A ‘good,average man’: calculation and the limits of statistics in enrolling insurance customers

Drawing upon the historical relationship between statistics, probabilistic reasoning and life insurance, the article argues that mathematical calculation played a necessary but limited role in making markets for life insurance. Insuring publics have been fairly consistently cautious in the use of probabilistic and statistical reasoning to inform investment in life insurance. In this they follow a pattern set by early insurance companies who themselves were slow to alter their commercial practices in line with emerging knowledge. I examine some of the reasons for this glacial pace and some of the ambiguities on which statistical ‘certainties’ were built as part of an argument that the role of statistics and mathematics in market calculation is both less and more than it seems. This is manifest in the history of industrial life assurance, an industry with a phenomenally successful track record in the mass enrolment of consumers. Unlike their predecessors, industrial companies disdained swamping their target markets with probabilistic arguments in favour of a very different sort of argument that, nevertheless, carried a trace of statistical thinking with it. This trace came in the form of ‘good, average men’, the agents who became industrial insurance's core marketing device and who translated the essentials of a statistically informed product into a more palatable, more calculable form.     

The new mentality: Youth–adult partnerships in community mental health promotion

Youth–adult partnerships (Y-APs) engage young people in meaningful community activity and in the institutions and decisions that affect their lives. The current study is an examination of the process of The New Mentality, a multi-site pilot program intended to mobilize Y-APs to raise community awareness of child and youth mental health, reduce the stigma surrounding mental illness, and advocate for a mental health service system that is more responsive to the needs of children and youth. Data were gathered through individual interviews, focus groups, observations, and questionnaires with youth and adult stakeholders at various levels of the project. A number of themes emerged from the data. These included the critical nature of relationships youth experienced, the cultural differences and advocacy opportunities presented in the child and youth mental health system, the program's level of structure, and individual learning and knowledge sharing.     

HEALTH CARE, INSURANCE, AND THE CONTRACT CHOICE EFFECT

This article explores the interdependence between the individual consumer's demand for medical care and choice of health insurance coverage, with emphasis on its implications for demand behavior and empirical analysis. We show that an increase in the price of medical care has two effects on demand, the usual response of reduced quantity demanded and a health insurance contract choice effect resulting from the consumer's incentive to change insurance plan. The contract choice effect, widely neglected in studies of medical care demand, alters both the quantitative and qualitative predictive properties of the consumer's demand for medical services. (JEL D11, D81, I11 )     

Health care reform and older adults: notes from the Polish experience

Poland enacted in 1997 legislation that founded a health care system in which health insurance societies contract with providers to deliver health services to the insured population. Through a review of the new statutes, interviews with key informants, analysis of public opinion polls and surveys of insurance administrators and health care workers, we examined the impact of reform on Poland's older citizens. The findings indicate that older adults are likely to be adversely affected by the inadequacies of insurance premiums as a source of finance, the lack of emergent private medical enterprise, and the failure to eradicate private health in its earlier, black market incarnation.     

EMPLOYER SPONSORED MEDICAL BENEFITS: The Influence of Occupational Characteristics and Gender

This research investigates gender differences in employer-sponsored medical fringe benefits: health insurance, dental insurance, sick leave, life insurance, and eye care coverage. Using data from a nationally representative sample of workers in the United States, human capital and structural theoretical approaches are drawn upon to explain the receipt of these benefits. The data suggest (a) men were more likely than women to receive each medical benefits from their employer; (b) occupational conditions largely account for the gender differences in coverage; (c) structural conditions of the occupation were more likely to predict the receipt of employer-sponsored medical benefits than were human capital attributes; (d) hazardous working conditions were not compensated for with medical benefits, with the exception of eye care coverage; and (e) gender did influence the relationship between several occupational conditions and benefit coverage.     

Donor Requirements and Pockets of Effectiveness in Senegal's Bureaucracy

Donors increasingly value the work of statistics, project assessment and related offices in developing countries, but can they ensure these offices are able to do their work? This article assesses donors’ efforts to do so in Senegal's ministries of finance, health and agriculture in the mid‐2000s. It contends that donors' impact is greatest if they generate political incentives for governments to create ‘pockets of effectiveness’ in these areas. The health and agriculture case studies indicate that direct donor involvement, particularly if incompatible with domestic political forces, produces disappointing results, while the finance case studies suggest donors can induce political support for the work of specific offices if donor incentives coincide with domestic political imperatives.     

Student health insurance programs at collegiate institutions: a national survey

Increasing health care costs are forcing collegiate institutions to find more economical ways to meet the health care needs of students. Student health insurance programs are a major component in meeting these needs. This national survey reports the extent to which student health insurance programs are offered or administered by 2-year and 4-year colleges, universities, and professional and graduate schools in both the public and private sectors. The study finds that most programs are optional, open to all registered students regardless of age or credit load, with dependent coverage options usually available. Reported enrollment levels suggest that less than 20% of the students participate at a majority of the institutions surveyed. Concern about group health insurance at the collegiate level reflects national concern over the large number of Americans who currently lack health coverage.     

Postmodern synergistic knowledge creation: extending the boundaries of disability studies

The tensions between the competing discourses of the medical and the social models of disability have traditionally provided a platform for discussion and research in the fields of disability studies and special needs education. Over the last 30 years a wealth of literature has consolidated the debate and produced particular knowledge of impairment and disability. In this paper we argue that by privileging notions of ‘deficit’ within these medical or social model perspectives the richness of the lived experience of people with impairments is denied. The individual becomes lost within a framework of medical symptoms or social inequalities. This paper considers alternative approaches which reveal a fuller picture of the lives of people with impairments. The authors conducted two separate empirical studies, one employing a Deleuzo‐Guattarian perspective, the other a Bourdieusian perspective. In this paper we illustrate how these theories of practice can reveal situated understandings of the individual with impairments and his/her daily life. By embracing new understandings and different theoretical perspectives we show how new knowledge can emerge to illuminate the fluid and ever‐changing notions of ‘disability’, ‘inclusion’ and ‘exclusion’, which form elements of the individual lived experience of the research participants.     

Health Insurance and Worker Retention in the Construction Industry

Using samples of blue collar construction workers from the 1996 and 2001 SIPP, a shared frailty survival model shows that controlling for wages, occupational and demographic factors, both portable union and nonportable nonunion employer-provided health insurance increase the probability of worker retention within the construction industry. Portable union health insurance increases the probability of worker-industry retention by 30 to 41% compared to 13 to 18% for nonunion employer-provided insurance. Our research suggests that by encouraging industry retention, health insurance preserves and encourages the accumulation of human capital in a turbulent industry with high firm-and-industry-labor turnover and also may reduce worker disabilities by immediately treating medical problems. Furthermore, in the union sector of construction where health insurance is portable across signatory contractors, the problem of job-lock inefficiencies is reduced.     

Perception and role of informal rural finance in developing countries: the example of Tanzania

Negative perceptions on the value of informal rural finance or credit which are prevalent in a number of developing countries are compounded in the case of Tanzania because of the country's Ujamaa and socialist policies. Consequently, informal rural finance has been neglected both in terms of research and policy planning. This paper attempts to fill part of the research gap on informal rural finance in Tanzania, and to contribute to the growing body of knowledge on this subject in the developing countries. The paper briefly investigates the policy and perception scenario on informal rural finance in Tanzania in the last two decades. Based on empirical data collected through village surveys in three regions of the country, the paper describes the sources of informal credit for smallholder farmers in those areas, and assesses the use, repayment, terms and conditions of such credit.     

The Insurance Industry in Jordan

This paper examines the structure and performance of the insurance industry in Jordan during the period of 2000–2005. The Jordanian insurance industry is free of state ownership in both primary insurance and reinsurance markets and has been spared the pervasive premium, product, investment, and reinsurance controls that have bedeviled the insurance markets of so many developing countries around the world. Despite these positive features, the insurance industry is not developed, which mainly reflects the underdevelopment of life insurance that has annual premiums of only 0.27 percent of GDP. In contrast, the level of general insurance is comparable to that of several other developing countries in the region. To overcome this situation a major modernization effort should be undertaken.      

Normal Parents:

Institutions influence the transition to parenthood in two ways: they affect the timing of the decision to have children and they shape the experience of parenting. This paper explores both types of influence focusing on education, economic, medical, legal and religious institutions. After looking at the role of institutions in delaying childbirth, examination focuses on the response of institutions to today's older new parents and consideration is given to normal (i.e., typical) parent roles are created. The article concludes by analyzing the importance of "experts" in the lives of new parents.     

Expanding the focus of health insurance education for Medicare beneficiaries

Health insurance education plays an important role in helping consumers make informed decisions about their need for supplemental coverage. This article reviews findings on the knowledge of Medicare beneficiaries about their health insurance coverage. Then, current health insurance education programs are examined with regard to their ability to meet the needs of a competition-based public policy. Barriers outside the control of individuals that impede the growth of the long-term care insurance market are identified and the need for an alternative, broader form of health insurance education is suggested. Changes in the scope and content of health insurance education are proposed that would educate the elderly to their own needs as well as the larger policy issues. An expanded model of education based on the concept of the Swedish study circle is discussed to illustrate the possibility of combining individual knowledge and public debate about complex social issues.     

Optimal Annuity Purchase Decisions Under Uncertain Lifetime

This paper developed a wealth allocation framework for longevity risk protection under stochastic lifetime. By combining the dynamics of wealth evolution and health evolution in stochastic multi-period discrete-time models, an optimization problem was formulated with the objective of maximizing lifetime utility of consumption and bequest. We implemented the framework in different scenarios and provided results to illustrate the practical implications of the framework. Computational results suggested that it is optimal for most people to purchase an annuity at some point in their lives. However, an individual’s health status, risk aversion, retirement objective, and the insurance charge associated with annuities could significantly influence the choice of optimal annuitization time, consumption plans, and trade off between lifetime versus fixed-term annuity.     

Paying for the health and social care of the elderly

The aging population of Japan is causing serious concern among social policymakers. The most urgent issue is to find a way to pay for the health and social care of the frail elderly. After universal coverage of pension and health insurance was achieved, but just before the economic growth rate was considerably slowed, in part, because of the oil crisis, the Japanese government more than doubled pension benefits and made medical care for the elderly free. Since the early 1980s, the government has tried hard to cut and control these benefits, only with moderate success. With a consumption tax rate of only 5%, rather than the proposed 7%, the government is now considering establishing a new health and social care insurance scheme for the elderly to finance the increasing cost of their care.     

Expanding the Focus of Health Insurance Education for Medicare Beneficiaries

Health insurance education plays an important role in helping consumers make informed decisions about their need for supplemental coverage. This article reviews findings on the knowledge of Medicare beneficiaries about their health insurance coverage. Then, current health insurance education programs are examined with regard to their ability to meet the needs of a competition-based public policy. Barriers outside the control of individuals that impede the growth of the long-term care insurance market are identified and the need for an alternative, broader form of health insurance education is suggested. Changes in the scope and content of health insurance education are proposed that would educate the elderly to their own needs as well as the larger policy issues. An expanded model of education based on the concept of the Swedish study circle is discussed to illustrate the possibility of combining individual knowledge and public debate about complex social issues.     

Paying for the Health and Social Care of the Elderly

The aging population of Japan is causing serious concern among social policymakers. The most urgent issue is to find a way to pay for the health and social care of the frail elderly. After universal coverage of pension and health insurance was achieved, but just before the economic growth rate was considerably slowed, in part, because of the oil crisis, the Japanese government more than doubled pension benefits and made medical care for the elderly free. Since the early 1980s, the government has tried hard to cut and control these benefits, only with moderate success. With a consumption tax rate of only 5%, rather than the proposed 7%, the government is now considering establishing a new health and social care insurance scheme for the elderly to finance the increasing cost of their care.     

‘Our Diagnoses,Our Selves’: The Rise of the Technoscientific Illness Identity

Biomedicine situates the definitions, practices, and controls of the medical system within the field of technoscience, which relies on new knowledge, high technology, and biomedical health and risk surveillance. Since the middle of the 20th century technoscientific efforts to understand human phenomena at the microbiological level have secured the place of the biomedical model of disease and the technology used to understand and manage human bodies, selves, and socialities. Specifically, high technology has provoked a paradigm shift from controlling disease and finding cures (medicalization) to transforming bodies and managing risk through technoscientific means (biomedicalization). Though there has been a major shift in the role of the medical consumer since the 1970s and a general recognition of patients’ rights to meaningful information about their health and illness conditions, biomedicine holds significant authority over peoples’ lives to the degree that biomedicalization now involves the production of individual and collective identities that are constructed through technoscientific means. The technoscientific identity has even become a type of illness identity that involves applying biomedical information and characteristics to a person’s sense of self in the face of illness.     

Medical Utilization and Health Expenditure of the Elderly in Taiwan

The present analysis, based upon data from the 1989 Taiwan Labor Force Survey, includes two parts. First, the determinants of physician visits and hospitalization by the elderly are analyzed according to the behavioral systems approach, and, second, variation in health expenditures among the elderly are examined using the Tobit model with sample selection. Findings show that elderly with good or poor health conditions are less likely to use medical services than the frail elderly and that married elders are less likely than the non-married to use medical care. The higher the educational level, the lower the probability of using formal medical services, and elderly who have health insurance are more likely to use formal health care than those who have no health insurance. The elderly who live with their children are less likely to use formal medical services than those who do not live with their children. Finally, among the elderly who have used formal health care, individual health expenditures are influenced primarily by three factors: health condition, health insurance, and residential location. Implications for Taiwan's relatively newly established national health insurance program (effective April 1, 1995) are discussed based upon the findings of this research.