ECONOMIC AFFAIRS, Issue 4 2004
Alan D. MorrisonArticle first published online: 28 JUN 200
Debating the minutiae of insurance regulation without a clear understanding of why insurance companies are regulated is futile. In this article I discuss the economic rationale for insurance business regulation and conclude that the appropriate role of the regulator is to enforce contracts which might otherwise be broken. I argue that if this is the case, regulation should be optional, and that it need not be a monopoly activity. [source]

BANK RUNS: DEPOSIT INSURANCE AND CAPITAL REQUIREMENTS*

INTERNATIONAL ECONOMIC REVIEW, Issue 1 2002
RUSSELL COOPER
Diamond and Dybvig provide a model of intermediation in which deposit insurance can avoid socially undesirable bank runs. We extend the Diamond,Dybvig model to evaluate the costs and benefits of deposit insurance in the presence of moral hazard by banks and monitoring by depositors. We find that complete deposit insurance alone will not support the first-best outcome: depositors will not have adequate incentives for monitoring and banks will invest in excessively risky projects. However, an additional capital requirement for banks can restore the first-best allocation. [source]

CONSTANT PROPORTION PORTFOLIO INSURANCE IN THE PRESENCE OF JUMPS IN ASSET PRICES

MATHEMATICAL FINANCE, Issue 3 2009
Rama Cont
Constant proportion portfolio insurance (CPPI) allows an investor to limit downside risk while retaining some upside potential by maintaining an exposure to risky assets equal to a constant multiple of the cushion, the difference between the current portfolio value and the guaranteed amount. Whereas in diffusion models with continuous trading, this strategy has no downside risk, in real markets this risk is nonnegligible and grows with the multiplier value. We study the behavior of CPPI strategies in models where the price of the underlying portfolio may experience downward jumps. Our framework leads to analytically tractable expressions for the probability of hitting the floor, the expected loss, and the distribution of losses. This allows to measure the gap risk but also leads to a criterion for adjusting the multiplier based on the investor's risk aversion. Finally, we study the problem of hedging the downside risk of a CPPI strategy using options. The results are applied to a jump-diffusion model with parameters estimated from returns series of various assets and indices. [source]

COMMERCIAL ACTIVITY AS INSURANCE: THE INVESTMENT BEHAVIOUR OF NON-PROFIT ORGANIZATIONS

ANNALS OF PUBLIC AND COOPERATIVE ECONOMICS, Issue 3 2010
John Bennett
ABSTRACT,:,We provide a new explanation for commercial activities by non-profit organizations whose primary concern is to supply mission output. Starting from the observation that donations to individual non-profits are often highly volatile, we show how investment in commercial activity can constitute a form of insurance for mission activity. Although investment in commercial activity has an opportunity cost in terms of capacity to produce mission output, if donations turn out to be low the commercial revenue will enable cross-subsidization of mission output. The equilibrium commercial investment is (weakly) positively related to the degree of risk aversion. [source]

RISK ATTITUDES AND THE DEMAND FOR PRIVATE HEALTH INSURANCE: THE IMPORTANCE OF ,CAPTIVE PREFERENCES'

ANNALS OF PUBLIC AND COOPERATIVE ECONOMICS, Issue 4 2009
Joan Costa-Font
ABSTRACT,:,Captivity to a mainstream public insurer, is hypothesized to constrain the choice of purchasing private health insurance, by influencing risk attitudes. Namely, risk averse individuals are more likely to stay captive to the National Health System (NHS). To empirically test this hypothesis we use a small scale database from Catalonia to explore the determinants of private health insurance (PHI) purchase under different forms of captivity along with a measure of risk attitudes. Our results confirm that the captivity corrections are significant and can potentially bias the estimates of the demand for PHI. Risk aversion increases the probability of an individual being captive to the NHS. The latter suggests a potential behavioural (or cultural) mechanism to isolate the influence of risk attitudes on the demand for PHI in publicly financed health systems. [source]

Social Insurance and the Public Budget

ECONOMICA, Issue 275 2002
Torben M. Andersen
Restraints on the public budget may limit the ability of the public sector to use financial markets for the diversification of shocks. This interferes with the role of the public budget as a buffer which may provide insurance by stabilizing income and thereby private consumption. We consider this insurance or stabilizing role of public budgets and show why pro-cyclical budgets and a progressive taxation system may be optimal even when tax distortions are taken into account. Balanced budget restrictions interfere with this insurance effect, and they do not necessarily imply that a lower level of public consumption is optimal. [source]

Social Insurance with Risk-Reducing Investments

ECONOMICA, Issue 265 2000
Dan Anderberg
A two-sector model with sector-dependent disability risks is presented. Working in the low-risk sector requires skills that can be obtained by investments in education. Moral hazard precludes full insurance. The labour force allocation is responsive to the incentives created by a social insurance system. The rationale for intervention lies in the government's power to cross-subsidize between the sectors, and it is demonstrated how the responsiveness of the labour force allocation limits cross-subsidization. The second-best policy is time-inconsistent. The consistent equilibrium is explored and is argued to provide weak incentives to reduce risks. [source]

Environmental liability and accident prevention: preliminary experiences in Germany,

ENVIRONMENTAL POLICY AND GOVERNANCE, Issue 6 2001
Reimund Schwarze
Strict environmental liability, in conjunction with improved environmental liability insurance, proves to be an effective instrument to tackle environmental risks of industrial installations. This paper examines the experience with the Environmental Liability Act and Environmental Liability Insurance in Germany. It rebuts the widespread criticism of the preventive effect of the Act and considers the actual changes in the number of environmental accidents in Germany. The picture that emerges from this study is that the Act seems to have a measurable preventive effect from 1993 onwards, the year in which the new environmental liability policy was introduced. Copyright © 2001 John Wiley & Sons, Ltd and ERP Environment. [source]

2nd Workshop on "Epilepsy, Risks, and Insurance"

EPILEPSIA, Issue 1 2000
E. Beghi
No abstract is available for this article. [source]

Income Insurance in European Agriculture

EUROCHOICES, Issue 1 2003
Miranda P. M. Meuwissen
Summary Income Insurance in EuropeanAgriculture The agricultural risk environment in Europe is changing, for example because of WTO agreements and governments increasingly withdrawing from disaster assistance in case of catastrophic events. In this context, some form of income insurance may be a useful risk management tool for farmers. Insuring farmers' incomes, however, is rather problematical for reasons of asymmetric information and high correlation of the risks amongst the would-be insured, for example risks due to price fluctuations, floods, droughts and livestock epidemics. It is concluded that the most aggregated forms of income insurance that are likely to be feasible include revenue insurance for field crops, especially if there are relevant futures markets and area yield data, and business interruption insurance for livestock commodities. In Europe, only a few such schemes currendy exist; some are purely private, others are subsidised. A somewhat larger involvement of the public sector, for example through public-private partnerships for reinsurance, could extend the availability of income insurance schemes throughout Europe. Governments, however, should tread warily in entering the field of subsidised agricultural insurance, which experience shows is beset with pitfalls. Pilot tests are useful in establishing the attractiveness of income insurance schemes and other income stabilising tools for the various parties involved. Le contexte du risque agncoie est en train de changer en Europe, en raison notamment des accords de 'OMC et d'un retrait croissant des gouvernements de , assistance sinistre en cas de catastrophes. Dans ce contexte, une certaine forme ? assurance sur le revenu peut être un outil utile de gestion des risques pour les agriculteurs. Assurer les revenus des agriculteurs, cependant, est une activitécute; assez délicate pour des raisons ? information asymétrique et de forte corrélation des risques chez les assurés potentiels, avec , exemple des risques dus aux fluctuations de prix, aux inondations, aux sécheresses et aux épidémies animales. On en conclut que les formes ? assurance revenu les plus complètes et les plus plausibles comprennent ľ assurance-revenu pour les récoltes, notamment s'il existe des marchés a terme appropriés et des données sur le rendement par région, et ,,assurance pour cessation ?'activite pour les produits de ,élevage;. En Europe, seuls quelques projets similaires existent; certains sont purement privés, ? autres sont subventionés. Une implication un peu plus importante du secteur public, par exemple par le biais de partenariats public-privé pour la réassurance, permettrait ?élargir la disponibilité des plans ? assurance-revenu dans toute , Europe. Les gouvernements, cependant, doivent aborder avec prudence le domaine de , assurance agricole subventionée qui, , expérience le montre, est semée ? embûches. Des expériences pilotes sont utiles pour définir , intérêt des projets ? assurance-revenu et des autres outils permettant de stabiliser les revenus pour les différentes parties impliquées. In Europa ändern sich zur Zeit die _ Rahmenbedingungen für die Landwirtschaft hinsichtlich des Risikos. Dies liegt zum Beispiel an WTO-Abkommen und Regierungen, die ihre Hilfsleistungen im Schadensfall zunehmend verweigern. In diesem Zusammenhang könnte irgendeine Form von Einkommenversicherung im Bereich des Risikomanagements für Landwirte von Nutzen sein. Eine solche Versicherung wirft jedoch Probleme auf, da asymmetrische Information und eine hohe Risikokorrelation bei den potenziellen Versicherungsnehmem vorliegen, wie beispielsweise Risiken, die auf Preisschwankungen, Flut- und Dürrekatastrophen oder Tierseuchen beruhen. Hieraus wird gefolgert, dass zu den umfassendsten realisierbaren Formen von Einkommenversicherungen die Erlösversicherung im Ackerbau - insbesondere bei Vorliegen von relevanten Warenterminmärkten und Flächenertragsdaten - und die Betriebsausfallversicherung für tieriscbe Erzeugnisse gehören. In Europa sind zur Zeit nur wenige solcher Programme vorhanden; bei einigen handelt es sich um ausschließlich private Versicherungen, andere werden subventioniert. Würde der öffentliche Sektor stärker mit eingebunden, zum Beispiel mit Hilfe von öffendich-privaten Rückversicherungsgesellschaften, könnten in ganz Europa weitere Programme zur Einkommenversicherung zur Verfügung gestellt werden. Für die Regierungen jedoch ist beim Etablieren subventionierter Versicherungen im Bereich der Landwirtschaft größte Vorsicht geboten, da dies erfahrungs-gemäß Schwierigkeiten aufwirft. Zunächst sollten Pilotprojekte durchgeführt werden, mit deren Hilfe die Attraktivität von Programmen zur Einkommen-aversicherung und von weiteren einkommensstabilisierendenMaßnahmen fÜr die verschiedenen beteiligten Parteien sicher gestellt wird. [source]

Deposit Insurance, Banking Reform, and Financial Sector Development in Several Nations of Southeastern Europe

FINANCIAL MARKETS, INSTITUTIONS & INSTRUMENTS, Issue 1 2006
By Neil B. Murphy
Deposit insurance has spread to many sections of the world. In the newly formed nations of the former Yugoslavia, this has occurred under conditions of post-conflict reconstruction, hyperinflation, and several different governmental structures. Three cases are examined; Bosnia and Herzegovina, Croatia, and Serbia and Montenegro. They all have developed deposit insurance programs. The implementation process was compared to "best practice" recommendations. It is found that the situation in Bosnia and Herzegovina was difficult due to the fractured nature of the Dayton Accord government structure on the one hand but easier to the strong international presence supporting required actions. In the case of Croatia, a unified state emerged from the war, but it was somewhat isolated. Its bank restructuring was costly, and a fragmented deposit insurance program was introduced in the middle of a banking crisis. In the case of Serbia and Montenegro, the bank restructuring process is still underway, and implementation of a functioning deposit insurance program properly awaits its completion. [source]

Increased Concentration in Banking: Megabanks and Their Implications for Deposit Insurance

FINANCIAL MARKETS, INSTITUTIONS & INSTRUMENTS, Issue 1 2005
Kenneth D. Jones
During the past two decades, the U.S. banking industry has experienced an unprecedented wave of consolidation, marked by a substantial decline in the number of insured depository institutions and the emergence of banking behemoths with assets totaling in the hundreds of billions of dollars. This unparalleled concentration of assets and deposits among a handful of "megabanks" has important implications for deposit insurance. Most importantly, the Federal Deposit Insurance Corporation (FDIC) now faces a situation in which the failure of even a single megabank could overwhelm the resources immediately available to the deposit insurance system and expose both the banking industry and the government (i.e., taxpayers) to huge potential liabilities. This article highlights the current structure of the banking industry, examines the threat that this structure poses to the deposit insurance funds, and suggests possible approaches for dealing with megabanks and the increasing concentration of insured deposits. [source]

Pricing Pension Insurance: The Proposed Levy Structure for the Pension Protection Fund,

FISCAL STUDIES, Issue 4 2005
David McCarthy
The UK Pension Protection Fund (PPF), established by the 2004 Pensions Act to protect beneficiaries of defined benefit pension schemes when the sponsor becomes insolvent and the scheme is underfunded, is required to finance itself through a levy on participating schemes. In July 2005, the PPF issued a consultative document setting out its proposal for the structure of the levy. In this paper, we provide a critique of the proposal and, in particular, its heavy reliance on securing levy income from the weakest schemes. We propose an alternative structure for the levy that recognises the limits on capacity to pay and also mitigates some other undesirable features of the proposal. [source]

Is it possible to identify early predictors of the future cost of chronic arthritis?

FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2009
The VErA project
Abstract This study was conducted to identify early predictors of the total cost of inflammatory arthritis (IA). One hundred and eighty patients affected by undifferentiated arthritis (UA) or rheumatoid arthritis (RA) were included in the French Very Early rheumatoid Arthritis (VErA) cohort between 1998 and 2001. Health economic data for 2003 were collected using a patient self-questionnaire. Results were analysed in terms of direct, indirect and total costs in 2003 euros (2003,) for the population as a whole and in diagnostic subgroups. A payor perspective (the French National Health Insurance, in this case) was adopted. Multiple linear regression models were used to identify predictors of total cost from among the criteria assessed on recruitment. Results of the study showed that for the study population as a whole, the mean total cost was ,4700 per patient. The costs attributable to the RA and UA sub-groups were ,5928 and ,2424 per patient, respectively. In a univariate analysis, certain parameters were significantly correlated with a higher cost of illness. In the multivariate analysis, some of these parameters were further identified as being predictive of higher cost. Two strong significant, early predictors of total cost were identified: higher pain (P = 0.002) and the presence of rheumatoid factor (P = 0.004). In the RA sub-group, lower grip strength of the dominant hand (P = 0.039) was another predictor of the illness's subsequent economic impact. In conclusion, our data show that simple clinical and laboratory parameters can be used early in the course of IA to predict the condition's impact on healthcare budgets. [source]

Assessing horizontal equity in medication treatment among elderly Mexicans: which socioeconomic determinants matter most?

HEALTH ECONOMICS, Issue 10 2008
Jürgen Maurer
Abstract Many low- and middle-income countries are currently undergoing a dramatic epidemiological transition, with an increasing disease burden due to degenerative noncommunicable diseases. Inexpensive medication treatment often represents a cost-effective means to prevent, control or cure many of these health conditions. Using micro-data from the 2001 Mexican Health and Aging Study, we assess horizontal inequity in medication treatment among older Mexicans before the introduction of Popular Health Insurance in Mexico. In doing so, we investigate the role of various dimensions of socioeconomic status for obtaining indicated medication treatment within a comparatively fragmented health-care system that features relatively high out-of-pocket expenditures. Our empirical analysis suggests health insurance coverage as a key socioeconomic determinant of indicated medication use with large and statistically significant positive effects on take-up. The effects of insurance status thereby clearly dominate any other possible effects of socioeconomic status on medication treatment. Our results thus highlight the importance of access to reliable health care and comprehensive coverage for rational medication use in the management of degenerative diseases. In light of this evidence, we expect that recent Mexican health-care reforms, which expand health insurance coverage to the previously uninsured population, will alleviate socioeconomic gradients in medication treatment among older people in need. Copyright © 2007 John Wiley & Sons, Ltd. [source]

The effects of Taiwan's National Health Insurance on access and health status of the elderly

HEALTH ECONOMICS, Issue 3 2007
Likwang Chen
Abstract The primary objective of this paper is to evaluate the impact of Taiwan's National Health Insurance program (NHI), established in 1995, on improving elderly access to care and health status. Further, we estimate the extent to which NHI reduces gaps in access and health across income groups. Using data from a longitudinal survey, we adopt a difference-in-difference methodology to estimate the causal effect of Taiwan's NHI. Our results show that Taiwan's NHI has significantly increased utilization of both outpatient and inpatient care among the elderly, and such effects were more salient for people in the low- or middle-income groups. Our findings also reveal that although Taiwan's NHI greatly increased the utilization of both outpatient and inpatient services, this increased utilization of health services did not reduce mortality or lead to better self-perceived general health status for Taiwanese elderly. Measures more sensitive than mortality and self-perceived general health may be necessary for discerning the health effects of NHI. Alternatively, the lack of NHI effects on health may reflect other quality and efficiency problems inherent in the system not yet addressed by NHI. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Health insurance and treatment seeking behaviour: evidence from a low-income country

HEALTH ECONOMICS, Issue 9 2004
Matthew Jowett
Abstract This paper analyses the effect of being insured under the voluntary component of Vietnamese Health Insurance, on patterns of treatment seeking behaviour. A multinomial logit model is estimated using household survey data from three provinces in Vietnam. Decisions regarding both the type of provider sought and type of care received are analysed. Insurance status is treated as both exogenous and endogenous to account for potential selection bias. The results indicate that, overall, insured patients are more likely to use outpatient facilities, and public providers, an effect that is particularly strong at lower income levels. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Demand for traditional medicine in Taiwan: a mixed Gaussian,Poisson model approach

HEALTH ECONOMICS, Issue 3 2001
Steven T. Yen
Abstract Hurdle count models are used to examine the participation and consumption decisions in Chinese medicine use. Motivated by a household production model, a second censoring mechanism is introduced into existing single-hurdle models, and the resulting specification accommodates conscientious abstainers, as well as economic non-consumers, and admits excessive zeros in the sample. In contrast to previous studies that found few predictors, empirical results based on a Taiwanese national sample suggest that Western medicine is a gross substitute to Chinese medicine, and both time price and money price play more important roles than income. Insurance, lifestyle and demographics also determine the use of Chinese medicine. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Effects of Poverty and Lack of Insurance on Perceptions of Racial and Ethnic Bias in Health Care

HEALTH SERVICES RESEARCH, Issue 3 2008
Irena Stepanikova
Objective. To investigate whether poverty and lack of insurance are associated with perceived racial and ethnic bias in health care. Data Source. 2001 Survey on Disparities in Quality of Health Care, a nationally representative telephone survey. We use data on black, Hispanic, and white adults who have a regular physician (N=4,556). Study Design. We estimate multivariate logistic regression models to examine the effects of poverty and lack of health insurance on perceived racial and ethnic bias in health care for all respondents and by racial, ethnic, and language groups. Principal Findings. Controlling for sociodemographic and other factors, uninsured blacks and Hispanics interviewed in English are more likely to report racial and ethnic bias in health care compared with their privately insured counterparts. Poor whites are more likely to report racial and ethnic bias in health care compared with other whites. Good physician,patient communication is negatively associated with perceived racial and ethnic bias. Conclusions. Compared with their more socioeconomically advantaged counterparts, poor whites, uninsured blacks, and some uninsured Hispanics are more likely to perceive that racial and ethnic bias operates in the health care they receive. Providing health insurance for the uninsured may help reduce this perceived bias among some minority groups. [source]

The Impact of Private Insurance Coverage on Veterans' Use of VA Care: Insurance and Selection Effects

HEALTH SERVICES RESEARCH, Issue 1p1 2008
Yujing Shen
Objective. To examine private insurance coverage and its impact on use of Veterans Health Administration (VA) care among VA enrollees without Medicare coverage. Data Sources. The 1999 National Health Survey of Veteran Enrollees merged with VA administrative data, with other information drawn from American Hospital Association data and the Area Resource File. Study Design. We modeled VA enrollees' decision of having private insurance coverage and its impact on use of VA care controlling for sociodemographic information, patients' health status, VA priority status and access to VA and non-VA alternatives. We estimated the true impact of insurance on the use of VA care by teasing out potential selection bias. Bias came from two sources: a security selection effect (sicker enrollees purchase private insurance for extra security and use more VA and non-VA care) and a preference selection effect (VA enrollees who prefer non-VA care may purchase private insurance and use less VA care). Principal Findings. VA enrollees with private insurance coverage were less likely to use VA care. Security selection dominated preference selection and naïve models that did not control for selection effects consistently underestimated the insurance effect. Conclusions. Our results indicate that prior research, which has not controlled for insurance selection effects, may have underestimated the potential impact of any private insurance policy change, which may in turn affect VA enrollees' private insurance coverage and consequently their use of VA care. From the decline in private insurance coverage from 1999 to 2002, we projected an increase of 29,400 patients and 158 million dollars for VA health care services. [source]

Commentary: What Is the Right Price of Health Insurance?

HEALTH SERVICES RESEARCH, Issue 6p1 2007
A Rejoinder
No abstract is available for this article. [source]

Welfare Reform and Health Insurance of Immigrants

HEALTH SERVICES RESEARCH, Issue 3 2005
Neeraj Kaushal
Objective. To investigate the effect of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) on the health insurance coverage of foreign- and U.S.-born families headed by low-educated women. Data Source. Secondary data from the March series of the Current Population Surveys for 1994,2001. Study Design. Multivariate regression methods and a pre- and post-test with comparison group research design (difference-in-differences) are used to estimate the effect of welfare reform on the health insurance coverage of low-educated, foreign- and U.S.-born unmarried women and their children. Heterogenous responses by states to create substitute Temporary Aid to Needy Families or Medicaid programs for newly arrived immigrants are used to investigate whether the estimated effect of PRWORA on newly arrived immigrants is related to the actual provisions of the law, or the result of fears engendered by the law. Principal Findings. PRWORA increased the proportion of uninsured among low-educated, foreign-born, unmarried women by 9.9,10.7 percentage points. In contrast, the effect of PRWORA on the health insurance coverage of similar U.S.-born women is negligible. PRWORA also increased the proportion of uninsured among foreign-born children living with low-educated, single mothers by 13.5 percentage points. Again, the policy had little effect on the health insurance coverage of the children of U.S.-born, low-educated single mothers. There is some evidence that the fear and uncertainty engendered by the law had an effect on immigrant health insurance coverage. Conclusions. This research demonstrates that PRWORA adversely affected the health insurance of low-educated, unmarried, immigrant women and their children. In the case of unmarried women, it may be partly because the jobs that they obtained in response to PRWORA were less likely to provide health insurance. The research also suggests that PRWORA may have engendered fear among immigrants and dampened their enrollment in safety net programs. [source]

Older Married Workers and Nonstandard Jobs: The Effects of Health and Health Insurance

INDUSTRIAL RELATIONS, Issue 3 2009
JEFFREY B. WENGER
We examine the effects of health and health insurance coverage on older married workers' decisions to work in temporary, contract, part-time, self-employment, and regular full-time jobs. We model the behavior of older married workers as interdependent, showing that one spouse's health and insurance status affects the employment of the other. In general, we find that men and women are less likely to be employed in regular full-time jobs when they are in fair or poor health and are more likely to be in regular full-time employment when their spouses are in poor health. [source]

Voting on Unemployment Insurance

INTERNATIONAL ECONOMIC REVIEW, Issue 4 2001
Stéphane Pallage
In this article, we ask heterogeneous agents in a dynamic general equilibrium economy to vote on the generosity of their unemployment insurance program. We observe the influence on their vote of (1) moral hazard, (2) private alternatives, and (3) changes in employment status. Agents differ in skills, employment probabilities, income prospects, and assets. For a calibration to the United States, we show that: (1) in contrast to the literature, plausible levels of moral hazard need not induce large cuts in optimal benefits. (2) Switching to private insurance is rejected for most status quo, though it would be as generous. (3) Skill groups vote as a block. For reasonable discount factors, solidarity is never broken simultaneously for more than one group. [source]

Regulated Competition in Social Health Insurance: A Three-Country Comparison

INTERNATIONAL SOCIAL SECURITY REVIEW, Issue 3 2006
Stefan Gre
The objectives guiding healthcare reforms in Germany, Switzerland and the Netherlands were to increase efficiency and consumer satisfaction in the provision of healthcare services. This paper reviews the incentives for and instruments of competition for consumers, sickness funds and healthcare providers in these three countries which are necessary to fulfil these objectives. Incentives for risk selection of sickness funds are high in Germany and Switzerland while they are low in the Netherlands. Incentives for consumer choice are also highest in Germany and Switzerland. In all three countries sickness funds have only a few instruments of competition. The effects of competition have been disappointing so far. The objectives of competitive healthcare reforms can be achieved only if incentives for and instruments of competition consistently support competitive behaviour on the part of market actors. [source]

The Role of Insurance in Social Protection in Latin America

INTERNATIONAL SOCIAL SECURITY REVIEW, Issue 2-3 2005
Daniel Titelman
Social protection schemes in Latin America face serious short falls in the financial resources available to meet their needs. New types of insurance envisaged in reforms should help to contain costs and increase coverage. However, in strengthening schemes' coverage it is highly probable that considerable demand for additional financial resources will arise to address the need to introduce the principle of solidarity into the system. This article examines reforms in the financing of social security for healthcare and pensions, highlighting the implications of various public-private combinations for financial management and coverage. [source]

Social Health Insurance: Key Factors Affecting the Transition Towards Universal Coverage

INTERNATIONAL SOCIAL SECURITY REVIEW, Issue 1 2005
Guy Carrin
Several low- and middle-income countries are interested in extending their existing health insurance for specific groups to eventually cover their entire populations. For those countries interested in such an extension, it is important to understand the factors that affect the transition from incomplete to universal coverage. This paper analyses the experience of eight countries in the implementation of social health insurance. It highlights the importance of the socioeconomic and political context, particularly in relation to the level of income, structure of the economy, distribution of the population, ability to administer and level of solidarity within the country, but also stresses the important stewardship role government can play in facilitating the transition to universal coverage via social health insurance. [source]

Welfare reform and future challenges in the Republic of Korea: Beyond the developmental welfare state?

INTERNATIONAL SOCIAL SECURITY REVIEW, Issue 4 2002
ju Kwon
Since the economic crisis of 1997,98, the Republic of Korea has carried out vigorous social policy initiatives including the reform of the National Pension Programme and National Health Insurance. This paper seeks to answer whether the country's welfare state has moved beyond welfare developmentalism, by examining the cases of those two programmes. By the reform, the coverage of the National Pension Programme was extended to the whole population; and its financial sustainability and accountability were enhanced. Regarding National Health Insurance, efficiency reform was carried out on the management structure, while reform regarding financing was put on hold. These reforms were in clear contrast to the welfare developmentalism that used to place overwhelming emphasis on economic considerations. Despite these reforms, however, the Republic of Korea's welfare state faces the issues of ineffectual implementation and lack of financial sustainability of social policy. The National Pension Programme has failed to cover the majority of irregular workers, whose numbers are on the increase, and National Health Insurance needs to find a way to meet increasing health expenditure. [source]

Protecting the Old in a Young Economy: Old Age Insurance in the West Bank and Gaza Strip

INTERNATIONAL SOCIAL SECURITY REVIEW, Issue 3 2000
Markus Loewe
Taking the West Bank and Gaza Strip as a reference point, this paper looks at social protection in developing economies, which are beset by economic stagnation, widespread poverty and unemployment. If the main breadwinner dies, is unable to work or is an older person, these factors are prime causes of absolute poverty. This is hardly surprising, since private and public systems of social security are totally inadequate in this area in particular. Current thinking on social security suggests that what is needed is the rapid introduction of a comprehensive system of retirement provision, comprising a mandatory capital-funded insurance component, with defined contributions, administered on a decentralized basis; and a state-administered pay-as-you-go basic insurance component with lump-sum transfers to safeguard the poorest. A system of this kind works to prevent poverty in old age by redistributing funds from some individuals to others and ensuring an income for life, and it represents a compromise between a fair return on what people have contributed and a fair distribution over society as a whole. It is thus a major force for stability in society. [source]

Interview with a Quality Leader,Karen Davis, Executive Director of The Commonwealth Fund

JOURNAL FOR HEALTHCARE QUALITY, Issue 2 2009
Lecia A. Albright
Dr. Davis is a nationally recognized economist, with a distinguished career in public policy and research. Before joining the Fund, she served as chairman of the Department of Health Policy and Management at The Johns Hopkins School of Public Health, where she also held an appointment as professor of economics. She served as deputy assistant secretary for health policy in the Department of Health and Human Services from 1977 to 1980, and was the first woman to head a U.S. Public Health Service agency. Before her government career, Ms. Davis was a senior fellow at the Brookings Institution in Washington, DC; a visiting lecturer at Harvard University; and an assistant professor of economics at Rice University. A native of Oklahoma, she received her PhD in economics from Rice University, which recognized her achievements with a Distinguished Alumna Award in 1991. Ms. Davis is the recipient of the 2000 Baxter-Allegiance Foundation Prize for Health Services Research. In the spring of 2001, Ms. Davis received an honorary doctorate in human letters from John Hopkins University. In 2006, she was selected for the Academy Health Distinguished Investigator Award for significant and lasting contributions to the field of health services research in addition to the Picker Award for Excellence in the Advancement of Patient Centered Care. Ms. Davis has published a number of significant books, monographs, and articles on health and social policy issues, including the landmark books HealthCare Cost Containment, Medicare Policy, National Health Insurance: Benefits, Costs, and Consequences, and Health and the War on Poverty. She serves on the Board of Visitors of Columbia University, School of Nursing, and is on the Board of Directors of the Geisinger Health System. She was elected to the Institute of Medicine (IOM) in 1975; has served two terms on the IOM governing Council (1986,90 and 1997,2000); was a member of the IOM Committee on Redesigning Health Insurance Benefits, Payment and Performance Improvement Programs; and was awarded the Adam Yarmolinsky medal in 2007 for her contributions to the mission of the Institute of Medicine. She is a past president of the Academy Health (formerly AHSRHP) and an Academy Health distinguished fellow, a member of the Kaiser Commission on Medicaid and the Uninsured, and a former member of the Agency for Healthcare Quality and Research National Advisory Committee. She also serves on the Panel of Health Advisors for the Congressional Budget Office. [source]