基本医疗保险中共谋问题的研究与防范

本文首先讨论了在我国当前实行的基本医疗保险体系中患者和医疗机构为了共同的利益,利用信息优势,形成共谋来欺骗医疗保险机构的可能性。然后在建立基本医疗保险体系的简单模型的基础上,分析了医患共谋产生的情况,详细讨论了有效防止医患共谋的保险合同的设计问题,并且得出了此类保险合同所具有的一系列基本特性。     

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.     

Health care futures, Part 1. The emergence of the new health care consumer. Panel discussion

In Part 1 of this second annual panel discussion, six experts examine the new health care consumer. The whole concept of the patient as consumer still makes people uneasy when it's applied to health care. Whether you prefer consumer, customer, purchaser, end-user, ultimate buyer, or beneficiary, one thing's for sure: Many of us are as different from the bygone patient as an HMO is from the general practitioner who made house calls. One of the reasons for many Americans' new interest, knowledge, attitudes, and expectations about health and health care is the Internet, the second topic in this discussion. In Part 2, physician executives from the three leading physician practice management companies (PPMCs) join Jeff Goldsmith, Barbara LeTourneau, and Uwe Reinhardt for a spirited exchange about this burgeoning new industry in the American health care sector. They will tackle questions such as: Are PPMCs delivering what they promise? What will separate successful PPMCs from the rest? Can PPMCs meet Wall Street's earnings expectations and also help physicians deliver better care? When PPMCs win, who loses? And, what roles will physician executives play in PPMCs?     

The Role of NGOs in Ameliorating Sweatshop‐like Conditions in the Global Supply Chain: The Case of Fair Labor Association (FLA), and Social Accountability International (SAI)

Over the last 20+ years, globalization has made international trade and investment more efficient and productive. In the absence of coordinated global regulatory regimes, it has also made multinational corporations (MNCs) impervious to social concerns in the countries where they operate. There is considerable debate in the academic, political, and business arena as to the causes of the apparently inequitable distribution of benefits between labor and capital. Notwithstanding, the relative merits of this debate, and facing tremendous societal pressure, companies have adopted voluntary codes of conduct to ensure that workers making products for them in poor and developing countries are protected from hazardous working conditions and receive wages that meet local laws and market conditions. These codes, however, suffer from a lack of credibility and proof of substantive compliance. A new type of nongovernmental organization (NGO) has emerged that monitors a company's compliance with prespecified standards and provides assurance to the external stakeholders that the company has fulfilled its voluntary obligations. From an historical perspective, this has been an innovative phenomenon where the monitoring organization purports to act as an honest broker to ensure all concerned that the company/industry has fulfilled its obligations. In this article, we undertake a thorough examination of two such organizations, that is, Fair Labor Association, and Social Accountability International, that have played a pioneering role in bridging the gap between societal expectations and corporate performance. We examine their governance structures, operating procedures, monitoring standards, and public disclosure of findings, and above all, their success in improving the level of corporate compliance with their self‐created codes or standards. Unfortunately, our findings and conclusions are disappointing. In our view, the two groups have mostly failed to meet their avowed goals. Rather than using their NGO status to help companies improve their code compliance, they have suffered from managerial capture and have been reduced to corporate apologists.     

Getting the Fundamentals Right: Autonomization as a Reform and Governance Tool in the Case of the State Insurance Company Ltd. (SIC) in Ghana

The article is primarily a case study of the use of autonomization in the reform and restructuring of the State Insurance Company Ltd, an SOE in Ghana and addresses two main questions. (1) In view of the fact that the SIC has dual commercial and political objectives, is autonomization suitable for its reform? (2) Under what circumstances can autonomization actually promote efficiency and effectiveness in the proper management and functioning of the SIC? The findings point to answers for both questions. First, autonomization is a defective tool for reforming politically sensitive SOEs but better for non-politically sensitive ones. Secondly, the results point to genuine concerns that autonomization weakens the bonds of political accountability and increases fragmentation of government programs. Finally, the key words in the adoption and implementation of autonomization ought to be context, agency task-specificity and creative adaptation. It adds to the management literature on sub-Saharan Africa and to understanding the management context of Ghana.     

The evolution of organizations and leadership from the ancient world to modernity: A multilevel approach to organizational science and leadership (OSL)

The purpose of this paper is to offer an initial theory, timeline, and taxonomy for discussing and researching the evolution of types of organizations and the concomitant context they provide for leadership. Specifically, leadership roles in the ancient world and modernity are contrasted and found to be almost diametrically opposed. To arrive at this conclusion, this work draws upon current extensions of evolutionary theory from biology and psychology to organizational studies and leadership (Yammarino & Dansereau, 2011). This framework is then contrasted with Kellerman (2012) who calls for an end to leadership studies. The question this paper attempts to address is: from a multi-level perspective, how have evolutionary changes in the types of commercial organizational structures led to differing dominant leadership styles? Without having to call for an end to leadership studies, an understanding of ancient forms of organization can lend insight into a number of contemporary business and geopolitical conflicts where tribalism is a factor.     

The Impact of Dietary Changes Among the Inuit of Nunavik (Canada): A Socioeconomic Assessment of Possible Public Health Recommendations Dealing with Food Contamination

Inuit populations meet a large portion of their food needs by eating country food in which pollutants are concentrated. Despite the fact that they contain pollutants, the consumption of country food has many health, social, economic, and cultural benefits. A risk determination process was set up in order to help regional health authorities of Nunavik to deal with this particular issue. Based on Nunavik health authorities' objectives to encourage the region's inhabitants to change their dietary habits, and on both the risks and the benefits of eating country food, several management options were developed. The options aimed at reducing exposure to contaminants by either substituting certain foods with others that have a lower contaminant content or by store-bought foods. This article aims at assessing the potential economic impact of these risk management options before being implemented. Relevant economic data (aggregate income and monetary outlays for the purchase of food and equipment required for food production by households) were collected and identified to serve as a backdrop for the various replacement scenarios. Results show that household budgets, and the regional economy, are not significantly affected by the replacement of contaminated foods with the purchase of store-bought meat, and even less so if the solution involves replacing contaminated foods with other types of game hunted in the region. When financial support is provided by the state, the households can even gain some monetary benefits. Results show that public health authorities' recommended changes to dietary habits among the Inuit of Nunavik would not necessarily involve economic constraints for Inuit households.     

A new approach to risk evaluation and management: risk-based, precaution-based, and discourse-based strategies.

Our concept of nine risk evaluation criteria, six risk classes, a decision tree, and three management categories was developed to improve the effectiveness, efficiency, and political feasibility of risk management procedures. The main task of risk evaluation and management is to develop adequate tools for dealing with the problems of complexity, uncertainty. and ambiguity. Based on the characteristics of different risk types and these three major problems, we distinguished three types of management--risk-based, precaution-based, and discourse-based strategies. The risk-based strategy--is the common solution to risk problems. Once the probabilities and their corresponding damage potentials are calculated, risk managers are required to set priorities according to the severity of the risk, which may be operationalized as a linear combination of damage and probability or as a weighted combination thereof. Within our new risk classification, the two central components have been augmented with other physical and social criteria that still demand risk-based strategies as long as uncertainty is low and ambiguity absent. Risk-based strategies are best solutions to problems of complexity and some components of uncertainty, for example, variation among individuals. If the two most important risk criteria, probability of occurrence and extent of damage, are relatively well known and little uncertainty is left, the traditional risk-based approach seems reasonable. If uncertainty plays a large role, in particular, indeterminacy or lack of knowledge, the risk-based approach becomes counterproductive. Judging the relative severity of risks on the basis of uncertain parameters does not make much sense. Under these circumstances, management strategies belonging to the precautionary management style are required. The precautionary approach has been the basis for much of the European environmental and health protection legislation and regulation. Our own approach to risk management has been guided by the proposition that any conceptualization of the precautionary principle should be (1) in line with established methods of scientific risk assessments, (2) consistent and discriminatory (avoiding arbitrary results) when it comes to prioritization, and (3) at the same time, specific with respect to precautionary measures, such as ALARA or BACT, or the strategy of containing risks in time and space. This suggestion does, however, entail a major problem: looking only to the uncertainties does not provide risk managers with a clue about where to set priorities for risk reduction. Risks vary in their degree of remaining uncertainties. How can one judge the severity of a situation when the potential damage and its probability are unknown or contested? In this dilemma, we advise risk managers to use additional criteria of hazardousness, such as "ubiquity versibility," and "pervasiveness over time," as proxies for judging severity. Our approach also distinguishes clearly between uncertainty and ambiguity. Uncertainty refers to a situation of being unclear about factual statements; ambiguity to a situation of contested views about the desirability or severity of a given hazard. Uncertainty can be resolved in principle by more cognitive advances (with the exception of indeterminacy). ambiguity only by discourse. Discursive procedures include legal deliberations as well as novel participatory approaches. In addition, discursive methods of planning and conflict resolution can be used. If ambiguities are associated with a risk problem, it is not enough to demonstrate that risk regulators are open to public concerns and address the issues that many people wish them to take care ot The process of risk evaluation itself needs to be open to public input and new forms of deliberation. We have recommended a tested set of deliberative processes that are, at least in principle, capable of resolving ambiguities in risk debates (for a review, see Renn, Webler, & Wiedemaun. 1995). Deliberative processes are needed, however, for ail three types of management. Risk-based management relies on epistemiological, uncertainty-based management on reflective, and discourse-based management on participatory discourse forms. These three types of discourse could be labeled as an analytic-deliberative procedure for risk evaluation and management. We see the advantage of a deliberative style of regulation and management in a dynamic balance between procedure and outcome. Procedure should not have priority over the outcome; outcome should not have priority over the procedure. An intelligent combination of both can elaborate the required prerequisites of democratic deliberation and its substantial outcomes to enhance the legitimacy of political decisions (Guttman & Thompson, 1996; Bohman, 1997. 1998).