Insurance Branch Research Articles

Medicoeconomic evaluation of total disc replacement based on French National Health Care System data

Total disc replacement (TDR) has existed since 1984 but is not covered by the French national healthcare system (Sécurité Sociale). The present study assessed clinical outcomes, and also pre-, peri- and postoperative treatment costs. Surgical management of low back pain (LBP) provides medical and economic benefit. A prospective study recruited 19 patients in the Nice University Hospital Center (France); mean age, 41 years; 15 female. Inclusion criteria were: age less than 60 years; chronic low back pain (LBP) with single-segment discopathy; work related injuries and patients not covered under the General provision of the Sécurité Sociale were excluded. VAS, Oswestry and SF36 scores and return to work capability were analyzed. The local national health insurance branch office (Caisse Primaire d'Assurance Maladie [CPAM]) provided detailed coverage data for a 39-month period around the operation. Revision surgery was required for one instance of vertebral fracture. Preoperative follow-up was 14 months, postoperative FU 21 months and the perioperative period 4 months. LBP and quality of life showed improvement. Seventy-nine percent of patients reported satisfaction, 59% returned to work, and 84% had leisure activity. Total CPAM payout (reimbursement) was €399,082. Daily sickness benefit and disability compensation were the main cost items. Mean TDR cost per patient was €6833. Mean reimbursements were 19% lower post- than preoperatively. Pre- and postoperative clinical results did not correlate, while pre- and postoperative reimbursement costs did, as did cost and postoperative clinical status (r=-0.72). Preoperative cost was a predictive factor for postoperative clinical result. TDR achieves favorable medicoeconomic results. III: case-control study.

Early warning model with statistical analysis procedures in Turkish insurance companies

In this study, we have developed and tested a statistical early warning model to identify companies experiencing deteriorating financial health by examining 45 insurance companies acting in non-life elementary branches of insurance during the period between 1992 and 2006. We developed the model using data regarding 45 dependent and 17 independent variables and logit model. The present study extends previous analyses by using relatively more comprehensive accounting data in logit analysis. This study compared the ability of logit, discriminant and regression analyses to predict insurance company underperformance. The same model, comprised of identical variables, was obtained as the result of the multiple regression and multiple discriminator methods. When comparing the predictive ability of all three models, the logit model showed slightly better prediction ability than the other models. The three models used information from 2003 - 2006 to predict the performance of insurance companies in 2007. The research demonstrates that logit analysis has a strong potential. Key words: Insurance companies, early warning, discriminator analysis, regression analysis, financial failure, financial non-failure, financial analysis.

Gerechtigkeit im Verhältnis von Sozialer Pflegeversicherung und Privater Pflegepflichtversicherung

The long-term care insurance act of 1994 introduced two branches of long-term care insurance (LTCI), namely the social LTCI and a mandatory private LTCI. Both branches together cover almost the whole population. Insurees of the social LTCI, however, have a higher age-specific dependency ratio. Furthermore, social LTCI covers a higher share of elderly people. Therefore, per capita expenses are twice as high as in private LTCI - even if benefits for civil servants directly financed out of the public purse are taken into consideration. Moreover, on average members of private LTCI have higher incomes. If organised according to the principles of social LTCI, private LTCI could therefore operate with a contribution rate that is only one third of the rate necessary in social LTCI. Being assigned to social LTC thus creates a considerable disadvantage for the insurees that cannot be justified. Fairness considerations therefore demand reform. The most simple, but politically most difficult, reform option is to abolish the dualism of social and private LTCI and create an integrated system for the whole population instead. If this is not possible at least a risk equalization scheme should be introduced that equalizes the risk structure concerning the expenses and - if possible - also the income side.

Finanční krize modifikuje úlohu a postavení odvětví pojišťovnictví

Clanek analyzuje soucasnou financni krizi jako výsledek předchozi expanze uvěrů a poskytovani hypotecnich uvěrů nad ramec tolerovani tržnich principů. Vznik financnich problemů je spojen s financnimi inovativnimi instrumenty, v sekuritizovane podobě. Za pomoci těchto instrumentů bylo možne bez barier statni regulace, aby bankovni sektor ziskal nový soukromý kapital a obnovil uvěrovou aktivitu. Autoři ukazuji na roli investicniho bankovnictvi a ratingových agentur v tomto procesu. Zvlastni pozornost je věnovana vlivu financni krize na pojisťovnictvi. Krize v pojisťovnictvi se projevuje jako důsledek dvou vlivů: jednak riskantnějsich strategii pojistitelů v konstrukci pojistných produktů zahrnujicich inovativni financni produkty a jednak jako důsledek sniženi hodnoty aktiv pojisťovny. Clanek pojmenovava vliv otazky asymetrie informace na možne dopady na pojistitele v souvislosti s financni krizi. Zabýva se regulatornimi projekty (zejmena Solvency II pro pojisťovaci cinnost) a jejich možným dopady na pojisťovaci trh.

Application of classical and robust chain-ladder methods: results for the Belgian non-life business

The solvency II regulation for the non-life insurance business focuses on the application of the chain-ladder method in the EU. A recent memorandum of the EU also expresses its concern about the treatment of outlying data. Not only the appearance but certainly the consequences for the solvency risk capital are brought up. We will discuss the results of applying classical and robust chain-ladder methods to real data from several lines of business in the non-life insurance branch in Belgium.

Stochastic Actuarial Modelling of a Defined-Benefit Social Security Pension Scheme: An Analytical Approach

ABSTRACTAmong the systems in place in different countries for the protection of the population against the long-term contingencies of old-age (or retirement), disability and death (or survivorship), defined-benefit social security pension schemes, i.e. social insurance pension schemes, by far predominate, despite the recent trend towards defined-contribution arrangements in social security reforms. Actuarial valuations of these schemes, unlike other branches of insurance, continue to be carried out almost exclusively on traditional, deterministic lines. Stochastic applications in this area, which have been restricted mainly to occasional special studies, have relied on the simulation technique. This paper develops an analytical model for the stochastic actuarial valuation of a social insurance pension scheme. Formulae are developed for the expected values, variances and covariances of and among the benefit expenditure and salary bill projections and their discounted values, allowing for stochastic variation in three key input factors, i.e., mortality, new entrant intake, and interest (net of salary escalation). Each deterministic output of the valuation is thus supplemented with a confidence interval, that is, a range with an attached probability. The treatment covers the premiums under the different possible financial systems for these schemes, which differ from the funding methods of private pensions, as well as the testing of the level of the Fund ratio when the future contributions schedule is pre-determined. Although it is based on a relatively simplified approach and refers only to retirement pensions, with full adjustment in line with salary escalation, the paper brings out the stochastic features of pension scheme projections and illustrates a comprehensive stochastic valuation. It is hoped that the paper will stimulate interest in further research, both of a theoretical and a practical nature, and lead to progressively increasing recourse to stochastic methods in social insurance pension scheme valuations.

Některé aktuální problémy státního dohledu nad finančními trhy

Článek pojednává o hledání vhodného modelu tržně konformní regulace na českých finačních trzích. Je diskutováno v současnosti v ČR platné uspořádní integrovaného dohledu nad finančními trhy v rámci ČNB. Dále jsou komentovány názory Světové banky na některé otázky corporate governance v pojišťovncitví a při ochraně spotřebitele na finančním trhu. Autoři jsou zastánci nezvyšování míry regulace na finačních trzích.

Risk Classification and Public Policy

The economic effects of prohibiting the use of sex and other potentially discriminatory risk classifiers such as age, race or nationality are subject of a lasting debate among insurance economists. It can be traced back to the 1950s and received broad economic attention in the 1980s when spiralling car insurance premiums in the U.S. were blamed on tariff regulations prohibiting the use of sex, age and location as risk classifiers. The majority view today is that the problem of adverse selection arises if insurance firms are unable to distinguish between different types of risks. Risk classification, in this view, is not only a necessary but also a good thing. The leading justifications for risk classification are that without risk classification, low risks are unfairly forced to subsidize high risks, and that risk classification promotes socially beneficial efforts to prevent loss. Dissenting authors have demonstrated that the efficiency cost of prohibiting risk classification are much less than commonly stated. It depends critically on the propensity of people to self-insure (price elasticity of demand). It will therefore differ among branches of insurance, for example be higher for voluntary retirement schemes where savings alternatives exist than for life insurance with few substitutes. It will also differ according to regulatory embeddings, e.g., be non-existent in mandatory insurance schemes (if properly enforced). Critics have also demonstrated that risk classification can be socially wasteful. This is the case if it becomes purely selective. In a world of competitive voluntary insurance, eliminating the most risky from an insurance pool is a powerful tool of competition. It reduces the average cost of insuring the members of the pool, allowing the insurer to offer a lower price and, possibly, obtain a greater profit. This adverse selection ‘‘on the side of the insurers’’, while individually rational, produces a result that is contrary to the interest of society. It inhibits the ability of insurance to spread risk. The latest blow against risk classification comes from the EU’s directive implementing the principle of equal treatment between women and men in the supply of goods and services. This so-called ‘‘Gender Equality Directive’’ aims to prohibit the

Prevalence of Physician-Diagnosed Asthma in Saskatchewan, 1981 to 1990

To examine trends in asthma prevalence in the Province of Saskatchewan using the Medical Claim Insurance Branch (MCIB) database. For each calendar year from 1981 to 1990, first visits to physicians for asthma were identified from the MCIB database. Age- and sex-specific prevalence rates were obtained for each calendar year by dividing the number of first asthma visits by the number of subjects in the age- and sex-specific group insured by the Provincial Government of Saskatchewan in that calendar year. Asthma prevalence increased in children and adults from 1981 to 1990. In the calendar year 1990, the prevalence of asthma was 5.1% in children < or = 4 years old, 4.4% in children 5 to 14 years old, 2.2% in young adults 15 to 34 years old, and 1.9% in adults 35 to 64 years old. Boys had higher asthma prevalence than girls in the age groups 0 to 4 years and 5 to 14 years, but it was reversed in older age groups, with women having greater asthma prevalence than men. Asthma diagnoses were verified by checking for asthma-related drug purchase in the Prescription Drug Plan database. Among the 0- to 4-year-old children with physician-diagnosed asthma, 57.3% purchased at least one asthma-related drug in 1981 and 72.3% purchased that in 1990. Among adults, asthma-related drug purchase was >73% in 1990. Asthma prevalence increased in children and adults in the province of Saskatchewan. Reasons for the increase are not clear and further studies are required to determine factors related to the increase.

The role of insurance in the prevention of work-related accidents in France in the first half of the 20th century.

Insurance has played a role in the develoment of prevention of work-related accidents in several ways in France since the industrical revolution. The first attempts at prevention were taken at the initiative of manufacturers' associations, but it remained a matter of goodwill for manufacturers. The 1898 law gave systematic, if partial, financial responsability for occupational hazards to employers, who turned to insurance companies to carry the risks. As a result a new branch of insurance (assurance-loi) appeared, which accounted for 40% of general accident revenue for companies at the time of World War II. But the new law made no mention of prevention and even had a negative impact, since compensation was taken care of by insurance. However, after World War I, insurance companies created an association for the prevention of work-related accidents and illnesses and started to adjust rates according to the prevention efforts of corporations. When social insurance was generalized in 1946, insurance of occupational hazards went under state control and became compulsory. But the experience accumulated in the field of prevention by insurance companies was put to use in this new context, both on the technical side and the financial side.

Insurance branch index

Insurance branch index

Extreme Values in Business Interruption Insurance

The size distribution of yearly claims in the French business interruption insurance branch is a Pareto law with an extremely long tail. The behavior of that law reflects the fact that the total value of yearly claims is dominated by a small number of huge claims. The estimated characteristic exponent of the tail is very close to one. The article analyzes the consequences of that particular value on the actuarial risk covered by the insurance and the reinsurance companies.

İŞ KAZALARI İLE MESLEK HASTALIKLARI VE SOSYAL GÜVENLİK SİSTEMİ

In the world experience, Work accidents and Occupational diseases have an important place in the development of social security systems. These insurance branches also pose a threat to the insured, businesses and the actuarial balance of the social security system. Occupational accident constitutes the situation of the accident that occurs completely in working life and is one of the leading occupational risks. Occupational diseases are diseases that are caused by the factors that the employee faces in the working environment. Occupational diseases are diseases specific to certain occupations. The purpose of the occupational accident and occupational disease insurance is to provide social, legal and economic security to the insured individual in case of a work accident or occupational disease. There is an increase in occupational accidents and occupational diseases in working life. This increase harms individual and public health and negatively affects working life. However, it imposes an economic burden on social security systems. The loss of the individual who has had a work accident due to labor, earnings and social life, has material and moral effects on the society in which the accident victim lives. In addition, their effects on the working environment, businesses and social security systems necessitate the examination of work accidents and occupational diseases separately. In this study, work accidents and occupational diseases, their effects on social security systems are emphasized.

The Preventive Approaches of the Statutory Accident Insurance System and Their Effectiveness.

For decades, prevention has been an integral and important part of the German statutory accident insurance system. The very close link between prevention, rehabilitation, and compensation, which is so typical for the German system, had an extremely positive effect on the frequency of notifiable occupational accidents. What is more, if we compare benefits and costs of the system, it appears that prevention has also been successful in a strictly monetary sense. After a short outline of the basic principles of the German accident insurance system, the authors take stock of the last 33 years. The period between 1960 and 1993 also covers the repercussions of the German reunification in 1990. The trends in accident and disease frequency are presented together with the trends in costs and benefits. To allow a realistic comparison, all figures are indicated in terms of 1960. It can be shown that the average contribution rate to accident insurance decreased in the period under consideration. This is particularly remarkable if we look at the enormous increase in contribution rates that took place in all other branches of social insurance. It is also noted that the contribution rates of the different industrial branches are immediately dependent on the accident risks in those industries. The last part of the article contains a qualitative and quantitative description of the prevention measures available to the German accident insurance institutions.

BUSINESS INTERRUPTION INSURANCE, A RISKY BUSINESS: A STUDY ON SOME PARETIAN RISK PHENOMENA

Both the size-distribution or yearly claims in the French business interruption insurance branch and the claim size-distribution per firm have a Pareto tail. It is so long that the theoretical law has an infinite expectation. This paper analyzes the data and investigates the consequences of that Paretian behavior on the actuarial value of the business interruption insurance policies.

Insurance branch index

Insurance branch index

Restrictions of competition on insurance markets and the applicability of EC antitrust law

This paper discusses the exemption of the insurance branch from the applicability of EC antitrust rules. It argues that the conditions for an exemption are not met and that the exemption allows the existing restrictions on competition to remain in existence, which will seriously hinder the realization of a common insurance market. The exemption, which is the result of lobbying by the insurance industry, will reduce the importance of modest successes of liberalization of insurance markets. Copyright 1995 by WWZ and Helbing & Lichtenhahn Verlag AG

Etat, compagnies d'assurances et marché de la protection des biens

According to this paper the taking off and the mobility of the protection market is more or less linked to the new orientations of the insurance branch, due to the fading State. Today, insurance companies do not only reimburse claims. Being involved in more and more numerous steps of the «security process», they are modeling the main forms of property risks' prevention; they prompt their clients to buy protection and check for the consequences of this policy.

French surgeons accused of fraud

Thirty French orthopaedic surgeons are being investigated for allegedly having swindled the social security's health insurance branch by receiving kickbacks for prescribing hip prostheses. Twenty two separate complaints have been lodged by regional branches of the “Secu” after a lengthy investigation showed the existence of a company that overcharged for prosthetic devices and paid doctors a percentage of the inflated sales prices. The investigation was led by Maurice Dachary, director of the health insurance branch of …

French orthopaedic surgeons charged with fraud

Public prosecutors in several French cities have charged a dozen orthopaedic surgeons with overpricing knee prostheses and receiving kickbacks from producers or importers of the devices. More than 100 surgeons may have been involved in an alleged swindle that may have cost the social security's health insurance branch about Fr100m (pounds sterling12m) over three years. About 22000 knee prostheses are used in France …