Minimum Benefit Research Articles

Response to: Prescribed Minimum Benefits complaints: A 5-year retrospective review.

Response to: Prescribed Minimum Benefits complaints: A 5-year retrospective review.

Community Benefit and Tax-Exemption Levels at Non-Profit Hospitals Across U.S. States.

To assess the association between state policies and sociodemographic characteristics and state mean fair share spending at non-profit hospitals. Fair share spending is a hospital's charity care and community investment less the estimated value of their tax-exempt status. Hospitals with non-profit status in the United States are exempt from paying taxes. In return, they are expected to provide community benefits by subsidizing medical care for those who cannot pay and investing in the health and social needs of their community. We used a multivariable linear regression model to determine the association of state-level sociodemographics and policies with state-level mean fair share spending in 2019. Fair share spending data was obtained from the Lown Institute. We found no association between the percentage of people living in poverty, in rural areas, or U.S. region and fair share spending. Similarly, there was no association found for state minimum community benefit and reporting requirements. The state percentage of racial/ethnic minorities was associated with higher mean fair share spending [+$1.48 million for every 10% increase (95% CI: 0.01 to 2.96 million)]. Medicaid expansion status was associated with a 6.9-million-dollar decrease (95% CI: -10.4 to -3.3 million). State-level community benefit policies have been ineffective at raising community benefit spending to levels comparable to the value of non-profit hospital tax-exempt status.

Moderate strategy for efficient recovery of rare earth elements from scintillation crystal waste

The lutetium has been known to be used in medical imaging materials, but its scarcity in the Earth’s crust makes it expensive. In this work, we present a process for efficient lutetium recovery from the lutetium-yttrium oxyorthosilicate crystals (LYSO) waste. The process involves preliminary mechanical activation, followed by rare earth extraction via acid leaching. The key factors for activation and leaching were studied and optimized. The mechanism of mechanical activation promoting rare earth leaching was revealed by employing the characterizations of morphology and crystal structure of LYSO. It was found that the mechanical activation process could destroy the crystal structure of LYSO waste, forming numerous amorphous phases and grain boundaries, which facilitated the breaking of existing bonds and mass transfer of acid. It was also discovered that the formation of silica gel during leaching impedes the leaching of rare earth, and low concentrations of hydrochloric acid, combined with stirring during acid leaching, could reduce the impact of silica gel. Ultimately, following a mechanical activation pretreatment at 300 rpm for 90 min, 98.7 % of lutetium could be leached after 60 min of acid leaching in 3 mol/L hydrochloric acid. This process addresses the problems associated with high energy consumption and excessive usage of acidic and alkaline reagents in conventional recycling techniques. Compared to conventional methods, the mechanical activation-acid leaching method has a minimum economic benefit improvement of 20.8 % in the process of recovery from LYSO waste. It offers an alternative and more energy-efficient and economical recycling route for waste scintillation crystals.

Stakeholder perceptions of issues and possible solutions to access to oncology medicines: a case study of multi-stakeholder engagement

Aim This case study reports on a series of multi-stakeholder dialogues on challenges to access to oncology medicines in both the public and private sectors. Methods Key stakeholders, identified from various points in the pharmaceutical supply chain, were invited to attend a series of virtual discussion sessions to address specific medicines access challenges to the provision of cancer care in South Africa. For each session, a case scenario, based on a real world situation/event was presented for discussion, and viable solutions and areas requiring further research or legislative changes were identified. Topics covered in these discussions included registration pathways and obstacles; limitations of current medicine pricing policies; alternate reimbursement models; funders’ initiatives to ensure access to oncology medicines; and essential medicine selection and procurement in the public sector. Findings The key issues raised in the discussions included: non-transparency in the approval and pricing of unregistered medicines accessed in terms of section 21 of the Medicines and Related Substances Act of 1965 (as amended); commercial decisions related to the small market for oncology medicines in South Africa; inequities between public and private sector access; alternate forms of price negotiation in the private sector; the restrictions imposed by the single exit price model; and the role of co-payments for those medicines not included as prescribed minimum benefits. Conclusions There is a clear need for a forum where all stakeholders and actors in this field can engage in discussions to find solutions to the oncology medicines access conundrum, including the development of legislative amendments.

Enhancing valuation of variable annuities in Lévy models with stochastic interest rate

This paper extends the valuation and optimal surrender framework for variable annuities with guaranteed minimum benefits in a Lévy equity market environment by incorporating a stochastic interest rate described by the Hull-White model. This approach frames a more dynamic and realistic financial setting compared to previous literature. We exploit a robust valuation mechanism employing a hybrid numerical method that merges tree methods for interest rate modeling with finite difference techniques for the underlying asset price. This method is particularly effective for addressing the complexities of variable annuities, where periodic fees and mortality risks are significant factors. Our findings reveal the influence of stochastic interest rates on the strategic decision-making process concerning the surrender of these financial instruments. Through comprehensive numerical experiments, and by comparing our results with those obtained through the Longstaff-Schwartz Monte Carlo method, we illustrate how our refined model can guide insurers in designing contracts that equitably balance the interests of both parties. This is particularly relevant in discouraging premature surrenders while adapting to the realistic fluctuations of financial markets. Lastly, a comparative statics analysis with varying interest rate parameters underscores the impact of interest rates on the cost of the optimal surrender strategy, emphasizing the importance of accurately modeling stochastic interest rates.

Efficient valuation of variable annuities under regime-switching jump diffusion models with surrender risk and mortality risk

We present an efficient valuation approach for guaranteed minimum accumulation benefits (GMABs), guaranteed minimum death benefits (GMDBs), and surrender benefits (SBs) embedded in variable annuity (VA) contracts in a regime-switching jump diffusion model. We incorporate into the contract the risks of mortality and surrender, with these events generally monitored discretely over the life of the policy. Using a combination of the continuous-time Markov chain (CTMC) approximation and the Fourier cosine series expansion (COS) method, we determine that the valuation problem can be resolved within a regime-switching jump diffusion framework. Extensive numerical experiments showcase the efficiency of the proposed method, which proves to be more advantageous when compared to existing approaches like Monte Carlo (MC) simulation. The thorough analysis explores how model parameters affect the valuation outcomes.

Constructing the Discount Function with Parsimonious Extended Nelson-Siegel Function: Evidence from Nigerian Eurobond

Nigeria currently carrying out economic reforms is under the surveillance of institutional investors. To construct the market discount function through its yield curve, we applied the extended functional Nelson-Siegel parsimonious function with time-decay parameters to the Eurobond data to employ flexibility of the model and estimate the time varying parameters. In order to present a deep investigation of the Euro-bond market by reason of time to maturity, our contribution is anchored on following objectives: (i) construct the discount function (ii) investigate the limiting behavior of the yield curves and (iii) predict the in-sample yield. The data presented involves the daily closing of the Nigerian Eurobond yield covering January to December 2021 and 2022. The data was fitted to the observed Nigerian Eurobond yield curve to model the discount function. The ordinary least square method is used for the analysis and the estimated parameters were used to compute the in-sample yield. Test of goodness of fit was conducted showing that the model fits in well to the observed data demonstrated by the model’s R-square adjusted through the predicted yields after obtaining the two decay factors. This paper has implications on life insurance products associated with minimum guaranteed benefit schemes for the insured. Based on the terms and conditions of the contract, the insured pays regular premium invested in debt instruments and receives benefit at death or at maturity of the policy depending on the market performance of the fund. There is a guaranteed benefit which the insured earns irrespective of the performance of the life fund. The insurer would then pay the guaranteed amount even if the benefit eventually drops below the guaranteed amount. Given the discount 𝛿(𝜏)and benefit∅, the present value of future death benefits is modeled as 𝑃𝑉𝐹𝐵 = ∅1𝛿(1) + ∅2𝛿(2) + ⋯ + ∅𝑇−1𝛿(𝑇 − 1) + ∅𝑇𝛿(𝑇).

Prescribed Minimum Benefits complaints: a five-year retrospective review.

No matter which benefit option members have chosen, medical schemes are required by the Medical Schemes Act no. 131 of 1998 to pay costs associated with the diagnosis, treatment, or care of a specified set of benefits known as Prescribed Minimum Benefits (PMBs). Medical scheme beneficiaries have the right to lodge complaints with the Council for Medical Schemes (CMS) when their claims are denied. To determine and describe the pattern of PMBs complaints received by CMS from January 2014 to December 2018. This was a cross-sectional study that utilised the CMS' clinical complaints. Data for PMBs, complainants, medical scheme types, and reasons for payment denial were extracted. The CMS' lists of chronic conditions, PMBs, and registered schemes were used to confirm PMBs and to categorise schemes as either restricted (i.e., to only members of specific organisations) or open (i.e., to all South Africans). Extracted and coded data were analysed using SAS v.9.4 software. A total of 2141 complaints were retrieved and 1124 PMBs complaints were included in the study. The median of PMBs complaints per year was 225. Most of the complaints (43.6%, n=490/1124) were lodged by members themselves. Non-Communicable Diseases (NCDs) constituted most of the PMBs conditions that members complained about. Medicine and surgery were the services that were mostly denied full payment by medical schemes. Open medical schemes accounted for more (73.8%, n=830/1124) of the complaints. Chronic conditions are the main diseases that medical scheme members complained about. Member education and clear definition of PMBs should be prioritised by medical schemes and the Council for Medical Schemes.

Analysis on Evolutionary Game of Risk Supervision over Public Pension Investment under Minimum Benefit Guarantee System

Analysis on Evolutionary Game of Risk Supervision over Public Pension Investment under Minimum Benefit Guarantee System

Comparative Efficacy and Economics of Selected Chemicals with Neem Oil against Mustard Aphid, Lipaphis erysimi (Kaltenbench)

The research was carried out at Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, Uttar Pradesh, Central Research Field, during Rabi season from november 2023- march 2024. The insecticide management experiment was conducted under Randomized Block Design (RBD) with the eight treatments and three replications by undertaking two spraying with fifteen-day intervals. The insecticides tested significantly reduced the pest population compared to control. Among the eight treatments evaluated for their efficacy in field condition against mustard aphids was recorded in treatment Neem oil 5% + Imidacloprid 17.8 SL (6.95) which was the minimum aphid population, followed by Imidacloprid 17.8 SL (8.46), Neem oil 5% + Acetamiprid 20% SP (9.78), Acetamiprid 20% SP (10.45), Neem oil 5% + Cypermethrin 10% EC (11.27), Cypermethrin 10% EC (11.55) and Neem oil 5% (12.01). The maximum aphid population was recorded in control plot (23.33 per 5 plant). Based on the results obtained in the investigation it is concluded that Imidacloprid 17.8SL with Neem oil and chemicals combined with neem oil could be utilized as a component in Integrated Pest Management of Lipaphis erysimi (Kalt.) on mustard. Similarly, the result revealed that the maximum C:B was recorded by treatment Neem oil 5%+ Imidacloprid 17.8% SL (1:2.77) followed by Imidacloprid 17.8% SL (1:2.67) and the minimum Cost Benefit Ratio was recorded in the control plot (1:1.27). The combination of Neem oil 5% and Imidacloprid 17.8 SL has offered cost-effective solutions that they effectively control aphid populations at lower costs. Thus, integrated pest management (IPM) approaches combining chemical treatments with cultural, biological, and mechanical controls may provide sustainable and cost-effective solutions in the long term.

Preferences among patients with triple-class exposed (TCE) relapsed/refractory multiple myeloma (RRMM) in the era of B-cell maturation antigen (BCMA)-directed T-cell–engaging therapies.

e23309 Background: BCMA-directed T-cell–engaging therapies have been introduced into clinical practice for the treatment of TCE RRMM. While efficacious, such treatments are associated with safety considerations such as cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and serious infections. These treatments also vary in reported efficacy, administration processes, and hospitalization requirements. The aim of this study is to quantify patient preferences and tradeoffs regarding these attributes. Methods: A discrete choice experiment (DCE) was designed to elicit preference weights corresponding to seven attributes related to efficacy (objective response rate [ORR], overall survival [OS]), safety (all-grade CRS, all-grade ICANS, serious infections) and treatment procedures (treatment administration, hospitalization requirements). Attribute levels were based on plausible ranges of potential values. Patients in the United States (US) with a physician-confirmed diagnosis of TCE RRMM were recruited. Pre-test interviews with patients were conducted and the final survey deployed online in 2023. A random-parameters logit model was used to estimate preference weights. Conditional relative importance (CRI) was calculated to rank the relative importance of each attribute. The minimum acceptable benefit (MAB) and maximum acceptable risk (MAR) were calculated to estimate the tradeoffs between efficacy and safety attributes. Results: The sample included 200 respondents (mean [standard deviation] age: 61 [6.4] years; 43% female; 46% White; 10% African American). A total of 197 participants reported having responded to prior treatment, of whom 195 had relapsed or become refractory. In the DCE, a 24-month increase in OS was found to be the most important attribute, with a CRI of 32.0%. Next most important were avoiding a 60% risk of serious infection (CRI 17.3%), avoiding 14-day hospitalization requirements (CRI 15.0%), and a 38% increase in ORR (CRI 13.7%). A treatment that could be started immediately and administered weekly or up to every 4 weeks was preferred over a CAR T-like procedure with a waiting period. Fewer initial hospitalization days was significantly preferred over more hospitalization days. The MABs for OS when the risk of serious infection was increased from 20% to 60%, CRS from 40% to 95%, and ICANS from 3% to 20% were 24.2, 17.1, and 18.0 months, respectively. When OS was increased from 12 to 36 months, the estimated MARs for serious infections, CRS, and ICANS were > 60%, > 95%, and > 20%, respectively. Conclusions: This study highlights US patient preferences regarding treatment attributes for TCE RRMM. Treatment benefits and risks and the mutual tradeoffs considered by patients should be evaluated when developing and selecting therapeutic approaches.

GEO satellite on-orbit refueling and debris removal hybrid mission planning under uncertainty

This article proposes two optimization models to solve the multi-satellite on-orbit hybrid service mission planning problem under uncertainty. During the process of on-orbit refueling and debris removal, two categories of uncertainties are taken into account. These uncertainties have an impact on the mass of the service satellite as well as its fuel consumption during the orbit transfer. The two-stage orbit transfer strategy is given to save fuel for maneuvering, which also determines the directed graph between target orbits of satellites or debris. The stochastic expectation model is to get the service sequence with the optimal average benefit, while the robust model considers the worst situation and gives the optimal minimum benefit. Simulations of GEO satellites in orbit are conducted to demonstrate the impact of various models on handling uncertain tasks.

Guaranteed minimum withdrawal benefits with high-water mark fee structure.

The Guaranteed Minimum Withdrawal Benefit (GMWB), an adjunct incorporated within variable annuities, commits to reimbursing the entire initial investment regardless of the performance of the underlying funds. While extensive research exists in financial and actuarial literature regarding the modeling and valuation techniques of GMWBs, much of it is founded on a static fee structure. Our study introduces an innovative fee structure based on the high-water mark (HWM) principle and a regime-switch jump-diffusion model for the pricing of GMWBs, employing numerical solutions through the Monte Carlo method for solving the stochastic differential equation (SDE). Furthermore, a companion piece of research addresses the risk management of GMWBs within the same analytical framework as the pricing component, an aspect that has received limited attention in the existing literature. In assessing the necessary capital reserves for unforeseen losses, our methodology involves the computation of two risk metrics associated with the tail distribution of net liability from the insurer's perspective, Value-at-Risk (VaR) and Conditional-Tail-Expectation (CTE). Comprehensive numerical results and sensitivity analyses are also provided.

If it is adequate, it is not affordable: stakeholder perceptions on opportunities and constraints for pension reform in Indonesia

PurposeThe purpose of the study is to emphasise the urgent need for pension policy reform within Indonesia’s social security system.Design/methodology/approachThe methodology employed in this research includes qualitative techniques such as in-depth interviews and thematic content analysis.FindingsThe findings suggest various measures for pension reform, including revising eligibility criteria, adjusting benefit designs to cover housing and transportation costs, promoting Defined Benefit Plans, enforcing compliance, addressing insufficient contributions, advocating for transparency, and aligning social assistance programs with pension system enhancements. However, there is a trade-off between the adequacy of pension benefits and the amount of resources required.Research limitations/implicationsThis study is limited by the need for more individuals knowledgeable about pension issues in Indonesia, primarily due to their high-ranking positions, making access challenging and potentially compromising the small sample size in research.Practical implicationsThe research underscores the importance of maintaining policy consistency. It proposes a gradual increase in pension contributions as a pivotal strategy to ensure sustained financial security for retirees, particularly in the face of fiscal constraints. Also, the government should undertake comprehensive reforms, encompassing the revision of eligibility criteria, adjustment of minimum benefit designs, encouragement of employer contributions and effective management of compliance issues.Social implicationsSocial implications emphasise the importance of enhancing the financial security of retirees within Indonesia’s ageing population.Originality/valueThe originality and value of the research lie in guiding pension reform from the viewpoint of key policymakers involved in Indonesia’s pension system.

Minimum wage and the survival of hotel industry: Evidence from China

The economic impacts of the minimum wage have been the focus of ongoing conflicting debates among policymakers and researchers. Taking a sample of 69694 firms established from 2011 and 2019 in the Chinese hotel sector, we analyzed the impact of minimum wage on firm survival and the moderating effect of the digital economy. Empirical evidences show that minimum wage has a positive impact on the survival risk of hotels, and the digital economy can negatively moderate the relationship between minimum wage and the survival risk of hotels. These findings are robust when tested with the hotel data of cross-provincial city pairs, other estimation models or longer observation periods. In addition, this study finds that the impact of the minimum wage and the moderating effect of the digital economy vary with hotel types. The rise of the minimum wage has brought greater operating pressure to formal hotel enterprises, and the digital economy has a greater inhibitory effect on the relationship between the rise of the minimum wage and the survival risk of hotel enterprises in informal hotel enterprises. The results indicate that informal hotels are less adversely affected by the increasing minimum wage and benefit more from the development of the digital economy.

Receipt of RhD-positive whole blood for life-threatening bleeding in female children: A survey in alloimmunized mothers regarding minimum acceptable survival benefit relative to risk of maternal alloimmunization to anti-D.

Low-titer group O whole blood (LTOWB) for treatment of hemorrhagic shock sometimes necessitates transfusion of RhD-positive units due to short supply of RhD-negative LTOWB. Practitioners must choose between using RhD-positive LTOWB when RhD-negative is unavailable against the risk to a female of childbearing potential of becoming RhD-alloimmunized, risking hemolytic disease of the fetus and newborn (HDFN) in future children, or using component therapy with RhD-negative red cells. This survey asked females with a history of red blood cell (RBC) alloimmunization about their risk tolerance of RhD alloimmunization compared to the potential for improved survival following transfusion of RhD-positive blood for an injured RhD negative female child. A survey was administered to RBC alloimmunized mothers. Respondents were eligible if they were living in the United States with at least one red cell antibody known to cause HDFN and if they had at least one RBC alloimmunized pregnancy. Responses from 107 RBC alloimmmunized females were analyzed. There were 32/107 (30%) with a history of severe HDFN; 12/107 (11%) had a history of fetal or neonatal loss due to HDFN. The median (interquartile range) absolute improvement in survival at which the respondents would accept RhD-positive transfusions for a female child was 4% (1%-14%). This was not different between females with and without a history of severe or fatal HDFN (p = .08 and 0.38, respectively). Alloimmunized mothers would accept the risk of D-alloimmunization in a RhD-negative female child for improved survival in cases of life-threatening bleeding.

Shifts at the margin of European welfare states: How important is food aid in complementing inadequate minimum incomes?

In recent decades, disappointing poverty trends and welfare state limitations in many European countries – including constraints on minimum income benefits – have paved the way for a larger role of the third sector. An interesting but controversial form of third-sector in-kind support is food aid provision. In Europe, food aid is, so far, a non-rights-based practice displaying worrisome discretionary and stigmatizing characteristics. Yet, the phenomenon of food aid in Europe has spread, professionalized, and penetrated the institutions of the welfare state. This raises the question if, how and to what extent food aid plays a role in bypassing structural constraints on minimum income protection. This article applies an exploratory case study approach to estimate the monetary value of food aid in relation to statutory minimum incomes in four EU-countries. We use cross-nationally comparable food reference budgets to price food aid packages in Belgium, Finland, Hungary and Spain. The results show that food aid, although not sufficient to close the at-risk-of-poverty gap, is non-trivial for some European households. In Spain and Belgium food aid packages can reach up to €100 a month (expressing 7% to 11% of respective minimum income benefit levels). Importantly, we perceive (formalized) cooperation and interaction between local welfare agencies and food charities in all countries, suggesting that welfare state actors use non-rights-based food aid for filling gaps in the social safety net. The large between- and within-country variation of the monetary values of food aid packages points, however, to food aid as a problematic discretionary practice.

Roadmaps to managed competition: to what extent does South Africa meet the preconditions for equity and efficiency?

South Africa offers universal health coverage through large public and private systems. The private system is characterised by a regulated market for health insurance, referred to domestically as medical schemes. From 2000, the private system was undergoing a reform process consistent with theoretical approaches for regulated competition for health insurance. However, from 2008, the reform process was interrupted, leaving in place a partial framework which included open enrolment, community rating and regulated minimum benefits but excluded, inter alia, risk equalisation. The incomplete reform, however, provides an opportunity to examine the system outcomes that result from a partial approach. This paper therefore reviews the system outcomes of the partial reform using a descriptive data analysis. The findings then inform an evaluation of the extent to which the preconditions for regulated competition have been met as indicated by the theory of regulated competition in healthcare. The paper therefore highlights the areas where regulatory interventions need to be prioritised in South Africa to achieve the objectives of regulatory competition that are able to achieve access, fairness and efficiency. The analysis points to significant failures at the level of health insurance competition in South Africa with resulting outcomes consistent with the theory of regulated competition.

Risk management of guaranteed minimum benefits under a regime-switching jump-diffusion model

Risk management of guaranteed minimum benefits under a regime-switching jump-diffusion model

Optimal Static Hedging of Variable Annuities with Volatility-Dependent Fees

Variable annuities (VAs) and other long-term equity-linked insurance products are typically difficult to hedge in the incomplete markets. A state-dependent fee tied with market volatility for VAs is designed to contribute the risk-sharing mechanism between policyholders and insurers. Different from prior research, we discuss several aspects on a fair valuation, fee-rate determination and hedging with volatility-dependent fees from the perspective of a VA hedger. A method of efficient hedging strategy as a benchmark compared to other strategies is developed in the stochastic volatility setting. We illustrate this method in guaranteed minimum maturity benefits (GMMBs), but it is also applicable to other equity-linked insurance contracts.