武汉市城镇居民基本医疗保险未成年人适宜缴费水平模型研究
|
摘要
研究目的
本篇论文是基于城镇居民基本医疗保险框架内的未成年人的缴费水平模型测算的一项理论探索和实证研究,是建立在不同年龄段和不同缴费水平的设计思路上的理论探索。本篇论文通过文献规范研究和实证研究,定性研究与定量研究相结合,研究国内外未成年人医疗保险缴费水平测算的相关资料,通过分析与总结我国各试点城市未成年人医疗保险缴费水平及模式的异同,以武汉市为研究对象,重点分析武汉市未成年人基本医疗消费需求特征及医疗保险基金补偿支出情况。同时,运用医疗保险学、保险精算学、社会学和经济学的有关筹资理论和方法,建立政府、医保部门、未成年人及其家庭等多方的医疗诉求及其优先次序关系；研究未成年人缴费水平所需的关键参数及其测算方法,构建未成年人适宜缴费水平的数学理论模型,为确定未成年人适宜缴费水平提供依据。
研究方法
(一)文献分析法
查阅国内外医疗保险保费、筹资水平、补偿支出、保险因子、支付意愿以及我国各试点城市未成年人医疗保险缴费水平及模式的相关文献资料,运用内容分析方法对有关内容进行比较,进一步分析提炼可供本研究借鉴的理论和方法。
(二)专家咨询法
向医疗保险、卫生经济、卫生管理、医学社会学等领域的专家分别就末成年人年龄段划分、医疗保险补偿支出增长系数、政府、医保部门、未成年人家庭等多方诉求的优先次序等问题进行咨询,并通过专家座谈的方式对上述问题进行讨论。
(三)专题小组讨论
分别就政府和医保部门对未成年人缴费水平的测算依据、医疗诉求以及未成年人缴费水平的动态变化机制进行专题小组讨论,每个专题小组讨论由人力资源和劳动保障部门、财政部门、卫生行政部门、居民医保经办机构工作人员和高校教师等组成,共计28名。
(四)知情人访谈
通过医疗保险管理部门的知情人访谈,了解当前未成年人医疗保险的缴费水平的基本测算思路与方法。
(五)现场调查法
以武汉市为调查对象,按照社会经济发展、地理位置和医疗资源分行等特点,分别选取江汉区、青山区、洪山区和黄陂区作为本研究的现场调查地点。对未成年人参保情况、参保未成年人医疗保险基金补偿支出情况、未成年人缴费水平的测算依据和目标诉求情况、未成年人就医的医疗机构级别、基本医疗消费支出、居民医保的参保情况和家庭支付意愿等方面进行调查。对4个调查地点按分层随机抽样原则抽取500户的未成年人家庭。调查的具体内容包括未成年人就医的医疗机构级别、基本医疗消费支出、居民医保的参保情况和支付意愿等。
(六)资料分析方法
①使用描述性统计分析和多因素方差分析对未成年人的基本医疗消费需求特征进行分析；②使用四步模型法构造未成年人基本医疗消费支出的测算模型；③使用入户问卷调查,通过竞价法和直接法初步得出未成年人医疗保险家庭支付意愿；④使用排序法对政府、医保部门、未成年人家庭等多方目标诉求进行优先次序的比较；⑤构建居民医保未成年人适宜缴费水平的测算模型。
研究结果
(1)未成年人医疗保险的参保年龄分段为：0-1周岁,2-3周岁,4-6周岁,7-12周岁,13-18周岁。
(2)人均未成年人医疗保险筹资额(S)的基本公式为：S’参保=(Go·Po,’·Ko·Eo·Co+Gi·Pi’·Ki·Ei·Ci)／(82%～96%)其中,Go表示年人均门诊就诊率,P’o表示次均门诊医药费用,Ko表示门诊补偿比例,Eo表示门诊保险因子,Co表示门诊增长系数,Gi表示年人均住院率,Pi’表示次均住院医药费,Ki表示住院补偿比例,Ei表示住院保险因子,Ci表示住院增长系数。
(3)2008-2010年武汉市未成年人医疗保险实际补偿比为58.6%；若考虑武汉市7个中心城区高达93%的未成年人参保率,保险因子近似于1.0；若考虑不同级别医院的医疗费用差别,则一、二、三级医疗机构的保险因子分别近似为1.10、1.15和1.20。不同年龄段的未成年人在不同级别的医院就诊,其门诊和住院费用增长系数不一样；若选择医药费用比值法,则增长系数均值为0.538；若选择医药行业CPI为增长系数估计值,则为0.420；若选择综合比值法,则为0.745。
(4)2008-2010年,武汉市未成年人的两周患病率、两周就诊率和年人均就诊率等差别不大(P>0.05),说明武汉市未成年人的疾病发生率变化不大,是一个相对稳定的疾病模型。0-1岁、2-3岁和4-6岁年龄段,男性和女性的两周患病率、两周就诊率和年人均就诊率的差别不大(P>0.05),7-12和13-18岁年龄段,男性和女性的两周患病率、两周就诊率和年人均就诊率间存在显著性差异(P＜0.01)
(5)性别和年龄对医疗费用的支出有显著影响。不同年龄段的未成年人的医疗费用支出及其结构也存在着较大差异。其中,13-18岁年龄组的未成年人的医疗费用的差异显著。2-3岁和4-6岁年龄组的未成年人的医疗费用较高,住院利用率较高。
(6)在社会经济等影响因素不变的情况下,武汉市未成年人医疗消费随着家庭收入的增加而增加,且家庭收入每增加1%,医疗消费支出将会增加0.6839%。若考虑物价增长和家庭恩格尔系数因素,由于基本医疗消费需求的刚性特征,家庭医疗支出已经成为家庭开支的重要组成部分。医疗费用的支出与未成年人的生理和心理发育阶段密切相关,也与不同年龄段所患疾病的类型及其分布密切相关。
(7)未成年人家庭更愿意参照居民医保的缴费水平缴纳未成年人医疗保险。
研究结论
国内围绕着未成年人缴费水平测算的模型研究目前还属于初步探索阶段,未成年人的生理和心理发育的特点,及其疾病分布与结构特征,决定了其缴费水平测算的复杂性。家庭收入与支付意愿在一定程度上呈现正相关,但是由于医疗服务属于刚性需求,尤其是未成年人的医疗服务需求的刚性较成年人大,因此,政府和医疗保险管理部门在制定相关制度确定相关缴费标准、医疗费用补偿比等时必须慎重。国内部分学者提出保险因子的概念,认为在医疗保险制度中随着补偿比的提高,其医疗支出也将随之扩大,但是保险因子的测算仅仅局限于线性模型,系数估计的不准确使得我国实施医疗保险当中医疗费用的合理测算带来了相当大的困扰。按照不同年龄段测量的医疗费用支出特征和家庭支付意愿,0-1周岁未成年人缴费水平应在40元,2-3周岁和4-6周岁未成年人缴费水平应在50元,7-12周岁未成年人缴费水平应在40元,13-18周岁未成年人缴费水平应在30元。
Objective
This study is a theoretical exploration and empirical research of the model calculation of minors'payment level, based on the framework of basic medical insurance for urban residents. It is a beneficial exploration of design ideas based on different ages and different payment levels and standards. By doing literature and empirical research, combining qualitative research with quantitative research, studying materials about the medical insurance payment level of minors at home and abroad, the study analyzed and summarized the similarities and differences of the levels and models of Medicare payment in the pilot cities. Taken Wuhan city as an object of study, analyzes the consumer demand characteristics of the minors'basic medical insurance and expenses of material benefits fund in Wuhan. Using medical insurance theory, actuarial science theory, sociology and economics theories and methods related to financing,①to establish health care appeals and the multi-priority relationship which involves government, health care departments, minors and their families;②to study minors the key parameters and calculation method of minors'payment level, to build a mathematical model for an appropriate payment level of minors;③to demonstrate and amend the core parameters and constraints in building the theoretical model, providing the basis to determine an appropriate payment level. Research Methods (A) Document analysis
Consult related literature on domestic and international medical insurance premiums, funding levels, compensation expenses, the insurance factors, willingness to pay, and the payment level and mode of minors in pilot cities, using content analysis method to compare the contents to figure out the theories and methods which can be utilized in this study.
(B) Expert consultation
Inquire the experts in health insurance, health economics, health management, medical sociology about the priority among minors division by age, health insurance compensation expense growth factors, government, health care departments, juvenile and family parties and other issues. By expert panel, launch a discussion on these issues.
(C) Focus group discussions
Launch focus group discussions on government and related departments'calculation basis of minors'payment level, health care appeals and the dynamic mechanism of the level. Each group consisted of 4-6 members from human resources and labor security department, finance department, health administration, health care agencies.
(D) Insider interview
By interviewing medical insurance management department insiders, understand the current basic ideas and methods of calculation of minor health insurance payment level.
(E) On-site survey
Take Wuhan as an object of study, in accordance with the social and economic development, geographical characteristics and distribution of medical resources, select Jianghan District, Qingshan District, Hongshan District, and Huangpi District as locations of the site survey. Investigate the insurance case of minors, material benefits fund expenditures, the residents health insurance agencies'calculation basis of minors payment level and target resorts, levels of medical institutions for minors' medical treatment, basic medical care spending, the situation of the insured health care residents and willingness to pay and so on. About 500 families of minors are chosen in each location. The specific content of the survey, including levels of medical institutions for minors' medical treatment, basic medical care spending, and residents insured situation and willingness to pay and so on. (Vi) Data analysis methods
①Use descriptive statistical analysis and multi-factor analysis of variance to analyze the characteristics of minors basic medical consumer demand;②Use the four-step model method to construct the calculation model of minors basic health consumer spending;③Using home questionnaires, initial bidding method and direct method, to calculate families' willingness to pay;④Use the AHP to adjust the precedence order of the government, health care departments, juvenile families demands and target resorts;⑤Build a calculation model for an appropriate payment level of minors medical insurance.
Results:
(1) The age groups of insured minors were divided into:0-1 years old,2-3 years old,4-6 years old,7-12 years old,13-18 years old.
(2) The basic formula for Per capita medical insurance financing is: S'=(Go·Po·Ko·Eo·Co+Gi·Pi·Ki·Ei·Ci)/(82%～96%)
Go refers to per capita rate of out-patient treatment in one year; P o refers to per out-patient health care costs, Ko refers to the proportion of out-patient compensation, Eo refers to out-patient insurance factor, Co refers to out-patient increasing coefficient;Gi refers to the per capita rate of hospitalization treatment in one year; P; refers to per hospitalization costs; Ki refers to the proportion of hospitalization compensation; Ei refers to hospitalization insurance factor; Ci refers to hospitalization increasing coefficient.
(3) From 2008 to 2010, the actual compensation rate for minors was 58.6%; if taking account of all the minors in 7 center districts in Wuhan, the insurance factor was approximated 1.0. If taking account of differences health costs in different level hospitals, the insurance factors of grade one, two, three medical are approximately 1.10,1.15 and 1.20 respectively. The minors of different ages hospitalized in different levels hospitals, the growth factors of outpatient and hospitalization costs were different; if adopting health care cost ratio method, the mean growth factor is 0.538; If taking pharmaceutical industry CPI as estimated growth coefficient ratio, it was 0.420; if adopting comprehensive ratio method, it was 0.745.
(4) From 2008 to 2010, In Wuhan City, two weeks prevalence, two weeks treatment rate and per capita outpatient rate are not very different (P>0.05). It shows that the disease incidence in Wuhan is a relatively stable disease model. The two weeks prevalence, two weeks treatment rate and per capita outpatient rate changed much. The two weeks prevalence, two weeks treatment rate and per capita outpatient rate of 0-1,2-3 years old and 4-6 years age group, male and female are not very different (P> 0.05),while 7-12 years old and 13-18 years old age group, male and female are significantly different(P<0.01).
(5) The relationship between health care costs with gender and age. The influences of gender and age on health care expenses are significant. The structure and the number of health care costs of different age groups are quite different. The health care costs of 13 to-18 age group were significantly different. The health care costs and hospitalization rate of 2-3 years and 4-6 years age group are higher. The health care costs of 13-18 years old group are quite different.
(6) The influence of family income on health care costs. After a minor illness, if taking the development of social and economic factors as the same circumstances, the medical care cost increases as family income increases, and each 1% increase will cause health care cost increased by 0.6839 percent. If taking account of the price factor in growth and family Engel coefficient, due to the rigidity of the basic features of consumer demand, health care cost has become an important component of household expenditure. Health care cost is closely related with phases of the physiological and psychological development, and also the type of illness and its distribution.
(7) the relationship between willingness to pay for health insurance and health care costs. Residents are more willing to pay health insurance for minors according to the level of the residents health insurance.
Conclusions
The study on measuring model of medical insurance financing is still in preliminary exploration stage. The minor's physical and mental development characteristics and disease distribution and structure cause determine the complexity of financing measuring. The household income is positively related with willingness to pay, but due to demand for health care services are rigid, especially the demand for medical care services for minors is larger, so the government and the medical insurance management department must be careful to put forwards relevant rules, financing standard, medical expenses, compensation ratio. Some domestic scholars have proposed the concept of the insurance factor, and argued that medical expenditures will grow as the compensation ratio increases. But insurance factor was limited to the linear model, and the coefficient estimates are not accurate, which results in considerable problems for reasonable estimates of medical expenses. The research made a comprehensive comparison of domestic and foreign research results and the experience of one city, and set the corresponding demographic indicators (gender and age), household income, willingness to pay and disease type (including its distribution), and other factors affecting Empirical study of medical expenses, and combined the classification of medical insurance with the generalized linear model to reflect the role of the insurance factor, and so provided new ideas and methods to improve the management of minor medical insurance system.
本篇论文是基于城镇居民基本医疗保险框架内的未成年人的缴费水平模型测算的一项理论探索和实证研究,是建立在不同年龄段和不同缴费水平的设计思路上的理论探索。本篇论文通过文献规范研究和实证研究,定性研究与定量研究相结合,研究国内外未成年人医疗保险缴费水平测算的相关资料,通过分析与总结我国各试点城市未成年人医疗保险缴费水平及模式的异同,以武汉市为研究对象,重点分析武汉市未成年人基本医疗消费需求特征及医疗保险基金补偿支出情况。同时,运用医疗保险学、保险精算学、社会学和经济学的有关筹资理论和方法,建立政府、医保部门、未成年人及其家庭等多方的医疗诉求及其优先次序关系；研究未成年人缴费水平所需的关键参数及其测算方法,构建未成年人适宜缴费水平的数学理论模型,为确定未成年人适宜缴费水平提供依据。
研究方法
(一)文献分析法
查阅国内外医疗保险保费、筹资水平、补偿支出、保险因子、支付意愿以及我国各试点城市未成年人医疗保险缴费水平及模式的相关文献资料,运用内容分析方法对有关内容进行比较,进一步分析提炼可供本研究借鉴的理论和方法。
(二)专家咨询法
向医疗保险、卫生经济、卫生管理、医学社会学等领域的专家分别就末成年人年龄段划分、医疗保险补偿支出增长系数、政府、医保部门、未成年人家庭等多方诉求的优先次序等问题进行咨询,并通过专家座谈的方式对上述问题进行讨论。
(三)专题小组讨论
分别就政府和医保部门对未成年人缴费水平的测算依据、医疗诉求以及未成年人缴费水平的动态变化机制进行专题小组讨论,每个专题小组讨论由人力资源和劳动保障部门、财政部门、卫生行政部门、居民医保经办机构工作人员和高校教师等组成,共计28名。
(四)知情人访谈
通过医疗保险管理部门的知情人访谈,了解当前未成年人医疗保险的缴费水平的基本测算思路与方法。
(五)现场调查法
以武汉市为调查对象,按照社会经济发展、地理位置和医疗资源分行等特点,分别选取江汉区、青山区、洪山区和黄陂区作为本研究的现场调查地点。对未成年人参保情况、参保未成年人医疗保险基金补偿支出情况、未成年人缴费水平的测算依据和目标诉求情况、未成年人就医的医疗机构级别、基本医疗消费支出、居民医保的参保情况和家庭支付意愿等方面进行调查。对4个调查地点按分层随机抽样原则抽取500户的未成年人家庭。调查的具体内容包括未成年人就医的医疗机构级别、基本医疗消费支出、居民医保的参保情况和支付意愿等。
(六)资料分析方法
①使用描述性统计分析和多因素方差分析对未成年人的基本医疗消费需求特征进行分析；②使用四步模型法构造未成年人基本医疗消费支出的测算模型；③使用入户问卷调查,通过竞价法和直接法初步得出未成年人医疗保险家庭支付意愿；④使用排序法对政府、医保部门、未成年人家庭等多方目标诉求进行优先次序的比较；⑤构建居民医保未成年人适宜缴费水平的测算模型。
研究结果
(1)未成年人医疗保险的参保年龄分段为：0-1周岁,2-3周岁,4-6周岁,7-12周岁,13-18周岁。
(2)人均未成年人医疗保险筹资额(S)的基本公式为：S’参保=(Go·Po,’·Ko·Eo·Co+Gi·Pi’·Ki·Ei·Ci)／(82%～96%)其中,Go表示年人均门诊就诊率,P’o表示次均门诊医药费用,Ko表示门诊补偿比例,Eo表示门诊保险因子,Co表示门诊增长系数,Gi表示年人均住院率,Pi’表示次均住院医药费,Ki表示住院补偿比例,Ei表示住院保险因子,Ci表示住院增长系数。
(3)2008-2010年武汉市未成年人医疗保险实际补偿比为58.6%；若考虑武汉市7个中心城区高达93%的未成年人参保率,保险因子近似于1.0；若考虑不同级别医院的医疗费用差别,则一、二、三级医疗机构的保险因子分别近似为1.10、1.15和1.20。不同年龄段的未成年人在不同级别的医院就诊,其门诊和住院费用增长系数不一样；若选择医药费用比值法,则增长系数均值为0.538；若选择医药行业CPI为增长系数估计值,则为0.420；若选择综合比值法,则为0.745。
(4)2008-2010年,武汉市未成年人的两周患病率、两周就诊率和年人均就诊率等差别不大(P>0.05),说明武汉市未成年人的疾病发生率变化不大,是一个相对稳定的疾病模型。0-1岁、2-3岁和4-6岁年龄段,男性和女性的两周患病率、两周就诊率和年人均就诊率的差别不大(P>0.05),7-12和13-18岁年龄段,男性和女性的两周患病率、两周就诊率和年人均就诊率间存在显著性差异(P＜0.01)
(5)性别和年龄对医疗费用的支出有显著影响。不同年龄段的未成年人的医疗费用支出及其结构也存在着较大差异。其中,13-18岁年龄组的未成年人的医疗费用的差异显著。2-3岁和4-6岁年龄组的未成年人的医疗费用较高,住院利用率较高。
(6)在社会经济等影响因素不变的情况下,武汉市未成年人医疗消费随着家庭收入的增加而增加,且家庭收入每增加1%,医疗消费支出将会增加0.6839%。若考虑物价增长和家庭恩格尔系数因素,由于基本医疗消费需求的刚性特征,家庭医疗支出已经成为家庭开支的重要组成部分。医疗费用的支出与未成年人的生理和心理发育阶段密切相关,也与不同年龄段所患疾病的类型及其分布密切相关。
(7)未成年人家庭更愿意参照居民医保的缴费水平缴纳未成年人医疗保险。
研究结论
国内围绕着未成年人缴费水平测算的模型研究目前还属于初步探索阶段,未成年人的生理和心理发育的特点,及其疾病分布与结构特征,决定了其缴费水平测算的复杂性。家庭收入与支付意愿在一定程度上呈现正相关,但是由于医疗服务属于刚性需求,尤其是未成年人的医疗服务需求的刚性较成年人大,因此,政府和医疗保险管理部门在制定相关制度确定相关缴费标准、医疗费用补偿比等时必须慎重。国内部分学者提出保险因子的概念,认为在医疗保险制度中随着补偿比的提高,其医疗支出也将随之扩大,但是保险因子的测算仅仅局限于线性模型,系数估计的不准确使得我国实施医疗保险当中医疗费用的合理测算带来了相当大的困扰。按照不同年龄段测量的医疗费用支出特征和家庭支付意愿,0-1周岁未成年人缴费水平应在40元,2-3周岁和4-6周岁未成年人缴费水平应在50元,7-12周岁未成年人缴费水平应在40元,13-18周岁未成年人缴费水平应在30元。
Objective
This study is a theoretical exploration and empirical research of the model calculation of minors'payment level, based on the framework of basic medical insurance for urban residents. It is a beneficial exploration of design ideas based on different ages and different payment levels and standards. By doing literature and empirical research, combining qualitative research with quantitative research, studying materials about the medical insurance payment level of minors at home and abroad, the study analyzed and summarized the similarities and differences of the levels and models of Medicare payment in the pilot cities. Taken Wuhan city as an object of study, analyzes the consumer demand characteristics of the minors'basic medical insurance and expenses of material benefits fund in Wuhan. Using medical insurance theory, actuarial science theory, sociology and economics theories and methods related to financing,①to establish health care appeals and the multi-priority relationship which involves government, health care departments, minors and their families;②to study minors the key parameters and calculation method of minors'payment level, to build a mathematical model for an appropriate payment level of minors;③to demonstrate and amend the core parameters and constraints in building the theoretical model, providing the basis to determine an appropriate payment level. Research Methods (A) Document analysis
Consult related literature on domestic and international medical insurance premiums, funding levels, compensation expenses, the insurance factors, willingness to pay, and the payment level and mode of minors in pilot cities, using content analysis method to compare the contents to figure out the theories and methods which can be utilized in this study.
(B) Expert consultation
Inquire the experts in health insurance, health economics, health management, medical sociology about the priority among minors division by age, health insurance compensation expense growth factors, government, health care departments, juvenile and family parties and other issues. By expert panel, launch a discussion on these issues.
(C) Focus group discussions
Launch focus group discussions on government and related departments'calculation basis of minors'payment level, health care appeals and the dynamic mechanism of the level. Each group consisted of 4-6 members from human resources and labor security department, finance department, health administration, health care agencies.
(D) Insider interview
By interviewing medical insurance management department insiders, understand the current basic ideas and methods of calculation of minor health insurance payment level.
(E) On-site survey
Take Wuhan as an object of study, in accordance with the social and economic development, geographical characteristics and distribution of medical resources, select Jianghan District, Qingshan District, Hongshan District, and Huangpi District as locations of the site survey. Investigate the insurance case of minors, material benefits fund expenditures, the residents health insurance agencies'calculation basis of minors payment level and target resorts, levels of medical institutions for minors' medical treatment, basic medical care spending, the situation of the insured health care residents and willingness to pay and so on. About 500 families of minors are chosen in each location. The specific content of the survey, including levels of medical institutions for minors' medical treatment, basic medical care spending, and residents insured situation and willingness to pay and so on. (Vi) Data analysis methods
①Use descriptive statistical analysis and multi-factor analysis of variance to analyze the characteristics of minors basic medical consumer demand;②Use the four-step model method to construct the calculation model of minors basic health consumer spending;③Using home questionnaires, initial bidding method and direct method, to calculate families' willingness to pay;④Use the AHP to adjust the precedence order of the government, health care departments, juvenile families demands and target resorts;⑤Build a calculation model for an appropriate payment level of minors medical insurance.
Results:
(1) The age groups of insured minors were divided into:0-1 years old,2-3 years old,4-6 years old,7-12 years old,13-18 years old.
(2) The basic formula for Per capita medical insurance financing is: S'=(Go·Po·Ko·Eo·Co+Gi·Pi·Ki·Ei·Ci)/(82%～96%)
Go refers to per capita rate of out-patient treatment in one year; P o refers to per out-patient health care costs, Ko refers to the proportion of out-patient compensation, Eo refers to out-patient insurance factor, Co refers to out-patient increasing coefficient;Gi refers to the per capita rate of hospitalization treatment in one year; P; refers to per hospitalization costs; Ki refers to the proportion of hospitalization compensation; Ei refers to hospitalization insurance factor; Ci refers to hospitalization increasing coefficient.
(3) From 2008 to 2010, the actual compensation rate for minors was 58.6%; if taking account of all the minors in 7 center districts in Wuhan, the insurance factor was approximated 1.0. If taking account of differences health costs in different level hospitals, the insurance factors of grade one, two, three medical are approximately 1.10,1.15 and 1.20 respectively. The minors of different ages hospitalized in different levels hospitals, the growth factors of outpatient and hospitalization costs were different; if adopting health care cost ratio method, the mean growth factor is 0.538; If taking pharmaceutical industry CPI as estimated growth coefficient ratio, it was 0.420; if adopting comprehensive ratio method, it was 0.745.
(4) From 2008 to 2010, In Wuhan City, two weeks prevalence, two weeks treatment rate and per capita outpatient rate are not very different (P>0.05). It shows that the disease incidence in Wuhan is a relatively stable disease model. The two weeks prevalence, two weeks treatment rate and per capita outpatient rate changed much. The two weeks prevalence, two weeks treatment rate and per capita outpatient rate of 0-1,2-3 years old and 4-6 years age group, male and female are not very different (P> 0.05),while 7-12 years old and 13-18 years old age group, male and female are significantly different(P<0.01).
(5) The relationship between health care costs with gender and age. The influences of gender and age on health care expenses are significant. The structure and the number of health care costs of different age groups are quite different. The health care costs of 13 to-18 age group were significantly different. The health care costs and hospitalization rate of 2-3 years and 4-6 years age group are higher. The health care costs of 13-18 years old group are quite different.
(6) The influence of family income on health care costs. After a minor illness, if taking the development of social and economic factors as the same circumstances, the medical care cost increases as family income increases, and each 1% increase will cause health care cost increased by 0.6839 percent. If taking account of the price factor in growth and family Engel coefficient, due to the rigidity of the basic features of consumer demand, health care cost has become an important component of household expenditure. Health care cost is closely related with phases of the physiological and psychological development, and also the type of illness and its distribution.
(7) the relationship between willingness to pay for health insurance and health care costs. Residents are more willing to pay health insurance for minors according to the level of the residents health insurance.
Conclusions
The study on measuring model of medical insurance financing is still in preliminary exploration stage. The minor's physical and mental development characteristics and disease distribution and structure cause determine the complexity of financing measuring. The household income is positively related with willingness to pay, but due to demand for health care services are rigid, especially the demand for medical care services for minors is larger, so the government and the medical insurance management department must be careful to put forwards relevant rules, financing standard, medical expenses, compensation ratio. Some domestic scholars have proposed the concept of the insurance factor, and argued that medical expenditures will grow as the compensation ratio increases. But insurance factor was limited to the linear model, and the coefficient estimates are not accurate, which results in considerable problems for reasonable estimates of medical expenses. The research made a comprehensive comparison of domestic and foreign research results and the experience of one city, and set the corresponding demographic indicators (gender and age), household income, willingness to pay and disease type (including its distribution), and other factors affecting Empirical study of medical expenses, and combined the classification of medical insurance with the generalized linear model to reflect the role of the insurance factor, and so provided new ideas and methods to improve the management of minor medical insurance system.
引文
3 Brennan, M.J. and E.S. Schwartz. "Alternative Investment Strategies for the Issuers of Equity-linked Life Insurance Policies with an Asset Value Guarantee"[J].Journal of Business,1979(52):63-93.
工东进.回顾与前瞻:中国医疗保险制度改革[M].北京：中国社会科学出版社，2008.
1唐莉.我国农村合作医疗筹资问题研究[D].(硕士学位论文),武汉科技大学,2006.
2李良年.杨树勤.保险因子的初步研究[J].中国农村卫生事业管理,1994(4)：13-17.
3畅金侠,李林贵,李士雪.新型农村合作医疗基金测算方法研究[J].卫生经济研究,2005(9)：16-17.
4参考贾洪波、孟宏斌、尹爱田等学者的研究结果。
(?)孟宏斌,陈娥英.西部新型农村合作医疗筹资标准的测算确定[J].人文杂志,2008(5)：183-185.
①Guy Carrin, P(?) ilip D avies,江芹.中国农村合作医疗最佳实践分析框架-卫生系统的功能与筹资组织[J].中国卫生经济,2002(2)：7-10.
②杨树勤.农村健康保险的精算体系[J].现代预防医学,1994(2)：69-72.
1 国外未成年人医保的管理费一般不超过未成年人医保基金的5%。
2 成吕慧.山东省农村合作医疗筹资、利用和费用之间数量关系模型研究[D].(硕士学位论文),山东医科大学,1996.
1李鹏翔,尹爱田.农村大病统筹医疗保险方案中的费率测算[J].中国初级卫生保健,2000,14(1)：19-22.2
2邓大松,杨红燕.老龄化趋势下基本医疗保险筹资费率测算[J].财经研究,2003,29(12)：39-44.
[1]贾洪波.中国基本医疗保险适度缴费率研究[M].吉林：吉林大学出版社,2009.
[2]Newacheck PW, Stoddard JJ, Hughes DC, Pearl M. Health insurance and access to primary care for children [J]. N Engl J Med.1998,338(8):513-519.
[3]贾洪波.中国基本医疗保险适度缴费率模型与测算[J].预测,2010(1)：26-29.
[4]刘小兵.中国医疗保险费率水平研究[J].管理世界,2002(7)：22-24.
[5]贾洪波.城镇居民基本医疗保险适度缴费率分析[J]；财经科学,2009(11)：40-43.
[6]贾洪波,刘玮玮.中国基本医疗保险适度缴费率研究[J].价格月刊,2008(9)：22-24.
[7]汪忠.国外风险管理研究的理论、方法及其进展[J].外国经济与管理,2005,27(2)：26-30.
[8]黎民,崔璐.社会医疗保险中的道德风险与费用控制[J].人口与经济,2007(4)：34-36.
[9]王留女.社会医疗保险的道德风险及其约束机制[J].经济论坛,2008(7)：22-23.
[10]刘国恩,唐婷婷,雷震.医疗保险个人账户对医疗费用的影响：基于镇江医疗保险数据的面板分析[J].中国卫生经济,2009,23(2)：9-12.
[11]刘冬冬,刘国恩,林枫.医疗个人账户“通道式”和“板块式”的积累作用——基于镇江和南京医保数据的分析[J].实证,2009(1):21-30.
[12]Pauly,MarkV.Theeconomicsofmoralhazard. Comment.Am.Econ.1968.
[13]McGureT.PhysicianResponse to Fee Changes with Multiple Payers. Journal of Health Economics.2001(10).
[14]Ozanne L. How Will Medical Savings Accounts Affect Medical Spending?. Inquiry.1996(33).
[15]Newhouse JP.A model of physician pricing. Southern Economic Journal.1977.37(2).
[16]Buehanan,Allen.Managed care:Rationing without justice,but not Unjustly. Journal of Health Politics,Policy and Law.1998(4).
[17]Laurence C. Baker. The Effect of HMOs on Fee-for-Service Health Care Expenditures:Evidence from Medicare. Journal of Health Economics.1997(16).
[18]Goldman Fred. The demand for Pediatric care:An Hedonic Approach.1977(12).
[19]郑大喜.医疗保险费用支付方式的比较及其选择[J].中国初级卫生保健,2005(6)：.
[20]梁春贤.我国医疗保险费用支付方式问题的探讨[J].财政研究,2007(8)：.
[21]Parmenter EM. Health care benefit crisis:cost drivers and strategic solutions. Journal of Financial Service Professionals,2004,58(4):63-78.
[22]Kingsbury K. Pressure on your health benefits[J]. Time,2006,168(19):53-54.
[23]张奇林.美国的医疗卫生费用及其控制[J].世界经济,2002,(6)：53-59.
[24]Woodrum DL. Provider response to cost containment:an insider perspective[J].Ann Health Law,2006,15(2):387-391,393-398.
[25]郑小华,胡锦梁,钱恩奎,等.中美两国医疗费用控制理论与方法比较研究[J].中国循证医学杂志,2009,9(11)：1193-1199.
[26]张音,刘辉,谢文新,等.病例组合方式付费的可行性分析[J].中国医院统计,2004,11(3)：241-242.
[27]张侃,冯宗宪,李哲.浅谈住院医疗费用的外部影响因素及控制[J].中国医院,2005,9(7)：50-53.
[28]杨卫泽.政府公共管理[M].江苏：东南大学出版社,2005.
[29]De Maeseneer JM, De Prins L, Gosset C, Heyerick J. Provider continuity in family medicine:does it make a difference for total health care costs?[J]. Ann Fam Med,2003,1(3):144-148.
[30]Mitton CR, Adair CE, McDougall GM, Marcoux G. Continuity of care and health care costs among persons with severe mental illness[J]. Psychiatr Serv,2005,56(9):1061-1069.
[31]武建强.对委托代理理论中保险营销员激励监督机制的思考[J].上海保险,2007(3)：33-35.
[32]Saultz JW, Lochner J. Interpersonal continuity of care and care outcomes:a critical review[J]. Ann Fam Med,2005,3(2):159-166.
[33]Kasper JD. The importance of type of usual source of care for children's physician access and expenditures[J]. Medical Care,1987,25(5):386-398.
[34]朱铭来,尚颖.健康保险需求理论研究综述[J].保险与风险管理研究动态,2010(3)：1-14.
[35]张荣贵,申俊龙.过度医疗服务需求的成因及干预机制设计[J].现代医院管理,2008(3)：29-31.
[36]高梦滔.美国健康经济学的发展[J].经济学动态,2002(8)：17-23.
[37]刘厚俊.现代西方经济学原理[M].南京大学出版社,2002(3)：112-113.
[38]王根贤.关于医疗需求的经济学分析[J].商业研究,2007(5)：168-170.
[39]杨波.我国公立医院提供过度服务的契约解释[J].改革与战略,2007(8)：146-149.
[40]顾听.全球性医疗体制改革的大趋势[J].中国社会科学,2005(6)：121-128.
[41]Christakis DA, Mell L, Koepsell TD, Zimmerman FJ, Connell FA. Association of lower continuity of care with greater risk of emergency department use and hospitalization in children[J]. Pediatrics,2001,107(3):524-529.
[42]Robert J.LaLonde. Evaluating the econometric evaluations of training programs with experimental data[J].American Economic Review.1986,76(4):604-620.
[43]James J.Heckman,Hidehiko Ichimura,Petra E.Todd. Matching as an econometric evaluation estimator:evidence from evaluating a job training programme[J]. Review of Economic Studies.1997,64(4):605-654.
[44]Gill J, Mainous A. The role of provider continuity in preventing hospitalizations [J]. Arch Fam Med,1998,7(4):352-357.
[45]Rajeev H.Dehejia, Sadek Wahba. Propensity score matching methods for non-experimental causal studies[J].Review of Economics and Statistics,2002,84(1):151-161.
[46](美)曼昆著,梁小民译.经济学原理—微观经济学分册(第4版).北京：北京大学出版社.2006.
[47]徐凌中.立方亿编译.经济学评价中支付意愿的测量方法[J].国外医学·卫生经济分册,1998,15(2)：63-65.
[48]Robert K.Davis.Recreation planning as an economic problem [J].Natural Resources Journal,1963(3):239-249.
[49]Richard D.Smith. Construction of contingent valuation market in health care:a critical assessment[J].Health Economics.2003,12(8):609-628.
[50]张治国,龚勋,罗五金.我国城镇未成年人医疗保障制度比较研究[J].中国卫生经济,2010,27(8)：32-34.
[51]Janet R. Cummings, Shana Alex Lavarreda, Thomas Rice, E. Richard Brown.The Effects of Varying Periods of Uninsurance on Children's Access to Health Care [J]. Pediatrics 2009(123):411.
[52]Sarah A. Birken, Michelle L. Mayer.An Investment in Health:Anticipating the Cost of a Usual Source of Care for Children [J]. Pediatrics,2009(123):77.
[53]秦侠.卫生管理运筹学.北京：人民卫生出版社.2005.
[54]Duan,Naihua,et al.A comparison of alternative models for the demand for medical care[J].Journal of Business and Economic Statistics.1983,1(2):115-126.
[55]邱晓丹.深圳市中小学生和幼儿园儿童住院医疗保险费的测算[J].中国卫生经济,1997,16(3)：24-26.
[56]饶克勤.中国城市居民医疗服务利用影响因素的研究一四步模型法的基本理论及其应用[J].中国卫生统计,2000,17(2)：70-73.
[57]封进,余央央,秦蓓.中国农村医疗负担解析：如何为穷人减负[D].第六届中国经济学年会中国女经济学者研究培训项目学员参会论文.2006.
[58]顾听.居民医保：筹资水平知多少[J].中国社会保障,2007,25(8)：46-47.
[59]吴明,张里程.医疗保险费测算[J].中国医院管理,2000,20(4)：58-59.
[60]程晓明.提高新型农村合作医疗实际住院补偿比及制度完善研究[R].卫生部农村卫生管理司、卫生部新型农村合作医疗研究中心新型农村合作医疗课题研究报告汇编(2006-2007).
[61]代志明.中国“城镇居民医保”基金盈余敏感性分析—以郑州市为例[J].人口与发展,2008,14(3)：52-57.
[62]谢慧玲,张璐莹.影响新型农村合作医疗实际住院补偿比的因素分析[J].中国卫 生政策研究,2010,3(3)：30-33.
[63]刘思峰,党耀国,方志耕,等.灰色系统理论及其应用[M].北京：科学出版社,2004.
[64]S Cretin,N H Duan,A P Williams,Jr,X Y Gu,and Y Q Shi. Modeling the effect of insurance on health expenditures in the People's Republic of China. Santa Monica:RAND Corporation,August,1987.
[65]S Cretin,番传旭,杨树勤.医疗费用的预测模型.见：中国农村健康保险研究组.农村健康保险研究(1).成都：1989.
[66]Shan Cretin医疗费用的预测模型.中国农村健康保险实验研究,1989：63-66.
[67]Shan Cretin et al. Modeting the effect of insurance om health expenditures in the people's Republic of China, June,1987.
[68]杨金侠,李林贵,李士雪.新型农村合作医疗基金测算方法研究[J].卫生经济研究,2005(9)：16-17.
[69]Shan Cretin et al. Methods for setting health insurance Premiums,July,1987.
[70]李良军,杨树勤,刘关键,等.医药费用预测模型及保险因子分析[J].中国卫生事业管理,1994,10(5)：235-240.
[71]李士雪.新型农村合作医疗对农民卫生服务利用的影响研究[R].卫生部农村卫生管理司、卫生部新型农村合作医疗研究中心新型农村合作医疗课题研究报告汇编(2006-2007).
[72]Feldstein M S. Quality change and the demand for hospital care[J]. Econometrica. 1997,45(7):1681-1702.
[73](美)伍德里奇著,费剑平译.计量经济学导论(第三版).北京:中国人民大学出版社.2007.
[74]Feldstein M S,Friedman B. Tax subsidies, the rational demand for insurance and the health care crisis[J].Journal of Public Economics.1997,7(2):155-178.
[75]Bradley Herring,Mark V.Pauly. Incentive-compatible guaranteed renewable health insurance premiums[J].Journal of Health Economics.2006,25(3):395-417.
[76]卢祖洵.社会医疗保险学[M].北京：人民卫生出版社,2003.
[77]程晓明.医疗保险学概论[M].上海：复旦大学出版社,2003.
[78]李良军.保险因子的测算[J].中国卫生事业管理,1994(6)：55-56.
[79]左树岩.探索合作医疗制度下的大病补偿比[J].卫生经济研究,2001(3)：14-15.
[80]汪妍,孙秋柏.基于广义线性模型的分类费率厘定方法[J].辽宁科技大学学报,2009,32(4)：391-393.
[81]李致炜,宋世斌.居民医保中的医疗费用分新及预测在处理医疗费用[J].统计与决策,2008(16)：72-74.
[82]Lave JR, Keane CR, Lin CJ, Ricci EM, Amersbach G, LaVallee CP. Impact of a children's health insurance program on newly enrolled children[J]. JAMA,1998,279(22):1820-1825.
[83]Duan N, Manning WG, Morris CN, Newhouse JP. A comparison of alternative models for the demand for medical care [J]. J Bus Econ Stat.1983,1(1):115-126.
[84]Wooldridge JM. Introductory Econometrics:A Modern Approach.3rd ed [M]. Mason, OH. South-Western College Publishing,2005.
[85]Bice TW, Boxerman SB. A quantitative measure of continuity of care [J]. Med Care.1977,15(4):347-349.
[86]Brown JB, Nichols GA, Glauber HS. Case-control study of 10 years of comprehensive diabetes care [J]. West J Med.2000,172(2):85-90.
[87]Selden TM, Banthin JS, Cohen JW. Waiting in the wings:eligibility and enrollment in the State Children's Health Insurance Program [J]. Health Aff (Millwood),1999,18(2):126-133.
[88]Miller PA, Binns HJ, Christoffel KK. Children's bicycle helmet attitudes and use [J]. Arch Pediatr Adolesc Med,1996,150(12):1259-1264.
[89]Sege RD, Perry C, Stigol L. Short-term effectiveness of anticipatory guidance to reduce early childhood risks for subsequent violence [J]. Arch Pediatr Adolesc Med. 1997,151(4):392-397.
[90]Clamp M, Kendrick D. A randomised controlled trial of general practitioner safety advice for families with children under 5 years [J]. BMJ.1998,316(7144):1576-1579.
[91]Wall MA, Severson HH, Andrews JA Lichtenstein E, Zoref L. Pediatric office-based smoking intervention:impact on maternal smoking and relapse [J]. Pediatrics. 1995,96(4 pt 1):622-628
[92]Newacheck PW, Hughes DC, Hung Y, Wong S, Stoddard JJ. The unmet health needs of America's children [J]. Pediatrics.2000,105(4 pt 2):989-997
[93]Aiken KD, Freed GL, Davis MM. When insurance status is not static:insurance transitions of low-income children and implications for health and health care [J]. Ambul Pediatr.2004;4(3):237-243.
[94]Olson LM, Tang SF, Newacheck PW. Children in the United States with discontinuous health insurance coverage [J]. N Engl J Med.2005;353(4):382-391.
[95]李良军,杨树勤,刘关键,等.医药费用预测模型及保险因子分析[J].中国卫生事业管理,1994,10(5)：235-240.
[96]何文炯,杨一心,刘晓婷,等.社会医疗保险纵向平衡费率及其计算方法[J].中国人口科学,2010(3)：88-95.
[97]徐玲,简伟研.中国基本医疗保障制度受益公平性的实证研究[J].医学与社会,2010,23(11)：45-47
[98]夏俊,田听,张新平.基本药物医保报销政策研究[J].医学与社会,2010,23(6)：64-66.
[99]董乐,陈圣芳.武汉市大学生医疗保障问题及对策[J].医学与社会,2009,22(10)：35-37.
[100]Judith R. Lave, Christopher R. Keane, ScD, Chyongchiou J. Lin, Edmund M. Ricci, Gabriele Amersbach, Charles P. LaVallee. Impact of a Children's Health Insurance Program on Newly Enrolled Children [J]. JAMA.1998,279(22):1820-1825.
[1]2008年我国卫生改革与发展情况.www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s6690/200902/39109.htm.
[2]广州市城镇居民基本医疗保险试行办法.穗府办[2008]22号.
[3]荆门市城镇居民基本医疗保险暂行办法.荆政发[2007]29号.
[4]贵阳市城镇居民基本医疗保险试点工作方案.黔居医联办函[2007]1号.
[5]秦侠主编,袁长海副主编.卫生管理运筹学.北京：人民卫生出版社.2005.
[6]Duan, Naihua, et al.A comparison of alternative models for the demand for medical care[J].Journal of Business and Economic Statistics.1983,1(2):115-126.
[7]邱晓丹.深圳市中小学生和幼儿园儿童住院医疗保险费的测算[J].中国卫生经济, 1997,16(3)：24-26.
[8]饶克勤.中国城市居民医疗服务利用影响因素的研究—四步模型法的基本理论及其应用[J].中国卫生统计,2000,17(2)：70-73.
[9]封进,余央央,秦蓓.中国农村医疗负担解析：如何为穷人减负.第六届中国经济学年会中国女经济学者研究培训项目学员参会论文.2006年12月16日-17日.
[10]顾听.居民医保：筹资水平知多少[J].中国社会保障,2007,25(8)：46-47.
[11]新型农村合作医疗培训讲义(试行).卫生部农村卫生管理司.2005年5月.
[12]吴明,张里程.医疗保险费测算[J].中国医院管理,2000,20(4)：58-59.
[13]程晓明.提高新型农村合作医疗实际住院补偿比及制度完善研究.卫生部农村卫生管理司、卫生部新型农村合作医疗研究中心新型农村合作医疗课题研究报告汇编(2006-2007).
[14]代志明.中国“城镇居民医保”基金盈余敏感性分析—以郑州市为例[J].人口与发展,2008,14(3)：52-57.
[15]S Cretin, N H Duan, A P Williams, Jr, XYGu, and Y Q Shi. Modeling the effect of insurance on health expenditures in the People's Republic of China. Santa Monica:RAND Corporation, August,1987.
[16]S Cretin,潘传旭,杨树勤.医疗费用的预测模型.见：中国农村健康保险研究组.农村健康保险研究(1).成都：1989.
[17]Shan Cretin,等.医疗费用的预测模型.中国农村健康保险实验研究,1989：63-66.
[18]Shan Cretin et al. Modeting the effect of insurance om health expenditures in the people's Republic of China, June,1987.
[19]Shan Cretin et al. Methods for setting health insurance Premiums,July,1987.
[20]李良军,杨树勤,刘关键,等.医药费用预测模型及保险因子分析[J].中国卫生事业管理,1994,10(5)：235-240.
[21]李士雪.新型农村合作医疗对农民卫生服务利用的影响研究.卫生部农村卫生管理司、 卫生部新型农村合作医疗研究中心新型农村合作医疗课题研究报告汇编(2006-2007).
[22]Feldstein M S. Quality change and the demand for hospital care[J]. Econometrica. 1997,45(7):1681-1702.
[23](美)伍德里奇著,费剑平译.计量经济学导论(第三版).北京：中国人民大学出版社.2007.
[24]Feldstein M S, Friedman B. Tax subsidies, the rational demand for insurance and the health care crisis[J].Journal of Public Economics.1997,7(2):155-178.
[25]Bradley Herring, Mark V.Pauly. Incentive-compatible guaranteed renewable health insurance premiums[J].Journal of Health Economics.2006,25(3):395-417.
[26]Robert J.LaLonde. Evaluating the econometric evaluations of training programs with experimental data[J].American Economic Review..1986,76(4):604-620.
[27]James J.Heckman, Hidehiko Ichimura, Petra E.Todd. Matching as an econometric evaluation estimator:evidence from evaluating a job training programme[J]. Review of Economic Studies.1997,64(4):605-654.
[28]Rajeev H.Dehejia, Sadek Wahba. Propensity score matching methods for non-experimental causal studies[J].Review of Economics and Statistics,2002,84(1): 151-161.
[29](美)曼昆著,梁小民译.经济学原理一微观经济学分册(第4版).北京：北京大学出版社.2006.
[30]徐凌中,立方亿编译.经济学评价中支付意愿的测量方法[J].国外医学·卫生经济分册,1998,15(2)：63-65.
[31]Robert K.Davis. Recreation planning as an economic problem. Natural Resources Journal,1963(3):239-249.
[32]Richard D.Smith. Construction of contingent valuation market in health care:a critical assessment[J].Health Economics.2003,12(8):609-628.
[33]O'Brien B, Gafni A. When do the "dollars" make sense?Toward a conceptual framework for contingent valuation studies in health care [J].Medical Decision Making.1996,16(3):288-299.
[34]卢宪中,陈文,应晓华.条件价值评估法在卫生经济学研究中的应用[J].中国卫生经 济,2005,24(11)：58-60.
[35]陈文,应晓华,胡善联,等.补充医疗保险的需求研究[J].中国卫生生经济,2002,21(12)：17-21.
[36]Davis R K. Recreation planning as an economic problem. Natural Resources Journal, 1963(3):239-249
[37]2张志强.徐中民.程国栋.条件价值评估法的发展与应用.地球科学进展,2003,18(3)：454-463
[38]Bayoumi AM. The measurement of contingent valuation for health economics. Pharmacoeconomics,20o4,24(11):691—700
[39]Klose T. The contingent valuation method in health care. Heahh Policy.1999(47): 97-123
[40]陈文,应晓华.胡善联,等.补充医疗保险的需求研究.中国卫生经济,2002,21(12)： 17-21
[41]Diener A, O'Brien B. Gafni A. Health care contingent valuation studies:, a review and classification of the literature. Health Econ,1998,7(4):313-326
[42]Smith RD. Construction of the contingent valuation market in health care:a critical assessment. Health Econ.2003,12(8):609-628
[43]Blumenschein K, Johannesson M. Use of contingent valuation to place a monetary value on pharmacy services:an overview and review of the literature. Clin Ther.1999,21(8):1402-1407.
[44]Konig HH. Measuring preferences of psychiatric patients. Psychiatr Prax,2004,31(3): 118-127
[45]Sampietro-Colom L, Phillips VL, Hutchinson AB. Eliciting woment'S preferences in health care:a review of the literature. Int J Technol Assess Health Care.2004,20(2): 145-155
[46]National Oceanic and Atmospheric Administration. Repo of the NOAA panel on contingent valuation. Federal Register,1993 (58):4607-4614
[47]Johannesson M. The contingent valuation method-appraising the appraisers. Health Economics,1993(2):357-359
[48]O'Brien B. and Gafni A. When do the dollars make sense?Toward a conceptual framework for contingent valuation studied in health care. Medical Decision Making, 1996(16):288-299
工东进.回顾与前瞻:中国医疗保险制度改革[M].北京：中国社会科学出版社，2008.
1唐莉.我国农村合作医疗筹资问题研究[D].(硕士学位论文),武汉科技大学,2006.
2李良年.杨树勤.保险因子的初步研究[J].中国农村卫生事业管理,1994(4)：13-17.
3畅金侠,李林贵,李士雪.新型农村合作医疗基金测算方法研究[J].卫生经济研究,2005(9)：16-17.
4参考贾洪波、孟宏斌、尹爱田等学者的研究结果。
(?)孟宏斌,陈娥英.西部新型农村合作医疗筹资标准的测算确定[J].人文杂志,2008(5)：183-185.
①Guy Carrin, P(?) ilip D avies,江芹.中国农村合作医疗最佳实践分析框架-卫生系统的功能与筹资组织[J].中国卫生经济,2002(2)：7-10.
②杨树勤.农村健康保险的精算体系[J].现代预防医学,1994(2)：69-72.
1 国外未成年人医保的管理费一般不超过未成年人医保基金的5%。
2 成吕慧.山东省农村合作医疗筹资、利用和费用之间数量关系模型研究[D].(硕士学位论文),山东医科大学,1996.
1李鹏翔,尹爱田.农村大病统筹医疗保险方案中的费率测算[J].中国初级卫生保健,2000,14(1)：19-22.2
2邓大松,杨红燕.老龄化趋势下基本医疗保险筹资费率测算[J].财经研究,2003,29(12)：39-44.
[1]贾洪波.中国基本医疗保险适度缴费率研究[M].吉林：吉林大学出版社,2009.
[2]Newacheck PW, Stoddard JJ, Hughes DC, Pearl M. Health insurance and access to primary care for children [J]. N Engl J Med.1998,338(8):513-519.
[3]贾洪波.中国基本医疗保险适度缴费率模型与测算[J].预测,2010(1)：26-29.
[4]刘小兵.中国医疗保险费率水平研究[J].管理世界,2002(7)：22-24.
[5]贾洪波.城镇居民基本医疗保险适度缴费率分析[J]；财经科学,2009(11)：40-43.
[6]贾洪波,刘玮玮.中国基本医疗保险适度缴费率研究[J].价格月刊,2008(9)：22-24.
[7]汪忠.国外风险管理研究的理论、方法及其进展[J].外国经济与管理,2005,27(2)：26-30.
[8]黎民,崔璐.社会医疗保险中的道德风险与费用控制[J].人口与经济,2007(4)：34-36.
[9]王留女.社会医疗保险的道德风险及其约束机制[J].经济论坛,2008(7)：22-23.
[10]刘国恩,唐婷婷,雷震.医疗保险个人账户对医疗费用的影响：基于镇江医疗保险数据的面板分析[J].中国卫生经济,2009,23(2)：9-12.
[11]刘冬冬,刘国恩,林枫.医疗个人账户“通道式”和“板块式”的积累作用——基于镇江和南京医保数据的分析[J].实证,2009(1):21-30.
[12]Pauly,MarkV.Theeconomicsofmoralhazard. Comment.Am.Econ.1968.
[13]McGureT.PhysicianResponse to Fee Changes with Multiple Payers. Journal of Health Economics.2001(10).
[14]Ozanne L. How Will Medical Savings Accounts Affect Medical Spending?. Inquiry.1996(33).
[15]Newhouse JP.A model of physician pricing. Southern Economic Journal.1977.37(2).
[16]Buehanan,Allen.Managed care:Rationing without justice,but not Unjustly. Journal of Health Politics,Policy and Law.1998(4).
[17]Laurence C. Baker. The Effect of HMOs on Fee-for-Service Health Care Expenditures:Evidence from Medicare. Journal of Health Economics.1997(16).
[18]Goldman Fred. The demand for Pediatric care:An Hedonic Approach.1977(12).
[19]郑大喜.医疗保险费用支付方式的比较及其选择[J].中国初级卫生保健,2005(6)：.
[20]梁春贤.我国医疗保险费用支付方式问题的探讨[J].财政研究,2007(8)：.
[21]Parmenter EM. Health care benefit crisis:cost drivers and strategic solutions. Journal of Financial Service Professionals,2004,58(4):63-78.
[22]Kingsbury K. Pressure on your health benefits[J]. Time,2006,168(19):53-54.
[23]张奇林.美国的医疗卫生费用及其控制[J].世界经济,2002,(6)：53-59.
[24]Woodrum DL. Provider response to cost containment:an insider perspective[J].Ann Health Law,2006,15(2):387-391,393-398.
[25]郑小华,胡锦梁,钱恩奎,等.中美两国医疗费用控制理论与方法比较研究[J].中国循证医学杂志,2009,9(11)：1193-1199.
[26]张音,刘辉,谢文新,等.病例组合方式付费的可行性分析[J].中国医院统计,2004,11(3)：241-242.
[27]张侃,冯宗宪,李哲.浅谈住院医疗费用的外部影响因素及控制[J].中国医院,2005,9(7)：50-53.
[28]杨卫泽.政府公共管理[M].江苏：东南大学出版社,2005.
[29]De Maeseneer JM, De Prins L, Gosset C, Heyerick J. Provider continuity in family medicine:does it make a difference for total health care costs?[J]. Ann Fam Med,2003,1(3):144-148.
[30]Mitton CR, Adair CE, McDougall GM, Marcoux G. Continuity of care and health care costs among persons with severe mental illness[J]. Psychiatr Serv,2005,56(9):1061-1069.
[31]武建强.对委托代理理论中保险营销员激励监督机制的思考[J].上海保险,2007(3)：33-35.
[32]Saultz JW, Lochner J. Interpersonal continuity of care and care outcomes:a critical review[J]. Ann Fam Med,2005,3(2):159-166.
[33]Kasper JD. The importance of type of usual source of care for children's physician access and expenditures[J]. Medical Care,1987,25(5):386-398.
[34]朱铭来,尚颖.健康保险需求理论研究综述[J].保险与风险管理研究动态,2010(3)：1-14.
[35]张荣贵,申俊龙.过度医疗服务需求的成因及干预机制设计[J].现代医院管理,2008(3)：29-31.
[36]高梦滔.美国健康经济学的发展[J].经济学动态,2002(8)：17-23.
[37]刘厚俊.现代西方经济学原理[M].南京大学出版社,2002(3)：112-113.
[38]王根贤.关于医疗需求的经济学分析[J].商业研究,2007(5)：168-170.
[39]杨波.我国公立医院提供过度服务的契约解释[J].改革与战略,2007(8)：146-149.
[40]顾听.全球性医疗体制改革的大趋势[J].中国社会科学,2005(6)：121-128.
[41]Christakis DA, Mell L, Koepsell TD, Zimmerman FJ, Connell FA. Association of lower continuity of care with greater risk of emergency department use and hospitalization in children[J]. Pediatrics,2001,107(3):524-529.
[42]Robert J.LaLonde. Evaluating the econometric evaluations of training programs with experimental data[J].American Economic Review.1986,76(4):604-620.
[43]James J.Heckman,Hidehiko Ichimura,Petra E.Todd. Matching as an econometric evaluation estimator:evidence from evaluating a job training programme[J]. Review of Economic Studies.1997,64(4):605-654.
[44]Gill J, Mainous A. The role of provider continuity in preventing hospitalizations [J]. Arch Fam Med,1998,7(4):352-357.
[45]Rajeev H.Dehejia, Sadek Wahba. Propensity score matching methods for non-experimental causal studies[J].Review of Economics and Statistics,2002,84(1):151-161.
[46](美)曼昆著,梁小民译.经济学原理—微观经济学分册(第4版).北京：北京大学出版社.2006.
[47]徐凌中.立方亿编译.经济学评价中支付意愿的测量方法[J].国外医学·卫生经济分册,1998,15(2)：63-65.
[48]Robert K.Davis.Recreation planning as an economic problem [J].Natural Resources Journal,1963(3):239-249.
[49]Richard D.Smith. Construction of contingent valuation market in health care:a critical assessment[J].Health Economics.2003,12(8):609-628.
[50]张治国,龚勋,罗五金.我国城镇未成年人医疗保障制度比较研究[J].中国卫生经济,2010,27(8)：32-34.
[51]Janet R. Cummings, Shana Alex Lavarreda, Thomas Rice, E. Richard Brown.The Effects of Varying Periods of Uninsurance on Children's Access to Health Care [J]. Pediatrics 2009(123):411.
[52]Sarah A. Birken, Michelle L. Mayer.An Investment in Health:Anticipating the Cost of a Usual Source of Care for Children [J]. Pediatrics,2009(123):77.
[53]秦侠.卫生管理运筹学.北京：人民卫生出版社.2005.
[54]Duan,Naihua,et al.A comparison of alternative models for the demand for medical care[J].Journal of Business and Economic Statistics.1983,1(2):115-126.
[55]邱晓丹.深圳市中小学生和幼儿园儿童住院医疗保险费的测算[J].中国卫生经济,1997,16(3)：24-26.
[56]饶克勤.中国城市居民医疗服务利用影响因素的研究一四步模型法的基本理论及其应用[J].中国卫生统计,2000,17(2)：70-73.
[57]封进,余央央,秦蓓.中国农村医疗负担解析：如何为穷人减负[D].第六届中国经济学年会中国女经济学者研究培训项目学员参会论文.2006.
[58]顾听.居民医保：筹资水平知多少[J].中国社会保障,2007,25(8)：46-47.
[59]吴明,张里程.医疗保险费测算[J].中国医院管理,2000,20(4)：58-59.
[60]程晓明.提高新型农村合作医疗实际住院补偿比及制度完善研究[R].卫生部农村卫生管理司、卫生部新型农村合作医疗研究中心新型农村合作医疗课题研究报告汇编(2006-2007).
[61]代志明.中国“城镇居民医保”基金盈余敏感性分析—以郑州市为例[J].人口与发展,2008,14(3)：52-57.
[62]谢慧玲,张璐莹.影响新型农村合作医疗实际住院补偿比的因素分析[J].中国卫 生政策研究,2010,3(3)：30-33.
[63]刘思峰,党耀国,方志耕,等.灰色系统理论及其应用[M].北京：科学出版社,2004.
[64]S Cretin,N H Duan,A P Williams,Jr,X Y Gu,and Y Q Shi. Modeling the effect of insurance on health expenditures in the People's Republic of China. Santa Monica:RAND Corporation,August,1987.
[65]S Cretin,番传旭,杨树勤.医疗费用的预测模型.见：中国农村健康保险研究组.农村健康保险研究(1).成都：1989.
[66]Shan Cretin医疗费用的预测模型.中国农村健康保险实验研究,1989：63-66.
[67]Shan Cretin et al. Modeting the effect of insurance om health expenditures in the people's Republic of China, June,1987.
[68]杨金侠,李林贵,李士雪.新型农村合作医疗基金测算方法研究[J].卫生经济研究,2005(9)：16-17.
[69]Shan Cretin et al. Methods for setting health insurance Premiums,July,1987.
[70]李良军,杨树勤,刘关键,等.医药费用预测模型及保险因子分析[J].中国卫生事业管理,1994,10(5)：235-240.
[71]李士雪.新型农村合作医疗对农民卫生服务利用的影响研究[R].卫生部农村卫生管理司、卫生部新型农村合作医疗研究中心新型农村合作医疗课题研究报告汇编(2006-2007).
[72]Feldstein M S. Quality change and the demand for hospital care[J]. Econometrica. 1997,45(7):1681-1702.
[73](美)伍德里奇著,费剑平译.计量经济学导论(第三版).北京:中国人民大学出版社.2007.
[74]Feldstein M S,Friedman B. Tax subsidies, the rational demand for insurance and the health care crisis[J].Journal of Public Economics.1997,7(2):155-178.
[75]Bradley Herring,Mark V.Pauly. Incentive-compatible guaranteed renewable health insurance premiums[J].Journal of Health Economics.2006,25(3):395-417.
[76]卢祖洵.社会医疗保险学[M].北京：人民卫生出版社,2003.
[77]程晓明.医疗保险学概论[M].上海：复旦大学出版社,2003.
[78]李良军.保险因子的测算[J].中国卫生事业管理,1994(6)：55-56.
[79]左树岩.探索合作医疗制度下的大病补偿比[J].卫生经济研究,2001(3)：14-15.
[80]汪妍,孙秋柏.基于广义线性模型的分类费率厘定方法[J].辽宁科技大学学报,2009,32(4)：391-393.
[81]李致炜,宋世斌.居民医保中的医疗费用分新及预测在处理医疗费用[J].统计与决策,2008(16)：72-74.
[82]Lave JR, Keane CR, Lin CJ, Ricci EM, Amersbach G, LaVallee CP. Impact of a children's health insurance program on newly enrolled children[J]. JAMA,1998,279(22):1820-1825.
[83]Duan N, Manning WG, Morris CN, Newhouse JP. A comparison of alternative models for the demand for medical care [J]. J Bus Econ Stat.1983,1(1):115-126.
[84]Wooldridge JM. Introductory Econometrics:A Modern Approach.3rd ed [M]. Mason, OH. South-Western College Publishing,2005.
[85]Bice TW, Boxerman SB. A quantitative measure of continuity of care [J]. Med Care.1977,15(4):347-349.
[86]Brown JB, Nichols GA, Glauber HS. Case-control study of 10 years of comprehensive diabetes care [J]. West J Med.2000,172(2):85-90.
[87]Selden TM, Banthin JS, Cohen JW. Waiting in the wings:eligibility and enrollment in the State Children's Health Insurance Program [J]. Health Aff (Millwood),1999,18(2):126-133.
[88]Miller PA, Binns HJ, Christoffel KK. Children's bicycle helmet attitudes and use [J]. Arch Pediatr Adolesc Med,1996,150(12):1259-1264.
[89]Sege RD, Perry C, Stigol L. Short-term effectiveness of anticipatory guidance to reduce early childhood risks for subsequent violence [J]. Arch Pediatr Adolesc Med. 1997,151(4):392-397.
[90]Clamp M, Kendrick D. A randomised controlled trial of general practitioner safety advice for families with children under 5 years [J]. BMJ.1998,316(7144):1576-1579.
[91]Wall MA, Severson HH, Andrews JA Lichtenstein E, Zoref L. Pediatric office-based smoking intervention:impact on maternal smoking and relapse [J]. Pediatrics. 1995,96(4 pt 1):622-628
[92]Newacheck PW, Hughes DC, Hung Y, Wong S, Stoddard JJ. The unmet health needs of America's children [J]. Pediatrics.2000,105(4 pt 2):989-997
[93]Aiken KD, Freed GL, Davis MM. When insurance status is not static:insurance transitions of low-income children and implications for health and health care [J]. Ambul Pediatr.2004;4(3):237-243.
[94]Olson LM, Tang SF, Newacheck PW. Children in the United States with discontinuous health insurance coverage [J]. N Engl J Med.2005;353(4):382-391.
[95]李良军,杨树勤,刘关键,等.医药费用预测模型及保险因子分析[J].中国卫生事业管理,1994,10(5)：235-240.
[96]何文炯,杨一心,刘晓婷,等.社会医疗保险纵向平衡费率及其计算方法[J].中国人口科学,2010(3)：88-95.
[97]徐玲,简伟研.中国基本医疗保障制度受益公平性的实证研究[J].医学与社会,2010,23(11)：45-47
[98]夏俊,田听,张新平.基本药物医保报销政策研究[J].医学与社会,2010,23(6)：64-66.
[99]董乐,陈圣芳.武汉市大学生医疗保障问题及对策[J].医学与社会,2009,22(10)：35-37.
[100]Judith R. Lave, Christopher R. Keane, ScD, Chyongchiou J. Lin, Edmund M. Ricci, Gabriele Amersbach, Charles P. LaVallee. Impact of a Children's Health Insurance Program on Newly Enrolled Children [J]. JAMA.1998,279(22):1820-1825.
[1]2008年我国卫生改革与发展情况.www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s6690/200902/39109.htm.
[2]广州市城镇居民基本医疗保险试行办法.穗府办[2008]22号.
[3]荆门市城镇居民基本医疗保险暂行办法.荆政发[2007]29号.
[4]贵阳市城镇居民基本医疗保险试点工作方案.黔居医联办函[2007]1号.
[5]秦侠主编,袁长海副主编.卫生管理运筹学.北京：人民卫生出版社.2005.
[6]Duan, Naihua, et al.A comparison of alternative models for the demand for medical care[J].Journal of Business and Economic Statistics.1983,1(2):115-126.
[7]邱晓丹.深圳市中小学生和幼儿园儿童住院医疗保险费的测算[J].中国卫生经济, 1997,16(3)：24-26.
[8]饶克勤.中国城市居民医疗服务利用影响因素的研究—四步模型法的基本理论及其应用[J].中国卫生统计,2000,17(2)：70-73.
[9]封进,余央央,秦蓓.中国农村医疗负担解析：如何为穷人减负.第六届中国经济学年会中国女经济学者研究培训项目学员参会论文.2006年12月16日-17日.
[10]顾听.居民医保：筹资水平知多少[J].中国社会保障,2007,25(8)：46-47.
[11]新型农村合作医疗培训讲义(试行).卫生部农村卫生管理司.2005年5月.
[12]吴明,张里程.医疗保险费测算[J].中国医院管理,2000,20(4)：58-59.
[13]程晓明.提高新型农村合作医疗实际住院补偿比及制度完善研究.卫生部农村卫生管理司、卫生部新型农村合作医疗研究中心新型农村合作医疗课题研究报告汇编(2006-2007).
[14]代志明.中国“城镇居民医保”基金盈余敏感性分析—以郑州市为例[J].人口与发展,2008,14(3)：52-57.
[15]S Cretin, N H Duan, A P Williams, Jr, XYGu, and Y Q Shi. Modeling the effect of insurance on health expenditures in the People's Republic of China. Santa Monica:RAND Corporation, August,1987.
[16]S Cretin,潘传旭,杨树勤.医疗费用的预测模型.见：中国农村健康保险研究组.农村健康保险研究(1).成都：1989.
[17]Shan Cretin,等.医疗费用的预测模型.中国农村健康保险实验研究,1989：63-66.
[18]Shan Cretin et al. Modeting the effect of insurance om health expenditures in the people's Republic of China, June,1987.
[19]Shan Cretin et al. Methods for setting health insurance Premiums,July,1987.
[20]李良军,杨树勤,刘关键,等.医药费用预测模型及保险因子分析[J].中国卫生事业管理,1994,10(5)：235-240.
[21]李士雪.新型农村合作医疗对农民卫生服务利用的影响研究.卫生部农村卫生管理司、 卫生部新型农村合作医疗研究中心新型农村合作医疗课题研究报告汇编(2006-2007).
[22]Feldstein M S. Quality change and the demand for hospital care[J]. Econometrica. 1997,45(7):1681-1702.
[23](美)伍德里奇著,费剑平译.计量经济学导论(第三版).北京：中国人民大学出版社.2007.
[24]Feldstein M S, Friedman B. Tax subsidies, the rational demand for insurance and the health care crisis[J].Journal of Public Economics.1997,7(2):155-178.
[25]Bradley Herring, Mark V.Pauly. Incentive-compatible guaranteed renewable health insurance premiums[J].Journal of Health Economics.2006,25(3):395-417.
[26]Robert J.LaLonde. Evaluating the econometric evaluations of training programs with experimental data[J].American Economic Review..1986,76(4):604-620.
[27]James J.Heckman, Hidehiko Ichimura, Petra E.Todd. Matching as an econometric evaluation estimator:evidence from evaluating a job training programme[J]. Review of Economic Studies.1997,64(4):605-654.
[28]Rajeev H.Dehejia, Sadek Wahba. Propensity score matching methods for non-experimental causal studies[J].Review of Economics and Statistics,2002,84(1): 151-161.
[29](美)曼昆著,梁小民译.经济学原理一微观经济学分册(第4版).北京：北京大学出版社.2006.
[30]徐凌中,立方亿编译.经济学评价中支付意愿的测量方法[J].国外医学·卫生经济分册,1998,15(2)：63-65.
[31]Robert K.Davis. Recreation planning as an economic problem. Natural Resources Journal,1963(3):239-249.
[32]Richard D.Smith. Construction of contingent valuation market in health care:a critical assessment[J].Health Economics.2003,12(8):609-628.
[33]O'Brien B, Gafni A. When do the "dollars" make sense?Toward a conceptual framework for contingent valuation studies in health care [J].Medical Decision Making.1996,16(3):288-299.
[34]卢宪中,陈文,应晓华.条件价值评估法在卫生经济学研究中的应用[J].中国卫生经 济,2005,24(11)：58-60.
[35]陈文,应晓华,胡善联,等.补充医疗保险的需求研究[J].中国卫生生经济,2002,21(12)：17-21.
[36]Davis R K. Recreation planning as an economic problem. Natural Resources Journal, 1963(3):239-249
[37]2张志强.徐中民.程国栋.条件价值评估法的发展与应用.地球科学进展,2003,18(3)：454-463
[38]Bayoumi AM. The measurement of contingent valuation for health economics. Pharmacoeconomics,20o4,24(11):691—700
[39]Klose T. The contingent valuation method in health care. Heahh Policy.1999(47): 97-123
[40]陈文,应晓华.胡善联,等.补充医疗保险的需求研究.中国卫生经济,2002,21(12)： 17-21
[41]Diener A, O'Brien B. Gafni A. Health care contingent valuation studies:, a review and classification of the literature. Health Econ,1998,7(4):313-326
[42]Smith RD. Construction of the contingent valuation market in health care:a critical assessment. Health Econ.2003,12(8):609-628
[43]Blumenschein K, Johannesson M. Use of contingent valuation to place a monetary value on pharmacy services:an overview and review of the literature. Clin Ther.1999,21(8):1402-1407.
[44]Konig HH. Measuring preferences of psychiatric patients. Psychiatr Prax,2004,31(3): 118-127
[45]Sampietro-Colom L, Phillips VL, Hutchinson AB. Eliciting woment'S preferences in health care:a review of the literature. Int J Technol Assess Health Care.2004,20(2): 145-155
[46]National Oceanic and Atmospheric Administration. Repo of the NOAA panel on contingent valuation. Federal Register,1993 (58):4607-4614
[47]Johannesson M. The contingent valuation method-appraising the appraisers. Health Economics,1993(2):357-359
[48]O'Brien B. and Gafni A. When do the dollars make sense?Toward a conceptual framework for contingent valuation studied in health care. Medical Decision Making, 1996(16):288-299
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |