比较及其前提--即使只用一个指标！

潇湘渌水 @ 2010-12-01 13:57

Peter A. Muenning and Sherry A. Glied 在 Health Affairs 发表了一篇研究13个国家45-65岁生存率比较的文章。What Do Changes in Survival Rankings Tell Us About U.S. Health Care? 反驳使用age-adjusted survival rates（生存率）来测量卫生系统的成败，其理由如：
1．Survival rates are not good measures of health system quality is that individual behavior has a large influence on health and, as a result, the health outcomes that produce survival rates.
2. The authors do consider trans-national differences in smoking, obesity, and traffic accidents/homicide, three
behavioral risk factors that receive a great deal of popular coverage.
3. At the same time, the authors ignore such factors as suicide, alcoholism, illegal drug use, poisoning, drowning, burns, and accidents other than homicide and traffic accidents.
4. The authors also do not discuss the possibility that different countries use different methods of classifying deaths due to traffic accidents or how those differences in classification might affect their results.
5. The authors provide no information about the construction of the life tables used in their calculations.

跨国或夸系统比较卫生体系是一个非常敏感sensitive的事，就前提假设上来说，现在的数据和方法基本上很难有很robust的，所以结论往往不靠谱，只能做参考。

费率rates和总费用

潇湘渌水 @ 2010-11-30 20:24

在November 2010的<Expect the Unexpected? Physicians’ Responses to Payment Changes>上，这可是大名鼎鼎的RAND的Mireille Jacobson和哈佛的Newhouse写的一篇小综述：
Economic theory tells us that the effect of fee cuts on physician effort depends on the share of income accounted for by the services whose fees are cut. On the one hand, a fee cut for one service can make other services or even leisure time more attractive to physicians, leading them to spend more of their time on these other activities and less on the
activity whose fee was cut. Economists term this response a substitution effect.
On the other hand, a fee cut for services that account for a large share of a physician’s practice can generate the opposite response: physicians may provide more of the service(s) to make up for some of the lost income. Economists call this response an income effect. How physicians respond to payment cuts depends critically on the balance between the substitution and income effects.
收入效应和替代效应的tradeoff在这里起作用。在他们描述的研究中，虽然单个或单次得到固定费用(fee)减少了，但是结果却是整个expending增加了。

人性和医疗商品

潇湘渌水 @ 2010-11-30 13:22

经济学首先是以假设为前提理论的，而经济学考察的人本身的nature，所以人性本身的性质加上个人人性虚伪和群体性虚伪的协同作用，往往使得一个社会或一个国家对某种商品的价值定位出现摇摆和差异，而这往往也是为什么医疗商品在各个国家“公共性”差异极大的根本原因。恬弘君在文章中说：
“医疗本身就是有各种不同的价值或定位，看我们从哪一个角度去看。不过我觉得基本上在台湾，医疗是偏向被定位在公共财(社会共同的福祉与资产)，而非商品。在这种社会观与大环境下，要发展纯商业导向的国际医疗是会格格不入的。
新加坡和泰国，他们社会对医疗的价值观与医疗体制或环境与台湾是相当不同的。新加坡强调健康与医疗照护是个人的责任，以及使用者付费的精神，倾向将医疗视为商品，而非政府的责任。在泰国，虽然政府也开办健保，政府负担健康照护支出的比例也不小，但整体来说医疗资源仍相当不足，政府的管制也不是很深入。这两种情况都比较容易发展出商业取向的国际医疗，而台湾目前的体制环境、民众的观念、甚至医疗机构的经营模式，都是架构在医疗是一种公共财，而非商品，体质上并不合适发展国际医疗。”
即使台湾仍然会如此偏向对公共商品的价值取向，大陆就更是不用说，zf几十年前甚至还不自量力的想包下国民的医疗。但是我有个很大的疑问就是：同是华人社会，新加坡和台湾大陆咋就差别那么大呢？不过新加坡是个弱肉强食的社会，它一立国就必须在艰难困苦的环境中生存下去，所以这个社会非常尊重个人奋斗，认为每个人都要像他们这个社会一样拼搏竞争，所以强调责任感。这样的背景是可以理解的，且可作为价值取向的基本参照。但是当然，这并不意味着新加坡zf就不对医疗进行投入和关注，相反它从医方和保方都以不同方式进行了赞助。就我个人而言，我是相当欣赏新加坡“视健康为个人责任”的思想，因为现代社会的基本医疗技术如此发达，小病小痛根本奈何不了人类，只有你自找或你可以预防的疾病才是现代医疗的天敌—比如艾滋、慢性病等等，所以凭什么让一个社会，让别人，让纳税人的钱为你承担你的愚蠢和懒惰？？？

3 Universal Laws of Health Care Systems

潇湘渌水 @ 2010-11-29 21:46

Economist Tsung-Mei Cheng has developed three Universal Laws of Health Care Systems.  These are:
1. No matter how good the health care in a particular country, people will complain about it.
2. No matter how much money is spent on health care, the doctors and hospitals will argue it is not enough.
3. The last reform always failed.
Tsung-Mei Cheng，中文“郑宗美”，是大名鼎鼎的U Reinhardt的妻子，伉俪皆在health领域工作，且建树颇丰，郑的工作集中在亚洲卫生政策这一块（主要是台湾和大陆），且主持一个Princeton的国际论坛。在08年一期HealthAffairs上，有她采访陈竺的访谈，很值得一读：China’s Latest Health Reforms: A Conversation With Chinese Health Minister Chen Zhu.

羊皮效应sheepsskin effect

潇湘渌水 @ 2010-11-17 15:21

就业招聘中对文凭的偏爱在东西方原来差不多的，只是他们把这叫羊皮效应。它的命名是基于毕业文凭通常都是纪录在羊皮上这一事实。其基于曾经研究过教育报酬的劳动经济学家注意到以下颇具启发性的事实：中学毕业者的收入远远高于只完成3年中学教育的人的收入。
Employers have used the education level of applicants for years as a way of delineating who is qualified for what kinds of jobs. The preference for college and graduate school degrees is known as the sheepskin effect, so named because the degree dresses up an applicant but does not necessarily change their skills or overall value. The sheepskin is the actual diploma.
Definition
?The sheepsskin effect is the common term for the additional value, both in terms of future earning power and marketability for future employment, of a formal education. For example, the sheepskin effect increases income and marketability for an individual with four years of college education and a degree receives over a person with four years of college education and no degree. The sheepskin effect favors graduates, both high school and college.
Measuring Sheepskin Effect
?The gains measured through the sheepskin effect are not the same as the gains an individual receives for acquiring additional education. The sheepskin effect compares the change in salary and overall earning potential of two individuals sharing the same amount of education with one having acquired a degree and another still seeking a degree. The number of years of overall education remains constant when measuring the sheepskin effect. Ideally, the only difference should be acquisition of a degree. All personal factors, including gender, race, background and all other personal details should be controlled.
Sheepskin Effect Data
?Earning potential as it relates to years of schooling is different for dropouts and individuals earning degrees. Dropouts acquire a benefit of marketability by having more years of schooling because this increases the number of skills that they are likely to take into the job market. Graduates have the most earning potential by spending the fewest amount of years in school; thus, those that can graduate quickest get the largest benefit because they gain the benefit of their degree while spending the largest number of years in the job market. In short, those getting a degree should get it quickly to maximize their earning potential while those not getting a degree should acquire as much education as possible to shore up the discrepancy in their skills between them and others benefitting from the sheepskin effect.
Criticism of Sheepskin Effect
?Some academic sources, including Seamus McGuinness of the Northern Ireland Economic Research Centre, state that there is not always a correlation between the job requirements for jobs that require a graduate degree and the skill requirements actually necessary to complete that job. In short, the sheepskin effect of the increased marketability of graduate degrees may obstruct people from truly measuring the skill levels of applicants to successfully complete a job. Jobs that have graduate level entry requirements traditionally have a larger earning potential when compared to those that do not.
Advantages of Sheepskin Effect
?However, the sheepskin effect can be useful in measuring intangibles. Individuals devoted enough to pay the opportunity costs for extended education are more likely to be self-motivated and may provide more value in devotion and project completion than those who have not finished a degree program, states Michael Spence in "The Quarterly Journal of Economics." The sheepskin effect of a diploma in this case is not simply the skills acquired through diploma acquisition but rather through the willingness to acquire the degree to become marketable.
source：http://www.ehow.com/about_6683865_sheepskin-effect_.html