基于利益相关者理论的医疗保险诚信体系构建

运用利益相关者理论分析我国基本医疗保险改革过程中各利益相关者之间的利益博弈和妥协,并从各个利益相关者的视角出发提出相应的改善措施,这些措施将是改善诚信缺失现状的切入点,亦会为构建和谐的基本医疗保险诚信体系提供参考。正确梳理我国基本医疗保险领域内各利益相关者的角色定位及行为模式,均衡其利益冲突、协调其平衡关系,是加快我国基本医疗保险统筹层次提高的必要前提和基础,有利于构建和谐的基本医疗保险诚信体系。     

医患合谋诱导医疗保险消费的道德风险及其规避

通过对医患合谋诱导医疗消费的道德风险产生的原因进行系统分析,找到规避这种风险的可行办法。医疗保险领域广泛地存在着道德风险,其中以供方诱导需求下的医患合谋表现最为突出,它的存在与目前医疗保险的付费方式、制度本身的漏洞、利益的驱使、医生的自我保护等多方面因素有关,其后果是增加了医疗保险的负担,导致了保险基金的浪费。规避供方诱导需求下的医患合谋需从政策、医方、患方三方入手,并辅以一定的配套措施,才能从源头上杜绝这种道德风险。     

医疗保健是权利还是特权

分析了医疗保健是权利还是特权的问题,美国和中国的医疗保健供给体制在医疗保健的概念上被界定为医疗市场的一种商品。虽然作为商品的医疗保健的性质已被讨论,但更具社会责任感的论证应是强调医疗保健是一种权利。社会表示对其成员健康的关不的主要方式主要是通过国家健康保险而体现的,从这个角度出发回顾了美国和中国的医疗保健情况。     

医疗保障制度改革过程中的价值取向问题及其影响

随着社会主义市场经济体制的建立,我国传统的劳保医疗制度和公费医疗制度已越来越不适应社会发展的要求,呈现出诸多弊端,亟待改革。作为一项公共政策,医疗保障制度在改革与完善的过程中应根据科学行政的要求对政策的价值取向进行深入分析,以便顺利实施改革的各项方案。分析医疗保障制度改革中所涉及的各方面的价值观及其对改革的影响,希望唤起政策制定者对不同群体利益的关注,从而保证政策体系的稳定。     

关于城镇职工医疗保险制度改革和发展趋势

我国城镇职工医疗保险制度改革是本届政府的五大改革之一。改革的基本思路是“低水平、广覆盖、双方负担、统筹结合”。同时,国家有关部委又区同制定出台了６个医疗保险制度改革配套文件。最后对我国医疗保险的发展趋势进行了分析！?     

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.     

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.     

江苏省高校学生医保现状与提高医保水平研究

在高等教育规模不断扩大的形势下,大学生群体数量随之增加,而针对这一特殊群体,迄今为止无规范性的医疗保障制度出台。在对江苏省内5所高校学生抽样调查的基础上,对2284份问卷进行分析,提出将高校学生纳入社会医疗保险体系是建立健全大学生医疗保障制度的选择,也能更好提高大学生医疗保险水平。     

试论社会医疗保险物流式定点药店的可行性

社会医疗保险中药品支出比例过高的现象成为目前焦点性问题,如何通过减少药品支出比例在社会医疗保险基金支出中的比例从而有效控制保险基金的合理支出,提高参保人员的医疗保障水平。提出了通过成立社会医疗保险物流式定点药店的解决途径,并就其对社会医疗保险的正面与负面影响进行了可行性分析讨论。