Defined contribution health care: future direction or fantasy?

Will payers embrace defined contribution plans as an alternative to traditional health insurance or is this new approach a pipe dream? Are consumers truly ready to make informed decisions on purchasing their own health care? This article explores barriers to defined contribution health plans, including consumer reluctance to take ownership of buying insurance and a preference for the cost predictability of liberal coverage in employer-sponsored programs versus MSAs or higher co-payment arrangements. For the ultimate form of defined contribution health care to work, several tax and insurance barriers must be overcome. As a practical matter, the author argues that the current employer-sponsored approach is the most efficient system for large employers.     

Significant Factors of Aviation Insurance and Risk Management Strategy: An Empirical Study of Taiwanese Airline Carriers

Aviation insurance premiums have become a heavy burden for the airline industry since September 11, 2001. Although the industry must constantly balance its operations between profitability and safety, the reality is that airlines are in the business of making money. Therefore, their ability to reduce cost and manage risk is a key factor for success. Unlike past research, which used subjective judgment methods, this study applied quantitative historical data (1999–2000) and gray relation analysis to identify the primary factors influencing ratemaking for aviation insurance premiums. An empirical study of six airlines in Taiwan was conducted to determine these factors and to analyze the management strategies used to deal with them. Results showed that the loss experience and performance of individual airlines were the key elements associated with aviation insurance premiums paid by each airline. By identifying and understanding the primary factors influencing ratemaking for aviation insurance, airlines will better understand their relative operational strengths and weaknesses, and further help top management identify areas for further improvement. Knowledge of these factors combined with effective risk management strategies, may result in lower premiums and operating costs for airline companies.     

The role of the coordinator of care

Regardless of the specific outcome of the current health reform debate in Washington, it is likely that major changes to the health care system are in the offering. These changes, many of which are already in place or imminent in some locations, will have a major impact on the evolving relationships between physicians and hospitals. Most expect that these changes will accelerate the development of integrated health care delivery systems that will compete in the marketplace for a mixture of public and private health insurance dollars. In this system of "managed competition," health care dollars will flow to those systems that can ensure the best clinical outcomes while using the least economic resources. In this scenario, competing collaborative health networks that can manage the continuum of care will be central to the health care delivery system. The economic and political ties between physicians and hospitals will become more closely linked as government and private payers of health care services foster the development of these integrated, value-based health care delivery systems.     

Underprotection of Unpredictable Statistical Lives Compared to Predictable Ones

Existing ethical discussion considers the differences in care for identified versus statistical lives. However, there has been little attention to the different degrees of care that are taken for different kinds of statistical lives. Here we argue that for a given number of statistical lives at stake, there will sometimes be different, and usually greater, care taken to protect predictable statistical lives, in which the number of lives that will be lost can be predicted fairly accurately, than for unpredictable statistical lives, where the lives are at stake because of a low‐probability event, such that most likely no one will be affected by the decision but with low probability some lives will be at stake. One reason for this difference is the statistical challenge of estimating low probabilities, and in particular the tendency of common approaches to underestimate these probabilities. Another is the existence of rational incentives to treat unpredictable risks as if the probabilities were lower than they are. Some of these factors apply outside the pure economic context, to institutions, individuals, and governments. We argue that there is no ethical reason to treat unpredictable statistical lives differently from predictable statistical lives. Moreover, lives that are unpredictable from the perspective of an individual agent may become predictable when aggregated to the level of a societal decision. Underprotection of unpredictable statistical lives is a form of market failure that may need to be corrected by altering regulation, introducing compulsory liability insurance, or other social policies.     

不完全市场中相关性风险的对冲策略研究

随着我国资本市场的进一步完善,以及市场波动的更加剧烈,投资者对于相关性风险的关注日益增强,如何对冲相关性风险是一个亟待解决的重要课题。本文在基于跳跃的不完全市场中,以带有跳跃的价格过程为基础,引入相关性随机过程,依据期权的希腊字母对冲原理,构建相关性风险的对冲策略——卖出一份股票指数看跌期权同时买入若干份对应个股的看跌期权和若干份标的股票,使投资组合保持资产波动率以及价格跳跃风险中性,进而通过卖出组合中指数期权的相关性风险溢价来对冲个股组合的相关性风险。本文选取2007年3月到2013年3月香港恒生指数及其成份股期权的日数据用以实证分析,结果表明:该策略能够对冲个股投资组合的相关性风险,且在大部分情况下获得显著为正的收益。本文对事前构建对冲策略以规避极端事件发生时的相关性风险具有重要的参考价值。     

The Role of Insurance in Managing Natural Hazard Risks: Private Versus Social Decisions

We explore the interaction between individual and collective decisions concerning natural hazards. Collective actions such as building a dam change the risks faced by private individuals. We show that, with proper incentives, individual reactions to such changes in risk can serve to enhance risk management by utilizing individual's decisions to take account of their specialized knowledge about their risk preferences and losses. We demonstrate that the efficient response to construction of a dam may be private actions that lead to a fully anticipated increase in flood damage. In such instances, zoning that focuses on reducing flood damage may lead to less efficient use of the flood plain. More generally, even where incentives for underinvestment in market insurance and self-insurance are present, constraining use of the flood plain by zoning will not generally lead to efficient outcomes. The model identifying conditions under which informed individuals have the incentives to make efficient decisions is powerful and directs attention toward more fruitful approaches.     

强制性约束下企业信息安全投资与网络保险的最优决策分析

研究了强制性约束下企业信息安全投资和网络保险的最优决策问题,对比了可观测企业损失和不可观测企业损失两种情形下基于破产概率约束的最优安全投资和网络保险保费厘定。研究结果表明：在可观测损失和公平保费情况下,当最大化单个企业的期望效用时,存在最优安全投资额,并且政府补贴和强制性约束都可以激励企业增加安全投资;但是当最大化所有企业效用时,只有强制性约束才能增加企业安全投资使得总效用最大化,并且企业的最优安全投资与损失的可观测程度无关。在不可观测损失情况下,当最大化单个企业期望效用时,企业的安全投资增大,而最大化所有企业效用时,存在正网络外部性,即任何企业均不敢轻易的减少安全投资,即使同在一个网络中的其他企业减少了安全投资。此外,在破产概率约束下,随着保费的增加,当损失可观测时,企业的安全投资也增加,但期望效用减少了;而当损失不可观测时,企业的安全投资和期望效用均减少。本文所得结论对政府设定强制性标准,以及企业利用安全投资和网络保险进行信息安全风险控制具有较好的参考价值。     

基于保险交易的静态最优区块链模型研究

保险业的经营特征与区块链技术存在天然契合性,本文通过分析基于区块链技术的保险交易流程,构建了基于保险交易的静态最优区块链模型,得到了保单区块存储员的最优区块存储能力、区块存储成本以及限制区块链违约分叉的约束条件。进一步以我国车险市场的经营数据为例进行数值模拟,得到区块规模、平均记录时间、平均交易费用等指标的最优结果。通过比较静态分析发现,保险交易数量、保单区块存储员人数、区块存储时间等增加以及风险损失率的降低均会导致区块规模增加以及保险交易记录时间和保险交易费用的减少,而外部冲击的增加会导致区块规模的增加以及保险交易记录时间减少,但对保险交易费用的影响取决于因外部冲击增加而产生的交费激励增加和区块规模受限而导致的交费激励减少之间的平衡。基于研究结果,本文在保险科技协同、区块链系统设计和具体场景实践等方面提出了政策建议,同时也指出了一些有待解决的现实问题。     

Using input—output models for planning in groups with considerable inter-company trading

In any group where a lot of inter-company trading takes place and where the member companies are allowed a degree of autonomy, conflicts of interest will arise. Actions taken by individual companies in their own best interest will, on occasion, be detrimental to the group as a whole. Furthermore, the accounts relating to a particular company will tell head office management very little about the through-group profitability of the products concerned. Nor will the usual accounts and statistics throw much light on the extent to which individual companies or processes depend on the group's main end markets, since in many cases these companies will be largely or partly concerned with supplying other members of the organization.It follows that in such groups an information system is needed which will not reflect the organizational structure of the enterprise—as do individual company accounts—but which will provide top management with an overall group view. It should also make a contribution, both towards resolving any conflicts of interest which might occur, and to improving the overall return on group assets employed.This article examines the role of the micro input–output model in this situation with particular reference to its application in areas where conflicts of interest between the group and its member companies are likely to arise.     

Dispositional Factors Affecting Choices Surrounding the Purchase of Insurance and the Taking of Mitigating Measures Against Flooding

This research investigated the role of dispositional factors in decisions to purchase insurance and to take mitigating measures against flooding. Two dispositional factors—risk aversion in the domain of losses and time discounting rate—were found to be predictors of the decision to acquire flood insurance. The observation of a relationship between experiment-based risk attitudes and the decision to insure oneself against flooding replicates a finding of Petrolia et al. The finding that impatience negatively impacts decisions to take out insurance against flooding is novel. However, support was not found for analogous hypotheses concerning relationships between the two dispositional variables and decisions to take mitigating measures. Evidently, factors other than individual risk aversion and time discounting rate play a crucial role in this behavior.     

The old ways of doing medical business are passing

Doctors must realize that the ?us and them? labels have to be discarded. No longer do physicians wield the ultimate power. We've lost our patients to insurance companies and part of our medical knowledge rests with nonphysicians. Likewise, physicians must accept the reality that all doctors aren't going to be in the same practice setting: some will work for hospitals, some for insurance companies, some for HMOs, some for themselves. But we're all members of a great profession that has proven its ability to give high-quality care to our patients, and now more than ever with more attention paid to costs.     

银行投资组合多元化与系统性风险的关系研究

在现代金融系统中,人们逐渐开始关注整个银行业的系统性风险而不仅仅是个体风险,而传统经济学中个体银行投资组合多元化理论对于系统性风险来说并不一定是有效的,因此对于银行投资组合多元化与系统性风险之间的关系仍需要深入研究。本文基于简化的金融市场,通过资产负债表刻画银行和资产之间的联系,构建了描述银行破产边界的数学模型,并以此为基础分别研究了银行个体风险、系统性风险、考虑拆借关系的系统性风险以及同时考虑减价出售和拆借关系的系统性风险之间的区别与联系,进而分析了银行投资组合多元化对不同风险的影响。最后,参考实际金融市场中的参数取值,对本文构建的模型进行了数值实验,研究结果表明：多元化会使银行的投资组合变得相似从而更容易引发系统性风险,资产减价出售和银行间拆借关系的存在同样会增加银行系统性风险,因而通过减少投资组合多元化和控制银行拆借比例等措施可以在一定程度上降低系统性风险的发生,这对于系统性风险的监管具有较高的参考价值。     

Medicare's ESRD Program, Part 1: Dialysis.

The federal End State Renal Disease (ESRD) program was created by statute in 1972 as a general population entitlement to be administered by Medicare. The program extends all Medicare benefits to patients, regardless of age, who are diagnosed as having ESRD, as long as they are fully insured for old age and survivor insurance benefits (Social Security), are entitled to monthly insurance benefits under the Social Security Act, or are spouses or dependent children of individuals with the foregoing Social Security benefits. About 7 percent of all ESRD patients are excluded from this entitlement by these criteria. The two major therapies embraced by the ESRD program are renal dialysis and kidney transplantation. In this first part of a two-part article, dialysis is the focal point. Kidney transplants will be covered in the May-June issue of Physician Executive.     

Implied Preference for Seismic Design Level and Earthquake Insurance

Seismic risk can be reduced by implementing newly developed seismic provisions in design codes. Furthermore, financial protection or enhanced utility and happiness for stakeholders could be gained through the purchase of earthquake insurance. If this is not so, there would be no market for such insurance. However, perceived benefit associated with insurance is not universally shared by stakeholders partly due to their diverse risk attitudes. This study investigates the implied seismic design preference with insurance options for decisionmakers of bounded rationality whose preferences could be adequately represented by the cumulative prospect theory (CPT). The investigation is focused on assessing the sensitivity of the implied seismic design preference with insurance options to model parameters of the CPT and to fair and unfair insurance arrangements. Numerical results suggest that human cognitive limitation and risk perception can affect the implied seismic design preference by the CPT significantly. The mandatory purchase of fair insurance will lead the implied seismic design preference to the optimum design level that is dictated by the minimum expected lifecycle cost rule. Unfair insurance decreases the expected gain as well as its associated variability, which is preferred by risk-averse decisionmakers. The obtained results of the implied preference for the combination of the seismic design level and insurance option suggest that property owners, financial institutions, and municipalities can take advantage of affordable insurance to establish successful seismic risk management strategies.     

A revolution in genetics: changing medicine, changing lives

The sequencing of the human genome is only the tip of the iceberg. It is the beginning of a revolution that many predict will transform medicine. How will genetics research affect physicians and patients and the practice of medicine? When investigators identify the function and association of human genes with common chronic diseases, diagnosis, treatment, and classification of human diseases will be changed forever. Genetic susceptibility testing allows patients to know their predisposition to disease long before symptoms appear. Physicians can intervene with customized advice so that the patient can prevent, modify, or avoid the predisposed condition by better understanding both his or her genetic and environmental risk for disease. The promise of a genetic approach to drug therapy involves moving from one size fits all to personalized medicine tailored to the individual patient. Physicians will become mentors and counselors, advising patients on the best treatment path given their unique genetic predisposition--even in this sophisticated, high tech field, the physician-patient relationship is likely to improve, highlighted by individualized therapies and personal attention.     

I get paid fast; what about you?

The process of billing an insurance company for health care services has changed radically. In the past few years, the emphasis has been on automation. The change is fueled by the opinion of cost containment experts who claim that automation will help reduce costs in the U.S. health care delivery system. Key to success for the provider in adapting to this change will be understanding the coding used in the billing process and following standards of accuracy and fairness. This article is not intended to represent the adjudication rules of any particular insurance company. It is the result of experience as a practicing surgeon and as a consultant in the health care field.     

Measurement and Pricing of Risk in Insurance Markets

The theory and practice of risk measurement provides a point of intersection between risk management, economic theories of choice under risk, financial economics, and actuarial pricing theory. This article provides a review of these interrelationships, from the perspective of an insurance company seeking to price the risks that it underwrites. We examine three distinct approaches to insurance risk pricing, all being contingent on the concept of risk measures. Risk measures can be interpreted as representations of risk orderings, as well as absolute (monetary) quantifiers of risk. The first approach can be called an "axiomatic" one, whereby the price for risks is calculated according to a functional determined by a set of desirable properties. The price of a risk is directly interpreted as a risk measure and may be induced by an economic theory of price under risk. The second approach consists in contextualizing the considerations of the risk bearer by embedding them in the market where risks are traded. Prices are calculated by equilibrium arguments, where each economic agent's optimization problem follows from the minimization of a risk measure. Finally, in the third approach, weaknesses of the equilibrium approach are addressed by invoking alternative valuation techniques, the leading paradigm among which is arbitrage pricing. Such models move the focus from individual decision takers to abstract market price systems and are thus more parsimonious in the amount of information that they require. In this context, risk measures, instead of characterizing individual agents, are used for determining the set of price systems that would be viable in a market.     

Are People Willing to Buy Natural Disaster Insurance in China? Risk Awareness,Insurance Acceptance,and Willingness to Pay

After the Wenchuan earthquake (magnitude 7.9, May 12, 2008), intensive debates on how China should establish a natural disaster insurance system were initiated among researchers, policymakers, and insurance professionals. Our focus was the social aspects of disaster insurance, explored in China through a nationwide survey. Our questionnaires investigated people's risk awareness, insurance acceptance, their opinions on governmental measures for disaster management, and their willingness to pay for disaster house insurance. We analyzed the results at both regional and individual scales. We found that the integrated hazard index and respondents’ experience of insurance (considered objective factors), and their opinions on the importance of insurance and government responsibility (considered subjective factors) showed strong correlation with the regional overall acceptance of disaster insurance. An individual's decision to participate highly depended on his/her experience of both insurance and disaster and his/her opinion on the importance of insurance as a coping mechanism. Respondents from poverty‐stricken or less‐developed counties were not necessarily more reluctant to accept natural disaster insurance, though they exhibited relatively lower ability to afford insurance. In general, respondents had correct perceptions of natural disasters in their areas; however, people from regions with a greater multihazard threat showed less willingness to accept disaster insurance because they tended to expect the government to undertake to cover losses and considered insurance to be less important. People's willingness to pay for an assumed disaster house insurance was also investigated and analyzed. We consequently discuss the policy implications for developing a disaster insurance system in China.     

重尾索赔条件下现代风险模型的破产概率估计:多险种混合情形

破产概率是非寿险保险风险理论的核心问题。与经典的Cramér-Lundberg模型相比, 由Li Zehui等建立的现代风险模型更为准确地描述了非寿险保险运营的主要特征, 对现实保险业务具有较好的解释力。本文基于现代风险模型, 考虑保险公司多个险种混合经营这一更为现实的情形, 在索赔额服从正则尾分布条件下获得了破产概率的渐近等价估计。我们发现, 在具有大额索赔特征的多个险种混合的条件下, 公司面临的极端索赔风险将由索赔额分布尾部最厚的那些险种决定, 而索赔额分布尾部相对较薄的那些险种的影响作用将被淹没。该结论的有效性可用MATLAB数值模拟得到理想的验证。本文结果是对风险模型研究的重要推广, 也为多险种混合情形下保险公司的风险控制与初始保证金界定提供了依据。     

Exposure Assessment: Then, Now, and Quantum Leaps in the Future

Health risk assessments have become so widely accepted in the United States that their conclusions are a major factor in many environmental decisions. Although the risk assessment paradigm is 10 years old, the basic risk assessment process has been used by certain regulatory agencies for nearly 40 years. Each of the four components of the paradigm has undergone significant refinements, particularly during the last 5 years. A recent step in the development of the exposure assessment component can be found in the 1992 EPA Guidelines for Exposure Assessment. Rather than assuming worst-case or hypothetical maximum exposures, these guidelines are designed to lead to an accurate characterization, making use of a number of scientific advances. Many exposure parameters have become better defined, and more sensitive techniques now exist for measuring concentrations of contaminants in the environnment. Statistical procedures for characterizing variability, using Monte Carlo or similar approaches, eliminate the need to select point estimates for all individual exposure parameters. These probabilistic models can more accurately characterize the full range of exposures that may potentially be encountered by a given population at a particular site, reducing the need to select highly conservative values to account for this form of uncertainty in the exposure estimate. Lastly, our awareness of the uncertainties in the exposure assessment as well as our knowledge as to how best to characterize them will almost certainly provide evaluations that will be more credible and, therein, more useful to risk managers. If these refinements are incorporated into future exposure assessments, it is likely that our resources will be devoted to problems that, when resolved, will yield the largest improvement in public health.