基于医疗保险视角的医患关系研究

一例例关于医生被打、医院被砸的事件反映了医患关系的部分不和谐,医患关系紧张既有医患双方自身的原因,也有深层次的经济和社会根源。文章基于医疗保险的视角,从医疗保险的补偿机制、支付方式、医保规范等方面分析了医患关系与医疗保险制度建设的密切联系,并针对性地提出完善医疗保险制度改善医患关系的建议。     

多层次医疗保障体系的主体框架和基本特征

在大力推行基本医疗保险的同时,如何积极地建立多层次的医疗保障体系,来满足城镇职工中不同群体对不同层次医疗消费与保障的需求?笔者认为,"基本医疗保险为主体,补充医疗保险为辅助,医疗救助为扶持"应该是我国当前建立多层次的医疗保障体系的基本思路和主体框架.     

浅谈镇居民基本医疗保险的现状及之吾见

2007年国务院颁布的《关于开展城镇居民基本医疗保险试点的指导意见》,标志着以我国城镇职工基本医疗保险制度、城镇居民基本医疗保险制度、新型农村合作医疗制度为三大主体的基本医疗保障体系初步建立,也标志着我国即将进入“全民医保”时代。作为一项新的制度,在其运行过程中不可避免地会出现一些问题,本文将就城镇居民基本医疗保险制度目前存在的现象谈谈自己的观点。     

整合城镇居民医保和新农合 构建城乡居民医疗保险一体化

城镇居民医保的推开和新农合的实施,全民医保体系初步建立。探讨居民医保和新农合的整合,打破城乡居民基本医疗保险二元格局,推进城乡居民基本医疗保险一体化建设,有效优化参保人群的构成,增强城乡居民医疗保险基金的抗风险和调剂共济能力,已成为完善医疗保险制度改革的关键。     

论电力企业的企业补充医疗保险

电力系统企业补充医疗保险不同于商业保险,不以盈利为目的,而是系统内部为了提高职工的医疗待遇,对基本医疗保险体制的补充完善,是多层次医疗保障体系的有机组成部分。配合基本医疗保险的发展,完善企业内部补充医疗保险制度,加大医疗保险的保障力度,为参保职工的医疗和保健提供优质服务,是我们社保人孜孜以求的奋斗目标。     

从法律角度浅谈大学生医疗保险制度——以四川大学为例

随着国务院决定将大学生纳入城镇居民基本医疗保险试点范围,各地政府和高校也相应出台了相关的规章制度和具体的执行方案。成都市于2009年出台了《成都市人民政府办公厅关于将大学生纳入城乡居民基本医疗保险的通知》这一地方规范性文件,据此四川大学学生医疗保险正式纳入成都市社会保险体系中,为了更好的实施,四川大学于2009年颁布了《四川大学学生基本医疗保险管理细则》。本文将以四川大学为例,从制度、政策、实施等各个层面上探讨现行大学生医疗保险制度的不足并将其逐步完善。     

中国医疗保障模式呈现的缺陷与解决方法的探究

现阶段中国的医疗保障模式主要内容为医疗保险模式,我国医疗保险的组成内容有城镇职工医疗保险、城镇居民医疗保险和新型农村合作医疗。医疗保险制度的建立在城镇首先试点并逐渐发展得更全面更成熟。医疗保险制度对中国的医疗卫生做出了巨大贡献,但是现阶段的医疗保险模式也有许多不足,如流动人口的医疗保障问题;医疗服务过渡提供和过渡消费问题,这些问题正逐渐加重并且也促使医患关系的不和谐,因此这些不足之处亟待解决。     

辽宁城镇医疗保险基金的风险分析

医疗保险基金风险是一个非常庞大的系统体系,从医疗保险制度环境到制度的设计,再到制度的实施,每一个环节都存在着内生和外生风险。根据辽宁城镇医疗保险现状,对医保基金风险分析时,对它们分别进行讨论,使分析结果更加系统化,以便采取更为有效的应对风险措施。     

我国基本医疗保险制度中政府责任分析

本文笔者首先分析了在我国基本医疗保险制度中政府的责任；然后总结了当前我国政府在基本医疗保险制度中责任缺失的表现；最后就如何在基本医疗保险中强化政府责任发表了自己的看法。     

现行社会医疗保险中的碎片化

目前在一个地区内的社会医疗保险主要都是由城镇职工基本医疗保险,城镇居民基本医疗保险,外来人口医疗保险,新型合作医疗等几个碎片组成;而在全国范围内,几乎是一个地区就是一个碎片,彼此互不兼容。这种情况不仅影响了劳动力的正常流动还降低了政策的权威性。     

考虑保险机构参与的重大工程风险管理激励模型

重大工程建设过程往往面临着巨大的风险暴露，保险是重要的风险处置手段，承接保险合同的保险机构和业主一起成为风险损失的承担主体。考虑到保险机构拥有极强参与现场风险管理的动能，本文基于委托代理理论构建了保险机构介入下业主与承包商的激励模型，分别讨论了共同代理和独家代理两种模式下各方的策略与收益。研究结果表明：共同代理模式下，保险机构实现了主动风险管理，业主和保险机构的收益均得以提高，业主愿意提供比独家代理模式更高的激励系数；承包商在共同代理模式下将采取更为积极的风险管理努力，同时其机会主义行为得到了抑制；业主的最优激励系数受项目特征、承包商自身因素以及外界环境的不确定性共同作用。     

产品召回供应链中线性保险合约与订货决策

考虑一个由单供应商和单制造商组成的二级供应链,在不确定市场需求情形下考虑产品召回,站在制造商角度研究供应链线性保险合约下的最优订货决策以及最优线性保险合约决策。研究表明,最优的订货决策与产品召回概率以及线性保险系数相关,存在唯一的最优订货量来最大化制造商的利润。对于密度函数倒数的导数较大的一般需求分布函数,最优的线性保险系数与线性保险合约的固定费用以及产品召回概率有关。当产品召回概率和线性保险合约的固定费用均较小时或者产品召回概率较大但线性保险合约的固定费用适中时,制造商通过选择线性保险合约可以改善自己的利润。     

Policy tenure under the U.S. National Flood Insurance Program (NFIP)

In the United States, insurance against flood hazard (inland flooding or storm surge from hurricanes) has been provided mainly through the National Flood Insurance Program (NFIP) since 1968. The NFIP covers $1.23 trillion of assets today. This article provides the first analysis of flood insurance tenure ever undertaken: that is, the number of years that people keep their flood insurance policy before letting it lapse. Our analysis of the entire portfolio of the NFIP over the period 2001-2009 reveals that the median tenure of new policies during that time is between two and four years; it is also relatively stable over time and levels of flood hazard. Prior flood experience can affect tenure: people who have experienced small flood claims tend to hold onto their insurance longer; people who have experienced large flood claims tend to let their insurance lapse sooner. To overcome the policy and governance challenges posed by homeowners' inadequate insurance coverage, we discuss policy recommendations that include for banks and government-sponsored enterprises (GSEs) strengthening their requirements and the introduction of multiyear flood insurance contracts attached to the property, both of which are likely to provide more coverage stability and encourage investments in risk-reduction measures.     

存款保险制度、影子银行与银行系统性风险

为了防范系统性银行危机的发生,我国于2015年推出了存款保险制度,该制度能否有效降低我国银行系统性风险是关乎金融稳定的重要现实问题.以我国存款保险制度的实施为契机,本文基于16家上市银行2010年第四季度~2017年第二季度的面板数据,首先,将金融机构间的关联网络和金融机构市值纳入到系统性金融风险的测度中,进而探讨我国存款保险制度对银行系统性风险的影响及其作用渠道.结果表明存款保险制度的实施显著提高了其他商业银行(中、农、工、建以外的商业银行)的系统性风险;存款保险制度主要通过影子银行渠道增加其他商业银行的系统性风险.本文的研究对于我国强化影子银行的宏观审慎管理、引入基于银行系统性风险的差别存款保险费率设计和完善系统重要性金融机构的评定,具有一定的借鉴意义.     

Robustly Collusion‐Proof Implementation

A contract with multiple agents may be susceptible to collusion. We show that agents' collusion imposes no cost in a large class of circumstances with risk neutral agents, including both uncorrelated and correlated types. In those circumstances, any payoff the principal can attain in the absence of collusion, including the second‐best level, can be attained in the presence of collusion in a way robust to many aspects of collusion behavior. The collusion‐proof implementation generalizes to a setting in which only a subset of agents may collude, provided that noncollusive agents' incentives can be protected via an ex post incentive compatible and ex post individually rational mechanism. Our collusion‐proof implementation also sheds light on the extent to which hierarchical delegation of contracts can optimally respond to collusion.     

保险业在金融系统性风险传染路径中起到“媒介”作用吗？——基于金融市场尾部风险传染路径的实证分析

2008年金融危机之后,保险业固有的不会产生系统性风险的传统认知被打破。关于保险业在金融系统性风险传染路径中的角色定位,本文从其业务特点和风险传染特点出发,首次提出"媒介"作用的猜想并进行实证研究。本文沿用当前主流研究方法,利用尾部风险的传染网络来研究其媒介作用的大小。本文选取了包括6家上市保险机构在内的34家金融机构,研究区间跨度为2011到2018年。根据金融市场数据"厚尾"和"非对称性"特征,文章首先采用AR-（GJR）GARCH-Skew-t模型对股票收益序列进行处理,然后根据Copula函数,计算尾部相依度,再通过最小生成树和阈值方法构建金融市场的风险传染网络。本文还通过构建保险业媒介中心度来探究其媒介作用的程度。实证结果表明：（1）在金融市场风险传染网络中,保险业起到连接银行市场和证券市场的重要媒介作用;（2）保险机构中又以多元化经营的中国平安的风险传染作用最强,其次是中国人寿。（3）银行市场中的兴业银行和保险市场的联系最紧密,证券信托市场则是中信证券、广发证券等。研究明确了风险传染的路径和关键性节点,为制定更具针对性的系统性风险监管措施提供了参考。     

Contract design and insurance fraud: an experimental investigation

This paper experimentally examines the impact of contract design on insurance fraud. We test how fraud behavior varies for insurance contracts with full coverage, a straight deductible or claim-dependent premiums (bonus-malus contracts), in a setup where rational and selfish individuals have an incentive to always claim the maximum possible indemnity. We find a substantial impact of contractual arrangements: Deductible contracts lead to a greater extent to claim build-up than full coverage contracts. In contrast, bonus-malus contracts that entail the same net gains from fraud as deductible contracts do not increase claim build-up. Thus, our results indicate that bonus-malus contracts may be superior to deductible contracts for behavioral reasons.     

Insurance Against Climate Change and Flooding in the Netherlands: Present, Future, and Comparison with Other Countries

Climate change is projected to cause severe economic losses, which has the potential to affect the insurance sector and public compensation schemes considerably. This article discusses the role insurance can play in adapting to climate change impacts. The particular focus is on the Dutch insurance sector, in view of the Netherlands being extremely vulnerable to climate change impacts. The usefulness of private insurance as an adaptation instrument to increased flood risks is examined, which is currently unavailable in the Netherlands. It is questioned whether the currently dominant role of the Dutch government in providing damage relief is justified from an economic efficiency perspective. Characteristics of flood insurance arrangements in the Netherlands, the United Kingdom, Germany, and France are compared in order to identify possible future directions for arrangements in the Netherlands. It is argued that social welfare improves when insurance companies take responsibility for part of the risks associated with climate change.     

Implied Preference for Seismic Design Level and Earthquake Insurance

Seismic risk can be reduced by implementing newly developed seismic provisions in design codes. Furthermore, financial protection or enhanced utility and happiness for stakeholders could be gained through the purchase of earthquake insurance. If this is not so, there would be no market for such insurance. However, perceived benefit associated with insurance is not universally shared by stakeholders partly due to their diverse risk attitudes. This study investigates the implied seismic design preference with insurance options for decisionmakers of bounded rationality whose preferences could be adequately represented by the cumulative prospect theory (CPT). The investigation is focused on assessing the sensitivity of the implied seismic design preference with insurance options to model parameters of the CPT and to fair and unfair insurance arrangements. Numerical results suggest that human cognitive limitation and risk perception can affect the implied seismic design preference by the CPT significantly. The mandatory purchase of fair insurance will lead the implied seismic design preference to the optimum design level that is dictated by the minimum expected lifecycle cost rule. Unfair insurance decreases the expected gain as well as its associated variability, which is preferred by risk-averse decisionmakers. The obtained results of the implied preference for the combination of the seismic design level and insurance option suggest that property owners, financial institutions, and municipalities can take advantage of affordable insurance to establish successful seismic risk management strategies.     

An Equilibrium Model of Health Insurance Provision and Wage Determination

We investigate the effect of employer‐provided health insurance on job mobility rates and economic welfare using a search, matching, and bargaining framework. In our model, health insurance coverage decisions are made in a cooperative manner that recognizes the productivity effects of health insurance as well as its nonpecuniary value to the employee. The resulting equilibrium is one in which not all employment matches are covered by health insurance, wages at jobs providing health insurance are larger (in a stochastic sense) than those at jobs without health insurance, and workers at jobs with health insurance are less likely to leave those jobs, even after conditioning on the wage rate. We estimate the model using the 1996 panel of the Survey of Income and Program Participation, and find that the employer‐provided health insurance system does not lead to any serious inefficiencies in mobility decisions.