不同收入等级农村居民基本医疗保险受益公平性研究

公平普惠是我国卫生和健康事业建设的目标,基本医疗保险是实现目标的制度保障。本文基于安德森医疗服务利用行为理论,采用三阶段随机抽样方法采集湖北省少数民族贫困县965个农村参保者的调查数据,通过收入五等分法、二元选择模型和两部分模型对基本医疗保险受益公平性进行分析。结果发现:均等化的医疗保险政策不仅实现了规则公平,实践中也提高了低收入参保者的医疗服务利用行为,即低收入组与高收入组有相似的就诊行为,且最低收入组比最高收入组还有更高的报销可能性。但是从医疗服务利用结果和疾病经济负担来看,低收入者仍然处于劣势。最低收入组和较低收入组均比最高收入组有更高的慢性病患病可能性和更差的自我健康评价,同时低收入组有着更重的疾病经济负担。此外,少数民族居民、失业者、年长者、有配偶的居民可能有更差的医疗服务利用结果。因此,中国在实现全民医保的基础上,未来还要进一步提高医保受益公平性。     

Medicaid coverage expansions and liability insurance

Do changes in the population covered by health insurance affect liability insurers, who compensate billions of dollars in medical claims each year? We examine this question by exploiting the selective rollout across states of Medicaid expansions under the Affordable Care Act. Using data on insurer losses across a range of insurance lines, and employing a triple‐difference research design that contrasts states, years, and lines of insurance, we demonstrate that coverage expansions reduce auto liability and workers’ compensation outlays by 6–11 percent, but do not measurably impact other lines of insurance. Our analysis provides some of the first evidence regarding the use of the tort system particularized to the low‐income population and is the first to consider the impacts of health insurance on medical professional liability and commercial auto insurance claims.     

Perceived health risks and perceptions of expert consensus in modern food society

The article deals with perceptions of food and health risks. Relevant questions are: (1) To what degree do consumers associate specific negative health consequences with food additives and genetically modified food, and do their perceptions differ from the experts’ views? (2) How do consumers perceive experts’ evaluations of health risks connected to food additives and genetically modified food? The results are based on a survey of Norwegian residents in 1999/2000, and of a selected sample of Norwegian experts on food and risks. There were great differences between consumers and experts in their assessments of health risks. To varying extents, consumers associate various health consequences with the risk factors. Consumers seem to perceive experts as more united about the risk factors as health risks than experts do themselves. The findings are discussed with reference to the stigma concept and to a social constructionist perspective. The results contribute to the understanding of consumer perception of risks and their understanding of expert agreement about health risks. They also point to the importance of the interplay between consumers and experts in the public debate and communication process about food and risks.     

Examining the Marginal Access Value of Private Health Insurance

According to a new theory advanced by Nyman (1999, 2003) , an important access motivation underlies the demand for health insurance. However, little empirical research has attempted to quantify and explain changes in the access value of health insurance. By assuming the demand for health insurance is derived from the demand for good health, this article shows mathematically that the marginal access value of private health insurance can be reasonably indexed by dividing the price of health insurance by a composite measure of medical prices. For the period from 1960 through 2002, national data for the United States suggests that the marginal access value of private health insurance has tended to increase over time. Based upon multiple regression analysis, marginal access value is shown to have increased over time in response to rising income, more generous benefit coverage, new medical technologies, and, in recent years, the backlash against health maintenance organizations (HMOs). In addition, expansions in the Medicaid program are shown to have slowed the growth of the marginal access value of private health insurance.     

保险业渠道整合“进行曲”

2012年中国保监会主席项俊波在全国保险监管工作会议上指出,保险业力抓服务,抓服务体现监管为民的思想。借助创新,不断拓宽服务渠道,优化服务流程,创新服务手段。在保险业提升服务水平与服务能力的大环境下,各家保险公司力求通过借助IT以及多渠道、跨平台的整合来提升客服水平。     

Come Rain or Shine: Evidence on Flood Insurance Purchases in Florida

This article provides a detailed analysis of the operation of the National Flood Insurance Program (NFIP) in Florida, which accounts for 40 percent of the NFIP portfolio. We study the demand for flood insurance with a data set of more than 7.5 million NFIP policies‐in‐force (the largest ever studied) for the years 2000–2005, as well as all NFIP claims filed in Florida. We answer four questions: What are the characteristics of the buyers of flood insurance? What types of contracts (deductibles and coverage levels) are purchased? What are the determinants of claims payments? How are prices determined and how much does NFIP insurance cost?     

Intergenerational Transfers and Insurance Policy Design

Abstract

Group health insurance policies offering an identical benefit package to every member of the group result in lower expected health benefits for younger cohorts than older cohorts. The dispersion in insurance benefits across age groups differs among insurance policies. Simulation results presented in this paper demonstrate that a shift from comprehensive health insurance to high-deductible health insurance decreases the share of expected benefits going to younger cohorts. An estimated 81.5% of the 23-to-32-year-old cohort is expected to receive less than $500 in health benefits during a year for one prototypical high-deductible health plan. Low expected benefits for younger relatively healthy cohorts could increase the number of younger individuals who eschew health coverage. Age-rated premiums are probably the most straightforward way to stimulate demand for high-deductible health plans among younger healthier individuals.     

Price presentation and consumers’ choice

Currently, regulatory authorities and consumers ask for more cost transparency with respect to financial product components. In life insurance, for instance, the premium for products should be split in its components: A premium for death benefits, the savings premium, the cost of an investment guarantee, and the administration costs. In this regard, it is important for insurance companies and regulators to know to what extent the way of presenting the prices of an offer affects consumer evaluation of the product. Based on a paper by Huber et al. (How do price presentation effects influence consumer choice? The case of life insurance products. Working paper, 2011) as presented at the annual meeting of Deutscher Verein für Versicherungswissenschaft in 2011, this article presents the effects of different forms of presenting the price of life insurance contract components and especially of investment guarantees on consumer evaluation of this product. This is done by means of an experimental study using a representative panel for Switzerland and by focusing on unit-linked life insurance products. The findings reveal that, contrary to consumer products, there is no effect of price bundling and price optic on consumer evaluation and purchase intention for life insurance products. However, there is a significant moderating effect of consumer experience with insurance products on this relationship.     

The interplay between risk adjustment and risk rating in voluntary health insurance

Many regulated health insurance markets include risk adjustment (aka risk equalization) to mitigate selection incentives for insurers. Empirical studies on the design and evaluation of risk-adjustment algorithms typically focus on mandatory health insurance schemes. This paper considers risk adjustment in the context of voluntary health insurance, as found in Chile, Ireland, and Australia. In addition to the challenge of mitigating selection by insurers, regulators of these voluntary schemes have to deal with selection by consumers in and out of the market. A strategy for mitigating selection by consumers is to apply some form of risk rating. Our paper shows how risk adjustment and risk rating interact: (1) risk rating reduces the need for risk adjustment and (2) risk adjustment reduces premium variation across rating factors, thereby increasing incentives for consumers to select in and out of the market.     

Accounting for Infrastructure Service Delivery by Government: Generational Issues

Infrastructure service provision by government creates huge distributional issues about service availability and performance over time and the relative funding burdens borne by successive generations of consumers across time. But providing financial disclosure on these issues through inter-generational accounting pre-supposes that accounting measurement is both generationally neutral (temporal neutrality) and does not legitimate any particular pattern of distribution. At the very least, accounting measurements of service provision costs should possess the attribute of distributional fairness. They should not bias the inter-generational allocation of cost or funding burdens. We argue that the forced application of inappropriate commercial accounting concepts of asset valuation, depreciation and capital maintenance does produce significant generational bias. More flexibility is required to produce the necessary accounting measurement attributes for financial disclosure on whether government has discharged its continuing accountability for inter-generational equity in burden sharing. We discuss three conceptual issues and illustrate the need for flexibility by proposing an alternative 'flow of obligations' approach which does not require reference to valuations of community service resources or arbitrary cost allocations under depreciation.     

The Distribution of Subsidies through Public Health Services in Indonesia, 1978-87

Indonesia has made great progress during the past fifteen yearsin enhancing the command of the poor over privately providedgoods, such as food, clothing, and housing. Has similar progressbeen made in improving their access to publicly provided socialservices? The article looks at how the use of health servicesand the incidence of subsidies in the health sector varied acrosssocioeconomic groups in Indonesia in 1987. It also examineshow the distributions of utilization and subsidies altered between1978 and 1987. The findings indicate that changes in utilizationpatterns and in the incidence of subsidies have been pro-poor.Disparities in access and utilization have diminished. However,public spending on health care is not yet well targeted.     

Consumers’ collision insurance decisions: a mental models approach to theory evaluation

Using interviews with 74 drivers, we elicit and analyze how people think about collision insurance coverage and decide whether to buy coverage, and if so, what deductible level to carry. We compare respondents’ judgments and behaviors to predictions of three models: baseline expected utility (EU) theory, which predicts that insurance is an inferior good, meaning more wealthy people buy less; a modified EU model, which incorporates income constraints and suggests that property insurance is a normal good, meaning more wealthy people buy more; and a mental accounting model which predicts that consumers budget income across consumption categories. The results suggest they purchase insurance as a normal good, guided by a cognitive model that emphasizes budget constraints. Verbal reports reveal a desire to balance two conflicting goals in deductible decisions: keeping premiums ‘affordable’ and keeping deductible level ‘affordable.’ Thus, wealth does not distinguish people by risk aversion, but by ability to pay. In other words, the behavior of less wealthy people is not driven by greater risk aversion, but by their lesser ability to pay, both now and later. We find that a simple heuristic using only vehicle value accounts for most decisions of whether to purchase optional collision coverage: out of 45 respondents who did not have loans on their vehicles, 90% of those with vehicles worth more than $1000 carried collision coverage, while less than 30% of those with lower‐valued vehicles did.     

Health Care Reform,Efficiency of Health Insurers,and Optimal Health Insurance Markets

This research examines the efficiency of the U.S. health insurers. It shows that more insurers are less efficient than in the previous sample year; however, the results suggest that the federal health care reform has no significant effect on the overall efficiency of all insurers as a whole, which is very low but does not change much over time. This research explores how to improve the efficiency of the health insurance market by proposing state, regional, and national efficiency-based goal-oriented market models and an efficiency duplicating system, and it discusses important implications to the health care compacts, the health insurance exchanges or marketplaces, and the national multistate programs. It also analyzes further moves for efficiency enhancement with regard to payment methods and the health care delivery system. One interesting finding is that the Medicaid program is very efficient because it provides support to the offering of Medicaid coverage and further expansion, which enhances the health welfare of society with fewer resources inputs from the perspective of efficiency. This research should provide important insights for state and federal governments, policy makers, regulators, the health insurance industry, and consumers.     

Culture, infrastructure and international health benefits delivery

When selecting a health insurance carrier for international employees, it is advantageous to recognize that valid assumptions made when selecting domestic benefits simply do not apply in the international realm and can lead to costly errors. This article examines some scenarios and cultural anomalies that invalidate commonly accepted domestic health insurance practices. It explores strategies for simplifying benefit design, providing access to quality care abroad, assessing costs, minimizing overseas risks and understanding the cultural impact on health care delivery.     

Flood insurance literacy and flood risk knowledge: Evidence from Portland,Oregon

Flood costs are escalating due to climate change and increased development in hazardous areas. Flood insurance plays a critical role in financial recovery, but there is very little research on how well consumers understand flood insurance policies. Poor insurance literacy could lead to suboptimal risk management decisions. This paper presents some of the first evidence on homeowner flood insurance literacy from a survey of residents in Portland, Oregon. We find that while a basic understanding of general insurance terms is widespread, details about flood insurance policies are not well-understood and many respondents do not know the specific terms of their policy. Residents of the 100-year floodplain are more likely to know that their homeowners’ insurance does not cover flooding, but do not have substantially better understanding or knowledge of specifics about their policy than those outside the floodplain. We also find that the majority of survey respondents did not learn about their flood risk or the cost of flood insurance until after making an offer on their property.     

An Analysis of the Demand for Earthquake Insurance

This research examines the decision to purchase earthquake insurance by analyzing data on earthquake insurance price and penetration in the New Madrid fault zone in Missouri. Earthquake risk is of concern to consumers, the insurance industry, industry regulators, and government agencies because of the potentially catastrophic nature of losses resulting from a major earthquake. Despite the significance of the earthquake peril, the recent literature does not contain estimates of the price and income elasticity of the demand for earthquake insurance. Our analysis indicates that homeowners acquire earthquake insurance because of risk considerations, at higher levels of risk the demand for earthquake insurance is higher, and the price of earthquake coverage does not provide incremental information in explaining the demand for earthquake coverage.     

The medical officer's role in critical illness insurance product development

Critical illness insurance is a new (to the US), medically sophisticated insurance product that is tantalizing some US insurers. Few have brought a product to market, but many opine that a US breakthrough is in the offing. Would you rise to the challenge and craft an opportunity to participate in the development of a new product concept? How do medical officers bring value to the product development world? Do medical officers belong in the domain of product actuaries and consultants who bring new product ideas to life? Dr. Jan von Overbeck and I presented a workshop at the 2004 AAIM meeting to discuss the role of the medical officer in the development and evaluation of critical illness insurance. This article summarizes that discussion for the Journal's readers.     

Capital markets,financial intermediaries,and liquidity supply

We study a dynamic economy endowed with a sequence of overlapping generations of consumers and production processes, and where productive assets are illiquid and consumption preferences are subject to uninsurable demand for liquidity. We characterize the steady states that can be achieved with alternative financial systems. We show that infinitely lived financial intermediaries offering a liability with age-dependent restrictions may implement a social optimum with full insurance. If, instead, they offer anonymous, unrestricted contracts, then only second-best consumption allocations with partial insurance obtain. We also examine the consumption allocations available when agents can trade shares in competitive stock markets. While allowing for trade across generations may or may not improve upon generational autarky, we show that this competitive equilibrium is not a social optimum, and is dominated by a system of infinitely lived, unrestricted intermediaries.     

A Comparison of HMO Efficiencies as a Function of Provider Autonomy

Current debates in the insurance and public policy literatures over health care financing and cost control measures continue to focus on managed care and HMOs. The lower utilization rates found in HMOs (compared to traditional fee‐for‐service indemnity plans) have generally been attributed to the organization's incentive to eliminate all unnecessary medical services. As a consequence HMOs are often considered to be a more efficient arrangement for delivering health care. However, it is important to make a distinction between utilization and efficiency (the ratio of outcomes to resources). Few studies have investigated the effect that HMO arrangements would have on the actual efficiency of health care delivery. Because greater control over provider autonomy appears to be a recurrent theme in the literature on reform, it is important to investigate the effects these restrictions have already had within the HMO market. In this article, the efficiencies of two major classes of HMO arrangements are compared using “game‐theoretic” data envelopment analysis (DEA) models. While other studies confirm that absolute costs to insurance firms and sponsoring companies are lowered using HMOs, our empirical findings suggest that, within this framework, efficiency generally becomes worse when provider autonomy is restricted. This should give new fuel to the insurance companies providing fee‐for‐service (FFS) indemnification plans in their marketplace contentions.     

Friedens-versus Ausscheidegrenze in der Krankenversicherung: Ein<Emphasis Type="Italic">kriegerischer</Emphasis> Beitrag für mehr Nachhaltigkeit

The German health insurance system is separated between the private and public sector by a social security ceiling. To reduce the risk selection of the current system we discuss the implications of the conversion of the upper income limit into a provision limit. Using a generational accounting approach, we find that such a conversion has a negative effect in respect of sustainability. In addition, we present the idea of a transfer premium, which reflects the value of the analyzed group of insurants. Our results show that with a transfer premium or in a system of lump-sum-premiums, the provision limit would have positive implications and would leave the German system more sustainable.