Long-term Insurance Research Articles

The US-Philippine Alliance: An Evolving Hedge Against an Emerging China Challenge

In the mid-1990s the Philippines and the United States revived their dormant alliance after China's occupied Mischief Reef, a small atoll in the disputed Spratlys archipelago and lying 130 miles off the country's easternmost island of Palawan. On the heels of the 11 September 2001 Al Qaeda attacks in the United States, the two allies further revitalized their security relationship to address transnational terrorism. In the process, Manila was able to secure vital US military and economic assistance for its counter-terrorism/insurgency campaign against domestic insurgents, i.e. Abu Sayyaf Group (ASG), the New People's Army (NPA) and the Moro Islamic Liberation Front (MILF). Since that time, the two allies have taken gradual but significant steps to transform their alliance as a hedge against the geostrategic challenges posed by China's rising power. This transformation involves deepening the two countries' military relations through organizational planning, professional training and the development of interoperability for a long-term mobilization strategy in a potential US-China military/diplomatic face-off. This article examines recent trends that have gradually transformed the US-Philippine alliance from a product of the Cold War to a hedge against changes in the regional strategic equation generated by China's economic and political emergence. Hedging is primarily a long-term insurance policy that involves the following strategies: (i) the hedging states engage the potentially threatening state in an effort to socialize it into accepting certain norms of international behaviour; and (ii) the hedging states strengthen their diplomatic and military relations so that they can effectively influence the target state's foreign policy behaviour. Neither Manila nor Washington considers Beiiing as an imminent security threat. Both countries, in fact, are pursuing policies of active engagement with China. However, the two allies view that China has the potential to become an acute security challenge in East Asia due to its expansive claims in the South China Sea and ongoing military modernization. Should engagement fail, and should China adopt a more assertive posture that undermines the regional status quo, the US and the Philippines will have in place a cohesive and strengthened security relationship to constrain this emerging power's behaviour. This article specifically addresses one primary question: what recent developments have deepened the US-Philippine security relationship against international terrorism and in the process, slowly and incrementally transformed the alliance into a hedge strategy for dealing with a long-term China challenge? The article also tackles several corollary questions: First, what incidents led to the revival of US-Philippine security relations in the mid-1990s? Second, how is this revitalized alliance functioning in the current campaign against global terrorism? Third, how has China tried to create a cleavage in the alliance? Fourth, how has the US responded to China's economic and diplomatic gambits in the Philippines? And fifth, what is the future of the US-Philippine alliance in the face of China's rising power? Alliances and Alliance Cohesion States form alliances for the purposes of aggregating power, enhancing the capacities of each member through a deterrent guarantee provided by a more powerful state, or to increase their capabilities by pooling their resources to bolster their defence and security capabilities. As a form of interstate cooperation, an alliance is defined as an explicit promise or commitment of mutual military (and sometimes political) assistance between two or more sovereign states. (1) Thus in general, alliances involve the physical act of assisting allies through military cooperation and collaboration. Allies usually combine their efforts against a specific and common enemy, ordinarily another state, more powerful than either or any of the allies individually. …

Excessive Financialisation: Insuring Lifestyles, Enlivening Subjects, and Everyday Spaces of Biosocial Excess

The last two decades have witnessed, as part of a wider financialisation of British economy and society, a creeping privatisation of social welfare provision. Political justification for the expansion of privatised social insurance markets has frequently been couched in the language of responsibility. However, as the ‘credit crunch’ spectacularly attests and as studies of the dynamics of financialisation have succeeded in showing, financialised capitalism turns on excess. In this paper we explore some of the ways in which the reworking of long-term insurance or life assurance has contributed to the financialisation of everyday life. More particularly, we trace the emergence of what we call ‘lifestyle insurance’. Our purpose here is not only to begin to map the terrain and consider the consequences of this nascent modality of insurance in the UK, but in so doing to contribute to wider debates about the processes of subjectification that underwrite financialisation. In addition to pressing for a greater attention to be given to life assurance the paper suggests, by mobilising the figure of excess, three more areas to which studies of the financialisation of the everyday might productively attend: first, the financialisation of life itself; second, the ways in which financialisation is affectively charged; third, the spatial politics of financialisation.

Sampling Distributions of Critical Illness Insurance Premium Rates: Breast and Ovarian Cancer

Evaluating the risk of disorders in long-term insurance often relies on rates of onset estimated from quite small epidemiological studies. These estimates can carry considerable uncertainty, hence so may functions of them, such as a premium rate. In the case of genetic disorders, where it may be required to demonstrate the reliability of genetic information as a risk factor, such uncertainty may be material. Epidemiological studies publish their results in a variety of forms and it is rarely easy to estimate the sampling distribution of a premium rate without access to the original data. We found a large study of breast and ovarian cancer that cited relative risks of breast and ovarian cancer onset, with confidence intervals, in 10-year age groups. We obtained critical illness premium rates and their sampling distributions by parametric bootstrapping, and investigated the effect of possible patterns of sampling correlations. We found that this study provides ample statistical evidence that known BRCA1 or BRCA2 mutations, or a typical family history of breast or ovarian cancer, are reliable risk factors, but the sampling covariances of the relative risks could be important at some ages and terms. Studies that cite only standard errors of parameter estimates erect a small but awkward barrier between the models they describe, and some important actuarial questions.

Sampling Distributions of Critical Illness Insurance Premium Rates: Breast and Ovarian Cancer

Evaluating the risk of disorders in long-term insurance often relies on rates of onset estimated from quite small epidemiological studies. These estimates can carry considerable uncertainty, hence so may functions of them, such as a premium rate. In the case of genetic disorders, where it may be required to demonstrate the reliability of genetic information as a risk factor, such uncertainty may be material. Epidemiological studies publish their results in a variety of forms and it is rarely easy to estimate the sampling distribution of a premium rate without access to the original data. We found a large study of breast and ovarian cancer that cited relative risks of breast and ovarian cancer onset, with confidence intervals, in 10-year age groups. We obtained critical illness premium rates and their sampling distributions by parametric bootstrapping, and investigated the effect of possible patterns of sampling correlations. We found that this study provides ample statistical evidence that known BRCA1 or BRCA2 mutations, or a typical family history of breast or ovarian cancer, are reliable risk factors, but the sampling covariances of the relative risks could be important at some ages and terms. Studies that cite only standard errors of parameter estimates erect a small but awkward barrier between the models they describe, and some important actuarial questions.

Reducing Losses from Catastrophic Risks through Long-Term Insurance and Mitigation

Howard Kunreuther Reducing Losses from Catastrophic Risks through Long-Term Insurance and Mitigation RECENT CHANGES IN THE IMPACTS OF EXTREME EVENTS Increases in Economic and Insured Losses The econom ic and in su red losses from n atu ra l disasters have increased significantly in recent years, as shown in figure 1 (each verti­ cal bar represents the total economic losses, the darker zone repre­ sents the insured portion of it).' A comparison of these economic losses over tim e reveals a huge increase: $53.6 billion (1950-59), $93.3 billion (1960-69), $161.7 billion (1970-79), $262.9 billion (1980-89), and $778.3 billion (1990-99). The current decade has already seen $420.6 billion in losses, principally due to the 2004 and 2005 hurricane seasons, which produced historic records. Catastrophes have had a m ore devastating im pact on insurers over the past 15 years than in the entire histoiy of insurance. Between 1970 and the mid-1980s, annual insured losses from natural disasters (including forest fires) were in the $3 billion to $4 billion range. The insured losses from Hurricane Hugo that made landfall in Charleston, South Carolina on Septem ber 22, 1989 exceeded $4 billion (in 1989 prices). It was the first natural disaster to inflict m ore than $1 billion of insured losses in the United States. There was a radical increase in insured losses in the early 1990s w ith Hurricane Andrew (1992) in social research Vol 75 : No 3 : Fall 2 008 905 Figure 1. Evolution of “Great Natural Catastrophes” Worldwide, 1950-2007: Economie Versus Insured Impact Great natural disasters 1950 ± 2007 Overall and Insured losses 200 180 160 140 120 100 -aLj-d 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 i i overall losses Insured losses (2007 values) (2007 values) .............. Trend overall losses ------------ Trend insured losses Sources: Data from Munich Re; 2008 Geo Risks Research. In billions of US dollars, indexed to 2007. Florida ($23.7 billion in 2007 dollars) and the Northridge earthquake (1994) in California ($19.6 billion in 2007 dollars). The four hurricanes in Florida in 2004 (Charley, Frances, Ivan, and Jeanne) taken together cost insurers alm ost $33 billion. Insured and reinsured losses from Hurricane Katrina, which made landfall in the United States in August 2005, are now estim ated at $46 billion; total losses paid by private insurers due to m ajor natural catastrophes were $87 billion in 2005. Figure 2 depicts the upw ard trend in worldwide insured losses from catastrophes between 1970 and 2007 (in 2007 indexed prices; corrected for inflation). Table 1 reveals the 20 most costly catastrophes for the insurance sector since 1970 (in 2007 dollars). Several observations are relevant here. First, 18 of the 20 m ost costly events have occurred since 1990. Hurricane Andrew and the Northridge earthquake were the first two 906 social research Figure 2. Worldwide Evolution of Catastrophe Insured Losses, 1970-2007 Note: For 9/11, all lines, including property and business interruption (BI). All figures are in billions of US dollars, indexed to 2007. Source:Wharton Risk Center, with data from Swiss Re and Insurance Information Institute. disasters th a t th e in d u stry ex p erie n c ed w h ere lo sses w ere greater th a n $10 b illio n (d esig n a ted as “su p er-cats”) and cau sed in su rers to reflect o n w h e th e r risk s fro m n a tu ra l d isa sters w ere in su ra b le. To a ssist th e m in m a k in g th is d ete r m in a tio n , m a n y firm s b eg a n u sin g ca ta s­ tro p h e m o d els to estim a te th e lik e lih o o d an d co n se q u e n c e s to th eir in su red p ortfolios from sp ecific d isasters in hazard-prone areas (G rossi and K unreuther, 2005). W ith th...

Dynamics of livestock production systems, drivers of change and prospects for animal genetic resources

SummaryThis overview analyses the key drivers of change in the global livestock sector and assesses how they are influencing current trends and future prospects in the world's diverse livestock production systems and market chains; and what are their consequent impacts on the management of animal genetic resources for food and agriculture. The trends are occurring in both developing and industrialized countries, but the responses are different. In the developing world, the trends are affecting the ability of livestock to contribute to improving livelihoods and reducing poverty as well as the use of natural resources. In the industrialized world, the narrowing animal genetic resource base in industrial livestock production systems raises the need to maintain a broader range of animal genetic resources to be able to deal with future uncertainties, such as climate change and zoonotic diseases.This chapter discusses:• What are the global drivers of change for livestock systems? Economic development and globalization; changing market demands and the “livestock revolution”; environmental impacts including climate change; and science and technology trends.• How are the livestock production systems responding to the global drivers of change? Trends in the three main livestock production systems (industrial, crop-livestock and pastoral systems); the range and rate of changes occurring in different systems and how these affect animal genetic resources. The implications are that breeds cannot adapt in time to meet new circumstances. Hence new strategies and interventions are necessary to improve the management of animal genetic resources in situations where these genetic resources are most at risk.• What are the implications for animal genetic resources diversity and for future prospects of their use? - Industrial livestock production systems are expected to have a limited demand for biodiversity, while crop-livestock and pastoral systems will rely on biodiversity to produce genotypes of improved productivity under changing environmental and socio-economic conditions. All systems will rely on biodiversity, albeit to varying degrees, to cope with expected climate change.• What immediate steps are possible to improve animal genetic resources characterization, use and conservation? Appropriate institutional and policy frameworks are required to improve animal genetic resources management and these issues are being addressed at national and intergovernmental levels, in a process led by FAO to promote greater international collaboration on animal genetic resources. Based on an analysis of the current situation, the continuing loss of indigenous breeds and new developments in science and technology, there are several complementary actions that can begin to improve the management of animal genetic resources and maintain future options in an uncertain world.These are summarized here as:a. “Keep it on the hoof” - Encouraging the continuing sustainable use of traditional breeds and in situ conservation by providing market-driven incentives, public policy and This paper has benefited from inputs from several reviewers and other contributors, and we thank all for their thoughtful insights. We acknowledge the contributions of our colleagues at FAO, particularly Irene Hoffmann, Dafydd Pilling and Henning Steinfeld, and at the International Livestock Research Institute (ILRI): Ade Freeman, Mario Herrero, Olivier Hanotte, Steve Kemp, Sandy McClintock, Sara McClintock, Margaret MacDonald-Levy, Susan MacMillan, Grace Ndungu, An Notenbaert, Mwai Okeyo and Robin Reid. other support to enable livestock keepers to maintain genetic diversity in their livestock populations.b. “Move it or lose it” - Enabling access to and the safe movement of animal genetic resources within and between countries, regions and continents is a key factor in use, development and conservation of animal genetic resources globally.c. “Match breeds to environments” - Understanding the match between livestock populations, breeds and genes with the physical, biological and economic landscape. This “landscape livestock genomics” approach offers the means to predict the genotypes most appropriate to a given environment and, in the longer term, to understand the genetic basis of adaptation of the genotype to the environment.d. “Put some in the bank” — New technologies make ex situ, in vitro conservation of animal genetic resources feasible for critical situations and are a way to provide long-term insurance against future shocks.The multiple values, functions and consequences of livestock production systems and their rapid rate of change lead to divergent interests within and between countries. Conversely, the uncertainty about the implications of rapid, multifaceted global change for each livestock production system and the resulting future changes in the required genetic make-up of animal genetic resources make collective action to tackle conservation of animal genetic resources a long-term, global public good. Conserving animal genetic resources will not by itself solve these problems, but it is an important first step towards maintaining future options.Advances in science and the technology, in areas such as reproductive technology, genomics and spatial analysis, as well as progress in conceptualization of global public good production for the future management of animal genetic resources, should enable the international community to address both the short- and long-term challenges in innovative ways.

Uncertain Bequest Needs and Long-Term Insurance Contracts

We examine how long-term life insurance contracts can be designed to incorporate uncertain future bequest needs. An individual who buys a life insurance contract early in life is often uncertain about the future financial needs of his or her family, in the event of an untimely death. Ideally, the individual would like to insure the risk of having high future bequest needs; but since bequest motives are typically unverifiable, a contract directly insuring these needs is not feasible. We derive two equivalent long-term life insurance contracts that are incentive compatible and achieve a higher welfare level than the naive strategy of delaying the purchase of insurance until after one’s bequest needs are known. We also examine the welfare effects of such contracts and we show how third-party financial products, although beneficial to the individual in the short run, can be welfare decreasing over one’s lifetime.

Disability Issues in Emergency Physicians

As the average age of emergency physicians increases, the emergency physician becomes prone to the development of potentially disabling conditions that might affect his or her ability to practice emergency medicine. Emergency physicians may not have a full understanding of the assessment of disability or of the legal, financial, and technical issues involved. The authors report 3 cases of emergency physicians who experienced severe disabilities and were unable to return to the practice of emergency medicine. All 3 physicians had long-term disability insurance policies that enabled them to financially maintain their pre-disability standard of living, despite the devastating effects of the specific disability itself. The authors strongly advise emergency physicians to have a long-term disability policy in effect at all times and review the issues associated with the assessment of disability, as well as the legal, financial, and technical issues.

WHY IT IS IMPORTANT TO HAVE A KIND DAUGHTER‐IN‐LAW IN JAPAN: LONG‐TERM CARE FOR THE ELDERLY IN JAPAN AND AUSTRALIA

This research examines the reasons for delay in the development of a universal public long‐term caring system and public insurance system for the frail and elderly in Japan, up to April 2000. Japan is one of the richest countries in the world but is also a relatively aged society. However, it lags behind other OECD countries in the development and provision of long‐term care services. In Japan, over half of women are not in paid employment and a quarter work in unstable and low‐paid jobs, mostly due to the scarcity of permanent positions for married women and strong social expectations relating to the role of Japanese women. Most Japanese people believe that married women will be the primary carers for both young and old members of the family. As a result of this expectation, the introduction of long‐term care insurance for the frail elderly was delayed until April 2000. Long‐term care insurance has lightened the burden of caring for the frail elderly. However, it still requires women at home to provide primary care.

Premium rates based on genetic studies: How reliable are they?

Underwriting the risk of rare disorders in long-term insurance often relies on rates of onset estimated from quite small epidemiological studies. These estimates can have considerable sampling uncertainty and any function based upon them, such as a premium rate, is also an estimate subject to uncertainty. This is particularly relevant in the case of genetic disorders, because the acceptable use of genetic information may depend on establishing its reliability as a measure of risk. The sampling distribution of a premium rate is hard to estimate without access to the original data, which is rarely possible. From two studies of adult polycystic kidney disease (APKD) we obtain, not the original data, but the cases and exposures used for Kaplan–Meier estimates of the survival probability. We use three resampling methods with these data, namely: (a) the standard bootstrap; (b) the weird bootstrap; and (c) simulation of censored random lifetimes. Rates of onset were obtained from each simulated sample using kernel-smoothed Nelson–Aalen estimates, hence critical illness insurance premium rates for a mutation carrier or a member of an affected family. From 10,000 such samples we estimate the sampling distributions of the premium rates, finding considerable uncertainty. Very careful consideration should be given before using small-sample epidemiological data to deal with insurance problems.

‘Freedom with Publicity’ — The Actuarial Profession and United Kingdom Insurance Regulation from 1844 to 1945

ABSTRACTFrom 1870, in the United Kingdom, a generally liberal legal framework for life insurance existed which commanded wide support, particularly from the actuarial profession. Despite its apparent liberalism, however, it is likely that the regulatory framework impeded market entry, particularly of mutual companies. The liberal framework broke down in a number of incremental steps from 1946. This paper traces the development of U.K. life assurance regulation for 101 years from the mid-Victorian period, analyses contemporary reflections on the legal framework within the actuarial profession, and examines the appropriateness of the legal framework for achieving specific economic objectives for long-term insurance regulation.

Factors that Affect Older Japanese People’s Reluctance to Use Home Help Care and Adult Day Care Services

The purpose of this study was to examine the factors related to the reluctance of older Japanese people to utilize home help services and day services. Home help services consist of three different types of services (i.e., assisting in bathing and toileting, doing household choirs, such as cooking and laundry, and counseling) and are provided by visiting home helpers at the homes of older people. Day services are services (e.g., providing bathing and meals, monitoring the health status of older people, and counseling) that are provided at day service centers in the community to improve the physical and psychological functioning of older people and to help the burden of caregiving of family members. The data used in the study came from the first wave of the Nihon University Japanese Longitudinal Study of Aging, conducted in November 1999 (and again in March 2000 for those people who had been unable to respond to the initial survey). Face-to-face interviews were conducted with a national probability sample of 6,700 people aged 65 and older. Logistic regression analyses were used to analyze factors that were thought to be related to older people's reluctance to use services. Approximately, one half of the respondents indicated reluctance to use home help services, and one quarter of the respondents showed reluctance to use day services. Respondents who were female and who lived in urban areas showed a higher probability of feeling reluctant about using both home-help and day services. Also, respondents who had had caregiving experience using these two types of services showed a lower probability of feeling reluctant about using the services. Furthermore, respondents who were older and had income showed a higher probability of feeling reluctant about using day services, whereas those who had had caregiving experience and who participated in social activities showed a lower probability of feeling reluctant about using day services. According to the 1999 survey, there were still many older Japanese people who felt reluctant about using either type of care service. But it is expected that the quality of services under Kaigo Hoken (the mandatory public long-term care social insurance system) will improve further and that older people's attitudes toward service utilization will change for the better. In the meantime, professional service providers will have to be sensitive to older people's perceptions about service utilization if they would like to continue to contribute to the improvement process of Kaigo Hoken as a positive force.

The significance of ex situ seed conservation to reintroduction of threatened plants

Ex situ seed conservation aims to support species survival in the wild. This can be achieved by contributing genetic material for reintroduction. The goals of reintroduction are to increase both plant and population numbers, create self-sustaining populations and ultimately remove a species from its threatened listing. Quality seed collections with a broad genetic base are required to achieve this goal. Storage conditions that minimise deterioration of seeds will maximise the quality of seeds available for future use. Additionally, ex situ seed conservation provides long-term insurance against species or genotype loss until actual or potential threats can be removed. As threats to biodiversity escalate the most judicious conservation strategies will be ones that combine available resources to provide the highest possible degree of protection. Banked seeds are available irrespective of season and periods of low fecundity. Forward planning of reintroduction projects can be achieved with knowledge of the quantity and quality of banked seed. This paper discusses the challenges facing ex situ seed conservation while highlighting the benefits of integrating ex situ seed storage and plant reintroduction to help provide for better conservation outcomes.

Securitization in the Life Insurance Industry

Securitization structures have proven to be an effective means of accessing the capital markets to fund long-term life insurance reserves as an alternative to traditional, shorter-term sources of capital funding in the insurance industry. In the past five years, life insurance securitization has emerged as a significant development in the capital markets, with more than $10 billion of life securitizations coming to market in this period involving more than 15 different sponsoring life insurers and reinsurers. This article focuses on three types of life insurance securitizations that have witnessed the most significant growth in recent years: (1) regulatory reserve securitizations, (2) block-of-business securitizations, and (3) mortality catastrophe bonds. Life insurance regulatory reserve securitizations, in particular Regulation XXX securitizations, have provided the most significant growth in the life insurance securitization market in the last three years. Securitization techniques have also recently been applied to support reserves and capital requirements with respect to certain defined blocks of business, as well as to provide a significant source of catastrophic mortality risk cover for life insurers and reinsurers.

Back to work: Correlates of employment among persons receiving highly active antiretroviral therapy

The aim of this study was to quantify the level of employment at one-year and to determine potential predictors of future employment among HIV-positive persons on highly active antiretroviral therapy (HAART) in the province of British Columbia. Of the 392 individuals that were initially unemployed at baseline 63 (16.1%) found a job over the subsequent year. Factors associated with becoming employed included a baseline income over $10 000, having long-term disability or unemployment insurance as an income source, having higher CD4 cell counts, and better physical, social, and role functioning. Factors negatively associated with finding employment included having provincial assistance as an income source and having ever been an injection drug user (IDU). In multivariate analyses, not using provincial assistance as a source of income (Odds Ratio [OR] = 7.39; 95% CI: 3.26–16.7; p < 0.001) and higher MOS-SF role functioning (OR = 1.12 per 10 point increment; 95% CI: 1.03–1.21; p = 0.005) were independent predictors of becoming employed. In conclusion, our study demonstrates that while significant advances have been made in the reduction of HIV-related mortality, the majority of HIV-infected individuals on adequate treatment are still unable to be gainfully employed.

Perinatal stroke in baby, prothrombotic gene in mom

Maternal prothrombotic disorders may contribute to stroke in the fetus before and during birth. Many of the mothers of children with perinatal stroke have no previous history of pathologic thrombosis. To determine if finding the Factor V Leiden mutation, prothrombin 20210 G-A gene defect, or methylene tetrahydrofolate reductase C677T mutation in an asymptomatic mother of a child with perinatal stroke would affect that mother's ability to obtain health insurance. 1) The authors reviewed the literature on genetic prothrombotic risk factors and health insurance. 2) The authors surveyed the 17 largest insurance carriers in Indiana to find if diagnosing genetic prothrombotic risk factors in asymptomatic mothers of children with perinatal stroke would affect the mothers' health insurance status. Three articles on genetic prothrombotic risk factors and insurance were identified. Twelve of 17 insurance companies responded to our survey; three had policies on genetic testing. Most companies refused to provide clear, useful information on their policies regarding these risk factors. The authors are currently unable to counsel their patients' families on the long-term insurance implications of screening for genetic prothrombotic risk factors. The insurance implications of diagnosing healthy women with genetic prothrombotic risk factors need further study.

The Determinants of Long-Term Care Utilization and Equity of Access to Care among Older Adults in Dong-Ku of Incheon Metropolitan City, South Korea

Under the current health care system, around three percent of the elderly remain uninsured. Based on the 2003 Dong-Ku Health Status Survey and the Aday and Andersen Access Framework, the present study examined the social and behavioral determinants of long-term care utilization and the extent to which equity in the use of long-term care services for the elderly has been achieved. The results indicate that universal health insurance system has not yielded a fully equitable distribution of services. Type of coverage and resource availability do not remain predictors of long-term care utilization. The data suggest that a universal health insurance system exists in South Korea with significant access problems for the population without insurance. Access differences also arise from obstacles in expanding the scope and level of plan benefits due to financial disparity among insurers. Health policy reforms must continue to concentrate on extending insurance coverage to the uninsured and establishing long-term insurance system for the elderly.

Market failure in long-term private health insurance markets: a proposed solution

Recently, private health insurance rates have declined in many countries. In places requiring community rating in their health insurance premiums, a major cause is age-based adverse selection. However, even in countries without community rating, a de facto type of partial community rating tends to occur. In this note, a modified version of Pauly et al.'s guaranteed renewability model, which addresses the problem of age-based adverse selection (Pauly et al., 1995) is presented. Their model is extended from three to 35 periods. Also, probabilities are allowed to increase by age for low-risk types using actual age-based probabilities. This extension of their work shows that private health insurance contracts available stray far from optimal contracts that deal with age-based adverse selection. This suggests that government actions to affect private insurance options are warranted.

Long-Term Disability Protection for Executives

Employer-provided group long-term disability insurance typically falls short in covering higher paid executives for several reasons. First, although group plans cover a percentage of salary, they often exclude bonus and other nonsalary compensation. Second, group plans impose maximum benefit limits. Sadly, employers and employees often fail to realize how devastatingly inadequate executive coverage is until disability strikes. Employers can help executives close this gap by sponsoring an optional supplemental long-term disability insurance plan. Under these plans, executives pay for individual supplemental policies that cover nonsalary compensation and have higher dollar limits. The individual policies are noncancelable, include premium discounts unavailable outside of the plan and are portable. Sponsoring a supplemental plan is an increasingly popular way for employers to provide a crucial executive benefit at little or no cost to companies and with little continuing effort required by HR departments.

要介護認定の所要日数に及ぼす主治医意見書の影響―２年間の調査

Prompt notification of recognition of the need for nursing is necessary for smooth application of Long-term Care Insurance Services. The Long-term Insurance Act requires notification of applicants of certification within 30 days. However, recognition of the need actually may be delayed for various reasons. To explain the influence of investigation for certification and the doctor's opinion for notification delay, 38,285 applications were investigated for 2 years in a city close to Osaka. The investigation period was divided into two stages, the first stage (from July 2000 to June 2001) and the second stage (from July 2001 to June 2002). The notification rate of the recognition result within 30 days was 42.0% in the first stage, and it improved to 46.8% in the second stage. However, the approximate number of days required for investigation for certification improved from 10.5 to 10.3, and that for the doctor's opinion improved from 20.2 to 19.1. Thus the doctor's opinion is a rate-controlling factor for the notification. By the standard operating procedures of the city, a two-week period is needed to prepare the long-term care requirement certification, thus it is necessary to obtain the doctor's opinion within 15 days.