医疗服务机构在医疗保险逆选择中的角色扮演

医疗保险中存在的逆选择问题阻碍了我国医疗保险事业发展。从医疗保险逆选择过程的第三方即医疗服务机构角度出发探究如何解决逆选择困境,结合预期效用理论对医疗服务机构在逆选择过程的角色扮演作出阐述,指出医疗服务机构行为构成逆选择的重要制约因素,认为实施群组保险等解决逆选择困境的措施必须与医疗服务机构改革相结合才能取得成效。     

Buying Insurance for Disaster-Type Risks: Experimental Evidence

This paper presents a series of experiments that confront subjects with low probability, high loss situations. A rich parameter set is examined and we find subjects respond to low probability, high loss risks in predictable ways. As loss events become more likely, or loss amounts get larger, or the cost of insurance falls, subjects are more likely to buy indemnifying insurance, even for the class of low probability risks that usually presents problems for standard expected utility theory. A novel application of Cameron's method to estimate willingness to pay from dichotomous choice responses allows us to estimate willingness to pay for insurance. We do not observe the bimodal distribution of bids found in other studies of similar risk situations.     

Precarious workers' choices about unemployment insurance membership after the Ghent system reform: The Finnish experience

The literature on the Ghent system has focused on the link between voluntary unemployment insurance and union membership in terms of industrial relations. Less attention has been paid to unemployment benefits and employees' decision‐making concerning unemployment insurance, even though the core function of the Ghent system is to provide unemployment insurance. This paper examines both of the options that precarious workers (i.e., part‐timers, temporary employees, and low‐skilled service employees) choose regarding unemployment insurance membership and the change in union density after the Ghent system reform in Finland. First, the results show that the growth of the independent unemployment insurance fund was the main reason for declining union density in the 2000s and early 2010s. Second, in terms of precarious workers, we find that the emergence of the independent fund has affected their choices about unemployment insurance membership and that their choices depend on the type of precarious employment they have. Moreover, part‐timers and temporary employees younger than 35 years of age are much less likely to enroll in unemployment insurance than older employees who have the same types of employment contracts.     

Incentives and government relief for risk

Government relief is offered for a wide range of risks-natural disaster, economic dislocation, sickness, and injury. This article explores the effect of such relief on incentives and the allocation of risk in a model with private insurance. It is shown that government relief is inefficient, even when its level is less than the private insurance coverage that individuals would otherwise have purchased and even when private insurance coverage is incomplete due to problems of moral hazard.Harvard University and National Bureau of Economic Research (Cambridge, MA 02138; 617-495-4101). I am grateful for comments from Lucian Bebchuk, Martin Feldstein, John Parsons, Michael Rothschild, Steven Shavell, Lawrence Summers, and a referee, and for support from the John M. Olin Foundation.     

Why the Young Do Not Buy Long-Term Care Insurance

This paper explains why those individuals who purchase long-term care insurance usually postpone their decision until they reach the age of retirement. This behavior is shown to be rational if there are fixed costs of loading or if there is uncertainty about the costs of disability. Individuals with a low risk of becoming disabled before retirement may prefer to buy insurance late in order to avoid losses in expected income. However, if the probability of becoming disabled after retirement is uncertain, it is generally preferable to buy long-term care insurance early.     

Welfare Chauvinism in Populist Radical Right Platforms: The Role of Redistributive Justice Principles

Welfare chauvinism has become an important element in the agenda of the populist radical right. This article proposes a novel argument to explain variation in the strength of welfare chauvinist appeals across social policy programmes. It theorizes that the redistributive justice principles (equity, equality, and need) that underpin a social programme matter. Equality‐ and need‐based programmes are more likely to contradict a nativist worldview in principle or practice, whereas equity‐based schemes are less vulnerable to welfare chauvinistic appeals. As a consequence, welfare chauvinism should be targeted at social policies that provide universal or means‐tested benefits. Insurance‐based systems are more likely to be immune. This argument is tested through a qualitative content analysis of populist radical right election manifestos in four West European democracies. The results show that insurance‐based systems (pensions, unemployment) are less likely to attract welfare chauvinism, whereas universal healthcare and means‐tested social assistance programmes are more prone to draw nativist appeals. Universal family allowances, however, are less likely to attract welfare chauvinism than predicted by the theory.     

Replacement Cost Endorsement and Opportunistic Fraud in Automobile Insurance

Traditional insurance contracts do not offer protection against the replacement value of a vehicle. A replacement cost endorsement gives the opportunity to get a new vehicle in the case of a total theft or in the case of total destruction of the car in a road accident. This type of protection was introduced in Canada in the late 1980's. It is also offered in France and many insurers in the United States are going to move in that direction. We propose tests that separate moral hazard from adverse selection in the analysis of the effect of this additional protection on car theft. We show that holders of car insurance policies with a replacement cost endorsement have a higher probability of theft near the end of this additional protection (usually 24 months following the acquisition of a new car). Our tests indicate that this result is a form of ex post moral hazard or opportunistic insurance fraud.     

Retirement and health benefits for Mexican migrant workers returning from the United States

In the absence of a bilateral agreement for the portability and totalization of social security contributions between the United States and Mexico, this article examines the access to pension and health insurance benefits and employment status of older Mexican return migrants. We find that return migrants who have spent less than a year in the United States have a similar level of access to social security benefits as non‐migrants. Return migrants who have spent at least a year in the United States are less likely to have public health insurance or social security benefits, and could be more vulnerable to poverty in old age. These results inform the debate on a bilateral social security agreement between the United States and Mexico to improve return migrants' social security.     

Health insurance coverage of Hispanic adults: An assessment of subgroup difference and the impact of immigration

This research explores the health insurance coverage of various Hispanic subgroups in comparison to non-Hispanic whites and blacks. The impact of immigration status is also considered as we hypothesize that nativity, duration, and naturalization tap a possible process of structural acculturation that increases access to insurance coverage for Hispanic groups. We find that the immigration variables impact the type of insurance reported. However, race/ethnic disparities continue to exist, with the various Hispanic subgroups more likely to report miscellaneous government health insurance or no health insurance coverage as compared to non-Hispanic whites.     

The Demand for Flood Insurance: Empirical Evidence

Flood damages that occur worldwide remain largely uninsured losses despite the efforts of governmental programs that in many cases make insurance available at below fair market cost. The current study focuses on the financial experience of the United States' National Flood Insurance Program (NFIP) from 1983 through 1993 to examine the hypothetical determinants of the flood insurance purchasing decision. The empirical analysis supports the hypotheses that income and price are influential factors in one's decision to purchase flood insurance. Flood insurance purchases at the state level are found to be highly correlated with the level of flood losses in the state during the prior year.     

Adverse selection,moral hazard and propitious selection

We propose a simple model with preference-based adverse selection and moral hazard that formalizes the cherry picking/propitious selection argument. This argument assumes that individuals differ in risk aversion, potentially resulting in more risk averse agents buying more insurance while being less risky. The propitious selection argument is summarized by two properties: regularity (more risk averse agents exert more caution) and single-crossing (more risk averse agents have a higher willingness to pay for insurance). We show that these assumptions are incompatible with a pooling equilibrium, and that they do not imply a negative correlation between risk and insurance coverage at equilibrium.

The Development of Social Assistance and Unemployment Insurance in Germany and Japan

Both Japan and (West) Germany were subjected to foreign “Allied”Occupation from 1945. In this fiftieth anniversary year of the ending of World War Two and the commencement of these periods of Occupation, this paper assesses and compares the impact of the latter experience on social policy development in Germany and Japan. In particular, it focusses on social assistance and unemployment insurance, on the grounds that provision for “the able-bodied poor”constitutes a clear guide as to how far each society has progressed or is progressing along the road to “social citizenship”as defined by T. H. Marshall. The import of Allied Occupation was in practice quite different in the two cases, not least because of their very different paths of social policy development beforehand. Developments in the wake of Occupation and upto the present are nonetheless indicative of there being some elements of policy “convergence”, which welfare state regime theory has hitherto failed to allow for in its concentration upon “whole systems”at the expense of more detailed policy “subsystem”review.     

Does subsidized crop insurance affect farm industry structure? Lessons from the U.S.

Farm policies have unintended consequences and subsidized crop insurance is no different. We draw on the theory of long-run competitive equilibrium to estimate the effect of subsidized crop insurance on farm output and number of farms in the U.S. Results show that the subsidy led to fewer and larger farms. To the extent that larger farms benefit disproportionately from other farm subsidies, known to increase farm size, subsidized crop insurance can only contribute to further farm consolidation, with consequences for sustainability and depopulation of rural communities. These unintended effects could make the case for reverting to ad-hoc disaster payment programs.     

广西政策性农房保险现状及对策研究——以广西柳州市融水苗族自治县为例

政策性农村住房保险是一种由政府推动,农户自愿参保,财政资金补助,保险公司经营,以农民居住用房为保险对象,按照保险合同约定对倒塌房屋损失予以赔偿的新型保险制度。广西壮族自治区从2011年起,在全区范围内推广政策性农房保险,对灾后农户重建家园、恢复基本生产生活起到了积极的保障作用,取得了应有的成效,但由于推广时间短,还存在一些不足和缺陷,要采取相应的政策和措施,及时的调整和完善。     

Determinants of the timing of social insurance legislation among 18 OECD countries

The purpose of this paper is to determine which theory best explains the development of social insurance programs. The survival analyses of 4 social insurance programs in 18 OECD countries present mixed results. The adoption of each social insurance program is developed and related to a combination of industrialism, modernization, left-wing participation, state autonomy, and international environment. Based on these findings, it is concluded that no single paradigm adequately explains the adoption of each of the social insurance programs. However, the combination of two society-centered approaches – namely, logic of industrialism and political conflict explanation – and a state-centered approach better explains the origin and development of modern social policy than does the international diffusion theory.     

社会医疗保险对老年人健康水平的影响：基于浙江省的实证研究

本研究根据2010年浙江省城乡老年人口生活状况调查的数据认为,对于老年人的社会医疗保险问题,不仅要关注保险覆盖面的扩大,更应关注不同保险项目参保老人之间的健康平等。在揭示医疗服务使用与健康水平负向关系这一主效应的基础上,研究发现,职工医保作为moderator可以改善使用较多医疗服务老人的健康水平,新农合的作用则相反。研究希望对医疗保险的改革思路进行反思,全民医保的改革思路不仅是医疗服务可及性的提高,更应该是不同社群享有平等的医疗福利,并最终促进健康结果的平等。     

Equality and Income Security in Market Economies: What's Wrong with Insurance?

This article critically assesses the marketization of income security, and identifies links between equality, self‐reliance and welfare reform. Marketization in emergent economies is distinguished by a strong separation between the use of insurance for the mainstream economy and relief for the poor. The impact of this model on the shaping of working lives and on market rigidity is discussed through a review of implications in the areas of subsistence, integrity interests and employment transitions. The broad faith in insurance solutions is argued to derive from a highly abstract approach to welfare reform and to result in a lack of attention to uneven and unstable markets, and to self‐government as a motive to work. Evidence of this emerges from a comparison of insurance in its more ideal form (in Chile) with modified models (Brazil and Korea). In the last two cases a developmental orientation has aided in the provision of broad‐based security. Other factors that appear to enhance the importance of direct assistance are also discussed, including aspects of state administration and labour services that limit work opportunity and individual autonomy in uneven economies. The segregated dual approach to income security is argued to be broadly deficient, but not because insurance is inherently wrong. Countries as diverse as Barbados and Denmark show that more cohesive economies are a better foundation for integrating insurance with general welfare and for income security and individual enterprise broadly conceived.     

Adverse selection and equilibrium in liability insurance markets

Models of asymmetric information in insurance markets typically consider insurance buyers with Bernoulli loss distributions differing in expected loss. This article analyzes markets where buyer loss distributions are characterized by mean-preserving spreads and insurers can classify applicants in terms of expected values but not by risk. Because liability losses are characterized by skewed continuous probability distributions, both discrete and continuous loss distributions are considered. In contrast to the single separating equilibrium in the classic Rothschild-Stiglitz insurance market, multiple separating equilibria are identified in this article: three in the discrete case and four in the continuous case. The possibility of extreme discontinuities in insurer policy offers provides a new explanation for crises in liability insurance markets.The support of the National Association of Insurance Commissioners is gratefully acknowledged.     

Ambiguity Aversion in the Field of Insurance: Insurers’ Attitude to Imprecise and Conflicting Probability Estimates

This article presents the results of a survey designed to test, with economically sophisticated participants, Ellsberg’s ambiguity aversion hypothesis, and Smithson’s conflict aversion hypothesis. Based on an original sample of 78 professional actuaries (all members of the French Institute of Actuaries), this article provides empirical evidence that ambiguity (i.e. uncertainty about the probability) affect insurers’ decision on pricing insurance. It first reveals that premiums are significantly higher for risks when there is ambiguity regarding the probability of the loss. Second, it shows that insurers are sensitive to sources of ambiguity. The participants indeed, charged a higher premium when ambiguity came from conflict and disagreement regarding the probability of the loss than when ambiguity came from imprecision (imprecise forecast about the probability of the loss). This research thus documents the presence of both ambiguity aversion and conflict aversion in the field of insurance, and discuses economic and psychological rationales for the observed behaviours.     

不确定性防范与城市务工人员主观幸福感：基于反事实框架的研究

本文基于2007年中国家庭收入调查数据,评估了不确定性防范对城市务工人员的影响,并获得了一些重要发现：(1)不同类型的不确定性防范措施对影响居民主观幸福感存在着显著差异,参与养老保险、失业保险和工伤保险能够显著提高城市务工人员主观幸福感,但参与医疗保险对城市务工人员主观幸福感没有显著影响;(2)四种不确定性防范手段对城市务工人员之间主观幸福感差异的总贡献率接近10%,其中参与失业保险的贡献率最大。进一步研究发现,城市务工人员主观幸福感变化符合享乐适应理论,即随着不确定性防范措施的逐步实施推广,城市务工人员的主观幸福感可能会返回到未采取不确定性防范措施前的水平。