Genetics,Alzheimer’s Disease,and Long-Term Care Insurance

Abstract

This paper applies a model of Alzheimer’s disease (AD) developed by Macdonald and Pritchard (2000) to the question of the potential for adverse selection in long-term care (LTC) insurance introduced by the existence of DNA tests for variants of the ApoE gene, the ε4 allele of which is known to predispose one to earlier onset of AD. It computes the expected present values (EPVs) of model LTC benefits with respect to AD for each of five ApoE genotypes, weighted average EPVs with and without adverse selection, and sample underwriting ratings. The paper concludes that adverse selection could increase costs significantly in a small LTC insurance market only if current population genetic risk is not much smaller than that observed in case-based studies, and if carriers of the ε4 allele are very much more likely to buy LTC insurance. Finally, the paper considers the cost of a combined retirement package, providing both pension and LTC insurance, and shows that it can reduce adverse selection.     

Temporal Profitability and Pricing of Long-Term Care Insurance

Equilibrium models of dynamic insurance markets can be bifurcated according to underlying assumptions about whether or not insurers commit to long‐term contracts. The difference is substantial in that commitment models imply price highballing over time while no‐commitment models indicate price lowballing. Extant empirical studies provide mixed evidence, however. We use long‐term care (LTC) insurance data, which allow us both to better control for heterogeneous, observable risk, to examine dynamic profitability and pricing in a relatively young, innovative insurance market. Our tests generally indicate temporal price lowballing, thereby providing support for the no‐commitment models.     

Financing long-term care: employee needs and attitudes, and the employer's role.

Because of increasing life expectancies, high costs for nursing home and home health care, declining levels of informal family care, and the stated policy of the federal and state governments to foster self-reliance, individuals are increasingly exposed to the risk of financial ruin from long-term care (LTC) expenses. Yet, because of psychological barriers and aversions, particularly to thinking about residing in a nursing home, most individuals have not purchased LTC insurance. Hence, it may be the responsibility of employers to provide education to employees about LTC and to sponsor either individual or group plans of LTC insurance. Educational efforts may be particularly effective at the time of retirement when employees are in a more serious mood to consider the contingencies of retired life. A formal and perhaps more economical response for employers would be to offer combined life annuity and LTC insurance benefits through the retirement plan, provided certain regulatory and tax barriers can be removed.     

Product pricing and solvency capital requirements for long-term care insurance

This paper presents a comprehensive assessment of premiums, reserves and solvency capital requirements (SCRs) for long-term care (LTC) insurance policies using Activities of Daily Living and US data. We compare stand-alone policies, whole life insurance policies with LTC benefit riders (LTC insurance combined with whole life insurance), life care annuities (LTC insurance combined with annuities) and shared LTC insurance in terms of net premium cost and SCRs. Net premiums and best-estimate reserves for base LTC insurance policies are determined using Thiele’s differential equation. Product features such as the elimination period and the maximum benefit period are compared using a simulation-based model. We show how a maximum benefit period can reduce costs and risks for LTC insurance products. SCRs for longevity risk and disability risk are based on the Solvency II standard formula. We quantify the extent to which whole life insurance policies with LTC benefit riders and life care annuities provide lower SCRs than stand-alone LTC insurance policies.     

Don't They Care? Or,Are They Just Unaware? Risk Perception and the Demand for Long‐Term Care Insurance

The potential need for long‐term care (LTC) is one of the greatest financial risks faced not only by the elderly but also by their adult children, who often provide care or financial assistance. We investigate adult children's role in the demand for LTC insurance. Similar to flood insurance, we find that demand for LTC insurance is low due to low risk perception. The more aware adult children are of the risk, the more likely LTC insurance is to be purchased, either by the children themselves on behalf of their parents or by the parents under the influence of their children.     

Social long-term care insurance and redistribution

We study the role of social long-term care (LTC) insurance when income taxation and private insurance markets are imperfect. Policy instruments include public provision of LTC as well as a subsidy on private insurance. The subsidy scheme may be linear or nonlinear. For the linear part we consider an arbitrary number of types, characterized by earnings and survival probabilities. In the nonlinear part, society consists of three types: poor, middle class and rich. The first type is too poor to provide for dependence; the middle class type purchases private insurance and the high income type is self-insured. The main questions are at what level LTC should be provided to the poor and whether it is desirable to subsidize private LTC for the middle class. Interestingly, the results are not totally similar under both linear and nonlinear schemes. First, whereas in the linear case a subsidy of private LTC insurance is desirable, it is not in the nonlinear case (at least at the margin). Second, the desirability of public provision of LTC services depends on the way the income tax is restricted. In the linear case, it may be desirable only if no demogrant (uniform lump-sum transfer) is available. In the nonlinear case, public provision is desirable when the income tax is sufficiently restricted. Specifically, this is the case when the income is subject only to a proportional payroll tax while the LTC reimbursement policy can be nonlinear.     

关于农业保险改革的经济法思考

我国现行的商业性农业保险模式过于强调了私法自治,完全放弃了公法对农业保险市场的必要的适当的干预,未能处理好政府与市场在农业保险中的关系,片面强调市场机制的作用,忽视了农业保险作为公共产品的特殊性和市场机制本身的局限性.改革现行的农业保险模式,必须在立法和实践中贯彻经济法的理念、原则和方法,因为农业保险法本质上是经济法.     

基于社会主义新农村建设的商业保险发展策略

建设社会主义新农村离不开商业保险的保驾护航,同时也为商业保险提供了千载难逢的发展机遇.扎实做好保险宣传普及工作,提高农村公众的参与度;积极争取政府政策扶持,为农村保险发展创造良好环境;因地制宜地细分市场,开发适销对路的农村保险产品;完善服务措施等都是促进农村商业保险发展的有效手段,也是抓住这一机遇谋求自身发展,并积极推动社会主义新农村建设的重要措施.     

我国保险企业扩张模式分析

本文从产业组织理论角度对我国保险业普遍关心的扩展业务规模、寻求多元化发展、建立竞争优势的模式问题进行较为系统的分析,指出企业的竞争能力并不完全取决于规模,而且由于保险商品的特殊性和中国经济与社会发展的巨大的不平衡性,中国保险企业必然存在一个市场定位和适度规模问题,文章对保险业的扩张模式进行了分析并提出一些具体建议。     

Basel II and the Need for Bank Distress Resolution Procedures*

It is argued that without increased market discipline Basel II is not likely to resolve the regulatory problem caused by explicit and implicit guarantees of depositors and other creditors of banks. One way to enhance market discipline is to implement proposals for mandatory subordinated debt. For these proposals to achieve their objective, the non‐insurance of holders of subordinated debt must be credible. Increased credibility of non‐insurance of one or several groups of creditors could be enhanced if distress resolution procedures for banks were pre‐specified, and if they made possible bank failures without serious disruption of the financial system. The existence of rules for dealing with banks in distress not only enhances the credibility of non‐insurance of some creditors, it also allows for predictability of distress resolution costs for shareholders and management of banks. Such costs—if predictable—reduce the moral hazard incentives caused by deposit insurance schemes.     

Product Ratings as a Market Reaction to Deregulation: Evidence From the German Insurance Market

This study provides the first investigation of information markets as a reaction to deregulation of product forms in insurance markets. The article studies the case of Germany, where insurance product ratings entered the market after relaxation of product regulation in 1994. The ratings’ potential for enhancing the performance of a deregulated insurance market is analyzed by considering both market structure and governance characteristics of the rating market, since the theoretical literature predicts that both are important determinants of rating outcomes. Data from a unique panel data set containing disability insurance ratings from the three major rating agencies are also examined in light of theoretical predictions. Results suggest that market governance and competition characteristics are favorable for the production of unbiased and informative ratings. Ratings for disability insurance support this interpretation, since the characteristics of the ratings conform to theoretical predictions about ratings in well‐functioning rating markets.     

经济转轨国家存款保险制度的建立与实施

存款保险制度对转轨国家可以起到防止银行“挤兑传染”,达到金融体系稳定的目的;有利于建立平等竞争的市场环境;有利于构建有效的市场退出机制;有利于促进金融业的对外开放等。计划经济体制下隐性存款保险制度存在着影响公平、影响效率、滋生道德风险等问题。转轨国家存款保险制度的特点是:成立的时间较短;专门机构经营;强制性保险和设立保险额度等。     

我国人身保险市场结构变化与预测分析

虽然保险业经受了本次金融危机的考验,但是保险业可能成为系统性风险传导链条上的一环,因此,保险监管机构需要转变审慎监管方式,建立适合保险业的宏观审慎监管框架。在这个背景下,对中国人身保险市场结构现状有一个较为清晰和准确的认识就显得十分必要。研究发现:从全国范围来说,我国寿险市场主体数量较少,人身险市场集中度过高,市场结构为寡头垄断,但各地区的人身险市场结构又各有特点,经济发达地区人身险保险市场结构已经过渡到垄断竞争阶段。根据成分数据预测结果分析,在"十二五"期间,我国人身险的市场集中度继续呈下降趋势。     

全面开放对中国寿险产业组织的影响

在全面开放的背景下,中国寿险业的产业组织面临重构.寿险公司占有市场份额与其竞争努力程度负相关.国有背景的寿险公司及中资寿险公司具有一定的行为优势.较高的集中度代表较强的市场势力,必将导致较高绩效;市场竞争行为越激烈时,绩效越会因竞争消磨而表现欠佳.市场结构的改变可能会对不同的竞争行为模式产生差异化结果.应对全面开放,需从寿险公司、保险行业以及保险监管部门几方面进行改革.     

论重构现代市场经济环境下的保险业诚信文化——以国学古代伦理“义利之辩”为鉴

诚实守信是市场经济的一项最基本道德要求,就国家、企业和个人而言,皆有重要意义。保险业因其特有的金融性质、保障特点及社会责任,决定了此行业较其他行业而言,须有更高的诚信操守：诚信是保险企业生存与发展的内在要求,是提高公司核心竞争力的必然路径,更是保障保险市场的交易安全的逻辑前提。因此,要培育中国保险诚信文化,就必须借鉴国...     

Aged-care support in Japan: perspectives and challenges

This article explores economic aspects of the market for long-term care (LTC) in Japan. As the world's most rapidly aging nation, it is of interest to understand that country's current LTC system and projections of LTC utilization patterns and costs, as well as their potential drivers. Since Japan appears likely to experience important shortfalls in LTC in the future, the authors also discuss alternate forms of provision.     

美国保险市场对外开放的发展及对中国的启示

美国是发达国家中完全开放保险市场的代表。作为世界上最大的保险市场,无论从市场化程度或本国保险业发育程度看,美国无疑是市场开放度最高的国家。本文通过对美国保险市场对外开放发展的考察,尤其是金融危机后美国保险市场对外开放现状的分析,总结其发展的规律和特点,并结合中国的实际情况,对保险市场对外开放进程进行了研究,得出对中国的...     

Two Classroom Simulations in Financial Risk Management and Insurance

ABSTRACT: Few classroom experiences provide as much educational value as a simulation exercise. A properly structured simulation provides students with the motivation to learn, the opportunity to explore strategies in an environment conducive to experimentation, and the immediate instructional benefit of watching their decisions affect the outcome of the collective simulation experience. This article describes the procedure and relative success of two classroom simulations for students in introductory and intermediate risk management and insurance courses. The first simulation replicates the risk management function of futures contracts through the use of hypothetical traders in the corn market with different risk management needs. The corn futures trading simulation achieves several goals for an introductory course in risk management and insurance: (1) students learn the importance of capital market risk management mechanisms; (2) students understand the transfer of risk among hedgers and speculators; and (3) students receive exposure to the concept that risk management is both possible and necessary for both speculative and pure risks. The second simulation mimics the operation of the market for homeowners insurance. By dividing students into consumer groups and insurer groups, participants experience the effect of chance events and insurance purchase decisions on their wealth. Small groups of upper‐level students act as insurers, and must price, package, and sell their product with a limited amount of surplus. Introductory students serve as consumers with limited resources who must survey the market and decide what product to buy and from whom. The competitive element and relatively unregulated market provide students with the incentive to innovate in a market for a common type of insurance and also demonstrates the need for some amount of insurance regulation. These simulations supply a simple way to enhance students' understanding of important basic concepts in a format that provides a welcome break from the traditional lecture format.     

Value Creation in the Insurance Industry

Using the insights of current research in corporate finance and financial institutions, the authors briefly present a consistent economic framework for looking at insurance. Shareholders of insurance companies provide risk capital that is invested in financial assets and therefore earns the market return of the assets it is invested in. However, due to the legal and fiscal environment insurance companies are in, they have a competitive disadvantage at investing, and this gives rise to frictional capital costs. The core competence of insurers is in managing the size of these frictional capital costs. Insurers must ensure that they can sell insurance for a price in excess of what they need to produce the cover they sell and compensate the incurred frictional costs on risk capital. It is through the ability to do so that insurers create shareholder value.     

过度医疗行为研究述评

因为道德风险等投机行为普遍存在于医疗保险与医疗服务市场,所以过度医疗问题基本是保险市场的一个顽疾,也是相关学术界关注的焦点。在梳理对过度医疗行为概念界定的基础上,从医疗市场的特殊性、制度设计、防御治疗行为等角度解释了过度医疗行为产生的原因,并对现有抑制过度医疗行为的对策进行梳理,提出更为综合的过度医疗解决框架。最后,对过度医疗行为的研究文献进行了客观评价。