Federal Regulation of Use of Genetic Information by Insurers

This paper analyzes policy developments at the national level during 1997, including proposed federal legislation and the response of the insurance industry. With broad bipartisan support, it appears that some form of federal regulation is likely within the next two sessions of Congress. The debate appears to be centering on two issues: the definition of genetic information and whether regulation will extend to a blanket prohibition on testing. The insurance industry is suggesting that restrictions based on an “unfair discrimination” standard would permit coverage and cost distinctions based on actuarially sound data, while the health care industry is opposed to any discrimination based on genetic information. A utilitarian ethical perspective would likely support restrictions on testing for life insurance but not health insurance.     

重大公共卫生危机下的健康保险应对研究

公共卫生危机对经济的影响较大,21世纪以来,面对频发的重大公共卫生危机,健康保险业如何通过科技赋能,有效参与到公共卫生安全体系建设中亟待研究对策。通过数据比较分析法、模型构建法,分析了我国商业健康保险业在防控重大疫情期间的作为、短板、机遇和挑战,并基于健康保险参与公共卫生安全体系建设的国际经验和保险科技的发展,提出了我国健康保险业应对重大公共卫生危机的一系列政策建议,以便完善现有公共卫生安全体系,助推"健康中国战略"和"可持续发展战略"的实现。     

保险在应对公共卫生事件中的功能发挥与演进——基于2003年非典与2020年新冠肺炎疫情的比较视角

保险业是我国国民经济重要的支柱行业,其发展是我国社会进步和经济发展的典型缩影,其功能演进也受到特定的社会文化背景与经济环境的影响。选取2003年非典和2020年新冠肺炎疫情两个外生公共卫生事件,分析我国保险业的功能发挥与演进。研究发现：在应对公共卫生事件中,保险业除发挥了常规的损失补偿、风险保障和风险管理功能外,同时也发挥着社会责任、类社会保障、社会管理等延展功能。进一步比较发现,保险业在应对2003年和2020年的两起公共卫生事件中,同样功能的发挥能力和程度有很大差异,这主要是我国近二十年来保险业的快速发展,其功能的有效发挥有赖于坚实的行业基础和救助能力。     

试析医疗卫生事业发展的特殊矛盾和我国医改的路径选择

市场经济条件下医疗卫生事业发展面临五大特殊矛盾。现行医疗卫生体制要解决的首要问题是体制、机制创新问题。公立医院改革和医疗保险体制改革相结合,建立以公益性医院为主题的医疗保险职能和公共医疗服务职能相结合的制度统一、全民覆盖、统筹城乡的新型公共医疗服务保险制度,构建政事分开、管办分开、医保基金管用分开的医疗卫生管理体制,是化解现行医药卫生体制蕴藏的内在矛盾,破解我国医改难题的可行的路径选择。     

健康保险单独监管问题研究

商业健康保险最能体现保险的社会管理功能,在我国多层次医疗保障体系建设中发挥着愈加明显的重要作用。本文从促进健康保险发展的行业监管角度,提出应将商业健康保险作为与产险、寿险并列的第三领域实施单独监管。本文详细分析了健康保险的专业经营特点,阐述了对健康保险实施单独监管的必要性,明确了单独监管的基本内容并提出了相关政策建议。     

ECONOMIC ANALYSIS FOR HEALTH PROJECTS

This paper applies to the health sector a method of projectanalysis advocated recently by Devarajan, Squire, and Suthiwart-Narueput.A health project evaluation should establish a firm justificationfor public involvement; establish the counterfactual—whatwould happen with and without the project; and determine thefiscal effect of the project and the appropriate levels of feesin conjunction with project evaluation. The evaluation shouldalso acknowledge the fungibility of project resources and examinethe incentives both for high-level public servants to shiftgovernment resources away from project-funded activities tothose that have not been evaluated and for lower-level contractorsand civil servants to provide good or bad service. Market failuresin health services and insurance markets should serve as a startingpoint for economic analysis, not as a reason to ignore economicsin health projects. Project outputs should be predicted aftertaking into account the reaction of consumers and providersin the private sector as well as market structures of supply,demand, and equilibrium for health services.      

存在道德风险的医院等级选择与最优公共医疗保险合同

通过构造一个医疗服务系统的均衡模型,分析了医院等级、居民道德风险与最优公共医疗保险合同之间的关系。研究表明只存在公共医疗保险体系时,如果政府部门之间缺乏协调机制,各自为政,中国的公共医疗保险支付方式将不能实现社会最优并消除道德风险;公共医疗保险合同可能引起社会福利的损失或引致道德风险。政府应该完善医院评价系统,对不同医院的水平给予准确的评级,特别是要建立起政府各部门之间的协调机制;理顺医疗服务价格体系;鼓励更多市场参与主体进入医疗保险领域,建立合理的疾病风险分担机制。     

Will Private Health Insurance Make the Distribution of Public Health Subsidies More Equal? The Case of India

This paper assesses the impact of the entry of private players in the health insurance market on the size of the insurance market and the distribution of public health subsidies on health care provision in India. Simulation results presented in the paper suggest that the redistributive effect is small when richer groups have privileged access to public facilities.     

Gendiagnostikgesetz und Versicherung: Anspruch und Wirklichkeit

With the new German Gene Diagnostic Act (Gendiagnostikgesetz) the legislator aims at improving the protection of insurance applicants by prohibiting private insurers from collecting and using genetic information. However, the analysis of the new provisions shows that the provisions pertaining to insurance neither provide a comprehensive protection against genetic discrimination of insurance applicants and insured nor do they protect their right of gene-informational self-determination. Cuts of insurance benefits of the insured in private health insurance as well as incoherent disclosure obligations for insurance applicants unconstitutionally limit the rights of affected people as compared to the time before the Gene Diagnostic Act came into force. In summary, the new Gene Diagnostic Act does not only fail to meet its claims and thus falls short of the expectations, but also, due to numerous unclear provisions, poses a series of grave problems for insurance applicants, privately insured and private insurers.     

Public Versus Private Insurance with Dual Theory: A Political Economy Argument

This paper analyzes the political support for public insurance in the presence of a private insurance alternative. The public insurance is compulsory and offers a uniform insurance policy. The private insurance is voluntary and can offer different insurance policies. Adopting Yaari's [Econometrica, 55, 95–115, 1987] dual theory to expected utility (i.e., risk aversion without diminishing marginal utility of income), we show that adverse selection on the private insurance market may lead a majority of individuals to prefer public insurance over private insurance, even if the median risk is below the average risk (so that the median actually subsidizes high-risk individuals). We also show that risk aversion makes public insurance more attractive and that the dual theory is less favourable to a mixed insurance system than the expected utility framework. Lastly, we demonstrate how the use of genetic tests may threaten the political viability of public insurance.     

Genetic Testing,Insurance Economics,and Societal Responsibility

Three major perspectives emerge when the discussion of the implications of genetic testing on the insurance industry commences. One viewpoint, strongly advocated by certain consumer groups and ethicists on the basis of societal responsibility, categorically denies any necessity for connecting the results of genetic testing and issuance of insurance. By contrast, the insurance industry, upon examining the economics and dynamics of participation in voluntary insurance markets, lives in fear of a world filled with asymmetrical information (counter to the axioms for competitive markets), adverse selection (action by the insured as a result of asymmetric information to the perceived economic disadvantage of the insurer), and ultimately even the possibility of potential market failure or insurance company insolvency. An actuarial perspective considering the benefits (to the insurer) of this new genetic information concentrates primarily on the possibility of developing improved quantitative assessments of risk and better calculations of the actuarial present value of future loss costs based on the new statistically significant information gained from genetic testing. The strengths and weaknesses and facts and fallacies of each of these perspectives are examined in this paper, and potential solutions to the ultimate role of genetic testing in insurance underwriting and rate making are considered from the perspectives of the major players in this debate.     

我国健康保险业的健康管理运行模式构建

健康管理是健康保险转移财务风险、控制成本、解决信息不对称、道德危害等问题的成功策略之一。积极借鉴国外保险业健康管理的成功运行模式(如HMO,PPO,POS等),构建我国健康保险的健康管理运行模式对于我国健康保险业的可持续发展有着重大意义。本文重点研究了健康管理运行模式的重要组成部分:服务人群、服务方式、服务内容、支付机制、成本控制与医疗服务管理机制、利益协调机制、反馈机制等,并探讨了健康管理当前在我国面临的问题,指出必须结合国情构建健康管理运行模式,从而促进我国健康保险业务稳定、持续、健康的发展。     

Australia's Implicit Deposit Insurance — Should It Be Reconsidered?

Most major developed countries have bank deposit insurance; the European Parliament recently mandated it for all member countries. One of the characteristics of most deposit insurance schemes to protect depositors is that the banking industry funds the scheme through assessments. Interestingly, Australia does not have explicit deposit insurance and to date there has been little public debate on this subject. This paper proposes that such a debate should be initiated.     

Relative Hedging of Systematic Mortality Risk

A number of problematic issues have arisen in anticipation of the potential role of molecular tests for genetic predispositions to illness in risk assessment by insurance underwriters. We argue in this paper that the regrettable history and current risks of genetic discrimination warrant a presumption that genetic predisposition status should not be used in any nonmedical contexts, unless compelling evidence can demonstrate that serious harm will result to third-party interests without such use. We argue that insurers should not be able to initiate testing for genetic predisposition. We also argue that there are many reasons to doubt whether patients’ test results will result in such serious adverse selection as to cause substantial harm to insurance markets, except possibly at higher policy amounts in life or disability income insurance. We conclude that the burden of proof must be on insurers to demonstrate necessity of use in specific cases in which test availability shows high probability of imminent, serious harm to insurance markets.     

补充医疗保险对居民消费的影响——来自城乡居民大病保险的证据

促进消费对我国稳定经济增长和构建新发展格局至关重要。本文基于中国家庭追踪调查数据(CFPS),利用地级市层面实施城乡居民大病保险的时间差异,运用双重差分法估计了大病医疗保险对居民消费的影响。结果表明,大病保险使家庭人均消费显著增长了约6%。使用了事件分析法、置换检验、改变回归样本和控制变量等一系列检验后,结论仍保持一致,且这一效果在期初住院率高、储蓄率高以及收入较高的家庭中更明显。进一步地,本文检验了大病保险对居民消费的三种可能影响渠道,发现降低家庭对未来医疗支出风险的预期是大病保险促进家庭非医疗消费进而影响家庭总消费的主要渠道,印证了我国居民对高额医疗支出的担忧是影响消费意愿的重要因素。本文研究对于完善多层次医疗保障体系和促进居民消费具有启示意义。     

Author’s Reply: Skewness and Stock Option Prices - Discussion by Terence Chan,Michel Jacques,Heinz H. Mu¨ller,Geérard Pafumi,Elias S.W. Shiu,and Serena Tiong,July 1997

Abstract

In recent years, the combined effects of deregulation in financial services, along with advances in telecommunications and information technology, are forcing far-reaching changes upon the insurance industry. The result is the industry is becoming more competitive. The emerging role of electronic commerce (e-commerce) is particularly important and interesting to study.

I offer a brief survey of the role of e-commerce in the insurance industry. The paper is organized in the following manner: Section 1 summarizes Internet trends and discusses various related public policy issues; Section 2 addresses online insurance supply and demand; Section 3 discusses the economics of disintermediation and reintermediation and explains how this applies to e-commerce in the insurance industry. Finally, Section 4 offers a set of concluding remarks.     

日本养老服务体系及其财政问题争议

日本的社会保障体系由公共扶助、社会保险、社会福利、公共卫生与医疗四大部分构成,根据日本现行护理社会保险法之规定,护理社会保险服务由国家、都道府县、市町村的行政主管机构承担管理,在履行各自职能的同时提供服务。本文在简述日本福利服务及老年福利服务体系结构的基础上,着重分析日本的护理社会保险制度、服务体系及财政机制,围绕当前日本社会福利及护理社会保险制度存在问题展开的争议逐一加以分析,提出相应的课题与见解。     

The evolution of the Australian life insurance industry

The life insurance industry in Australia has traditionally been an important source of long term finance for both the public and private sector. However, very little historical analysis has been undertaken into an industry that constitutes a fundamental part of the economy's financial sector. The present climate of deregulation has initiated an irrevocable process of change within the industry. To comprehend the full implications of this change it is necessary to have an understanding of how the industry has evolved. This paper seeks to provide a background account of the growth of the life insurance industry in Australia highlighting the influences that have determined the structure of the industry.     

国外基本医疗保险体系中的商业参与——兼论公共物品供给

本文从国际经验借鉴的角度,根据基本医疗保险体系中的商业参与程度,选取了瑞士、澳大利亚和日本三个国家,对其基本医疗保险体系的特点和商业参与方式进行了阐述和总结。商业参与基本医疗保险这一公共物品的供给,是社会经济发展的必然,也是政府与市场的共同选择。当前,我国需要处理好政府部门与商保机构的衔接和职能分工,以提高基金运行效率、并维护参保者的合法权益。     

Opting Out of Public Insurance: Is It Socially Acceptable?

The privatization of social services is being increasingly discussed. The market of social services is often characterized by market failures, like informational asymmetries, externalities, distributional problems, which all justify public intervention. But the quality of services provided by public authorities or by private insurers in the context of health insurance is different and could be observable. The public reimbursement of health care is often conditional on rules, like the choice of the physician or the hospital, that induce a disutility of using social insurance instead of private insurance. An alternative solution to a complete privatization is to allow some individuals to opt out. We can imagine that the government allows and even in some cases favors part of the population leaving the public health insurance system. We analyze the situations where the opting out is welfare improving. We then study the optimal policy depending on the characteristics of the economy considering a Rawlsian criterion.