

The public social health insurance coverage has rapidly increased in China in the last decade. The rapid market development and high economic growth also present an immense opportunity for the private insurance market. This paper uses the China Health and Nutrition Survey panel data and the difference-in-difference method to identify the causal effects of public health insurance expansion on private health insurance development in the case of expansion of the China Urban Residential Basic Medical Insurance (URBMI) program. The paper finds private health insurance enrollment is not affected by the introduction and expansion of URBMI. Rather, private health insurance plays supplementary roles. The findings present the challenges and opportunities for public policies to develop and regulate private health insurance to meet the market niches and provide health insurance to the demands of a heterogeneous population. The findings also have broader implications for other developing nations where public health insurance intends to rapidly expand towards the universal health coverage.     

城镇居民医保制度的实践探索与发展趋向

分析了上海市城镇居民医保制度的特点,对部分难点问题和发展方向提出思考和建议,认为城市到农村,城乡保障一体;地区到全省,提高统筹层次;住院到门诊,待遇逐步完善;职工和居民,逐步融合统一将是未来制度的发展方向。     

职工医疗保险改革对卫生服务公平性的影响

文章从政策和卫生服务利用两个方面,对职工医疗保险改革进行分析.改革提高了卫生服务筹资和居民健康保障的社会化程度,增加了个人卫生投入,树立了参保者的费用意识,对遏止卫生服务费用的快速上涨起到了积极作用.但个人帐户和统筹基金的分配比例不尽合理,客观上也抑制了居民的卫生服务利用,且对卫生服务供方的管理与监督缺乏有效的措施.建议建立医疗保险事务管理机构,加强供需双方的管理与监督,促进卫生服务的合理利用,变押制需求为调节需求.     

我国城市社区卫生服务与医疗保险制度衔接机制研究

目的：分析城市社区卫生服务与医疗保险制度（以下简称社区医保）衔接中的问题,探索促进衔接的方法策略。方法：通过专家咨询、问卷调查法收集资料,采用机构间合作模式和主题框架法进行分析评价。结果：我国社区医保衔接机制处于发展中合作较低水平。在治理结构上缺乏集权化和有效的领导方式,政策环境缺乏对创新的支持;卫生、医保部门在目标上存在分歧,互信程度不高;工作中缺乏规范化的管理程序,合作技术方案不够健全。结论：建议加强体制改革,建立大卫生体制;推进运行机制改革,根据社区卫生特点改进社区医保技术方案;促进部门沟通合作;加强业务管理。     

全民医保视角下对职工医保制度的审视及建议

通过对城镇职工基本医疗保险制度的审视,发现城镇职工基本医疗保险制度存在如下问题:(1)制度内容与"城镇职工"及"基本医疗保险"名称不相符合。(2)筹资制度存在企业单位及部分参保者缴费负担沉重;个人账户分流超过总量60%的医保基金,且构成反向补助;退休人员不承担缴费义务却有通过个人账户不当获利之可能。(3)效率低下且基金超支风险大。(4)制度覆盖范围内人员参保率低。建议:(1)在合并城镇居民基本医疗保险和新型农村合作医疗的基础上,构建统一的全民基本医疗保险。(2)取消城镇职工基本医疗保险制度,将城镇职工纳入全民基本医疗保险。(3)开征"医疗费附加税",用于设立医疗救助基金或直接补充全民基本医疗保险基金。(4)发展商业性医疗保险,构建全面的医疗保障体系。     

城镇职工医疗保障制度改革对不同就业人群的卫生服务利用影响

该通过对黑龙江省大庆市就“医改”的实施对不同就业人群的卫生服务需求利用所产生的影响进行分析,认为（1）“医改”的实施杜绝了职工将门诊看病转向挂床住院,使得大庆市“医改”实施后参保职工门诊就诊率比实施前增加较多;参保职工住院率明显降低;（2）大庆市“医改”实施后,职工患病未住院率明显下降,同时限制了以往的住院利用过度情况。“医改”实施后,经济困难仍然是影响参保职工有病未住院的一个主要原因。“医改”的实施只在一定程度上缓解了参保职工因经济原因而导致的提前出院;（3）医疗费用的负担方式在患就医时对卫生服务机构的选择起了重要作用,由原来的大中型医院较为集中而转向定点医院;（4）影响参保职工卫生服务利用的困难均与参保职工的年龄（高龄人口对住院的利用增加,离退休人员对服务的利用显高于其他人群）和现在享受的医保形式（“参保人群”、“未参保人群”、“补充医疗保险人群”）有关,而目前的医保形式又与职工的单位性质,就业状况及“医改”前的医保形式有密切关系。     

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.     

公共健康投资与农村健康保障制度

本文从健康投资的角度，依据人力资本理论，分析了农村健康保障的市场化问题，提出了建立以人力资本形成为中心的农村基本健康保障制度的观点与政策建议。     

城乡居民基本医疗保障制度改革引发的理论思考

本文阐述了我国目前"新型农村合作医疗与城镇居民基本医疗保险制度衔接"(简称"两制"衔接)的必要性、可行性以及当前"两制"并轨模式构想,提出了在"两制"并轨基础上建立城乡居民基本医疗保障制度的设计理念、制度内核以及管理模式选择。研究认为,我国现阶段"两制"并轨模式应该实行城乡"2+2"制度板块,即在以农业生产为主和农业人口占比重大的地区将城镇居民医保并入新农合,实行"新农合+城镇职工医保"两个板块模式的城乡居民基本医疗保障体系;在城市化发展水平较高或发展速度较快的经济发达地区,实行"城镇居民医保+城镇职工医保"两个板块模式的城市居民基本医疗保障体系。并指出城乡居民基本医疗保障制度的发展应从目前的医疗保险向健康保险过渡,基层医疗卫生服务与健康保险应该实行捆绑式运作。     

我国医疗卫生体制评析

随着2009年3月17日中共中央、国务院《关于深化医药卫生体制改革的意见》出台以来,医疗卫生体制改革已经成为一个受社会关注的问题。文章在简要回顾我国医疗卫生体制的形成发展及改革开放以来我国医疗卫生体制改革的基础上,分析了目前我国医疗卫生体制存在的主要问题,并对其原因进行了深入分析。     

中国医疗保障制度公平性探讨

中国医疗保障制度跨越近60年的历史轨迹，如何概括？作者以公平为主线，分为四个历史阶段：急推公乎，消灭差别；挑战公平，扩大差别；兼顾公平，缩小差别；追求公平，善待差别，并对每个历史阶段的成因和结果作了分析研究。     

Reforming America's health system through innovation and entrepreneurship

America's attempts for healthcare reform are gridlocked. Healthcare special interests are reluctant to abandon profitable activities, and American culture-distrust of centralized federal power, belief in self-improvement, desire for choice, and belief in equal access to medical technologies-is slow to change. Physician entrepreneurship and innovation, coupled with consumer-driven healthcare and public-private partnerships, may break the present gridlock.