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Income variability and incident cardiovascular disease in diabetes: a population-based cohort study.

Longitudinal change in income is crucial in explaining cardiovascular health inequalities. However, there is limited evidence for cardiovascular disease (CVD) risk associated with income dynamics over time among individuals with type 2 diabetes (T2D). Using a nationally representative sample from the Korean National Health Insurance Service database, 1 528 108 adults aged 30-64 with T2D and no history of CVD were included from 2009 to 2012 (mean follow-up of 7.3 years). Using monthly health insurance premium information, income levels were assessed annually for the baseline year and the four preceding years. Income variability was defined as the intraindividual standard deviation of the percent change in income over 5 years. The primary outcome was a composite event of incident fatal and nonfatal CVD (myocardial infarction, heart failure, and stroke) using insurance claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for potential confounders. High-income variability was associated with increased CVD risk (HRhighest vs. lowest quartile 1.25, 95% CI 1.22-1.27; Ptrend < .001). Individuals who experienced an income decline (4 years ago vs. baseline) had increased CVD risk, which was particularly notable when the income decreased to the lowest level (i.e. Medical Aid beneficiaries), regardless of their initial income status. Sustained low income (i.e. lowest income quartile) over 5 years was associated with increased CVD risk (HRn = 5 years vs. n = 0 years 1.38, 95% CI 1.35-1.41; Ptrend < .0001), whereas sustained high income (i.e. highest income quartile) was associated with decreased CVD risk (HRn = 5 years vs. n = 0 years 0.71, 95% CI 0.70-0.72; Ptrend < .0001). Sensitivity analyses, exploring potential mediators, such as lifestyle-related factors and obesity, supported the main results. Higher income variability, income declines, and sustained low income were associated with increased CVD risk. Our findings highlight the need to better understand the mechanisms by which income dynamics impact CVD risk among individuals with T2D.

Willingness to pay for insurance against mobile money fraud: evidence from Ghana

PurposeThe rapid growth of the mobile money industry has been matched by a rise in mobile money fraud. The technology required to apprehend perpetrators of such fraud is nonexistent in most developing countries. Hence, the need for individuals to be willing to pay for insurance against such frauds is crucial. This paper aims to examine individuals’ willingness to pay for insurance against mobile money fraud in Ghana.Design/methodology/approachThe paper uses nationally representative data collected from 4,266 adults (persons 18 years and above) in Ghana. Individuals’ willingness to pay premiums for protection against mobile money fraud was elicited by a single-bound dichotomous choice and open-ended contingent valuation designs.FindingsOn average, 24.34% of Ghanaians are willing to pay premiums for insurance against mobile money frauds, with more men (26.37%) being willing than women (22.56%). Similarly, the average monthly premium that men are willing to pay for protection against mobile money fraud is GH¢32.16 (US$8.16), while that of women is GH¢22.5 (US$5.62). Furthermore, the results show that years of schooling, income, previous fraud experience, and using the accounts for saving are all positively associated with willingness to pay. However, using other networks apart from MTN has a negative association with willingness to pay.Originality/valueTo the best of our knowledge, this is the first study that examines willingness to pay for insurance against mobile money fraud. Thus, this is the first that estimate quantitatively how much mobile account holders will pay as premiums for insurance against mobile money fraud.

Does National Health Protection Cover the Vulnerable Groups in Indonesia? A Case Study of Waste Pickers in Surabaya.

The National Health Protection (NHP) of Indonesia is a pro-poor social health insurance as the government pays the monthly premium for the poor. A waste picker is classified as an urban poor group needing affordable or free access to health care. This study explores the extent to which the NHP protects the health of waste pickers and provides them with quality health care. For this mixed-method study, 342 waste pickers completed the survey, 40 engaged in interviews, and 15 participated in Natural Group Discussions. The study found that 20% of waste pickers were not enrolled in NHP due to issues such as incorrect validation of poverty, discrimination, illegal fees, nepotism, unaffordable premiums, and lack of interest in purchasing the health plan. Among those who were enrolled, waste pickers expressed satisfaction with the health care they received and the behavior of the staff. However, they did criticize certain aspects such as waiting times, service gaps between full-paying and subsidized patients, suspicion of the quality of medicines, complicated medical administration procedures, and inflexibility of the capitation system. The study concludes that despite the NHP, poor groups remain vulnerable to accessing free health care.

Establishing industrial community energy systems: Simulating the role of institutional designs and societal attributes

The importance of decreasing industrial CO2 footprints has become evident, as also highlighted in COP26. As such, the transition to renewable energy in the industrial sector is essential to meet the targets. To this aim, establishing industrial community energy systems (InCES) where industries collectively invest in a shared energy system is an economically and environmentally attractive option. Yet, the emergence and continuity of such collective initiatives among industrial companies has neither received considerable attention in the scientific literature nor in practice. This research, as the first of its kind, aims to investigate institutional design options that allow for such collaboration to take place for the establishment and continuity of an InCES. Given the bottom-up and collaborative nature of such initiatives, we take an agent-based modeling and simulation approach, for the first time in this area, that incorporates the institutional and societal attributes that influence the formation and continuation of an InCES. We take data from an industrial cluster in Arak, one of the most prominent industrial cities in Iran. The results of this study confirm the economic feasibility of an InCES as compared to individual renewable energy investment in the cluster. The results also highlight the importance of flexible membership in increasing the number of investors (i.e., industrial companies) in such initiatives. Other important recommendations are: considering the installation of at least 15% extra capacity for the powerplant, restricting electricity consumption and enforcing on-time payment of monthly premium fees.

Financing of health services for undocumented immigrants in Iran: common challenges and potential solutions

IntroductionIran is host to one of the largest urban refugee populations worldwide, about two million of whom are undocumented immigrants (UIs). UIs are not eligible to enroll in the Iranian health insurance scheme and have to pay out-of-pocket to access most health services. This increases the likelihood that they will delay or defer seeking care, or incur substantial costs if they do seek care, resulting in worse health outcomes. This study aims to improve understanding of the financial barriers that UIs face in utilizing health services and provide policy options to ensure financial protection to enhance progress towards UHC in Iran.MethodsThis qualitative study was conducted in 2022. A triangulation approach, including interviews with key informants and comparing them with other informative sources to find out the complementary findings, was applied to increase data confirmability. Both purposive and snowball sampling approaches were used to select seventeen participants. The data analysis process was done based on the thematic content analysis approach.ResultsThe findings were explained under two main themes: the financial challenges in accessing health services and the policy solutions to remove these financial barriers, with 12 subthemes. High out-of-pocket payments, high service prices for UIs, fragmented financial support, limited funding capacity, not freeing all PHC services, fear of deportation, and delayed referral are some of the barriers that UIs face in accessing health care. UIs can get insurance coverage by using innovative ways to get money, like peer financing and regional health insurance, and by using tools that make it easier, like monthly premiums without policies that cover the whole family.ConclusionThe formation of a health insurance program for UIs in the current Iranian health insurance mechanism can significantly reduce management costs and, at the same time, facilitate risk pooling. Strengthening the governance of health care financing for UIs in the form of network governance may accelerate the inclusion of UIs in the UHC agenda in Iran. Specifically, it is necessary to enhance the role of developed and rich regional and international countries in financing health services for UIs.

Extreme Liquidity Risk and the Cross‐Section of Expected Returns: Evidence from China*

AbstractIn this study, we investigate whether extreme liquidity risk is priced in the China A‐shares market. We find that the market extreme liquidity risk significantly and negatively predicts market returns up to 9 months. In addition, the extreme liquidity risk beta of individual stocks commands a positive monthly premium of 0.75%. Moreover, our findings show that the extreme liquidity risk beta can subsume the tail risk beta in predicting stock returns. Furthermore, our findings show that both the potential selling pressures caused by insiders and by institutional investors significantly and positively influence an individual stock's extreme liquidity risk beta. We also find that the potential selling pressure component of the extreme liquidity risk beta significantly and positively predicts stock returns. Taken together, our evidence demonstrates that a stock's extreme liquidity risk beta provides a channel through which the stock's potential selling pressure caused by both insiders and institutional investors influences its expected return in the China A‐shares market.

“It is like an umbrella covering you, yet it does not protect you from the rain”: a mixed methods study of insurance affordability, coverage, and financial protection in rural western Kenya

Countries in Sub-Saharan Africa are increasingly adopting mandatory social health insurance programs. In Kenya, mandatory social health insurance is being implemented through the national health insurer, the National Hospital Insurance Fund (NHIF), but the level of coverage, affordability and financial risk protection provided by health insurance, especially for rural informal households, is unclear. This study provides as assessment of affordability of NHIF premiums, the need for financial risk protection, and the extent of financial protection provided by NHIF among rural informal workers in western Kenya.Methods We conducted a mixed methods study with a cross-sectional household survey (n = 1773), in-depth household interviews (n = 36), and 6 focus group discussions (FGDs) with community stakeholders in rural western Kenya. Health insurance status was self-reported and households were categorized into insured and uninsured. Using survey data, we calculated the affordability of health insurance (unaffordability was defined as the monthly premium being > 5% of total household expenditures), out of pocket expenditures (OOP) on healthcare and its impact on impoverishment, and incidence of catastrophic health expenditures (CHE). Logistic regression was used to assess household characteristics associated with CHE.Results Only 12% of households reported having health insurance and was unaffordable for the majority of households, both insured (60%) and uninsured (80%). Rural households spent an average of 12% of their household budget on OOP, with both insured and uninsured households reporting high OOP spending and similar levels of impoverishment due to OOP. Overall, 12% of households experienced CHE, with uninsured households more likely to experience CHE. Participants expressed concerns about value of health insurance given its cost, availability and quality of services, and financial protection relative to other social and economic household needs. Households resulted to borrowing, fundraising, taking short term loans and selling family assets to meet healthcare costs.Conclusion Health insurance coverage was low among rural informal sector households in western Kenya, with health insurance premiums being unaffordable to most households. Even among insured households, we found high levels of OOP and CHE. Our results suggest that significant reforms of NHIF and health system are required to provide adequate health services and financial risk protection for rural informal households in Kenya.

Determinants of payment compliance of the national health insurance among non-salaried participants

This study analyzed the compliance of non-salaried participants, in paying the monthly premium of the National Health Insurance (known as Jaminan Kesehatan Nasional, JKN) in Indonesia. The sustainability of this program is essential to realize universal health coverage (UHC) in the country, and its success heavily relies on the compliance of its participants in paying the premiums. Non-salaried workers constitute a membership category with a lower level of compliance in paying premiums compared to salaried workers and premium contribution beneficiaries. This study used the logit regression method and revealed significant findings. Specifically factors such as age, income stability, payment point, decision maker, and distance to health facilities were found to be associated with the compliance of private participants in paying the monthly premium of the JKN program. The study identified that older age is linked to higher compliance, and having a stable monthly income increases the probability of payment. Respondents who utilize bank auto-debit services for payments exhibit a higher level of compliance compared to those who make payments at modern mini-markets or e-commerce platforms. The joint decision-making by both spouses to participate in the JKN Program leads to higher compliance compared to decisions made solely by one spouse. Furthermore, the study discovered that a greater distance to health facilities corresponds to an increased likelihood of compliance in paying the monthly premium.

Nonparametric Estimates of Demand in the California Health Insurance Exchange

We develop a new nonparametric approach for discrete choice and use it to analyze the demand for health insurance in the California Affordable Care Act marketplace. The model allows for endogenous prices and instrumental variables, while avoiding parametric functional form assumptions about the unobserved components of utility. We use the approach to estimate bounds on the effects of changing premiums or subsidies on coverage choices, consumer surplus, and government spending on subsidies. We find that a $10 decrease in monthly premium subsidies would cause a decline of between 1.8% and 6.7% in the proportion of subsidized adults with coverage. The reduction in total annual consumer surplus would be between $62 and $74 million, while the savings in yearly subsidy outlays would be between $207 and $602 million. We estimate the demand impacts of linking subsidies to age, finding that shifting subsidies from older to younger buyers would increase average consumer surplus, with potentially large impacts on enrollment. We also estimate the consumer surplus impact of removing the highly‐subsidized plans in the Silver metal tier, where we find that a nonparametric model is consistent with a wide range of possibilities. We find that comparable mixed logit models tend to yield price sensitivity estimates toward the lower end of the nonparametric bounds, while producing consumer surplus impacts that can be both higher and lower than the nonparametric bounds depending on the specification of random coefficients.

Association of Medicare Advantage Premiums With Measures of Quality and Patient Experience

Quality of care varies substantially across Medicare Advantage plans. The price information that Medicare Advantage enrollees are most likely to consider when selecting a Medicare Advantage plan is the monthly premium. Enrollees may select plans to minimize premium or, alternatively, use premium as a proxy for quality and select plans with higher premiums; however, quality implications of these choices are unknown. To determine the extent to which the quality of care offered by Medicare Advantage plans varies within vs across premium levels. This was a retrospective cross-sectional study of the population enrolled in Medicare Advantage plans in 2016 to 2017 using clinical quality measures from the Healthcare Effectiveness Data and Information Set (HEDIS), patient experience measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, and administrative data. Data were analyzed from March 2021 to March 2022. Medicare Advantage monthly premium. Ten publicly reported 2017 HEDIS measures and 5 publicly reported 2017 CAHPS measures linearly transformed to a 0 to 100 scale. The 168 968 Medicare Advantage CAHPS respondents were representative of the enrollee population (14% were <65 years old and eligible through disability; 24% ≥80 years old; sex and race/ethnicity data were not considered); 40% were in 591 plans with no monthly premiums and less than 6% were in 144 plans with monthly premiums of $120 or more. There were from 77 054 to 2 139 422 enrollees by HEDIS measure. Among all Medicare Advantage enrollees, 79% were in plans with either a $0 premium or a low monthly premium (≤$60); patient experience and clinical quality were generally similar in these 2 categories of plans. To a small extent, enrollees in moderately high ($60-$120) and high (≥$120) premium plans reported better patient experience (+1.4 [95% CI, 0.7-2.1] and 2.2 [95% CI, 1.5-2.9] points) and received better clinical care (1.4 [95% CI, 0.3-2.5] to 3.3 [5% CI, 2.1-4.5] percentage points on most measures than those with $0 and low-premium plans. Quality differences within each premium level category were substantial; the within-premium category plan-level SDs were 6.5 points and 7.2 percentage points for patient experience and clinical quality, respectively. A plan at the 50th percentile of clinical quality and patient experience in the high premium category would fall in the 65th and 62nd percentile within the $0-premium category, respectively. This population-based cross-sectional study found that although quality of care and patient experience were slightly higher with higher-premium plans, quality varied widely within each premium category. High-quality care and patient experience were found in each price category. Thus, paying higher premiums is not necessary for higher quality care in Medicare Advantage plans. Greater engagement of enrollees and advocates with quality of care and patient experience information for Medicare Advantage plan selection is recommended.

Is Pet Health Insurance Able to Improve Veterinary Care? Why Pet Health Insurance for Dogs and Cats Has Limits: An Ethical Consideration on Pet Health Insurance.

Simple SummaryThe standards of veterinary medicine are increasingly approaching those of human medicine. As a result, the cost of veterinary medicine is also rising noticeably. For many veterinarians and also pet owners, the question therefore arises as to whether animal health insurance is a possible solution. Based on a thought model, we have classified pet owners into four groups according to their willingness to pay and their dispensable funds. We found that animal health insurance can reduce price discussions, but reaches its limits as soon as an animal owner can afford neither the veterinary costs nor a monthly insurance premium.Background: Owners often feel the cost of veterinary care is too high, as there remains a limited understanding of the cost of health care in human and veterinary medicine alike. Pet health insurance is often seen as a universal solution. However, especially for patient owners with few financial resources, both the bill at the vet and the monthly premium for pet health insurance can become a challenge. Hypothesis: Pet health insurance can prevent or ease many price discussions at the vet, but it does not offer a solution for patient owners with little financial means. Methods: In order to verify for which patient owners pet health insurance can be a solution, four theoretical groups were formed depending on the patient owner’s willingness to pay and his/her dispensable funds based on a theoretical model. Results: Dispensable funds are a factor that cannot be influenced by the veterinary surgeon. However, low dispensable funds as a result of an insufficient willingness to save (whether due to a lack of financial education or a lack of will) can be solved by pet health insurance. Willingness to pay, on the other hand, can be influenced by empathetic communication from the veterinary surgeon and thus also from pet health insurance. Nevertheless, situations remain where pet health insurance is not a solution either, because owners can neither afford the veterinary costs nor a premium for a pet health insurance.

Green is Good—The Impact of Information Nudges on the Selection of Voluntary Green-Power Plans

A recent trend has been a move toward greater reliance on renewable or “green” energy sources, especially in the residential sector. Using a choice experiment, this paper examines how providing information regarding the efficiency, cost, and environmental impacts of different power-generating sources impact consumers’ stated preferences for selecting voluntary green-power plans. Based on 21,000 plan choices from two different samples totaling over 1,800 respondents, our results indicate that information nudges significantly impact respondents’ choice of plan. Promoting the advantages of the green plan or the disadvantages of the “gray” plan increase green plan selection. The magnitudes of these estimated effects are economically significant being roughly equivalent to a change in the monthly green price premium of $4/month. We also find that promoting the advantages of the green plan is more effective when the green plan premium is relatively small, while highlighting the drawbacks of the gray plan is more effective when the green plan premium is relatively large. Our results suggest that information nudges have the potential to be a plausible, economical, and effective mechanism to increase adoption of voluntary green-power plans.

Earning like a Prof: Academic rank wage premia in Ústí nad Labem, Czechia

Abstract The article attempts to estimate the size of the wage premia fetched by ranked academics on the academic market in Ústí nad Labem, Czechia. We employed a large (anonymized) data set of contracts and wages of employees of a medium-sized regional public university in Ústí nad Labem. We used OLS regression in various specifications to determine the wage premia of all educational levels (mainly full professors over associate professors/ docents and associate professors/docents over assistant professors/PhDs) while controlling for many attributes (of employees or contracts) possibly affecting wage levels. The local context regarding the topic of this article is discussed as well. The results generally confirm the intuition and show a clear pattern of increasing wages with levels and ranks. Focusing predominantly on the academic ranks, the monthly premium of associate professors (docents) over PhDs seems to be somewhere between 5 and 6 thousand CZK (185 and 220 EUR), and the premium of full professors over associate professors to an average of around 4 thousand CZK (150 EUR). The latter premium, however, exhibits systematic variation across different schools within the university: in some it is insignificant (around 0), while in others it is rather large and averages around 8 thousand CZK (300 EUR).

PRİMSİZ UYGULAMALARLA YAŞLI VE ENGELLİLERİN SOSYAL GÜVENLİĞİ: TÜRKİYE ÖRNEĞİ

In Turkey, although the social security of the disadvantaged, elderly and/or individuals with disabilities take place within the non-contributory system and them having the same requirements to claim their monthly payments, the amount of individuals with disabilities’ Monthly Payments which were paid until June 2018 have always exceeded the Elderly Persons’ Monthly Premiums. In contrast, afterwards the 2016 amendment, the individuals with disabilities have faced injustice with the “per capita income” principle, which was implemented in favor of the elderly. With this study, we aim to emphasize that with the adoption of the Individuals with Disabilities' Law of 2005, the conditions and amount of premiums to claim Elderly and Individuals with Disabilities’ Monthly Benefits are inconsistent with the social justice principle. Thus, we state that the amount of monthly payments paid to the disadvantaged elderly people and individuals with disabilities are insufficient to have them reach the minimum living standards. Accordingly, it became evident that to fulfill the social justice principle in paying the elderly and individuals with disabilities’ monthly premiums within the non-contributory system in Turkey, indexation has to be carried at 40% rate of the “per capita net income”.

Kurtosis and Skewness on Lagged Market Risk Premium in Indonesian Market During Covid 19 Pandemic

This study investigates the impact of return distribution such as skewness and kurtosis on lagged market risk premium to risk premium in Indonesia capital market during COVID-19 pandemic. Data are monthly, from january to December 2020, and 674 firms. Panel data predictive regression is used The method For this study, I first looked for market risk premium and risk premium desripitives. Second, I used monthly panel data predictive regression from lagged market risk premium and risk premium in 2020. Third, I incorporate skewness and kurtosis simultaneously. Fourth, I exclude kurtosis or skewness in previous model. The results are market risk premium and risk premium having negative return. Risk premium has lower returns than market risk premium. The beta lagged market risk premium is significant to risk premium. The skewness and kurtosis market risk premium do not signify to risk premium together but significant separately. I can clonclude that the movement market risk premim and risk premium during COVID-19 pandemic are average negative. Beta lagged market risk premium can explain the future monthly risk premium. Contrary skewness and kurtosis, those can not be run together. When the model used to beta lagged market risk premium and skewness, partially the skewness was significant and the direction was positive. However, only beta lagged market risk premium and kurtosis were staying negative to the previous model. Incorporating lagged assumptive distribution only explain the risk premium under 1 % about 0.24%.

Estimation of nonstationary nonparametric regression model with multiplicative structure

Summary This paper presents a multiplicative nonstationary nonparametric regression model which allows for a broad class of nonstationary processes. We propose a three-step estimation procedure to uncover the conditional mean function and establish uniform convergence rates and asymptotic normality of our estimators. The new model can also be seen as a dimension-reduction technique for a general two-dimensional time-varying nonparametric regression model, which is especially useful in small samples and for estimating explicitly multiplicative structural models. We consider two applications: estimating a pricing equation for the US aggregate economy to model consumption growth and estimating the shape of the monthly risk premium for S&amp;P 500 Index data.

THE NEED TO INTEGRATE ZAKAT AND WAKAF IN THE DEVELOPMENT OF MICRO TAKAFUL MODEL

Micro Takaful is an affordable alternative protection policy for those who cannot afford a high-end level protection policy. However, many in the low-income group do not own a personal or family protection policy because they cannot afford the monthly premium rates. Zakat and wakaf could become an alternative source of funds for developing micro takaful. This qualitative study intends to explain the need to integrate zakat funds and wakaf in order to develop micro takaful. Data were collected through semi-structured interviews involving three institutions, namely Syarikat Takaful Malaysia Keluarga Berhad, Muftis Office in the Federal Territories Islamic Religious Council and the Muftis Office in the Selangor Islamic Religious Council. Findings show that there are two major pressing needs for integrating zakat and wakaf, which are to provide a huge risk savings fund and to support an insufficient zakat fund and wakaf.

The Value Premium

Abstract Value premiums, which we define as value portfolio returns in excess of market portfolio returns, are on average much lower in the second half of the July 1963–June 2019 period. But the high volatility of monthly premiums prevents us from rejecting the hypothesis that expected premiums are the same in both halves of the sample. Regressions that forecast value premiums with book-to-market ratios in excess of market (BM–BMM) produce more reliable evidence of second-half declines in expected value premiums, but only if we assume the regression coefficients are constant during the sample period. Received: January 21, 2020; editorial decision: July 21, 2020; Editor: Jeffrey Pontiff.

Association between vitiligo and subsequent risk of dementia: A population‐based cohort study

Increasing evidence suggests a positive association between autoimmune disorders and the subsequent risk of dementia, supporting the idea that neuroinflammation is a major contributor to dementia. However, whether or not adults with vitiligo have an increased risk of dementia remains unclear. We aimed to investigate the association between vitiligo and the subsequent risk of dementia. A total of 1320 patients with vitiligo and 5280 matched controls were identified from the Taiwan National Health Insurance Research Database between 1998 and 2011. Dementia was diagnosed by board-certificated psychiatrists or neurologists in the follow-up period. Cox proportional hazards models were used to estimate the adjusted hazard ratios (aHR) after controlling for age, sex, income-related monthly premium, residence and comorbidities associated with dementia. The incidence rate of dementia (per 100000person-years) was 502.8 among patients with vitiligo and 101.9 among the controls. Patients with vitiligo were more likely to develop any type of dementia (aHR, 5.30; 95% confidence interval [CI], 3.30-8.51), Alzheimer's disease (aHR, 12.22; 95% CI, 3.71-40.28) and vascular dementia (aHR, 3.99; 95% CI, 1.31-12.15) compared with the controls. In conclusion, middle-aged and old patients with vitiligo are more likely to develop dementia compared with those without vitiligo. This novel finding reminds physicians to be more careful about signs of dementia when managing patients with vitiligo and provides the basis for further investigations that clarify the underlying mechanisms.

The Determination of Monthly Premium of Joint Term Health Insurance for Hospital Care

Hospital care is one of the insurance products giving compensation to the members by reimbursing the medicine and hospital care costs. According to the number of members in one insurance policy, health insurance is classified into two categories namely individual health insurance and joint health insurance. This article discusses the monthly premium of joint health insurance. The monthly premium of joint term health insurance is calculated before deciding the probability to facilitate hospital care for two or more people using The RP-2000 Combined Healthy Tables and joint life annuity. Based on the simulation, at the same benefit, the monthly premium that must be paid for joint health insurance is smaller than for individual health insurance because the premium for joint insurance are borne by some insured under the same insurance policy