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.

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.

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.

医院管理建设中智慧医保的SWOT分析

采用SWOT分析智慧医保在医院建设中的优势、劣势、机遇和威胁,了解智慧医保对于医院医保建设的影响,为医院医保精细化管理和便捷医保服务提供参考。依托信息平台给医院建设智慧医保服务和医保基金监管带来机遇,同时给医院医保“粗放型管理”转换为“精细化管理”带来挑战。医疗机构需牢牢抓住时代趋势,依靠自身优势以及信息技术的加持,不断加强医疗实力同时,注重智慧医保的机遇与威胁。医疗机构在享受智慧医保带来福利的同时,也要通过智慧医保更规范医院医保基金监管,通过优化信息系统让患者在实处体验到智慧医保带来的便民服务。

基于CiteSpace我国重特大疾病医疗保障研究可视化分析

目的采用文献计量学方法综合分析我国重特大疾病医疗保障研究已发表文献的特征及研究特点,以了解该领域研究现状及前沿方向。方法通过中国知网(CNKI)数据库,搜索我国重特大疾病医疗保障相关研究,检索时间为建库至2023年5月31日。使用CiteSpace 5.7.R2软件对纳入研究的文献作者、研究机构和关键词等进行可视化网络图绘制和聚类分析。结果2010—2015年发文量呈快速增长趋势,在2015年达到峰值,发文量为208篇,占总发文量的9.938%;形成了以朱铭来等学者为合作网络中心的多个高影响力团队;华中科技大学同济医学院医药卫生管理学院发文量最高(25篇,1.194%);载文量≥10篇的期刊共17个,累计刊文155篇,期刊载文量最多的是《中国卫生经济》;医疗救助出现频次(625次)和中心性(0.85)均最高,贫困人口突现时长最长,从1999持续至2011年,突现强度较高的关键词为大病保险(56.48)和医疗救助(43.79),强度为其他关键词的3.65~16.22倍。结论近10年发文量下降但政策逐步完善,研究作者发文量与合作关系强度无关,高校机构占比较大但合作密度极小,医疗救助和大病保险是重特大疾病保障研究的重点及热点。

Chinese herbal medicine decreases incidence of hepatocellular carcinoma in diabetes mellitus patients with regular insulin management

BACKGROUND Type 2 diabetes mellitus(DM)is an independent risk factor for hepatocellular carcinoma(HCC),while insulin is a potent mitogen.Identifying a new therapeutic modality for preventing insulin users from developing HCC is a critical goal for researchers.AIM To investigate whether regular herbal medicine use can decrease HCC risk in DM patients with regular insulin control.METHODS We used data acquired from the Taiwan,Chinaese National Health Insurance research database between 2000 and 2017.We identified patients with DM who were prescribed insulin for>3 months.The herb user group was further defined as patients prescribed herbal medication for DM for>3 months per annum during RESULTS We initially enrolled 657144 DM patients with regular insulin use from 2000 to 2017.Among these,46849 patients had used a herbal treatment for DM,and 140547 patients were included as the matched control group.The baseline variables were similar between the herb users and nonusers.DM patients with regular herb use had a 12%decreased risk of HCC compared with the control group[adjusted hazard ratio(aHR)=0.88,95%CI=0.80–0.97].The cumulative incidence of HCC in the herb users was significantly lower than that of the nonusers.Patients with a herb use of>5 years cumulatively exhibited a protective effect against development of HCC(aHR=0.82,P<0.05).Of patients who developed HCC,herb users exhibited a longer survival time than nonusers(aHR=0.78,P=0.0001).Additionally,we report the top 10 herbs and formulas in prescriptions and summarize the potential pharmacological effects of the constituents.Our analysis indicated that Astragalus propinquus(Huang Qi)plus Salvia miltiorrhiza Bunge(Dan Shen),and Astragalus propinquus(Huang Qi)plus Trichosanthes kirilowii Maxim.(Tian Hua Fen)were the most frequent combination of single herbs.Meanwhile,Ji Sheng Shen Qi Wan plus Dan Shen was the most frequent combination of herbs and formulas.CONCLUSION This large-scale retrospective cohort study reveals that herbal medicine may decrease HCC risk by 12%in DM patients with regular insulin use.

基于CiteSpace的我国医疗保险药品目录研究现状及趋势分析

目的全面探究医疗保险(医保)药品目录的中文文献情况,梳理医保药品目录研究脉络,总结及探讨未来有关研究发展的趋势。方法在中国知网(CNKI)、万方数据库、维普数据库检索2003-2023年我国医保药品目录相关的研究性文献数据,运用CiteSpace 6.2.R4绘制可视图谱,结合相关重要政策发布时间进行文本分析。结果纳入文献共413篇,发文作者群体之间相对独立,该领域暂未形成较大的学术共同体;医保药品目录调整、医保基金使用、医保药品专家谈判等话题是热点主题。结论目前该领域发文数量总体呈增长趋势,应加强该领域合作性研究、多元化研究及实证研究。关注热点、提升论文数量和质量是发展该领域文献的关键。

Automated Actuarial Data Analytics-Based Inflation Adjusted Frequency Severity Loss Reserving Model

In this paper, the Automated Actuarial Loss Reserving Model is developed and extended using machine learning. The traditional actuarial reserving techniques are no longer compatible with the increase in technological advancement currently at hand. As a result, the development of the alternative Artificial Intelligence Based Automated Actuarial Loss Reserving Methodology which captures diverse risk profiles for various policyholders through augmenting the Micro Finance services, Auto Insurance Services and Both Services lines of business on the same platform through the computation of the Comprehensive Automated Actuarial Loss Reserves (CAALR) has been implemented in this paper. The introduction of the four further types of actuarial loss reserves to those existing in the actuarial literature seems to significantly reduce lapse rates, reduce the reinsurance costs as well as expenses and outgo. As a matter of consequence, this helps to bring together a combination of new and existing policyholders in the insurance company. The frequency severity models have been extended in this paper using ten machine learning algorithms which ultimately leads to the derivation of the proposed machine learning-based actuarial loss reserving model which remarkably performed well when compared to the traditional chain ladder actuarial reserving method using simulated data.

全民健身背景下我国群众体育保险的PEST分析与发展策略

采用文献资料法和PEST分析法,从政治、经济、社会和技术四个方面分析全民健身背景下我国群众体育保险发展的宏观环境。研究认为,群众体育保险发展面临支持政策体系有待完善、市场有效供给能力不足、社会体育保险意识薄弱、技术融合深度有待提高等困境。据此提出发展策略:加强群众体育保险立法,完善相关支持政策内容;大力开发保险市场,提高保险产品供给能力;加强保险宣传工作,增强社会投保意识;加大科研投入,促进技术深度融合应用。

普惠型商业医疗保险参保意愿影响因素分析——基于Logistic回归和CHAID决策树模型

目的:探讨普惠型商业医疗保险参保意愿影响因素,为普惠型商业医疗保险的研究和参保干预提供理论依据。方法:通过问卷对普惠型商业医疗保险参保意愿进行调研,利用Logistic回归和CHAID决策树模型,对人群参保意愿影响因素展开分析,并对比两种模型的预测效果。结果:本次调查共发放450份问卷,有效问卷率92.22%,其中,61.45%有参保意愿。Logistic回归模型分析结果显示,政府支持力度、对产品了解程度、年龄、是否购买商业健康保险、家庭人均年收入为影响因素(P<0.05),AUC为0.900;CHAID决策树模型分析结果显示,政府支持力度、对当地产品了解程度、保险机构宣传力度、家庭人均年收入为影响因素(P<0.05),AUC为0.891。结论:半数以上人群具有参保意愿,需要采取针对性干预措施,转化参保意愿为实际参保行为,进一步提升参保率;Logistic回归和CHAID决策树两种模型均可有效识别参保意愿影响因素,将政府支持力度、对产品了解程度、家庭人均年收入识别为关键因素,年龄、是否购买商业健康保险、保险公司宣传力度也对参保意愿产生一定影响;两种模型的结合可为普惠型商业医疗保险的深入研究和参保干预提供有益指导,促进普惠型商业医疗保险可持续发展。

Research on Reimbursement Management of Innovative Drugs Abroad and Its Enlightenment to China

Objective To analyze the reimbursement policies of innovative drugs in some developed countries,and to provide reference for future reimbursement management in China.Methods Literature research method was used to study the policies related to the reimbursement management of innovative drugs in Germany,France and Japan,and their successful experience was summarized.Results and Conclusion China should establish an open and transparent value evaluation standard to improve the medical insurance reimbursement management of innovative drugs.Besides,the value of innovative drugs should be taken as an important basis for reimbursement decisions,and an independent third-party value evaluation agency must be established.

基于CiteSpace的医疗保险专业教育教学研究的热点及趋势探析

目的 采用CiteSpace软件对医疗保险专业教育教学领域相关文献进行可视化分析,以期为今后继续开展研究提供思路。方法 梳理医疗保险专业教育教学领域研究热点及趋势。结果 医疗保险专业教育教学领域发文量呈波动趋势,且发文量不大,作者及发文机构间的联系不密切。研究热点主要为人才培养模式、课程设置、教学方法 3个主题。结论 目前医疗保险专业教育教学研究虽然在人才培养模式、课程设置、教学方法等方面取得了一定成果,但在交流合作、教学评价等方面还比较薄弱。未来,应加强主体间的交流合作及开展从学生视角出发的研究,从多层次教学评价机制及提高学生岗位胜任力两方面展开研究。

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.

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.

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.

DIP支付方式下四川省某三甲医院病种人组影响因素分析——基于多水平Logistic回归模型

目的:研究医保DIP支付背景下病例诊断入组的影响因素,为医疗机构提高入组率提供参考依据。方法:利用成都市某公立医院2021年1~11月17689例住院患者病历资料,进行多水平Logistic回归分析。结果:单因素分析结果显示入院途径、科室、参保类型、费用偏离度、年龄是住院病人能否入组的影响因素。住院费用(对数)、住院天数(对数)、性别对是否入组无统计学影响;多水平Logistic回归模型显示,住院费用、住院天数、性别对入组与否无统计学影响(P>0.05),入院方式、参保类型、年龄、费用偏离度是病人能否入组的正向影响因素(P<0.05)。结论:多水平模型结果显示,科室水平的入组结果存在一定的聚集性,病人入组与否不仅与个体特征有关,还受到所属科室的影响。实行按病种分值付费时,医院管理者应当考虑不同科室、不同病人特征对病种入组的影响,从而提升医院、科室的精细化管理水平。