Designing feasible and effective health plan payments in countries with data availability constraints

Risk equalization schemes, which transfer money to/from insurers that have above/below average risks, are a fundamental tool in regulated health insurance markets in many countries. Risk sharing (the transfer of some responsibility for costs from a plan to the regulator or the overall insurance market), are an additional method of insulating insurers who attract higher-than-average risks. This paper proposes, implements and quantifies incorporating risk sharing within a risk equalization scheme that can be applied in a data-poor context. Using Chile's private health insurance market as case study, we show that modest amount of risk sharing greatly improves fit even in simple demographic-based risk equalization. Expanding the model's formula to include morbidity-based adjustors and risk sharing redirects compensations at insurer level and reduces opportunity to engage in profitable risk selection at the group level. Our emphasis on feasibility may make alternatives proposed attractive to countries facing data-availability constraints.     

Competition leverage: how the demand side affects optimal risk adjustment

We study optimal risk adjustment in imperfectly competitive health insurance markets when high‐risk consumers are less likely to switch insurer than low‐risk consumers. Insurers then have an incentive to select even if risk adjustment perfectly corrects for cost differences. To achieve first best, risk adjustment should overcompensate insurers for serving high‐risk agents. Second, we identify a trade‐off between efficiency and consumer welfare. Reducing the difference in risk adjustment subsidies increases consumer welfare by leveraging competition from the elastic low‐risk market to the less elastic high‐risk market. Third, mandatory pooling can increase consumer surplus further, at the cost of efficiency.     

Risk selection in the London political risk insurance market: the role of tacit knowledge,trust and heuristics

This study demonstrates that the basis of decision-making and risk selection in the London Political Risk Insurance (PRI) market is a combination of Art and Science with such factors as trust and reputation playing an important role. The study breaks new ground by uncovering and examining different methods and strategies of political risk underwriting employed in the insurance market, which does not rely on statistical tools as seen in more traditional insurance types. Adopting a grounded theory approach, the data was generated through 14 semi-structured and unstructured interviews conducted with PRI experts from five PRI companies and two leading political risk broking houses. The data also included documentation reviews and observations.     

Insurance loss coverage and social welfare

Restrictions on insurance risk classification may induce adverse selection, which is usually perceived as a bad outcome, both for insurers and for society. However, a social benefit of modest adverse selection is that it can lead to an increase in ‘loss coverage’, defined as expected losses compensated by insurance for the whole population. We reconcile the concept of loss coverage to a utilitarian concept of social welfare commonly found in the economic literature on risk classification. For iso-elastic insurance demand, ranking risk classification schemes by (observable) loss coverage always give the same ordering as ranking by (unobservable) social welfare.     

中国寿险市场存在逆向选择吗?——来自CHARLS数据的经验证据

我国寿险市场是否存在逆向选择问题,在理论和实证两个方面缺乏细致的讨论。本文利用CHARLS数据和正相关理论检验了我国定期寿险和终身寿险市场中的逆向选择问题。我们选取了死亡率这一远期指标和健康状况这一近期指标来衡量消费者的死亡风险,从广延边际和集约边际两个方面利用正相关理论进行了深入的研究。实证结论表明,以死亡率和健康状况衡量的死亡风险与寿险消费负相关或者不相关,即我国寿险市场并不存在逆向选择问题。然后,我们讨论了模型的内生性问题,并根据年龄变量检验了结论的稳健性,实证结果表明我们的结论是稳健的。最后,本文利用双变量Probit模型设计了一个机制,并利用该机制验证了利他动机是我国寿险市场不存在逆向选择的原因之一。     

Automobile Insurance Contracts and Risk of Accident: An Empirical Test Using French Individual Data

Insurance has for a long time been perceived as a way of transferring responsibility from insured agents to insurers and thus as potentially influencing insured agents' behavior. Two particular opportunistic behaviors have been analyzed. First, the theory of adverse selection predicts that high-risk agents are likely to demand more insurance than are low-risk agents. Second, the theory of moral hazard predicts that the wider the insurance coverage, the less agents will try to prevent accidents. Both theories thus conclude that agents who are totally insured should have a higher probability of accident than those with only partial insurance, ceteris paribus. Nevertheless, one of the aims of insurance rating systems is to control for these opportunistic behaviors. In this article, we use individual data to see if the French automobile insurance rating system has achieved this aim. We do this using a two-step maximum-likelihood method. First, we compute a probit model to estimate the probability of taking out comprehensive versus third-party insurance. We then calculate the generalized residual, which is included as an independent variable in a negative binomial model estimating the probability of having an accident. The coefficient of this variable is argued to represent adverse selection and ex-ante moral-hazard behavior.     

中国寿险市场存在逆向选择吗?——来自CHARLS数据的经验证据

我国寿险市场是否存在逆向选择问题,在理论和实证两个方面缺乏细致的讨论。本文利用CHARLS数据和正相关理论检验了我国定期寿险和终身寿险市场中的逆向选择问题。我们选取了死亡率这一远期指标和健康状况这一近期指标来衡量消费者的死亡风险,从广延边际和集约边际两个方面利用正相关理论进行了深入的研究。实证结论表明,以死亡率和健康状况衡量的死亡风险与寿险消费负相关或者不相关,即我国寿险市场并不存在逆向选择问题。然后,我们讨论了模型的内生性问题,并根据年龄变量检验了结论的稳健性,实证结果表明我们的结论是稳健的。最后,本文利用双变量Probit模型设计了一个机制,并利用该机制验证了利他动机是我国寿险市场不存在逆向选择的原因之一。     

On the exposure of insurance companies to sovereign risk—Portfolio investments and market forces

A sovereign debt crisis can have significant knock-on effects in the financial markets and put financial stability at risk. This paper focuses on the transmission of sovereign risk to insurance companies as some of the largest institutional investors in the sovereign bond market. We use a firm level panel dataset that covers large insurance companies, banks and non-financial firms from nine countries over the time period from 1 January 2008–1 May 2013. We find significant and robust transmission effects from sovereign risk to domestic insurers. The impact on insurers is not significantly different from that on banks but larger than for non-financial firms. We find that systemically important insurers are more closely linked to the domestic sovereign. Based on European data, we show that risks in sovereign bond portfolios are an important driver of insurer risk, which is not reflected in current insurance regulation (incl. Solvency II in Europe).     

保险市场逆向选择与顺向选择共存研究

保险市场存在着逆向选择。经典逆向选择模型认为,风险高的人会购买更多的保险,但大多数实证研究表明保险市场还存在顺向选择。本文认为,逆向选择和顺向选择虽然对立,但共存于保险市场,在此基础上构建保险市场均衡模型,并进行了仿真研究。     

The drivers and value of enterprise risk management: evidence from ERM ratings

In the course of recent regulatory developments, holistic enterprise-wide risk management (ERM) frameworks have become increasingly relevant for insurance companies. The aim of this paper is to contribute to the literature by analyzing determinants (firm characteristics) as well as the impact of ERM on the shareholder value of European insurers using the Standard & Poor’s ERM rating to identify ERM activities. This has not been done so far, even though it is of high relevance against the background of the introduction of Solvency II, which requires a holistic approach to risk management. Results show a significant positive impact of ERM on firm value for the case of European insurers. In particular, we find that insurers with a high quality risk management (RM) system exhibit a Tobin’s Q that on average is about 6.5% higher than for insurers with less high quality RM after controlling for covariates and endogeneity bias.     

Accessibility of flood risk insurance in the UK: confusion,competition and complacency

Flood risk insurance can be an effective tool in assisting the restoration of damaged property after a flood event and sustaining communities through difficult times. It can also form part of a wider flood risk management strategy. In the light of recent flood events in the UK and in the context of changing property insurance markets, the universal cover previously enjoyed by floodplain residents has been called into question. Conflicting media and industry views leave the floodplain resident and the wider community in confusion. A survey of floodplain residents in England regarding their experience with flooding and flood insurance in England has been undertaken. The results reveal that some floodplain residents do indeed encounter difficulties when seeking insurance for their homes. However, despite the risk‐averse policies of some insurers, availability of insurance is still strong in both at‐risk and previously flooded locations. Success in gaining insurance may lead to complacency among residents who see no advantage in pursuing other, more costly, damage mitigation actions. As a tool in risk management, therefore, the market is prevented from realising its potential by competition, which results in a lack of a consistent approach, rewards homeowners' search strategies and reduces information flow.     

The effect of predation risk on cash holdings: Empirical evidence from the U.S. property‐liability insurance industry

Corporate cash holdings play a significant role in the U.S. property‐liability insurance industry yet the topic of insurer cash holdings policy has largely been overlooked by prior empirical research. While a number of studies have investigated firm‐specific factors related to cash holdings in the insurance industry, prior research has not examined how market concentration and potential predation risk impact cash holdings. We propose a new measure of market concentration and provide evidence in support of the predation risk theory. Specifically, we show that insurers exposed to more concentrated markets tend to hold more cash. Furthermore, the relation between market concentration and cash holdings is influenced by access to internal capital. While unaffiliated insurers without access to internal capital hold greater levels of cash in more concentrated markets, group insurers with access to internal capital do not hold greater levels of cash to mitigate predation risk.     

Parameter risk in time-series mortality forecasts

The projection of mortality rates is an essential part of valuing liabilities in life insurance portfolios and pension schemes. An important tool for risk management and solvency purposes is a stochastic projection model. We show that ARIMA models can be better representations of mortality time-series than simple random-walk models. We also consider the issue of parameter risk in time-series models from the point of view of an insurer using them for regulatory risk reporting – formulae are given for decomposing overall risk into undiversifiable trend risk (parameter uncertainty) and diversifiable volatility. Particular attention is given to the contrasts in how academic researchers might view these models and how insurance regulators and practitioners in life offices might use them. Using a bootstrap method we find that, while certain kinds of parameter risk are negligible, others are too material to ignore. We also find that an objective model selection criterion, such as goodness of fit to past data, can result in the selection of a model with unstable parameter values. While this aspect of the model is superficially undesirable, it also leads to slightly higher capital requirements and thus makes the model of keen interest to regulators. Our conclusions have relevance to insurers using value-at-risk capital assessments in the European Union under Solvency II, but also territories using conditional tail expectations such as Australia, Canada and Switzerland.     

Engineered nanomaterials: risk perception,regulation and insurance

Concerns surrounding the health risk of engineered nanomaterials, effective regulation and the lack of specifically tailored insurance products for the nanotechnology sector are putting the industry’s long-term economic viability at risk. From the perspective of the underwriter, this article speculates on the relationship between risk perception, regulation and insurability. In the nanotechnology sector, regulators are currently failing to keep pace with innovation, and insurers generally lack guiding principles for underwriting occupational risk from nanomaterial exposure. Such vulnerabilities when combined with misguided risk perceptions can lead to the overpricing of risk transfer and ill-conceived regulatory initiatives, thus potentially exhausting resources and stifling innovation in the sector. In the absence of well-developed regulatory protocols, the insurance industry has, and will continue, to occupy a key role as an effective lobby in terms of improved risk management practice. We suggest that the insurance industry will increasingly rely on control banding frameworks and ‘risk mitigation at source’ methods developed in conjunction with their clients to manage severe acute diversifiable risks. Long tail risk will continue to represent a serious challenge to insurers and regulators. In the meantime, insurers will have to bridge their current needs with improvised solutions. As an example of one possible solution, we outline a framework that utilizes financial instruments to hedge an insurer’s exposure to uncertain estimates of these long-term risks.     

Incentives for Voluntary Disclosure of Quality Information in HMO Markets

This study examines incentives for voluntary disclosure of quality information by health maintenance organizations (HMOs). Economic theory predicts complete voluntary disclosure without mandatory rules. This article introduces plans' selection motives to avoid high-risk consumers as a deterrent of full unraveling; if disclosure is expected to attract high-risk members, plans have incentives to withhold information. The empirical analysis shows that while market unraveling was an important mechanism to bring disclosure, it was not complete, and plans in markets with high-risk consumers were less likely to disclose. This study suggests that market unraveling may not arise if risk selection incentives are prevalent.     

Employer risk-adjustment transitions with inertial consumers: Evidence from CalPERS

Risk-adjustment policies, which transfer money from insurers with healthy consumers to those with sick consumers, are an important tool to contend with adverse selection in health insurance markets. While the steady-state properties of risk-adjustment have been studied extensively, there is less evidence on the transition phase of policy implementation. We study the introduction and removal of risk-adjustment at California Public Employees' Retirement System and show that these changes meaningfully impact premiums via plan differences in enrollee health status. Despite these premium differences, there is limited consumer resorting due to consumer inertia, though new active enrollees respond more fluidly. We show that, with inertial consumers, risk-adjustment changes have substantial distributional consequences, leading to worse outcomes for sicker consumers when removed and vice-versa when implemented. We estimate a model of plan choice with premium sensitivity, brand preferences, and inertia and use these estimates to study the interaction between risk-adjustment policies and the strength of inertia.     

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.     

Systemic risk of insurers around the globe

We study the exposure and contribution of 253 international life and non-life insurers to systemic risk between 2000 and 2012. For our full sample period, we find systemic risk in the international insurance sector to be small. In contrast, the contribution of insurers to the fragility of the financial system peaked during the recent financial crisis. In our panel regressions, we find the interconnectedness of large insurers with the insurance sector to be a significant driver of the insurers’ exposure to systemic risk. In contrast, the contribution of insurers to systemic risk appears to be primarily driven by the insurers’ leverage.     

CDS as insurance: Leaky lifeboats in stormy seas

What market features of financial risk transfer exacerbate counterparty risk? To analyze this, we formulate a model which elucidates important differences between financial risk transfer and traditional insurance, using the example of Credit Default Swaps (CDS). We allow for (heterogeneous) insurer insolvency, which captures the possibility that relatively risky counterparties may exist in the market. Further, we find that stable insurers become less stable as the price of the contract decreases. The analysis includes insured parties that have heterogeneous motivations for purchasing CDS. For example, some may own the underlying asset and purchase CDS for risk management, while others buy these contracts purely for trading purposes. We show that traders will choose to contract with less stable insurers, resulting in higher counterparty risk in this market relative to that of traditional insurance; however, a regulatory policy that removes traders can, perversely, cause stable counterparties to become less stable. We conclude with two extensions of the model that consider a Central Counterparty (CCP) arrangement and the consequences of asymmetric information over insurer type.     

我国商业医疗保险中的道德风险及对策

医疗行为的信息不对称以及疾病的客观性、严重性、复杂性、多样性等本质特征导致医疗保险成为道德风险发生频率最高、造成损失最大、又最难以有效规避风险的险种。道德风险是医疗保险市场失灵的重要表现。本文通过分析我国医疗保险市场逆选择和事后道德风险的不同形成原因,以期探讨有效的风险控制方法,从而降低商业医疗保险的经营风险,为促进其合理发展并最终满足居民更全面的健康需求提供帮助。