Prediction of outstanding payments in a Poisson cluster model

We consider a simple Poisson cluster model for the payment numbers and the corresponding total payments for insurance claims arriving in a given year. Due to the Poisson structure one can give reasonably explicit expressions for the prediction of the payment numbers and total payments in future periods given the past observations of the payment numbers. One can also derive reasonably explicit expressions for the corresponding prediction errors. In the (a, b) class of Panjer's claim size distributions, these expressions can be evaluated by simple recursive algorithms. We study the conditions under which the predictions are asymptotically linear as the number of past payments becomes large. We also demonstrate that, in other regimes, the prediction may be far from linear. For example, a staircase-like pattern may arise as well. We illustrate how the theory works on real-life data, also in comparison with the chain ladder method.     

健康险赔付与医院收入长期联动效应分析——基于VAR和VEC模型的实证

近年来我国健康险发展较快,但其高赔付率成了进一步发展的"瓶颈",这主要源于医险市场中的道德风险。本文运用计量经济学方法,对保险赔付和医院收入的关系进行了实证分析。结论:医院医疗收入、门诊收入和住院收入是导致保险赔付上升的原因,健康险赔付对医院收入的影响作用不显著,健康险业务的健康发展离不开医方的紧密协作。建议:保险公司需重视与医院和医生的合作,突出合作重点、改革合作方式和革新合作内容。     

Valuing reload options

Over the past quarter century, the use of stock options as pay for performance has grown enormously. Option grants now account for 32% of CEO pay—more than twice that of salaries. In addition options are now being granted to many more employees than before. During this same time period, there have been numerous innovations in the features on compensation options. One of these features is the reload—the grant of new options to replace shares tendered in the payment of the exercise. Within the past year, the long-delayed FASB requirement that options be expensed for financial reporting has finally become a fact. It is incumbent upon financial researchers to provide methods to achieve the goal of valuing options, not only to serve the accounting needs, but also to provide ways of determining their true costs and incentive effects. This paper analyzes the various forms of reload options and provides simple Black-Scholes like formulas for evaluating them. JEL Classification G13     

城镇职工医保基金结余问题与基金费用给付模式协同研究——基于某省W区的实证研究

职工医保统筹基金的结余水平与基金所采取的费用给付模式息息相关,城镇职工医保费用给付运营模式决定着统筹基金的结余水平应当保持在什么样的水平。本文以审计人员特有的视角,利用大数据分析技术及审计成果将职工医保基金结余进一步细分为个人账户结余与统筹基金结余进行研究,通过审计研究成果与政策规定的冲突以及职工医保与城乡医保基金相互之间的比较,分析基金结余研究的关键因素,进而探讨医保统筹基金费用给付模式,并就现阶段我国执行现收现付制加弱积累制混合模式的历史原因及现实因素作进一步的深入分析,最后基于人口老龄化背景下缓解职工医保收支恶化趋势提出相应的对策与建议。     

Interrogating an accounting-based intervention on three axes: Instrumental, moral and aesthetic

Accounting research is beginning to concern itself with mapping the operation of accounting in specific empirical settings. This paper has a similar aim — to track the effects of an accounting-based intervention in a rationalized lifeworld that is constituted by three cultural spheres with their associated modes of rationality —instrumental, moral and aesthetic (Habermas, J., The Theory of Communicative Action, Vol. 1, Heinemann, 1984). The institutional setting chosen is the U.S. health-care industry and the empirical event focused upon is the introduction of a prospective payment system in 1983. The empirics raise some interesting suggestions for future research. It appears that accounting struggles as an instrumental technology but enables action by providing a way out of moral dilemmas and in so doing enacts substantive power effects upon human bodies, both individual and collective.     

Option prices as predictors of stock prices: intraday adjustments to information releases

The purpose of this study is to analyse the evolution of payment behaviours by emphasizing the role of the regulation and the financial opening. We test whether the convergence process of payment technologies and regulations is propagated from upstream to downstream through the channel of standardized products, leading to the convergence of the demand for payment services. A test of conditional beta-convergence, relating to the use of five payment instruments, is performed on a panel of European countries. In general, results show evidence for convergence for all means of payment.     

The new technical basis of the Swedish life insurance companies

Abstract

During the past year most of the Swedish life insurance companies have agreed upon instituting common technical basis for the calculation of premiums, policy reserves, surrender values and prospective bonus (returns of premiums). Chiefly the same basis also has been adopted by two companies outside the agreement, and with one exception all Swedish life insurance companies now use the same premiums.     

Does Learning Matter for Knee Replacement Surgeries? Data Evidence from a German Hospital

In 2003, Germany will be the first country in the world to adopt a fully prospective payment system for the reimbursement of all inpatient hospital services. To face the increasing competition, hospitals can pursue either a specialization or a cost and quality leadership strategy. It stands to reason that organizational and individual learning will play an important role for both strategies. This paper raises the question, whether results from traditional learning curve theory can be applied to surgical procedures despite the latter's heterogeneity. We develop a theoretical model of surgical learning and test it using detailed operating room data from the first 601 total knee replacement surgeries of a small German hospital between 1994–2000. Our results suggest that classical learning curve theory can indeed be applied to this high cost high volume procedure.     

An Actuarial Analysis of Participating Life Insurance

An actuarial model is developed to reveal the intrinsic nature of participating life insurance. The basic safe-side criterion is examined. It is established how the first-order prospective net premium reserve includes safety margins or bonus loadings, and it is demonstrated how the bonus loadings are currently released. It is demonstrated how surplus may be distributed and accumulated as a terminal bonus in an equitable way. The level premium is divided into a variable recurrent single premium and a variable natural premium, and an alternative to the prospective net premium reserve is examined. A capitalization of future safety margins or bonus loadings, which are related to past premiums and the paid-up benefit, may allow the insurance company a considerable increase in investment freedom. The theory is illustrated by numerical results.     

Potential “Savings” of Medicare: The Analysis of Medicare Advantage and Accountable Care Organizations

Medicare faces significant financial challenges because of rising health care costs. In response, Medicare reform efforts have been testing various payment and service delivery models, including accountable care organizations (ACOs), aiming to reduce expenditures while preserving or enhancing the coordination of quality care. The idea behind ACOs is to form an organizational network to coordinate all care for Medicare beneficiaries and in so doing, at least theoretically, improve quality of care and hopefully reduce medical costs. The purpose of this research is to apply Data Envelopment Analysis (DEA) to assess the potential savings of Medicare obtainable through optimally efficient implementation of ACOs and Medicare Advantage plans. DEA comparisons across plans achieve this purpose by identifying which Medicare plans operate relatively more efficiently and which are inefficient, and additionally, for inefficient plans, the DEA analysis generates target levels of “inputs” and “outputs” required to bring the plan into efficient operation. Knowing sources of inefficiency can also provide insights into Medicare reform, such as Medicare privatization and innovation models. Our results show that Medicare Advantage plans are more efficient in reducing health expenditures but incur higher administrative costs. Health expenditure savings can also be achievable by promoting government-sponsored managed Medicare such as ACOs. Finally, compared to the profit efficiency of Medicaid managed care plans, Medicare Advantage should have the potential for more Medicare market penetration from the supply (insurer) side.     

A Risk Model with Multilayer Dividend Strategy

Abstract

In recent years various dividend payment strategies for the classical collective risk model have been studied in great detail. In this paper we consider both the dividend payment intensity and the premium intensity to be step functions depending on the current surplus level. Algorithmic schemes for the determination of explicit expressions for the Gerber-Shiu discounted penalty function and the expected discounted dividend payments are derived. This enables the analytical investigation of dividend payment strategies that, in addition to having a sufficiently large expected value of discounted dividend payments, also take the solvency of the portfolio into account. Since the number of layers is arbitrary, it also can be viewed as an approximation to a continuous surplus-dependent dividend payment strategy. A recursive approach with respect to the number of layers is developed that to a certain extent allows one to improve upon computational disadvantages of related calculation techniques that have been proposed for specific cases of this model in the literature. The tractability of the approach is illustrated numerically for a risk model with four layers and an exponential claim size distribution.     

门诊保障制度改革:“以门诊换住院”的政策效应分析——基于中国职工医保抽样数据的实证检验

本文利用中国医疗保险研究会2017年职工医保抽样数据库(CHIRA)和66个样本城市职工医保门诊报销政策文件,将实施"门诊统筹"作为外生冲击和改革变量,研究门诊保障制度改革对参保患者门诊和住院服务利用、医疗费用支出的影响。基于双变量Probit模型以及OLS模型的回归结果显示,门诊保障制度改革会带来两种效应:门诊服务和住院服务的"替代效应",即门诊保障制度改革显著提高了参保患者对门诊服务的使用(年门诊就诊概率上升37.3%),同时减少了对住院服务的使用(年住院概率下降4.6%);门诊费用和住院费用的"支出效应",即门诊保障制度改革显著提高了参保患者的年门诊费用支出,同时减少了年住院费用支出,但不会降低参保患者的年医疗费用总支出。进一步研究发现,改革带来的政策效应因门诊保障程度、参保群体(在职职工和退休职工)和改革时长存在异质性。     

美国长期护理保障制度改革及其对我国的启示

本文主要运用文献研究法,对美国长期护理保障制度的现状进行了分析。分析发现,当前关国长期护理保障制度存在两大问题,分别是政府财政转移支付缺乏可持续性、私人保单难以覆盖广大中低收入阶层。为解决上述问题,关国政府对长期护理保障制度采取了一系列改革措施,但改革始终没能达到预期效果。美国长期护理保障制度改革启示我们,长期护理保障...     

Medicare retiree drug subsidy compliance considerations

Employers and plan sponsors have struggled with many issues associated with Medicare's retiree drug subsidy program. Recent reviews of employer methods for collecting the subsidy from the Centers for Medicare and Medicaid Services (CMS) identified significant gaps that would affect the subsidy payment and create issues in case of an audit. In fact, the Department of Health and Human Services Office of Inspector General (OIG) has placed audits of employer retiree drug subsidy processes in its work plans for 2006 and 2007. This article discusses areas that employers must address now to avoid significant long-term financial and compliance problems in the future.     

The Welfare Returns to Finer Targeting: The Case of The Progresa Program in Mexico

It is common in developing countries to attempt finer targeting of the benefits from social safety net programs through combining different targeting methods. We evaluate the returns to finer targeting in the context of the PROGRESA program in Mexico. This program is a prominent program in the literature reflecting the fact that it has been widely evaluated, is perceived to be well targeted, and has been used as a prototype for many other programs in the region and beyond. We also identify the relative incremental contribution of each targeting method to the overall targeting performance of the program. We find that geographic targeting dominates demographic targeting (based on linking transfer levels to demographic composition), which in turn dominates household proxy-means targeting. However, the contribution of proxy-means targeting increases substantially as the program expands into less marginal localities. Adjusting for incomplete take-up increases the targeting performance of the program only slightly. JEL Code: D3, H50, O15 Disclaimer: The views expressed in this paper are those of the author and should not be attributed to the International Monetory Fund, its Executive Board, or its management.     

New development: Fiscal reform in South Korea: looking back and moving forward

ABSTRACT

At first glance, it seems that South Korea’s three fiscal systems (mid-term expenditure framework, top-down budgeting, and performance management) function well. However, each fiscal system operates separately and they are inefficient because they follow past practices. This article explains what the problems are and how to overcome them.     

An institutional theory perspective on the DRG framework, case-mix accounting systems and health-care organizations

Case-mix accounting systems have been advanced as both reflecting the economic reality that underlies a hospital's various “product lines”, as defined by DRG prospective payment categories, and facilitating rational decision making regarding resource acquisition, deployment and use. This article uses the institutional perspective to extend this conceptualization of case-mix accounting systems. The institutional perspective proposes that many elements of organizational structure, like case-mix accounting systems, reflect as much a need to conform to societal expectations of acceptable practice as the technical imperative of fostering rationality. This article also extends institutional theory regarding the issues of power and decoupling by considering institutionalization to be an unfinished process in the health-care context, wherein the active agency of individuals and organizations is subjected to systematic examination. In this specific context, case-mix accounting may play a significant role in establishing and perpetuating — not merely supporting — the very social structure of legitimacy, and may consequently be considered an interest-oriented activity having the potential to penetrate and alter the internal operating processes of financially strained hospitals.     

Does competition under Medicare Prospective Payment selectively reduce expenditures on high-cost patients?

Competition and prospective payment have been widely used to control health care costs but may together provide incentives to selectively reduce expenditures on high-cost relative to low-cost patients. We use patient discharge and hospital financial data from California to examine the effects of competition on costs for high- and low-cost admissions in the 12 largest Diagnosis-Related Groups before and after the Medicare Prospective Payment System (PPS). We find that competition increased costs before PPS, but that this effect decreased afterward, especially inpatients with the highest costs.We conclude that competition and PPS selectively reduced spending among the most expensive patients and that careful assessment of these patients' outcomes is important.