我国基本医疗保险经办机构的定位与职能

在"全民医保"即将建成的格局下,我国基本医疗保险经办机构本应成为积极而强势的医疗服务购买者。但目前我国基本医疗保险经办机构仍旧是一个"消极的医疗费用支付者",其具体职能离真正意义上的医疗服务购买者相去甚远。这也导致其无法发挥抑制医疗机构滥用专业优势的功能,并削弱了其所承载的医疗社会化的目标。因而有必要借鉴美国等医疗市场发达国家的"管理式医疗"经验,将我国基本医疗保险经办机构定位为医疗服务购买者,对现有的基本医疗保险经办机构进行公益性改革,并实现其职能转型,使其成为一个选拔合格医疗机构、参与医疗行业标准化诊疗流程和病种制度建设、对患者反馈信息进行分析和评价、控制医疗费用上涨并监督医疗服务质量的职能部门。     

Cyber insurance – What coverage in case of an alleged act of War? Questions raised by the Mondelez v. Zurich case

In October 2018, snack company Mondelez International, Inc. (Mondelez) filed an action against Zurich American Insurance Company (Zurich), requesting indemnification for more than USD $100,000,000 in losses caused by the NotPetya cyber virus. Zurich refuses to cover these damages alleging one of the insurance policy's exclusions for damage resulting from a hostile or warlike action by a government, as the NotPetya attack is said to have been sponsored by Russia. This case is noteworthy for multiple reasons: not only is it the first significant legal dispute in the insurance field concerning the recovery of costs resulting from a cyber attack, but it is also the first time that an insurance company is invoking the war exclusion to decline coverage for an allegedly state-sponsored cyber hack.This article analyzes the key issues of this important case, including attribution of a cyber attack to a State and interpretation of an insurance policy's war exclusion in a cyber context, and the likelihood of success of Mondelez's arguments. It also explores the strengths and limits of general principles of contract and public international law when applied to new technologies and cyber incidents. Finally, it discusses the potential impacts of the Mondelez case on the contents and limits of future traditional and cyber-specific insurance policies.     

论保险诈骗的特别共犯

刑法条文关于保险诈骗共犯的规定属于特别规定.保险诈骗共犯构成需要符合主体、主观方面、客观方面的特定条件.构成保险诈骗特别共犯所要求的故意,是指行为人对提供虚假证明文件行为具有故意,而不是对帮助他人诈骗具有故意.保险诈骗共犯的罪名应根据实施保险诈骗的人构成的罪名而定.     

诉讼保险：二十一世纪新型诉讼救助

诉讼费用是民事诉讼中一项极为重要的制度 ,它甚至关系到司法制度的根本。但长期以来该制度却始终未受到重视 ,立法和实践中问题重重。很多人由于不合理的诉讼费用而不能或不愿进入诉讼 ,出现了“费用排斥诉讼”的现象。传统诉讼救助措施的不得力呼唤着新制度的诞生。结合微观经济理论 ,建立诉讼费用保险机制 (简称诉讼保险机制 ) ,让多数人来分担诉讼费用的风险 ,实现诉讼费用的微观自救 ,不失为一个切实可行的方案。     

论《道路交通安全法》第76条无过错责任之合理性

《道路交通安全法》第76条之规定被解读为“机动车负全责”,从而成为社会讨论的的焦点问题。该第76条中规定了两个无过错责任,即保险公司的无过错责任以及机动车对行人、非机动车的无过错责任。分析得出,保险公司承担无过错责任,是与保险分散社会风险的原理分不开;机动车损伤行人、非机动车后,对保险赔偿剩余的部分,由机动车方承担相对的无过错责任,同时规定可以就受害人的过失进行相抵。具合理性。     

弃权和禁止抗辩在英美保险法中的运用及对我国的启示

弃权和禁止抗辩原本是英美法系保险法中的两个重要原则,用以对投保人在保险合同中的弱势地位进行救济。弃权和禁止抗辩具有自己特有的含义和适用条件,其作为英美保险法的基本原则对我国保险法的修改具有重要的启示,在我国保险法中具有适用的可能性。     

Insurance Fraud and the Role of the Civil Law

Two UK Supreme Court decisions have considered insurance fraud. The first, Versloot Dredging BV v HDI‐Gerling Industries Versicherung (The DC Merwestone), concerned the use of a fraudulent device being harnessed to support a legitimate claim which, in the view of the majority, was an area of insurance law in need of re‐evaluation. The second, Haywood v Zurich Insurance Co, concerned the use of fraud to increase the settlement paid by the insurer and whether an insurer, which suspects fraud but has nevertheless chosen to settle a claim, is entitled to set aside the settlement under the tort of deceit where it subsequently discovers proof that it was in fact fraudulent. This case note examines not only the legal implications of the decisions and their likely impact on industry practice, it also focuses on the broader issue of the proper province of the civil law and whether general deterrence can be justified as a proper objective where the criminal law is deficient in punishing fraud because of its higher standard of proof.     

贵州省少数民族地区保险业发展的现状与对策

贵州省是多民族省份,少数民族地区保险业既是当地经济的重要组成部分,也是支持和推动少数民族地区经济发展的重要手段。为促进我省少数民族地区,尤其是少数民族县保险的发展,更好地为少数民族地区经济社会发展服务,笔者对贵州省少数民族地区保险现状进行了综合调研,并针对面临的问题提出相应对策。     

“交强险”中赔偿对象之我见

“交强险”中的第三人特指“交强险”保单当事人以外的对被保险享有请求权的人。我国现行法律对“交强险”之第三人界定的范围比较狭窄,这对交通事故中许多无辜受害者的保护十分不利。而国外相关法律规定却相当人性化,我国应该借鉴他人的成功立法经验。     

中国社会养老保险基金面临的问题及对策

我国现行的养老保险体制在解决传统养老保险模式弊端的同时也产生了许多新问题。在社会养老保险基金的筹集方面,存在着基本养老保险覆盖面较窄,基金来源单一,参保企业漏缴保险费的问题。解决问题的关键在于增强缴费意识;做好养老保险征缴环节的稽核;开征社会保障税。在社会养老保险基金的给付方面存在人口老龄化对养老保险基金给付的冲击;退休年龄低以及历史债务的问题。认为只有建立机动灵活的就业与退休机制;逐渐消解隐性债务才能使这方面的问题得到缓解。