Total Insurance Research Articles

ZIP Code and ZIP Code Tabulation Area Linkage: Implications for Bias in Epidemiologic Research.

To our knowledge, no agreed-upon best practices exist for joining U.S. Census ZIP Code Tabulation Areas (ZCTAs) and U.S. Postal Service ZIP Codes (ZIPs). One-to-one linkage using 5-digit ZCTA identifiers excludes ZIPs without direct matches. "Crosswalk" linkage may match a ZCTA to multiple ZIPs, avoiding losses. We compared non-crosswalk and crosswalk linkages nationally and for mortality and health insurance in California. To elucidate selection implications, generalized additive models related sociodemographics to whether ZCTAs contained non-matching ZIPs. Nationwide, 15% of ZCTAs had non-matching ZIPs, i.e., ZIPs dropped under non-crosswalk linkage. ZCTAs with non-matching ZIPs were positively associated with metropolitan core location, lower socioeconomics, and non-white population. In California, 34% of ZIPs in the mortality and 25% in the health insurance data had ZCTAs with non-matching ZIPs; however, these ZIPs constitute only 0.03% of total mortality and 0.44% of total insurance enrollees. Our study findings support the use of crosswalk linkages and ZCTAs as a unit of analysis. One-to-one linkage may cause bias by differentially excluding ZIPs with more disadvantaged populations, although affected population sizes appear small.

Interfacility Competition and its Impact on Cost of Carpal Tunnel Release.

Carpal tunnel release (CTR) is the most common hand surgery procedure, but little is known about how healthcare market characteristics influence cost. The objective of this study was to understand the association of healthcare market competition and facility availability on out-of-pocket and total insurer payments for patients undergoing CTR. This retrospective cross-sectional study used a national sample of private insurance claims from 2015-2020. Adults who had CTR were included, while acute or inpatient CTRs, or lacking geographical information were excluded. Linear regression was applied to investigate the impact of the healthcare market competition and facility availability (ambulatory surgery center (ASC), hospital outpatient departments (HOPD), outpatient clinics) on the out-of-pocket expenses and total insurer payment. Market competition was measured using the Herfindahl-Hirschman Index. Of 119,828 patients, 76% underwent open CTR. The most competitive hospital markets were HOPDs and ASCs, respectively. As HOPD competition decreased, out-of-pocket expenses and total insurer payment decreased significantly. As ASC competition decreased, only total insurer payments decreased significantly. CTRs performed in outpatient clinics increased slightly over time. However, HOPDs remained the most common location until 2020 when their popularity was similar to ASCs. Finally, out-of-pocket expenses increased significantly whereas total insurer payments did not change significantly throughout the study period. This study found decreased healthcare market competition was not associated with increased CTR costs, suggesting that costs are complex and multifactorial. To reduce healthcare costs, this study supports the movement of CTRs to clinic and ASCs.

The Roles of Insurance on Economic Growth in Malaysia: An ARDL Approach

Malaysia’s economic growth has been rising steadily over the years and one of the main contributors is the insurance sector. The literature has recorded mixed findings on the relationship between insurance and economic growth. This paper examines the relationship between the insurance sector and economic growth in Malaysia over an extended period of 1990-2021. This paper uses three proxies for the insurance sector i.e. life insurance premiums, nonlife insurance premiums, and total insurance premiums. The Autoregressive-Distributed Lag (ARDL) and Error Correction Model (ECM) approaches are employed to achieve the objective. While controlling for foreign direct investment, export, and import, this paper found that there is a positive long-run relationship between non-life insurance premiums and economic growth. Conversely, a negative short-run relationship is observed between life insurance premiums and economic growth. The total insurance premium has a negative short-run relationship with economic growth yet is insignificant for the long-run. The non-life insurance sector has a larger contribution compared to life insurance on Malaysia's economic growth as the market depends more on capital formation and investments, particularly in infrastructure, real estate, and capital markets. The insurance sector provides financial expansion in terms of payment for protection which results in an economic boost.

Directors' and officers' liability insurance: a systematic literature review

PurposeWe review and synthesize the existing research on directors' and officers’ (D&O) liability insurance. Our objectives are (1) to examine the institutional forces and regulatory requirements that have influenced the development of D&O liability insurance; (2) to identify the factors that influence firms to purchase D&O liability insurance and explore the consequences associated with its usage and (3) to identify gaps in the current literature and provide recommendations for future research on D&O liability insurance.Design/methodology/approachWe perform a systematic literature review (SLR) using the Preferred Reporting Items for a Systematic Review of Meta-Analysis (PRISMA) guidelines to examine archival studies that investigate the determinants and consequences of D&O liability insurance. Using a Boolean search strategy on the “Web of Science” (WoS) and PRISMA selection criteria, we review 64 published archival research articles and three working papers from 1987 to October 2023.FindingsOur review reveals that disclosing detailed information regarding D&O liability insurance, such as total insurance premiums and coverage limit, is predominantly voluntary, except in Taiwan. Our findings suggest that the decision to purchase D&O liability insurance is influenced by litigation risk, which is determined by factors such as firm size, complexity and corporate governance variables. We also find that D&O liability insurance has implications for financial reporting, audit outcomes, investment behavior and capital market performance.Practical implicationsIn the post-COVID era, where firms face pressure due to financial constraints, our research emphasizes the practical importance of carefully considering and understanding the impact of D&O liability insurance, particularly as it concerns the demand for such insurance.Originality/valueTo the best of our knowledge, this study represents the first systematic review of previous research on D&O liability insurance. Our review highlights some research gaps, particularly in relation to the implications for financial reporting practices, auditing outcomes, firm investment behavior and capital market consequences.

The emergence of financial capital in the health insurance business in Europe: The case of Spain in the last fifty years

Abstract Sickness insurance companies were developed in Spain by doctors and healthcare professionals, remaining outside the interests of general insurance companies. Their management was hardly professional, with limited actuarial techniques and they only accounted for a small percentage of total insurance business premiums. From the 1970s onwards, various factors changed this situation, driving processes of concentration, with numerous takeovers and mergers, first reducing the number of local and regional companies to the benefit of companies of national scope. Subsequently, the growth in demand for this type of coverage sparked the interest of national general insurance companies and multinationals, leading to a restructuring of the sector which has progressively acquired greater weight within the insurance business and become increasingly internationalised. This last stage immersed the health sector in Spain in the great processes of globalisation of the sector, characterised by a financialisation of capital promoted by the bank investment funds. These processes are little known and are the focus of analysis of this paper, with the aim of enabling comparison at international level.

Hospital Prices for Physician-Administered Drugs for Patients with Private Insurance

BackgroundHospitals can leverage their position between the ultimate buyers and sellers of drugs to retain a substantial share of insurer pharmaceutical expenditures.MethodsIn this study, we used 2020–2021 national Blue Cross Blue Shield claims data regarding patients in the United States who had drug-infusion visits for oncologic conditions, inflammatory conditions, or blood-cell deficiency disorders. Markups of the reimbursement prices were measured in terms of amounts paid by Blue Cross Blue Shield plans to hospitals and physician practices relative to the amounts paid by these providers to drug manufacturers. Acquisition-price reductions in hospital payments to drug manufacturers were measured in terms of discounts under the federal 340B Drug Pricing Program. We estimated the percentage of Blue Cross Blue Shield drug spending that was received by drug manufacturers and the percentage retained by provider organizations.ResultsThe study included 404,443 patients in the United States who had 4,727,189 drug-infusion visits. The median price markup (defined as the ratio of the reimbursement price to the acquisition price) for hospitals eligible for 340B discounts was 3.08 (interquartile range, 1.87 to 6.38). After adjustment for drug, patient, and geographic factors, price markups at hospitals eligible for 340B discounts were 6.59 times (95% confidence interval [CI], 6.02 to 7.16) as high as those in independent physician practices, and price markups at noneligible hospitals were 4.34 times (95% CI, 3.77 to 4.90) as high as those in physician practices. Hospitals eligible for 340B discounts retained 64.3% of insurer drug expenditures, whereas hospitals not eligible for 340B discounts retained 44.8% and independent physician practices retained 19.1%.ConclusionsThis study showed that hospitals imposed large price markups and retained a substantial share of total insurer spending on physician-administered drugs for patients with private insurance. The effects were especially large for hospitals eligible for discounts under the federal 340B Drug Pricing Program on acquisition costs paid to manufacturers. (Funded by Arnold Ventures and the National Institute for Health Care Management.)

Impact and Prospects of Bancassurance in the Socio-Economic Landscape of Bangladesh

Bancassurance, the distribution of insurance products through banking channels, holds considerable promise for improving financial inclusion and promoting socio-economic growth in Bangladesh. This research investigates its current impact and potential using a mixed-methods approach, incorporating quantitative data from major banks and insurance firms along with qualitative insights from interviews with industry experts. The study assesses bancassurance's role in increasing insurance penetration, highlights regulatory and operational challenges, and identifies avenues for growth. Findings show that bancassurance has moderately boosted insurance coverage, with policies sold through banks accounting for 15% of total insurance sales by 2023. However, penetration in rural areas remains limited, hindered by regulatory uncertainties, low consumer awareness, and operational inefficiencies. Nonetheless, growth opportunities exist, particularly through digital platforms and microinsurance products tailored to underserved populations. The research concludes that bancassurance can significantly enhance financial inclusion and strengthen economic resilience, particularly for rural and low-income communities, provided it is supported by regulatory reforms, heightened public awareness, and improved technological integration. Key recommendations include streamlining regulatory frameworks, enhancing capacity within banks and insurance companies, and leveraging mobile and online banking platforms to expand bancassurance’s reach, especially in rural regions. Addressing these challenges could enable bancassurance to play a crucial role in advancing Bangladesh’s financial sector and contributing to its broader socio-economic development.

FINANCIAL RISK MANAGEMENT SYSTEM

Through the rapid development of the insurance market in Uzbekistan, by the end of 2022, respectively, compared to 2018, the share of insurance services in the gross domestic product (GDP) will be 2.0; the volume of total insurance premiums is 3.3; total assets of insurance organizations 2.1; to increase the number of types of insurance services by 1.7 times” determination requires the strengthening of the role of the insurance market and the wide use of insurance tools. Accordingly, during the comprehensive classification of the content of the "financial risk" category and the systematic research of its theoretical, methodological and practical aspects, the study of the causes of its occurrence, as well as the research of activities aimed at eliminating or minimizing its consequences, is considered one of the urgent topics.

Insurance Penetration and Inclusive Growth in Sub-Saharan Africa: Evidence from Panel Linear and Nonlinear Analysis

This study contributes to the emerging literature on the insurance industry in sub-Saharan Africa by investigating both the linear and nonlinear relationship between insurance penetration and inclusive growth. We employ a panel dataset in a system generalised method of moments approach and a dynamic panel threshold to account for endogeneity and turning points in the insurance-inclusive growth nexus. The linear evidence suggests a significant positive impact of insurance penetration (life, nonlife and total) on inclusive growth. Further, there exists a significant threshold level of nonlife and total insurance penetration, which countries must surpass to realise the positive impact of insurance on inclusive growth. The paper argues that below this threshold value, the relationship tends to be negative, suggesting a U-shaped relationship. We found no significant threshold for the life insurance industry. Important policy implications for fine-tuning the insurance industry to deliver the intended effects of managing risk in the wider economy are discussed.

Optimal Cyber Security Investment in a Mixed Risk Management Framework: Examining the Role of Cyber Insurance and Expenditure Analysis

Cyber security importance has escalated globally, driven by its pivotal role in shaping daily life, encompassing both personal and non-personal aspects. Cyber security breach probability functions play a crucial role in comprehending how cyber security investments affect vulnerability to cyber attacks. These functions employ mathematical models to guide decision making in cyber risk management. Thus, studying and improving them is useful in this context. In particular, using these models, this article explores the effectiveness of an integrated risk management strategy that merges insurance and security investments, aiming to minimize overall security expenses. Within this strategy, security investments contribute to reducing the insurance premium. This research investigates the optimal investment for this blended approach under total insurance coverage. When the integrated risk management strategy combining insurance and security investments is deemed the optimal choice, this paper reveals that the insurance premium tends to be the dominant component in the overall security expense in the majority of cases. This implies that the cost of insurance outweighs the cost of security investments.

The empirical demand for farm insurance in Ireland: a quantile regression approach

PurposeThe purpose of this paper is to analyse the association between farm/farmer characteristics and unsubsidized farm insurance premium expenditure in Ireland. The distribution of farm insurance expenditures is wide, and it is important to understand the extent to which individual factors influence demand for different levels of insurance premium.Design/methodology/approachThe quantile regression approach and farm accountancy data from the Teagasc National Farm Survey are used to model the association between farm/farmer characteristics and farm insurance demand in Ireland.FindingsAsset values (livestock, buildings and machinery) are positively associated with total insurance expenditure. Both forestry area and crop area are significantly associated with farm insurance expenditure with a stronger influence on the middle and upper part of the distribution. The interaction between farm income and farmer age is positively associated with insurance expenditure pointing to the importance of farm income protection.Research limitations/implicationsThe research is mainly concerned with insuring against substantive risks, which are capable of threatening the asset base and continuation of the farm business. Future research can integrate questions in relation to farm safety and farmer health with research on the economic survival of the farm business.Practical implicationsFarmers in Ireland adopt unsubsidized farm insurance as a risk management tool. This situation is relevant to other EU member states including Belgium, Denmark, Germany and Sweden. The findings can be used to inform stakeholders and policymakers about the relative impact of different factors on insurance expenditure.Originality/valuePrevious research has typically focused on the linear relationship between farm/farmer characteristics and insurance demand without accounting for variability across the size distribution. This research is based on the quantile regression approach where the association between farm/farmer characteristics and farm insurance expenditure can be assessed at different points of the distribution.

The comparison of the clinical outcomes and costs between surgical aortic valve replacement and transcatheter aortic valve implantation based on the Japanese Diagnosis Procedure Combination database.

We evaluated the clinical outcomes and costs of surgical aortic valve replacement (SAVR) and transfemoral transcatheter aortic valve implantation (TAVI) for aortic stenosis using the Japanese Diagnosis Procedure Combination (DPC) database. Using our extraction protocol, we retrospectively analyzed summary tables in the DPC database from 2016 to 2019, which were provided by the Ministry of Health, Labor and Welfare. A total of 27,278 patients were available (SAVR, n = 12,534; TAVI, n = 14,744). The TAVI group was older than the SAVR group (SAVR vs. TAVI: 74.6 vs. 84.5years; P < 0.01), with a lower in-hospital mortality (1.0 vs. 0.6%; P < 0.01) and a shorter hospital stay (26.9 vs. 20.3days; P < 0.01). TAVI conferred more total medical service reimbursement points than SAVR (493,944 vs. 605,241 points; P < 0.01), especially materials points (147,830 vs. 434,609 points; P < 0.01). Total insurance claims for TAVI were approximately 1 million yen higher than those for SAVR. Regarding the details of costs, only the operation cost was higher, while other costs were lower with TAVI than with SAVR. Our analysis revealed that both SAVR and TAVI showed acceptable clinical outcomes. TAVI was associated with higher total insurance claims than SAVR. If the material cost of TAVI operations can be reduced, greater cost-effectiveness can be expected.

Insurance cost and injury characteristics of anterior cruciate ligament injuries in sub-elite football: A population analysis involving 3 years of Australian insurance data.

To investigate the injury characteristics and insurance cost of anterior cruciate ligament injuries in sub-elite football players in New South Wales, Australia. Descriptive epidemiological study. Three years of insurance records (2018-2020) was used to describe anterior cruciate ligament injury costs and characteristics. Concomitant injuries and the mechanism of injury were determined by analysing the injury descriptions. Claim characteristics and costs are presented by age group (junior = 7-17 years, senior = 18-34 years, and veteran = 35 + years) and sex. Categorical data (including age-groups and sex) are presented as counts and percentages and analysed using a Chi squared or Fisher's exact test. Cost data are reported as means ± standard deviation with 95 % confidence intervals. Over the course of three football seasons (2018-2020), 786 anterior cruciate ligament injuries were reported to the injury insurance company. The total insurance cost was AU$3,614,742 with direct injury insurance costs accounting for 36.3 % of the total costs. The mean indirect insurance costs were six-fold higher than direct insurance costs (AU$11,458 vs AU$1914). Isolated injuries had an average cost of $4466 whilst concomitant injuries had an average cost of $4951. Surgical costs are excluded from direct cost calculations. The peak injury count occurred in the first month of all three football seasons, immediately after the pre-season. Anterior cruciate ligament injuries represent a substantial economic burden to the insurer and individual. The cost data provided can be used for future economic and modelling studies.

Insurance Premium and The Growth of Nigeria Economy (2007-2021)

The insurance industry's growing share of the global financial sector in both developed and developing countries has moved focus to the insurance-growth relationship. As a result, the study looked at the effect of insurance on Nigerian economic growth from 2007 to 2021. The study's goals were to look at the impact of life, and total insurance premiums on the growth of the Nigerian economy after the insurance regulations and reforms were implemented in 2006. Ex-post facto analytical research design was adopted in this work. The National Bureau of Statistics and the Central Bank Statistical Bulletin provided secondary data. The logarithm was used to alter the data. Ordinary Least Square regression technique was used to analyze the data. According to the findings, non-life gross premium has a considerable positive influence on real GDP, life gross premium has no significant effect on real GDP, and there is a significant positive association between total insurance gross premium and economic growth in Nigeria. Based on the findings, the general conclusion is that insurance and economic growth in Nigeria have a considerable positive association. The study recommends that the National Insurance Commission should adopt policies that promote the growth and development of the insurance industry as a whole. Individuals and families should be educated on the importance of life insurance in order for it to have a substantial impact on Nigeria's economic growth.

AN INSPECTION OF THE RELATIONSHIP BETWEEN THE INSURANCE AND BANKING SECTORS IN TÜRKİYE: A TIME-VARYING ASYMMETRIC CAUSAL RELATIONSHIP

Using yearly data from the Turkish insurance and banking sectors, the current research investigates the relationship between the insurance and banking sectors for the years 1983 to 2020. In contrast to earlier studies in the literature, the time-varying asymmetric causality test was implemented to see how the variables were linked within the different sub-periods. According to the asymmetric Hatemi-j (2012) causality test, it has been discovered that there exists a bidirectional causality between both positive and negative shocks of the total insurance density (TID), broad money supply (BRM) and private sector credit (PSC) variables. Time-Varying test results have shown that there is an asymmetric causality relationship between the data for only a short period and this causality relationship is not permanent.

Economic Growth and the Insurance Sector in South Africa: Toda-Yamamoto

Abstract. Introduction. The connection between the real economy and the financial sector continues to be a subject of debate amongst scholars. There is a plethora of studies dedicated to unravelling the relationship between economic activity and financial progress. However, a large share of those studies has concentrated on banking and the capital market industries; the studies that have undertaken to decipher the connection between the insurance industry and prosperity in the economy are insufficient. Purpose. This study attempts to explore the link between South Africa's insurance industry and economic growth. The study made use of secondary time-series quarterly data and employed the Toda-Yamamoto (non-Granger causality) test. Results. Firstly, the findings show a uni-directional causal relationship running from long-term insurance to GDP percapita. Implying that the South African long-term insurance sector is supply-leading. Secondly, the results revealed that GDP percapita and the short-term insurance sector are interdependent (bi-directional relationship). Lastly, the findings showed a unidirectional causal relationship between GDP per-capita and total insurance assets. Conclusions. The results imply that the South African total insurance sector is supply-leading.

Развитие рынка банкострахования Российской Федерации в современных условиях

The instability of modern economy forces economic entities to revise their business development strategies and risk management methods. As a result, financial intermediaries (banks and insurance companies) as financial market participants are cooperating to carry out joint activities and solve emerging problems. This leads to the development of bancassurance, one of the most promising ways to advance the Russian financial market. The purpose of the study is to analyze the bancassurance market and identify prospects for its development. The authors provide various definitions for the bancassurance concept, propose a new definition, and consider the interaction models as well as advantages and disadvantages of interaction between banks and insurance companies. To study the bancassurance market the researchers used statistical data of the Central Bank of the Russian Federation and the RAEX Rating Agency for 2012–2020. The authors examined the structure and dynamics of the market as a whole and by segments. The bancassurance accounts for more than a third of the total insurance market volume and continues to grow. The structure of the bancassurance market has radically changed since 2012. The least developed segment is bank risk insurance, most of which is devoted to insurance of bank employees. Non-credit insurance is the most developed, but its share is gradually decreasing. Credit insurance is less developed, but its share is steadily growing due to life and health insurance of consumer loans borrowers..

Differentiation of expenditure on health and life insurance in households in 2006–2020

Along with the growing wealth of society, the demand for insurance, including health insurance, increases. In recent years, there has been significant interest in insurance products which guarantee access to private healthcare facilities. The waiting time for an appointment with a specialist is shorter than in public institutions, and such insurance offers quick diagnostics and high-quality services.&#x0D; The study aimed to determine the level and differentiation of health insurance expenditure in various types of households and its share in total insurance expenses. From 2006 to 2020, as shown by statistics, the highest expenditure on health insurance was recorded in the households of non-manual workers (PLN 19.72 per person per year on average) and the lowest — in farmers’ families (8.85 per person per year on average). The indicator of the diversification of insurance expenditure structures for the surveyed households calculated for 2020 showed that farmers’ households had a significantly different (various) structure of expenditure on insurance than that observed in other types of households (total vpq = 0.96).

Indian Insurance Scenario vs Global Insurance

Abstract: India Insurance market stands at $131 Bn as of FY22. The Indian insurance industry grew at a CAGR of 17% over the last two decades and is expected to continue its commendable growth trajectory in the future years India is likely to become the sixth largest insurance market in the world over the next decade driven by regulatory push and rapid economic expansion. In its latest report, Swiss Re Institute expects the country's total insurance premiums to grow by an average of 14% n nominal local currency terms in the next 10 years. For the current year, Swiss Re expects India's life insurance industry to record a growth rate of 6.6% and a further rise to 7.1% in 2023.

Insurance and economic growth nexus: New Evidence from OECD countries

This study tackles the debate on the relationship between insurance development and economic growth by providing new evidence on the insurance sector. Most of the existing empirical studies focus primarily on the banking sector. This article applies linear dynamic panel-data approaches to examine the nexus between insurance (life insurance, non-life insurance, and the total insurance) and economic growth in 16 OECD countries from 2009 to 2020. We show that insurance development is associated with economic growth. The relationship between life and non-life insurance premiums and economic growth is non-linear. Based on the analysis of the data, an inverted U-shaped relationship is observed between insurance premiums and economic growth, thereby supporting the hypothesis reported in the literature on the non-linear relationship between financial development and economic growth. This implies that more finance may only be better up to a point, after which it tends to harm growth. Thus, our results confirm that the relationship between the insurance sector and economic growth appears to behave like the association between the financial industry and GDP. These findings offer several useful empirical implications for insurance companies and certain perspectives that would help policymakers, governments in OECD and other regions identify important aspects that can be considered while formulating financial regulations related to insurance activities.