醫(yī)療保險(xiǎn)講義課件培訓(xùn)課件

1、醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance醫(yī)療保險(xiǎn) Health Insurance提供一種分散由疾病引起的財(cái)務(wù)風(fēng)險(xiǎn)的方式 Provide a way to diversify financial risks associated with illness醫(yī)療保險(xiǎn)的需求理論 The theory of demand for health insurance個(gè)人希望最大化其效用 An individual wishes to maximize his or her utility如果事件確定，每個(gè)人最大化其確定的效用 if there are certain ev

2、ents, individual maximizes his or her certainty utility如果事件不確定，每個(gè)人最大化其期望效用 if there are uncertain events, individual maximizes his or her expected utility 2醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance醫(yī)療保險(xiǎn) Heal醫(yī)療保險(xiǎn) Health Insurance期望效用 Expected utility生病的概率生病時(shí)的財(cái)富所帶來(lái)的效用健康的概率健康時(shí)的財(cái)富所帶來(lái)的效用 =probability of illness utili

3、ty of wealth with illness + probability of healthy utility of wealth with healthy例子，假設(shè) Example, assume約翰有$20,000 的年收入，年內(nèi)沒(méi)有儲(chǔ)蓄和貸款 John has $20,000 annual income, no saving and borrowing健康的概率95% ，醫(yī)療支出為0，財(cái)富為$20,000 With 95% probability, he will be healthy. When he is healthy, his health care expenditure

4、 is 0 and his wealth is $20,000生病的概率5% ，醫(yī)療支出$10,000 ，財(cái)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醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance期望效用 Expe醫(yī)療保險(xiǎn) Health Insurance兩種可選的行動(dòng)方案 Two alternative courses of action他可以

5、購(gòu)買保險(xiǎn)，承擔(dān)一個(gè)數(shù)目不大的保險(xiǎn)費(fèi) He can purchase insurance and incur a small loss in the form of the insurance premium他也可以自我保險(xiǎn) He can self-insure生病概率小，但是一旦生病損失很大 small possibility of a large loss if the illness occurs不生病的概率大，也沒(méi)有醫(yī)療支出 large possibility that the medical loss will not occur問(wèn)題：哪種選擇可以使他的效用最大化？ Question:

6、 which choice provides him with a higher level of utility4醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance兩種可選的行動(dòng)方案醫(yī)療保險(xiǎn) Health Insurance如果約翰購(gòu)買醫(yī)療保險(xiǎn) If John would buy health insurance保險(xiǎn)費(fèi)預(yù)期醫(yī)療保健支出 insurance premium= expected health care expenditure=95% 0 + 5%10,000=500他的財(cái)富 20,000-500=19500 His wealth =20,000-500=19500他的確定

7、效用 His certainty utility=如果約翰不愿購(gòu)買醫(yī)保 If John wouldnt buy health insurance他的財(cái)富將是$20,000 或者$10,000 his wealth could be $20,000 or $10,000他的預(yù)期效用 his expected utility=5醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance如果約翰購(gòu)買醫(yī)療保醫(yī)療保險(xiǎn) Health Insurance約翰的偏好財(cái)富的效用 Johns preference-utility of wealth 財(cái)富 效用 邊際效用 10,000 100 12,000 130

8、 14,000 155 16,000 168 18,000 176 19,500 178 20,000 1806醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance約翰的偏好財(cái)富醫(yī)療保險(xiǎn) Health Insurance約翰的財(cái)富的效用 Johns utility of wealth如果他購(gòu)買保險(xiǎn)，其確定效用 if he would buy insurance, his certainty utility=U(財(cái)富=19500)=178如果他不愿購(gòu)買保險(xiǎn)，其期望效用 if he wouldnt buy insurance,his expected utility=5% U(w=10,00

9、0) + 95% U(w=20,000)=5% 100 + 95% 180 = 176約翰的確定效用大于期望效用 Johns certainty utility is greater than the expected utility如果購(gòu)買保險(xiǎn)，情況將得到改善 He will be better off if he buys insurance不確定性導(dǎo)致效用損失 uncertainty leads to a loss of utility7醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance約翰的財(cái)富的效用 醫(yī)療保險(xiǎn) Health Insurance效用函數(shù)對(duì)購(gòu)買保險(xiǎn)行為的影響 Th

10、e role of utility function in the purchase of insurance線性效用函數(shù)，邊際效用不變 Utility is linear function of wealth and marginal utility is constant 財(cái)富 效用 邊際效用 10,000 100 12,000 120 14,000 140 16,000 160 18,000 180 19,500 195 20,000 2008醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance效用函數(shù)對(duì)購(gòu)買保險(xiǎn)醫(yī)療保險(xiǎn) Health Insurance效用函數(shù) Utility f

11、unction U = a Y, Y=財(cái)富U=0.01Y利用約翰的例子 use Johns example他的確定效用=他的期望效用=確定效用期望效用 His certainty utility = his expected utility他是風(fēng)險(xiǎn)中性的 he is risk neutral9醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance效用函數(shù) Util醫(yī)療保險(xiǎn) Health InsuranceW1W2W3WUU1U2U3WW1W2W3MU10醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health InsuranceW1W2W3WUU醫(yī)療保險(xiǎn) Health Insurance效用函數(shù)對(duì)購(gòu)買保險(xiǎn)行

12、為的影響 The role of utility function in the purchase of insurance效用函數(shù)是財(cái)富的增函數(shù)，邊際效用遞增 Utility is increasing function of wealth and marginal utility is increasing 財(cái)富 效用 邊際效用 10,000 100 12,000 130 14,000 165 16,000 205 18,000 250 19,500 280 20,000 30011醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance效用函數(shù)對(duì)購(gòu)買保險(xiǎn)醫(yī)療保險(xiǎn) Health Insu

13、rance效用函數(shù) Utility function U = a Yb, Y=財(cái)富, b 1U=0.01Yb利用約翰的例子 use Johns example他的確定效用=他的期望效用=確定效用期望效用 His certainty utility his expected utility他是風(fēng)險(xiǎn)偏好者 he is risk lover他不愿購(gòu)買保險(xiǎn) he will not buy insurance12醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance效用函數(shù) Util醫(yī)療保險(xiǎn) Health InsuranceWUW1W2W3U1U2U3WW1W2W3MU13醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn)

14、Health InsuranceWUW1W2W3U醫(yī)療保險(xiǎn) Health Insurance效用函數(shù)對(duì)購(gòu)買保險(xiǎn)行為的影響 The role of utility function in the purchase of insurance效用函數(shù)是財(cái)富的增函數(shù)，邊際效用遞減 Utility is increasing function of wealth and marginal utility is increasingU=a Yb, b期望效用 His certainty utilityhis expected utility他將購(gòu)買保險(xiǎn) he will buy insurance他是風(fēng)險(xiǎn)規(guī)

15、避者 he is risk averse14醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance效用函數(shù)對(duì)購(gòu)買保險(xiǎn)醫(yī)療保險(xiǎn) Health InsuranceBA140200200001000019500WUWMU199D197C15醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health InsuranceBA1402002醫(yī)療保險(xiǎn) Health Insurance純保險(xiǎn)金 Pure premium預(yù)期醫(yī)療支出 expected health expenditure額外費(fèi)用 Loading cost執(zhí)行保險(xiǎn)政策時(shí)所發(fā)生的管理費(fèi)用和其他相關(guān)費(fèi)用administrative and other costs a

16、ssociated with underwriting an insurance policy最高保險(xiǎn)費(fèi) Maximum premium當(dāng)期望效用不大于確定效用時(shí)，人們?cè)敢庵Ц兜谋ｋU(xiǎn)費(fèi)的最大金額 the maximum amount the person would be willing to pay as long as his expected utility is not greater than his certainty utility16醫(yī)療保險(xiǎn)講義課件醫(yī)療保險(xiǎn) Health Insurance純保險(xiǎn)金 Pure保險(xiǎn)怎樣影響醫(yī)療保健的需求 How Insurance Affects

17、 a Demand Curve for Health Carem1530150510pm具有50%共付率保險(xiǎn)的需求沒(méi)有保險(xiǎn)時(shí)的需求17醫(yī)療保險(xiǎn)講義課件保險(xiǎn)怎樣影響醫(yī)療保健的需求 道德風(fēng)險(xiǎn) Moral Hazard道德風(fēng)險(xiǎn) Moral hazard problem如果有保險(xiǎn)，個(gè)人傾向于減少對(duì)健康的關(guān)注individuals would take care of themselves less if they had insurance由于保險(xiǎn)降低了醫(yī)療服務(wù)的價(jià)格，和自己支付所有費(fèi)用相比，人們將消費(fèi)更多的醫(yī)療保健 since insurance lowers the price of medica

18、l care to individuals, they will consume more health care than if they had to pay the entire price themselves. 道德風(fēng)險(xiǎn)問(wèn)題 The moral hazard problem取決于需求的價(jià)格彈性 depend on the price elasticity of demand價(jià)格彈性越大，道德風(fēng)險(xiǎn)問(wèn)題越嚴(yán)重 The more elastic demand, the more the moral hazard problem價(jià)格彈性越小，道德風(fēng)險(xiǎn)問(wèn)題越輕 the more inelast

19、ic demand, the less the moral hazard problem18醫(yī)療保險(xiǎn)講義課件道德風(fēng)險(xiǎn) Moral Hazard道德風(fēng)險(xiǎn) Moral ha道德風(fēng)險(xiǎn) Moral HazardDemand0Q1PmP1QQ2BCDemand0Q1PmP1QB19醫(yī)療保險(xiǎn)講義課件道德風(fēng)險(xiǎn) Moral HazardDemand0Q1PmP1醫(yī)療保險(xiǎn)講義課件培訓(xùn)課件道德風(fēng)險(xiǎn) Moral Hazard共付保險(xiǎn)和起付線 Coinsurance and deductible限制道德風(fēng)險(xiǎn)的另一種方法 another ways to limit moral hazard problem降低福利損失

20、reduce welfare loss管理保健 HMOs限制道德風(fēng)險(xiǎn)的一種方法 a way to limit moral hazard problem醫(yī)生具有限制患者的醫(yī)療保險(xiǎn)消費(fèi)的激勵(lì) physicians have incentive to reduce consumers consumption on health care21醫(yī)療保險(xiǎn)講義課件道德風(fēng)險(xiǎn) Moral Hazard共付保險(xiǎn)和起付線 Coi道德風(fēng)險(xiǎn) Moral Hazard主要國(guó)家費(fèi)用負(fù)擔(dān)制度一覽日本：門診20-30%；藥品每日份30-150日元韓國(guó)：診所30%；小醫(yī)院門診40%；大醫(yī)院門 診55%英國(guó)：門診免，但強(qiáng)制轉(zhuǎn)診；藥

21、品每次6英鎊加拿大：門診藥品自付全額德國(guó)：藥品每種自付8-10馬克；感冒藥、一般 成藥不給付法國(guó)：門診30%；藥品35-65%美國(guó)：門診每次10美元；藥品每種10美元22醫(yī)療保險(xiǎn)講義課件道德風(fēng)險(xiǎn) Moral Hazard主要國(guó)家費(fèi)用負(fù)擔(dān)制度一覽2道德風(fēng)險(xiǎn) Moral HazardDemand0Q1Q3PmP1QQ3BCDF23醫(yī)療保險(xiǎn)講義課件道德風(fēng)險(xiǎn) Moral HazardDemand0Q1Q3Pm道德風(fēng)險(xiǎn) Moral Hazard起付線（扣除保險(xiǎn)） deductible要求被保人在就醫(yī)時(shí)先支付一筆固定的費(fèi)用，保險(xiǎn)公司支付其余的費(fèi)用?？鄢ｋU(xiǎn)有幾種方式：應(yīng)用于每一醫(yī)療服務(wù)單位，如闌尾切除術(shù)。

22、累積性的，如，被保人一年內(nèi)門診服務(wù)支付費(fèi)用累積達(dá)到100圓，保險(xiǎn)公司就承擔(dān)100元以外的就診費(fèi)用。24醫(yī)療保險(xiǎn)講義課件道德風(fēng)險(xiǎn) Moral Hazard起付線（扣除保險(xiǎn)） de逆向選擇 Adverse Selection逆向選擇(adverse selection) 如果對(duì)高風(fēng)險(xiǎn)的人和低風(fēng)險(xiǎn)的人提供同一種保險(xiǎn)，使低風(fēng)險(xiǎn)的補(bǔ)貼高風(fēng)險(xiǎn)的人，低風(fēng)險(xiǎn)的人就會(huì)離開(kāi)市場(chǎng)，使得保險(xiǎn)項(xiàng)目下只存在高風(fēng)險(xiǎn)的人，同時(shí)使得保費(fèi)升高。這一過(guò)程不斷持續(xù)最后造成保險(xiǎn)市場(chǎng)失靈為什么在醫(yī)療保險(xiǎn)領(lǐng)域這個(gè)問(wèn)題更為嚴(yán)重？保險(xiǎn)公司選擇低風(fēng)險(xiǎn)的人銷售保險(xiǎn)產(chǎn)品可以產(chǎn)生利潤(rùn)25醫(yī)療保險(xiǎn)講義課件逆向選擇 Adverse Selection逆向

23、選擇(adv26醫(yī)療保險(xiǎn)制度的演變出現(xiàn)于現(xiàn)代社會(huì)之前主要問(wèn)題是大病風(fēng)險(xiǎn)無(wú)法分散個(gè)人負(fù)擔(dān)過(guò)重居民個(gè)人支付26醫(yī)療保險(xiǎn)講義課件26醫(yī)療保險(xiǎn)制度的演變出現(xiàn)于現(xiàn)代社會(huì)之前居民個(gè)人支付26醫(yī)療27醫(yī)療保險(xiǎn)制度的演變居民個(gè)人支付自發(fā)的醫(yī)療保險(xiǎn)出現(xiàn)于近代的行會(huì)、工廠等組織中一定程度上分散了疾病風(fēng)險(xiǎn)但是未形成制度、保障水平低27醫(yī)療保險(xiǎn)講義課件27醫(yī)療保險(xiǎn)制度的演變居民個(gè)人支付自發(fā)的醫(yī)療保險(xiǎn)出現(xiàn)于近代的28醫(yī)療保險(xiǎn)制度的演變居民個(gè)人支付自發(fā)的醫(yī)療保險(xiǎn)商業(yè)醫(yī)療保險(xiǎn)在自發(fā)的醫(yī)療保險(xiǎn)基礎(chǔ)上，出現(xiàn)了專門的商業(yè)醫(yī)療保險(xiǎn)有逆向選擇的問(wèn)題，真正需要醫(yī)療保險(xiǎn)的人得不到保險(xiǎn)28醫(yī)療保險(xiǎn)講義課件28醫(yī)療保險(xiǎn)制度的演變居民個(gè)人支付自發(fā)的醫(yī)療保險(xiǎn)商業(yè)醫(yī)療保險(xiǎn)29醫(yī)療保險(xiǎn)制度的演變居民個(gè)人支付自發(fā)的醫(yī)療保險(xiǎn)商業(yè)醫(yī)療保險(xiǎn)社會(huì)醫(yī)療保險(xiǎn)始于1883年德國(guó)為了解決商業(yè)保險(xiǎn)覆蓋面低、逆向選擇的問(wèn)題，政府舉辦強(qiáng)制性的社會(huì)醫(yī)療保險(xiǎn)解決了全民覆蓋的問(wèn)題，至今仍是部分國(guó)