Permanent Health Insurance Research Articles

Добровільне медичне страхування в Україні: стан та перспективи розвитку

Aim. The paper analyzes the state of the voluntary medical insurance in Ukraine and identifies the tendencies of its development. Material and Methods. The research was conducted on the basis of consolidated reporting data of the National Commission for State Regulation of Financial Services Markets using statistical methods, structural-logical analysis and systematic approach. Results and Discussion. According to the results of the study, the permanent health insurance is a dominant segment in the market of voluntary medical insurance in Ukraine; however the medical expenses insurance shows a steady upward trend. During the study period, the number of concluded contracts by type of medical insurance increased by 3.1 times. The increase in contracts on health insurance against disease turned out to be the most significant: in 2019, 4.7 times more contracts were concluded than in 2015. The dominance of corporate medical insurance in the segment of the market of permanent health insurance was established, while the insurance premiums made by individuals prevailed in the segment of health insurance against disease and medical expenses insurance. When studying the level of payments under voluntary medical insurance contracts, it was found that the highest level of payments had been recorded for permanent health insurance (56.95% - 62.12%). In the result of analyzing the level of reinsurance in the voluntary medical insurance market, a reduction in the ratio of insurance premiums transferred to non-resident reinsurers was established. On the basis of which it can be affirmed that the inwards reinsurance in Ukraine is being formed. The formation of the inwards reinsurance market in Ukraine has significant prospects, as it will ensure the attraction of funds into the national economy and promote integration into the international reinsurance space. Conclusions. The development tendencies study of the voluntary medical insurance is of practical importance for assessing and increasing the competitiveness of the medical insurance market in Ukraine

Implementation and Effects of Information Technology-Based and Print-Based Interventions to Promote Physical Activity Among Community-Dwelling Older Adults: Protocol for a Randomized Crossover Trial.

BackgroundDespite the known health benefits of physical activity (PA), less than half and less than one-third of older adults in Germany reach the PA recommendations for endurance training and strength training, respectively, of the World Health Organization. The aim of this study is to investigate the implementation and effectiveness over the course of 9 months of two interventions (information technology [IT]-based vs print-based) for PA promotion among initially inactive older adults in a randomized, crossover trial. This study is part of a large research consortium (2015-2021) investigating different aspects of PA promotion. The IT-based intervention was previously developed and refined, while the print-based intervention was newly developed during this funding phase.ObjectiveWe aim to compare the effectiveness and examine the preferences of study participants regarding both delivery modes.MethodsOur target sample size was 390 initially inactive community-dwelling older adults aged ≥60 years at baseline (3-month follow-up [T1]: expected n=300; 9-month follow-up [T2]: expected n=240) who were randomized to one of two interventions for self-monitoring PA: IT-based (50%) or print-based (50%) intervention. In addition, 30% of the IT-based intervention group received a PA tracker. At T1, participants in both groups could choose whether they prefered to keep their assigned intervention or cross over to the other group for the following 6 months (T2). Participants’ intervention preferences at baseline were collected retrospectively to run a post hoc matched-mismatched analysis. During the initial 3-month intervention period, both intervention groups were offered weekly group sessions that were continued monthly between T1 and T2. A self-administered questionnaire and 3D accelerometers were employed to assess changes in PA between baseline, T1, and T2. Adherence to PA recommendations, attendance at group sessions, and acceptance of the interventions were also tracked.ResultsThe funding period started in February 2018 and ends in January 2021. We obtained institutional review board approval for the study from the Medical Association in Bremen on July 3, 2018. Data collection was completed on January 31, 2020, and data cleaning and analysis started in February 2020. We expect to publish the first results by the end of the funding period.ConclusionsStrategies to promote active aging are of particular relevance in Germany, as 29% of the population is projected to be ≥65 years old by 2030. Regular PA is a key contributor to healthy aging. This study will provide insights into the acceptance and effectiveness of IT-based vs print-based interventions to promote PA in initially inactive individuals aged ≥60 years. Results obtained in this study will improve the existing evidence base on the effectiveness of community-based PA interventions in Germany and will inform efforts to anchor evidence-based PA interventions in community structures and organizations via an allocation of permanent health insurance funds.Trial RegistrationGerman Registry of Clinical Trials DRKS00016073; https://tinyurl.com/y983586mInternational Registered Report Identifier (IRRID)DERR1-10.2196/15168

ДІЯЛЬНІСТЬ СТРАХОВИХ КОМПАНІЙ НА РИНКУ МЕДИЧНИХ СТРАХОВИХ ПОСЛУГ В УКРАЇНІ

The article analyzes the activities of highly rated insurance companies, which provide health insurance services in Ukraine. Time series study took place between 2014 and the first half of 2019. The quantitative dynamics of insurance companies tends to decrease. This is due to introduction of the order of the National Commission for the State Regulation of Financial Services Markets. This implies that by 2020 insurance companies must confirm their solvency by clearing out insurance portfolios of high-risk assets and forming an additional reserve of paying capacity, thus strong players remain in the market, and weak ones cease their activities.The level of competition in the market for health insurance services has been estimated using the Herfindahl-Hirschman index. The calculations were carried out on the indicators of insurance premiums and insurance payments, separately for each component of the health insurance services market, namely: permanent health insurance, medical expenses insurance, health insurance in case of illness. It is noted that the calculation of the Herfindahl-Hirschman index in the insurance market as a whole does not provide optimal information about the level of competition, because it should be calculated for each segment of the insurance market, including the market for medical insurance services. In Ukraine, it is necessary to bring domestic legislation in line with the European Union norms instead of relying on outdated norms that have been in force in the last century.The analyzed insurance companies occupy leading positions in the ranking in terms of insurance premiums, insurance payments and the level of payments. It is worth mentioning that the insurance companies «Uniqa» and «Providna» are the most financially stable in the health insurance services market. The comparative characteristic of health insurance programs offered to the population by insurance companies «Uniqa», «Providna», «ARX», «Alfa Insurance», «INGO Ukraine» is given. It is found out that programs of these insurance companies are similar in terms of fullness of services, cooperation with some medical institutions, medical laboratories and pharmacies, so each client can choose a program that he can afford.

Challenges and Future Recommendation for Kidney Transplantation in Iran: A Narrative Review

ContextNowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of the world, which is growing the wait list. The Iranian model of a kidney transplant was initiated for solving organ shortage and has been extremely controversial both inside and outside of Iran.Evidence AcquisitionThis narrative review was done by using Iranian and international databases to retrieve literature dealing with the Iranian model of kidney transplantation. All publications up until January 2018 were included. It has drawn out the weaknesses and strengths as well as the advantages and disadvantages, then, it provides some suggestion for better functioning of the Iranian model.ResultsOverall, 61 publications were retrieved and selected. After exclusion of unsuitable and duplicate articles, 17 were included. The main strengths of the Iranian model were having a lawful structure, supporting health centers and patients financially by government and charity funds, as well as reducing the waiting list. The main weaknesses include inadequate public awareness regarding the concept of brain death, the absence of a well-defined kidney registry system, need for renewing existing laws, regulations, and guidelines, the absence of permanent health insurance and follow-up for donors, as well as absence of a comprehensive network organ bank.ConclusionsThe transplant authorities in Iran should work on reinforcement of the model by solving and overcoming some challenges. Preventing organ failure, as well as its risk factors, public education and encouraging organ donation from individuals who are brain dead, improving the outcomes of circulatory death donation, and investment in tissue engineering could significantly reduce organ shortage. The final solution is living unrelated renal donation (LURD).

Some Notes on the Average Duration of an Income Protection Claim

Cordeiro (2002a) has presented a multiple state model for Income Protection (formerly known as Permanent Health Insurance) which enables us to analyse claims by cause of disability. In that paper average claim durations conditioned on recovery have been calculated.Since, when an Income Protection claim is reported, the insurance company never knows whether it will end in recovery, in death or in expiry, to analyse only average claim durations conditioned on recovery could be misleading, specially for the people responsible for the claims control process.The main purpose of this paper is to calculate average claim durations conditioned on death and average claim durations not conditioned on any particular mode of claim termination. We calculate these claim durations for different deferred periods, causes of disability and ages at the beginning of sickness and we analyse the results obtained.

Some Notes on the Average Duration of an Income Protection Claim

Cordeiro (2002a) has presented a multiple state model for Income Protection (formerly known as Permanent Health Insurance) which enables us to analyse claims by cause of disability. In that paper average claim durations conditioned on recovery have been calculated.Since, when an Income Protection claim is reported, the insurance company never knows whether it will end in recovery, in death or in expiry, to analyse only average claim durations conditioned on recovery could be misleading, specially for the people responsible for the claims control process.The main purpose of this paper is to calculate average claim durations conditioned on death and average claim durations not conditioned on any particular mode of claim termination. We calculate these claim durations for different deferred periods, causes of disability and ages at the beginning of sickness and we analyse the results obtained.

Prévention de l’endocardite infectieuse : les recommandations sur le suivi bucco-dentaire des populations à risque sont-elles appliquées ?

Infective endocarditis (IE) is a rare but particularly serious disease. It frequently requires surgical treatment with cardiac valve replacement. In-hospital mortality is very high. The guidelines of the Society of Infectious Pathology of French Language (SPILF) for the prevention of infective endocarditis of at-risk patients were updated in 2002. They recommended a bi-annual oral health follow-up and antibiotic prophylaxis for invasive sequences of care for high-risk patients. The objective of the study was to assess the application of the guidelines.Using databases and medical files of self-employed persons insured by compulsory national health insurance in the Alps, we studied from January 2001 to December 2002 the oral ambulatory follow-up of patients with permanent health insurance for valvular heart disease or congenital heart disease.Among the 260 patients with valvular heart disease or congenital heart disease, 125 (48.1%) presented medical claims for at least one dental treatment. Antibiotic prophylaxis was found in 15.8% of the invasive sequences of care for high-risk patients. The prescribed antibiotic was amoxicillin in 90% of the cases.Guidelines are seldom applied. Public and practitioner awareness should be improved to promote oral health: patients should regularly consult their dentist, and practitioners should follow the guidelines for the prevention of infective endocarditis.

Transition Intensities for a model for Permanent Health Insurance

AbstractThe purpose of this paper is to obtain approximations to the transition intensities defined for a multiple state model for Permanent Health Insurance (PHI) which enables us to analyse PHI claims by cause of disability.The approximations to the transition intensities are obtained using a set of PHI data classified by 18 sickness categories and the graduations of the transition intensities defined for a simpler model proposed in Continuous Mortality Investigation Reports, 12 (1991).In order to derive the approximations to the recovery and mortality of the sick intensities for our model, we carry out tests of hypotheses based on the distributions of average sickness durations. The approximations to the sickness intensities are obtained by estimating a statistical model for the number of claim inceptions, which can be formulated as a generalized linear model.

A multiple state model for the analysis of permanent health insurance claims by cause of disability

In this paper, we present a multiple state model for permanent health insurance (PHI) which enables us to analyse PHI claims by cause of disability. This new model, which is a generalisation of the model proposed in Continuous Mortality Investigation Reports [The analysis of permanent health insurance data, Continuous Mortality Investigation Report No. 12, The Institute of Actuaries and the Faculty of Actuaries, 1991] is very useful in the underwriting and claims control stages of PHI business. In the last sections of the paper, we use the model mentioned above to calculate the average duration of a claim and claim inception rates by cause of disability. For that purpose, we use the approximations to the transition intensities obtained by Cordeiro [A stochastic model for the analysis of permanent health insurance claims by cause of disability, Ph.D. Thesis, Department of Actuarial Mathematics and Statistics, Heriot-Watt University, Edinburgh, UK, 1998] and numerical algorithms which make possible an efficient evaluation of basic probabilities. We also make general comments on the results obtained.

Buyer seller relationships in the UK insurance market: Is this the key competitive advantage?

In services marketing much of the recent literature recommends the use of relationship marketing frameworks rather than the extended marketing mix which adds people, process and physical evidence to the traditional four Ps of product, price, promotion and place. In the UK permanent health insurance sector some suppliers sell through intermediaries, making this an ideal environment for testing the value of relationship marketing. Using the Industrial Marketing and Purchasing (IMP) group framework, interviews were conducted with 100 intermediaries. Respondents were asked to rate their top two suppliers against five relationship marketing variables: commercial skills, technical skills, commitment, adaptability and conflict management.

Modelling the recent time trends in UK permanent health insurance recovery, mortality and claim inception transition intensities

Models representing the underlying trends in UK permanent health insurance (PHI) recovery, mortality and claim inception transition intensitives over the 20 year calendar period, from 1975 to 1994 inclusive, are proposed. The investigation of such trends is of special interest given that the three transition intensities, with stationary estimates based on the equivalent grouped data for the quadrennial observation window 1975–1978, form an important part of UK continuous mortality investigation (CMI) Bureau multiple-state model for PHI business and play an important role in the pricing and reserving for PHI sickness benefits.

Initial Selection and Cause of Disability for Individual Permanent Health Insurance

AbstractWe investigate the influence of initial selection (the impact of underwriting during the early years of a policy's life) on individual Permanent Health Insurance claim inceptions. In Gutiérrez-Delgado (1999) a decreasing trend was found. In this paper we include the effect of cause of disability and fit a generalized linear model in order to gain a greater understanding of the phenomenon. Both effects, policy duration and cause of disability, are found to have a significant effect on the number of claims. We describe their influence using factors that collect the information available through the fitted model. Results from both factors suggest that the grouping of diseases selected for the research helps to explain partially our earlier results. In addition there is some evidence of moral hazard in mental disorders and musculoskeletal diseases which also contributes to the understanding of the negative trend found.

Buyer seller relationships in the UK insurance market: Does performance match market share?

The purpose of this paper is to measure the performance of firms in the group permanent health insurance sector and to compare this to market share rankings. As most sales in this sector occur through intermediaries the key performance indicators should be the perceptions of buyers among this group. The research conducted uses the Industrial Marketing and Purchasing group (IMP, 1984) model to measure the performance of firms through the perceptions of independent financial advisers (IFAs) against the key relationship marketing factors. The research was conducted by an agency and includes telephone interviews with 100 buyers. The results show that there are significant differences between the ratings for the variables in the IMP model of relationship marketing. The results also show significant relationships between performance and market share for some of the relationship marketing variables. This research provides support for the use of the IMP model in this sector but also leads to a number of questions that need further research.

Initial selection for Permanent Health Insurance

We investigate the effect of underwriting during the first few years of a policy’s life (the initial selection effect) on the individual Permanent Health Insurance claim inceptions by fitting a generalized linear model. Initial selection is found to be significant and we describe its effect using a factor and a ratio that collect the influence of the policy duration detected through the fitted model. Results from both measures suggest that its effect, against intuition, is negative in most cases.

Estimating Per Capita Expenses in Multiple State Models of Permanent Health Insurance

AbstractThe aim of this work is to present a method to compute the expected amount of annual claims in the health insurance. (A more detailed analysis of the method can be found in Kovářová (1998).) We will be especially concerned with the permanent health insurance and compare our numerical results with those computed and published for the permanent health insurance in C.M.I.R. (1991). At the same time we will give a general methodology applicable not only to the permanent health insurance but for other types of health insurance as well.The methods used today can be divided into three groups: the method of the decrement tables, the Manchester Unity method and the multiple state model. We would like to describe a simple method to compute from the data of the multiple state model the bases for the Manchester United and for the decrement tables methods.

232013 (M11) Modelling the recent time trends in UK permanent health insurance recovery, mortality and claim inception transition intensities: Renshaw A.E., Haberman S.,Actuarial Research Paper No. 113, Department of Actuarial Science and Statistics, City University London, June 1998

232013 (M11) Modelling the recent time trends in UK permanent health insurance recovery, mortality and claim inception transition intensities: Renshaw A.E., Haberman S.,Actuarial Research Paper No. 113, Department of Actuarial Science and Statistics, City University London, June 1998

082024 (M12, B21) Permanent health insurance: A case study in piecewise-deterministic Markov modelling : Davis M.H.A., Vellekoop M.H.,Schweizerische Vereinigung der Versicherungsmathematiker, Mitteilungen - Bulletin, Heft 2, 1995, pp 177–212

082024 (M12, B21) Permanent health insurance: A case study in piecewise-deterministic Markov modelling : Davis M.H.A., Vellekoop M.H.,Schweizerische Vereinigung der Versicherungsmathematiker, Mitteilungen - Bulletin, Heft 2, 1995, pp 177–212

Problems in the assessment of psychosomatic conditions in social security benefits and related commercial schemes

The medical community must recognize that support of claims for Incapacity Benefit and related commercial schemes places the patient in a small and special sub-population of clinical practice which may require specialist investigation, treatment, and documentation. Determination of functional capacity and of disability requires knowledge either not available or unfamiliar to most physicians with caring and therapeutic roles, especially of legal or contractual provisions and occupational data. However, it is not necessary for them to determine disability and they should not be asked to do so. The new, medical assessment procedures for Incapacity Benefit in the UK do not require this, and the largest provider of related commercial schemes (Long Term Disability; Permanent Health Insurance) has already eliminated this requirement from its application process. When such application is anticipated or requested, the medical record should be prepared and appropriate consultation obtained. Subjective issues should be identified and addressed. Comprehensive psychiatric evaluation, especially in subjective impairment, is critical in chronic incapacity. The estimation of functional capacities in the absence of objective data is particularly troublesome, but, clinicians can provide the Disability Medical Analyst with appropriate medical documentation.

Permanent Health Insurance Pricing. Seminar, 5 April 1995

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On the graduations associated with a multiple state model for permanent health insurance

The paper puts forward a comprehensive methodology for graduating the transition intensities in a multiple state model for permanent health insurance applications. The approach is based on generalized linear models (GLM) and utilises the data collected and analysed by the U.K. Continuous Mortality Investigation (CMI) Bureau (under the auspices of the Institute and Faculty of Actuaries) in respect of male standard experience of individual PHI policies for the period 1975–1978. The comprehensive and versatile nature of this approach is shown to be applicable to three sets of transition intensities for which data are available: for sickness recovery (as functions of age at sickness onset, x, and duration of sickness, z), for death as sick (also a bivariate function of x and z) and for sickness inception (a function of x only). The full potential of the GLM methodology means that approximations to normality which would lead to complex, iterative methods of fitting can be avoided and that the presence of duplicate policies can be allowed for. A novel feature of the graduation proposed is the introduction of break-point predictors (similar to splines) into the graduation formula, and the method of location of the number and optimum positions of the underlying break-points (or knots).