推行职工基本医疗保险制度的现实问题、法律对策与思考

从医疗保险的理论入手,提出了改革是否成功的三条标准,进而推演到 我国城镇基本医疗保险制度的成效和优势。又从实践的角度,概括地列举了推行职工医疗保险制度改革中7个方面的现实问题。并着重论述了社会主义市场经济条件下解决上述问题的对策,其关键在于立法,在于建立健全相应的法律法规体系。从立法的角度阐述了立法规则、 立法监督、立法宣传和咨询,以及保险管理从业人员的专业化问题。对当前正在进行的医疗保险制度的改革有一定的借鉴意义。     

保险推销员(职业)自我效能感量表的建构

在对保险推销员自我效能感进行理论分析、现场访谈和问卷调查之基础上,采用探索性因素分析和验证性因素分析技术,对保险推销员自我效能感的内在结构进行了探讨。结果表明,保险推销员自我效能感由八个因素构成,即：晤谈技能、仪态、毅力、情绪调节、知识掌握、计划总结、直觉判断和前期准备。在此基础上,依据心理测量学原理和方法研制了保险推销员自我效能感量表。由此,保险推销员应从这八个方面来判断自己保险推销的总体素质。     

21世纪医疗保障制度改革与发展趋势管窥

21世纪的医疗保障制度改革与发展主要表现为:在理论上,强调医疗保障是人权的基本内容;在保障的对象上强调全民性和公平性;在保障的内容上更加重视预防保健;在医疗保障的运行机制上,强调政府主导与市场机制相结合;在服务模式方面,积极构建多层次网络化的社区卫生服务体系,推行医疗适宜技术;在筹资模式上,更注意建立以政府投入为主导的多元化筹资机制。     

中国社会医疗保险财务收支中的障碍与突破

财务收支是社会医疗保险制度运行的物质基础。近年来,财务收支失衡问题已经开始显现于我国社会医疗保险的部分统筹地区。其原因主要有责任主体、人口结构、财务机制、医疗递送等因素。为此,应该在走向全民医疗保险制度、加强医患双方的道德风险规避、扩展个人医疗账户的使用范围、适时建立退休人员的缴费制度等方面进行改革与发展。     

医院医疗欠费情况调查研究

运用描述性统计方法,对某三级甲等综合性医院五年来医疗欠费情况进行统计,探讨了医疗欠费患者的社会人口学特征和卫生经济学特征,提出解决医院医疗欠费问题的根本途径是建立覆盖全民的医疗保险体系。     

医疗保险与基层医疗卫生资源配置机制转型

基层医疗卫生事业的健康发展取决于医疗卫生资源的均衡配置。要促进医疗卫生资源的均衡配置,必须重构医疗卫生资源的配置机制。由于基层医疗机构缺乏较高的行政级别和较厚的盈利空间,所以医疗卫生资源的市场配置机制和计划配置机制均会陷入失灵。基于这个观点,提出以计划与市场联手为途径配置基层医疗卫生资源的思路,即让医疗保险承担对基层医疗卫生资源的配置功能。医疗保险配置基层医疗卫生资源主要通过三种途径：设立门诊统筹账户、建构购买服务机制、采取按人头预付费方式。     

Evaluating the impact of real-time coaching programs on drivers overtaking cyclists

Innovative motor insurance schemes involve the use of on-board devices to collect kinematic driving data as part of the so-called ‘Pay-How-You-Drive’ schemes, which charge premiums based on drivers’ behavior. Some of these schemes also involve on-board coaching programs, which give real-time feedback to users.Here, we aimed to investigate the influence of motor insurance on-board real-time coaching programs on drivers’ behavior while overtaking cyclists, as motor vehicle/bicycle interactions are a relevant issue in road safety. The tested programs give real-time feedback to users on their acceleration, promoting smoother and safer driving styles.Data were collected with a driving simulator experiment involving 67 young drivers. The experiment was divided into two trials: in the first, participants drove as normally as possible without receiving any type of feedback; in the second, which took place one month later, they received feedback based on their driving behavior. Using data from the first trial, participants were clustered (k-mean approximation) into two groups, according to their driving style (aggressive vs. defensive). For each group, half of the drivers received contingent positive feedback (when a smooth driving event occurred) and the other half received contingent negative feedback (when a harsh driving event occurred). Feedback was presented in the form of auditory cues (for half of one group) or as visual cues (for the others). Thus, there were eight groups based on driving style, feedback type, and feedback modality.Multiple kinematic variables were studied with mixed ANOVA, and included not only clearance distances, speeds, and acceleration, but also the chosen overtaking strategy (accelerative vs. flying). Driving style, gender, car usage, feedback type and modality were considered as factors in the analysis.Results showed that the coaching programs had a significant positive effect, in terms of safety, reducing acceleration and speeds during the overtaking and inducing drivers to adopt the safer accelerative strategy. It was also particularly effective in improving the performance of aggressive drivers. These results are of high interest for real-world applications because they were obtained with a general-purpose coaching program; conversely, it might be impractical to develop dedicate programs for specific situations such as drivers overtaking cyclists.     

Enacting Actuarial Fairness in Insurance: From Fair Discrimination to Behaviour-based Fairness

ABSTRACT

In line with developments in the personalisation of risk, the idea that insurance products should above all be ‘fair’ to the policyholders is increasingly voiced by commentators. The performativity thesis in Science and Technology Studies usually used to study economic markets can be used to investigate different enactments of ‘actuarial fairness’ in insurance practice. Actuarial fairness functions as a technical economic concept and was coined by the neoclassical micro-economist Kenneth Arrow (1921–2017). Faced with anti-discrimination legislation, the insurance industry has, since the 1980s, advanced the principle of actuarial fairness to legitimise their medico-actuarial technologies to discriminate between risk groups. In the absence of this actuarial fairness, it is assumed that dynamics of adverse selection—derived from neoclassical assumptions about economic actors— will result in the bankruptcy of insurance providers. The paradigmatic case of Fairzekering, a showcase of contemporary behaviour-based personalisation in car insurance, demonstrates an important shift in how actuarial fairness is enacted through behaviour-based calculative devices. Here, policyholders are enacted as being personally in control of their driving style while an interactive discount-infrastructure is set up to provide real-time feedback to incentivize policyholders towards ‘good behaviour.’ This enactment of behaviour-based fairness simultaneously implies a shift in the enactment of the economic actors involved, constitutive of the making of new economic ideas in behavioural economics.     

Lying to Insurance Companies: The Desire to Deceive among Physicians and the Public

This study examines the public's and physicians' willingness to support deception of insurance companies in order to obtain necessary healthcare services and how this support varies based on perceptions of physicians' time pressures. Based on surveys of 700 prospective jurors and 1617 physicians, the public was more than twice as likely as physicians to sanction deception (26% versus 11%) and half as likely to believe that physicians have adequate time to appeal coverage decisions (22% versus 59%). The odds of public support for deception compared to that of physicians rose from 2.48 to 4.64 after controlling for differences in time perception. These findings highlight the ethical challenge facing physicians and patients in balancing patient advocacy with honesty in the setting of limited societal resources.     

The Hidden Cost of Insurance on Cooperation

A common solution to mitigate risk is to buy insurance. Employing the trust game, we find that buying insurance against the risk of betrayal has a hidden cost: trustees are more likely to act opportunistically when trustors choose to be insured against the breach of trust. Supposedly, trustees are less likely to cooperate when trustors buy insurance because choosing insurance implicitly signals that the trustor expects the trustee to behave opportunistically, paradoxically encouraging trustees not to cooperate. These results shed new light on the potential drawbacks of financial safeguards that are intended to minimize the risky nature of trust taking: the presumed safeguard against the risk of betrayal may, under certain circumstances, increase the probability of betrayal. Copyright © 2017 John Wiley & Sons, Ltd.