让群众享受更多质优价宜医药服务

“十四五”期间,医疗保障将紧扣待遇、就医、服务等问题,着力提升人民群众医疗保障水平,让群众享受到更多质优价宜的医药服务,有力释放医保发展预期我国首次提出医疗保障三大体系建设任务,即健全多层次医疗保障制度体系、医疗保障协同治理体系、医疗保障服务支撑体系。三大体系相互联系、相互影响、相互作用,共同构筑起“十四五”医保发展的重点任务。     

政府责任视域下的农民工医疗保障问题探析

在农民工医疗保障领域,政府责任观强调政府在医疗保障中的权力与责任、义务的匹配性.它与政府权力的合法性来源、公信力、公平正义价值取向及人权保障密相关联,并以之为存在的基础性因素.虽然我国已实现“全民医保”,但每年有超过2亿的农民工在频繁流动,医疗保险制度的软肋愈益显现出来.其制度实施背后,有地方政府对农民工医疗保障制度实施缺少积极性、针对农民工的医保制度缺乏有效衔接、政府财政协调和监督职能缺位的影子.农民工医疗保障中的政府责任重构,呼唤着政府应在加快实现基本医疗保险城乡统筹、设立流动人口医保统筹基金调剂机构、促进医保制度间的协商与整合等方面作出制度改进.     

全球化视野下的中国社会保障制度的改革与选择

经济的全球化和全球性的治理运动加速了社会保障全球化,面对这一机遇与挑战,中国加快了社会保障制度改革的步伐并取得较大的成果:即保障模式从“企业 社会”到“企业保险”再到“社会保险”;改革取向变单位保障为社会保障;机制转换:由单一责任主体到多主体,社会统筹到社会统筹与个人帐户相结合;保障项目从短缺到充实;保障范围从按所有制覆盖到不分所有制的全覆盖;保障层次由单一到多层。但上述改革成果适应社会保障全球化趋势有一定差距,因此,中国未来社会保障改革须向市场化、民营化和社区化三个方向迈进,以全面应对全球化的挑战。     

西部地区社会养老保险制度城乡统筹:可能与可为

我国西部地区社会养老保险制度城乡统筹面临着养老保险制度“碎片化”程度深、养老保险待遇差距持续扩大、养老保险管理体制“分割化”现象突出、养老保险政策衔接机制不健全等困境.当前,西部地区科学、统筹发展的理念和政府对养老保险制度建设的重视,经济持续增长和财政支持能力的提高,城乡居民收入水平提升和参保意识增强,现有的法律依据和制度基础,使得进一步推进社会养老保险制度城乡统筹具备了一定的现实条件.应通过政府的全面主导,分三个阶段有重点地推进西部地区社会养老保险制度的城乡“统筹并轨”和“体系整合”:到2015年以前,基本实现城乡居民社会养老保险制度的全覆盖；到2020年以前,建立全面稳定的城乡居民养老保险制度和职工基本养老保险制度；到2030年以前,初步实现城乡居民养老保险与城镇职工养老保险制度的统筹并轨.     

基于差异的正义:我国全民基本医疗保险制度理论与思路研究

中国正处在并将长期处在差异性社会,这是构建中国基本医疗保险制度的主要社会基础。差异性社会的正义原则既不应为新自由主义的完全市场原则、也不能是民粹主义的超前空想原则,而应当是"差异的正义",即以"基本公平+比例公平"双层结构原则,探索实现全民基本医疗保险制度,走中国特色社会主义的基本医疗保险均等化之路。根据双层结构原则,改变我国基本医疗保险制度碎片化、多元化格局,建立统一的我国全民基本医疗保险制度体系,应包括"基本医疗保险+补充医疗保险":基本医疗保险以社会公平为原则,在全国范围内保障每个公民医疗保险的平等权益;多种补充医疗保险适应差异性社会的差异化医疗保险需求,体现比例公平原则。保障基本公平,适度尊重比例公平,不断消灭差异,走向最终公平,这就是全民基本医疗保险制度体系发展的"中国道路"。     

社会主要矛盾视角下基本养老保险的平衡充分发展

人民日益增长的美好养老新需要与基本养老保险发展不平衡、不充分之间的矛盾是新时代社会主要矛盾的一个具体表现。为解决制度统一性要求与碎片化发展、人群与地区间制度分离割裂、保障不足与保障过度并存等现实问题,完善全民基本养老保险,不仅需要从理念、制度与技术等层面进一步加快改革,促进其均衡充分发展,更要以解决人民基本养老生活的后顾之忧、增进人民福祉为根本发展目的,逐步全面建成覆盖全民、城乡统筹、权责清晰、保障适度、科学可持续的多层次社会保障体系。     

对抚恤优待制度改革的思考

我们必须从规范制度入手,逐步建构和完善抚恤优待体系。在今后一个时期要着力抓好以下工作:增强全社会优抚意识,整体设计制度改革,明确各级政府保障责任,创新多元化优抚保障模式,完善医疗保障机制,加强统一立法。     

我国农村医疗保障中的居民选择问题及其治理——基于政府行为优化的视角

作为社会保障制度的重要组成部分,农村医疗保障制度既是整个农村地区农民健康的基本保障,也是我国统筹城乡社会、经济及医疗卫生事业持续、稳定、和谐发展的客观需要。目前,我国农村的主要医疗制度为近些年顺势推行的新型农村合作医疗制度,但由于其自身发展所具有的固有缺陷,从而使其仍会陷入保险市场中常见的"逆向选择"悖论中,不利于新农合在一定时期内普遍覆盖这一目标愿景的实现。而现实中所采取的通过将"自愿性原则"改为"强制性原则"的处理方式,短期内无法实现"人人参与"的目标,更有悖于"人人有保障"的发展战略。本文基于政府行为优化视角,提出建立多层次、多元化的农村医疗保障体系的治理思路,并针对不同的目标群体,提出政府行为的宏观策略和微观策略。     

优化知识产权制度加快科技强国步伐

"十四五"时期我国进入新发展阶段,新发展阶段的首要任务是加快建设科技强国,推动中国经济向更高质量发展。加快建设科技强国,要立足国内国际新发展格局,着眼经济社会高质量运行,优化知识产权制度,以知识产权立法与应用为保障。具体而言,即要强化知识产权保护,推进创新资源配置国际化;提升知识产权效应,催生经济发展新动能;完善知识产权运营体系,加速科技成果转化。     

人口老龄化与农村老年医疗保障制度

人口老龄化导致老年人医疗服务需要增加。然而,经济因素制约了老年人医疗服务需要向需求的转化,阻碍了老年人健康状况的改善。为实现世界卫生组织(W H O)提出的“健康老龄化”目标,促进全面建设小康目标的实现,必须为老年人尤其是收入低且几乎没有任何医疗保障的大量农村老年人建立医疗保障制度。建立制度面临筹资来源少、技术难度高、医疗卫生条件落后等制约因素,需要采取“低水平、广覆盖、采用多种模式、利用各方力量、加强配套设施”的发展策略。通过建立农村老年医疗救助、合作医疗、“时间储蓄”等多种制度,提供完善的医疗供方体系,保障农村老年人的基本医疗需求,促进其健康状况的改善。     

“十四五”时期我国社会救助制度改革的目标与任务

“十四五”时期我国完成现阶段脱贫攻坚任务后将开启以解决相对贫困问题为目标的新的贫困治理阶段,社会救助制度在此期间应该发挥更加积极的作用。本文在总结“十三五”时期我国社会救助发展成绩和短板的基础上,提出了“十四五”时期社会救助改革与发展的基本目标和主要任务。本文认为,“十四五”时期社会救助应该转向以治理相对贫困为目标,继续提高社会救助的公平性,着眼于更高的社会效益和运行效率。为此,“十四五”时期应该提升社会救助的贫困识别标准,扩大社会救助的行动体系,优化社会救助制度体系,加强服务救助体系建设,并加强和优化社会救助的管理体系。     

我国社会保险费的征收体制探析

社会保险基金是整个社会保障体制持续健康运行的资金保障,基金的来源主要由社会保险经费的征缴完成。通过对我国社会保险费征收体制现状的解读,分析了其中存在的问题,在此基础上针对具体问题提出了体制完善的政策建议。     

Expanding access to health care for Social Security Disability Insurance beneficiaries: early findings from the accelerated benefits demonstration

Most Social Security Disability Insurance (DI) beneficiaries must complete a 5-month waiting period before they become entitled to DI cash benefits and an additional 24-month waiting period before Medicare benefits begin. The Accelerated Benefits (AB) demonstration is a randomized experiment designed to test the effects of providing newly entitled DI beneficiaries who do not have health insurance with a generous health benefits package during the Medicare waiting period. This article presents early findings on the prevalence of health insurance coverage among newly entitled beneficiaries and the characteristics of those without health insurance. It also examines the effects of AB on health care utilization, the extent to which AB reduces unmet medical needs, and the costs of providing the AB health benefits package.     

经济转型背景下地方政府行政逻辑的自主性辨析

加快经济发展方式转变以实现经济转型,是"十二五"规划目标的基本前提和要义之一,也已成为当下我国继续推进现代化进程的一个新的重要议题。本文认为,在此过程中,压力型体制下形成的我国地方政府行政逻辑中的自主性仍有其发挥作用的空间,但显然需予以再定位。那么,地方政府的这种自主性何以可能?有哪些主要变量因素?其行政逻辑转型的目标模式又应是什么?本文对这些问题进行了相应的讨论。     

Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non‐Expansion States

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference‐in‐difference‐in‐differences models that exploit cross‐sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre‐ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non‐expansion states. Our preferred specification suggests that, at the average pre‐treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer‐provided and non‐group coverage. The coverage gains from the full ACA were largest for those without a college degree, non‐whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.     

Disability benefit coverage and program interactions in the working-age population

Over three-fourths of the working-age population in the United States is insured for Disability Insurance (DI); this group is protected against a total loss of earned income typically associated with severe disability. However, little is known about the role the Supplemental Security Income (SSI) program plays in protecting against the financial consequences of severe disability for this population. We find that over one-third (36 percent) of the working-age population is covered by SSI in the event of a severe disability. Three important implications follow, which we discuss in sequence below: (1) SSI increases the overall coverage of the working-age population; (2) SSI enhances the bundle of cash benefits available to disabled individuals; and (3) interactions with other programs also enhance the safety net, most notably in the area of health insurance coverage. Ignoring these implications could lead to inaccurate inferences about disability program coverage, health insurance coverage, and the well-being of working-age individuals with disabilities. The first major finding is that SSI substantially increases overall cash benefit coverage. Thus SSI dramatically increases protection against the financial risk of disablement in the working-age population. While roughly 23 percent of the U.S. working-age population was not insured for DI in November 1996, SSI provides coverage for more than half of this seemingly "uncovered" population. An important innovation of our analysis is that we account for the possibility that many of those who appear ineligible for SSI based on current income could become eligible as a result of a disability shock that causes their earnings to drop. Thus the estimated proportion that is protected by SSI increases when the possibility of earnings loss because of disability is considered. Considering DI and SSI together, roughly 90 percent of the working-age population would be potentially covered for benefits in the event of a disability. Those who are covered by SSI--as opposed to those covered by DI alone-tend to be relatively young, less educated, and in relatively poor health. The remaining 10 percent or so are not covered by either DI or SSI. This group is economically vulnerable in some sense (they are poorer, older, and more likely to be women than those covered only by DI), but they are not as economically vulnerable in terms of income, resource holdings, and private health insurance coverage as those who are eligible for SSI. A disproportionate share of those who are not covered by either DI or SSI consists of married women. The second major finding is that SSI substantially enhances the bundle of available cash benefits. Roughly one-third of those covered by DI are initially covered by SSI as well. SSI enhances the bundle of available cash benefits through two mechanisms: (1) SSI provides cash payments during the 5-month DI waiting period, and (2) SSI supplements the DI benefit after the DI waiting period for people whose initial SSI payment is larger than the DI benefit. We find that the role of SSI cash payments is temporary for most of those who are initially covered by both SSI and DI: They would receive SSI during the DI waiting period, but would lose SSI eligibility afterwards because the higher DI benefit completely offsets the SSI benefit. However, a smaller group of DI beneficiaries with low DI benefit levels would continue to be covered by both SSI and DI after the DI waiting period because the relatively low DI benefit would not completely offset the SSI benefit. The third major finding is that interactions with other programs also substantially enhance the safety net. The most important interactions involve health insurance coverage. In the working-age population, Medicare is available to DI beneficiaries, but only after a 24-month waiting period. By contrast, SSI is an important pathway to Medicaid benefits for severely disabled adults with limited income and resources and has no waiting period. SSI can provide a pathway to health insurance coverage during the 24-month Medicare waiting period for some DI beneficiaries through providing access to Medicaid. Interactions with other programs, such as Temporary Assistance for Needy Families (TANF), Food Stamp, Unemployment Insurance (UI), workers' compensation (WC), and veterans' disability programs, modify the role of DI and SSI in protecting people against the adverse financial effects of disablement. The nature of the interactions with other programs differs depending on individual circumstances. Employment-related programs (including UI, WC, and veteran's disability programs) are particularly important for those who are covered by DI. By contrast, the means-tested programs (including TANF and Food Stamp) are more important for those who would be eligible for SSI. In conclusion, SSI plays a substantial role in protecting working-age people against the adverse financial consequences of disablement through three mechanisms: (1) providing coverage to many who are not DI insured; (2) providing additional cash benefits to many who are DI insured and also covered by SSI; and (3) enhancing the social safety net by interacting with other programs, most notably Medicaid. Through these mechanisms, the role of SSI is substantial enough that it cannot be safely ignored in econometric and policy research on DI.     

Managed Liberalization of the Dutch Welfare State: A Review and Analysis of the Reform of the Dutch Social Security System, 1985–1998

In this article the changes that have been implemented in the Dutch social security system are analyzed. The extensive changes are characterized as a form of "managed liberalization." This characterization points to the paradoxical nature of these changes. On the one hand a certain liberalization can be observed (an increase of social insurance and the administration of social security via the market) while on the other hand the control of the system by the state is also increasing. This process of managed liberalization, however, takes place under an umbrella of lasting universal social protection: entitlements are still determined by law and remain collective. In this article the changes in the Dutch social security are described extensively, interpreted theoretically and analyzed in their consequences for the level of social protection. By following the process of institutional change the system of social security has undergone, the authors also try to find out what the causes of the changes are and what determines the direction the process has taken.     

Social security: a program and policy history

Many of the federal and state programs that provide income security to U.S. families have their roots in the Social Security Act (the Act) of 1935. This Act provided for unemployment insurance, old-age insurance, and means-tested welfare programs. The Great Depression was clearly a catalyst for the Social Security Act of 1935, and some of its provisions--notably the means-tested programs--were intended to offer immediate relief to families. However, the old-age insurance program-the precursor to today's Old-Age, Survivors, and Disability Insurance, or Social Security, program-was not designed specifically to deal with the economic crisis of that era. Indeed, monthly benefit payments, under the original Act, were not scheduled to begin until 1942. In addition, from the beginning, the Social Security program has embodied social insurance principles that were widely discussed even before the onset of the Great Depression. The first four decades of the Social Security program were, in general, ones of expansion. In fact, the program was expanded even before it became truly operational. In 1939, amendments added child, spouse, and survivor benefits to the retirement benefits authorized by the 1935 Act. Those amendments also allowed for monthly benefits to begin in 1940. Although the program was not changed substantially during the war years and the initial postwar period, the 1950s were a transformational decade in the program's history: benefit amounts were increased substantially, coverage under the program became close to universal, and a new disability insurance benefit was offered. The 1960s witnessed additional growth in Social Security, but the most important development in social insurance occurred in health insurance, with the creation of the Medicare program in 1965. Legislative actions in the 1970s had profound effects on the Social Security program and, indeed, set the stage for many of today's reform debates. Large benefit increases, a new benefit formula that was erroneously generous, and other changes in the early 1970s created a situation in which annual program costs, as a share of gross domestic product, increased during a 12-year period from about 3 percent to 5 percent. In 1977, amendments to the Act corrected the flawed benefit formula and made other changes in the financing of the system to shore up the program. Thus, the 1970s represent a watershed in the program's history-program growth gave way to increasing concerns about the program's finances. Those concerns were reflected in the amendments to the Act in 1983, which were the last major changes to the program. These amendments, based largely on recommendations from a commission chaired by Alan Greenspan, adjusted benefits and taxes to address pressing near-term financing problems faced by the system. Although the Greenspan Commission focused to a large extent on short-range issues, the resulting reforms have generated large surpluses in the program and the buildup of a substantial trust fund. However, the looming retirement of the baby boomers and several other demographic factors will, according to projections, result in the exhaustion of the trust fund by 2042.     

Health insurance coverage of the unemployed: COBRA and the potential effects of Kassebaum-Kennedy.

We use the April 1993 Current Population Survey to examine the health insurance coverage decisions of the unemployed and to simulate the potential effects of the new Kassebaum-Kennedy legislation. After controlling for demographic characteristics, COBRA eligibility raises the probability of health insurance coverage by 0.095, while eligibility for spouse employer insurance increases the likelihood of coverage by 0.318, and eligibility for both increases the likelihood of coverage by 0.341. In our simulations, we find that had Kassebaum-Kennedy been in effect in April 1993, 9.0 percent of the unemployed would be eligible to take up coverage, and the coverage rate of the unemployed would have been increased by 0.85 percent to 1.5 percent from 41.6 percent. Our estimates of the effect of Kassebaum-Kennedy on health insurance coverage are much lower than those reported by the Government Accounting Office prior to the passage of the legislation.     

Food 2030: Towards a Redefinition of Food? A Commentary on the New United Kingdom Government Food Strategy

The British government published its new food strategy in January 2010, entitled ‘Food 2030: How We Get There’. This emerges out of a considerable amount of policy activity and debate since the sharp rises in food prices during 2007–2008. This demonstrated the need both to now have an explicit food policy, and to position this as a goal across various government departments. In addition, it is recognised that food security and hunger are key global concerns. How does the strategy face up to the arrival of these new and combined challenges associated with the need to produce more food sustainably and to allocate it more fairly? Clearly, we are in a period of new productivism with regard to trying to solve national and international food security and sustainability issues. Yet this strategy misses an opportunity to stimulate a new strategic approach in enhancing and developing the United Kingdom's food supply system albeit in its international context. We need more governmental and political innovation and imagination if we are to meet these challenges. The new food strategy may come to represent the start of this process.