Refusal of surgery in an insured population

Among 195 people who did not have recommended elective surgery in which a second opinion was required, virtually all indicated they were not going to have the operation and did not want a second opinion. The extent to which this decision adversely affected their health status and well-being and the extent to which alternate treatments were tried are examined. The findings also highlight the discretionary nature of patient and physician decision making.     

A new parametric model for converting excess mortality from clinical studies to insured population

We propose a new parametric model – the generalized excess mortality (GEM) model – for converting excess mortality from clinical to insured population. The GEM model has been formulated as a generalization of the excess death rate (EDR) model in terms of a single adjustment parameter (m) that accounts for a partial elimination of a clinical study’s EDR due to the underwriting selection process. The suggested value of the parameter m depends only on the ratio of the impairment’s prevalence rate in the insured population to that in the clinical population. The model’s development has been implemented in two phases: the design phase and the validation phase. In the design phase, the data from the National Health and Nutrition Examination Survey I pertaining to three broad impairments (diabetes, coronary artery disease, and asthma) have been used. As a result, the following equation for the parameter m has been proposed: m_k?=?(P_i,k/P_c,k)ⁿ, where P_i,k, P_c,k are the prevalence rates of impairment k under study in the insured and the clinical populations, respectively, and n a single universal parameter with its value best approximated as n?=?0.5 (95% confidence interval 0.5–0.6). In the validation phase, several independent clinical studies of three other impairments (Crohn’s disease, epilepsy, and chronic obstructive pulmonary disease) were used. As it has been demonstrated in the validation phase, for a number of impairments, the GEM model can provide a better fit for observed insured population mortality than either one of the conventional EDR or mortality ratio models.     

Post-war mortality among industrial insured lives in Norway

Abstract

The results of mortality investigations among industrial insured lives with weekly premiums in the Norwegian life insurance company Fram for the period 1931/40 and for the period 1940/46 have earlier been published in this journal.l It is now possible to render the main results of the continued investigation for the post-war years 1946/50.     

Comparison of body mass index and waist circumference as predictors of all-cause mortality in a male insured lives population

Obesity assessed by body mass index (BMI) is associated with increased mortality risk, but there is uncertainty about whether BMI is the best way to measure obesity. Waist circumference (WC) has been proposed as a better measure. The Swiss Re BMI/WC Study was conducted to determine whether BMI or WC is a better predictor of future all-cause mortality in a large male insurance population. Using Cox proportional hazard models, risk ratios for increasing BMI and WC were 1.033 (P < .001) and 1.027 (P < .001), respectively. Risk ratios for obesity defined by BMI > or = 30 kg/m2 and WC > or = 40 inches were 1.33 (P < .001) and 1.20 (P = .002), respectively. In this study, BMI and WC are essentially equivalent in their ability to predict mortality risk in a male insurance population. Obesity, measured by either BMI or WC, has important underwriting and pricing implications.     

The mortality among industrial insured lives in Norway during the war

In the Norwegian life insurance company Fram a continuous mortality investigation takes place in connection with the yearly valuation of policies issued with weekly premiums. The investigation gives the aggregate mortality, the unit is the policy and the year of observation is the calendar year. A detailed account of the method used has been given by Fredrik Borch in his paper: “The mortality among industrial insured lives in Norway 1931–1940” in this journal 1943. The most important results of the investigation from the years 1940–1946 are rendered below.     

Stochastic mortality models: an infinite-dimensional approach

Demographic projections of future mortality rates involve a high level of uncertainty and require stochastic mortality models. The current paper investigates forward mortality models driven by a (possibly infinite-dimensional) Wiener process and a compensated Poisson random measure. A major innovation of the paper is the introduction of a family of processes called forward mortality improvements which provide a flexible tool for a simple construction of stochastic forward mortality models. In practice, the notion of mortality improvements is a convenient device for the quantification of changes in mortality rates over time, and enables, for example, the detection of cohort effects. We show that the forward mortality rates satisfy Heath–Jarrow–Morton-type consistency conditions which translate to conditions on the forward mortality improvements. While the consistency conditions for the forward mortality rates are analogous to the classical conditions in the context of bond markets, the conditions for the forward mortality improvements possess a different structure. Forward mortality models include a cohort parameter besides the time horizon, and these two dimensions are coupled in the dynamics of consistent models of forward mortality improvements. In order to obtain a unified framework, we transform the systems of Itô processes which describe the forward mortality rates and improvements. In contrast to term structure models, the corresponding stochastic partial differential equations (SPDEs) describe the random dynamics of two-dimensional surfaces rather than curves.     

The non mortality of hypertrophic cardiomyopathy in an unselected, community diagnosed and treated population

Hypertrophic Cardiomyopathy (HC) is portrayed in past literature as having an ominous prognosis. However, most studies emanated from medical centers and suffered from potential referral bias. A population based, community diagnosed and treated survival study is analyzed by the life table method. Despite potential causes for both underestimation of the observed mortality as well as for overestimation of expected mortality, the study appears to reveal a more favorable prognosis for HC in this population.     

A Bayesian non-parametric model for small population mortality

This paper proposes a Bayesian non-parametric mortality model for a small population, when a benchmark mortality table is also available and serves as part of the prior information. In particular, we extend the Poisson-gamma model of Hardy and Panjer to incorporate correlated and age-specific mortality coefficients. These coefficients, which measure the difference in mortality levels between the small and the benchmark population, follow an age-indexed autoregressive gamma process, and can be stochastically extrapolated to ages where the small population has no historical exposure. Our model substantially improves the computation efficiency of existing two-population Bayesian mortality models by allowing for closed form posterior mean and variance of the future number of deaths, and an efficient sampling algorithm for the entire posterior distribution. We illustrate the proposed model with a life insurance portfolio from a French insurance company.     

A new perspective on the Gold Standard: Inflation as a population phenomenon

The purpose of this paper is to contribute a new model of the Gold Standard, focusing on the interaction between resource scarcity and demographics. In a dynamic micro-founded model we find that: i) prices and equilibrium gold holdings increase with population (a scale effect), but decrease with the population growth rate; ii) that the Gold Standard implies deflation unless extraction resources outstrip population growth; and iii) there is no optimal quantity of money. The predictions of the model are examined using a structural VAR. Our results also shed light on debates about the viability of a return to the Gold Standard, and, more generally, on the interaction between policy variables and scarce resources.     

Female labor force participation: an international perspective.

This article gives an international perspective in regard to female participation in the labor force. In most countries women contribute less than men toward the value of recorded production. Social environment, statistical inconsistencies and methods of recording labor all contribute to this inequity. In Britain for instance, women caring for the household duties are in some studies considered to be part of the labor force and in other studies they are not. Further, internationally, women often find themselves in casual, temporary, or seasonal work that goes unrecorded. Defining what "labor force participation" constitutes is a key starting point to any survey. At what age is one considered employable? What constitutes a person "actively seeking" employment? Economists often try to explain labor force participation rate by age, sex, race and income groups and use this information to cite trends. The income-leisure model theorizes that choice of work or non-work by women is based primarily upon wages for work vs. wages for non-work. This theory sees non-labor income exerting a negative influence. Empirical evidence, however, suggests that women will choose work if wages are good regardless of any non-work benefits. Because most men are permanently in the labor force, estimates of labor reserves and projections of supply focus mostly on women. International generalizations are often misleading since trends vary widely among countries. During the last 20 years the global female participation rate has remained almost constant, but this is misleading. The percentage of working women in industrial countries increased 10%; developing countries showed a decrease of 7%. Female rates are often tied closely to shifts in the overall economy, (e.g., a transition from an agricultural to an industrial economy often sees a drop in female labor because subsistence jobs are lost). Of course the ability of women to bear children and the social expectations regarding child care often play a role. It is common in western industrialized countries to see drops in female participation during childbearing years. Countries with the lowest female participation rates are those with strong religious views about women in society, (e.g., Catholic and Muslim countries).     

Scenarios in an organizational perspective

In everyday life there are many kinds of scenarios—those embracing society as a whole, and those limited to the local community centre. There is considerable variation in scenario subject matter, range, level and degree of detail.¹ Why have scenarios become so popular and which organizational arrangements have been created to design and implement this kind of policy-oriented futures research? This article looks at both elements of this question. It examines policy-oriented futures research in general, and scenarios as part of this type of research. It then discusses organizational structures for designing and applying scenarios. Following this, the strong and weak points of scenarios in policy formulation are explored and a number of conclusions are drawn.     

Intervention from an information perspective

This paper surveys some important recent developments, which have the common theme of interpreting intervention in terms of its effects on the flow of information. The article considers the role of information in generating expectations, the formation of trading rules, price discovery, and the importance of institutional arrangements for the implementation of intervention policy. Suggestions for future research directions are discussed.