Social Insurance Plans Research Articles

Have the Chinese Older Adults Received Adequate Healthcare Services since the 2009 Health Reform? Examining the Socioeconomic Disparity in Receiving Adequate Healthcare.

China launched a comprehensive health reform in 2009, as part of the central government’s plan to improve its healthcare system. This study investigates the associations of socioeconomic status with receiving adequate healthcare services among Chinese older adults following the 2009 health reform. Using the 6th and the 7th waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a repeated cross-sectional study design was adopted (n = 9305). Firth’s logistic regression models were used for statistical analysis. In the fully adjusted model, being non-married was negatively associated with adequate healthcare services (adjusted odds ratio (AOR) = 0.68, 95% confidence interval (CI): 0.54, 0.86). Higher levels of income were positively associated with adequate healthcare services (all ps < 0.05). Participants who relied on non-urban social insurance plans all had lower odds of receiving adequate healthcare services (all ps < 0.01), compared with older adults who used the urban employment basic medical insurance (UEBMI). However, disparities regarding education and urban-rural differences were not observed in the full model. As China is pushing for further reforms, vulnerable population groups, such as non-married or more impoverished older adults, should be assisted in receiving adequate healthcare services.

Study on Treatment Expenditures of Urban Cancer Patients: An Evidence-Based Study From Jinan, China

Background: Cancer has become the leading cause of death in China. A recent systematic review showed that the data about economic burden of cancer in China were still very limited. Aim: This study aims to use the linked registry-claims data to analyze treatment expenditures among the patients diagnosed with lung, female breast, colorectal, and stomach cancer between 2011 and 2014 in Jinan of Shandong Province. Methods: A total of 410 urban patients were identified and selected in a tertiary hospital in Jinan of Shandong Province. We have linked the cancer registry data with health insurance claims and hospital discharge data. We were able to create the linked data of a total of 349 patients (85.1%). Inpatient, outpatient, and total treatment expenditure were computed. We also estimated the one-, two-, and three-year healthcare costs after cancer diagnosis. The local consumer price index (CPI) was used to adjust for inflation in medical expenses during the study period, and we calculated our estimates in terms of 2016 Chinese yuan (CNY). We generalized linear models to examine the factors that were associated with treatment expenditure. Results: The average total treatment expenditures of lung, female breast, colorectal, and stomach cancer were respectively 114,965, 115,344, 92,905, and 105,571 CNY. The one-, two-, and three-year total treatment expenditures of all four cancers were 78,801, 101,370, and 113,024 CNY respectively. For patients enrolled in Urban Employee Basic Insurance, 68.1%, of total expenditures were paid by the insurance. In contrast, Urban Resident Basic Insurance and New Rural Cooperative Medical Scheme only paid 46.7% and 39.1% of total expenditures of their beneficiaries. After adjusting for other control variables, health insurance type, receipt of surgery, and length of hospital stay were statistically significant associated with healthcare expenditures in male patients. For female patients, clinical stage, number of hospitalizations, and length of stay were statistically significant factors. Conclusion: The average total treatment expenditures of urban cancer patients were over two times of local disposable income per capita of urban residents in 2016. So, it makes economic sense to invest in cancer prevention and control in China, and the reimbursement gaps between different social insurance plans should be narrowed.

The Contradictions of Pension Fund Capitalism ed. by Kevin Skerrett et al.

Reviewed by: The Contradictions of Pension Fund Capitalism ed. by Kevin Skerrett et al. Andrew Stevens Kevin Skerrett, Johanna Weststar, Simon Archer, and Chris Roberts, eds., The Contradictions of Pension Fund Capitalism (Ithaca: Cornell University Press 2017) Published in 2017 as part of the Labor and Employment Relations Association Series, The Contradictions of Pension Fund Capitalism assembles an international cast of researchers that bridge financial capitalism with the crude reality of employment entitlements that are increasingly under threat. The editors begin with a concise introductory chapter that captures the focus of subsequent contributions. "Invested across the planet," Skerrett, Weststar, Archer, and Roberts write, "in every conceivable industry, commodity, and asset class, pension funds are today leading agents in, and beneficiaries of, liberalized and globally integrated markets." (1) The narrative throughout the book is one that follows an unraveling of the post-war class compromise and the various features that have jeopardized pensions coverage and benefit entitlements. [End Page 306] Andrew Pendelton and Howard Gospel's treatment of the UK experience in Chapter 2 similarly claims that the development of an employer-based or occupational pension scheme contributed to financialization through the marshaling of a "large and liquid stock market and financial sector." (10) From here the authors examine today's reality in which, as a neoliberal policy agenda that launched in the 1980s, individualized self-invested personal pensions (SIPPS) have become fashionable. SIPPS have, of course, failed to fill gaps in provision, instead leading to pockets of pensioner poverty whereby retirees must rely on other means-tested and universal benefits in order to survive. Financialization has also provoked firms to respond to competitive pressures by adopting human resource requirements that rest on flexible and less costly labour forces. Financial capitalism is advancing this objective to a point where, the authors conclude, defined benefit schemes "have 'fed the beast' that eventually turned on them." (24) Chapter 3 moves from the political economic structure of finance capitalism to investigating the effects on workers across industrialized countries. Specifically, the extent to which the reduction of benefits in the pay-as-you-go (paygo) state social insurance plans and the emphasis on savings and personal wealth as a source of retirement income defines the lived realities of financialization and the erosion of formerly collective entitlements. What Teresa Ghilarducci and Amanda Novello recognize is that life expectancy, leisure time, and health outcomes are not shared evenly across classes and that, ultimately, higher-income workers "are most likely to have the economic lives that dovetail well with a financial retirement system." (49) Dick Bryan and Michael Rafferty further engage with the outcome question in Chapter 4, concluding that the "defined contribution superannuation is one of the starkest expression of the risk shift from states to citizens, and the associated role of finance." (80) A reversal, they point of out, of the Keynesian macroeconomic policies that dominated the political arena for decades. What the authors go on to query is the extent to which labour's capital represents a check on capital's power. Their resolution: labour's capital, manifested in pension funds, has behaved just like "capital's capital," providing little hope of wielding these massive pools of wealth to advance workers' interests. Indeed, their contribution is punctuated by the realization that labour is not just a working and consuming class but exists also as a financialized asset for capital. (93) To these points, Michael McCarthy addresses the social investment framework - or, concerns about environmental, social, and governance (esg) factors - that took off following the 2008 Great Recession. His conclusion here is that workers' retirement capital mirrors that of Wall Street investment trends, as conservative law makers and employers have blocked unions from "democratizing their funds and advancing an alternative approach to finance." (115) Contradictions also reveals the role of fiduciary responsibility in disciplining union pension trustees who might look to labour's capital as a venue to advance non-financial interests. Bernard Mees reflects on the realities of financialization in Australia and what impact this has had on the running of union-sponsored pension schemes. Part of the lived reality is how labour has responded to the growth of infrastructure privatization and subsequent investment...

Corporate Tax Changes

In this note, the author discusses recent changes to the Corporate Income Tax Act in respect of the taxation of expenses that companies incur for vehicles, employee health and social insurance plans and the purchase of company assets provided to employees for both company and personal usage (such as apartments, cars, telephones, laptops, etc.), as well as some changes in respect of the taxation of foreign legal persons.

Social Health Insurance in China: Getting the Incentive Right

Ninety-five per cent (or 1.2 billion) of China's population is covered by social health insurance. In 2011, various social insurance plans took up 25% of total health expenditure. Issues to be addressed for social health insurance include shallow financial coverage, high surpluses, opportunistic behaviours and an underdeveloped private insurance sector. The incentive of social insurers is the key to understanding these issues and for future policy implementation

我が国の高齢者医療・介護の行方を決めるものは医療環境の動向である (Con) (介護福祉の動向から)

The social security system in Japan was greatly revolutionized when the long-term care insurance plan began in April 2000. Thus, Japan began the 21st century with two great social insurance plans, that is, medical care insurance and long-term care insurance. Each delivery system is divided: the medical care insurance plan is for the acute stage, and the long-term care is for the chronic stage. Both systems can be intended to cooperate to provide continuous care throughout life. The public health and welfare system has been trying hard to efficiently integrate the medical and long-term care insurance plans. However, it is necessary to establish a new insurance plan for ensuring the integrated adequacy of both insurance systems. One's life is destined to shift from medical care to long-term care at some point. As one ages or becomes disabled, it becomes difficult to lead an independent life with self-decision, and social support become necessary from third parties, instead of from the family or from one's own means. The society imposes the responsibility of payment of the medical and long-term care plan premiums on the individual throughout life. However, the structure of these insurance foundations should be combined under an integrated system, "Careworks", in order to also combine the concepts of length of life from the medicine and the respect of living from the long-term case to improve the social security of the life.

MSJAMA: A historical survey of national health movements and public opinion in the United States.

THE UNITED STATES IS THE ONLY INDUSTRIALIZED NATION THAT does not have national health insurance. It has, however, witnessed 5 attempts to achieve it. In the early 1900s, patients paid physicians directly for their services. Concerned that more than a quarter of the population could not afford basic care, the American Association for Labor Legislation (AALL) in 1915 proposed a national insurance system that would cover medical care, sick pay, maternity benefits, and funeral expenses for low-paid workers and their dependents. It would be financed by mandatory employer and employee contributions and additional state funds. Later expanded to cover large segments of the population, the AALL proposal was called a social insurance plan because it would cover only those who paid into it. Opposition from the American Medical Association (AMA), business, and labor, compounded by shifting attitudes and priorities as the United States entered World War I, defeated the proposal. The next movement toward national health insurance came in the 1940s, when senators Robert Wagner and James Murray and Rep John Dingell proposed a plan to expand Social Security, enacted in 1935, to cover physician and hospital care for workers and retirees. Employers and employees would pay into a federal trust fund that would in turn reimburse providers. The unemployed would rely on government assistance or charity care. At the time, 74% of the public favored national health insurance, and 68% liked the idea of Social Security coverage of medical fees. In 1945, President Truman embraced a similar proposal, making him the first president to support national health insurance. Public opinion on the Truman proposal was initially evenly split—38% for and 38% against—but its support by a wide range of legislators and organizations led analysts to predict that it would be passed. The AMA opposed the plan, however, and defeated it with a massive campaign. The first successful push toward national health insurance came in 1965 with the passage of Medicare and Medicaid under President Johnson. At that time, 85% of the elderly were uninsured, and political pressure to cover them was great. Medicare narrowed the Wagner-Murray-Dingle plan to cover only those over 65 with funding from Social Security payments, federal income taxes, and individual premiums. Although Medicare was initially opposed by the AMA, it was supported by 61% of the public. At the same time, Medicaid became the first public assistance program in the national health insurance movement. Public assistance programs are need-based and, unlike social insurance programs, do not require that recipients have paid into them. Medicare and Medicaid are not true national health insurance programs because, unlike similar programs covering the elderly and poor in other nations, they were never expanded to cover all Americans. The 1970s brought a wave of public debate and over a dozen health reform bills, most espousing national health insurance. Two competing proposals, each the first of its kind, stood out. In 1970, Sen Edward Kennedy and Rep Martha Griffiths proposed the first single, universal health insurance program to cover all Americans. The KennedyGriffiths Health Security Program would be funded by employer and employee contributions and federal income taxes. Medicare and Medicaid would be folded into the program. Organized labor supported the bill but the AMA, the insurance industry, and President Nixon opposed it. Like earlier proposals, the Kennedy-Griffiths bill would have replaced the private insurance industry with government-based health insurance. Nixon countered with the first national health insurance plan to maintain the private insurance industry and tie health insurance to employment. Nixon’s plan mandated that employers purchase private insurance policies for their employees. The government would contribute funds to cover the unemployed. With two thirds of the public in support and both Nixon and Kennedy willing to compromise, many thought the passage of national health insurance was imminent. However, congressional delays and the distraction of the Watergate scandal reduced political pressure for national health insurance, and no plan was passed. National health insurance entered public discourse again in the early 1990s, as the number of uninsured in the United States rose from 25 million to 40 million. Voters ranked health care among the top three issues of the 1992 presidential campaign, and two thirds of Americans favored tax-financed national health insurance. President Clinton’s proposal, like Nixon’s, combined mandated employer-based private insurance with governmentfunded public assistance. Clinton’s plan organized payers into a government-regulated system called “managed competition.” Groups of insured would be consolidated into large purchasing cooperatives that would buy insurance for their members, decreasing but not eliminating the number of private insurance companies. Clinton’s plan initially had 59% of the public’s support, but opposition campaigns cut support to 40% in 10 months and reduced momentum for reform. At about the same time, supporters of governmentfinanced national health insurance began calling their pro-

Disparity of medical care utilization among different health insurance schemes in Taiwan

Potential excess use of health care services caused by insurance has been a major concern for almost every industrialized county. Moral hazard problems and fee-for-service payment methods are considered to be important factors for higher medical care utilization among those insured. Health care availability is another feature reportedly associated with health care use. Using the data from a National Health Interview Survey in Taiwan in 1990, this study examined differences in medical care utilization by beneficiaries under three major social insurance plans (i.e. Labor Insurance-LI, Government Employees' Insurance-GEI, and Farmers' Insurance-FI) which covered about half the population at that time. Logistic and Poisson regression models were applied to examine the effects of relevant factors on the probability and volume of physician visits. Results from the analyses revealed that (1) persons with different insurance plans had a similar higher probability of seeing a doctor than the uninsured, with the odds ratios ranged from 1.8 to 2.0. Also (2) the LI/FI participants consumed 60–73% more physician services than the uninsured, while the GEI enrollees utilized only 30% more physician services. Findings from our study concerning the access and use of physician services in different insurance plans provide some useful information for reforming a health care delivery system.

Managed care in the United States.

Medical care in the United States continues to consume an increasing amount of the Gross Domestic Product. To control the rising costs of health care many industries have turned to a controlled form of financing and delivery of health care--often referred to as managed care. Many types of managed care exist, including preferred provider organizations (PPO), exclusive provider organization (EPO), and health maintenance organizations (HMO). HMOs involve prepaid premiums, limited panels of providers and assumption of financial risk on the part of the providers. A variety of HMOs are currently operating in the United States. Managed care involves taking risks by those who administer it. Some methods of controlling patient and physician behaviour by taking risks are capitation, risk pools and withholds. With capitation the physician is paid a 'per member per month' fee regardless of whether the patient uses the service. Risk pools are concerned with who shares the risk; for example, the primary physician shares the financial risk with specialists. Withholds involve a fee-for-service with a portion withheld which may be returned to the provider if he/she is parsimonious. A concern expressed about HMOs is the possibility of restricted services. Moreover, hospital expenses make up a large portion of the total health care dollar. In 1995 the average length of stay for a Medicare patient was 6.1 days as opposed to 3.9 days for the non-Medicare patient. Indeed, HMOs were the leaders in the development of same-day surgery and out-patient treatment. Increasingly, in the United States, public and social insurance plans are turning to managed care as a method to control health care expenditure. Some government insurance plans, such as Medicare and Medicaid, also increasingly offer managed health options. The trend, for now, in the United States increases enrollment in managed care plans. Although this is occurring at a rapid pace, managed care will probably not be the final solution to provision of medical care in the United States.

The cost escalation of social health insurance plans in China: Its implication for public policy

China has been alarmed by its rapid rise in health care expenditures of social health insurance schemes. The health care expenditure per person for the 155 million people covered by the Chinese social insurance plans has been rising at an accelerative rate. We analyze why health care cost in China has risen, and show how other nations may benefit from this experience. The annual rate of increase in health expenditure per capita was only 3.1% during 1952 to 1978, the average rate rose to 8.2% during 1978 to 1985 and then 24.4% during 1985 to 1989. We found general inflation explained one-half of the high rates of increase between 1985–1989. Although China introduced patients co-payments in 1985, the residual expenditure per capita (after adjusting for general inflation and aging of the beneficiaries) increased at 7.4% per year due to the adoption of new technology, uses of more expensive drugs and increased quality of services. While we found the expenditure increases in China were largely caused by uncontrollable factors such as general inflation and aging of the population, we also found the change in Chinese hospital financing and payment policy caused rapid adoption of high-tech medicine and abusive usage of more expensive drugs which largely explained the annual increases in expenditures of 7.4% between 1985–1989. Chinese experience also shows that demand strategy (co-payment by patients) had very little effect to contain cost escalation.

Health System Reform in the Republic of China

IN RECENT years, the Republic of China, often referred to as Taiwan, has been on a course similar in many ways to that of the United States as it has tried to navigate its way through health system reform. Like the United States, Taiwan's reform initiative began in response to two primary factors: access to care problems and rising costs of health services. Lack of health insurance for 46% of the population was another contributing cause. Government officials, facing social insurance plans with large deficits, and politicians using the issues of cost and access to appeal to the public, pushed reform efforts forward. Although important differences between the two countries exist, they share similar challenges of large-scale health system reform in market-based economies. Since Taiwan began its reform process in 1987, its experience previews the reform process and highlights another policy perspective for the United States. <h3>Economic and Cultural Influences</h3>

The economics of health reform. A prototype.

An ideal healthcare system should aspire to achieve a balance between efficiency and social solidarity (i.e. all patients treated in a fair and equitable manner). Since the traits of healthcare systems are akin to those of competitive markets, competition between healthcare providers might be the most appropriate means of achieving efficiency. However, a completely competitive market is unable to address inequalities in incomes of patients in order to provide social solidarity. For these reasons, governments or regulated social insurance plans have assumed a major role in healthcare delivery. In a regulated insurance market, premiums are based on the average costs of healthcare. This provides an opportunity for cost reduction through the selection of patients at low risk of becoming sick. However, more healthy individuals may choose to opt out of such a scheme and pay their medical costs as they arise. The net effect would be to financially disadvantage individuals at higher risk of

Various Proposals to Change the Financing of Social Security

This paper deals first with the differences in the financing bases of social insurance and private insurance. Then, it discusses the underlying financing principles of the Security program (cash benefits and Medicare) as they have developed over the years. Finally, the paper takes up various proposals and possibilities of changing the present financing basis of the Security program. Among the several possibilities for changing the financing basis of the program, the principal proposals are centered around introducing contributions from general revenues. Several different approaches and rationales can be taken, and these are discussed in some detail, with indication being given of the pros and cons of each approach. Attention is also directed to the existing limited experience as to contributions to the program from general revenues. Perhaps there will be changes in the time-tested methods of financing the program that have underlaid its sound development over the past three decades. However, any changes in this fundamental aspect should be made only after thorough consideration and not merely for the sake of change. This paper will deal first with the differences in the financing bases of social insurance and private insurance, and it will then discuss the underlying financing principles of the Security program as they have developed over the years. The main portion of the paper will then take up various proposals and possibilities of changing the present financing basis of the Security program.1 Unique Financing Principles The major difference in financing princRobert J. Mlyers, M.S., LL.D., F.S.A., F.C.A.S., F.C.A., F.S.S., A.I.A., is Chief Actuary, Security Administration. Mlr. Myers has been in actuarial work with Security since 1934 and has been in his present position since 1947. This paper was presented at the 1968 Annual Meeting of A.R.I.A. 1 The term Social Security, as used here, means the combined systems of periodic cash benefits under the Old-Age, Survivors, and Disability Insurance program (OASDI) and the medical-services benefits under the Hospital Insurance program (HI) and under the Supplementary Medical Insurance program (SMI). iples between social insurance and private insurance is that the former need not be on a fully-funded basis, whereas the latter must be (or in the case of private pension plans, at least must be moving significantly in that direction). Since a social insurance plan is established and operated by a government, with coverage on a compulsory basis, its financing can be considered as involving the continuous entrance of new members. Accordingly, full reserves do not have to be set up in order that, if the plan were liquidated at any moment of time, sufficient assets would be on hand to meet the accrued liabilities. Rather, the major test of actuarial soundness is that, over a long period of time, there should be sufficient income to meet the outgo. Considerable differences in investment procedures are involved as between social insurance and private insurance (including various types of employee benefit