基本医疗保险服务协议的法律性质探讨

基本医疗保险服务协议是规范社会保险经办机构和定点医疗机构、定点零售药店双方行为的行为准则和重要法律依据,然而,对其法律性质的认定,学术界和实务界一直存有争议。行政私法合同是行政主体运用私法合同达致行政公法目的‘的手段,基本医疗保险服务协议符合行政私法合同的特征和本质属性,因此,基本医疗保险服务协议的法律性质是行政私法合同。     

不断完善医疗纠纷赔偿机制的思考

本文对海南省推行全省统一的医疗责任保险方案实施两年来,在运行过程中存在的问题与对策从医院层面进行分析,认为医疗纠纷通过医责险赔偿仍面临诸多矛盾和问题。主要表现在：一是保险公司的逐利性和医院对投保的初衷存在巨大差异,购买医责险并非医院自愿;二是医责险在理赔中困难重重,该赔不赔、随意压价、限制受理范围等等导致调解失败,医院没有真正从医疗纠纷中解脱出来,“医闹”问题仍困扰医院;三是保险方案设计和保费调整系数不合理,医院承担的保费过高,而赔偿过低,未能达到风险转嫁的目的。作者提出不断完善医疗纠纷赔偿机制,尝试建立医疗风险互助金制度。     

我国《农业保险法》的立法构想

我国农业保险的法律规制现状与立法的预期利益凸显了《农业保险法》立法的必要性。《农业保险法》的基本原则为:政府适度干预、合理补贴、强制保险与自愿保险相结合。我国未来的《农业保险法》至少应包括三方面的内容:农业保险合同制度、农业保险经营管理制度和农业保险责任制度。     

How the detection of insurance fraud succeeds and fails

Abstract

Insurance fraud is a serious and growing problem, and there is widespread recognition that traditional approaches to tackling fraud are inadequate. Studies of insurance fraud have typically focused upon identifying characteristics of fraudulent claims and claimants, and this focus is apparent in the current wave of forensic and data-mining technologies for fraud detection. An alternative approach is to understand and then optimize existing practices in the detection of fraud. We report an ethnographic study that explored the nature of motor insurance fraud-detection practices in two leading insurance companies. The results of the study suggest that an occupational focus on the practices of fraud detection can complement and enhance forensic and data-mining approaches to the detection of potentially fraudulent claims.     

我国养老保险基金保值增值的途径与制度设计

文章基于我国人口老龄化趋势日益加深,社会养老保险面临严峻挑战的社会背景,考察我国养老保险制度发展完善的历程,分析了现行养老保险基金运营管理中存在的问题和缺陷,以养老保险基金保值增值的途径与制度设计为线索进行研,艺,指出通过资本化运作可以实现养老基金的可持续发展。     

保险诈骗罪第4款解释路径的法律分析

片面共犯由于违背共同故意要件因而不属于共同犯罪,其不能对保险诈骗罪第4款的法律性质作出合理的解释。保险诈骗罪第4款既不属于法律拟制和注意规定,也不属于想象竞合和法规竞合,其是法律文本主义的当然解释,亦是大竞合理论下,适用从一重处断原则的当然结果。     

中国城镇居民养老保险对消费行为的影响研究——基于Feldstein生命周期假说模型

现阶段我国面临人口老龄化加剧和内需疲软难题,研究城镇居民养老保险对消费的影响,有利于为我国建立扩大消费需求长效机制提供理论支撑和政策建议。文章通过使用1980-2010年中国城镇居民人均消费性支出、人均可支配收入、人均储蓄和人均养老保险支出等数据,基于Feldstein生命周期假说模型,实证分析中国城镇居民养老保险对消费行为的影响效应。分析结果表明,中国城镇居民人均养老保险支出每增加1%,消费就会增加0.5%,说明城镇居民养老保险对消费有较大的推动作用,另外增加居民的人均可支配收入,也可以扩大消费。     

Equality,risk and responsibility: Dworkin on the insurance market

The concept of risk occupies centre-stage in debates about individual and social responsibilities and, within a broadly neo-liberal regime, the paradigmatic form of risk management is insurance. Nevertheless analysis of these recent shifts in welfare politics appears curiously disconnected from dominant trends of normative political theorizing. The rise of ‘insurance as government’ and ‘risk management as responsibility and opportunity’ has not obviously been addressed even by prominent liberal political theorists. Similarly the analysts of neo-liberalism have devoted little attention to tracing these concepts through the literature on political theory. This article seeks to remedy this disconnection, by showing how Ronald Dworkin – perhaps the foremost liberal theorist writing today – offers us an account of equality which foregrounds the apparatus of insurance, and represents the management of risk within the welfare system as both an opportunity and a responsibility. Furthermore, his account inherits many of the ambiguities and weaknesses of neo-liberal theory and redeploys them within the political theory of equality.     

保险诈骗犯罪手法分析及防范策略研究

近年来,保险诈骗案件呈多发态势,扰乱了正常的保险经营秩序,阻碍了中国保险业的健康发展。研究保险诈骗犯罪及防范策略,对加强预防保险欺诈行为、维护正常的保险秩序有着重要意义。防范保险诈骗可采取以下措施:(一)保险公司自身应强化管理,提高诈骗风险控制能力;(二)保险行业内部应相互配合,搭建业内信息共享平台;(三)金融检察部门要惩防并举,加强对保险行业的保护;(四)执法部门之间需加强协作,构建线索移送通报制度;(五)公众法制宣传要点面结合,加强骗保犯罪预防效果。     

建筑施工企业农民工工伤保险立法浅议

建筑行业农民工的工伤保险问题,已经引起社会各界的广泛关注。建立适合建筑行业农民工的工伤保险制度是保护农民工健康和维护社会稳定的必要条件。目前我国建筑行业农民工工伤维权存在一些问题,因此,需要建立符合我国建筑行业农民工自身特点的工伤保险。