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.

Empirical study on optimal reinsurance for crop insurance in China from an insurer's perspective

This study investigates the optimal reinsurance for crop insurance in China in an insurer＇s perspective using the data from Inner Mongolia, Jilin, and Liaoning, China. On the basis of the loss ratio distributions modeled by An Hua Crop Risk Evaluation System, we use the empirical model developed by Tan and Weng（2014） to study the optimal reinsurance design for crop insurance in China. We find that, when the primary insurer＇s loss function, the principle of the reinsurance premium calculation, and the risk measure are given, the level of risk tolerance of the primary insurer, the safety loading coefficient of the reinsurer, and the constraint on reinsurance premium budget affect the optimal reinsurance design. When a strict constraint on reinsurance premium budget is implemented, which often occurs in reality, the limited stop loss reinsurance is optimal, consistent with the common practice in reality. This study provides suggestions for decision making regarding the crop reinsurance in China. It also provides empirical evidence for the literature on optimal reinsurance from the insurance market of China. This evidence undoubtedly has an important practical significance for the development of China＇s crop insurance.

Incidence and in-hospital mortality of acute aortic dissection in China： analysis of China Health Insurance Research （CHIRA） Data 2011

Objective Acute aortic dissection （AAD） is a catastrophic event with high early mortality rate, but to date, no data on the incidence of AAD in China's Mainland is available. This study aimed to estimate the incidence of AAD in China and characterize the clinical profile, management and in-hospital outcomes of this vascular event. Methods We used the China Health Insurance Research Data （the CHIRA Data） 2011 which comprises all inpatient hospital records （300,886） during the period of Jan. 1st 2011 to Dec. 31 2011 of 3,335,000 randomly sampled beneficiaries （1,718,500 men and 1,616,500 women） from 25 cities and counties in different economic-geographic regions of China's Mainland. Patients with acute aortic dissection were identified according to International Classification of Disease 10m Revision （ICD-10） of I71.0, The estimated incidence of AAD was calculated using the equation： estimated incidence = 2.0 × （40% × hospital admission rate） ＋ 60% × hospital admission rate. Results The hospital admission rate was 2.0/100,000 （65/3,325,000, 95% CI： 1.2-2.8）. The estimated annual incidence of AAD was 2.8/100,000 （95% CI： 1.9-3.6） and was higher in male than in female （3.7 vs. 1.5, P 〈 0.001）. The mean age was 58.9 ± 13.4 years. During the mean hospital stay of 23 ±6 days, the overall in-hospital mortality was 13.9% （9/65）. Conclusions Our study showed relatively lower but not negligible incidence and in-hospital mortality of AAD in the mainland of China. The mean age of patients with AAD in Chinese was younger than that reported by researches from west countries, while the male to female incidence ratio is similar to those reported by other studies.

Analysis of the effect of medical insurance on cancer inpatients: A 10-year retrospective study on a large hospital in Northeast China

Objective The aim of the study was to analyze hospital costs for cancer inpatients availing different methods of payment and the influencing factors, to provide inputs to improve the medical insurance payment policy. Methods We analyzed the information related to length of hospital stay, hospitalization cost, and self-pay cost, collected from one large-scale, Grade A, Class Three hospital in Shenyang, China, during 2004–2013.Results The number of cancer inpatients with different payment types(medical insurance group and non-medical insurance group) presented a rising trend. Further, the ratio of medical insurance inpatients increased rapidly(from 22.2% to 48.7%); however, this group was still a minority. The length of hospital stay became shorter(21 d vs. 17 d; P = 0.000) while the gap got narrower; the hospitalized expense showed an upward trend and the difference was remarkable($24048.6 ± $4376.28 vs. $20544.36 ± $4057.01; P = 0.000). Conclusion Along with normalization of cancer therapy, the influence of payment on treatment has been getting weak, the policy has impact on controlling hospitalization cost, lightening burden of cancer patient, as well as allocating medical resources in a reasonable way, becoming an important defray pattern of hospitalization cost.

Weather index insurance for wind energy

As China vigorously promotes the development of new energy,photovoltaic power curtailment and wind power curtailment have been effectively resolved.At the same time,the yield from new energy power generation is becoming an important factor that affects the scale of investment in new energy.This paper focuses on the weather risks faced by wind power producers.By studying current research on weather index insurance in China and abroad,the functions and design methods for weather index insurance have been clarified.In addition,the feasibility of wind-power generation index insurance is discussed.The calculation methods for wind power generation index and the weather index insurance pricing methods for wind power enterprises are proposed.A weather index insurance model for wind power generation was established.The rationality and feasibility of the weather index insurance model proposed in this paper were verified using data from an existing power plant.The simulation results show that wind power enterprises can effectively avoid economic losses caused by weather risks through weather index insurance.

Existing Contradictions and Recommendations to China＇s Insurance Industry Characterized by Low-growth and Low-interest

This article seeks to analyze the contradictions and recommendations to China＇s insurance industry in the context of low-growth and low interest market. Under the pressure caused by the contradictions between the sustainable growth in the insurance premium income and the low ROI, it is very important to solve these contradictions for maintaining a sustainable and steady growth in insurance industry, at the same time, it is also favorable to play a role as a social stabilizer as well as an economic booster for insurance industry. This paper can be divided into four parts： Part I analyzes the five basic characteristics of Chinese low-growth and low-interest insurance industry; part II elaborates the principal contradictions faced by Chinese low-growth and low-interest insurance industry; part III analyzes the development environment of Chinese insurance industry; part IV proposes the recommendations to solve these contradictions.

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.

Constructing Index System for Evaluating Work Level in Rural Endowment Insurance

This paper used fuzzy math principles, analyzed different aspects of the work of the current rural endowment insurance and formed the indices to assess the work level of the rural endowment insurance. After selecting the indices of the work level scientificly, constructed the index system to evaluate the work level of the rural endowment insurance and the index system was expressed in the form of math equation. In this way, an objective standard used to evaluate the work level of rural endowment insurance was establised.

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.

A Study of Medical Insurance With Big Data in Taiwan

The structures of numerous industries, including the insurance industry, have been altered by the ongoing development of associated technologies. As the insurance industry undergoes this period of technology transformation, it is important to recognize the key role that big data play in the industry. Most critically, the industry could not function without the utilization of big data, which explains to a large extent why every insurance company maintains its own numeric database. Relatedly, Taiwan＇s Bureau of National Health Insurance recently established the Information Integration Application Service Center, to which qualified companies and institutions can submit applications for permission to analyze the bureau＇s collected disease data according to stipulated regulations. In effect, access to the center＇s data provides insurance companies with a further means of improving their operational effectiveness through the analysis of big data, with targets for potential improvements including the various strategies utilized to react to changes in the environment, such as those involved in marketing, administrative management, and product pricing and services. The foundation of the present study consisted of a literature review and survey, with the key objective being to determine and discuss the effects of big data analysis on the medical insurance industry, including the changes that the utilization of big data results in for the customers of medical insurance companies. With the issues discussed above in mind, the survey was designed to determine whether medical insurance consumers know about and understand the effects of big data. The survey data indicated the following key findings： （1） The two concepts exhibit clear differences in terms of population statistic wxiables; （2） The two concepts exhibit clear differences in terms of insurance purchasing variables; and （3） The two concepts exhibit clear differences in terms of the level of understanding regarding big data.

Assessing Drug Use Indicators in Health Insurance Facilities, Gezira State, Sudan, 2017-2018

Background: Inappropriate use of medicines is a global concern with serious consequences related to prescribing, dispensing, and use. WHO estimated that 50% of medicines are not used correctly on their journey from the facility to home. Objective: To assess medicines use using WHO drug core indicators regarding prescribing, patient, and facilities. Setting: Outpatients, Health centers in Wadmadani locality (Urban area) in Gezira State, Sudan. Method: A cross-sectional, prospective, analytical study was conducted in 30 health centers and 60 patients from each center were selected using a simple random sampling technique. WHO indicators form was used to collect data containing different variables. T-test at a level of confidence of 95% was used to test differences between indicators. Statistical Package for Social Science (SPSS) was used for data analysis. Results: The main prescribing indicators were 2.5 ± 0.6 for drugs per encounter, 44.1% ± 14.2%. Generic 54 ± 18.0 antibiotics, 12.0% ± 9.3% injectable, and 95.2% ± 11.5% of drugs were prescribed according to the NHIF-EML. The main patient’s indicators were, 2.9 ± 0.8 minutes for consultation time, 99.5 ± 36.8 seconds for dispensing time, and 72.5% ± 16.0% for medicines actually dispensed, 49.0% ± 18.0% for medicines adequately labeled, and 22.5% ± 7.3% of the patient’s knowledge about the correct dose. The Facility specific indicators were 66.7% for the availability of a copy of EML, while the percentage of key drugs in the stock was 75.3% ± 11.6%. No statistically significant differences were found between direct and indirect facilities except in generic prescribing. Main Outcome Measure: • Interventions to improve Generic and antibiotics prescribing indicators. • The patient-to-physician ratio should be revised to optimize consultation time. • The availability of key drugs should be improved to make sure effective treatment. • The pharmacy cadre should be oriented and trained to improve patients’ compliance. Conclusion: The study concluded that there was irrational use of medicines when investigated by WHO drug core indicators. So, the study recommended interventions to improve the rationale prescribing, dispensing, and use of medicines.

Demand Model for Investment-oriented Life Insurance under uncertain lifetime

In this paper, we set up continuous time model with Poisson Process to analyze demand of investment-oriented life insurance. Individual life time is assumed random, and he is received fixed income, investment-oriented life insurance is an important financial asset under this model. Dynamic programming is applied to analyze this problem. The optimal explicit solutions are obtained in the case of CRRA utilities, and draw its demand curve with numerical simulation.

Lexical and Syntactic Features of Insurance English

With the fast development of Chinese insurance market and the quickening process of globalization of the world economy,more and more English policies and wordings are coming up and the communication with the international insurance companies is much closer.Undoubtedly,to realize the insurance texts accurately and to manage the language features is very important to the insurance industry.Through the analysis of some English insurance policies and wordings,the stylistic characteristics of Insurance English are generalized at lexical and syntactic levels.At lexical level,Insurance English is mainly demonstrated with the following characteristics:the frequent use of archaic words,loan words,official words and technical words.Their characteristics at syntactic level are more complex,which are analyzed in terms of complicated long sentences,conditional adverbial clauses,restrictive attribute clauses,sentences with modal verbs and passive voice.

Evaluation of Deposit Insurance Fund Adequacy Using Credit Risk Model--An Indian Experience

There are two methods widely used for evaluating the adequacy of Deposit Insurance Fund： （i） Target Reserve Ratio and （ii） Credit Risk Model. Target Reserve Ratio is one of the macro level indicators more often set by Regulatory act on the basis of minimum Deposit Insurance Fund margin safety, Target Reserve Ratio is calculated as the ratio of Deposit Insurance Fund to the value of insured deposits. However, TRR does not take into consideration the level of Deposit Insurance potential liability, the Loss at Given Default （LGD） and the historical trend of default rate prevailing among the insured banks. It does not also consider the present condition of the economy and current scenario of the banking sector. This paper discusses primarily about development of Credit Risk Model for evaluating the Deposit Insurance Fund Adequacy. For this purpose, Econometric Credit Risk Model was developed based on the historical data of bank failures and the associated losses of the last 25 years from 1990-91 to 2014-15. The model assesses various possible factors impacting the Deposit Insurance Fund： Default rate, Deposit growth, Exposures, impact of macro-economic factors like GDP, GDS, Inflation and Interest rate changes, etc. on the Deposit Insurance Fund through econometric modeling. The model evaluates the adequacy of Deposit Insurance Fund under both （i） Normal scenarios where there is no （economic） systemic risk assumed and （ii） Worst case scenario at 1% level of significance using Monte Carlo Simulation. Since the model empirically validates all the critical factors impacting the assets and liabilities associated with Loss at Given Default, the model output can also be used to determine a suitable Target Reserve Ratio and such models are being used in countries like USA, Canada, Hong Kong, and Singapore, etc. （IADI, 2009）. More importantly, the model outputs are quite useful in determining the adequacy of deposit insurance fund which is an effective risk control measure that organization like Deposit Insurance Credit Guarantee Corporation （DICGC） can adopt both under normal economic scenario as well as worst case scenario, ensuring a strong financial safety net for the banking sector in India. The model also assesses the default probability and the Loss at Given Default of different types of banks： commercial banks, rural banks, cooperative banks, foreign banks, etc. A risk based on premium can possibly be determined for each type of banks in India.

Claim reserving for insurance contracts in line with the International Financial Reporting Standards 17:a new paid‑incurred chain approach to risk adjustments

This study considers the risk management of insurance policies in line with the implementation of the new International Financial Reporting Standards 17.It applies the paid-incurred chain method to model the future unpaid losses by combining the information channels of both the incurred claims and paid losses.We propose the recovery of the empirical distribution of the outstanding claims liabilities associated with a group of contracts via moment-based density approximation.We determine the risk measures and adjustments that are compliant with the new standard using the Monte–Carlo simulation method and approximated distributions.The historical data on the aggregate Ontario automobile insurance claims over a 15-year period are analyzed to examine the appropriateness and accuracy of our approach.

Discussion on the business performance of life insurance industries in Taiwan and China's Mainland Application of Metafrontier model

When using the Data Development Analysis method for analyzing the efficiency of different firms, it is common to put all similar DMU together for measurement in order to figure out the efficiency values of various DMU. However, such an analysis may easily neglect the source property of an individual DMU, meaning that the differences among various DMUs derive from different environmental backgrounds, e.g. environment variables such as economic civilization, laws and regulations, and political backgrounds. Applying the Metafrontier model can overcome the barriers resulting from the environment variables, and it can analyze and measure the differences among various DMUs which have different source properties. It can also be used for measuring the difference between each group of DMU and all DMUs. Therefore, this study adopts the DEA method, assuming variable returns to scale to evaluate and comparatively analyze the business performance of life insurance industries in Taiwan and China's Mainland based on ＂BBC input orientation＂. When evaluating the business performance, the operating management echelon is affected by uncontrollable external environment variables. Thus, this study applies the Four-Stage Data Envelopment Analysis to discuss the impact of environment variables on business performance and re-measures the business efficiency of life insurance industries in Taiwan and China's Mainland after adjusting the input variables. The demonstration period adopted by this study is from 2003 to 2005, and the research subject comprises 43 companies in Taiwan and China's Mainland, among which, there are 19 companies in Taiwan and 24 companies in China's Mainland, and there are 129 sets of sample data. It is assumed that the discount rate is ？ （）, is set as 3% in this paper）, and figured out the change of each life insurance company in technical efficiency in the inter-period accumulative years from 2003 to 2005.

On the Characteristics of Chinese Life Insurance Market

The Chinese life insurance market is developing on the road to join in WTO in the new millennium. The rate of increase in the first six months in 2003 reached 41.1%, and the market takes on some characteristics as follows：

The Impact of a Public Health Emergency on the Demand for Life Insurance-An Empirical Analysis Based on Severe Acute Respiratory Syndrome

We examined changes in personal life insurance purchase decisions after a public health event by incorporating perceived health risk and regret into the expected utility function.The model predicts that the epidemic will create incremental insurance demand.Based on the 2003 severe acute respiratory syndrome outbreak in China,we used a panel dataset of 30 provinces from 2000 to 2007 and applied the difference-in-differences method to confirm the prediction empirically.The results showed that the epidemic did not significantly impact the demand for life insurance in the short term but played a role in the long term.People increased their health-care expenditure and premiums for new policies after the severe acute respiratory syndrome event,suggesting that the epidemic changed people's perceived risk and triggered anticipated regret,which increased life insurance demand.Some robustness checks also supported our findings.

A new charging scheme in an emergency department observation unit under Beijing＇s basic medical insurance

Background The new medical insurance policy （JRSYF（2010） No.255） was released by the Beijing Municipal Government and became effective on January 1,2011.Medical expenses incurred during a stay in an emergency department （ED） observation unit can be reimbursed as a hospital admission.The aim of this study was to evaluate the impact of a new charging scheme during stays in ED observation unit under Beijing＇s Basic Medical Insurance.Methods Data for those patients who had stayed in ED observation unit in 2010 （before the implementation of a new charging scheme） and 2012 （after the implementation of this policy） were retrospectively analyzed in terms of length of stay,patients who were observed （PO）,and median medical costs.Results After the implementation of a new charging scheme,compared with the year of 2010,in year of 2012,there were statistically significant longer lengths of stay at the observation unit （6 （4-9） vs.5 （4-7） days; P〈0.001）,more PO （2 257vs.1 783; P〈0.001）,and more median medical costs （RMB 6 026 vs.3 650 Yuan; P〈0.01）.The proportion of elderly patients （≥60 years of age） in 2012 was larger than that in 2010 （70.22% vs.63.71%; P〈0.01）.It was performed on those patients who were admired after the implementation of a new charging scheme.Compared with patients who were not admired had stayed in ED observation units,the patients who were admired had stayed in ED observation units that had a higher proportion for 〉15 days （36.22% vs.5.61%; P〈0.01）; they had higher median medical costs RMB （9 186 vs.5 668Yuan; P〈0.001） and they were more elderly （≥60 years of age） （86.10% vs.66.39%; P〈0.01）.Conclusions The new charging scheme under Beijing＇s Basic Medical Insurance allows patients to get access to inpatient admission more easily.It lowers patients＇ financial burden in ED observation unit.Since more people stay at ED observation unit,it increases ED payments by the insurance system.However,it slows the turnover rate of ED observation unit and causes overcrowding in ED.Hence,the advantages and disadvantages of the new policy are obvious.

Life-insurance Efficiency in China:A Comparison of Foreign and Domestic Firms

The Chinese life-insurance industry has experienced major structural changes in recent years, primarily because of increasing demand and the entry of foreign insurers. Although the market is clearly booming, the efficiency of its growth and development is unclear. In this paper, we evaluate the efficiency of life insurers operating in China and compare foreign firms with domestic firms. We find that foreign insurers have not brought efficiency into the Chinese market, and that the market is still dominated by domestic giants. However, the gap between foreign insurers and domestic insurers is narrowing. After testing hypotheses regarding scale economy, technical progress andpotential improvements, we discuss several issues＇ of importance to life insurers, market investors and government regulators.