The Development of the Care Insurance System in Japan and Its Experience for China

对护理保险发展较有特色的国家——日本的成功实践进行分析研究,借鉴日本在护理方面的经验,依据我国实际情况提出实现并完善我国护理保险的具体措施和建议.     

论人口老龄化背景下我国长期护理保险制度的建立

随着我国老龄化形势加剧,老年人长期护理需求日渐增长,传统家庭式养老护理已经不能满足老年群体的需求,需要引入长期护理保险解决老年人护理问题。国外的长期护理保险模式无法与我国社会主义初级阶段的基本国情相适应,应结合中国实际情况,吸取国外宝贵经验,克服重重困难,在我国建立以强制性长期护理保险为主,以商业性长期护理保险为辅的长期护理保险制度。     

德日两国的长期护理保险制度比较及我国LTCI建立构想

德、日两国在不同时期以政府的强制力为保障,建立了强制性长期护理保险制度,对缓解本国人口老龄化的压力,改善老年生活具有重要意义。将两国的长期护理保险制度加以比较,以对我国长期护理保险制度的建立和发展起到积极的促进作用。纵观我国目前的人口状况,与德、日两国建立背景有相似性。但长期护理保险的建立必须要符合我国现有的国情,保证可持续性发展。故可考虑先发展商业长期护理保险,适时纳入社会保险的发展路径。     

浅析韩国老年人护理保险法律制度

目前我国已进入老年化社会,在老龄化趋势和家庭结构变化的背景下,出现了空巢家庭和失能老人数量增加等问题,仅靠基本的经济保障是无法解决老年人护理问题的.本文通过分析韩国老年人护理保险法律制度,再结合我国当前实际,提出对我国老年人护理保障相关的建议.     

日本社会保险立法的演变及最新动向

战后,日本从劳动保险出发,经过１５ 年发展,实现了“国民皆保险、国民皆年金”的全民保险体制;其后,立法重心逐步向老龄化对策演变,制定了立法理念全新的《就业保险法》和《护理保险法》。其审时度势,抓住有利时机发展社会保险事业的立法经验,对我国颇具参考价值。     

论我国长期护理保险制度试点中的争议问题与理论回应

伴随人口老龄化,家庭护理已难以满足失能老人的照护需求。为此,“十三五”规划提出“探索建立长期护理保险制度”,“十四五”规划建议进一步要求“稳步建立长期护理保险制度”。部分地区已开展试点工作,但是对于参保对象、基金筹集、保险待遇等核心问题试点不一。就参保对象,存在覆盖全民与仅面向老年居民之不同制度设计;就基金筹集,各地对于个人、单位及政府是否负担筹资义务规定不一;就保险待遇,各地对于给付对象、给付方式及给付标准规定不同。对家庭、单位、国家的职责定位以及对弥补家庭护理能力不足的路径选择,是构建长期护理保险制度的基础。基于平等原则、补充性原则,我国应建立覆盖全民、以参保人自行筹资为主体的长期护理保险制度。面对家庭护理能力之不足,立法应兼采支持劳动力回归家庭与护理社会化的应对路径,同时设立实物与现金给付方式,建立护理假等配套制度。     

统合视角下我国长期护理保险给付的规则形塑与制度建构

统一、完善、稳定的保险给付立法对于长期护理保险制度的公平可持续发展至关重要，我国的长期护理保险制度目前存在给付条件不一、给付方式各异、给付质量欠缺保障等碎片化问题，亟待统合式的规范设计。就给付条件而言，应当明确有权申请给付的主体不受年龄限制但须缴纳保费达特定年限，建立阶梯式的“失能”等级体系及其认定标准，同时确立兼具独立性和专业性的失能评估机构。就给付方式而言，应当以实物给付为原则，有条件地引入现金给付，建构多层次的长期护理保险实物给付护理体系，根据被保险人的失能程度提供差异化的保险给付，并且将预防理念融入给付规范之中。就保险给付质量保障而言，应当建立“结构”“过程”“结果”三位一体的护理服务质量保障体系，并分别从结构、过程、结果三个维度构建相应制度和规范，以提升长期护理服务的可及性、有效性、安全性、协调性与公平性。     

国外涉农保险法律制度的实践及其启示

我国目前执行的《农业保险统计制度》分为农业保险和涉农保险两大类.随着我国经济发展和经济实力的提高,对三农问题更加重视,由过去单纯的种植、养殖保险,逐渐扩大到涉农保险,更加重视农民福利的提高.国外的农业保险是“大农业保险”,不仅包括种植业保险和养殖业保险,而且还包括农民财产、农民人身等内容的涉农保险内容.通过分析法国、日本等国的农业保险法律制度,其成功的立法经验可为我国涉农保险法律制度的建立提供借鉴.     

日本《保险法》的立法原则及对我国的借鉴意义

2008年6月,日本颁布了在《商法》保险篇的基础上经大规模修订而成立的《保险法》,其立法原则主要体现为四个强化:第一,强化符合现代保险交易发展规则的制定。第二,强化对投保人方的保护。第三,强化保险契约当事人以外的第三人的法律地位。第四,强化道德风险的防范。日本保险法的修订不仅对日本国民的保险生活影响巨大,对刚刚经历过第二次修订的我国《保险法》,在法解释论及将来立法的进一步完善上,亦具有相当重要的参考价值。     

美、加、日农业保险立法的比较与借鉴

本文主要研究了美国、加拿大、日本等几个典型国家农业保险立法的背景、内容及其变化 ,希望通过比较和分析 ,对我国农业保险立法提供借鉴。     

Tort,Insurance and Ideology: Further Thoughts

This article explores the impact of insurance arrangements on the development of the law of obligations. It is accepted orthodoxy that the existence or otherwise of a duty of care in tort should be determined independently of the parties' underlying insurance arrangements. This article suggests that the traditional analysis is of limited value only, in that it fails to take full account of contractual arrangements which rest upon risk allocation backed by insurance; of the circumstances in which duties of care may arise; and of the relevance of insurance to the determination of the standard of care and causation principles. It is further suggested that insurance has a much greater part to play in the spreading of losses arising out of private suits than has to date been fully appreciated.     

Health care financing among the elderly: who really pays the bills?

This paper investigates the issue of who pays the health care bills of the elderly by considering the types of subsidized health insurance protection enjoyed by the noninstitutionalized elderly and the way that increased Medicare cost-sharing efforts in the 1980s are affecting those without additional health insurance subsidies. In making this examination we estimate the out-of-pocket health care expenditures of the elderly either directly or as nonsubsidized medigap premiums by income level, taking into account four types of health insurance subsidies received by elderly persons: Medicare, Medicaid, Veterans Administration health care, and subsidized health insurance from either current or former employers. We find that increased cost sharing is likely to fall most heavily on those elderly least likely to afford it: the poor and near-poor elderly who have only Medicare as a health insurance subsidy, particularly those who are older and sicker and who use Medicare services more heavily. These persons are caught between well-intentioned federal cost-cutting efforts and the often confusing panoply of health insurance programs for the aged, and they will bear an inequitably large portion of any future Medicare cost-sharing initiatives.     

Obstacles to dependent health care access in Oregon: health insurance or health care?

In the 1980s, Oregon was one of a handful of "states that could not wait" for national health care reform. Oregon's chosen approach to reform was predicated on two widely accepted assumptions. First, universal access to health care is best achieved by universal access to health insurance. Second, universal access to health care could best be achieved, at least politically, by incrementally building upon the existing health care delivery and insurance system. This article questions both of these assumptions in light of Oregon's decade-long experience in trying to expand access to health care among its dependent population.     

Moral hazard in health insurance: are consumer-directed plans the answer?

The concept of moral hazard in relation to health insurance is an area that has both haunted and fascinated economists, policy-makers, and payers almost since the first health insurance plans were offered by employers. Through the years since Kenneth Arrow's groundbreaking work in 1963, the health care industry has been looking for the proper level of cost-share for patient insureds that will affect their health care choices. The approach of some newer plan offerings, termed 'consumer-directed' or 'consumer-driven' plans by their promoters, seem to have the potential of affecting moral hazard in health insurance.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); amendment on elimination of nonavailability statement where primary insurance covers 75 percent of the cost--Office of the Secretary of Defense. Final rule

This amends the CHAMPUS Regulation to implement section 741 of Pub. L. 97-114. This public law eliminates the requirement for a nonavailability statement where the beneficiary has other insurance which will pay for at least 75 percent of the services. The intent of these changes is to encourage the use of other insurance to pay for necessary medical care, thus reducing the Government's expense through the direct care system. It also gives beneficiaries with other insurance greater freedom of choice as to where they obtain medical services.     

Symbols, rationality, and justice: rationing health care.

Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.     

论医疗责任保险——从法律经济学的角度切入

医疗责任保险是从国外引入的一种制度,目的之初在于,将医师的过错责任诱发的巨大风险社会化,以期医师安心于治理病患,而病患通过保险获得相应的保险费用保障自身的权益,缓和较为尖锐的医患关系和社会矛盾。但医疗责任保险发展的现实情况却是极其不理想的,学界对于医疗责任改革已有基本共识,具体设计上却甚少有人提出更为细致的建议。可以从法律经济学这个分析的全新视角,借助成本效益、纳什均衡、博弈的思维进路,以期为医疗责任保险制度的设计另辟蹊径。     

Using home equity to finance long-term care

A majority of elderly Americans have the bulk of their assets tied up in the houses they own. Reverse mortgages could tap this home equity, providing loan disbursements without requiring older homeowners to make monthly payments on principal and interest. In this paper we analyze the potential of using home equity to finance long-term care of the elderly, including payments for home care and for long-term care insurance. We first estimate each homeowner's risk of need for care (and risk of institutionalization) and then calculate the degree to which home equity could be used to cover the costs of home care (or of insurance premiums). Special emphasis is placed on those in the highest risk group and on those with the lowest incomes, who often turn out to be the same people.     

National health insurance and the new health occupations: nurse practitioners and physicians' assistants

This article considers a number of issues which might arise in formulating policy for new health occupations. Its particular focus is on nurse practitioners and physicians' assistants and their treatment under potential national health insurance arrangements. The development and expansion of these occupations are described, as is the evidence on their performance with respect to the quality of medical care provided, the impact on the cost of such care, and changes in access to care. We then discuss several issues which might arise in the context of national health insurance legislation, including reimbursement rates and methods, certification and licensure, training subsidies, deployment incentives, and compatibility with an increased supply of physicians.     

Most-favored-nation clauses and monopsonistic power: an unhealthy mix?

Most-favored-nations clauses appear in health insurance contracts allegedly to prevent price discrimination by health care providers among competing insurers. In fact, use of these provisions often works to exclude competitors from the health insurance market. This Note examines the antitrust implications of most-favored-nations clauses as used in the health insurance industry.