Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?Evidence from Ethiopia

Objectives This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance(CBHI)scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms.There is growing concern about the financial sustainability of CBHI schemes in developing countries.However,few empirical studies have identified potential contributors,including ex-ante and ex-post moral hazards.Methods We implement a household fixed-effect panel data regression model,drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.Results The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals.However,CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms.Particularly,on average,we estimate about 4-6 h delay for malaria symptoms,a little above 4 h for tetanus,and 10-11 h for tuberculosis among the insured households.Conclusions While there is evidence that CBHI improve the utilization of outpatient or primary care services,our study suggests that insured members may wait longer before visiting health facilities.This delay could be partly due to moral hazard problems,as insured households,particularly those from rural areas,may consider the opportunity costs associated with visiting health facilities for minor symptoms.Overall,it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

China Continues to Be World’s Second Largest Insurance Market

Allianz Group recently released the Allianz Global Insurance Report,predicting that China will consolidate its position as the world’s second largest insurance market in the next decade.The report analyzes the business performance of the global insurance market in 2023 and forecasts the development direction and trends of the global insurance industry in the next decade.2023:A year of significant growth According to the report,in 2023,the global insurance industry grew by an impressive 7.5%,which is the fastest rate since the pre-Global Financial Crisis(GFC)era.

Telematics as a Transformative Agent for the Zimbabwean Auto Insurance Ecosystem

Zimbabwe has witnessed the evolution of Information Communication Technology (ICT). The vehicle population soared to above 1.2 million hence rendering the Transport and Insurance domains complex. Therefore, there is a need to look at ways that can augment conventional Vehicular Management Information Systems (VMIS) in transforming business processes through Telematics. This paper aims to contextualise the role that telematics can play in transforming the Insurance Ecosystem in Zimbabwe. The main objective was to investigate the integration of Usage-Based Insurance (UBI) with vehicle tracking solutions provided by technology companies like Econet Wireless in Zimbabwe, aiming to align customer billing with individual risk profiles and enhance the synergy between technology and insurance service providers in the motor insurance ecosystem. A triangulation through structured interviews, questionnaires, and literature review, supported by Information Systems Analysis and Design techniques was conducted. The study adopted a case study approach, qualitatively analyzing the complexities of the Telematics insurance ecosystem in Zimbabwe, informed by the TOGAF framework. A case-study approach was applied to derive themes whilst applying within and cross-case analysis. Data was collected using questionnaires, and interviews. The findings of the research clearly show the importance of Telematics in modern-day insurance and the positive relationship between technology and insurance business performance. The study, therefore revealed how UBI can incentivize positive driver behavior, potentially reducing insurance premiums for safe drivers and lowering the incidence of claims against insurance companies. Future work can be done on studying the role of Telematics in combating highway crime and corruption.

Optimal Insurance with Background Risk under the Ambiguity and Belief Heterogeneity Structure

In this paper, we discuss the optimal insurance in the presence of background risk while the insured is ambiguity averse and there exists belief heterogeneity between the insured and the insurer. We give the optimal insurance contract when maxing the insured’s expected utility of his/her remaining wealth under the smooth ambiguity model and the heterogeneous belief form satisfying the MHR condition. We calculate the insurance premium by using generalized Wang’s premium and also introduce a series of stochastic orders proposed by [1] to describe the relationships among the insurable risk, background risk and ambiguity parameter. We obtain the deductible insurance is the optimal insurance while they meet specific dependence structures.

Research on the Establishment of a Long-Term Care System for the Elderly with Alzheimer’s Disease Under the Background of Long-Term Care Insurance: A Literature Review

With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.

Analysis of Drug Medical Insurance Access Pricing Based on the Perspective of Binary Equilibrium

Objective To study the influencing factors in the process of national medical insurance negotiation and drug pricing from the dualistic equilibrium perspective,and to provide reference for the harmonious management of drug pricing in China.Methods Through the literature analysis and policy review,the pricing subject,pricing basis and price control system in the pricing process of medical-accessed medicines were analyzed from the perspective of binary equilibrium and harmonious management.Results and Conclusion It is found that four balances in the drug pricing process,two balances in pricing basis and three balances in price control system need to be considered,respectively.Drug pricing is the key content of national medical insurance access,which is also the hotspot of the policy in the pharmaceutical fields in recent years.Drug pricing not only reflects the value of drugs,but also reflects a lot of top-level designs of binary equilibriums in medical insurance policy.While the rational design of drug pricing requires the joint efforts of the government,pharmaceutical companies and relevant experts to comprehensively consider many equilibriums,so as to improve the relevant systems.

A Market Model of Risk Transfer and Insurance

We introduce a model of a market where risk-averse consumers pay a fee to transfer their future losses to one or more firms.The future loss of each consumer is stochastic with a unique,known mean and variance.The law of large numbers allows the firms to know with certainty the expected aggregate loss of the consumers to whom they sell.The model could describe the behavior of agents in the market for property insurance where an insurance company sells a single type of policy to a specific group of consumers based upon the expected losses of those consumers and their willingness to pay for coverage.The model demonstrates how a single firm can choose the optimal segment of the market to which they sell a policy and how that choice might change when the distribution of consumers and their risk aversion changes.The model also demonstrates how two firms might engage in a cooperative strategy and share the market.The model shows how a firm entering the market will find it more advantageous to target a segment of the market with consumers that have a lower expected loss.

Are life insurance futures a safe haven during COVID‑19?

This study aims to examine whether life insurance futures can serve as a hedge against the COVID-19 pandemic and whether they have the characteristics of a safe haven under the impact of the health shocks of the COVID-19 pandemic.We chose three life insurance stock futures in India and one in Taiwan as samples,including the market index of the two countries and the number of confirmed COVID-19 cases as sample variables.We used the growth rate of COVID-19 cases as the threshold variable,esti-mated the asymmetric threshold vector autoregression model,and found that insur-ance futures in the regime with a significant growth rate of confirmed COVID-19 cases can hedge against COVID-19 risks;therefore,insurance futures are a safe haven for the market.We further estimated the time-varying parameter vector autoregression model,and the impulse response results showed that insurance futures are a safe haven for COVID-19 pandemic risks.

Assessing the Impact of Health Insurance on Household Financial Protection in Togo

Context: To facilitate financial access to care for the population, health insurance mechanisms have been established, in particular the National Health Insurance Institute, which covers civil servants and their dependents. In addition, other voluntary and community mechanisms have been developed. After several years of implementation, the level of catastrophic health expenditures among insured individuals shows that there is still a considerable level of financial risk associated with health care. This study aims to assess the impact of health insurance in Togo on insured populations. Methodology: The data used in this study come from the harmonized survey on household living conditions carried out in 2018 by the National Institute of Statistics, Economic and Demographic Studies. The propensity score matching method was used according to the following steps: estimation of propensity scores, verification of the conditional independence hypothesis (balancing property) and estimation of the average treatment effect on treated. Stata V14.2 software was used. Findings: The average effect of health insurance on household financial protection is −0.012 for the nearest neighbor method, −0.013 for the matching radius method, −0.015 for the Kernel and −0.016 for the stratification method. Results showed that health insurance contributes to reducing catastrophic health expenditures, but their effect remains very limited. This could be explained by the level of care package covered and the cost covered. Conclusion: Health insurance contributes to the reduction of catastrophic health expenses for households. However, it is important to widen the range of care covered and the cost covered. In addition, measures to extend this coverage to a larger proportion of the population will make it possible to have a greater impact.

The Potential of Commercial Pension Insurance to Develop into One of the Pillars of Rural Pension Insurance:A Study from the Demand Perspective

The development of a multi-pillar pension insurance system is an effective solution for an aging society.Commercial pension insurance,as the third pillar of pension insurance,is an integral part of this system in China and can play a critical and complementary role in rural areas where support for the elderly is a more pressing concern and a second pillar of pension insurance remains absent.To this end,we first elaborate on the theoretical logic that commercial pension insurance can develop into one of the pillars of rural pension insurance.We then empirically test rural residents’willingness to participate in a commercial pension insurance plan(CPIP)in a probit model with household research data from rural areas in major labor-exporting provinces,such as Sichuan and Henan so as to explore whether commercial pension insurance has the potential to become one of the pillars of rural pension insurance.Our research findings can be synthesized in three points.First,rural residents out of agricultural production for five consecutive years are more willing to participate in a CPIP than other rural residents,indicating that progress in industrialization and urbanization can significantly boost such willingness.Second,the younger rural residents are more inclined to participate in a CPIP than the older generation.Third,income increases can significantly boost rural residents’willingness to participate in a CPIP.Thus,with progress in industrialization and urbanization and an increase in rural disposable income,commercial pension insurance has a promising potential in rural areas and can hopefully develop into one of the pillars of rural pension insurance.

Explainable AI and Interpretable Model for Insurance Premium Prediction

Traditional machine learning metrics(TMLMs)are quite useful for the current research work precision,recall,accuracy,MSE and RMSE.Not enough for a practitioner to be confident about the performance and dependability of innovative interpretable model 85%–92%.We included in the prediction process,machine learning models(MLMs)with greater than 99%accuracy with a sensitivity of 95%–98%and specifically in the database.We need to explain the model to domain specialists through the MLMs.Human-understandable explanations in addition to ML professionals must establish trust in the prediction of our model.This is achieved by creating a model-independent,locally accurate explanation set that makes it better than the primary model.As we know that human interaction with machine learning systems on this model’s interpretability is more crucial.For supporting set validations in model selection insurance premium prediction.In this study,we proposed the use of the(LIME and SHAP)approach to understand research properly and explain a model developed using random forest regression to predict insurance premiums.The SHAP algorithm’s drawback,as seen in our experiments,is its lengthy computing time—to produce the findings,it must compute every possible combination.In addition,the experiments conducted were intended to focus on the model’s interpretability and explain its ability using LIME and SHAP,not the insurance premium charge prediction.Three experiments were conducted through experiment,one was to interpret the random forest regression model using LIME techniques.In experiment 2,we used the SHAP technique to interpret the model insurance premium prediction(IPP).

Impact of Dialysis Coverage on the Provision of Universal Health Insurance in the Republic of the Congo

Introduction: The launch of health insurance in the Republic of the Congo took place against a backdrop of extremely high costs for dialysis, which was not one of the services financed within this framework. The aim of this study is to assess the impact of including dialysis in the health insurance package in Congo. Methodology: This is a descriptive cross-sectional study with an evaluative aim, analyzing the impact of dialysis on the financing capacity of health insurance and health facilities to provide this type of care. Results: The results show that including dialysis in the universal health insurance package will require an additional financial effort of 6.20% of the current total financing capacity of the care basket. Most dialysis sessions are provided by the private health sector (87.5%), whose health facilities are unevenly distributed across the country, and concentrated in the country’s two major cities. This problem is the dual consequence of the very high cost of a dialysis session (average cost 140,234,375 FCFA or 229 US Dollars) and the number of patients under care, which will increase in the absence of effective and ongoing prevention efforts against chronic diseases in general and end-stage renal failure in particular. Conclusion: Dialysis is a high-impact public health intervention. The impact of its inclusion in the universal health insurance care package is difficult to bear financially. For dialysis to be covered by universal health insurance, additional funding and improved technical facilities are needed.

Inspiration of Foreign Innovative Drug Pricing Methods and Medical Insurance Payment Standards to China

Objective To study the innovative drug pricing methods and medical insurance payment standards in foreign countries and to provide reference for China’s government.Methods The official websites were searched for information and related literature,and literature review was used.Results and Conclusion In foreign countries,the clinical value of innovative drugs and their impact on medical insurance funds were comprehensively evaluated based on factors such as quality-adjusted life years,clinical benefit,and improvement of clinical benefit.Then,the evaluation results were taken as an important basis for whether innovative drugs were admitted to the medical insurance catalog and establishing medical insurance payment standards.By using international experience for reference,innovative drug pricing methods and medical insurance payment standards for China’s national conditions can be improved by establishing a basic database of clinical value and drug economic evaluation of innovative drugs,as well as innovative drug payment models based on decision thresholds.

The Impact of Population Aging on the Expenditure of Medical Insurance Fund for Urban Workers in China

Objective To explore the impact of population aging on the expenditures of medical insurance funds against the background that great changes in population structure influences economic development.Methods Through analyzing the impact of the population aging,the income and accumulated balance of the medical insurance fund,and other related factors on the expenditure of the medical insurance fund,development status of the medical insurance fund for urban employees in China since 2003 was obtained.Stata 16.0 was used to perform multiple linear regression analysis on related factors to determine the correlation between population aging and the change in medical insurance expenditures.Results and Conclusion The factors that have a greater impact on the expenditure of the medical insurance fund are the amount of income from the medical insurance,followed by the number of people over the age of 65 in China and the urban retired employees participating in medical insurance.We should focus on the sustainable development of the urban employee medical insurance fund to deal with the threat of aging.

Research on Accounting Issues of the Pension Insurance Fund for Urban Employees

Pension insurance is a vital component of China's social security system,ensuring the welfare of the general publie.This study centers on the revenue and expenses of City S's urban employee basic pension insurance fund.It introduces and analyzes the fund's accounting status from four key perspectives:fund raising.expenditure,financial statement system,and accounting information disclosure.The research identifes existing problems in City S's accounting system and conducts in-depth research on these issues.Furthermore,an empirical analysis is conducted on the management of the pension insurance fund.Through this empirical study,the paper aims to offer insights and recommendations for promoting stable and healthy development measures for City S'8 urban employee basic pension insurance fund.

保险创新服务新质生产力发展:风险特征、实现路径与对策建议

服务新质生产力发展是新时期保险创新的出发点和落脚点。保险创新主要通过科技保险、绿色保险、数字保险和保险资金运用四条路径服务新质生产力发展,且这四条路径已在宁波保险创新实验区科技攻关保险、粤港澳大湾区环境污染责任保险、人保资本设立科技保险创业投资基金等实例中得到初步印证。但是,保险创新服务新质生产力发展仍存在一些制约因素,需要完善监管与支持政策,开发和丰富产品体系,探索构建“保险元宇宙”生态,优化保险资金配置结构,以期进一步推动保险业守正创新,为新质生产力发展提供有力保障和强劲支撑。

乡村振兴战略下中国农业收入保险创新发展研究

在乡村振兴战略和粮食安全战略背景下,为深化农业供给侧结构性改革赋能我国“三农”产业结构升级,亟待加快构建农业收入保险制度体系,以实现农业强国目标。本文探讨了乡村振兴战略下创新发展我国农业收入保险的紧迫性和必要性,分析了我国农业收入保险试点中遇到的困难和不足,并借鉴美国、日本两国农业收入保险的制度安排和经营管理经验,提出了乡村振兴战略下创新发展中国农业收入保险的政策建议。

惠民保可持续发展研究

在多层次医疗保障体系建设中,惠民保是连接基本医疗保险与商业健康保险的中间层,是化解重大疾病风险、推进共同富裕的一项保障。本文探讨惠民保在多层次医疗保障体系中的地位,分析其参保、赔付以及产品现状,总结惠民保面临参保率不足、参保人群结构不良、赔付率不稳定且赔付不均等问题。基于此,本文提出实行基于DRG/DIP按病组支付的惠民保发展模式,旨在不影响相关主体利益的基础上改善参保率,优化参保结构,增强参保人获得感,从而吸引健康人群投保,提升制度普惠性和可持续性,为完善多层次医疗保障体系建设做出贡献。

共同富裕目标下的普惠保险与相对贫困减缓——基于2008-2021年31个省域数据

基于共同富裕的目标导向,分析普惠保险缓解相对贫困的机理,利用2008—2021年中国31个省域面板数据,建立基础面板回归模型、门槛回归模型及空间杜宾模型,实证检验普惠保险对相对贫困的减缓效应。研究结果表明,样本期内普惠保险通过提高生活保障、稳定相对贫困者收入、改善收入分配,显著缩小贫富差距;考虑相对贫困者的收入差异,普惠保险减缓相对贫困具有门槛效应;通过相邻地区的人员流动和信息交换等方式,普惠保险减缓相对贫困具有空间联动效应,且省际外溢效应强于省内。据此提出通过推进普惠保险高质量发展、提高相对贫困者的可支配收入和推动普惠保险省际协同的政策建议,减缓相对贫困和实现共同富裕。

中国社会医疗保险制度未来发展的挑战与创新建议

中国社会医疗保险制度发展至今,已覆盖了95%以上的人口,筹资和报销待遇都达到了与国民经济所处的中等收入国家地位相称的水平,但也存在不同人群待遇相差悬殊、医保基金使用效率不高的问题。未来需要从实现公平的国民待遇、进行科学的医保筹资规划、制定统一的医疗服务价格、设计合理的医保报销政策、明确划分中央与地方政府的职责等方面,正视挑战,创新发展,避免医保制度发展的中等收入陷阱。