Analysis of inpatient payments of breast cancer patients with different medical insurance coverages in China(mainland) in 2011–2015

Objective： An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China（mainland）, in an attempt to offer a clue to further control the costs.Methods： The inpatient payments of 9,716,180 breast cancer patients spent in medical institutions of different types and grades during 2011–2015 were collected from the inpatient medical record home page（IMRHP） dataset.The data were then processed with SAS（Version 9.3; SAS Institute, Cary, NC, USA）. Indicators like means,increase（decrease） percentages were used to descriptively analyze the average hospitalization expense of each time（AHEET） and its trends of breast cancer patients with different medical insurance coverages treated in medical institutions of different types and grades.Results：In 2011–2015,the AHEET borne by breast cancer patients in China had been constantly increasing.Specifically,the self-pay inpatients had the largest increase,inpatients covered by Urban Employee Basic Medical Insurance（UEBMI）and Urban Resident Basic Medical Insurance（URBMI）were the next,and those covered by New Rural Cooperative Medical System（NRCMS）had the least increase.Breast cancer inpatient treated in public hospitals had quite greater increase and higher expenditure level than those in private hospitals.The AHEET borne by the inpatients in Grade 3 hospitals had greater increase and higher cost than those in Grade 2 hospitals.Conclusions：The inpatient payments of breast cancer patients will be wisely controlled by reducing the number of self-pay inpatients,taking advantage of restriction mechanism of the medical insurances,and promoting healthy competition between private hospitals and public hospitals.The economic burden imposed on the society by breast cancer can be relieved through further control of inpatient payments of UEBMI-and URBMI-covered breast cancer patients and of Grade 3 hospitals.

Determinants of self-rated private health insurance coverage in Jamaica

The purpose of the current study was to model the health insurance coverage of Jamaicans;and to identify the determinants, strength and predictive power of the model in order to aid clinicians and other health practitioners in understanding those who have health insurance coverage. This study utilized secondary data taken from the dataset of the Jamaica Survey of Living Conditions which was collected between July and October 2002. It was a nationally representative stratified random sample survey of 25,018 respondents, with 50.7% females and 49.3% males. The data was collected by way of a self-administered questionnaire. The non-response rate for the survey was 29.7% with 20.5% not responding to particular questions, 9.0% not participating in the survey and another 0.2% being rejected due to data cleaning. The current research extracted 16,118 people 15 years and older from the survey sample of 25,018 respondents in order to model the determinants of private health insurance coverage in Jamaica. Data were stored, retrieved and analyzed using SPSS for Windows 15.0. A p-value of less than 0.05 was used to establish statistical significance. Descriptive analysis was used to provide baseline information on the sample, and cross-tabulations were used to examine some non-metric variables. Logistic regression was used to identify, determine and establish those factors that influence private health insurance coverage in Jamaica. This study found that approximately 12% of Jamaicans had private health insurance coverage, of which the least health insurance was owned by rural residents (7.5%). Using logistic regression, the findings revealed that twelve variables emerged as statistically significant determinants of health insurance coverage in this sample. These variables are social standing (two weal- thiest quintile: OR = 1.68, 95% CI = 1.23 – 2.30), income (OR = 1.00, 95%CI = 1.00 – 1.00), durable goods (OR = 1.16, 95% CI = 1.12 – 1.19), marital status (married: OR = 1.97, 95% CI = 1.61 – 2.42), area of residence (Peri-urban: OR = 1.45, 95% CI = 1.199 – 1.75;urban: OR = 1.83, 95% CI = 1.40 – 2.40), education (secondary: OR = 1.57, 95% CI = 1.20 – 2.06;tertiary: OR = 9.03, 95% CI = 6.47 – 12.59), social support (OR = 0.64, 95% CI = 0.53 – 0.76), crowding (OR = 1.14, 95% CI = 1.02 – 1.28), psychological conditions (negative affective: OR = 0.97, 95% CI = 0.94 – 1.00;positive affective: OR = 1.11, 95% CI = 1.06 – 1.16), number of males in household (OR = 0.85, 95% CI = 0.77 – 0.93), living arrangements (OR = 0.62, 95% CI = 0.41 – 0.92) and retirement benefits (OR = 1.55, 95% CI = 1.03 – 2.35). This study highlighted the need to address preventative care for the wealthiest, rural residents and the fact that social support is crucial to health care, as well as the fact that medical care costs are borne by the extended family and other social groups in which the individual is (or was) a member, which explains the low demand for health insurance in Jamaica. Private health care in Jamaica is substantially determined by affordability and education rather than illness, and it is a poor measure of the health care- seeking behaviour of Jamaicans.

Evolution of seismic risk management for insurance over the past 30 years

During the past 30 years, there has been spectacular growth in the use of risk analysis and risk management tools developed by engineers in the financial and insurance sectors. The insurance, the reinsurance, and the investment banking sectors have enthusiastically adopted loss estimation tools developed by engineers in developing their business strategies and for managing their financial risks. As a result, insurance/reinsurance strategy has evolved as a major risk mitigation tool in managing catastrophe risk at the individual, corporate, and government level. This is particularly true in developed countries such as US, Western Europe, and Japan. Unfortunately, it has not received the needed attention in developing countries, where such a strategy for risk management is most needed. Fortunately, in the last five years, there has been excellent focus in developing ＂Insur Tech＂ tools to address the much needed ＂Insurance for the Masses＂, especially for the Asian Markets. In the earlier years of catastrophe model development, risk analysts were mainly concerned with risk reduction options through engineering strategies, and relatively little attention was given to financial and economic strategies. Such state-of-affairs still exists in many developing countries. The new developments in the science and technologies of loss estimation due to natural catastrophes have made it possible for financial sectors to model their business strategies such as peril and geographic diversification, premium calculations, reserve strategies, reinsurance contracts, and other underwriting tools. These developments have not only changed the way in which financial sectors assess and manage their risks, but have also changed the domain of opportunities for engineers and scientists.This paper will address the issues related to developing insurance/reinsurance strategies to mitigate catastrophe risks and describe the role catastrophe risk insurance and reinsurance has played in managing financial risk due to natural catastrophes. Historical losses and the share of those losses covered by insurance will be presented. How such risk sharing can help the nation share the burden of losses between tax paying public, the ＂at risk＂ property owners, the insurers and the reinsurers will be discussed. The paper will summarize the tools that are used by the insurance and reinsurance companies for estimating their future losses due to catastrophic natural events. The paper will also show how the results of loss estimation technologies developed by engineers are communicated to the business flow of insurance/reinsurance companies. Finally, to make it possible to grow ＂Insurance for the Masses - IFM＂, the role played by parametric insurance products and Insur Tech tools will be discussed.

A Model to Estimate the Impact of Thresholds and Caps on Coverage Levels in Community-Based Health Insurance Schemes in Low-Income Countries

Background: Community-based health insurance (CBHI) schemes are increasingly implemented in low-income settings. These schemes limit the coverage they offer both by the types of care considered, and by applying thresholds and/or caps to costs reimbursed. The consequences of these thresholds and/or caps on insurance coverage have hitherto been usually ignored, for lack of data on the distributions of healthcare costs or understanding of their impact on effective coverage levels. This article describes a theoretical model to obtain the distributions even without data collection in the field, and demonstrates the quantitative impact of thresholds and/or caps on claim reimbursements. Methods: This model applies to applications on healthcare expenditures in low-income settings, following research methods examined in the Western world. We looked at hospitalizations and tests;we compared the simulated distributions to empirical data obtained through 11 household surveys conducted between 2008 and 2010 in rural locations (9 in India and 2 in Nepal). Results: We found that the shape of the distributions was very similar in all locations for both benefits, and could be represented by a model based on a lognormal distribution. The agreement between theoretical and empirical results was satisfactory (mostly within 10% difference). Conclusions: The model makes it possible to simulate the expected performance of the CBHI (represented by the percentage of costs or bills covered). The aim is to match costs with local levels of willingness-to-pay for health insurance. This model makes it possible to determine at the stage of package-design the optimal levels of thresholds and/or caps for each benefit-type included.

Effects of Agricultural Insurance on Poverty Alleviation under Uncertain Price of Agricultural Products

Poverty alleviation of the rural poor is the most arduous task in building a moderately prosperous society in all respects in China, and agricultural insurance is an important financial tool for this task. Due to different capital levels, individual farmer will adopt production technology with different efficiency. In the case of uncertain price of agricultural products, this paper establishes a series of multiple equilibrium models based on agricultural risk and agricultural insurance. Under the catastrophe risk, the probability of falling into the poverty trap is calculated, and the effects of agricultural insurance on poverty alleviation are discussed respectively. It is found that agricultural insurance can effectively reduce the probability of falling into the poverty trap for the farmers whose initial capital is greater than a certain critical value. While the government subsidizes the premium of agricultural insurance by a certain proportion, the effect on poverty alleviation will be further improved.

The Emerging Importance of Professional Liability Insurance Coverage for Pharmacists

As the responsibilities for clinical pharmacists have increased in recent years, the pharmacy practitioner finds the need for professional liability insurance. This report describes the practice changes under way and describes the malpractice insurance options available to current pharmacy practitioners.

Study on the Present Situation and Influencing Factors of Farmers'Agricultural Insurance Demand in Poverty-Stricken Mountainous Areas

Agricultural insurance can avoid the risks of agricultural production and operation to a large extent,promote agricultural development and increase farmers'income,and lay a solid foundation for rural revitalization.At present,China's agricultural insurance is in the stage of all-round development,and there are still many problems,especially the farmers'mistrust of agricultural insurance and their weak willingness to participate in agricultural insurance.Based on the data and information obtained from the field visit and questionnaire survey in Enshi Prefecture,this paper makes an empirical analysis on the factors affecting farmers'agricultural insurance demand by using binary Logistic regression model.According to the conclusion of the analysis,this paper puts forward the corresponding measures and suggestions from the three dimensions of the government,insurance companies and farmers.

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.

Research on Overseas Investment Insurance System

On April 17th,2020,Government of India has reviewed the extant Foreign Direct Investment policy for curbing opportunistic acquisitions due to the COVID-19 pandemic shows that overseas investment may face some uncertain political risks.As a natural barrier against risks,the insurance system should play an important role in protecting investors and financial institutions from economic losses.Compared with the following developed countries’models,the United States,Japan and German,the history and status quo of overseas investment insurance system are first discussed,and second the necessity of development.Then system’s deficiencies are basically analyzed from four aspects,namely insurance model,insurance coverage,single assurer and construction of specific legal rules.Lastly some relevant proposes of system construction are made respectively.

An Overview Study of Health Insurance in India

Health insurance is a mechanism by which a person protects himself from financial loss caused due to accident and/or disability.The chairman of Insurance Regulatory and Development Authority(IRDA)has mentioned that low consumer awareness and insufficient healthcare infrastructure are the major hindrances to widen the reach of healthcare insurance in India.Healthcare costs have witnessed a phenomenal rise in the current times.This has led the customers to insure not only themselves but their family members for any future medical expenses and other related requirements.The need to insure assumes is more importance for older generations who are either retired or will be retired in near future.Given high health cost,it is important for us to get covered for health risks.With this,a good insurance policy is needed to cover doctor's visit,laboratory tests,hospital stays and diagnostic tests.There are quite a few companies covering health risks with good insurance policies.Health insurance(popularly known as Mediclaim)offers protection in case of unexpected medical emergencies.In case of a sudden illness or accident,the health insurance policy takes care of the hospitalization,medical and other costs incurred.Thus,health insurance to be introduced to all consumers in India to protect them from financial loss caused by unfortunate incidents.

Community-Based Health Insurance： An Evolutionary Approach to Achieving Universal Coverage in Low-Income Countries

The WHO World Health Assembly, and the most recent WHO World Health Report, have called for all health systems to move toward universal coverage. However, low-income countries have made little progress in this respect. We use existing evidence to describe the evolution of community-based health insurance in low-income countries through the three stages of basic model, enhanced model, and nationwide model. We have concluded that community-based health insurance development is a potential strategy to meet the urgent need for health financing in low-income countries. With careful planning and implementation, it is possible to adopt such evolutionary approach to achieve universal coverage by extending tax-based financing/social insurance characteristics to community-based health insurance schemes.

The Acceptance Intention of Consumers for a Dynamic Payment Mechanism for Health Insurance Coverage

Currently, a consumer＇s monthly premium payment amount remitted to the National Health Insurance is based on the ＂monthly real wages,＂ while commercial health insurance uses ＂consumer age＂ as the basis for the premium amount charged. In reality, health, salary, and age have no visible connection. Therefore, the insurance premium scheme using salary and age as standards should be improved and adjusted upon. This study uses the Decomposed Theory of Planned Behavior as the research basis, and through the designed questionnaire, investigates the health data gathered from wearable devices and uses big data to process the constructed health assessment indicators. These indicators will be used to analyze whether consumers are willing to contribute to their health insurance using the dynamic payment mechanism. Subsequently, empirical research was performed using hypothesis architecture and structural equation.

The Extreme Machine Learning Actuarial Intelligent Agricultural Insurance Based Automated Underwriting Model

The paper presents an innovative approach towards agricultural insurance underwriting and risk pricing through the development of an Extreme Machine Learning (ELM) Actuarial Intelligent Model. This model integrates diverse datasets, including climate change scenarios, crop types, farm sizes, and various risk factors, to automate underwriting decisions and estimate loss reserves in agricultural insurance. The study conducts extensive exploratory data analysis, model building, feature engineering, and validation to demonstrate the effectiveness of the proposed approach. Additionally, the paper discusses the application of robust tests, stress tests, and scenario tests to assess the model’s resilience and adaptability to changing market conditions. Overall, the research contributes to advancing actuarial science in agricultural insurance by leveraging advanced machine learning techniques for enhanced risk management and decision-making.

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.

Should Medical Insurance Cover Stop-Smoking Drugs?

At a seminar discussing ways to prevent chronic disease held in Shanghai on March 31, 2012, Chen Zhu, Minister of Health, revealed that the ministry was planning to include expenditures on counseling to stop smoking into the basic medical insurance system provided by the govern- ment, and would pay for drugs that help reduce dependence on tobacco.

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.

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.

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.