政府支出对医疗服务健康公平影响的比较和启示

医疗服务公平和人民的健康是各国卫生系统向其国家居民提供医疗服务所应实现的两个重要目标。但以英美日为例的发达国家根据世界卫生统计年鉴中的医疗服务公平性排名确有明显差距,因此,高收入和高政府医疗卫生支出与医疗卫生服务公平和健康公平性并没有必然关系。本文通过比较分析美日英国的政府间医疗卫生支出责任划分的结构发现高政府医疗卫生支出比例是提高医疗服务筹资公平性的前提,中央承担社会医疗保险责任是实现医疗服务筹资公平性的保证,政府特别是中央政府出资的长期护理有助于提高国民健康水平,地方政府的参与更有助于提高一国医疗系统机构数量特别是医院的数量。     

从医疗保险制度考察城市居民医疗服务的不平等问题

文章通过对城市医疗保险制度的考察,分析过去20年城市实行医疗保险方案改革的经验,以及城市医疗保险制度在医保筹资和获取的公平性、服务提供的有效性方面的影响,探讨了新医疗保险政策的公平和效率含义及提高城市居民医疗服务公平性的挑战与机会。     

农村劳动力转移培训的市场机制分析及政策启示

文章以人力资本投资理论为基础,用微观经济学方法分析了农村劳动力转移培训的市场机制,提出应发挥市场机制的作用,采取“政府主导、市场化运作”的培训机制,以保证公平和效率目标的兼顾实现。     

中美公共医疗保险制度的比较研究——以美国Medicaid计划和我国新农合制度为实证研究对象

Medicaid计划系美国主流公共医疗保险项目,用以针对性补偿中低收入人群的医疗费用。自1965年推行以来,Medicaid计划的覆盖率和筹资额度保持较快增速,有效缓解了中低收入人群的就医压力。经过多年发展,Medicaid计划形成了较为成熟的筹资和补偿机制,值得我国新农合制度借鉴。     

试论德国的医疗保险体制改革

德国是世界上最早实施社会医疗保障的国家。德国的医疗保险体系以社会医疗保险为主,商业医疗保险为辅。德国的医疗保险体系具有优质、高效、公平、覆盖面广等优点,但近年来也难以摆脱资源浪费,经费入不敷出等问题的困扰。德国于20世纪90年代和21世纪初持续进行医疗保险体制改革,采取了取消部分医疗补贴,提高某些医疗服务的自费比例,扩大有偿医疗服务范围,并组建了由政府机构,保险公司和医保医院共同构成的独立机构,对疾病认证,治疗程序和医疗服务质量进行统一规定和管理。本文对德国医疗保险体制改革进行了系统介绍和评估,对构建和完善具有中国特色的医疗保险体制具有参考借鉴价值。     

美国医疗保险制度的改革及其启示

医疗保险制度是社会保障制度的组成部分，在西方发达国家，随着现代医疗技术的进步和人口老龄化的加剧，医疗费用开支迅猛上升，成为国家庞大的财政预算赤字的一个主要原因，各国在缩减社会保障福利开支的行动中，医疗保险改革成为重要的议事日程，而这往往最容易引起纷争和事端。中国作为发展中国家正面临从计划经济向市场经济的转轨，医疗保险制度也需要相应改革。这不仅成为政府的重要工作，也日益成为众所关注的事情。由中国统计局等六部门组织的中国职工生活进步调查组委会，与中央电视台在北京、大连、沈阳、哈尔滨、成都、贵阳和九江…     

商业健康保险在医疗保障体系中定位的理论阐释

本文从卫生筹资机制、信息不对称理论以及公共选择理论出发,探讨了商业健康保险和社会医疗保险应该协调发展,致力于构建商业健康保险与社会医疗保险相互补充、相互配合和共同发展的医疗保障新模式。商业健康保险绝不仅仅是社会基本医疗保险有限的、简单的补充,而应该成为我国医疗保障体系中必不可少的重要组成部分。     

医疗保险个人账户的公平与效率研究——基于广东省数据的分析

文章在对个人账户的功能与问题进行理论分析和文献综述的基础上,明确定位个人账户问题的实质是公平与效率问题,并利用实际数据进行分析。得出的主要结论是:从名义筹资负担比率和实际筹资负担比率来看,个人账户的筹资不公平;是否弱化个人账户功能对医疗服务利用公平性影响不大;但弱化个人账户功能有利于统筹基金的平衡运行;而在填补统筹基金缺口方面,相对于降低单位缴费划入个人账户的比例和提高个人自付比例,取消个人账户是更优的政策调整方案。因此,作者建议,应逐渐弱化并取消医保个人账户,并通过扩大个人账户使用范围、完善普通门诊统筹制度、加强社区医疗卫生服务建设等方式来实现从弱化到取消个人账户的过渡。     

印度私营医疗卫生服务体系的公平与效率

印度的全民免费公共医疗服务体系的公平性备受世界关注。本文分析了处于印度医疗卫生主体地位的私营医疗卫生服务体系的规模,着重从筹资水平、服务提供、费用支出以及监督管理等方面探讨了私营医疗卫生服务体系的运营和非营利私营医疗保险计划,重点研究了私营医疗卫生服务体系的公平与效率所在。旨在得出私营医疗卫生服务体系的公平与效率可以并行不悖的结论,为中国目前医疗卫生体制的改革提供有价值的借鉴。     

创新药物纳入医保管理的路径分析——兼评青岛、浙江、江苏等地的实践

将重大疾病领域的创新药物纳入医保管理的进路为大病医疗保险和大病医疗救助,两大进路均具正当性.两者的时间可及性、药物价格政策和发展趋势相当.大病医疗救助的药物容量、报销比例灵活性、筹资渠道优于大病医疗保险.两大路径均引入了以医疗保险机构主导的谈判机制,以降低创新药物的综合价格.     

中国大陆全民医保与台湾地区全民健保福利性之比较

中国大陆的全民医疗保险与台湾地区的全民健康保险在制度覆盖对象、基金给付范围和给付程度、基金实现效率及效果等体现制度福利强度的方面都有明显的差别,这与两地的经济实力、健保观念、健保管理经验和政治环境差异有关。借鉴台湾地区健保经验,大陆欲增强全民医保的福利效果,应把医疗保险发展成统一的全民健康保险,实行门诊和大病统筹保障;加快培育私营医疗服务机构,增加定点医疗机构并让民众自由就诊;建立以病人为中心的医院品质评价机制,引导医院改进服务设施,提高人本服务水平;加快基金按服务质量和病种付费的步伐,加速推行总额预算制;减少对公立医院的非建设性投入,加大对民众医保的投入。     

医疗体制改革与社会医疗保险基金合理利用原则的研究

中国医疗体制改革是社会主义经济体制改革的重要部分。中国的公费和劳保医疗制度为保障人民健康 ,做出了巨大的贡献。然而 ,4 0多年的实践证明 ,这种公费医疗体制不适合社会主义市场经济体制改革的趋势 ,所以导致了一系列的问题 ,如 :医疗费用激增 ,医疗服务质量下降 ,医疗机构配置不合理 ,以及医疗资源的浪费等。本文在医疗保险基金的筹资—利用系统中 ,分析了改革试点各种统账方式的利弊。在了解了医疗基金的性质、特征及支付管理内容的基础上 ,探讨了中国医疗保险基金支付方式的原则 ,分析了总额预付制在现阶段实施的可行性 ,为合理利用医疗保险基金的原则提出了较基础的评价     

新型农村合作医疗制度自愿保险的困境与出路

面对新型农村合作医疗在实践中普遍存在的逆向选择问题,政府补贴的增加虽能提高农民的参合意愿,但它仍是治标不治本。如果不能很好地解决这个问题,新型农村合作医疗不能可持续发展,要么会因保障水平不够而夭折,要么就会出现财政赤字而难以为续。在短期内,可以在坚持自愿原则下、在自愿性的框架中,通过兼顾门诊补偿、对一年内没有享受住院治疗服务或门诊服务的参合者提供相应的促进健康和预防疾病服务、调整筹资顺序等手段扩大受益面来寻求可持续发展之路;最终通过引入强制性从根本上解决逆向选择的困境。     

Work–Family Conflict and Well-Being Across Europe: The Role of Gender Context

This study analysed whether gender context is important to differences in the relationship between work–family conflict (WFC) and well-being across Europe. We hypothesised that in countries that support equality in work life and where norms support women’s employment, the relationship between WFC and low well-being is weaker than in countries with less support for gender equality. Cohabiting men and women aged 18–65 years from 25 European countries were selected from the European Social Survey. A multilevel analysis was conducted to investigate the relationship between well-being and WFC, and two measurements were used to represent gender context: gender equality in work life and norms regarding women’s employment. Contrary to the hypothesis, the results showed that the negative relationship was stronger in countries with high levels of gender equality in work life and support for women’s employment than in countries with a relatively low level of gender equality in work life and support for traditional gender relations. The context in which gender is constructed may be important when studying the relationship between WFC and well-being. In addition, emphasis should be placed on policies that equalise both the labour market and the work performed at home.     

The Impact of Social and Economic Indicators on Maternal and Child Health

As early as 1985, Rosenfield and Maine began to look at what is called the maternal child field (MCH). More than two decades later, maternal and infant mortality is still among the worst performing health indicator in resource-poor countries and regions, and it has barely changed since 1990. Although three of the eight United Nations Millennium Development Goals aim at reducing child mortality, maternal mortality, and promoting gender equality, most literature in the field is either clinical or exclusively deals with women’s health problems. In this study, I proposed an empirical model that tests the impact of gender equality, women’s human rights, and maternity care on MCH with economic and political development as background factors. The proposed model was tested by using structural equation analysis. Data were obtained from 137 developing countries. The proposed model is partially supported by the data. Empirical findings demonstrate that gender equality has a pivotal role to play in the promotion of MCH. The relationship between MCH and maternity care is found to be strong and statistically significant. This finding may permit a probable verification given the current social conditions in some developing countries, particularly the neglect of many of women’s health needs and the assignment of their primary responsibilities in childrearing. The women’s human rights hypothesis is not supported by the data. It is perhaps that human rights instruments provide a legal discourse for political functions and social welfare issues, but that the legal approach alone does not necessarily provide a moral and social foundation to ensure the implementation of social welfare and human well-being, particularly maternal and child health in developing countries. The findings also indicate the importance of economic development in predicting maternity care. Finally, a positive and statistically significant relationship is found between economic development and gender equality. Implications and limitations of the study are discussed.     

农村养老保障政策的绩效考察——基于27个省域的宏观数据

文章从养老保险、最低生活保障、养老服务、五保供养四个方面构建农村养老保障政策绩效的综合指标体系,采用因子分析和聚类分析方法对中国27个省域的农村养老保障政策绩效进行测度、排序和聚类分析。结果表明,中国农村养老保障政策绩效整体水平偏低,存在显著的省域差异,经济发展水平并非农村养老保障政策绩效的决定性因素,各省域养老救助、养老机构、养老保险等养老保障政策子系统发展极不均衡。     

Is Chinese National Health Insurance Effective in the Face of Severe Illness? A Perspective from Health Service Utilization and Economic Burden

Over the past decade, health insurance coverage has expanded dramatically in China. Health insurance benefits, however, remain shallow or ambiguous. This study examines the effect of Chinese national health insurance policy on health service utilization and economic burden in urban settings using the Urban Resident Basic Medical Insurance Household Survey. We employ the Heckman selection model to correct for selection bias among hospital inpatients, and find that compared to individuals without health insurance, those with health insurance are more likely to be admitted to the hospital when their physicians recommended them to enter the hospital as inpatients. Health insurance is also associated with about 45.6 % decrease in out-of-pocket inpatient expenditures. Individuals with urban employee basic medical insurance see the largest decrease in economic burden, followed by individuals with urban resident basic medical Insurance, and those with new rural cooperative medical insurance.     

Identifying Associations Between State Medicaid Expansion Decisions and Spatial Disparities in County Insurance Rate Changes Under the Affordable Care Act

By the end of 2014, twenty-four states rejected Medicaid expansion, providing a unique opportunity to examine changes in insurance coverage rates after the implementation of the Affordable Care Act within and between states that did versus did not expand Medicaid. Using multilevel regression analyses of county-level non-elderly adult small area health insurance estimates (N = 3135) from the US Census Bureau, several important findings emerge. Compared to counties located in states that did not expand Medicaid, counties located in states that did expand experienced significantly larger increases in adult health insurance coverage rates between 2013 and 2014, net of the county baseline insurance coverage rate, socioeconomic and demographic composition, and labor market characteristics. In states that did not expand Medicaid, counties with larger shares of vulnerable residents (i.e., poor adults and low education) experienced lagging improvements in health insurance coverage. However, counties in states that expanded Medicaid were protected from several of these exacerbated disparities, and in some cases, experienced larger insurance coverage improvements than counties with less disadvantaged populations. These findings suggest that although insurance coverage increased in nearly all counties between 2013 and 2014, increases would have been larger and disparities would have been further alleviated if more states with highly concentrated vulnerable populations had expanded Medicaid.