The impact of Chinese maternal and child healthcare institutions on maternal and child health

Although maternal and child health have experienced a continuous improvement in past decades, it is still behind the Millennium Development Goals. This research studies the influence of maternal and child health care institution (MCHCI), which occupies a special position in China’s healthcare field but its impacts on the health of women and children have not been received a plausible attention so far. By using Chinese provincial data, the empirical results show that the increase in MCHCI beds diminishes the incidence and mortality rate of neonatal tetanus in China. Additionally, the rise in MCHCI beds does not correspond to the increase in health expenditure per capita. Our findings reveal the profound significance of MCHCI in promoting social welfare in China, and provide policy implications for other low and middle-income countries to further improve both maternal and child health.     

Gaps in social protection for health care and long‐term care in Europe: Are the elderly faced with financial ruin?

While public expenditure on health care and long‐term care (LTC) has been monitored for many years in European countries, far less attention has been paid to the financial consequences for older people of private out‐of‐pocket (OOP) expenditure necessary to access such care. Employing representative cross‐sectional data on the elderly populations of 11 European countries in 2004 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we find that OOP payments for health care and LTC are very common among the elderly across European countries and such expenditures impact significantly on disposable income: up to 95 per cent of the elderly make OOP payments for health care and 5 per cent for LTC, resulting in income reductions of between 5 and 10 per cent, respectively. Failure to prevent financial ruin, as a consequence of excessive OOP payments, is evident in 0.7 per cent of elderly households utilizing health care and 0.5 per cent of elderly households utilizing LTC. Those particularly concerned are the poor, women and the very old.     

Family leave policy and child mortality: Evidence from 19 OECD countries from 1969 to 2010

This study examined the effects of family leave policy on five age‐specific child mortality rates across 19 Organization for Economic Co‐operation and Development countries from 1969 to 2010. I used the dataset developed by Ruhm and Tanaka and extended it with data from various institutions, including the Max Planck Institute for Demographic Research. I controlled for six relevant variables including GDP per capita and health expenditures, three child health indicators, as well as three social expenditure measures for families. I included in all models country and year fixed effects as well as country‐time trend interactions. Throughout all model specifications, the results indicated that job‐protected paid leave significantly reduces infant mortality (death at less than 1 year of age) and postneonatal mortality (death between 1 month and 1 year of age). Other leave (unpaid or nonjob protected) had no significant effects on any of the outcome indicators.     

Higher Education Policy,Enrollment, and Income Inequality*

Objective. The objective of this article is to examine whether public expenditure on higher education has an effect on income inequality by increasing enrollment. Methods. Combining data from the World Bank Development Indicators with data from the World Income Inequality Database version 2, we study the relation between government education expenditure and enrollment rates, as well as the relation between government education expenditure and the change in income inequality during the 1980s and the 1990s. Results. We find that public expenditure on higher education has no positive effect on enrollment. Increased enrollment is mainly explained by higher GDP per capita. Using carefully selected Gini coefficients to ensure comparability over time, we do not find a robust relation between higher education expenditure and lower income inequality, contrary to some previous studies. Conclusions. Government expenditure on higher education has very limited effects on enrollment and inequality. This finding, however, does not imply that there are no social benefits from such subsidies. For example, in countries where high marginal tax rates decrease the economic returns to education, governments may wish to compensate for this through subsidies.     

Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps,and social equity considerations

The Royal Government of Cambodia recently launched its National Social Protection Policy framework to strengthen and expand social security and assistance. To inform social health protection policy, we examine socio-economic survey data and administrative coverage data to assess the coverage potential of existing coverage mechanisms and current gaps; and compare equitable contribution rates. Over 53 per cent of the population currently has no social health protection coverage mechanism, and about 16 per cent of the population who do have access to a mechanism are not yet enrolled. Current expansion efforts focus on the formal employee scheme, primarily benefiting individuals from higher income households. In addition, recent coverage expansion to some informal workers leaves significant gaps, particularly among the informal sector. We find out-of-pocket health care expenditure to be an excessive share of income among lower wealth quintile individuals and conclude they are financially vulnerable. Finally, we illustrate that an equitable approach to individual, monthly health care contributions among the lower three quintiles has a severely limited potential for revenue generation, and collection costs could exceed the amount collected. Therefore, we recommend that vulnerable groups should be exempted from contribution payments as social health protection is expanded.     

The Social Work Role in Reducing 30-Day Readmissions: The Effectiveness of the Bridge Model of Transitional Care

The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components—care coordination, case management, and patient engagement—which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment’s emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.     

The impact of fiscal shocks on real GDP and income inequality: What do Australian data say?

This paper examines the impact of three fiscal policy shocks on per capita real GDP and income inequality in Australia during the period 1965–2014. A small structural vector autoregressive (SVAR) model is constructed for an open economy for contemporaneous identification and estimation purposes. Based on the evidence of one cointegrating vector among the variables, a structural vector error correction (SVEC) model is specified for the long run. Direct taxation, indirect taxation receipts and government spending are identified as permanent fiscal policy shocks. The convergent use of two different models (SVAR & SVEC) strengthens the credibility of the results. The results have three key policy implications. First, a reduction in direct taxation receipts increases per capita real GDP without increasing income inequality. Second, a reduction in government expenditure significantly increases income inequality. Third, the adverse effect of indirect taxation receipts on income inequality is greater than the redistributive effect of government expenditure, which questions the widely held fiscal policy strategy of using indirect taxation to finance redistributive expenditure.     

Indian agricultural policy: An applied general equilibrium model

A ten-sector, sequential applied general equilibrium model is formulated, estimated, and stimulated for analyzing agricultural policy choices for India until year 2000. Ten groups of consumers (five of them rural), each with its own preferences and claims on output are recognized in the model, the groups distinguished by the range of their per capita household (real) consumption expenditure. The simulations compare: four policies with respect to the compulsory purchase and subsidized distribution to consumers of a limited amount of foodgrains and four foreign trade and aid scenarios. Procuring and freely distributing 100 kgs of grain per capita per year and financing the cost through additional taxation improves income distribution with no reduction in growth. On the other hand, the same distributional policy financed by reducing investment has a negative impact on growth.     

Income and Power Inequality as Determinants of Environmental and Health Outcomes: Some Findings*

Objective. The article corrects for two main shortcomings in conventional economic analyses of environmental change. First is the overemphasis placed on income growth, and general disregard for other socioeconomic factors. Second is economists' often oversimplified view of the environment, where distinctions between environmental necessities such as potable water and so‐called environmental luxuries are ignored. I test for the effectiveness of power inequality in explaining access to sanitation and safe water as well as their health consequences. Methods. I develop a two‐stage model seeking first to explain changes in the environmental variables and then population health. I employ ordinary least squares regressions on international cross‐sectional data. Results. Some dimensions of power inequality outperform per‐capita income as possible determinants of population health. Neither power inequality nor income is clearly superior at explaining environmental quality. Conclusion. The study casts further doubt on the importance of per‐capita income in explaining environmental and health outcomes.     

Economics of public policy in health care systems

Externality arises when the private economy lacks incentives to set up a potential market in some commodity and when the nonexistence of this market results in a Pareto-suboptimal allocation. How can this idea be modified in the setting of the public benefits model of health care? This article argues that the equilibrium level of expenditure on health care is likely to vary markedly, depending on the institutional arrangements for its provision—public, mixed private-public, or purely private—but in none of these is the level of expenditure necessarily Pareto-optimal.     

A study of inadequate consumer demand among Chinese residents --based on data for urban and rural areas in different provinces

本文运用1995—2005年中国除西藏和台湾外30个省、自治区和直辖市城乡面板数据建立随机效应模型对中国城乡居民消费需求的影响因素分别进行计量分析,结果发现：中国居民人均可支配收入与居民人均消费支出高度相关,且在这11年里中国城乡居民消费函数相对稳定。在这个发现的基础上,本文又进一步运用1992—2004年中国的资金流量表（实物交易）数据,解释了1997—1998年以来中国居民消费需求持续低迷的原因之一是在国民收入分配和再分配过程中,政府在总收入和可支配收入中占有的份额越来越大,而居民占有的份额不断下降。     

An Enhanced Macroeconomic Approach to Long-Range Projections of Health Care and Social Security Expenditures as a Share of GDP

An enhanced two-sector economic growth model is created to project health care and Social Security expenditures as a share of GDP in the United States. Parameters used in the economic simulation model are based largely on consensus views in the literature. The main advantages of an economic model over the more commonly used actuarial models are: (1) explicit specification of underlying fundamental structures, (2) ability to investigate relationships in the entire economy, and (3) a fuller scope provided for policy analysis. Under the base model assumptions, that is, a continuation of current conditions for the production of, demand for, and financing of health care services, the economic model projects that the health care sector consumes 15.8 percent of national output by the year 2000 and 27.1 percent by the year 2040. The annual rate of increase in per capita consumption (less health spending) (“adjusted consumption”) falls from 1 percent in 2000 to 0.6 percent in 2025, and then increases to 0.8 percent in 2040, as the rate of increase in spending on health care for the elderly, and the capital investment required to support such spending, flow and ebb with the passing of the baby boom generation. Over the whole projection horizon, government spending on the health care of the elderly increases from a projected 3.8 percent of GDP in 2000 to 9.2 percent in 2040. Social Security expenditures for the elderly are projected to increase from 3.9 percent to 6.3 percent over the same period. More widespread HMO coverage is shown to lead to some small improvements in adjusted consumption. Over the long horizon, improved efficiency and productivity in the health sector and lower Social Security benefits assumed to cause an increased rate of savings and investment, however, actually cause the rate of growth in health spending to increase and adjusted consumption to decline, ceteris paribus. By contrast, an increase in sensitivity to health care prices leads to dramatically improved results, both in higher adjusted consumption and better finances for government programs of health care for the elderly.     

Immigration,terrorism, and the economy

In this paper, we look at the interaction of terrorism with immigrants’ quality of life (measured by the foreign-born unemployment rate and globalization level) for OECD countries, and its impact on GDP per capita. We find strong evidence that GDP per capita is adversely affected by domestic terrorism. The magnitude of this effect is also substantial: at the sample mean, a one-standard-deviation increase in the number of domestic incidents is found to decrease GDP per capita between 5.7 % and 7.8 % of the sample average depending on the specification used. These results contrast with previous research which finds that transnational terrorism primarily affects these economic indicators. We find strong evidence that when we factor in the interaction of the foreign-born unemployment rate with either type of terrorism, an increase in the foreign-born unemployment rate decreases GDP per capita. On the policy front, we show that peace is valuable, and OECD countries will benefit by adopting policies to reduce the problem of terrorism. We also find that an increase in the foreign-born unemployment rate has a large negative impact on GDP per capita and policies that close the gap between foreign-born and native-born unemployment rates (for example, those aimed at reducing discrimination against immigrants) help the economy.     

从“疾病治疗”到“健康维持”——老龄化社会健康服务模式的整体转型

老龄化对任何国家的医疗体系都是巨大的挑战,进入老龄化的发达国家无不把"控制医疗费用"作为卫生改革的核心。从国际经验,尤其是日本的经验看,影响健康服务体系和整个社会的可持续发展的并不是老龄化本身,而是采取了何种应对措施。日本的经验说明,尽管成本控制和改善服务两个目标之间经常存在冲突,但是对预防保健和长期照护服务的投入可以有效减少对昂贵且不适用的住院服务的利用,在更好地满足了社会成员健康需求的同时,反而使卫生费用获得了一定程度的控制。这对我国的启示是,一方面要将预防保健提高到战略位置进行重新规划,另一方面要尽快构建起全国性的长期照护制度框架。     

National Health Insurance: An Alternate Medical Viewpoint

Increasing medical technology, expertise and community expectations of health care are leading to an alarming escalation of health costs throughout the world. Many health planners are expressing doubts as to whether quality of health care can be maintained in the present circumstances. It is maintained that the Australian Government's proposal of National Health Insurance is an interim measure, intended to grant hospital and medical expenditure assistance to the entire community, at minimum cost. There is little evidence that the scheme threatens the medical market place, as it is seen at the moment, and a plea is made for productive and constructive discussion of the scheme by the medical profession.     

国家汲取能力、政策导向和中国城镇卫生保健的筹资与服务不公平

改革以后,中国政府在承担卫生保健职能方面的意愿和能力发生了变化,本文考察了这些变化对城镇卫生保健筹资和服务公平性的影响。文章着重分析了两个相关问题：在多大程度上,卫生保健的筹资具有累进性？在多大程度上,医疗服务的利用是公平的？第一节解释为什么在改革开放期间中国政府承担卫生保健的意愿与能力都有所下降,并探讨这些变化对卫生总费用的结构产生了什么样的影响。接下来的两节分别对中国城市卫生保健筹资和服务利用的不平等程度进行了实证分析。第四节进一步指出,筹资与服务方面的不平等将本来就处于弱势的社会群体置于更加不利的地位。总之,以市场为导向的卫生体制改革不但没有解决医疗费用上涨问题,反而加剧了这一问题;它因此损害了卫生保健筹资的公平性,降低了弱势人群对卫生服务的获取,增加了因病致贫的几率。     

The Fiscal Crisis of National Health Insurance in the Republic of Korea: In Search of a New Paradigm

In 2001, National Health Insurance (NHI) in Korea, the social insurance system for health care with universal population coverage, experienced a serious fiscal crisis as its accumulated surplus was depleted. This fiscal crisis is attributed to its chronic imbalance: health care expenditure has increased more rapidly than have insurance contributions. The recent failure in implementing pharmaceutical reform was a further blow to the deteriorating fiscal status of the NHI. Although the NHI has since recovered from the immediate fiscal crisis, this has mainly been because of a temporary increase in government subsidy into the NHI. The strong influence of the medical profession in health policy‐making remains a major barrier to the introduction of policy changes, such as a reform of the payment system to strengthen the fiscal foundations of the NHI. Korea also has to restructure its national health insurance in an era of very rapid population ageing. A new paradigm is called for in the governance of the NHI: to empower groups of consumers and payers in the policy and major decision‐making process of the NHI. The fiscal crisis in Korean national health insurance sheds light on the vulnerability of the social health insurance system to financial instability, the crucial role of provider payment schemes in health cost containment, the importance of governance in health policy, and the unintended burdens of health care reform on health care financing systems.     

Development of Social Health Insurance in Mongolia: Successes, Challenges and Lessons

This paper examines the process of developing social health insurance in Mongolia, and its successes, challenges and lessons. The government of Mongolia introduced social health insurance in 1994, which is compulsory for all public and private sector employees and low-income and vulnerable population groups. The scheme also provided voluntary insurance for unemployed people of working age. About 95 per cent of the population was covered by health insurance within the first two years thanks to a high level of government subsidy for vulnerable population groups. The insurance benefit initially covered nearly all inpatient services except the treatment of some specified chronic and infectious diseases, which were directly funded by the government. The scheme not only had many successes but also faced challenges in maintaining universal coverage. The new financing arrangement has provided little financial incentive for healthcare providers to contain health expenditure, contributing to rapid health cost inflation. In addition to reforming the payment system for providers, there has been an increasing need to expand benefits into ambulatory care. The development of compulsory health insurance in Mongolia shows that a prepaid health insurance mechanism based on risk sharing and fund pooling is feasible in low-income countries given political commitment and government financial support for vulnerable population groups.     

Links between social environment and health care utilization and costs

The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.     

Unemployment,Medicaid provisions,the mental health industry,and suicide

This study examines the association between unemployment, Medicaid provisions, the mental health industry, and adult suicides in nine US northeastern states from 1999 to 2009. Results show that increased unemployment is associated with more Medicaid beneficiaries and higher health care spending per beneficiary with no significant relationship with Medicaid mental health spending. The Medicaid beneficiary rate is positively associated with the number of mental health clinics, mental health and substance abuse social workers, mental health counselors, and psychiatrists, with no significant association with mental health physician offices or psychologists. Unemployment is also related with increasing suicide rates for the overall population and White non-Hispanics, aged 16–64, with the worst association for White non-Hispanic males. The composition of the mental health industry is also associated with suicide rates. Maintaining an appropriate mix of mental health facilities and professionals to prevent, diagnose, and treat mental health disorders remains a critical public health challenge.