医疗保险讲义课件培训课件

1、医疗保险讲义课件医疗保险讲义课件医疗保险 Health Insurance医疗保险 Health Insurance提供一种分散由疾病引起的财务风险的方式 Provide a way to diversify financial risks associated with illness医疗保险的需求理论 The theory of demand for health insurance个人希望最大化其效用 An individual wishes to maximize his or her utility如果事件确定，每个人最大化其确定的效用 if there are certain ev

2、ents, individual maximizes his or her certainty utility如果事件不确定，每个人最大化其期望效用 if there are uncertain events, individual maximizes his or her expected utility 2医疗保险讲义课件医疗保险 Health Insurance医疗保险 Heal医疗保险 Health Insurance期望效用 Expected utility生病的概率生病时的财富所带来的效用健康的概率健康时的财富所带来的效用 =probability of illness utili

3、ty of wealth with illness + probability of healthy utility of wealth with healthy例子，假设 Example, assume约翰有$20,000 的年收入，年内没有储蓄和贷款 John has $20,000 annual income, no saving and borrowing健康的概率95% ，医疗支出为0，财富为$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% ，医疗支出$10,000 ，财富$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医疗保险讲义课件医疗保险 Health Insurance期望效用 Expe医疗保险 Health Insurance两种可选的行动方案 Two alternative courses of action他可以

5、购买保险，承担一个数目不大的保险费 He can purchase insurance and incur a small loss in the form of the insurance premium他也可以自我保险 He can self-insure生病概率小，但是一旦生病损失很大 small possibility of a large loss if the illness occurs不生病的概率大，也没有医疗支出 large possibility that the medical loss will not occur问题：哪种选择可以使他的效用最大化？ Question:

6、 which choice provides him with a higher level of utility4医疗保险讲义课件医疗保险 Health Insurance两种可选的行动方案医疗保险 Health Insurance如果约翰购买医疗保险 If John would buy health insurance保险费预期医疗保健支出 insurance premium= expected health care expenditure=95% 0 + 5%10,000=500他的财富 20,000-500=19500 His wealth =20,000-500=19500他的确定

7、效用 His certainty utility=如果约翰不愿购买医保 If John wouldnt buy health insurance他的财富将是$20,000 或者$10,000 his wealth could be $20,000 or $10,000他的预期效用 his expected utility=5医疗保险讲义课件医疗保险 Health Insurance如果约翰购买医疗保医疗保险 Health Insurance约翰的偏好财富的效用 Johns preference-utility of wealth 财富 效用 边际效用 10,000 100 12,000 130

8、 14,000 155 16,000 168 18,000 176 19,500 178 20,000 1806医疗保险讲义课件医疗保险 Health Insurance约翰的偏好财富医疗保险 Health Insurance约翰的财富的效用 Johns utility of wealth如果他购买保险，其确定效用 if he would buy insurance, his certainty utility=U(财富=19500)=178如果他不愿购买保险，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约翰的确定效用大于期望效用 Johns certainty utility is greater than the expected utility如果购买保险，情况将得到改善 He will be better off if he buys insurance不确定性导致效用损失 uncertainty leads to a loss of utility7医疗保险讲义课件医疗保险 Health Insurance约翰的财富的效用 医疗保险 Health Insurance效用函数对购买保险行为的影响 Th

10、e role of utility function in the purchase of insurance线性效用函数，边际效用不变 Utility is linear function of wealth and marginal utility is constant 财富 效用 边际效用 10,000 100 12,000 120 14,000 140 16,000 160 18,000 180 19,500 195 20,000 2008医疗保险讲义课件医疗保险 Health Insurance效用函数对购买保险医疗保险 Health Insurance效用函数 Utility f

11、unction U = a Y, Y=财富U=0.01Y利用约翰的例子 use Johns example他的确定效用=他的期望效用=确定效用期望效用 His certainty utility = his expected utility他是风险中性的 he is risk neutral9医疗保险讲义课件医疗保险 Health Insurance效用函数 Util医疗保险 Health InsuranceW1W2W3WUU1U2U3WW1W2W3MU10医疗保险讲义课件医疗保险 Health InsuranceW1W2W3WUU医疗保险 Health Insurance效用函数对购买保险行

12、为的影响 The role of utility function in the purchase of insurance效用函数是财富的增函数，边际效用递增 Utility is increasing function of wealth and marginal utility is increasing 财富 效用 边际效用 10,000 100 12,000 130 14,000 165 16,000 205 18,000 250 19,500 280 20,000 30011医疗保险讲义课件医疗保险 Health Insurance效用函数对购买保险医疗保险 Health Insu

13、rance效用函数 Utility function U = a Yb, Y=财富, b 1U=0.01Yb利用约翰的例子 use Johns example他的确定效用=他的期望效用=确定效用期望效用 His certainty utility his expected utility他是风险偏好者 he is risk lover他不愿购买保险 he will not buy insurance12医疗保险讲义课件医疗保险 Health Insurance效用函数 Util医疗保险 Health InsuranceWUW1W2W3U1U2U3WW1W2W3MU13医疗保险讲义课件医疗保险

14、Health InsuranceWUW1W2W3U医疗保险 Health Insurance效用函数对购买保险行为的影响 The role of utility function in the purchase of insurance效用函数是财富的增函数，边际效用递减 Utility is increasing function of wealth and marginal utility is increasingU=a Yb, b期望效用 His certainty utilityhis expected utility他将购买保险 he will buy insurance他是风险规

15、避者 he is risk averse14医疗保险讲义课件医疗保险 Health Insurance效用函数对购买保险医疗保险 Health InsuranceBA140200200001000019500WUWMU199D197C15医疗保险讲义课件医疗保险 Health InsuranceBA1402002医疗保险 Health Insurance纯保险金 Pure premium预期医疗支出 expected health expenditure额外费用 Loading cost执行保险政策时所发生的管理费用和其他相关费用administrative and other costs a

16、ssociated with underwriting an insurance policy最高保险费 Maximum premium当期望效用不大于确定效用时，人们愿意支付的保险费的最大金额 the maximum amount the person would be willing to pay as long as his expected utility is not greater than his certainty utility16医疗保险讲义课件医疗保险 Health Insurance纯保险金 Pure保险怎样影响医疗保健的需求 How Insurance Affects

17、 a Demand Curve for Health Carem1530150510pm具有50%共付率保险的需求没有保险时的需求17医疗保险讲义课件保险怎样影响医疗保健的需求 道德风险 Moral Hazard道德风险 Moral hazard problem如果有保险，个人倾向于减少对健康的关注individuals would take care of themselves less if they had insurance由于保险降低了医疗服务的价格，和自己支付所有费用相比，人们将消费更多的医疗保健 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. 道德风险问题 The moral hazard problem取决于需求的价格弹性 depend on the price elasticity of demand价格弹性越大，道德风险问题越严重 The more elastic demand, the more the moral hazard problem价格弹性越小，道德风险问题越轻 the more inelast

19、ic demand, the less the moral hazard problem18医疗保险讲义课件道德风险 Moral Hazard道德风险 Moral ha道德风险 Moral HazardDemand0Q1PmP1QQ2BCDemand0Q1PmP1QB19医疗保险讲义课件道德风险 Moral HazardDemand0Q1PmP1医疗保险讲义课件培训课件道德风险 Moral Hazard共付保险和起付线 Coinsurance and deductible限制道德风险的另一种方法 another ways to limit moral hazard problem降低福利损失

20、reduce welfare loss管理保健 HMOs限制道德风险的一种方法 a way to limit moral hazard problem医生具有限制患者的医疗保险消费的激励 physicians have incentive to reduce consumers consumption on health care21医疗保险讲义课件道德风险 Moral Hazard共付保险和起付线 Coi道德风险 Moral Hazard主要国家费用负担制度一览日本：门诊20-30%；药品每日份30-150日元韩国：诊所30%；小医院门诊40%；大医院门 诊55%英国：门诊免，但强制转诊；药

21、品每次6英镑加拿大：门诊药品自付全额德国：药品每种自付8-10马克；感冒药、一般 成药不给付法国：门诊30%；药品35-65%美国：门诊每次10美元；药品每种10美元22医疗保险讲义课件道德风险 Moral Hazard主要国家费用负担制度一览2道德风险 Moral HazardDemand0Q1Q3PmP1QQ3BCDF23医疗保险讲义课件道德风险 Moral HazardDemand0Q1Q3Pm道德风险 Moral Hazard起付线（扣除保险） deductible要求被保人在就医时先支付一笔固定的费用，保险公司支付其余的费用。扣除保险有几种方式：应用于每一医疗服务单位，如阑尾切除术。

22、累积性的，如，被保人一年内门诊服务支付费用累积达到100圆，保险公司就承担100元以外的就诊费用。24医疗保险讲义课件道德风险 Moral Hazard起付线（扣除保险） de逆向选择 Adverse Selection逆向选择(adverse selection) 如果对高风险的人和低风险的人提供同一种保险，使低风险的补贴高风险的人，低风险的人就会离开市场，使得保险项目下只存在高风险的人，同时使得保费升高。这一过程不断持续最后造成保险市场失灵为什么在医疗保险领域这个问题更为严重？保险公司选择低风险的人销售保险产品可以产生利润25医疗保险讲义课件逆向选择 Adverse Selection逆向

23、选择(adv26医疗保险制度的演变出现于现代社会之前主要问题是大病风险无法分散个人负担过重居民个人支付26医疗保险讲义课件26医疗保险制度的演变出现于现代社会之前居民个人支付26医疗27医疗保险制度的演变居民个人支付自发的医疗保险出现于近代的行会、工厂等组织中一定程度上分散了疾病风险但是未形成制度、保障水平低27医疗保险讲义课件27医疗保险制度的演变居民个人支付自发的医疗保险出现于近代的28医疗保险制度的演变居民个人支付自发的医疗保险商业医疗保险在自发的医疗保险基础上，出现了专门的商业医疗保险有逆向选择的问题，真正需要医疗保险的人得不到保险28医疗保险讲义课件28医疗保险制度的演变居民个人支付自发的医疗保险商业医疗保险29医疗保险制度的演变居民个人支付自发的医疗保险商业医疗保险社会医疗保险始于1883年德国为了解决商业保险覆盖面低、逆向选择的问题，政府举办强制性的社会医疗保险解决了全民覆盖的问题，至今仍是部分国