医疗保险讲义课件.pptx

医疗保险医疗保险Health Insurance11 11月月1010日日1医疗保险讲义课件第1页医疗保险医疗保险 Health Insurancel医疗保险 Health Insurancel提供一个分散由疾病引发财务风险方式 Provide a way to diversify financial risks associated with illnessl医疗保险需求理论 The theory of demand for health insurancel个人希望最大化其效用 An individual wishes to maximize his or her utilityl假如事件确定，每个人最大化其确定效用 if there are certain events,individual maximizes his or her certainty utilityl假如事件不确定，每个人最大化其期望效用 if there are uncertain events,individual maximizes his or her expected utility 2医疗保险讲义课件第2页医疗保险医疗保险 Health Insurancel期望效用 Expected utilityl生病概率生病时财富所带来效用健康概率健康时财富所带来效用 =probability of illness utility of wealth with illness+probability of healthy utility of wealth with healthyl例子，假设 Example,assumel约翰有$20,000 年收入，年内没有储蓄和贷款 John has$20,000 annual income,no saving and borrowingl健康概率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$20,000l生病概率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医疗保险讲义课件第3页医疗保险医疗保险 Health Insurancel两种可选行动方案 Two alternative courses of actionl他能够购置保险，负担一个数目不大保险费 He can purchase insurance and incur a small loss in the form of the insurance premiuml他也能够自我保险 He can self-insurel生病概率小，不过一旦生病损失很大 small possibility of a large loss if the illness occursl不生病概率大，也没有医疗支出 large possibility that the medical loss will not occurl问题：哪种选择能够使他效用最大化？Question:which choice provides him with a higher level of utility4医疗保险讲义课件第4页医疗保险医疗保险 Health Insurancel假如约翰购置医疗保险 If John would buy health insurancel保险费预期医疗保健支出 insurance premium=expected health care expenditurel=95%0+5%10,000l=500l他财富 20,000-500=19500 His wealth=20,000-500=19500l他确实定效用 His certainty utility=l假如约翰不愿购置医保 If John wouldnt buy health insurancel他财富将是$20,000 或者$10,000 his wealth could be$20,000 or$10,000l他预期效用 his expected utility=5医疗保险讲义课件第5页医疗保险医疗保险 Health Insurancel约翰偏好财富效用 Johns preference-utility of wealthl 财富 效用 边际效用l 10,000 100l 12,000 130l 14,000 155l 16,000 168l 18,000 176l 19,500 178l 20,000 1806医疗保险讲义课件第6页医疗保险医疗保险 Health Insurancel约翰财富效用 Johns utility of wealthl假如他购置保险，其确定效用 if he would buy insurance,his certainty utility=lU(财富=19500)=178l假如他不愿购置保险，其期望效用 if he wouldnt buy insurance,his expected utility=l5%U(w=10,000)+95%U(w=20,000)l=5%100+95%180=176l约翰确实定效用大于期望效用 Johns certainty utility is greater than the expected utilityl假如购置保险，情况将得到改进 He will be better off if he buys insurancel不确定性造成效用损失 uncertainty leads to a loss of utility7医疗保险讲义课件第7页医疗保险医疗保险 Health Insurancel效用函数对购置保险行为影响 The role of utility function in the purchase of insurancel线性效用函数，边际效用不变 Utility is linear function of wealth and marginal utility is constantl 财富 效用 边际效用l 10,000 100l 12,000 120l 14,000 140l 16,000 160l 18,000 180l 19,500 195l 20,000 2008医疗保险讲义课件第8页医疗保险医疗保险 Health Insurancel效用函数 Utility function lU=a Y,Y=财富lU=0.01Yl利用约翰例子 use Johns examplel他确实定效用=l他期望效用=l确定效用期望效用 His certainty utility=his expected utilityl他是风险中性 he is risk neutral9医疗保险讲义课件第9页医疗保险医疗保险 Health InsuranceW1W2W3WUU1U2U3WW1W2W3MU10医疗保险讲义课件第10页医疗保险医疗保险 Health Insurancel效用函数对购置保险行为影响 The role of utility function in the purchase of insurancel效用函数是财富增函数，边际效用递增 Utility is increasing function of wealth and marginal utility is increasingl 财富 效用 边际效用l 10,000 100l 12,000 130l 14,000 165l 16,000 205l 18,000 250l 19,500 280l 20,000 30011医疗保险讲义课件第11页医疗保险医疗保险 Health Insurancel效用函数 Utility function lU=a Yb,Y=财富,b 1lU=0.01Ybl利用约翰例子 use Johns examplel他确实定效用=l他期望效用=l确定效用期望效用 His certainty utility his expected utilityl他是风险偏好者 he is risk loverl他不愿购置保险 he will not buy insurance12医疗保险讲义课件第12页医疗保险医疗保险 Health InsuranceWUW1W2W3U1U2U3WW1W2W3MU13医疗保险讲义课件第13页医疗保险医疗保险 Health Insurancel效用函数对购置保险行为影响 The role of utility function in the purchase of insurancel效用函数是财富增函数，边际效用递减 Utility is increasing function of wealth and marginal utility is increasinglU=a Yb,b期望效用 His certainty utilityhis expected utilityl他将购置保险 he will buy insurancel他是风险躲避者 he is risk averse14医疗保险讲义课件第14页医疗保险医疗保险 Health InsuranceBA14020001000019500WUWMU199D197C15医疗保险讲义课件第15页医疗保险医疗保险 Health Insurancel纯保险金 Pure premiuml预期医疗支出 expected health expenditurel额外费用 Loading costl执行保险政策时所发生管理费用和其它相关费用administrative and other costs associated with underwriting an insurance policyl最高保险费 Maximum premiuml当期望效用小于确定效用时，人们愿意支付保险费最大金额 the maximum amount the person would be willing to pay as long as his expected utility is not greater than his certainty utility16医疗保险讲义课件第16页保险怎样影响医疗保健需求保险怎样影响医疗保健需求 How Insurance Affects a Demand Curve for Health Carem1530150510pm含有50%共付率保险需求没有保险时需求17医疗保险讲义课件第17页道德风险道德风险 Moral Hazardl道德风险 Moral hazard probleml假如有保险，个人倾向于降低对健康关注individuals would take care of themselves less if they had insurancel因为保险降低了医疗服务价格，和自己支付全部费用相比，人们将消费更多医疗保健 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.l道德风险问题 The moral hazard probleml取决于需求价格弹性 depend on the price elasticity of demandl价格弹性越大，道德风险问题越严重 The more elastic demand,the more the moral hazard probleml价格弹性越小，道德风险问题越轻 the more inelastic demand,the less the moral hazard problem18医疗保险讲义课件第18页道德风险道德风险 Moral HazardDemand0Q1PmP1QQ2BCDemand0Q1PmP1QB19医疗保险讲义课件第19页道德风险道德风险 Moral Hazardl保险责任范围政策 Insurance coverage policyl对越缺乏弹性服务，保险责任范围越大 more complete coverage for more inelastic servicesl对弹性越大服务，保险责任范围越小 less coverage for more elastic servicesl利用需求价格弹性制订保险责任范围政策是限制道德风险一个方法 use the price elasticity of demand to set up insurance coverage policy is a way to limit moral hazard problem20医疗保险讲义课件第20页道德风险道德风险 Moral Hazardl共付保险和起付线 Coinsurance and deductiblel限制道德风险另一个方法 another ways to limit moral hazard probleml降低福利损失 reduce welfare lossl管理保健 HMOsl限制道德风险一个方法 a way to limit moral hazard probleml医生含有限制患者医疗保险消费激励 physicians have incentive to reduce consumers consumption on health care21医疗保险讲义课件第21页道德风险道德风险 Moral Hazard主要国家费用负担制度一览l日本：门诊20-30%；药品每日份30-150日元l韩国：诊所30%；小医院门诊40%；大医院门 诊55%l英国：门诊免，但强制转诊；药品每次6英镑l加拿大：门诊药品自付全额l德国：药品每种自付8-10马克；感冒药、普通 成药不给付l法国：门诊30%；药品35-65%l美国：门诊每次10美元；药品每种10美元22医疗保险讲义课件第22页道德风险道德风险 Moral HazardDemand0Q1Q3PmP1QQ3BCDF23医疗保险讲义课件第23页道德风险道德风险 Moral Hazardl起付线（扣除保险）deductiblel要求被保人在就医时先支付一笔固定费用，保险企业支付其余费用。l扣除保险有几个方式：l应用于每一医疗服务单位，如阑尾切除术。l累积性，如，被保人一年内门诊服务支付费用累积到达100圆，保险企业就负担100元以外就诊费用。24医疗保险讲义课件第24页逆向选择逆向选择 Adverse Selectionl逆向选择(adverse selection)l假如对高风险人和低风险人提供同一个保险，使低风险补助高风险人，低风险人就会离开市场，使得保险项目下只存在高风险人，同时使得保费升高。l这一过程不停连续最终造成保险市场失灵l为何在医疗保险领域这个问题更为严重？l保险企业选择低风险人销售保险产品能够产生利润25医疗保险讲义课件第25页26医疗保险制度演变医疗保险制度演变l出现于当代社会之前l主要问题是l大病风险无法分散l个人负担过重居民个人支付居民个人支付26医疗保险讲义课件第26页27医疗保险制度演变医疗保险制度演变居民个人支付居民个人支付自发医疗保险自发医疗保险n出现于近代行会、工厂等组织中l一定程度上分散了疾病风险l不过未形成制度、保障水平低27医疗保险讲义课件第27页28医疗保险制度演变医疗保险制度演变居民个人支付居民个人支付自发医疗保险自发医疗保险商业医疗保险商业医疗保险n在自发医疗保险基础上，出现了在自发医疗保险基础上，出现了专门商业医疗保险专门商业医疗保险p有逆向选择问题，真正需要医疗保险人得不到保险28医疗保险讲义课件第28页29医疗保险制度演变医疗保险制度演变居民个人支付居民个人支付自发医疗保险自发医疗保险商业医疗保险商业医疗保险社会医疗保险社会医疗保险n始于始于1883年德国年德国n为了处理商业保险覆盖面低、逆为了处理商业保险覆盖面低、逆向选择问题，政府举行强制性社向选择问题，政府举行强制性社会医疗保险会医疗保险p处理了全民覆盖问题，至今仍是部分国家主要医疗保障模式n社会保险存在问题是，保险方社会保险存在问题是，保险方和医疗服务提供方目标仍不一和医疗服务提供方目标仍不一致，医疗费用控制情况不好致，医疗费用控制情况不好29医疗保险讲义课件第29页30医疗保险制度演变医疗保险制度演变居民个人支付居民个人支付自发医疗保险自发医疗保险商业医疗保险商业医疗保险社会医疗保险社会医疗保险治治疗疗方案指南方案指南处处方用方用药药清清单单收收费费清清单单效果效果评评定定增加起付增加起付线线增加共付率增加共付率缩缩小保小保险险范范围围PPOs增加患者信息增加患者信息保保险险企企业业临临床决床决议议服服务务提供者提供者患者患者医疗博弈三角30医疗保险讲义课件第30页31医疗保险制度演变医疗保险制度演变居民个人支付居民个人支付自发医疗保险自发医疗保险商业医疗保险商业医疗保险社会医疗保险社会医疗保险国家举行公立医院国家举行公立医院n为了实现服务提供方和保险方目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保险职能和医疗服务职能合二为一，这就是公立医院制度安排一，这就是公立医院制度安排31医疗保险讲义课件第31页非正式保险制度非正式保险制度l假如个体是风险躲避，但又没有正式保险制度能够分担风险，非正式保险制度应运而生。l保险机制实质上是熨平个体在健康和疾病两种状态下消费l保险制度是在事前缴纳一定保费，事后取得赔偿。l假如事先不缴纳保费，不过达成协议，假如群体中某个人患病，治疗费用由群体中全部些人均摊，这也是一个保险。l这种非正式保险制度在现实中存在么？（对群体稳定性要求）l村庄（南街村）l家庭32医疗保险讲义课件第32页讨论讨论l怎样改革医疗保险系统？How to reform the health insurance system?l香港案例 Hong Kong casel医疗帐户中国模式 Medical savings accounts-China modell管理保健 美国案例 HMOs-US casel“30铢计划”泰国案例33医疗保险讲义课件第33页