Mutual Insurance Research Articles

Endogenous health risks, poverty traps, and the roles of health insurance in poverty alleviation

BackgroundFamily education investment is a key factor in reducing intergenerational transmission of poverty. At the price of higher health risk, the poor may overdraw their bodies to earn more money to invest in education. This study investigates the effect of physical overdraft, health risks and health insurance on poverty and economic growth.MethodsThis paper proposes an economic development model of endogenous health risks and poverty by setting up a physical overdraft decision. Furthermore, we introduce mutual health insurance mechanism to analyze its poverty alleviation effects.ResultsFirst, this study shows that health risks weaken the economy and are among the leading causes of poverty. Second, mutual health insurance can alleviate, but not completely eliminate, the negative impact of health risks on the economy. Third, appropriate health insurance arrangements can lift some or even all poor households out of poverty.ConclusionHealth risks have a significant effect on poverty. Furthermore, health insurance mechanisms have the advantages of transferring health risks, reducing poverty and improving health equity.

Price and Quality in the Generic Pharmaceutical Market.

Price and Quality in the Generic Pharmaceutical Market.

Mutual insurance in the entrepreneurial landscape

In this article, the authors introduce mutual insurance as a constructive component of the modern entrepreneurial landscape aimed at the protection of the wealth-related interests of the participants of the mutual insurance company (mutual insurance society, friendly society, etc.). Analyzing mutual insurance, the authors display it from the standpoint of entrepreneurship and assume that such companies (MICs) are among the insurance market actors. The specific feature of MICs is that they form the community of their members-policyholders. As far as members of each organization of this kind are its co-owners, they carry out some critical entrepreneurial activity functions. The object of this research is represented by the insurance market of the Russian Federation, through the prism of which the degree of development of MICs was demonstrated, and the barriers to its infrastructure growth were determined.

Did statutory insurance improve the welfare of Swedish workers? The statutory workplace accident insurance act of 1916

ABSTRACT Welfare researchers have regarded statutory accident insurance in 1916 as a starting point for the exceptional expansion of the Swedish welfare state. However, rather less attention has been paid to the roles played by mutual insurance societies and employer compensation schemes in offering voluntary welfare protection. We argue that voluntary welfare protection was an integral part of the early-twentieth century welfare system and played a crucial role in protecting workers in the case of sickness and accident. We also examine the limitations of these arrangements and explore the ways in which the design of the statutory scheme ensured that there was a continuing role for voluntary provision after the new Act came into operation. We also explore the impact of the scheme on wage levels, and show how its introduction eroded the wage premiums which had previously been earned by workers in high-risk industries.

From the Chair

From the Chair

Evolving corporate crisis response coordination for maximum resilience

Crisis management in large organisations should evolve response structures to prepare better for real-time, enterprise-wide events, and boost overall resilience. This paper proposes that organisations shift from an incident command structure to a more agile approach that reflects changes in business operations. This paper describes the evolution in Liberty Mutual Insurance’s US operations practice from a more traditional emergency response team structure to an agile one that seeks to unify crisis teams globally and cross-functionally. The paper concludes that the adoption of a collaborative methodology across disciplines fundamentally increases organisational resilience.

FROM LAND INSURANCE IN RUSSIA TO MASS RISK MANAGEMENT

The article discusses land insurance as a way to manage massive risks. The author examines in detail the concept of risk and touches upon the structure of the formation of the concept of mass risk management. This allows us to examine in more detail the system of zemstvo insurance in the second half of the 19th century and understand the degree of influence of this type of mutual insurance on the further stages of the formation of the modern insurance market in Russia.

Ophthalmic Trauma Malpractice in the Ophthalmic Mutual Insurance Company Database.

To review ophthalmic trauma malpractice claims in the Ophthalmic Mutual Insurance Company (OMIC) database to determine the frequency and causes of litigation. A retrospective case series analysis of ophthalmic trauma claims from 2009 to 2019 was completed. Cases were selected only if the injury was secondary to trauma (e.g., fall, gunshot wound, paintball injury, etc.); iatrogenic traumatic surgical injuries were excluded. 31 closed cases associated with 40 total claims related to ophthalmic trauma out of 2565 claims (1.56%) in the OMIC database were analysed. 13 of the 31 cases (41.9%) were decided for the plaintiff. In decisions for the plaintiff, the median settlement amount was $330,000 (range $125,000-$1,000,000). The most frequent initial diagnoses were corneal abrasion (n = 10), hyphema (n = 5) and open-globe injury (n = 5), and the most common final diagnoses were endophthalmitis (n = 8), intraocular foreign body (n = 7) and retinal detachment (n = 7). The most common causes of malpractice litigation were a delay in referral or follow-up (n = 11) and failure to get appropriate imaging (n = 8). In the 13 cases decided for the plaintiff, experts concluded nine did not meet standard of care. Ophthalmic trauma malpractice claims are very uncommon in the United States, however, the payout is higher than non-trauma settlements, and approximately 40% of cases were decided for the plaintiff. Care could be improved with a careful history and complete ophthalmic examination (with dilated fundoscopy), imaging in appropriate patients, meticulous documentation, and early sub-specialist referral when the diagnosis or management plan was unclear.

Russian laws governing marine insurance and the development of mutual insurance

The importance of marine insurance is determined by the nature of the risks, associated with maritime navigation, the cost of marine vessels and the cargo’ size. Navigation is still hazardous despite technological advances and innovations, and ships continue to sink, causing people to die, cargo loss, and harm to third parties. The level of development in marine insurance of a maritime state is one of the key characteristics of that state's economy as a whole. Russia has traditionally been one of the world's major maritime powers, playing an active role in marine research and development. Over the last decade, Russia has made extensive progress in developing natural gas resources and supporting infrastructure on its northern coast. With the growth of ship traffic along the Northern Sea Route, it is a timely opportunity to evaluate the prevailing Russian marine insurance system and determine whether it is adequate to meet the needs for insurance in this realm over the foreseeable future. The main objectives of this study are to introduce the system of Russian marine insurance law, including the legislative acts regulating relationships arising out of the insurance contract law, governing the organisation of the insurance business in the Russian Federation, and to analyse the reasons for the imperfections of the legislation in terms of mutual insurance and its impact to the realisation of projects relating to the navigation in the Northern Sea Route waters. The study concludes that in order to safeguard the key national projects, taking account of the fact that risks of damages to ships operating in Arctic waters are high and costly, thus there is a need for a careful and verified state policy and legislation in the field of marine insurance aimed at promoting and supporting the development of mutual insurance.

Principi solidarnosti i uzajamnosti u obaveznom socijalnom osiguranju zanatlija, trgovaca i rudara u 19. veku u Srbiji

Solidarnost i uzajamnost su bili osnova udruživanja različitih skupina lica sa zajedničkim interesom za pokrićem od različitih rizika. U ovom radu se ukratko analizira značenje pojmova „solidarnost” i „uzajamnost” kao osnovama socijalnog osiguranja, a zatim nastanak socijalnog osiguranja i današnji ustavni okvir Republike Srbije i prava Evropske unije. U posebnim delovima se istražuje sadržina i obim solidarnosti i uzajamnosti organizovanih kroz kase uzajamne pomoći zanatlija i trgovaca po Uredbi o esnafima iz 1847. godine i rudarsko-bratinske kase rudara iz Rudarskog zakonika iz 1866. godine. Istorijskim metodom prate se različiti vidovi zbrinjavanja i pomoći i ukratko objašnjavaju razlozi koji su doveli do njihovog nastanka, a kasnije i institucije socijalnog osiguranja, dok se logičkim metodama izvlače zaključci o obeležjima uzajamnog osiguranja zanatlija, trgovaca i rudara po navedenim propisima. Prilikom istraživanja autori se bave analizom sadržaja i značenja samo onih odredbi i pravila koji su relevantni za temu ovog rada.

How volatility affects the behaviour of institutional investors in emerging markets

The investments made by domestic institutional investors (DII) have turned out to be a dynamic force for the development of Indian stock markets. This situation has motivated me to study the nexus between DII's capital flows and stock market volatility. Most studies have taken mutual funds as the proxy for DII. This paper has considered the disintegrated data of DII, which includes mutual funds and insurance companies, banks, and development financial institutions (DFI). The study discloses that out of four DII, insurance companies increase the market volatility. On the other hand, trading of banks, mutual funds, and DFI are helping to decrease the volatility in stock markets. Thus, they contribute to correct the overreaction in stock markets resulting from noise trading. Moreover, all the DII's act as informed traders because they take advantage of the volatile markets for investments.

Direct costs of hospital care of heart failure at cardiology institute of Abidjan

To evaluate the direct cost of hospitalization for heart failure (HF) at Institut de Cardiologie d’Abidjan. From December 1, 2019 to June 30, 2020, we conducted a prospective study on a sample of 150 patients hospitalized in the medicine department of Institut de Cardiologie d’Abidjan. 150 patients hospitalized for HF were included in our study. 61% of the patients were male. The mean age was 54.5 ± 17.2 years. Nearly 40% of our patients had a monthly income of less than 60,000 CFA Francs. The majority of patients did not have health insurance, 83.3%. Most of our patients were admitted with NYHA stages III and IV (32% and 56%). Dilated cardiomyopathy (42.7%) was the most frequent etiology. As regards the economic aspect, the average direct cost per patient for the management of heart failure in our study was estimated at 490,500.8 CFA Francs with extremes of 74,414 and 1,512,857 CFA Francs and the cost of the paraclinical assessment occupied an important part (211,130 CFA Francs) (43%). This cost increased with male sex, low monthly income, NYHA stage, ischemic heart disease and the occurrence of death but without any statistically significant relationship. The cost of treating heart failure is high in our country, where the guaranteed minimum wage is 60,000 CFA Francs. This suggests that a policy should be implemented to identify and treat the risk factors of the pathology among people at risk and to put in place a good system of health insurance and mutual health insurance in Côte d’Ivoire.

Study of the Viability of Community-Based Mutual Health Insurances in the Department of Vélingara in 2019 in Senegal

Introduction: Access to basic healthcare services for the whole population has been a priority the successive governments in Senegal since independence. Mutual health insurance has been the driving force behind health coverage since the 2000s. This policy aimed to reach 75% coverage of the population by 2019. This study aims to describe the characteristics and also analyze the viability of mutual health insurances in Vélingara. Methodology: The mixed method was used to evaluate both the viability of mutual health insurances and the perception of the communities. Viability was evaluated in its four technical, functional, financial and institutional aspects. For the population's perception, interviews were conducted with beneficiaries, non-beneficiaries, community leaders and UHC officials. Results: At the institutional level, all of the mutual health insurances were viable and had internal regulations, a statute, a license and a bank account. On the technical level, they were exposed to the risk of adverse selection. On the other hand, from a functional point of view, none of mutual health insurances was viable, with a very low rate of retention. Finally, from a financial point of view, none of the mutual health insurances had the capacity to honor their medium- and long-term debts without resorting to external resources. In addition, the results of the survey showed a lack of information and a high cost of membership. Conclusion: All the mutual health insurances were experiencing difficulties and required urgent corrective measures and support from the state and local authorities.

The Ownership and Governance of Mutual Insurance Companies

The Ownership and Governance of Mutual Insurance Companies

How Load Aggregators Avoid Risks in Spot Electricity Market: In the Framework of Power Consumption Right Option Contracts

There is uncertainty in the electricity price of spot electricity market, which makes load aggregators undertake price risks for their agent users. In order to allow load aggregators to reduce the spot market price risk, scholars have proposed many solutions, such as improving the declaration decision-making model, signing power mutual insurance contracts, and adding energy storage and mobilizing demand-side resources to respond. In terms of demand side, calling flexible demand-side resources can be considered as a key solution. The user's power consumption rights (PCRs) are core contents of the demand-side resources. However, there have been few studies on the pricing of PCR contracts and transaction decisions to solve the problem of price forecast deviation and to manage the uncertainty of spot market prices. In addition, in traditional PCR contracts, PCRs are mostly priced using a single price mechanism, that is, the power user is compensated for part of the electricity that was interrupted or reduced in power supply. However, some power users might engage in speculative behaviours under this mechanism. Further, for load aggregators, their price risk avoidance ability has not substantially improved. As a financial derivative, options can solve the above problems. In this article, firstly, the option method is used to build an option pricing optimization model for power consumption right contracts that can calculate the optimal option premium and strike price of option contracts of power consumption rights. Secondly, from the perspective of power users and load aggregators, a simulation model of power consumption right transaction decision-making is constructed. The results of calculation examples show that (1) Under the model in this article, the pricing of option contracts for power consumption rights with better risk aversion capabilities than traditional compensation contracts can be obtained. (2) The decision to sell or purchase the power consumption rights will converge at respective high-value periods, and option contracts will expedite the process. (3) Option contracts can significantly reduce the loss caused by the uncertainty of spot electricity prices for load aggregators without reducing users’ willingness to sell power consumption rights.

Factors associated with loyalty in the mutual health of Kisantu inDemocratic Republic of the Congo

Some African countries have initiated mutual health insurance to improve access to health care, However, most of these initiatives have not succeeded in covering the majority of the population, nor in securing long-term loyalty. Considering that very few studies, if not none, allude to the Democratic Republic of Congo (DRC), this study aims to determine the explanatory factors for both loyalty and non-loyalty within the Kisantu health mutual insurance in DRC and to identify any specific factors in the urban-rural Congolese context. We conducted a five-year prospective study, starting in 2013, among 320households, selected among a cohort of 2202households. Using the SPSS® 21.0 software, the association between loyalty and socio-demographic, socioeconomic variables and the degree of satisfaction with insurance products, as well as the motivations with respect to targeted loyalty, was sought. Thus, we found that the sociodemographic characteristics were not associated with loyalty of payments. In contrast, statistically significant relations were found between loyalty and socioeconomic characteristics, including occupation, estimated income, as the motivations expressed with regard to loyalty (P≤0.001). In a logistic regression model, occupation, estimated household income of $100 or above were twice more likely to be loyal than those with an income below $100. Protection by income has not been identified as a predictor in the studies included in our survey of the literature, but it proved to be significantly associated with loyalty in the present study. On the other hand, beyond the fidelity factors observed in this study, aspects relating to the management of mutual health insurance, which have appeared as predictors in other contexts, are not identified as such in our community. In an urban - rural context in DR Congo where the majority of the population has a low and unstable income, and considering the low amount of contribution to the Kisantu health mutual, 4.2% of the median household income, it will be necessary therefore rethink the place of health spending in households and the extension of solidarity in the form of uniform or income-based contributions.

Freedom to Define Membership in a Mutual Insurance Company

A mutual insurance society is one of the basic forms of conducting insurance activity. It is characterized by a very wide range of options which its founders and subsequently entitled members have in order to choose the organizational and systemic model of operation, to change it in the course of business, to define the concept of membership, to create various categories of members and provide them with different rights and duties, to determine the powers of statutory bodies, and, above all, to apply the method of mutuality. The Insurance and Reinsurance Activity Act regulates the basic legal framework of mutual companies, while referring quite a number of issues to the Polish Commercial Partnerships and Companies Code. This does not alter the fundamental principle on which the company's activity is based, namely that its articles of association play an extremely important role, which is much greater than in the case of public limited liability companies, and that members of a mutual insurance society enjoy considerable freedom to conduct business and categorize its members, which is unparalleled for other legal forms of business activity.

Evolution of Culture on Patient Safety in the Clinical Setting of a Spanish Mutual Insurance Company: Observational Study between 2009 and 2017 Based on AHRQ Survey.

Background: Patient safety (PS) is a key factor in reducing or even eradicating adverse incidents and events. Many health organizations promote strategies to improve PS, while also pointing out the importance of measuring it. For more than eight years, our institution has developed strategies focused on improving PS-culture among our personnel. The goal of this paper is to analyze the PS-culture between the years 2009 and 2017. Methods: A cross-sectional survey focused on PS, and developed by the American Agency for Healthcare Research and Quality (AHRQ), was conducted in 2009 and in 2017 among all healthcare workers at Mutualia, anonymously and voluntarily. Results: The overall response rate was similar in both 2009 and 2017 (37.2% and 38.5%, respectively). The average rating obtained showed a significant improvement over the period (7.7 vs. 8.1; p < 0.05). Itemizing by question, the main strengths were found in management support, organizational learning and continuous improvement, and, especially, in teamwork. Regarding weaknesses, the two lowest scores were those which refer to the balance between clinical safety and workload and the freedom to question the decisions made by superiors. Conclusions: The results obtained from the PS-surveys show that the overall PS-culture in our institution has increased, suggesting that the strategies focused on the improvement of PS-culture were well adopted among our personnel. The overall score places Mutualia at similar levels to those reached by the AHRQ and Spanish National Health System.

Analysis of community‐owned mutual insurers' prospects of development in CEE countries: Outlining research agenda

AbstractThe aim of the article is to discuss the development of prospects of mutual insurers in Central and Eastern Europe (CEE) countries and outline a possible research agenda for understanding their development direction in these countries. This has been achieved by exploring and identifying reasons behind community‐owned mutual insurers' underdevelopment and potential for future development through analysis of 24 interviews that included representatives from three stakeholder groups: supervisory authorities, insurance industry associations, and academics. Respondents were located in eight CEE countries: the Czech Republic, Hungary, Poland, the Slovak Republic, Slovenia, Bulgaria, Croatia, and Romania. Results of the study explaining mutual insurers' current underdevelopment and the potential for future development form four categories: citizens as consumers; mutual insurer's organizational characteristics and management; the impact of regulation; and society at large. Based on the results, in the article, we envision and point out several research approaches, perspectives of development, and directions that should be considered further by the scholars in the future.

Incentive Mechanism Design for Distributed Autonomous Organizations Based on the Mutual Insurance Scenario

The rise of blockchain has led to discussions on new governance models and the cooperation of multiple participants. Due to the cognitive defects of the blockchain protocol in terms of intelligent contracts and decentralized autonomous organizations (DAOs), it is often unclear as to how to make decisions about the evolution of blockchain applications. Many autonomous organizations, with the support of network technologies such as blockchain, blindly absorb members and expand the scale of the capital pool, while ignoring the cost advantage of traditional autonomous organizations based on social relations and mutual supervision to fight information asymmetry. In this context, this study analyzes the evolutionary trend of autonomous organizations and their members’ strategies under different policy environments. To this end, under the digital economy background, based on game theory, the evolutionary dynamics method, and the form of the mutual insurance organization, this study constructs an evolutionary dynamics model of distributed autonomous organizations. The results show that blind expansion without review aggravates the overall risk pool’s moral hazard, in the context of mutual insurance. Organizational strategies, such as risk pool splits, can effectively improve the risk pool’s operating performance and establish a benign competition elimination mechanism. Driven by cooperation efficiency and split supervision based on homogeneous clustering, the comprehensive application of the market elimination mechanism can effectively combat moral hazards, restrain the adverse effects of member flow, expand the living space of small- and medium-sized insurance organizations, curb the emergence of a large-scale monopoly risk pool, and improve market vitality. These conclusions and suggestions also apply to autonomous organizations based on social relations and mutual supervision. The results offer specific decision-making guidance and suggestions for the government, insurance companies, and risk management.