Essay 1: Individuals with higher socioeconomic status (SES) also tend to enjoy better health. Evidence from the economics literature suggests that a potential mechanism behind this “social health gradient” is that human capabilities, that form SES, also facilitate health-promoting behaviors. This essay empirically investigates the significance of socioeconomic differences in health behaviors, using dental care consumption as an operationalization of health investments. I focus on adults at an age where lifetime trajectories for SES can be taken as given and use lifetime income to capture SES. I estimate the impact of lifetime income on dental care consumption and find robust evidence that the social gradient in dental care consumption steepens dramatically over the life-cycle. Considering that dental care consumption only reflects a small part of individuals' health investments the results suggest that lifetime effects of SES on health behaviors could be substantial in other dimensions. Essay 2: This essay studies the effect of competition on prices on a health care market where prices are market determined, namely the Swedish market for dental care. The empirical strategy exploits that the effect of competition differs across services, depending on the characteristics of the service. Price competition is theoretically more intense for services such as examinations and diagnostics (first-stage services), compared to more complicated and unusual treatments (follow-on services). By exploiting this difference, I identify a relative effect of competition on prices. The results suggest small but statistically significant negative short-term effects on prices for first-stage services relative to follow-on services. The results provide evidence that price-setting among dental care clinics responds to changes in the market environment and substantial effects of competition on prices over time cannot be ruled out. Essay 3: The Swedish dental care insurance subsidizes dental care costs above a threshold and becomes more generous as dental care consumption increases. On average, higher-income individuals consume more dental care and have better oral health than low-income individuals. Therefore, the redistributional effects of the Swedish dental care insurance are ambiguous a priori. I find that the dental care insurance adds to the progressive redistribution taking place through other parts of the Swedish social insurance (SI) for individuals aged 35-59 years whereas it reduces the progressivity in the SI for those aged 60-89 years. While the result for the oldest individuals is problematic from an equity point of view, the insurance seems to strengthen the progressitivy of the Swedish social insurance for the vast majority of patients.

There is plenty of support for local musicians in Austin. It ranges from providing health benefits to receiving home loans to equipment insurance. The live music capital of the world has provisions for recording artists as well as street performers whose primary source of income is music. These facilities go a long way in maintaining Austin‟s identity as one of the major music cities in the world. They also bring together members of this community for benefits that help strengthen the local music industry, which has been an important part of the city‟s economy for several years. / text

<p>At the turn of the year 2009/2010 there was a change in the regulations on sickness impact. This led to 328 persons in County of Kronoberg had an expired period of sickness benefit from the Social Insurance Office (Försäkringskassan) when they reached the maximum time for sickness or temporary disability compensation. These individuals were offered introductory programs with the employment services. The purpose of this study is to investigate how the population with expired period of sickness benefit from the Regional Social Insurance Office in the County of Kronoberg (Försäkringskassan Kronoberg) is described in the initial stage, and to explore how individuals who achieved expired period of sickness benefit from the Social Insurance Office (Försäkringskassan) talks about the meaning to get an expired period of sickness benefit regarding economic and social issues. The study was inspired by Grounded theory. The method has consisted of both quantitative and qualitative interviews. In total, six persons participated in the surveys. Narrative method was used in the interview with a person with experience of an expired period of sickness benefit from the Social Insurance Office (Försäkringskassan). The interviews indicate that the authorities have different focus on the concept of rehabilitation. This means that what is to be regarded as rehabilitation and the efforts which may benefit the individual depends on which authority has the power of definition. This study is made before preparing administrators for either statistics or working methods were established by the relevant authorities. Longer experience in the field is still missing about what the change means for both individuals who have experience of the expired period of sickness benefit and professionals. This points out; further research in this area is needed.</p>

一個國家要維持正常穩定的運作狀態，作全面性的有效管理，是立足於現代社會環境的必要條件。如何建立一個低風險、高水準的生活環境與社會保障（Social Security）體制，是現代社會中急切而且必要的措施。 在各項社會保障體制下，醫療保險的保障範圍最大、內容最繁複，且攸關人民健康與生命最密切，世界各國均非常重視。中共在建政之初，醫療制度由國家包攬，由於缺乏成本概念，加上管理制度不健全，造成許多醫藥資源浪費，使國家財政難以負擔。改革開放後，隨著經濟體制的轉軌，原有計劃經濟體制下的醫療保險已不合時宜，因而於1998年正式將以往之醫療保險做全新的變革，由於中國大陸地大人多，各地在醫療改革上的重點及進度不一，且實行上都未臻完善，然改革目標卻是一致的。為配合醫療保險制度的完善，中共政府除於1998年頒訂醫療保險改革措施外，複於2000年推出醫藥衛生體制改革措施與之配套，期能「在醫療保險制度改革中引入分擔機制；在醫藥衛生體制改革中引入競爭機制」。而於其醫療改革實施方式中，多處可見其參酌國外觀念與台灣全民健康保險之蹤影存在。 在連串的試點、擴充改革範圍的執行下，中國大陸一方面發展其既定之改革與配套措施，一方面也面臨許多執行上的瓶頸。然而無可否認的，隨著中國大陸加入WTO，外來醫療資源的進入，對中國大陸醫療相關產業與社會發展造成相當的刺激。中國大陸在躋身國際，走入全球化的腳步中，對於本身特殊條件造成的醫療改革缺點與障礙必須努力排除，否則其與世界的接軌，將因內部貧富不均等社會因素所造成的社會不穩定而功虧一簣。本論文在對中國大陸醫療改革措施的肯定與鼓勵之同時，亦針對轉軌中的改革政策及執行缺失提出檢討。 關鍵辭：社會保障、醫療保險、醫療改革、全民健康保險 / Overall and effective management is indispensable to a nation to assure sound and secure operation. How to set up a low risk, high level social security system is the very essential for the society today. Under all sorts of social security systems, medical insurance offers the largest coverage and most complicated contents. Such medical insurance is closely related to nationals' health and assurance of life. In People's Republic of China, the medical system was provided by the nation in package in the initial phase after it came into being. With lack in cost concept and unsound managerial systems, they have undergone critical waste in medical resources, leading to heavy burden to the nation. After People's Republic of China launched the reform and open-door policy, the economic systems have been restructured. The previous medical insurance system under planned economy no longer oriented itself to the trends. In 1998, therefore, it launched an overall reform. With vast territories and huge number of population, the medical reforms have been launched in varied highlights and paces, not satisfactorily though they have all aimed at the same objectives. The PRC government launched the medical reform in 1998 and further worked out the supporting package for the medical and health system reform in 2000 in an effort to "bring in sharing instrument in the medical insurance reform and bring in competition instrument in the medical & health system reform". In the medical reform, foreign concepts and the National Health Insurance launched in Taiwan have been significantly seen. In the series of tests and expansions. People's Republic of China has launched the established reform policies on the one hand and run into significant bottlenecks on the other. Undeniably, anyway, with foreign medical resources pouring in in the wake of the WTO admission, the business lines and society in China have undergone tremendous stimulation. In the pace of playing a pivotal role in the global village, China must try by all means to remove the stumbling blocks on the way of medical reform otherwise the significant gaps between the rich and the poor and such social problems must ruin the entire efforts. This thesis focuses on the reassessment on the shortcoming China has undergone in enforcement of the policies while approving the praiseworthy performance in the medical reform. Key words: Social security, medical insurance, medical reform, National Health Insurance

許多公共政策的的實施雖以提升社會福利為出發點, 但往往造成了扭曲 勞動市場的現象。為了瞭解實施公共政策對勞動市場會產生多大的衝擊, 在 本論文中, 我們以台灣為對象, 分別探討兩項公共政策對勞動市場的效果。首 先我們探討全民健康保險制度的實施對勞動市場均衡工資與工時的影響。台 灣自1995年起推行全民健保, 以透過收取健保費的方式來籌措經費。但由於 員工及雇主所負擔的健保費為員工薪資的比例, 如同對員工課徵了一筆薪資 稅, 加上健保費與健保福利兩者在制度中並沒有任何關聯, 因此, 在這樣的機制之下, 我們認為全民健保的實施對勞動市場將可能形成負面衝擊。我們的 實證結果發現, 全民健保的實施的確會使勞動市場均衡工時下降, 但對均衡 工資率的效果則不顯著。其次, 本論文探討勞動保護法令的實施對勞動市場 流動的影響。台灣於1984年實施勞動基準法。由於勞基法是台灣第一套全面 性的勞動法規, 在勞基法實施後, 勞工在就業上受到許多保障, 但相對的, 卻提高了雇主的解雇成本。雇主很可能為了因應較高的解雇成本而減少解雇數 量, 且在雇用新進員工時也變得相對保守, 使勞動市場的流動將會因此降低, 進而可能造成生產力下降等的社會成本。我們的實證結果顯示, 勞基法的實 施會使勞動市場流動下降。而且, 當勞動檢查越嚴格時, 勞動市場流動亦下 降得更嚴重。 / The original purpose of most labor market policies is to enhance social welfare of a specific group of individuals and sustain a fair social relationship. However, the labor market may be distorted by the introduction of these public policies. In this thesis we examine the labor market effects of two public policies in Taiwan. Firstly, we investigates the impacts of national health insurance on the labor market. Taiwan's national health insurance is financed by premiums, which are proportional to an employee's salary. These premiums may introduce distortions to the labor market. Based on repeated cross-sections of individual data we find that, on average, private sector employees' work hours declined relative to their public sector counterparts, while their relative wage rates were almost unchanged with the introduction of national health insurance. Secondly, we investigates the effects of employment protection legislation on the rates of worker flows, job reallocation, and churning flows. Our study’s empirical identification takes advantage of the natural experiment created by Taiwan's enactment of Labor Standards Law, which substantially increases the costs of firing an employee, in 1984 and the subsequent measures of the law’s enforcement. Moreover, our identification also exploits the fact that in Taiwan the stringency of Labor Standards Law’s provisions and the intensity of the law's enforcement vary with establishment size. Our analysis is based on monthly data at the establishment level for the period 1983–1995. We find that Taiwan’s Labor Standards Law and its enforcement measures dampen worker and job turnover rates for medium-sized and large establishments, and the dampening effects vary with establishment size.

研究動機與問題：本研究最主要的目的希望能夠將最易被大家忽略的健保醫療檢驗資源使用問題，從實務面上探討，並指認出有效使用醫療檢驗資源的關鍵因素，針對這些因素與措施進行評估，歸納出具體明確可行的方向，提供主管機關做為費用管控的參考，為我國健保永續經營貢獻一份力量。 本研究根據研究動機與目的，設定三個研究問題：1.影響醫師有效的使用醫療檢驗資源的因素有哪些？2.藉由桃園縣執業醫師的看法了解有效使用醫療檢驗資源關鍵因素為何？3.不同執業院所、服務科別、職別的醫師對有效的使用醫療檢驗資源看法是否有差異？ 研究資料與方法：以文獻回顧法、問卷調查法、深度訪談法蒐集資料及驗證資料；研究過程分三個階段進行，第一階段為背景資料與文獻資料的蒐集，瞭解醫療檢驗資源使用現況與問題，並透過訪談實務界菁英驗證文獻與補充資料不足；第二階段依文獻分析與彙整內容設計問卷與訪談大綱；第三階段將回收的問卷編碼、整理後以Excel/2003版與SPSS for window12.0版套裝軟體進行資料分析；深度訪談資料透過內容分析法予以歸納整理分析。獲得研究答案，達成研究目的。 研究結果與建議：量化研究部分，本研究共分送488份問卷，回收318份，回收率為65.1％。並以卡方檢定樣本與母群體並無差異，可代表母群體。質化研究部分，深度訪談三位年資10年以上實務界菁英，建構本研究實務上的概念。歸納研究結果：醫療檢驗資源有效使用的關鍵影響因素有「醫療風險」、「病人就醫行為」與「照護之連續性」3項。根據研究結果，為有效使用醫療檢驗資源，必需減少醫療風險、規範病人就醫行為與進行照護流程改造。 / Background:The purpose of this research is to find out the influencing factors related to the usage of resources for medical examinations under the Taiwanese National Health Insurance (NHI). From the practical point of view, this research focuses on, the first, defining the efficient use of medical test and then finding out the critical factors effecting the efficient usage from medial practitioners’ viewpoints in Taoyuan County, Taiwan. It is expected to provide advisory values to improve the global budget system of NHI. Research Questions: 1.What are the factors influencing doctors to utilize medical examination efficiently? 2.What are the certified medical doctors of Taoyuan County thinking about these factors? 3.Concerning the above factors, do there exist systematic differences among medical doctors from different hospitals, rank of medical doctors and fields of profession? Methods: In this study, author utilizes literature review, questionnaires, and in-depth interview. The survey was divided into three stages. First, related information was collected to clarify the problems of medical examination usage in present situation from both interviewing medical practitioners and literature review. In the 2nd stage, a general questionnaire was designed to administrate to selected medical doctors in Taoyuan County in mid-2008. The last stage was data coding and analyzing by using Excel/2003 and SPSS for Windows. The return rate was 65% (318/488) and there is no difference between population and sample after consistency test. Results and Suggestions The results show that the key factors of efficient medical examination usage are medical risk-aversion of doctors, clinical shopping of patients, and the need to medical care continuity. These exist a greater viewpoint differences between different level of hospital than different ranks or specialties of doctors. These results will lead the author to suggest that the Bureau of NHI needs to promote adequate mediation mechanism to reduce medical risk, to promote inter-hospital patient information sharing system, and to improve the logistic of continuity care.

全民健保自開辦以來，財務一直存在入不敷出之隱憂，醫療院所頻頻呼籲健保的給付不足，將造成經營困難。除此之外，醫師人口逐年增長、診所成本入不敷出、人口老化迅速及新醫療設備之引進及各政策之影響下，本研究想瞭解在競爭及不確定的環境中，診所應如何以創新經營。本研究導入資料採礦之觀點，將商業智慧用於眼科診所之案例，利用忠誠度分析、流失度分析、獲利貢獻度分析、就診時段分析，想瞭解診所客戶之特性並且針對其習性及特點，並加上SWOT分析，清楚瞭解診所內部之優缺點及外部的機會與威脅，作好準備以謀取事業的永續發展。忠誠度分析之結果發現，其特點為家庭來診人數最多，性別比例較其他集群平均，案類分佈則以一般案類為主，年齡層為22歲以下及35歲以上居多；而在獲利貢獻度中，高利潤收入之地區分佈為竹北市、新竹市明湖路、福德街等；在流失度分析當中，研究發現客戶群在22歲以下，案類為一般案類，且兩人看診家庭的流失比例最高；最後就診時段分析當中，發現所有病例之地區時段、看診日分析看診人數除星期四外，皆以早上時段為最多。資料採礦是很好的輔助工具，將商業智慧應用於診所之經營上，可依照不同的分析集群搭配不同的行銷策略，增加競爭力，規畫創新之營運模式，以追求更好的發展。 / Since its start, expenditure exceeding income has always been a hidden concern in the finance of the National Health Insurance (NHI). Medical clinics have repeatedly said insufficient payment from the NHI will result in difficulty in their management. Moreover, other factors are affecting the clinics, namely, the growing number of doctors statewide, the income shortage of running a clinic, the rapidly aging population, the introduction of new medical equipment, and the various new policies. This paper intends to explore some innovative management plans for the clinics in a competitive and uncertain environment. Business intelligence is applied in the case study of an eye clinic. The analysis of client the degree of loyalty, run off, profit contribution, and visiting time help understand client habits and characteristics. A SWOT analysis further helps the clinic clearly understand its own strength and weakness, and the opportunities and threats from outside. Thus it can better prepare itself for a long term business. The analysis of client the degree of loyalty shows the following: most of the clients are family members; there is an even male/female ratio while in other categories it is not so; most medical cases are general cases; most of the clients aged under 22 or above 35. The analysis of the degree of profit contribution reveals that the districts related to higher profit are Zhubei City, and Minghu Road and Fude Road of Hsinchu City. In the analysis of The degree of run offs, it is found that most of them are under 22, most medical cases are general cases, and most of the clients are two people from a same family. Lastly, in terms of visiting time, analysis shows that most of the clients, regardless of their residential areas, visit in the morning except on Thursday. Business intelligence is an helpful tool. According to the analysis a clinic can match different client groups with different marketing policies, enhance it competitive edge, plan for an innovative management model, and pursue a better development.

Im Jahr 1986 wurde über das Gesundheitsreformgesetz ein zahnmedizinisches Bonusheft für gesetzliche Krankenversicherte eingeführt. Über dieses sollte mit der Möglichkeit einer erhöhten Zuzahlung bei Zahnersatz ein Anreiz für eine Individualprophylaxe in Form von regelmäßigen jährlichen zahnärztlichen Kontrolluntersuchung geschaffen werden. Im Gegensatz zur Einführung des Systems befundbezogener Festzuschüsse im Jahr 2005 wurde eine begleitende Evaluation des Systems nicht durchgeführt. Im Zuge des demographischen Wandels in Deutschland mit einer überproportionalen Zunahme der älteren Bevölkerung, bis 2060 werden 9 Millionen bzw. 13 % der Bevölkerung über 85 Jahre alt sein, kommt der Erforschung des Alterns eine hohe Bedeutung zu. Dieser widmet sich die Interdisziplinäre Längsschnittstudie des Erwachsenenalters (ILSE). Zum ILSE-Untersuchungszeitpunkt 2006 wurden soziodemographische und dentale Parameter, die Inanspruchnahme von zahnmedizinischen Leistungen und mundgesundheitsbezogenes Verhalten sowie das Vorhandensein des zahnmedizinischen Bonusheftes erhoben. Mit diesen Daten werden Beobachtungen, Auswirkungen und Effekte des Bonusheftes bei jungen Senioren auf ihre orale Gesundheit sowie das mundgesundheitsbezogene Verhalten untersucht. Hierzu wurden zwischen 2005 und 2006 insgesamt 240 Probanden aus Heidelberg und Leipzig mit den Geburtsjahren 1930-1932 mit einem Durchschnittsalter von 74 Jahren untersucht und befragt. Über eine Selektion von gesetzlich Versicherten mit der beantworteten Frage nach dem zahnmedizinischen Bonusheft ergaben sich 182 Probanden (88 Frauen, 94 Männer). Hiervon kamen 81 aus Heidelberg und 101 aus Leipzig. Alle Probanden ohne zahnmedizinisches Bonusheft, bis auf einen, waren in Heidelberg ansässig. Die soziodemographischen Faktoren umfassen das Geschlecht, Ort und Bildungsstand in Jahren. Zu dem Inanspruchnahme- und mundgesundheits-bezogenen Verhalten wurden die Parameter GOHAI, OHIP, Bedeutung der Mundgesundheit, Vorhandensein des eigenen Zahnarztes, Besuchsverhalten, Häufigkeit der Kontrollbesuche, Zurückliegen des letzten Zahnarztbesuchs und der Grund des Zahnarztbesuchs (Schmerzen, Wunsch auf neue Prothese, Kontrolle, Bonusheft) ausgewertet. Die dentalen Parameter beinhalten den DMF/T, mDMF/T, Anzahl vorhandener Zähne (28/32) und Zahnlosigkeit. Die statistische Auswertung erfolgte mit SPSS 15.0.1. Es wurden den Parametern entsprechend der exakte Test nach Fischer, der Odds Ratio und der Mann-Whitney-U-Test als statistische Testverfahren genutzt. Aufgrund des enggeschnittenen Alterslimits, der städtischen Region und der Ungleichverteilung der Studienteilnehmer ohne zahnmedizinisches Bonusheft sind Abweichungen möglich und Verallgemeinerungen auf die Gesamtbevölkerung nur eingeschränkt möglich. Zudem sind Fragen zum Ursache-Wirkung-Verhältnis wegen der retrospektiven Betrachtung der Daten nicht endgültig zu beantworten. Signifikant mehr zahnmedizinische Bonushefte besaßen Probanden aus Leipzig und solche mit einer längeren Bildungsdauer. Das Geschlecht hatte keinen Einfluss auf das Vorhandensein eines Bonushefts. In Bezug auf das Inanspruchnahmeverhalten von zahnmedizinischen Leistungen konnte festgestellt werden, dass Teilnehmende mit Bonusheft signifikant eher einen eigenen Zahnarzt haben, der Mundgesundheit eine höhere Bedeutung beimaßen und kontrollorientierter, mindestens einmal im Jahr, zum Zahnarzt gingen, als Probanden ohne Bonusheft. Der letzte Zahnarztbesuch lag für diese Gruppen im Median 4 zu 15 Monaten signifikant unterschiedlich lang zurück. Der Grund des letzten Zahnarztbesuchs war für Studienteilnehmer ohne Bonusheft signifikant eher Schmerzen oder der Wunsch nach einer neuen Prothese und weniger der Wunsch nach Kontrolle oder wegen des Bonushefts. Das Risiko, wegen Schmerzen zum Zahnarzt zu gehen, war für diese Probanden um 7,2 erhöht. Die Einschätzung der subjektiven Mundgesundheit ergab für Probanden mit Bonusheft für den GOHAI einen signifikant niedrigeren Wert und somit bessere Einschätzung der Mundgesundheit, wobei der OHIP nur einen tendenziellen Unterschied erkennen lies. Bei der Untersuchung der dentalen Parameter fiel eine signifikant höhere Zahnlosigkeit, ein höherer DMF/T sowie mDMF/T und eine geringere Anzahl von Zähnen bei Probanden ohne Bonusheft auf. So hatten diese Teilnehmer im Median 16 Zähne weniger und ein 6,8-fach erhöhtes Risiko zahnlos zu sein. Bemerkenswert war bei diesen Studienteilnehmern auch, dass der Median des DMF/T bzw. des mDMF/T beim jeweiligen Maximalwert von 28 bzw. 32 lag. Durch diese Ergebnisse zeigt das zahnmedizinische Bonusheft unter Berücksichtigung der Limitierungen dieser Studie einen positiven Effekt auf die orale Gesundheit und ein mundgesundheitsbewussteres Verhalten. Insgesamt handelt sich jedoch um ein rein reparatives System ohne zeitlichen Zusammen-hang zwischen Aktion und Bonus, welches erst einen Nutzen für den „Zahnkranken“ und nicht den „Zahngesunden“ hat. Eine Ausdehnung des Bonussystems um Leistungen, die auch „Zahngesunde“ in Anspruch nehmen können, wie z.B. professionelle Zahnreinigungen, wäre wünschenswert.

Il est admis qu’avoir une mauvaise santé est une des causes principales de pauvreté,particulièrement dans les pays à faible et moyen revenus. Une des raisons de ce constat est une absence de protection financière. L’objectif de cette thèse est de discerner le rôle que l'assurance maladie pourrait jouer dans l'organisation du système de protection financière de la santé. La thèse se compose de deux parties. La première partie aborde les problèmes liés au financement de santé d’un point de vue global. Le chapitre 1 apporte des discussions théoriques sur trois thèmes: 1) les spécificités des risques de la consommation médicale qui rendent la gestion du risque par l’assurance maladie privé difficile, 2) le rôle du gouvernement et du marché dans la répartition des ressources de santé. 3) les options pour l'organisation du financement de la santé. Le chapitre 2 présente une comparaison statistique sur la performance des systèmes de financement de la santé entre des pays à contextes socio-Économique différents. Les discussions sont menées autour de trois aspects du financement de la santé: la disponibilité des ressources,l'organisation du financement de la santé, et la couverture de la protection financière. La deuxième partie qui comporte trois chapitres étudie l'évolution du système de financement de la santé dans un pays donné: la Chine. Le chapitre 3 présente l'histoire du système de financement de la santé en Chine depuis 1950. Il nous aide à comprendre les défis dans le financement de la santé suscités par la réforme économique. Le chapitre 4 porte sur une étude empirique de la répartition de la charge financière de la santé en Chine dans les années 1990. Il illustre les résultats directs de la baisse du financement public et de l'augmentation des paiements directs sur le bienêtre de la population. Le chapitre 5 présente la réforme de l'assurance maladie lancée par le gouvernement depuis la fin des années 1990. L'objectif est d'estimer l'impact de la mise en oeuvre du nouveau système rural d’assurance médical (NRMCS) sur les activités et la structure financière de ces hôpitaux. Une analyse d'impact est réalisée sur un échantillon de 24 hôpitaux dans la préfecture de Weifang, au Nord de la Chine. Nous concluons que le système d'assurance maladie permet un partage des responsabilités financières entre prestataires de services, patient consommateurs et acheteurs de services. Elle inclut à la fois les agents publics et privés dans la contribution au financement de santé, ce qui rend chaque partie plus responsable vis-À-Vis de son comportement en raison des risques qu'il doit assumer du fait de la consommation médicale.Cependant, il est nécessaire de noter que l’assurance maladie sociale n’est qu’une option parmi d’autres systèmes de financement de la santé. La mise en oeuvre de ce système exige un certain niveau de développement socio-Économique. L’assurance maladie ne conduit pas systématiquement à une meilleure performance du financement de la santé si elle n'est pas accompagnée de réformes quant au paiement au fournisseur ou au système de prestation de services. L'engagement du gouvernement et des capacités institutionnelles sont également des facteurs clés pour le bon fonctionnement du système. / It has been widely recognized that poor health is an important cause of poverty, especiallyamong the low- and middle- income countries. One of the reasons is the absence of publicfinancial protection against the medical consumption risk in these countries. This Phd dissertationis dedicated to discern the role that health insurance could play in the organization of healthfinancial protection system. The dissertation is composed of two parts. The first part discusses theproblems linking to the financing to medical consumption from a global point of view. Chapter 1brings theoretical discussions on three topics: 1) the specialties of medical consumption risks andthe difficulties in using private health insurance to manage medical consumption risks. 2) Therole of government and market in the distribution of health resources. 3) The options for theorganization of health financing system. Chapter 2 conducts a statistical comparison on theperformance of health financing systems in the countries of different social-Economic background.The discussion is carried out around three aspects of health financing: the availability of resources,the organization of health financing, and the coverage of financial protection. The second part ofthe dissertation studies the evolution of heath financing system in a specific country: China. Threechapters are assigned to this part. Chapter 3 introduces the history of Chinese health financingsystem since 1950s. It helps us to understand the challenges in health financing brought byeconomic reform. Chapter 4 carries out an empirical study on the distribution of health financingburden in China in the 1990s. It illustrates the direct results of the decline of public financing andincrease of direct payment. Chapter 5 presents health insurance reform that launched by thegovernment since the end of 1990s. An impact analysis is conducted on an original dataset of 24township hospitals in Weifang prefecture in the north of the China. The objective is to estimatethe impact of the implementation of New Rural Medical Cooperation System (NRMCS) on theactivities and financial structure of township hospitals. At last, we conclude that social healthinsurance (SHI) permits a sharing of health financial responsibilities between the service provider,the patient-Consumer, and the service purchaser. It can not only involve both public and privateagents into the collection of funds for health financing system, but also make each party moreaccountable due to the risks they bear from the result of medical consumption. Meanwhile it isnecessary to note that SHI is just one option among others to organize health financing system.The implementation of SHI requires a certain level of social-Economic development. SHI does notsystematically bring better performance on health financing if it is not accompanied by thereforms on provider payment or on service delivery system. Government commitment andinstitutional capacity are also key factors for the good function of the system.

The risk adjustment model currently used does not adequately compensate insurers for predictable differences in individuals' health care expenditures in the Czech Republic. It then leads to financial inequality in the redistribution of funds to the insurance companies and causes their financial problems. This study introduces a PCG model as another method for risk adjustment and determines to what extent the predictive performance of the model can be improved when applied to Czech data. We analyze 10% of population sample in the Czech Republic in years 2011 and 2012. Our results confirm the appropriateness of the PCG model for the Czech environment. When the PCG variables are added to the demographic model, R2 value of the prediction model increases from 2.03% to 13.87%.