医疗保险讲义课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,医疗保险Health Insurance,11月10日,1,医疗保险,Health Insurance,医疗保险,Health Insurance,提供一种分散由疾病引起的财务风险的方式,Provide a way to diversify financial risks associated with illness,医疗保险的需求理论,The theory of demand for health insurance,个人希望最大化其效用,An individual wishes to maximize his or her utility,如果事件确定，每个人最大化其确定的效用,if there are certain events, individual maximizes his or her certainty utility,如果事件不确定，每个人最大化其期望效用,if there are uncertain events, individual maximizes his or her expected utility,2,医疗保险,Health Insurance,期望效用,Expected utility,生病的概率生病时的财富所带来的效用健康的概率健康时的财富所带来的效用,=probability of illness utility of wealth with illness + probability of healthy utility of wealth with healthy,例子，假设,Example, assume,约翰有$20,000 的年收入，年内没有储蓄和贷款,John has $20,000 annual income, no saving and borrowing,健康的概率95% ，医疗支出为0，财富为$20,000,With 95% probability, he will be healthy. When he is healthy, his health care expenditure is 0 and his wealth is $20,000,生病的概率5% ，医疗支出$10,000 ，财富$10,000,with 5% probability, he will be sick. When he is sick, his health care expenditure is $10,000 and his wealth is reduced to $10,000,.,3,医疗保险,Health Insurance,两种可选的行动方案,Two alternative courses of action,他可以购买保险，承担一个数目不大的保险费,He can purchase insurance and incur a small loss in the form of the insurance premium,他也可以自我保险,He can self-insure,生病概率小，但是一旦生病损失很大 small possibility of a large loss if the illness occurs,不生病的概率大，也没有医疗支出 large possibility that the medical loss will not occur,问题：哪种选择可以使他的效用最大化？,Question: which choice provides him with a higher level of utility,4,医疗保险,Health Insurance,如果约翰购买医疗保险,If John would buy health insurance,保险费预期医疗保健支出,insurance premium= expected health care expenditure,=95% 0 + 5%10,000,=500,他的财富 20,000-500=19500,His wealth =20,000-500=19500,他的确定效用,His certainty utility=,如果约翰不愿购买医保,If John wouldnt buy health insurance,他的财富将是$20,000 或者$10,000,his wealth could be $20,000 or $10,000,他的预期效用,his expected utility=,5,医疗保险,Health Insurance,约翰的偏好财富的效用,Johns preference-utility of wealth,财富 效用 边际效用,10,000 100,12,000 130,14,000 155,16,000 168,18,000 176,19,500 178,20,000 180,6,医疗保险,Health Insurance,约翰的财富的效用,Johns utility of wealth,如果他购买保险，其确定效用,if he would buy insurance, his certainty utility=,U(财富=19500)=178,如果他不愿购买保险，其期望效用,if he wouldnt buy insurance,his expected utility=,5% U(w=10,000) + 95% U(w=20,000),=5% 100 + 95% 180 = 176,约翰的确定效用大于期望效用,Johns certainty utility is greater than the expected utility,如果购买保险，情况将得到改善,He will be better off if he buys insurance,不确定性导致效用损失,uncertainty leads to a loss of utility,7,医疗保险,Health Insurance,效用函数对购买保险行为的影响,The role of utility function in the purchase of insurance,线性效用函数，边际效用不变,Utility is linear function of wealth and marginal utility is constant,财富 效用 边际效用,10,000 100,12,000 120,14,000 140,16,000 160,18,000 180,19,500 195,20,000 200,8,医疗保险,Health Insurance,效用函数,Utility function,U = a Y, Y=财富,U=0.01Y,利用约翰的例子,use Johns example,他的确定效用=,他的期望效用=,确定效用期望效用,His certainty utility = his expected utility,他是风险中性的,he is risk neutral,9,医疗保险,Health Insurance,W,1,W,2,W,3,W,U,U,1,U,2,U,3,W,W,1,W,2,W,3,MU,10,医疗保险,Health Insurance,效用函数对购买保险行为的影响,The role of utility function in the purchase of insurance,效用函数是财富的增函数，边际效用递增,Utility is increasing function of wealth and marginal utility is increasing,财富 效用 边际效用,10,000 100,12,000 130,14,000 165,16,000 205,18,000 250,19,500 280,20,000 300,11,医疗保险,Health Insurance,效用函数,Utility function,U = a Y,b, Y=财富, b 1,U=0.01Y,b,利用约翰的例子,use Johns example,他的确定效用=,他的期望效用=,确定效用期望效用,His certainty utility his expected utility,他是风险偏好者,he is risk lover,他不愿购买保险,he will not buy insurance,12,医疗保险,Health Insurance,W,U,W,1,W,2,W,3,U,1,U,2,U,3,W,W,1,W,2,W,3,MU,13,医疗保险,Health Insurance,效用函数对购买保险行为的影响,The role of utility function in the purchase of insurance,效用函数是财富的增函数，边际效用递减,Utility is increasing function of wealth and marginal utility is increasing,U=a Y,b, b期望效用,His certainty utilityhis expected utility,他将购买保险,he will buy insurance,他是风险规避者,he is risk averse,14,医疗保险,Health Insurance,B,A,140,200,20000,10000,19500,W,U,W,MU,199,D,197,C,15,医疗保险,Health Insurance,纯保险金,Pure premium,预期医疗支出,expected health expenditure,额外费用,Loading cost,执行保险政策时所发生的管理费用和其他相关费用,administrative and other costs associated with underwriting an insurance policy,最高保险费,Maximum premium,当期望效用不大于确定效用时，人们愿意支付的保险费的最大金额,the maximum amount the person would be willing to pay as long as his expected utility is not greater than his certainty utility,16,保险怎样影响医疗保健的需求,How Insurance Affects a Demand Curve for Health Care,m,15,30,15,0,5,10,p,m,具有50%共付率保险的需求,没有保险时的需求,17,道德风险 Moral Hazard,道德风险,Moral hazard problem,如果有保险，个人倾向于减少对健康的关注,individuals would take care of themselves less if they had insurance,由于保险降低了医疗服务的价格，和自己支付所有费用相比，人们将消费更多的医疗保健,since insurance lowers the price of medical care to individuals, they will consume more health care than if they had to pay the entire price themselves.,道德风险问题,The moral hazard problem,取决于需求的价格弹性,depend on the price elasticity of demand,价格弹性越大，道德风险问题越严重 The more elastic demand, the more the moral hazard problem,价格弹性越小，道德风险问题越轻 the more inelastic demand, the less the moral hazard problem,18,道德风险 Moral Hazard,Demand,0,Q,1,P,m,P,1,Q,Q,2,B,C,Demand,0,Q,1,P,m,P,1,Q,B,19,道德风险 Moral Hazard,保险责任范围政策,Insurance coverage policy,对越缺乏弹性的服务，保险责任范围越大,more complete coverage for more inelastic services,对弹性越大的服务，保险责任范围越小,less coverage for more elastic services,利用需求的价格弹性制定保险责任范围政策是限制道德风险的一种方法,use the price elasticity of demand to set up insurance coverage policy is a way to limit moral hazard problem,20,道德风险 Moral Hazard,共付保险和起付线,Coinsurance and deductible,限制道德风险的另一种方法,another ways to limit moral hazard problem,降低福利损失,reduce welfare loss,管理保健,HMOs,限制道德风险的一种方法,a way to limit moral hazard problem,医生具有限制患者的医疗保险消费的激励,physicians have incentive to reduce consumers consumption on health care,21,道德风险,Moral Hazard,主要国家费用负担制度一览,日本：门诊20-30%；药品每日份30-150日元,韩国：诊所30%；小医院门诊40%；大医院门 诊55%,英国：门诊免，但强制转诊；药品每次6英镑,加拿大：门诊药品自付全额,德国：药品每种自付8-10马克；感冒药、一般 成药不给付,法国：门诊30%；药品35-65%,美国：门诊每次10美元；药品每种10美元,22,道德风险 Moral Hazard,Demand,0,Q,1,Q,3,P,m,P,1,Q,Q,3,B,C,D,F,23,道德风险 Moral Hazard,起付线（扣除保险）,deductible,要求被保人在就医时先支付一笔固定的费用，保险公司支付其余的费用。,扣除保险有几种方式：,应用于每一医疗服务单位，,如,阑尾切除术。,累积性的，如，被保人一年内门诊服务支付费用累积达到100圆，保险公司就承担100元以外的就诊费用。,24,逆向选择 Adverse Selection,逆向选择(adverse selection),如果对高风险的人和低风险的人提供同一种保险，使低风险的补贴高风险的人，低风险的人就会离开市场，使得保险项目下只存在高风险的人，同时使得保费升高。,这一过程不断持续最后造成保险市场失灵,为什么在医疗保险领域这个问题更为严重？,保险公司选择低风险的人销售保险产品可以产生利润,25,26,医疗保险制度的演变,出现于现代社会之前,主要问题是,大病风险无法分散,个人负担过重,居民个人支付,26,27,医疗保险制度的演变,居民个人支付,自发的医疗保险,出现于近代的行会、工厂等组织中,一定程度上分散了疾病风险,但是未形成制度、保障水平低,27,28,医疗保险制度的演变,居民个人支付,自发的医疗保险,商业医疗保险,在自发的医疗保险基础上，出现了专门的商业医疗保险,有逆向选择的问题，真正需要医疗保险的人得不到保险,28,29,医疗保险制度的演变,居民个人支付,自发的医疗保险,商业医疗保险,社会医疗保险,始于,1883,年德国,为了解决商业保险覆盖面低、逆向选择的问题，政府举办强制性的社会医疗保险,解决了全民覆盖的问题，至今仍是部分国家主要的医疗保障模式,社会保险存在的问题是，保险方和医疗服务提供方的目标仍不一致，医疗费用控制的情况不好,29,30,医疗保险制度的演变,居民个人支付,自发的医疗保险,商业医疗保险,社会医疗保险,治疗方案指南,处方用药清单,收费清单,效果评估,增加起付线,增加共付率,缩小保险范围,PPOs,增加患者信息,保险公司,临床决策,服务提供者,患者,医疗博弈三角,30,31,医疗保险制度的演变,居民个人支付,自发的医疗保险,商业医疗保险,社会医疗保险,国家举办公立医院,为了实现服务提供方和保险方目标一致、激励相容，国家把医疗保险职能和医疗服务职能合二为一，这就是公立医院的制度安排,31,非正式的保险制度,如果个体是风险规避的，但又没有正式的保险制度可以分担风险，非正式保险制度应运而生。,保险机制实质上是熨平个体在健康和疾病两种状态下的消费,保险制度是在事前缴纳一定保费，事后获得补偿。,如果事先不缴纳保费，但是达成协议，如果群体中的某个人患病，治疗的费用由群体中的所有人均摊，这也是一种保险。,这种非正式的保险制度在现实中存在么？（对群体稳定性的要求）,村庄（南街村）,家庭,32,讨论,怎样改革医疗保险系统？,How to reform the health insurance system?,香港案例 Hong Kong case,医疗帐户中国模式 Medical savings accounts-China model,管理保健 美国案例 HMOs-US case,“30铢计划”泰国案例,33,