German Insurance Research Articles

Negative effects in internet-based interventions for depression: A qualitative content analysis

An increasing number of studies is proving the efficacy of Internet-based interventions (IBI) for treating depression. While the focus of most studies is thereby lying on the potential of IBI to alleviate emotional distress and enhance well-being, few studies are investigating possible negative effects that might be encountered by participants. The current study was therefore exploring self-reported negative effects of participants undergoing a cognitive-behavioral IBI targeting mild to moderate depression over 6 weeks. Data from the client pool of a German insurance company (n = 814, 68% female) revealed that 8.6% of the participants reported the experience of negative effects. Qualitative content analysis yielded two broad categories and five subcategories for the nature of participants' experiences of negative effects: participant-related negative effects (insight and symptom) and program-related negative effects (online format, contact, and implementation). By using both, qualitative and quantitative methods, results did not only shed light on the characteristics of negative effects but analyses also found that working alliance was a predictor for the experience of negative effects. Monitoring the occurrences of negative effects as well as working alliance throughout treatment was considered essential to help prevent negative effects and attrition among participants undergoing IBI for depression.

Benefits of a Disease Management Program for Sickle Cell Disease in Germany 2011-2019: The Increased Use of Hydroxyurea Correlates with a Reduced Frequency of Acute Chest Syndrome.

Sickle Cell Disease (SCD) is the most common monogenic disorder globally but qualifies as a rare disease in Germany. In 2012, the German Society for Paediatric Oncology and Haematology (GPOH) mandated a consortium of five university hospitals to develop a disease management program for patients with SCD. Besides other activities, this consortium issued treatment guidelines for SCD that strongly favour the use of hydroxyurea and propagated these guidelines in physician and patient education events. In order to quantify the effect of these recommendations, we made use of claims data that were collected by the research institute (WIdO) of the major German insurance company, the Allgemeine Ortskrankenkasse (AOK), and of publicly accessible data collected by the Federal Statistical Office (Statistisches Bundesamt, Destatis). While the number of patients with SCD in Germany increased from approximately 2200 in 2011 to approximately 3200 in 2019, important components of the recently issued treatment guidelines have been largely implemented. Specifically, the use of hydroxyurea has more than doubled, resulting in a proportion of approximately 44% of all patients with SCD being treated with hydroxyurea in 2019. In strong negative correlation with the use of hydroxyurea, the frequency of acute chest syndromes decreased. Similarly, the proportion of patients who required analgesics and hospitals admissions declined. In sum, these data demonstrate an association between the dissemination of treatment guidelines and changes in clinical practice. The close temporal relationship between the increased use of hydroxyurea and the reduction in the incidence of acute chest syndrome in a representative population-based analysis implies that these changes in clinical practice contributed to an improvement in key measures of disease activity.

EU intermediary regulation and its impact on insurance agent quality: Evidence from Germany

Implementation of the EU Directive on Insurance Mediation (2002/92/EG) created the first professional licensing requirements for insurance agents in Germany. This study uses data on property-liability insurance policies from a German insurer encompassing the years just before and just after the Directive, to provide evidence of the impact of licensing on insurance intermediation quality. Because many agents left the market once licensing was required, we compare the pre-Directive quality of agents who exit the market with those who remain, and the pre- versus post-Directive quality of agents who remain in the market. Estimation results show no significant effects of licensing on agent quality, either through exit of low-quality agents or through changes in post-Directive quality. Results are most consistent with an increase in consumer search activity after the enactment of licensing.

Effectiveness of a Dental Intervention to Improve Oral Health among Home Care Recipients: A Randomized Controlled Trial.

We quantified the effectiveness of an oral health intervention among home care recipients. Seven German insurance funds invited home care recipients to participate in a two-arm randomized controlled trial. At t0, the treatment group (TG) received an intervention comprising an oral health assessment, dental treatment recommendations and oral health education. The control group (CG) received usual care. At t1, blinded observers assessed objective (Oral Health Assessment Tool (OHAT)) and subjective (Oral Health Impact Profile (OHIP)) oral health and the objective periodontal situation (Periodontal Screening Index (PSI)). Of 9656 invited individuals, 527 (5.5%) participated. In the TG, 164 of 259 (63.3%) participants received the intervention and 112 (43.2%) received an outcome assessment. In the CG, 137 of 268 (51.1%) participants received an outcome assessment. The OHAT mean score (2.83 vs. 3.31, p = 0.0665) and the OHIP mean score (8.92 vs. 7.99, p = 0.1884) did not differ significantly. The prevalence of any periodontal problems (77.1% vs. 92.0%, p = 0.0027) was significantly lower in the TG than in the CG, but the prevalence of periodontitis was not (35.4% vs. 44.6%, p = 0.1764). Future studies should investigate whether other recruitment strategies and a more comprehensive intervention might be more successful in improving oral health among home care recipients.

How Does SARS-CoV-2 Infection Affect Survival of Emergency Cardiovascular Patients? A Cohort Study From a German Insurance Claims Database

A previous study revealed a preliminary trend towards higher in hospital mortality in patients admitted as an emergency with acute stroke during the COVID-19 pandemic in Germany. The current study aimed to further examine the possible impact of a confirmed SARS-CoV-2 infection on in hospital mortality.

Multicriteria asset allocation in practice

In this paper, we consider the strategic asset allocation of an insurance company. This task can be seen as a special case of portfolio optimization. In the 1950s, Markowitz proposed to formulate portfolio optimization as a bicriteria optimization problem considering risk and return as objectives. However, recent developments in the field of insurance require four and more objectives to be considered, among them the so-called solvency ratio that stems from the Solvency II directive of the European Union issued in 2009. Moreover, the distance to the current portfolio plays an important role. While the literature on portfolio optimization with three objectives is already scarce, applications in the financial context with four and more objectives have not yet been solved so far by multi-objective approaches based on scalarizations. However, recent algorithmic improvements in the field of exact multi-objective methods allow the incorporation of many objectives and the generation of well-spread representations within few iterations. We describe the implementation of such an algorithm for a strategic asset allocation with four objective functions and demonstrate its usefulness for the practitioner. Our approach is in operative use in a German insurance company. Our partners report a significant improvement in their decision-making process since, due to the proper integration of the new objectives, the software proposes portfolios of much better quality than before within short running time.

Financial Stability of European Insurance Companies during the COVID-19 Pandemic

The European Insurance and Occupational Pensions Authority suggests that as the coronavirus disease 2019 (COVID-19) pandemic has caused significant disruption to the economy, businesses, and people’s lives, national supervisory authorities should mitigate the pandemic’s impact on the European insurance sector. The functioning of insurance companies is in danger as they must balance a drastic increase in the number of claims with their capital and solvency stability. In this study, we evaluate the effects of the COVID-19 pandemic on insurance companies using European insurance companies’ financial statement data from 2010 to 2020. The results unambiguously demonstrate that the pandemic has negatively affected the functioning of the insurance sector. In particular, the return on assets decreased in German and Italian insurance companies during the pandemic. Furthermore, the solvency ratio decreased in the Belgian, French, and German insurance sectors. Conversely, the Polish insurance sector was unaffected. Moreover, we did not find any effects on the Z-score ratio in our sample. Lastly, the value of receivables owed to Belgian insurance companies increased. Based on this evidence, we argue that European legislators should discuss how to manage the probable financial problems of insurance companies during the COVID-19 pandemic.

How Does SARS-CoV-2 Infection Affect Survival of Emergency Cardiovascular Patients? A Cohort Study From a German Insurance Claims Database

ObjectiveA previous study revealed a preliminary trend towards higher in hospital mortality in patients admitted as an emergency with acute stroke during the COVID-19 pandemic in Germany. The current study aimed to further examine the possible impact of a confirmed SARS-CoV-2 infection on in hospital mortality.MethodsThis was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalised for ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction, acute limb ischaemia (ALI), aortic rupture, acute stroke, or transient ischaemic attack (TIA) between 1 January 2017, and 31 October 2020, were included. Admission rates per 10 000 insured and mortality were compared between March − June 2017 – 2019 (pre-COVID) and March − June 2020 (COVID). Mortality rates were determined by the occurrence of a confirmed SARS-CoV-2 infection.ResultsA total of 316 718 hospitalisations were included (48.7% female, mean 72.5 years), and 21 191 (6.7%, 95% CI 6.6% – 6.8%) deaths occurred. In hospital mortality increased during the COVID-19 pandemic when compared with the three previous years for patients with acute stroke from 8.3% (95% CI 8.0 – 8.5) to 9.6% (95% CI 9.1 – 10.2), while no statistically significant changes were observed for STEMI, NSTEMI, ALI, aortic rupture, and TIA. When comparing patients with confirmed SARS-CoV-2 infection (2.4%, 95% CI 2.3 – 2.5) vs. non-infected patients, a higher in hospital mortality was observed for acute stroke (12.4% vs. 9.0%), ALI (14.3% vs. 5.0%), and TIA (2.7% vs. 0.3%), while no statistically significant differences were observed for STEMI, NSTEMI, and aortic rupture.ConclusionThis retrospective analysis of claims data has provided hints of an association between the COVID-19 pandemic and increased in hospital mortality in patients with acute stroke. Furthermore, confirmed SARS-CoV-2 infection was associated with increased mortality in patients with stroke, TIA, and ALI. Future studies are urgently needed to better understand the underlying mechanism and relationship between the new coronavirus and acute stroke.

German Insurance Market

German Insurance Market

Affirmative and silent cyber coverage in traditional insurance policies: Qualitative content analysis of selected insurance products from the German insurance market

This paper examines the design of affirmative and silent coverage in view of the cyber risks in traditional insurance policies for select product lines on the German market. Given the novelty and complexity of the topic and the insufficient coverage in the literature, we use two different sources. We analysed the general insurance terms and conditions of different traditional insurance lines using Mayring’s qualitative content analysis. Also, we conducted interviews with experts from the German insurance industry to evaluate how insurers understand their silent cyber exposures, and what measures they take to deal with this new exposure. The study shows a considerable cyber liability risk potential for insurers in the considered insurance lines. This arises from the affirmative as well as silent cover inclusions and exclusions for cyber risks, which result from imprecise wordings of insurance clauses and insufficient descriptions of the contractually specified scope of the insurance coverage.

A Lean Six Sigma framework for the insurance industry: insights and lessons learned from a case study

It has long been recognized in the literature that the Lean and Six Sigma methodologies can complement each other fruitfully. So far, however, researchers have not been able to derive definitive conclusions on how to combine these methods; furthermore, there is little research on how to apply them to service firms. We develop a framework for integrating Lean and Six Sigma instruments in the service industry, particularly in the insurance sector, and discuss it in the context of the insights we gained from a large-scale project carried out at a large German insurance company. We show how various instruments drawn from these two methodologies can be (a) adapted to the insurance industry and (b) combined productively to enable a company to achieve its strategy and goals. The conclusions we draw from these insights can help a wide range of companies customize the combination of the Lean and Six Sigma approaches to suit their specific needs.

Customer-centric prioritization of process improvement projects

Today, customers can conveniently compare products and decide how to interact with companies. With customer centricity becoming an important success factor, companies must drive customer satisfaction not only through excellent products but also through customer-centric processes. As many companies face an abundance of action possibilities, fast-changing customer needs, and scarce resources, guidance regarding the customer-centric prioritization of process improvement projects is in high need. As existing approaches predominantly focus on process efficiency, we propose a decision model that accounts for the effects of process improvement on customer centricity in line with justificatory knowledge on value-based process decision-making, project portfolio selection, and the measurement of customer satisfaction. When building the decision model, we adopted the design science paradigm and used multi-criteria decision analysis as well as normative analytical modeling as research methods. We evaluated the model by discussing it with practitioners, by building a software prototype, and by applying it at a German insurance company. Overall, our research extends the prescriptive knowledge on process prioritization and customer process management.

Corporate governance of insurers in Germany. German National Report

Corporate governance is the set of rules, be they legal or self-regulatory, practices and processes pursuant to which an insurance undertaking is administrated. Good corporate governance is not only key to establishing oneself and succeeding in a competitive environment but also to safeguarding the interests of all stakeholders in an insurance undertaking. It is insofar not surprising that mandatory requirements on the administration of insurance undertakings have become rather prolific in recent years, in an attempt by regulators to protect especially policyholders against perceived risks hailing from improperly governed insurance undertakings. In Germany this has been regarded by many undertakings as an overly paternalistic approach of the legislator, especially considering that the German insurance sector has experienced for decades if not centuries a remarkably low number of insolvencies and that German insurers were neither the trigger nor the (especially) endangered actors in the financial crisis commencing in 2007. Notwithstanding the true core of this criticism, that the insurance industry was taken to a certain degree hostage by the shortcomings within the banking sector, the reform of German Insurance Supervisory Law via implementation of the Solvency II-System has brought many advances in the sense of better governance of insurance undertakings and has also brought to light many deficiencies that the administration of some insurance undertakings may have suffered from in the past, which are now more properly addressed.

Acceptance Factors of Car Insurance Innovations: The Case of Usage-Based Insurance

Usage-Based Insurance (UBI) is an application of Intelligent Transportation Systems (ITS) in the context of car insurance. UBI refers to insurance models in which insurers collect driving data using a telematics device. Based on the collected information, insurers can offer individual discounts depending on driving behaviour and provide feedback about each trip. Although there are plenty of advertising materials about the benefits of UBI, its user acceptance and usability have not received much research attention so far. To cover this gap, we conducted two user studies: semi-structured interviews with UBI users and a qualitative analysis of 186 customer inquiries concerning a UBI program from a web forum of a German insurer. We found that UBI can benefit drivers, insurers and society. Moreover, the country driving conditions, the policy conditions, the users’ perceived driving style, the perception of UBI, and the premium reduction influence UBI acceptance. Regarding traffic safety, some of our participants were concerned that UBI may provoke dangerous driving behaviour under certain circumstances. Finally, we make recommendations for insurers derived from users’ views, such as to provide to drivers more control over the user interface and over the way driving feedback is given to them. Concerning the driving scores, the ways in which they are calculated should be more transparent.

독일 보험감독법상 보험그룹 규제에 관한 연구

독일 보험감독법상 보험그룹 규제에 관한 연구

Responsible Recruiting in Insurance Sales

Recruiting processes imply a considerable potential for waste of resources, both in general and in the insurance sales area focused here. A comprehensible measure for sustainability in sales was identified and information offers of large German insurers on job offers in the field of sales force were analysed. While the recruitment of lateral entrants has no measurable influence on sustainable sales, clear correlations between the information offered for future salespeople and sustainable results were found. In addition, a clear negative correlation between multi-level marketing and sustainable insurance sales was found.

Enterprise risk management and economies of scale and scope: evidence from the German insurance industry

Enterprise risk management (ERM) is the approach of managing all risks faced by an enterprise in an integrated, holistic fashion. This research investigates whether the utilization of the ERM approach helps firms achieve economies of scale and scope. We use detailed survey data of German property-liability insurance companies that allows us to construct continuous measures of ERM quality. We find that ERM quality positively moderates the size-scale efficiency relationship, and we find that ERM positively moderates the diversification-revenue scope efficiency relationship, indicating that ERM facilitates economies of scale and economies of scope with respect to revenue complementarities. We do not find any evidence of economies of scope with respect to cost complementarities. Our results suggest that ERM’s impact on economies of scale and scope is one answer to the question of how ERM can create value.

책임보험의 운용에 있어서 한ㆍ독 보험계약법상 차이

책임보험의 운용에 있어서 한ㆍ독 보험계약법상 차이

SOCIAL INSURANCE SYSTEMS IN RUSSIA AND GERMANY: SOCIOLOGICAL ANALYSIS

Social insurance occupies a special place in the entire social policy of the state. Developed system of social insurance in the country provides citizens with effective protection mechanisms and thereby ensures economic stability and creates an atmosphere of social cohesion in society. At present, social insurance systems in Russia and Germany have significant differences that include both the structure and functioning of each type of insurance separately. These differences in the organization of social insurance systems in Russia and Germany are traceable from the very beginning. System of social insurance in modern Russia has been developing to a certain extent inconsistently and to the present time still is not completely formed. The German system developed gradually and improved with regard to the features of the interests of society at various stages of its development. The establishment of the Federal Republic of Germany as a social state determined the modern model of the social insurance system. Therefore, the study of the German model is interesting from the point of view of the subsequent possible introduction of its elements into Russian insurance practice. The article compares social insurance systems of Russia and Germany. The components of the systems are studied; their similarities and differences are revealed. Opinions of experts of the Federal Service for Labor and Employment on the prospects and problems of the development of the Russian model of the social insurance system and the possibility of using the German insurance experience in Russian practice are given.

Balancing growth, profitability and safety in the German insurance market

The contribution of this paper is to provide an improved understanding of the relationship between the three strategic objectives growth, profitability and safety of insurance companies in Germany. Extending on the work by Eling et al (2017), we introduce measures and provide descriptive statistics for each objective. Our numerical analysis relies on panel data of German insurers for the years from 2001 to 2016 providing almost full market coverage. We apply different statistical tests and multilinear regression models to test how and to what extent the objectives are related. At the same time, we control for the legal status, the size of the insurance business and the calendar year. Regarding the total insurance market, our results suggest a positive and significant relationship between growth and profitability and a negative significant one between the safety level and profitability. Further, mutual and public insurers relate to lower growth and higher safety levels than listed companies. For the business volume, we find that larger companies tend to grow at a lower rate when compared to smaller companies while achieving higher profitability but lower safety levels. The results per business line show that life insurers yield significantly different results from non-life insurers. Thus, we separately analyze and discuss the results for the life and the non-life sectors.