Damages Caps, Insurability, and the Performance of Medical Malpractice Insurance

This article uses the complete property‐casualty insurance files of the National Association of Insurance Commissioners from 1984 to 1991 to assess the effect of medical malpractice reforms pertaining to damages levels and the degree to which these damages are insurable. Limits on noneconomic damages were most influential in affecting insurance market outcomes. Several punitive damages variables specifically affected the medical malpractice insurance market, including limits on punitive damage levels, prohibitions of the insurability of punitive damages, and prohibition of punitive damages awards. Estimates for insurance losses, premiums, and loss ratios indicate effects of reform in the expected directions, where the greatest constraining effects were for losses. The quantile regression analysis of losses indicates that punitive damages reforms and limits were most consequential for firms at the high end of the loss spectrum. Tort reforms also enhanced insurer profitability during this time period.     

The Effects of Tort Reform on Medical Malpractice Insurers' Ultimate Losses

Whereas the literature evaluating the effect of tort reforms has focused on the impact of reforms on insurers' reported incurred losses, this article examines the ultimate effects of reforms using the developed losses from a comprehensive sample of insurers writing medical malpractice insurance from 1984 to 2003. Noneconomic damages caps are particularly influential in reducing medical malpractice losses and increasing insurer profitability. The long-run effects of these reforms are greater than insurers' expected effects; for example, 5- and 7-year developed loss ratios are below the initially reported incurred loss ratios for those years following the enactment of noneconomic damages caps. Analyses of reported losses consequently understate the ultimate effects of tort reforms. The quantile regressions show that reforms have the greatest effects for the firms that are at the high end of the loss distribution.     

“Crises” in medical malpractice insurance: Evidence of excessive price-cutting in the preceding soft market

Prior work suggests that heterogeneous information or weak incentives for solvency could have caused some general liability insurers to charge low ex ante prices during the early 1980s and mid-to-late 1990s, putting downward pressure on other firms’ prices and plausibly aggravating subsequent periods of rapid premium growth. We analyse whether the 1994–1999 “soft” market in medical malpractice insurance led some firms to underprice, grow rapidly, and subsequently experience upward revisions in loss forecasts (“loss development”), which could have aggravated subsequent market “crises”. Consistent with the underpricing hypothesis, the results indicate a positive relation between loss development and premium growth among growing firms. Underpricing was likely more prevalent among non-specialist malpractice insurers.     

Claims‐Made and Reported Policies and Insurer Profitability in Medical Malpractice

The liability crisis of the 1970s led to the introduction of a new type of insurance policy designed to reduce the undiversifiable uncertainty associated with writing long‐tail liability lines. These new claims‐made and reported policies gained favor in place of the traditional occurrence coverage in the early 1980s not only in medical malpractice but also in the general liability arena. The main question we want to address in this article is why two types of contracts that cover the same risk exposure exist in the medical malpractice insurance industry whereas only one exists primarily in other insurance lines.     

Reinsurance for Natural and Man-Made Catastrophes in the United States: Current State of the Market and Regulatory Reforms

U.S. insurers are heavily dependent on global reinsurance markets to enable them to provide adequate primary market insurance coverage. This article reviews the response of the world's reinsurance industry to recent mega-catastrophes and provides recommendations for regulatory reforms that would improve the efficiency of reinsurance markets. The article also considers the supply of insurance and reinsurance for terrorism and makes recommendations for joint public–private responses to insuring terrorism losses. The analysis shows that reinsurance markets responded efficiently to recent catastrophe losses and that substantial amounts of new capital enter the reinsurance industry very quickly following major catastrophic events. Considerable progress has been made in improving risk and exposure management, capital allocation, and rate of return targeting. Insurance price regulation for catastrophe-prone lines of business is a major source of inefficiency in insurance and reinsurance markets. Deregulation of insurance prices would improve the efficiency of insurance markets, enabling markets to deal more effectively with mega-catastrophes. The current inadequacy of the private terrorism reinsurance market suggests that the federal government may need to remain involved in this market, at least for the next several years.     

普惠型医疗保险发展:实践困境与优化方向

近年来,普惠型医疗保险成为多层次医疗保障体系发展的一大热点。文章首先介绍了中国普惠型医疗保险的发展现状及主要特点,其次通过对国内部分保险公司线上及线下调研,发现当前普惠型医疗保险发展面临配套法律法规有待健全、市场认可度普遍偏低、可持续经营能力不强、保险效果低水平重复、相关主体联动不足等困境。进一步分析美国、英国、德国、新加坡相关经验,提出具体的优化路径:以优化顶层设计为立足点,提高保险规制水平;以强化市场环境建设为切入点,提升市场认可度;以优化运行模式为突破点,激发保险生命力;以设计差异化产品为关键点,强化保险增补性;以建立联通机制为动力点,提高相关主体协同度。     

Ex Post Moral Hazard and Bayesian Learning in Insurance

We study a dynamic insurance market with asymmetric information and ex post moral hazard. In our model, the insurance buyer's risk type is unknown to the insurer; moreover, the buyer has the option of not reporting losses. The insurer sets premia according to the buyer's experience rating, computed via Bayesian estimation based on buyer's history of reported claims. Accordingly, the buyer has strategic incentive to withhold information about losses. We construct an insurance market information equilibrium model and show that a variety of reporting strategies are possible. The results are illustrated with explicit computations in a two‐period risk‐neutral case study.     

An Examination of Adverse Selection in the Public Provision of Insurance

Using a unique data set from Florida's residual property insurer, we test for adverse selection in the public provision of homeowners’ insurance in Florida. We find a significant relationship between the losses and deductible choices of insureds in Florida's residual homeowners’ insurance market. This relationship provides strong evidence of the existence of an adverse selection problem in Florida's residual property insurance market. While this relationship is important to Florida regulators (and taxpayers) specifically, a finding of an adverse selection problem in residual markets in general has implications more broadly for government providers of insurance as an adverse selection problem in these settings will impact the public policy debates and decisions involving these markets.     

The market value impact of operational loss events for US banks and insurers

This paper conducts an event study analysis of the impact of operational loss events on the market values of banks and insurance companies, using the OpVar database. We focus on financial institutions because of the increased market and regulatory scrutiny of operational losses in these industries. The analysis covers all publicly reported banking and insurance operational risk events affecting publicly traded US institutions from 1978 to 2003 that caused operational losses of at least $10 million – a total of 403 bank events and 89 insurance company events. The results reveal a strong, statistically significant negative stock price reaction to announcements of operational loss events. On average, the market value response is larger for insurers than for banks. Moreover, the market value loss significantly exceeds the amount of the operational loss reported, implying that such losses convey adverse implications about future cash flows. Losses are proportionately larger for institutions with higher Tobin’s Q ratios, implying that operational loss events are more costly in market value terms for firms with strong growth prospects.     

中国财产保险业巨灾损失赔付能力实证研究

中国社会已步入一个历史性的风险高度累积的发展阶段,在这样的环境中,以损失补偿为主要功能的财产保险业是否有足够的损失赔付能力就成为一个不能不考虑的重要问题。本文基于Cummins,Doherty和Anita(2002)的保险赔付能力度量模型,引入1998年～2007年中国保险业经营数据,在改进后的损失对数正态分布假设下,对2007年年末时点上在中国大陆经营财产保险业务的39家保险公司以及全行业整体巨灾损失赔付能力进行了实证分析。结果显示,在800亿到2000亿元的巨灾损失区间内,中国财产保险业的赔付效率在68.36%以上,全行业巨灾赔付能力缺口巨大,且损失幅度越大短缺的幅度越大。本文认为,造成这种赔付能力短缺的主要原因在于全行业资本与盈余的低水平以及再保险市场发展的严重滞后。     

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。     

The Economic Effects of Federal Participation in Terrorism Risk

The catastrophic terrorist attack of September 11, 2001 caused unprecedented insured losses. While the insurance industry covered these losses, it also took swift steps to limit its exposure to such risks in the future. In response to ensuing market dislocations, the Terrorism Risk Insurance Act (TRIA) was passed in 2002. The law temporarily requires primary insurers to offer terrorism coverage and creates a federal "backstop" to limit losses on such coverage. In anticipation of the program's scheduled expiration, and to inform debate on its possible extension, this article analyzes market developments in the wake of 9/11 and the passage of TRIA. We find that to date, TRIA has facilitated private sector participation in the market for terrorism insurance by lending structure to an otherwise ill-defined risk. While alternative terrorism risk bearing mechanisms are evolving, none appear ready to replace federal involvement presently. We conclude that a continuation of TRIA for a period of time would enhance U.S. economic performance in the near term. Failing to extend TRIA in the near term would result in decreased economic performance absent another major terrorist attack and greater instability, job loss, and bankruptcy in the event of another attack.     

Insurance Contract Design When the Insurer Has Private Information on Loss Size

This article examines the optimal indemnity contract in an insurance market, when the insurer has private information about the size of an insurable loss. Both parties know whether or not a loss occurred, but only the insurer knows the true value of the loss and/or to what extent the losses are covered under the policy. The insured may verify the insurer's loss estimate for a fixed auditing cost. The optimal contract reimburses the auditing costs in addition to full insurance for losses less than some endogenous limit. For losses exceeding this limit, the contract pays a fixed indemnity and requires no monitoring. The optimal contract is compared with the contracts obtained in cases where it is only the insured who can observe the loss size.
     

Corporate Insurance Strategy: The Case of British Petroleum

The authors provide a fundamental rethinking of how corporations should evaluate various kinds of risks and risk management solutions—a rethinking that leads to a major shift in British Petroleum's approach to insuring property and casualty losses, product liability suits, and other insurable events. Conventional corporate practice—and until the early 1990s (when this article was written) the longstanding policy of BP and most large oil companies—was to insure against large losses while self‐insuring against smaller ones. In this article, the authors explain why BP has chosen to go against the conventional wisdom and instead buy insurance for mainly smaller losses while self‐insuring larger ones. The BP decision came down to factors affecting the market supply of insurance as well as the corporate demand for it. On the demand side, the authors demonstrate that the primary source of demand for insurance by large public companies is not, as standard insurance textbooks assume, to transfer risk away from the corporation's owners. Because corporate stockholders and bondholders effectively manage the effects of such risks by diversifying their own portfolios, the corporate demand for insurance in BP's case stems from the insurers' comparative advantage in evaluating and monitoring BP's smaller risks and in processing claims. On the supply side, the authors explain why the capacity of insurance companies and markets to underwrite very large or highly specialized exposures—when compared to the industry expertise and financial resources of companies like BP—is quite limited, and likely to remain so. Since premiums would be experience‐rated and prior years' losses simply rolled into the following years' premiums, there would be no effective transfer of risk, and so no gain to BP from buying insurance.     

Asymmetric Information Problems in Taiwan's Automobile Insurance Market: The Effect of Policy Design on Loss Characteristics

This article investigates asymmetric information problems for the automobile insurance market in Taiwan. Using panel data for the comprehensive automobile insurance coverage from 1995 to 1999, this article analyzes how types of coverage, deductible amounts, and experience ratings have affected the adverse selection and moral hazard problems in Taiwan's automobile insurance market. The empirical results provide partial evidence to demonstrate that the loss frequency and loss ratio were reduced by the addition of self-selection mechanisms in policies with different levels of coverage. In addition, the deductible amounts, experience ratings, and better control of underwriting and claims processing were shown possibly to have decreased potential losses from adverse selection and moral hazard problems.     

上海自贸区对我国养老保险服务市场的影响

目前我国是世界上唯一一个老年人口接近2亿的国家．且正在以每年3％以上的速度在增长。庞大的老年人群体对医疗、护理等养老服务有着巨大的需求。这一需求单靠政府的力量是不可能满足的,亟待社会多元资本的参与。根据上海自贸区的总体方案．外商独资的医疗机构获得了准八的机会,因此,对我国医疗保险产品的创新和发展,以及老年医疗服务的提供有很好的借鉴作用,进而为外资参与养老服务领域提供了可能,带动我国养老服务市场的升级。     

Spillover effects of increased health insurance enrollment on workers’ compensation insurance

The Patient Protection and Affordable Care Act (ACA) was designed to increase the accessibility and affordability of health insurance. While the ACA did not contain direct provisions related to workers’ compensation (WC), because health‐related coverage is a significant portion of WC costs, the ACA could have unintentionally impacted the WC market. Specifically, expanded health insurance enrollment could reduce WC losses and result in higher performance among insurers participating in the WC market. Using insurer‐state level data, we consider the impact of increased health insurance enrollment on the performance of property‐casualty (PC) insurers. Utilizing multiple measures of performance, we find that the post‐ACA period is generally associated with greater profitability for PC insurers operating in the WC market, a positive unintended consequence of this federal regulation.     

Does Surplus Participation Reflect Market Discipline? An Analysis of the German Life Insurance Market

The aim of this paper is to analyze whether the level of surplus participation affects customer demand. We use multivariate linear regression models and data on surplus participation, new business, and lapse for the German life insurance market from 1998 to 2008. We find a significant positive dependence between surplus participation and new business growth as well as a significant negative dependence between surplus participation and growth of lapse volume. Overall, these findings indicate that customers do react to changes in product characteristics, which might be seen as indicative of market discipline. Our results are important for insurance company managers, regulators, and boards of insurance associations.     

Ökonomische Überlegungen zur Rationierung im Gesundheitswesen

This contribution first recalls the fact that binding budgets imposed by policy makers induce rationing, which in its turn by superseding the price mechanism causes inefficiencies in the market for medical services. In addition, inefficiencies spill over into the market for health insurance providing in-kind benefits, while possibly benefiting reimbursement health insurance. But then, the commodity ‘rationing’ itself has a market; indeed, the mere existence of health insurance creates demand for rationing that even increases over time. The contribution concludes with a listing of instruments at the disposal of health insurers designed to make the insured opt for policies with self-limitation features. Thus, insurers can help to reduce that demand for rationing and the inefficiencies that come with it.     

政府购买医疗保障服务政策下商业健康保险的盈利模式

新医改提出政府向商业健康保险公司购买医疗保障管理服务的思路,为私营医疗保险市场的进一步发展提供了政策支持。但医改方案公布后,除人保健康进入这一市场外,其他公司仍举旗观望,提供该类服务的公司寥寥无几。这一困境出现的原因是保险机构对政府购买经办服务政策下,相关产品组合的盈利模式缺乏认识。对可得的有限数据进行分析,期望总结中...