The way of chinese medical reform : new trends in the era of the “internet+” and big data

Mestrado em Desenvolvimento e Cooperação InternacionalA China é um país com uma população imensa, com recursos médicos insuficientes e distribuição desigual. Portanto, existem muitos problemas no serviço de saúde. Devido ao desenvolvimento atrasado do sistema médico, a qualidade dos recursos médicos é baixa, o custo é alto e a eficiência dos serviços médicos é baixa. Um dos principais fatores explicativos dessa situação é a falta de apoio do governo e seguro médico imperfeito. Para resolver esse problema, o governo começou a reformar o sistema de segurança médica. Desde a reforma do seguro médico de 1988, após várias mudanças, o sistema de seguro médico da China amadureceu gradualmente. A tese descreve brevemente a estrutura básica, o conteúdo e o caminho da mudança nos cuidados de saúde. E as deficiências do atual sistema de seguro médico. A análise introduz o papel da "Internet+" e da "big data" na reforma do sistema de seguro médico e avalia as potencialidades da sua introdução e operacionalização para a gestão e governança do sistema de saúde.China is a population republic country has insufficient medical resources and uneven distribution. Therefore, there are many medical problems. Due to the backward development of the medical system, the quality of medical resources is poor, the efficiency of medical services is low, and the cost is high, which brings many difficulties for the Chinese people to seek medical treatment. However, one of the main factors of these problems is the lack of government support and imperfect medical insurance. To solve this problem, the government began to reform the medical security system. Since the 1988 medical insurance reform, after several changes, China's medical insurance system has gradually matured. The thesis will briefly describe the basic framework, content and path of change in health care. And the shortcomings of the current medical insurance system. According to the characteristics of the times, talk about the impact of "Internet +" and "Big Data" on the current Chinese industry, including people's lives. Therefore, the analysis introduces the positive role of big data Internet for the reform of medical insurance system, and provides convenience for the management and governance of medical insurance system. Analyze whether "Internet +" and "Big Data" can lead to new trends in the reform of the health care system.info:eu-repo/semantics/publishedVersio

Because we can - eHealth encounters New Public Management in Swedish Healthcare

Since November 2012 all citizens in Uppsala County in Sweden have access to their medical record on the internet sight “my health contacts”. This is the first step in a EU deployment- project where a total of 12 different eHealth services will be launched over time. The IT director of the county has engaged himself in the idea of medical records and other eHealth services since 1997 and has had several setbacks before the actual project was launched. He himself claims that the reason behind his interest to develop the service was mainly that the technique existed, inspired by the internet bank, and that it was possible, or as he puts it – because we can! In 2010 a national strategy for eHealth was launched by; the Ministry of Health in collaboration with the Swedish Association of Local Authorities and Regions, The Swedish Association of Health Professionals and Famna. According to the strategy eHealth services will increase the quality of care and patients involvement in the care process. From our interviews with some of the key organizers of the service: Key authorities, professional organizations, organizers of the implementation project together with the official debate, we can detect different logics and rhetorics for and against the service, in different parts of the field. Some are in line with the NPM discourse but it is far from a perfect fit. Our aim with the paper is thus to sort out the aims behind the “eHealth reform” and hopefully give an example of what might be a new trend in the public sector

History and Options Regarding the Unfunded Liabilities of Alaska’s Public Employees’ and Teachers’ Retirement Systems

In early 2003, financial analysts working for the State of Alaska announced that the two largest public employee retirement systems in Alaska had become significantly underfunded.3 From fiscal year 2006 (July 1, 2005 through June 30, 2006) to date, the state has paid $6.951 billion— (an average of$534.7 million annually)—to pay down these obligations, which will be called “unfunded liabilities” in this paper.4 The State of Alaska has substantial unfunded liabilities remaining to pay off for these two systems, the Public Employees’ Retirement System (PERS) and the Teachers’ Retirement System (TRS). There is uncertainty about the size of these unfunded liabilities, and there are also different ways of calculating them. For example, the State of Alaska’s snapshot balance-sheet approach, subtracting the accrued liabilities from the assets, based on their actuarial value, produces an estimate of $6.609 billion for the combined unfunded liabilities of PERS and TRS.5 That figure is an estimate of the unfunded liabilities discounted to the present day. Estimates of the size of the unfunded liabilities particularly vary based on the use of different critical assumptions, such as the rate of future returns on investment. As an example, using an estimated rate of return of 2.142 percent instead of the State of Alaska’s assumption of 8 percent produces an estimate of$33.9 billion for the state’s unfunded liabilities. 6 The State of Alaska has committed to paying off the unfunded liabilities under a 25-year amortization schedule that started in 2014, so another highly relevant measurement of those liabilities appears to be the amount actuaries for the state currently project will be needed under that pay-off plan, which runs through fiscal year 2039. The state’s actuaries project that from fiscal year 2019 through fiscal year 2039 the state will pay a total of $10.815 billion in extra contributions—called “state assistance” or “additional state contributions” in this paper—to pay off the unfunded liabilities. 7 In contrast to the state’s snapshot estimate of$6.609 billion, this estimate of $10.815 billion in state assistance represents a flow of annual cash payments. That is, the$10.815 billion is an estimate of the total amount needed to eliminate the unfunded liabilities of PERS and TRS under the 25-year amortization schedule the state adopted in 2014. 4 Note that this state assistance is above and beyond the amount the state is projected to owe in its role as employer in the normal course of funding the two systems.8 Employers other than the state—primarily local governments and school districts—also participate in PERS and TRS, and the figure for state assistance covers not only unfunded liabilities attributed to the state but also a portion of the unfunded liabilities attributed to non-state employers. As explained more later, the state has assumed, by statute, the responsibility to pay for a share of the unfunded liability of these other employers. 9 This paper: • Describes the structure of the Alaska public employee retirement systems in the context of some unusual features of public employment on the Last Frontier • Reviews how the problem of unfunded liabilities came about • Examines how concerns over unfunded liabilities produced both changes and proposed changes in the retirement systems over the past dozen years, including proposals for changes in the allocation of burdens between the state and local governments in paying for retirement benefits • Describes current projections of future amounts needed to pay off the unfunded liabilities • Discusses how future estimates of the unfunded liabilities might change in response to economic and demographic factors • Discusses legal provisions protecting the rights of beneficiaries of the retirement systems • Lays out options for policymakers—other than the current policy of paying down the unfunded liabilities over time—including buyout, bailout, and bankruptcyNorthrim Bank University of Alaska Foundatio