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Public hospitals in China usually rely on revenues from medical services and medications to compensate for major costs given their nonprofit nature. The lack of government subsidies and unreasonable prices of medical services have led to high medical costs and unbalanced reimbursement system for public hospitals. There is a critical need of research on improvement of reimbursement system that will create positive effect on China’s health-care system. This paper aims to focus on four dimensions of stakeholders (government, patients, medical insurance agencies and social organization) and six major expenditures to explore reimbursement scheme for public hospitals in China with the purpose of relieving unbalanced income and expenditure of hospitals, avoiding medication markups and reducing medical expenses from patients.

In this paper, the authors study reimbursement scheme for public hospitals from the perspective of four dimensions of stakeholders and how stakeholders reimburse six major expenditures of hospitals. A total of 128 effective samples were collected from financial data of 32 public hospitals through 2009-2012. This paper analyzes the econometric models of the selected revenue and expenditure. This paper analyzes the econometric models of the selected revenue and expenditure using linear regression. The linear relationship between each cost and different types of incomes (i.e. reimbursements from government, patients, insurance agencies and social organization) is analyzed before and after cancelling the medication markups.

Results from empirical research verify that government reimbursement is insufficient, and using medication markups to compensate for medical service costs has become a serious problem for China’s public hospitals. To avoid the medication markups and improve the reimbursement scheme, government should reimburse labor cost, fixed assets cost and research cost; patients and medical insurance agencies should reimburse the costs of medical service, medication and administration/operations; and social organization should supplement the fixed assets cost.

In this study, the authors defined and classified stakeholders of reimbursement scheme for public hospitals in China, which help understand the roles and effects that different stakeholders can play in compensation. Along with the proposed reimbursement scheme framework, this study will help make effective implementation of new health-care reform program in China.

High volume of international migration calls for the establishment of financial and organizational mechanisms that would ensure provision of treatment for tuberculosis (TB) among migrants. In the case of countries like Russia where budget funding goes for TB treatment, the need is acute as delivering these services is affected by social perception that they should be provided to taxpayers only. While official policies in Russia promote voluntary medical insurance as a way to cover their health care needs, the problem is that neither voluntary medical insurance, nor the National Medical Insurance Plan, extend to cover the treatment of infectious diseases, such as TB making proposal of possible alternatives to these delivery vehicles appropriate. The paper aims to discuss these issues.

The analysis includes review of survey results on the extent of medical insurance coverage among migrants as well as legal provisions concerning access to medical care among migrants in Russia and some other migrant-receiving countries.

This exercise illuminates the public health risks and economic consequences related to inadequate access to medical help among migrants. Availability of medical insurance even among socially integrated segment of this group is limited. Also of notice is that citizens of Belarus as opposed to others are granted access to the full range of TB services in Russia.

Using this precedent, the authors propose an alternative mechanism – Inter-State Medical Insurance Fund – to be established by governments of CIS countries, with national allocations covering the provision of medical help to labor migrants from the respective countries in Russia.

Since 1999, China has undergone reform of its healthcare system. City‐based social health insurance (SHI) is the primary form of current health insurance, supplemented by various commercial health insurance programs. The rural new cooperative medical system (NCMS) was introduced in 1993 and extended to cover the whole of rural China in 2003.

The paper developed a theoretical model for consumer demand of medical services and health insurance based on an expected utility framework with a two‐stage decision under uncertainty. The model is then applied to current health insurance systems in China for urban citizens and rural residents separately. Least square and logistic regressions are employed.

The major results are that although the factors driving the decisions on health insurance participation are basically the same for rural and urban citizens, the participation levels are quite different. The major difference is that urban SHI has higher coverage and urban citizens have higher income, resulting in a much larger urban medical expenditure.

The empirical analysis reveals that health insurance programs have played an important role in the healthcare expenditure for urban residents, while the NCMS has not made a significant impact towards increasing the ability of rural residents to seek more medical services, based on data at 2004.

This is the first paper employing a health production theory on China's new urban and rural healthcare programs.

This paper aims to review the institutional evolution of China's rural social security system in the past 35 years, focusing on major policy transformations of the rural social security system in a large country, and extract the Chinese experience on developing rural social security.

This paper systematically reviews the evolution of rural social security system via organizing policy documents, key events and research literature on the construction of rural social security since the Reform and Opening-up.

First, institutional transformation is a profound change in China's rural social security system; second, policy transformation has taken place in the main areas of China's rural social security system, including rural endowment insurance, medical insurance and social assistance; third, the policy evolution of China's rural social security system has a unique experience in a large country.

China is the country with the largest rural population in the world. The process and experience of transforming the social security system in the vast rural areas of China have important value and reference significance for other developing countries.

This paper examines the risk factors of medical expense in China and applies statistical models to analyze these factors. Adopting data from social and private health insurance, this paper discusses the application of some multi‐variable statistical models in analyzing the risk factors of medical service utilization and medical expense. This study concludes that while the medical service utilization rate mainly depends on some hazard characteristics of the insured, the main risk factors of medical expense come from doctors and hospitals. The study also shows that an analysis of risk factors is useful for the risk control in health insurance, but the statistical models should be used properly according to the type of data.

The purpose of this paper is to investigate first, the consumer buying behaviour and claims pattern of medical and health insurance (MHI)/medical and health takaful (MHT) policies and second, to determine whether moral hazard exists among policyholders at the time of application for the product and during claiming for compensation.

The study was conducted on respondents from the insurance industry in Malaysia.

It was found that most claims were rejected due to the discovery of some irregularities by the managed care organizations (MCO) while the Islamic insurer's claims experience, was otherwise. During the buying behaviour stage of MHT, there are fewer tendencies to withhold information but during the claiming stage, due to the generous level of compensation and their awareness of the coverage available naturally influence them to submit excessive claims. To a certain extent moral hazard is present when claims are made for longer disability durations than necessary, and having high average claims per person even for shorter duration disabilities.

The paper concentrates only on the MHI/MHT in Malaysia.

The results provide insights on how the Malaysian insurance industry and other organizations of a similar structure could improve on their business performance.

This paper is perhaps one of the first to address adverse selection and its consequences on MHI/MHT in Malaysia.

This paper first reviews the history of social insurance policy and coverage in urban China, documenting the evolution in the coverage of pensions, medical and unemployment insurance for both local residents and migrants, and highlighting obstacles to expanding coverage. The paper then uses two waves of the China Urban Labor Survey, conducted in 2005 and 2010, to examine the correlates of social insurance participation before and after implementation of the 2008 Labor Contract Law. A higher labor tax wedge is associated with a lower probability that local employed residents participate in social insurance programs, but is not associated with participation of wage-earning migrants, who are more likely to be dissuaded by fragmentation of the social insurance system. The existing gender gap in social insurance coverage is explained by differences in coverage across industrial sectors and firm ownership classes in which men and women work.

One of the leading indicators of the quality of human life is health and access to medical care. Increasing social concern over the problems of health has resulted in various nationwide proposals like medicare and medicaid. At present, many bills are pending before the United States Congress for the creation of a comprehensive national health insurance scheme. One result of this public awareness is the demand in many libraries for information on the various aspects of the health care industry in general and in particular, on health legislation, resources and facilities, prices and costs and insurance. The following survey aims to examine certain leading publications which provide statistical and other types of information in this area. Excluded from this survey are sources dealing specifically with clinical aspects of drugs and medicine. Moreover, additional and uptodate information on the specific topics discussed below can be obtained by consulting subject indexes like the Hospital Literature Index and the Insurance Periodicals Index.

Prior to widespread social insurance, European governments experimented with a variety of programs to protect workers from income loss due to illness. This paper examines the consequences for worker absenteeism of making sickness insurance coverage voluntary or compulsory. Medical benefits appear to have reduced absenteeism for all workers. The effect of paid sick leave depended on insurance fund membership status. Better-paid workers found it easier to take time off in compulsory than in voluntary funds. Distinctive information problems plagued voluntary systems, and eventually were resolved by rejecting the voluntary ideal and forcing all workers into a single risk pool.

The purpose of this paper is to present a new method and model for constructing a new decision-making paradigm of Medicare, which can not only satisfy the needs of the sick people but also reduce the possibility of people slipping back to poverty due to diseases under the policy of Targeted Poverty Alleviation (TPA) of China.

This paper uses the traditional supply chain theory to analyze the Medicare of impoverished people with the policy of TPA of China and transforms it into a multi-layer supply chain optimization decision-making problem. First, a nonlinear integer programming model for poor people’s Medicare decision with opportunity constraints is constructed. To facilitate the solution of the optimal decision scheme, the abovementioned model is transformed into a linear integer programming model with opportunity constraints by using the Newsvendor model for reference. Meanwhile, the scope of the inventory model is discussed, for it can be combined with the construction of the medical insurance system better. Second, the theoretical model is applied to the practical problem. Finally, based on the results of the theoretical model applying the practical problem, we give further improvement and modification of the theoretical model applies it to the actual situation further.

This paper presents a theoretical model about determine the optimal the inventory, under the framework of traditional supply chain decision-making, for it can be combined with the construction of the medical insurance system better. The theoretical model is applied to the practical problem of the fight against poverty in XX County, China. By using the actual data and MATLAB, optimal decision scheme is obtained.

There are two aspects of value. On the one hand, this paper provides a new way to construct a Medicare system of impoverished people with TPA of China. On the other hand, this paper tries making a new way to handle the storage of medicines and related medical devices at basic standard clinics decision-making problems based on above mentioned Medicare system.