信息化经济管理学与财务知识分析.pptx

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,*,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,信息不对称,Asymmetric Information,信息问题,Information Problems,患者缺乏信息，也没有能力识别质量,Patientslack of information and inability to discern quality,保险方缺乏参保者健康情况信息,Insurerslack of information about individuals health background,逆向选择,Adverse selection,假设有10个低风险人和10个高风险人，高风险人预期医疗保健费是1000美元，低风险人预期医疗保健费是100美元。医疗保险费确实定基于平均预期医疗保健费，也就是550美元,Suppose there are 10 low risk people and 10 high risk people,the high risk peoples expected health care expenditure will be$1000,the low risks will be$100.The health insurance premium is based on average expected expenditure,which is$550.,信息化经济管理学与财务知识分析,第1页,逆向选择,Adverse Selection,保险企业无法区分风险高和风险低人。保险费只反应了两类人平均风险。所以高风险人将购置保险，因为此时保险费低于完全依照他们风险确定保险费。而低风险人可能不会购置保险，因为此时保险费高于完全依照他们风险确定保险费。,The insurance company is unable to distinguish between high and low risks.The insurance premium only reflects the average risk of the two groups.Then,the high risk group will purchase insurance since a premium based on the average risk is lower than a premium based solely on their own risk.The low risk individuals may not purchase insurance since a premium based on the average would be greater than their own risk-based premium.,信息化经济管理学与财务知识分析,第2页,逆向选择,Adverse Selection,逆向选择将会造成一些人购置医疗保险,Adverse selection would result in a biased sample of those that purchase health insurance,更多高风险个人将购置保险,Predominantly,more high risk individuals would purchase insurance,“,柠檬”法则,The Lemons Principle,高风险人驱逐低风险人直至市场不存在,The bad drives out the good until no market is left,信息化经济管理学与财务知识分析,第3页,柠檬法则,The Lemons Principle,Akerlof(1970),用信息不对称观点分析二手车市场,Akerlof(1970)used the idea of asymmetric information to analyze the used car market,二手车质量千差万别,Used cars available for sale vary in quality,对称不信息,Asymmetric information,卖者比买者更了解车子质量,The sellers know better the true quality of their cars than the buyers,有9辆车供出售,There are 9 cars for sale,质量,(Q)=0,1,1,1,1,2,卖者了解每辆车质量,Seller(owner)knows each cars quality,买者只知道质量分布,Buyer only knows the distribution of quality,信息化经济管理学与财务知识分析,第4页,柠檬法则,The Lemons Principle,卖者保留价值是,$1000 xQ,Seller has a reserve value=$1000 xQ,买者保留价值是,$1,500 xQ,Buyer has a reserve value=$1,500 xQ,雇佣一个拍卖人报价。拍卖人找到一个需求量等于供给量价格就成交,An auctioneer is hired to call out prices.Sales take place when the auctioneer finds a price that makes quantity demanded equal quantity supplied,我们现在进行这个拍卖游戏,We do the sales game together in class,信息化经济管理学与财务知识分析,第5页,柠檬法则,The Lemons Principle,假如信息对称，买者和卖者都不清楚详细质量，他们只知道车子平均质量，此时二手车市场能否存在？市场价格是多少？,If information had been symmetric,both owners and buyers were uncertain of the quality,they only know the average quality of cars,then is there a market for the used cars?What would be the market price?,信息化经济管理学与财务知识分析,第6页,柠檬法则应用：医疗保险,Application of The Lemons Principle:Health Insurance,信息不对称,Information asymmetry,潜在参保者比医疗保险企业更了解自己未来可能医疗保健支出,The potential insured person knows more about her(his)expected health expenditures in the coming period than does the insurance company.,详细地讲,More specifically,参保者知道自己未来医疗费用（类似于二手车车主）,Insured knows her(his)future expenditure exactly(similar to the owner of the cars),保险企业只了解全部参保者医疗费用分布（类似于买车人）,Insurance company knows only the distribution of expenditures for all insured persons(similar to the buyer of the cars),信息化经济管理学与财务知识分析,第7页,柠檬法则应用：医疗保险,Application of The Lemons Principle:Health Insurance,医疗保险市场有5个人,There are 5 persons in health insurance market,预期医疗费用0,1,Expected expenditure=0,1,平均医疗费用,Average expenditure=,我们再做一个游戏看医疗保险市场是否存在,We do the game again in class to check if there is health insurance market,假如信息对称，参保者和保险企业都只知道风险分布，那将会怎样？,If information had been symmetric,both insured and insurance company only know the distribution of expenditure,then?,信息化经济管理学与财务知识分析,第8页,代理关系委托代理问题,Agency RelationshipThe Principal Agent Problem,代理关系,Agency relationship,委托方委托另一方，也就是代理方作出决定,A principal delegates decision-making authority to another party,the agent,信息不对称和代理问题是相关现象,Asymmetric information and agency are closely related phenomena,委托代理问题,The Principal Agent Problem,怎样确定医生作出了最符合患者利益决议,How to determine the physician is acting in the patients best interests,信息化经济管理学与财务知识分析,第9页,供给诱导需求,Supplier-Induced Demand,供给诱导需求问题,The Supplier-Induced Demand problem,医生含有影响需求利益驱动,The physician has a financial interest to influence the demand.,医生能够经过提供不准确信息“创造”需求,The physician can“create”the demand by providing the biased information to the patient,供给诱导需求问题源于信息不对称,The SID problem results from asymmetric information,患者和保险方都缺乏作出关于医疗方面决议必要信息,Both patients and insurers lack the necessary information to make many medical-related decision,患者依赖于医生提议和他们所提供服务,The patient depends upon the physician for both advice and service,信息化经济管理学与财务知识分析,第10页,供给诱导需求,Supplier-Induced Demand,传统经济学模型,The traditional economic model,传统经济学模型假设医生是患者完美代理人，能够推出其它条件不变，供给增加将降低医生收费，从而降低医生收入。,The traditional economic model,which assumes the physician is a perfect agent for the patient,would predict that an increase in supply,other things being equal,would result in a decline in physicians fees,and consequently physician incomes.,现实观察恰好相反,The observation in reality is opposite,需要更合理理论解释医生行为,Need alternative theory to study physician behavior,信息化经济管理学与财务知识分析,第11页,S,1,S,0,D,0,E,0,E,1,供给诱导需求,Supplier-Induced Demand,传统经济学模型,The traditional economic model,供给量增加,价格下降,M,Q,0,Q,1,P,0,P,1,P,m,信息化经济管理学与财务知识分析,第12页,供给诱导需求,Supplier-Induced Demand,供给诱导需求价格刚性模型,The price rigidity model of SID,为何竞争市场会出现诱导需求？一个解释是假设医疗价格倾向于刚性,One approach that can explain demand inducement within the context of a competitive market model is to argue that prices tend to be rigid,伴随供给增加，为了保持固定价格，医生含有增加需求激励,As supply increases,in order to fix the price,the physician has incentive to induce demand,不过这个理论只能解释为何价格没有下降，但不能解释为何价格上升,But this model can only explain why price doesnt go down and cant explain why price goes up,信息化经济管理学与财务知识分析,第13页,D,1,供给诱导需求,Supplier-Induced Demand,SID,价格刚性模型,The price rigidity model of SID,供给量增加,价格不变,S,1,E,0,M,Q,0,Q,2,P,0,P,m,S,0,D,0,E,2,信息化经济管理学与财务知识分析,第14页,供给诱导需求,Supplier-Induced Demand,SID,目标收入模型,The target income model of SID,尽管医生供给快速增加，医疗价格依然上升,The price of health care increases despite rapid increase in physician supply,目标收入模型用以解释医生收费快速上升,The target income model is used to explain the rapid increase in physician fees.,在目标收入假设下，医生供给增加造成收费上升以确保目标收入，或者医生将诱导患者需求以确保目标收入,Under the target income hypothesis,increase in supply of physicians lead to higher fees in order for earning to be maintained,or physician will induce demand to maintain the target income,信息化经济管理学与财务知识分析,第15页,供给诱导需求,Supplier-Induced Demand,SID,目标收入模型,The target income model of SID,供给量增加,价格上升,D,1,S,1,E,0,S,0,D,0,E,2,M,Q,0,Q,2,P,0,P,m,P,1,信息化经济管理学与财务知识分析,第16页,供给诱导需求,Supplier-Induced Demand,SID,目标收入模型,The target income model of SID,目标收入假设主要证据是医生/人口比率和医生收费呈正相关,The major evidence for target income hypothesis is that physician/population ratios are positively related to physician fees,医生诱导需求范围和价格水平取决于医生期望收入目标,The extent of the demand the physician can create and the price that will be established are based upon what target income the physician desires,目标收入水平取决于当地收入水平，尤其是其它医生和专业人士收入水平,The target income is determined by the local income distribution,particularly with respect to the income of other physicians and professionals,信息化经济管理学与财务知识分析,第17页,供给诱导需求,Supplier-Induced Demand,SID利润最大化模型,M,Q,1,Q,2,P,2,P,m,P,1,MR,2,D,1,MC1,MR,1,D,2,MC2,信息化经济管理学与财务知识分析,第18页,供给诱导需求,Supplier-Induced Demand,Roemer&Shain,提出，一个地域增加床位供给创造对床位需求。为何？,信息化经济管理学与财务知识分析,第19页,(1),短缺存在,假如制订医疗价格低于均衡水平，即在,P,0,处，,S,0,表明床位供给，医院利用为,Q,0,。,在,P,0,价格上，就会出现,Q,3,到,Q,0,过分需求。假如床位供给从,S,0,增加到,S,1,，,从,S,1,增加到,S,2,，,再至,S,3,，,医院利用就会从,Q,0,增加到,Q,3,。,供给诱导需求,Supplier-Induced Demand,S,1,S,2,S,3,S,0,Q,0,Q,1,Q,2,Q,3,D,M,P,0,P,m,解释一,信息化经济管理学与财务知识分析,第20页,(2),预计需求扩大,图中,S0&D0,表示起始供求曲线，,Q0,为医院服务利用。假如床位供给增加到,S1，,医院服务利用增加到,Q1，,这种情况表明供给创造新需求,D1，,相反，床位供给是建立在对需求增加预测基础上。,供给诱导需求,Supplier-Induced Demand,D,0,S,0,D,1,S,1,M,Q,0,Q,1,P,m,信息化经济管理学与财务知识分析,第21页,患者往返成本发生了改变。假如增加床位建在靠近预期患者新型较小医院，到医院往返成本将降低，这时，床位供给增加并不创造新需求，而是降低非货币成本(如路途时间成本），使患者医疗总价格下降，从而使患者沿着其需求曲线向下移动。如图：,解释二,M,Q,1,Q,2,P,1,P,2,P,m,供给诱导需求,Supplier-Induced Demand,信息化经济管理学与财务知识分析,第22页,医生经过收治患者入院来提升效益。,解释三,供给诱导需求,Supplier-Induced Demand,还有其它解释吗？,信息化经济管理学与财务知识分析,第23页,供给诱导需求,Supplier-Induced Demand,一项研究表明，平均每人受诊数和一定人口拥有医生数量呈正相关，如一定人口拥有外科医生数每年增加10，则手术例次增加3。,另一项研究表明，医生按服务项目收费得到赔偿时，外科手术率是比较高。某研究对有一样保险赔付雇员做了比较。其中一组按人头预付计划（,capitation)，,另一组按服务项目收费(,fee-for-service)。,结果发觉住院手术处理率在按人头付费为3.9,而在按项目收费中为7.0。在手术处理率差异中，有1/3 是阑尾切除术，扁桃体摘除术，女性外科手术（如剖腹产）等造成。,信息化经济管理学与财务知识分析,第24页,供给诱导需求,Supplier-Induced Demand,信息化经济管理学与财务知识分析,第25页,供给诱导需求,Supplier-Induced Demand,信息化经济管理学与财务知识分析,第26页,供给诱导需求,Supplier-Induced Demand,供给诱导需求识别问题,The identification problem of SID,实证研究中，诱导需求影响无法用计量方法识别,In the empirical work,the SID effect cannot be econometrically identified,极难区分患者需求和医生诱导需求,It is hard to distinguish between patients demand and physicians induced demand,信息化经济管理学与财务知识分析,第27页,供给诱导需求,Supplier-Induced Demand,供给诱导需求成本,The costs of SID,时间成本,Time cost,声誉下降,Reputation loss,“,心理精神”成本,“,psychic”cost,信息化经济管理学与财务知识分析,第28页,供给诱导需求,Supplier-Induced Demand,防止医生创造需求方法：,增加患者受教育水平可能会降低医生创造额外需求能力。,当患者被提议做手术时，应从保险企业或其它医生处取得更多信息。,向医生提供经济刺激以防止无须要手术。这些经济刺激主要包含，告诉医生无须要手术可能引发医疗事故诉讼。,信息化经济管理学与财务知识分析,第29页,