Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues

Science.gov (United States)

Fusheini, Adam; Marnoch, Gordon; Gray, Ann Marie

2017-01-01

Background: Ghana’s National Health Insurance Scheme (NHIS), established by an Act of Parliament (Act 650), in 2003 and since replaced by Act 852 of 2012 remains, in African terms, unprecedented in terms of growth and coverage. As a result, the scheme has received praise for its associated legal reforms, clinical audit mechanisms and for serving as a hub for knowledge sharing and learning within the context of South-South cooperation. The scheme continues to shape national health insurance thinking in Africa. While the success, especially in coverage and financial access has been highlighted by many authors, insufficient attention has been paid to critical and context-specific factors. This paper seeks to fill that gap. Methods: Based on an empirical qualitative case study of stakeholders’ views on challenges and success factors in four mutual schemes (district offices) located in two regions of Ghana, the study uses the concept of policy translation to assess whether the Ghana scheme could provide useful lessons to other African and developing countries in their quest to implement social/NHISs. Results: In the study, interviewees referred to both ‘hard and soft’ elements as driving the "success" of the Ghana scheme. The main ‘hard elements’ include bureaucratic and legal enforcement capacities; IT; financing; governance, administration and management; regulating membership of the scheme; and service provision and coverage capabilities. The ‘soft’ elements identified relate to: the background/context of the health insurance scheme; innovative ways of funding the NHIS, the hybrid nature of the Ghana scheme; political will, commitment by government, stakeholders and public cooperation; social structure of Ghana (solidarity); and ownership and participation. Conclusion: Other developing countries can expect to translate rather than re-assemble a national health insurance programme in an incomplete and highly modified form over a period of years

Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues

Directory of Open Access Journals (Sweden)

Adam Fusheini

2017-05-01

Full Text Available Background Ghana’s National Health Insurance Scheme (NHIS, established by an Act of Parliament (Act 650, in 2003 and since replaced by Act 852 of 2012 remains, in African terms, unprecedented in terms of growth and coverage. As a result, the scheme has received praise for its associated legal reforms, clinical audit mechanisms and for serving as a hub for knowledge sharing and learning within the context of South-South cooperation. The scheme continues to shape national health insurance thinking in Africa. While the success, especially in coverage and financial access has been highlighted by many authors, insufficient attention has been paid to critical and context-specific factors. This paper seeks to fill that gap. Methods Based on an empirical qualitative case study of stakeholders’ views on challenges and success factors in four mutual schemes (district offices located in two regions of Ghana, the study uses the concept of policy translation to assess whether the Ghana scheme could provide useful lessons to other African and developing countries in their quest to implement social/NHISs. Results In the study, interviewees referred to both ‘hard and soft’ elements as driving the “success” of the Ghana scheme. The main ‘hard elements’ include bureaucratic and legal enforcement capacities; IT; financing; governance, administration and management; regulating membership of the scheme; and service provision and coverage capabilities. The ‘soft’ elements identified relate to: the background/context of the health insurance scheme; innovative ways of funding the NHIS, the hybrid nature of the Ghana scheme; political will, commitment by government, stakeholders and public cooperation; social structure of Ghana (solidarity; and ownership and participation. Conclusion Other developing countries can expect to translate rather than re-assemble a national health insurance programme in an incomplete and highly modified form over a period

Insured persons dilemma about other family members: a perspective on the national health insurance scheme in Nigeria

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Nasir Umar

2011-09-01

Full Text Available The need for health care reforms and alternative financing mechanism in many low and middle-income countries has been advocated. This led to the introduction of the national health insurance scheme (NHIS in Nigeria, at first with the enrollment of formal sector employees. A qualitative study was conducted to assess enrollee’s perception on the quality of health care before and after enrollment. Initial results revealed that respondents (heads of households have generally viewed the NHIS favorably, but consistently expressed dissatisfaction over the terms of coverage. Specifically, because the NHIS enrollment covers only the primary insured person, their spouse and only up to four biological children (child defined as <18 years of age, in a setting where extended family is common. Dissatisfaction of enrollees could affect their willingness to participate in the insurance scheme, which may potentially affect the success and future extension of the scheme.

Dropping out of Ethiopia’s Community Based Health Insurance scheme

NARCIS (Netherlands)

A.D. Mebratie (Anagaw); R.A. Sparrow (Robert); Z.Y. Debebe (Zelalem); G. Alemu (Getnet ); A.S. Bedi (Arjun Singh)

2014-01-01

textabstractLow contract renewal rates have been identified as one of the challenges facing the development of community based health insurance schemes (CBHI). This paper uses longitudinal household survey data to examine dropout in the case of Ethiopia’s pilot CBHI scheme, which saw enrolment

Utilization and perception of Community Health Insurance Scheme ...

African Journals Online (AJOL)

Shell in collaboration with four communities in Obio-Akpor LGA, Port Harcourt, started a Community Health Insurance Scheme in February 2010. An evaluation of enrollees' utilization and perception of the services provided was done. Methodology: Quantitative data were collected by the use of structured interviewer ...

A design of mathematical modelling for the mudharabah scheme in shariah insurance

Science.gov (United States)

Cahyandari, R.; Mayaningsih, D.; Sukono

2017-01-01

Indonesian Shariah Insurance Association (AASI) believes that 2014 is the year of Indonesian Shariah insurance, since its growth was above the conventional insurance. In December 2013, 43% growth was recorded for shariah insurance, while the conventional insurance was only hit 20%. This means that shariah insurance has tremendous potential to remain growing in the future. In addition, the growth can be predicted from the number of conventional insurance companies who open sharia division, along with the development of Islamic banking development which automatically demand the role of shariah insurance to protect assets and banking transactions. The development of shariah insurance should be accompanied by the development of premium fund management mechanism, in order to create innovation on shariah insurance products which beneficial for the society. The development of premium fund management model shows a positive progress through the emergence of Mudharabah, Wakala, Hybrid (Mudharabah-Wakala), and Wakala-Waqf. However, ‘model’ term that referred in this paper is regarded as an operational model in form of a scheme of management mechanism. Therefore, this paper will describe a mathematical modeling for premium fund management scheme, especially for Mudharabah concept. Mathematical modeling is required for an analysis process that can be used to predict risks that could be faced by a company in the future, so that the company could take a precautionary policy to minimize those risks.

Participation in the National Health Insurance Scheme Among ...

African Journals Online (AJOL)

Background: The National Health Insurance Scheme was established under Act 35 of 1999 by the Federal Government of Nigeria and is aimed at providing easy access to health care for all Nigerians at an affordable cost through various prepayment systems. It is totally committed to achieving universal coverage and ...

Indian community health insurance schemes provide partial protection against catastrophic health expenditure

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Ranson Kent

2007-03-01

Full Text Available Abstract Background More than 72% of health expenditure in India is financed by individual households at the time of illness through out-of-pocket payments. This is a highly regressive way of financing health care and sometimes leads to impoverishment. Health insurance is recommended as a measure to protect households from such catastrophic health expenditure (CHE. We studied two Indian community health insurance (CHI schemes, ACCORD and SEWA, to determine whether insured households are protected from CHE. Methods ACCORD provides health insurance cover for the indigenous population, living in Gudalur, Tamil Nadu. SEWA provides insurance cover for self employed women in the state of Gujarat. Both cover hospitalisation expenses, but only upto a maximum limit of US$23 and US$45, respectively. We reviewed the insurance claims registers in both schemes and identified patients who were hospitalised during the period 01/04/2003 to 31/03/2004. Details of their diagnoses, places and costs of treatment and self-reported annual incomes were obtained. There is no single definition of CHE and none of these have been validated. For this research, we used the following definition; "annual hospital expenditure greater than 10% of annual income," to identify those who experienced CHE. Results There were a total of 683 and 3152 hospital admissions at ACCORD and SEWA, respectively. In the absence of the CHI scheme, all of the patients at ACCORD and SEWA would have had to pay OOP for their hospitalisation. With the CHI scheme, 67% and 34% of patients did not have to make any out-of-pocket (OOP payment for their hospital expenses at ACCORD and SEWA, respectively. Both CHI schemes halved the number of households that would have experienced CHE by covering hospital costs. However, despite this, 4% and 23% of households with admissions still experienced CHE at ACCORD and SEWA, respectively. This was related to the following conditions: low annual income, benefit

Knowledge and uptake of community-based health insurance scheme among residents of Olowora, Lagos

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O A Ibukun

2013-01-01

Full Text Available Background and Objective: The informal sector population in developing nations has low health coverage from Community Based Health Insurance (CBHI and problems such as limited awareness about the potential impact of prepayment health financing and the limited resources to finance health care can impede success. This study assessed the community based health insurance scheme uptake and determinants in Olowora, Lagos State. Methods: This was a descriptive cross sectional study carried out in July 2010 in all households of 12 out of 41 streets in Olowora,by multistage sampling. Four hundred and sixteen interviewer-administered questionnaires were completed and returned. Analysis was by Epi- info version 3.5.1 software. Results: Although 75.5% of respondents were aware of the Community Health Insurance scheme at Olowora, just about half (49.5% of them had good knowledge of the scheme. A substantial proportion (44.2% of respondents did not believe in contributing money for illness yet to come, and majority (72.3% of such respondents prefers payment for health care when ill. While about half (53% of respondentshad enrolled into the community health insurance scheme, 45.6% of those who had not enrolled were not aware of the scheme. Lack of money was the main reason (51.5% why some enrollees had defaulted. Conclusion: The study identified information gaps and poor understanding of the scheme as well as poverty as factors that have negatively affected uptake. The scheme management has to re-evaluate its sensitization programmes, and also strengthen marketing strategies with special emphasis on the poor.

Exclusion from the Health Insurance Scheme

CERN Multimedia

2003-01-01

A CERN pensioner, member of the Organization's Health Insurance Scheme (CHIS), recently provided fake documents in support of claims for medical expenses, in order to receive unjustified reimbursement from the CHIS. The Administrator of the CHIS, UNIQA, suspected a case of fraud: Accordingly, an investigation and interview of the person concerned was carried out and brought the Organization to the conclusion that fraud had actually taken place. Consequently and in accordance with Article VIII 3.12 of the CHIS Rules, it was decided to exclude this member permanently from the CHIS. The Organization takes the opportunity to remind Scheme members that any fraud or attempt to fraud established within the framework of the CHIS exposes them to: - disciplinary action, according to the Staff Rules and Regulations, for CERN members of the personnel; - definitive exclusion from the CHIS for members affiliated on a voluntary basis. Human Resources Division Tel. 73635

Low enrolment in Ugandan Community Health Insurance Schemes: underlying causes and policy implications

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Criel Bart

2007-07-01

Full Text Available Abstract Background Despite the promotion of Community Health Insurance (CHI in Uganda in the second half of the 90's, mainly under the impetus of external aid organisations, overall membership has remained low. Today, some 30,000 persons are enrolled in about a dozen different schemes located in Central and Southern Uganda. Moreover, most of these schemes were created some 10 years ago but since then, only one or two new schemes have been launched. The dynamic of CHI has apparently come to a halt. Methods A case study evaluation was carried out on two selected CHI schemes: the Ishaka and the Save for Health Uganda (SHU schemes. The objective of this evaluation was to explore the reasons for the limited success of CHI. The evaluation involved review of the schemes' records, key informant interviews and exit polls with both insured and non-insured patients. Results Our research points to a series of not mutually exclusive explanations for this under-achievement at both the demand and the supply side of health care delivery. On the demand side, the following elements have been identified: lack of basic information on the scheme's design and operation, limited understanding of the principles underlying CHI, limited community involvement and lack of trust in the management of the schemes, and, last but not least, problems in people's ability to pay the insurance premiums. On the supply-side, we have identified the following explanations: limited interest and knowledge of health care providers and managers of CHI, and the absence of a coherent policy framework for the development of CHI. Conclusion The policy implications of this study refer to the need for the government to provide the necessary legislative, technical and regulative support to CHI development. The main policy challenge however is the need to reconcile the government of Uganda's interest in promoting CHI with the current policy of abolition of user fees in public facilities.

Hierarchical Markov Model in Life Insurance and Social Benefit Schemes

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Jiwook Jang

2018-06-01

Full Text Available We explored the effect of the jump-diffusion process on a social benefit scheme consisting of life insurance, unemployment/disability benefits, and retirement benefits. To do so, we used a four-state Markov chain with multiple decrements. Assuming independent state-wise intensities taking the form of a jump-diffusion process and deterministic interest rates, we evaluated the prospective reserves for this scheme in which the individual is employed at inception. We then numerically demonstrated the state of the reserves for the scheme under jump-diffusion and non-jump-diffusion settings. By decomposing the reserve equation into five components, our numerical illustration indicated that an extension of the retirement age has a spillover effect that would increase government expenses for other social insurance programs. We also conducted sensitivity analyses and examined the total-reserves components by changing the relevant parameters of the transition intensities, which are the average jump-size parameter, average jump frequency, and diffusion parameters of the chosen states, with figures provided. Our computation revealed that the total reserve is most sensitive to changes in average jump frequency.

Community Based Health Insurance Schemes and Protection of the ...

African Journals Online (AJOL)

The objectives of this study are two folds: firstly to explore the magnitude of catastrophic expenditure, and secondly to determine its contributing factor,s including the protective impact of the voluntary community based health insurance schemes in Tanzania. The study covered 274 respondents. Study findings have shown ...

Renewing membership in three community-based health insurance schemes in rural India

NARCIS (Netherlands)

P. Panda (Pradeep); A. Chakraborty (Arpita); W.A. Raza (Wameq); A.S. Bedi (Arjun Singh)

2015-01-01

textabstractLow renewal rate is a key challenge facing the sustainability of Community-based Health Insurance (CBHI) schemes. While there is a large literature on initial enrolment into such schemes, there is limited evidence on the factors that impede renewal. This paper uses longitudinal data to

Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana's National Health Insurance Scheme.

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Aryeetey, Genevieve Cecilia; Westeneng, Judith; Spaan, Ernst; Jehu-Appiah, Caroline; Agyepong, Irene Akua; Baltussen, Rob

2016-07-22

Ghana since 2004, begun implementation of a National Health Insurance Scheme (NHIS) to minimize financial barriers to health care at point of use of service. Usually health insurance is expected to offer financial protection to households. This study aims to analyze the effect health insurance on household out-of-pocket expenditure (OOPE), catastrophic expenditure (CE) and poverty. We conducted two repeated household surveys in two regions of Ghana in 2009 and 2011. We first analyzed the effect of OOPE on poverty by estimating poverty headcount before and after OOPE were incurred. We also employed probit models and use of instrumental variables to analyze the effect of health insurance on OOPE, CE and poverty. Our findings showed that between 7-18 % of insured households incurred CE as a result of OOPE whereas this was between 29-36 % for uninsured households. In addition, between 3-5 % of both insured and uninsured households fell into poverty due to OOPE. Our regression analyses revealed that health insurance enrolment reduced OOPE by 86 % and protected households against CE and poverty by 3.0 % and 7.5 % respectively. This study provides evidence that high OOPE leads to CE and poverty in Ghana but enrolment into the NHIS reduces OOPE, provides financial protection against CE and reduces poverty. These findings support the pro-poor policy objective of Ghana's National Health Insurance Scheme and holds relevance to other low and middle income countries implementing or aiming to implement insurance schemes.

Exploring fraud and abuse in National Health Insurance Scheme ...

African Journals Online (AJOL)

This study explored patterns of fraud and abuse that exist in the National Health Insurance Scheme (NHIS) claims in the Awutu-Effutu-Senya District using data mining techniques, with a specific focus on malaria-related claims. The study employed quantitative research approach with survey design as a strategy of enquiry.

Evaluation of Rajiv Aarogyasri Health Insurance Scheme in Andrha ...

International Development Research Centre (IDRC) Digital Library (Canada)

In 2007, out-of-pocket expenditures accounted for 90% of total private expenditure on healthcare in India. The cost of coping with serious disease can be ruinous for families living below the poverty line. The Rajiv Aarogyasri Health Insurance Scheme was established in Andrha Pradesh to mitigate catastrophic healthcare ...

[Extension of health coverage and community based health insurance schemes in Africa: Myths and realities].

Science.gov (United States)

Boidin, B

2015-02-01

This article tackles the perspectives and limits of the extension of health coverage based on community based health insurance schemes in Africa. Despite their strong potential contribution to the extension of health coverage, their weaknesses challenge their ability to play an important role in this extension. Three limits are distinguished: financial fragility; insufficient adaptation to characteristics and needs of poor people; organizational and institutional failures. Therefore lessons can be learnt from the limits of the institutionalization of community based health insurance schemes. At first, community based health insurance schemes are to be considered as a transitional but insufficient solution. There is also a stronger role to be played by public actors in improving financial support, strengthening health services and coordinating coverage programs.

The Best Laid Plans: Access to the Rajiv Aarogyasri community health insurance scheme of Andhra Pradesh

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H. Narasimhan

2014-05-01

Full Text Available This paper is a qualitative assessment of a public health insurance scheme in the state of Andhra Pradesh, south India, called the Rajiv Aarogyasri Community Health Insurance Scheme (or Aarogyasri, using the case-study method. Focusing on inpatient hospital care and especially on surgical treatments leaves the scheme wanting in meeting the health care needs of and addressing the impoverishing health expenditure incurred by the poor, especially those living in rural areas. Though well-intentioned, people from vulnerable sections of society may find the scheme ultimately unhelpful for their needs. Through an in-depth qualitative approach, the paper highlights not just financial difficulties but also the non-financial barriers to accessing health care, despite the existence of a scheme such as Aarogyasri. Narrative evidence from poor households offers powerful insights into why even the most innovative state health insurance schemes may not achieve their goals and systemic corrections needed to address barriers to health care.

Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme.

Science.gov (United States)

Goudge, Jane; Alaba, Olufunke A; Govender, Veloshnee; Harris, Bronwyn; Nxumalo, Nonhlanhla; Chersich, Matthew F

2018-01-04

Many low- and middle-income countries are reforming their health financing mechanisms as part of broader strategies to achieve universal health coverage (UHC). Voluntary social health insurance, despite evidence of resulting inequities, is attractive to policy makers as it generates additional funds for health, and provides access to a greater range of benefits for the formally employed. The South African government introduced a voluntary health insurance scheme (GEMS) for government employees in 2005 with the aim of improving access to care and extending health coverage. In this paper we ask whether the new scheme has assisted in efforts to move towards UHC. Using a cross-sectional survey across four of South Africa's nine provinces, we interviewed 1329 government employees, from the education and health sectors. Data were collected on socio-demographics, insurance coverage, health status and utilisation of health care. Multivariate logistic regression was used to determine if service utilisation was associated with insurance status. A quarter of respondents remained uninsured, even higher among 20-29 year olds (46%) and lower-skilled employees (58%). In multivariate analysis, the odds of an outpatient visit and hospital admission for the uninsured was 0.3 fold that of the insured. Cross-subsidisation within the scheme has provided lower-paid civil servants with improved access to outpatient care at private facilities and chronic medication, where their outpatient (0.54 visits/month) and inpatient utilisation (10.1%/year) approximates that of the overall population (29.4/month and 12.2% respectively). The scheme, however, generated inequities in utilisation among its members due to its differential benefit packages, with, for example, those with the most benefits having 1.0 outpatient visits/month compared to 0.6/month with lowest benefits. By introducing the scheme, the government chose to prioritise access to private sector care for government employees, over

Household perceptions and their implications for enrollment in the National Health Insurance Scheme in Ghana.

NARCIS (Netherlands)

Jehu-Appiah, C.; Aryeetey, G.C.; Agyepong, I.; Spaan, E.J.; Baltussen, R.M.

2012-01-01

OBJECTIVE: This paper identifies, ranks and compares perceptions of insured and uninsured households in Ghana on health care providers (quality of care, service delivery adequacy, staff attitudes), health insurance schemes (price, benefits and convenience) and community attributes (health 'beliefs

Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana's National Health Insurance Scheme

NARCIS (Netherlands)

Aryeetey, G.C.; Westeneng, J.; Spaan, E.J.; Jehu-Appiah, C.; Agyepong, I.A.; Baltussen, R.M.

2016-01-01

BACKGROUND: Ghana since 2004, begun implementation of a National Health Insurance Scheme (NHIS) to minimize financial barriers to health care at point of use of service. Usually health insurance is expected to offer financial protection to households. This study aims to analyze the effect health

Designing an Health Insurance Scheme for Government Employees in Bangladesh: A Concept Paper

OpenAIRE

Hamid, Syed Abdul

2014-01-01

Introducing compulsory health insurance for government employees bears immense importance for stepping towards universal healthcare coverage in Bangladesh. Lack of scientific study on designing such scheme, in the Bangladesh context, motivates this paper. The study aims at designing a comprehensive insurance package simultaneously covering health, life and accident related disability risks of the public employees, where the health component would extend to all dependent family members. ...

Supplementary contribution payable to the health insurance scheme for the spouse's coverage

CERN Multimedia

HR Department

2007-01-01

Staff Members, Fellows and Pensioners are reminded that any change in their marital status, as well as any change in the spouse or registered partner's income or health insurance cover, shall be notified in writing to CERN, within 30 calendar days of the change, in accordance with Articles III 6.01 to 6.03 of the Rules of the CERN Health Insurance Scheme. Such changes may have consequences on the conditions of the spouse or registered partner's affiliation to the CERN Health Insurance Scheme (CHIS) or on the payment of the supplementary contribution to the CHIS for the coverage of the spouse or registered partner. From 1.1.2007, for the following monthly income brackets, the indexed amounts in Swiss francs of the monthly supplementary contribution are: more than 2'500 CHF and up to 4'250 CHF: 134.- more than 4'250 CHF and up to 7'500 CHF: 234.- more than 7'500 CHF and up to 10'000 CHF: 369.- more than 10'000 CHF: 461.- It is in the member of the personnel's interest to declare a change in the annual ...

PROMISING FINANCING SCHEME OF HEALTH INSURANCE IN UKRAINE

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Martha Slavitych

2016-11-01

Full Text Available The promising financing scheme of health insurance in Ukraine should be found at the present stage of its development. The health care system in Ukraine is cumbersome and outdated. It is based on the Semashko model with rigid management and financing procedures. The disadvantages accumulated in the national health care system due to lack of modernization, disregard of the population needs, non-use of modern global trends, the inefficient operation of the system and the high level of corruption cause the underlying situation. The decision of new government policy in the sector is introduction of new financial mechanisms, in order to ensure human rights in the health sector. Methodology. The study is based on a comparison of systems of financing of medicine in Ukraine and in other countries, provided advantages and disadvantages of each model. Results showed that the availability of medical services is the key problem in any society. The availability of health care services is primarily determined by the proportion of services guaranteed by the government (government guarantees. In some countries such as the United States, practically the whole medicine is funded by voluntary health insurance (VHI. In Europe the mandatory health insurance (MHI and government funding are the most significant source of funds. Practical importance. The improvement of the demographic situation, the preservation and improvement of public health, improvement of social equity and citizens' rights in respect of medical insurance. Value/originality. Premiums for health insurance are the source of funding. Based on the new model requirements it is necessary to create an appropriate regulation, which would determine its organizational and regulatory framework. This process is primarily determined by identification and setting rules governing the relationship between patients, health care providers and insurers, creation of the conditions and the implementation of quality

CERN Health Insurance Scheme (CHIS) Contributions – Changes for 2012

CERN Multimedia

HR Department

2012-01-01

Following the 2010 five-yearly review of financial and social conditions, which included the CERN Health Insurance Scheme (CHIS), the CERN Council decided in December 2010 to progressively increase the level of contributions over the period 2011-2015.   For 2012, the contribution rate of active and retired CHIS members will be 4.41%. The amounts of the fixed premiums for voluntarily insured members (e.g. users and associates) as well as the supplementary contributions for spouses with income from a professional activity increase accordingly : Voluntary contributions The full contribution based on Reference Salary II is now 1094 CHF per month. This fixed amount contribution is applied to voluntarily affiliated users and associates with normal coverage. Half of this amount (547 CHF) is applied to apprentices as well as to voluntarily affiliated users and associates with reduced coverage. Finally, an amount of 438 CHF is applied to children maintaining their insurance cover on a voluntary and tempo...

Social capital and active membership in the Ghana National Health Insurance Scheme - a mixed method study.

Science.gov (United States)

Fenenga, Christine J; Nketiah-Amponsah, Edward; Ogink, Alice; Arhinful, Daniel K; Poortinga, Wouter; Hutter, Inge

2015-11-02

People's decision to enroll in a health insurance scheme is determined by socio-cultural and socio-economic factors. On request of the National health Insurance Authority (NHIA) in Ghana, our study explores the influence of social relationships on people's perceptions, behavior and decision making to enroll in the National Health Insurance Scheme. This social scheme, initiated in 2003, aims to realize accessible quality healthcare services for the entire population of Ghana. We look at relationships of trust and reciprocity between individuals in the communities (so called horizontal social capital) and between individuals and formal health institutions (called vertical social capital) in order to determine whether these two forms of social capital inhibit or facilitate enrolment of clients in the scheme. Results can support the NHIA in exploiting social capital to reach their objective and strengthen their policy and practice. We conducted 20 individual- and seven key-informant interviews, 22 focus group discussions, two stakeholder meetings and a household survey, using a random sample of 1903 households from the catchment area of 64 primary healthcare facilities. The study took place in Greater Accra Region and Western Regions in Ghana between June 2011 and March 2012. While social developments and increased heterogeneity seem to reduce community solidarity in Ghana, social networks remain common in Ghana and are valued for their multiple benefits (i.e. reciprocal trust and support, information sharing, motivation, risk sharing). Trusting relations with healthcare and insurance providers are, according healthcare clients, based on providers' clear communication, attitude, devotion, encouragement and reliability of services. Active membership of the NHIS is positive associated with community trust, trust in healthcare providers and trust in the NHIS (p-values are .009, .000 and .000 respectively). Social capital can motivate clients to enroll in health insurance

China in transition: the new health insurance scheme for the urban employed.

Science.gov (United States)

Hindle, D

2000-01-01

China has been very successful in achieving good health at a low cost, mostly through national programs for health promotion and illness prevention. However, increased prosperity in recent years has led to higher expectations for therapeutic care, and the change to a socialist market economy has created new risks and opportunities for both financing and care provision. After several years of experimentation, China committed itself in 1996 to a major reform program which includes implementation of a new method of financing of care for the urban employed population. It comprises a mix of government-operated compulsory basic insurance, individual health savings accounts, and optional private health insurance. This paper outlines the new Scheme, and notes some tactical and strategic issues. I conclude that the Chinese government is correctly choosing to balance new and old ideas, but that there are many challenges to be faced including integration of the new Scheme with the rest of the health care system.

Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme

OpenAIRE

Goudge, Jane; Alaba, Olufunke A.; Govender, Veloshnee; Harris, Bronwyn; Nxumalo, Nonhlanhla; Chersich, Matthew F.

2018-01-01

Background Many low- and middle-income countries are reforming their health financing mechanisms as part of broader strategies to achieve universal health coverage (UHC). Voluntary social health insurance, despite evidence of resulting inequities, is attractive to policy makers as it generates additional funds for health, and provides access to a greater range of benefits for the formally employed. The South African government introduced a voluntary health insurance scheme (GEMS) for governme...

Supplementary contribution payable to the Health Insurance Scheme for spouses

CERN Multimedia

HR Department

2008-01-01

Staff members, fellows and pensioners are reminded that any change in their marital status, as well as any change in their spouse or registered partner’s income or health insurance cover, must be reported to CERN in writing within 30 calendar days, in accordance with Articles III 6.01 to 6.03 of the Rules of the CERN Health Insurance Scheme (CHIS). Such changes may affect the conditions of the spouse or registered partner’s membership of the CHIS or the payment of the supplementary contribution to it for the spouse or registered partner’s insurance cover. For more information see: http://cern.ch/chis/contribsupp.asp From 1.1.2008, the indexed amounts of the supplementary monthly contribution for the different monthly income brackets are as follows, expressed in Swiss francs: more than 2500 CHF and up to 4250 CHF: 134.- more than 4250 CHF and up to 7500 CHF: 234.- more than 7500 CHF and up to 10,000 CHF: 369.- more than 10,000 CHF: 470.- It is in the member of the ...

Essays on evaluating a community based health insurance scheme in rural Ethiopia

NARCIS (Netherlands)

A.D. Mebratie (Anagaw)

2015-01-01

markdownabstract__Abstract__ Since the late 1990s, in a move away from user fees for health care and with the aim of creating universal access, several low and middle income countries have set up community-based health insurance (CBHI) schemes. Following this approach, in June 2011, with the

Disability, and social and economic inclusion: who is in and out of the Australian National Disability Insurance Scheme?

OpenAIRE

Cebulla, Andreas; Zhu, Rong

2015-01-01

A new National Disability Insurance Scheme is being trialled in Australia, following criticism of the fragmented and inequitable nature of existing disability supports (e.g. in the 2009 ‘Shut Out’ report by the National People with Disabilities and Carer Council) and reform recommendations made by the Australian Government's Productivity Commission in 2011. The Insurance Scheme distinguishes between people living with disability who will be eligible for different types of supports: either mai...

Investigating the Willingness to Pay for a Contributory National Health Insurance Scheme in Saudi Arabia: A Cross-sectional Stated Preference Approach.

Science.gov (United States)

Al-Hanawi, Mohammed Khaled; Vaidya, Kirit; Alsharqi, Omar; Onwujekwe, Obinna

2018-04-01

The Saudi Healthcare System is universal, financed entirely from government revenue principally derived from oil, and is 'free at the point of delivery' (non-contributory). However, this system is unlikely to be sustainable in the medium to long term. This study investigates the feasibility and acceptability of healthcare financing reform by examining households' willingness to pay (WTP) for a contributory national health insurance scheme. Using the contingent valuation method, a pre-tested interviewer-administered questionnaire was used to collect data from 1187 heads of household in Jeddah province over a 5-month period. Multi-stage sampling was employed to select the study sample. Using a double-bounded dichotomous choice with the follow-up elicitation method, respondents were asked to state their WTP for a hypothetical contributory national health insurance scheme. Tobit regression analysis was used to examine the factors associated with WTP and assess the construct validity of elicited WTP. Over two-thirds (69.6%) indicated that they were willing to participate in and pay for a contributory national health insurance scheme. The mean WTP was 50 Saudi Riyal (US$13.33) per household member per month. Tobit regression analysis showed that household size, satisfaction with the quality of public healthcare services, perceptions about financing healthcare, education and income were the main determinants of WTP. This study demonstrates a theoretically valid WTP for a contributory national health insurance scheme by Saudi people. The research shows that willingness to participate in and pay for a contributory national health insurance scheme depends on participant characteristics. Identifying and understanding the main influencing factors associated with WTP are important to help facilitate establishing and implementing the national health insurance scheme. The results could assist policy-makers to develop and set insurance premiums, thus providing an additional source

Private healthcare provider experiences with social health insurance schemes: Findings from a qualitative study in Ghana and Kenya.

Science.gov (United States)

Sieverding, Maia; Onyango, Cynthia; Suchman, Lauren

2018-01-01

Incorporating private healthcare providers into social health insurance schemes is an important means towards achieving universal health coverage in low and middle income countries. However, little research has been conducted about why private providers choose to participate in social health insurance systems in such contexts, or their experiences with these systems. We explored private providers' perceptions of and experiences with participation in two different social health insurance schemes in Sub-Saharan Africa-the National Health Insurance Scheme (NHIS) in Ghana and the National Hospital Insurance Fund (NHIF) in Kenya. In-depth interviews were held with providers working at 79 facilities of varying sizes in three regions of Kenya (N = 52) and three regions of Ghana (N = 27). Most providers were members of a social franchise network. Interviews covered providers' reasons for (non) enrollment in the health insurance system, their experiences with the accreditation process, and benefits and challenges with the system. Interviews were coded in Atlas.ti using an open coding approach and analyzed thematically. Most providers in Ghana were NHIS-accredited and perceived accreditation to be essential to their businesses, despite challenges they encountered due to long delays in claims reimbursement. In Kenya, fewer than half of providers were NHIF-accredited and several said that their clientele were not NHIF enrolled. Understanding of how the NHIF functioned was generally low. The lengthy and cumbersome accreditation process also emerged as a major barrier to providers' participation in the NHIF in Kenya, but the NHIS accreditation process was not a major concern for providers in Ghana. In expanding social health insurance, coordinated efforts are needed to increase coverage rates among underserved populations while also accrediting the private providers who serve those populations. Market pressure was a key force driving providers to gain and maintain accreditation

Private healthcare provider experiences with social health insurance schemes: Findings from a qualitative study in Ghana and Kenya

Science.gov (United States)

Sieverding, Maia; Onyango, Cynthia

2018-01-01

Background Incorporating private healthcare providers into social health insurance schemes is an important means towards achieving universal health coverage in low and middle income countries. However, little research has been conducted about why private providers choose to participate in social health insurance systems in such contexts, or their experiences with these systems. We explored private providers’ perceptions of and experiences with participation in two different social health insurance schemes in Sub-Saharan Africa—the National Health Insurance Scheme (NHIS) in Ghana and the National Hospital Insurance Fund (NHIF) in Kenya. Methods In-depth interviews were held with providers working at 79 facilities of varying sizes in three regions of Kenya (N = 52) and three regions of Ghana (N = 27). Most providers were members of a social franchise network. Interviews covered providers’ reasons for (non) enrollment in the health insurance system, their experiences with the accreditation process, and benefits and challenges with the system. Interviews were coded in Atlas.ti using an open coding approach and analyzed thematically. Results Most providers in Ghana were NHIS-accredited and perceived accreditation to be essential to their businesses, despite challenges they encountered due to long delays in claims reimbursement. In Kenya, fewer than half of providers were NHIF-accredited and several said that their clientele were not NHIF enrolled. Understanding of how the NHIF functioned was generally low. The lengthy and cumbersome accreditation process also emerged as a major barrier to providers’ participation in the NHIF in Kenya, but the NHIS accreditation process was not a major concern for providers in Ghana. Conclusions In expanding social health insurance, coordinated efforts are needed to increase coverage rates among underserved populations while also accrediting the private providers who serve those populations. Market pressure was a key force

Private healthcare provider experiences with social health insurance schemes: Findings from a qualitative study in Ghana and Kenya.

Directory of Open Access Journals (Sweden)

Maia Sieverding

Full Text Available Incorporating private healthcare providers into social health insurance schemes is an important means towards achieving universal health coverage in low and middle income countries. However, little research has been conducted about why private providers choose to participate in social health insurance systems in such contexts, or their experiences with these systems. We explored private providers' perceptions of and experiences with participation in two different social health insurance schemes in Sub-Saharan Africa-the National Health Insurance Scheme (NHIS in Ghana and the National Hospital Insurance Fund (NHIF in Kenya.In-depth interviews were held with providers working at 79 facilities of varying sizes in three regions of Kenya (N = 52 and three regions of Ghana (N = 27. Most providers were members of a social franchise network. Interviews covered providers' reasons for (non enrollment in the health insurance system, their experiences with the accreditation process, and benefits and challenges with the system. Interviews were coded in Atlas.ti using an open coding approach and analyzed thematically.Most providers in Ghana were NHIS-accredited and perceived accreditation to be essential to their businesses, despite challenges they encountered due to long delays in claims reimbursement. In Kenya, fewer than half of providers were NHIF-accredited and several said that their clientele were not NHIF enrolled. Understanding of how the NHIF functioned was generally low. The lengthy and cumbersome accreditation process also emerged as a major barrier to providers' participation in the NHIF in Kenya, but the NHIS accreditation process was not a major concern for providers in Ghana.In expanding social health insurance, coordinated efforts are needed to increase coverage rates among underserved populations while also accrediting the private providers who serve those populations. Market pressure was a key force driving providers to gain and maintain

A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

Science.gov (United States)

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

2016-01-01

The introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana. Electronic search was done for literature published between 2003-2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context. Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients' trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper. The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors.

A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

Directory of Open Access Journals (Sweden)

Robert Kaba Alhassan

Full Text Available The introduction of the national health insurance scheme (NHIS in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana.Electronic search was done for literature published between 2003-2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context.Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients' trust in the scheme and consequently decreases (reenrolment rates. These sustainability challenges were reviewed and discussed in this paper.The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors.

CERN Health Insurance Scheme (CHIS) Monthly Contributions – Changes for 2015

CERN Multimedia

HR Department

2015-01-01

Following the 2010 five-yearly review of financial and social conditions, which included the CERN Health Insurance Scheme (CHIS), the CERN Council decided in December 2010 to progressively increase the level of contributions over the period 2011-2015.   For 2015, the contribution rate of active and retired CHIS members will be 4.86%. The amounts of the fixed premiums for voluntarily insured members (e.g. users and associates) as well as the supplementary contributions for spouses with income from a professional activity or with a retirement pension (including the CERN pension) increase accordingly : 1. Voluntary contributions The full contribution based on Reference Salary II is now 1208 CHF per month. This fixed amount contribution is applied to voluntarily affiliated users and associates with normal coverage. Half of this amount (604 CHF) is applied to voluntarily affiliated users and associates with reduced coverage. Finally, an amount of 483 CHF is applied to children maintaining their insur...

CERN Health Insurance Scheme (CHIS) Monthly Contributions – Changes for 2013

CERN Multimedia

Human Resources Department

2013-01-01

Following the 2010 five-yearly review of financial and social conditions, which included the CERN Health Insurance Scheme (CHIS), the CERN Council decided in December 2010 to progressively increase the level of contributions over the period 2011-2015.   For 2013, the contribution rate of active and retired CHIS members will be 4.55%. The amounts of the fixed premiums for voluntarily insured members (e.g. users and associates) as well as the supplementary contributions for spouses with income from a professional activity will increase accordingly: 1. Voluntary contributions The full contribution based on Reference Salary II is now 1116 CHF per month. This fixed amount contribution is applied to voluntarily affiliated users and associates with normal coverage. Half of this amount (558 CHF) is applied to voluntarily affiliated users and associates with reduced coverage. Finally, an amount of 446 CHF is applied to children maintaining their insurance cover on a voluntary and temporarily basis. More ...

Perspectives of frontline health workers on Ghana's National Health Insurance Scheme before and after community engagement interventions

NARCIS (Netherlands)

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Rinke de Wit, Tobias F.

2016-01-01

Barely a decade after introduction of Ghana's National Health Insurance Scheme (NHIS), significant successes have been recorded in universal access to basic healthcare services. However, sustainability of the scheme is increasingly threatened by concerns on quality of health service delivery in

Incentives in statutory health insurance bonus schemes - Communication as an underrated precondition of success

OpenAIRE

Viviane Scherenberg; Gerd Glaeske

2009-01-01

Aim - Bonus schemes within German statutory health insurance (GKV) use monetary incentives to promote health-conscious behaviour, particularly amongst risk groups. The idea is to exploit a latent potential for participation in money-saving preventive measures. First studies suggest that incidental effects (good risks) are more common than prevention effects. The purpose of the article is to present factors contributing to the successfulness of incentive schemes. Methods - To outline the findi...

A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

Science.gov (United States)

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

2016-01-01

Background The introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana. Methods Electronic search was done for literature published between 2003–2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context. Results Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients’ trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper. Conclusions The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy

Expanding health insurance scheme in the informal sector in Nigeria: awareness as a potential demand-side tool.

Science.gov (United States)

Adewole, David Ayobami; Akanbi, Saidat Abisola; Osungbade, Kayode Omoniyi; Bello, Segun

2017-01-01

The implementation and expansion of a health insurance scheme in the informal sector, particularly in developing countries, is a challenge. With the aid of an innovative Information-Education and Communication model, titled 'Understanding the concept of health insurance: An innovative social marketing tool', an assessment of the awareness and perception of the scheme among market women was carried out. This is a cross-sectional descriptive survey, carried out among market women in Ibadan, Nigeria. In a multi-stage sampling technique, a total of 351 women were interviewed using an interviewer-administered, semi-structured questionnaire. The data was analysed using SPSS version 16. Chi-square test was used to test associations between selected variables of interest. Logistic regression model was used to determine predictors of awareness of the National Health Insurance Scheme (NHIS). A model controlling for participants' enrolment status was built and Adjusted Odds Ratio (AOR) reported. Level of statistical significance was set at p market women aged 18 years and above participated in the study, a response rate of 98.0%. Respondents' educational status was the only predictor significantly associated with awareness of the NHIS. Respondents with post-primary education had 10 times the odds of being aware of the NHIS than respondents with no education or only primary education (Adjusted Odds Ratio = 10.3; 95% CI = 4.1-26.0). Innovative models to enable potential beneficiaries, especially among the informal sector, to better comprehend and accept the concept of prepayment methods of financing healthcare costs is important in efforts to implement and expand a social health insurance scheme.

Socioeconomic and programmatic determinants of renewal of membership in a voluntary micro health insurance scheme: evidence from Chakaria, Bangladesh.

Science.gov (United States)

Iqbal, Mohammad; Chowdhury, Asiful Haidar; Mahmood, Shehrin Shaila; Mia, Mohammad Nahid; Hanifi, S M A; Bhuiya, Abbas

2017-01-01

Out-of-pocket (OOP) healthcare expenditure is a major obstacle for achieving universal health coverage in low-income countries including Bangladesh. Sixty-three percent of the USD 27 annual per-capita healthcare expenditure in Bangladesh comes from individuals' pockets. Although health insurance is a financial tool for reducing OOP, use of such tools in Bangladesh has been limited to some small-scale voluntary micro health insurance (MHI) schemes run by non-governmental organizations (NGO). The MHI, however, can orient people on health insurance concept and provide learning for product development, implementation, barriers to enrolment, membership renewal, and other operational challenges and solutions. Keeping this in mind, icddr,b in 2012 initiated a pilot MHI, Amader Shasthya, in Chakaria, Bangladesh. This paper explores the determinants of membership renewal in this scheme, which is a perpetual challenge for MHI. Identify socioeconomic and programmatic determinants and their effects on membership renewal in a voluntary MHI scheme. Data came from the online management information system of the scheme and Health and Demographic Surveillance System of Chakaria, covering the period February 2012-May 2015. Association between renewal and independent variables was examined using cross-tabular and logistic regression analyses. Nearly 20% of households in the catchment area ever enroled in the scheme, and 38% renewed membership over the initial 3 years of operation. Frequency of consultation with healthcare providers, benefits received, proximity of member's residence to health facility, socioeconomic status, educational level, and age of the household head showed significant positive association with renewal of membership. Villagers' enrolment in the scheme indicated that even in poor economic and literacy conditions people can be motivated to enrol in insurance schemes. Degree of service utilization and benefits received can greatly enhance the probability of

Treatment-seeking behaviour and social health insurance in Africa: the case of Ghana under the National Health Insurance Scheme.

Science.gov (United States)

Fenny, Ama P; Asante, Felix A; Enemark, Ulrika; Hansen, Kristian S

2014-10-27

Health insurance is attracting more and more attention as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures. Currently about 52 percent of the resources for financing health care services come from out of pocket sources or user fees in Africa. Therefore, Ghana serves as in interesting case study as it has successfully expanded coverage of the National Health Insurance Scheme (NHIS). The study aims to establish the treatment-seeking behaviour of households in Ghana under the NHI policy. The study relies on household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah.Out of the 1013 who sought care in the previous 4 weeks, 60% were insured and 71% of them sought care from a formal health facility. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. Overall, compared to the uninsured, the insured are more likely to choose formal health facilities than informal care including self-medication when ill. We discuss the implications of these results as the concept of the NHIS grows widely in Ghana and serves as a good model for other African countries.

Modifications to the Rules of the CERN Health Insurance Scheme

CERN Multimedia

HR Department

2010-01-01

On the proposal of the CHIS Board, and following examination by the Standing Concertation Committee on 29 April 2010, the Director-General has approved the new Rules of the CERN Health Insurance Scheme, which will come into effect on 1 June 2010. The Rules will shortly be available on the CHIS web site. As the Rules had not been revised since 2003, it had become necessary to make certain changes in order to bring them into line with other texts (such as the Staff Rules and Regulations and Administrative Circulars) and to clarify some practices. The new Rules do not introduce any new benefits or remove any existing ones. The following changes will affect all insured members:   Description of change Articles in the new Rules Time limit for claiming reimbursement The time period is measured from the invoice date (instead of the date of treatment). ...

CERN Health Insurance Scheme - changes on 1 January 2011

CERN Multimedia

HR Department

2011-01-01

Changes decided by the Council on 16 December 2010 Following the five-yearly review of financial and social conditions, which included the CERN Health Insurance Scheme (CHIS), the CERN Council has taken certain decisions which affect both active and retired staff. In order to restore the financial equilibrium of the CHIS, the level of contributions will increase progressively over the next five years. In 2011, the contributions of both active and retired members increase from 4.02% to 4.27%. The amounts of the fixed premiums for voluntary insured members (e.g. users and associates) as well as the supplementary contributions for spouses with an income from a professional activity increase accordingly. The amounts of the daily allowance for Long-Term Care have been increased by 20% as of 1 January 2011. The CHIS Rules have been amended according to the above decisions. They entered into force on 1 January 2011 and are available on the CHIS site. Tel. 74125 Members of the personnel shall be deemed to ...

Autonomy and Financial Sources, Key Factors in the Performance of Health Insurance Scheme: Case of Albania

Directory of Open Access Journals (Sweden)

Enkelejda Avdi

2013-12-01

Full Text Available Autonomy of public health insurance scheme comprises political, financial, organizational, normative and contractual aspects. The paper analyses the role and position of a health insurance scheme (HIS within the overall healthcare system in Albania, the relationship to all other institutions, stakeholders and actors. By analyesing published literature and collected data through secondary sources, the paper focuses on financial autonomy, which refers first of all to a certain level of budgetary independence regarding source generation and spending on health services. For assuring effective and efficient performance of the single payer for health care services in Albania, need effective changes in the legislation do take into account the various levels of autonomy mentioned above.

Management initiatives in a community-based health insurance scheme.

Science.gov (United States)

Sinha, Tara; Ranson, M Kent; Chatterjee, Mirai; Mills, Anne

2007-01-01

Community-based health insurance (CBHI) schemes have developed in response to inadequacies of alternate systems for protecting the poor against health care expenditures. Some of these schemes have arisen within community-based organizations (CBOs), which have strong links with poor communities, and are therefore well situated to offer CBHI. However, the managerial capacities of many such CBOs are limited. This paper describes management initiatives undertaken in a CBHI scheme in India, in the course of an action-research project. The existing structures and systems at the CBHI had several strengths, but fell short on some counts, which became apparent in the course of planning for two interventions under the research project. Management initiatives were introduced that addressed four features of the CBHI, viz. human resources, organizational structure, implementation systems, and data management. Trained personnel were hired and given clear roles and responsibilities. Lines of reporting and accountability were spelt out, and supportive supervision was provided to team members. The data resources of the organization were strengthened for greater utilization of this information. While the changes that were introduced took some time to be accepted by team members, the commitment of the CBHI's leadership to these initiatives was critical to their success. Copyright (c) 2007 John Wiley & Sons, Ltd.

National Disability Insurance Scheme, health, hospitals and adults with intellectual disability.

Science.gov (United States)

Wallace, Robyn A

2018-03-01

Preventable poor health outcomes for adults with intellectual disability in health settings have been known about for years. Subsequent analysis and the sorts of reasonable adjustments required in health and disability support settings to address these health gaps are well described, but have not really been embedded in practice in any significant way in either setting. As far as health is concerned, implementation of the National Disability Insurance Scheme (NDIS, the Scheme) affords an opportunity to recognise individual needs of people with intellectual disability to provide reasonable and necessary functional support for access to mainstream health services, to build capacity of mainstream health providers to supply services and to increase individual capacity to access services. Together these strands have potential to transform health outcomes. Success of the Scheme, however, rests on as yet incompletely defined operational interaction between NDIS and mainstream health services and inherently involves the disability sector. This interaction is especially relevant for adults with intellectual disability, known high users of hospitals and for whom hospital outcomes are particularly poor and preventable. Keys to better hospital outcomes are first, the receiving of quality person-centred healthcare from physicians and hospitals taking into account significance of intellectual disability and second, formulation of organised quality functional supports during hospitalisation. Achieving these require sophisticated engagement between consumers, the National Disability Insurance Agency, Commonwealth, State and Territory government leaders, senior hospital and disability administrators, NDIS service providers and clinicians and involves cross fertilisation of values, sharing of operational policies and procedures, determination of boundaries of fiscal responsibility for functional supports in hospital. © 2018 Royal Australasian College of Physicians.

New CERN Health Insurance Scheme (CHIS) forms

CERN Multimedia

HR Department

2015-01-01

New versions of the following forms for claims and requests to the CERN Health Insurance Scheme (CHIS) have been released:   form for claiming reimbursement of medical expenses,   form for requesting advance reimbursement, and   dental estimate form (for treatments foreseen to exceed 800 CHF).   The new forms are available in French and English. They can either be completed electronically before being printed and signed, or completed in paper form. New detailed instructions can be found at the back of the claim form; CHIS members are invited to read them carefully. The electronic versions (PDF) of all the forms are available on the CHIS website and on the UNIQA Member Portal. CHIS Members are requested to use these new forms forthwith and to discard any previous version. Questions regarding the above should be addressed directly to UNIQA (72730 or 022.718 63 00 or uniqa.assurances@cern.ch).

The Political Economy of International Emission Trading Scheme Choice: Empirical Evidence

DEFF Research Database (Denmark)

Boom, J.T.; Svendsen, Gert Tinggaard

2000-01-01

The Kyoto Protocol allows emissions trading. It does however not specify how this is to take place and the discussion on the design of an emissions trading scheme is ongoing. In this paper, we give some empirical evidence on the preference of industry and environmental organizations for internati...... for international emissions trading scheme. Since they may have an influence on decision makers, their opinion is important. Our conclusion is that both industry and environmental organizations prefer credit trading, although for widely different reasons....

The effects of China's urban basic medical insurance schemes on the equity of health service utilisation: evidence from Shaanxi Province.

Science.gov (United States)

Zhou, Zhongliang; Zhu, Liang; Zhou, Zhiying; Li, Zhengya; Gao, Jianmin; Chen, Gang

2014-03-09

In order to alleviate the problem of "Kan Bing Nan, Kan Bing Gui" (medical treatment is difficult to access and expensive) and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively. This study aims to analyse the effects of UEBMI and URBMI on the equity of outpatient and inpatient utilisation in Shaanxi Province, China. Using the data from the fourth National Health Services Survey in Shaanxi Province, the method of Propensity Score Matching was employed to generate comparable samples between the insured and uninsured residents, through a one-to-one match algorithm. Next, based on the matched data, the method of decomposition of the concentration index was employed to compare the horizontal inequity indexes of health service utilisation between the UEBMI/URBMI insured and the matched uninsured residents. For the UEBMI insured and matched uninsured residents, the horizontal inequity indexes of outpatient visits are 0.1256 and -0.0511 respectively, and the horizontal inequity indexes of inpatient visits are 0.1222 and 0.2746 respectively. Meanwhile, the horizontal inequity indexes of outpatient visits are -0.1593 and 0.0967 for the URBMI insured and matched uninsured residents, and the horizontal inequity indexes of inpatient visits are 0.1931 and 0.3199 respectively. The implementation of UEBMI increased the pro-rich inequity of outpatient utilisation (rich people utilise outpatient facilities more than the poor people) and the implementation of URBMI increased the pro-poor inequity of outpatient utilisation. Both of these two health insurance schemes reduced the pro-rich inequity of inpatient utilisation.

Health insurance subsidies and deductible choice: Evidence from regional variation in subsidy schemes.

Science.gov (United States)

Kaufmann, Cornel; Schmid, Christian; Boes, Stefan

2017-09-01

The extent to which premium subsidies can influence health insurance choices is an open question. In this paper, we explore the regional variation in subsidy schemes in Switzerland, designed as either in-kind or cash transfers, to study their impact on the choice of health insurance deductibles. Using health survey data and a difference-in-differences methodology, we find that in-kind transfers increase the likelihood of choosing a low deductible plan by approximately 4 percentage points (or 7%). Our results indicate that the response to in-kind transfers is strongest among women, middle-aged and unmarried individuals, which we explain by differences in risk-taking behavior, health status, financial constraints, health insurance and financial literacy. We discuss our results in the light of potential extra-marginal effects on the demand for health care services, which are however not supported by our data. Copyright © 2017 Elsevier B.V. All rights reserved.

The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana

OpenAIRE

Dalinjong, Philip Ayizem; Laar, Alexander Suuk

2012-01-01

Background: Prepayments and risk pooling through social health insurance has been advocated by international development organizations. Social health insurance is seen as a mechanism that helps mobilize resources for health, pool risk, and provide more access to health care services for the poor. Hence Ghana implemented the National Health Insurance Scheme (NHIS) to help promote access to health care services for Ghanaians. The study examined the influence of the NHIS on the behavior of healt...

Spatial analysis of factors associated with household subscription to the National Health Insurance Scheme in rural Ghana

Directory of Open Access Journals (Sweden)

Stephen Manortey

2014-02-01

Full Text Available The use of health insurance schemes in financing healthcare delivery and to minimize the poverty gap is gaining considerable recognition among the least developed and resource challenged countries around the world. With the implementation of the socialized health insurance scheme, Ghana has taken the lead in Sub-Saharan Africa and now working out further strategies to gain universal coverage among her citizenry. The primary goal of this study is to explore the spatial relationship between the residential homes and demographic features of the people in the Barekese subdistrict in Ghana on the probability to enroll the entire household unit in the National Health Insurance Scheme (NHIS. Household level data were gathered from 20 communities on the enrollment status into the NHIS alongside demographic and socioeconomic indicators and the spatial location of every household that participated in the study. Kulldorff’s purely spatial scan statistic was used to detect geographic clusters of areas with participatory households that have either higher or lower enrollment patterns in the insurance program. Logistic regression models on selected demographic and socioeconomic indicators were built to predict the effect on the odds of enrolling an entire household membership in the NHIS. Three clusters significantly stood out to have either high or low enrollment patterns in the health insurance program taking into accounts the number of households in those sub-zones of the study region. Households in the Cluster 1 insurance group have very high travel expenses compared to their counterparts in the other idenfied clusters. Travel cost and time to the NHIS registration center to enroll in the program were both significant predictors to participation in the program when controlling for cluster effect. Residents in the High socioeconomic group have about 1.66 [95% CI: 1.27-2.17] times the odds to enroll complete households in the insurance program compared to

The effect of urban basic medical insurance on health service utilisation in Shaanxi Province, China: a comparison of two schemes.

Science.gov (United States)

Zhou, Zhongliang; Zhou, Zhiying; Gao, Jianmin; Yang, Xiaowei; Yan, Ju'e; Xue, Qinxiang; Chen, Gang

2014-01-01

Urban population in China is mainly covered by two medical insurance schemes: the Urban Employee Basic Medical Insurance (UEBMI) for urban employees in formal sector and the Urban Resident Basic Medical Insurance (URBMI) for the left urban residents, mainly the unemployed, the elderly and children. This paper studies the effects of UEBMI and URBMI on health services utilisation in Shaanxi Province, Western China. Cross-sectional data from the 4th National Health Services Survey - Shaanxi Province was studied. The propensity score matching and the coarsened exact matching methods have been used to estimate the average medical insurance effect on the insured. Compared to the uninsured, robust results suggest that UEBMI had significantly increased the outpatient health services utilisation in the last two weeks (pinsured was associated with higher health services utilisation, compared with the uninsured, none of the improvement was statistically significant (p>0.10). It was also found that compared with the uninsured, basic medical insurance enrollees were more likely to purchase inpatient treatments in lower levels of hospitals, consistent with the incentive of the benefit package design. Basic Medical insurance schemes have shown a positive but limited effect on increasing health services utilisation in Shaanxi Province. The benefit package design of higher reimbursement rates for lower level hospitals has induced the insured to use medical services in lower level hospitals for inpatient services.

Does the National Health Insurance Scheme provide financial protection to households in Ghana?

Science.gov (United States)

Kusi, Anthony; Hansen, Kristian Schultz; Asante, Felix A; Enemark, Ulrika

2015-08-15

Excessive healthcare payments can impede access to health services and also disrupt the welfare of households with no financial protection. Health insurance is expected to offer financial protection against health shocks. Ghana began the implementation of its National Health Insurance Scheme (NHIS) in 2004. The NHIS is aimed at removing the financial barrier to healthcare by limiting direct out-of-pocket health expenditures (OOPHE). The study examines the effect of the NHIS on OOPHE and how it protects households against catastrophic health expenditures. Data was obtained from a cross-sectional representative household survey involving 2,430 households from three districts across Ghana. All OOPHE associated with treatment seeking for reported illness in the household in the last 4 weeks preceding the survey were analysed and compared between insured and uninsured persons. The incidence and intensity of catastrophic health expenditures (CHE) among households were measured by the catastrophic health payment method. The relative effect of NHIS on the incidence of CHE in the household was estimated by multiple logistic regression analysis. About 36% of households reported at least one illness during the 4 weeks period. Insured patients had significantly lower direct OOPHE for out-patient and in-patient care compared to the uninsured. On financial protection, the incidence of CHE was lower among insured households (2.9%) compared to the partially insured (3.7%) and the uninsured (4.0%) at the 40% threshold. The incidence of CHE was however significantly lower among fully insured households (6.0%) which sought healthcare from NHIS accredited health facilities compared to the partially insured (10.1%) and the uninsured households (23.2%). The likelihood of a household incurring CHE was 4.2 times less likely for fully insured and 2.9 times less likely for partially insured households relative to being uninsured. The NHIS has however not completely eliminated OOPHE for the

Public vs private administration of rural health insurance schemes: a comparative study in Zhejiang of China.

Science.gov (United States)

Zhou, Xiaoyuan; Mao, Zhengzhong; Rechel, Bernd; Liu, Chaojie; Jiang, Jialin; Zhang, Yinying

2013-07-01

Since 2003, China has experimented in some of the country's counties with the private administration of the New Cooperative Medical Scheme (NCMS), a publicly subsidized health insurance scheme for rural populations. Our study compared the effectiveness and efficiency of private vs public administration in four counties in one of China's most affluent provinces in the initial stage of the NCMS's implementation. The study was undertaken in Ningbo city of Zhejiang province. Out of 10 counties in Ningbo, two counties with private administration for the NCMS (Beilun and Ninghai) were compared with two others counties with public administration (Zhenhai and Fenghua), using the following indicators: (1) proportion of enrollees who were compensated for inpatient care; (2) average reimbursement-expense ratio per episode of inpatient care; (3) overall administration cost; (4) enrollee satisfaction. Data from 2004 to 2006 were collected from the local health authorities, hospitals and the contracted insurance companies, supplemented by a randomized household questionnaire survey covering 176 households and 479 household members. In our sample counties, private administration of the NCMS neither reduced transaction costs, nor improved the benefits of enrollees. Enrollees covered by the publicly administered NCMS were more likely to be satisfied with the insurance scheme than those covered by the privately administered NCMS. Experience in the selected counties suggests that private administration of the NCMS did not deliver the hoped-for results. We conclude that caution needs to be exercised in extending private administration of the NCMS.

CERN Health Insurance Scheme (CHIS) Monthly Contributions – Changes for 2014

CERN Multimedia

2014-01-01

Following the 2010 five-yearly review of financial and social conditions, which included the CERN Health Insurance Scheme (CHIS), the CERN Council decided in December 2010 to progressively increase the level of contributions over the period 2011-2015.   For 2014, the contribution rate of active and retired CHIS members will be 4.7%. The amounts of the fixed premiums for voluntarily insured members (e.g. users and associates) as well as the supplementary contributions for spouses with income from a professional activity or with a retirement pension (including the CERN pension) will increase accordingly: Voluntary contributions The full contribution based on Reference Salary II is now 1161 CHF per month. This fixed amount contribution is applied to voluntarily affiliated users and associates with normal coverage. Half of this amount (580 CHF) is applied to voluntarily affiliated users and associates with reduced coverage. Finally, an amount of 464 CHF is applied to children maintaining their ins...

The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts

Directory of Open Access Journals (Sweden)

Wang Hong

2011-01-01

Full Text Available Abstract Background One of the key functions of health insurance is to provide financial protection against high costs of health care, yet evidence of such protection from developing countries has been inconsistent. The current study uses the case of Ghana to contribute to the evidence pool about insurance's financial protection effects. It evaluates the impact of the country's National Health Insurance Scheme on households' out-of-pocket spending and catastrophic health expenditure. Methods We use data from a household survey conducted in two rural districts, Nkoranza and Offinso, in 2007, two years after the initiation of the Ghana National Health Insurance Scheme. To address the skewness of health expenditure data, the absolute amount of out-of-pocket spending is estimated using a two-part model. We also conduct a probit estimate of the likelihood of catastrophic health expenditures, defined at different thresholds relative to household income and non-food consumption expenditure. The analysis controls for chronic and self-assessed health conditions, which typically drive adverse selection in insurance. Results At the time of the survey, insurance coverage was 35 percent. Although the benefit package of insurance is generous, insured people still incurred out-of-pocket payment for care from informal sources and for uncovered drugs and tests at health facilities. Nevertheless, they paid significantly less than the uninsured. Insurance has been shown to have a protective effect against the financial burden of health care, reducing significantly the likelihood of incurring catastrophic payment. The effect is particularly remarkable among the poorest quintile of the sample. Conclusions Findings from this study confirm the positive financial protection effect of health insurance in Ghana. The effect is stronger among the poor group than among general population. The results are encouraging for many low income countries who are considering a

Factors That Influence Enrolment and Retention in Ghana' National Health Insurance Scheme.

Science.gov (United States)

Kotoh, Agnes Millicent; Aryeetey, Genevieve Cecilia; Van der Geest, Sjaak

2017-10-17

The government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2004 with the goal of achieving universal coverage within 5 years. Evidence, however, shows that expanding NHIS coverage and especially retaining members have remained a challenge. A multilevel perspective was employed as a conceptual framework and methodological tool to examine why enrolment and retention in the NHIS remains low. A household survey was conducted after 20 months educational and promotional activities aimed at improving enrolment and retention rates in 15 communities in the Central and Eastern Regions (ERs) of Ghana. Observation, indepth interviews and informal conversations were used to collect qualitative data. Forty key informants (community members, health providers and district health insurance schemes' [DHISs] staff) purposely selected from two casestudy communities in the Central Region (CR) were interviewed. Several community members, health providers and DHISs' staff were also engaged in informal conversations in the other five communities in the region. Also, four staff of the Ministry of Health (MoH), Ghana Health Service (GHS) and National Health Insurance Authority (NHIA) were engaged in in-depth interviews. Descriptive statistics was used to analyse quantitative data. Qualitative data was analysed using thematic content analysis. The results show that factors that influence enrolment and retention in the NHIS are multi-dimensional and cut across all stakeholders. People enrolled and renewed their membership because of NHIS' benefits and health providers' positive behaviour. Barriers to enrolment and retention included: poverty, traditional risk-sharing arrangements influence people to enrol or renew their membership only when they need healthcare, dissatisfaction about health providers' behaviour and service delivery challenges. Given the multi-dimensional nature of barriers to enrolment and retention, we suggest that the NHIA should engage DHISs, health

A quantitative study on factors influencing enrolment of dairy farmers in a community health insurance scheme.

Science.gov (United States)

Greef, Tineke de Groot-de; Monareng, Lydia V; Roos, Janetta H

2016-12-09

Access to affordable and effective health care is a challenge in low- and middle- income countries. Out-of-pocket expenditure for health care is a major cause of impoverishment. One way to facilitate access and overcome catastrophic expenditure is through a health insurance mechanism, whereby risks are shared and financial inputs pooled by way of contributions. This study examined factors that influenced the enrolment status of dairy farmers in Western Kenya to a community health insurance (CHI) scheme. Quantitative, cross-sectional research was used to describe factors influencing the enrolment in the CHI scheme. Quota and convenience sampling was used, recruiting a sample of 135 farmers who supply milk to a dairy cooperation. Data were collected using a structured interview schedule and analysed using Stata SE, Data Analysis and Statistical Software, Version 12. Factors influencing non-enrolment were identified as affordability (40%; n = 47), unfamiliarity with the management of the scheme (37%; n = 44) and a lack of understanding about the scheme (41%; n = 48). An exploratory factor analysis was used to reduce the variables to two factors: information provision and understanding community health insurance (CHI). Logistic regression identified factors associated with enrolment in the Tanykina Community Healthcare Plan (TCHP). Supplies of less than six litres of milk per day (OR: 0.22; 95% CI: 0.06-0.84) and information provision (OR: 8.77; 95% CI: 2.25-34.16) were significantly associated with enrolment in the TCHP. Nearly 30% (29.6%; n = 40) of the respondents remarked that TCHP is expensive and 17% (n = 23) asked for more education on CHI and TCHP in an open-ended question. Recommendations related to marketing strategies, financial approach, information provision and further research were outlined to be made to the management of the TCHP as well as to those involved in public health.

Social health insurance

CERN Document Server

International Labour Office. Geneva

1997-01-01

This manual provides an overview of social health insurance schemes and looks at the development of health care policies and feasibility issues. It also examines the design of health insurance schemes, health care benefits, financing and costs and considers the operational and strategic information requirements.

Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDR-TB health insurance schemes, in Chhattisgarh state, India.

Science.gov (United States)

Kundu, Debashish; Sharma, Nandini; Chadha, Sarabjit; Laokri, Samia; Awungafac, George; Jiang, Lai; Asaria, Miqdad

2018-01-27

There are significant financial barriers to access treatment for multi drug resistant tuberculosis (MDR-TB) in India. To address these challenges, Chhattisgarh state in India has established a MDR-TB financial protection policy by creating MDR-TB benefit packages as part of the universal health insurance scheme that the state has rolled out in their effort towards attaining Universal Health Coverage for all its residents. In these schemes the state purchases health insurance against set packages of services from third party health insurance agencies on behalf of all its residents. Provider payment reform by strategic purchasing through output based payments (lump sum fee is reimbursed as per the MDR-TB benefit package rates) to the providers - both public and private health facilities empanelled under the insurance scheme was the key intervention. To understand the implementation gap between policy and practice of the benefit packages with respect to equity in utilization of package claims by the poor patients in public and private sector. Data from primary health insurance claims from January 2013 to December 2015, were analysed using an extension of 'Kingdon's multiple streams for policy implementation framework' to explain the implementation gap between policy and practice of the MDR-TB benefit packages. The total number of claims for MDR-TB benefit packages increased over the study period mainly from poor patients treated in public facilities, particularly for the pre-treatment evaluation and hospital stay packages. Variations and inequities in utilizing the packages were observed between poor and non-poor beneficiaries in public and private sector. Private providers participation in the new MDR-TB financial protection mechanism through the universal health insurance scheme was observed to be much lower than might be expected given their share of healthcare provision overall in India. Our findings suggest that there may be an implementation gap due to weak

Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh, India: a comprehensive analytic view of private public partnership model.

Science.gov (United States)

Reddy, Sunita; Mary, Immaculate

2013-01-01

The Rajiv Aarogyasri Community Health Insurance (RACHI) in Andhra Pradesh (AP) has been very popular social insurance scheme with a private public partnership model to deal with the problems of catastrophic medical expenditures at tertiary level care for the poor households. A brief analysis of the RACHI scheme based on officially available data and media reports has been undertaken from a public health perspective to understand the nature and financing of partnership and the lessons it provides. The analysis of the annual budget spent on the surgeries in private hospitals compared to tertiary public hospitals shows that the current scheme is not sustainable and pose huge burden on the state exchequers. The private hospital association's in AP, further acts as pressure groups to increase the budget or threaten to withdraw services. Thus, profits are privatized and losses are socialized.

Refusal to enrol in Ghana's National Health Insurance Scheme: is affordability the problem?

Science.gov (United States)

Kusi, Anthony; Enemark, Ulrika; Hansen, Kristian S; Asante, Felix A

2015-01-17

Access to health insurance is expected to have positive effect in improving access to healthcare and offer financial risk protection to households. Ghana began the implementation of a National Health Insurance Scheme (NHIS) in 2004 as a way to ensure equitable access to basic healthcare for all residents. After a decade of its implementation, national coverage is just about 34% of the national population. Affordability of the NHIS contribution is often cited by households as a major barrier to enrolment in the NHIS without any rigorous analysis of this claim. In light of the global interest in achieving universal health insurance coverage, this study seeks to examine the extent to which affordability of the NHIS contribution is a barrier to full insurance for households and a burden on their resources. The study uses data from a cross-sectional household survey involving 2,430 households from three districts in Ghana conducted between January-April, 2011. Affordability of the NHIS contribution is analysed using the household budget-based approach based on the normative definition of affordability. The burden of the NHIS contributions to households is assessed by relating the expected annual NHIS contribution to household non-food expenditure and total consumption expenditure. Households which cannot afford full insurance were identified. Results show that 66% of uninsured households and 70% of partially insured households could afford full insurance for their members. Enroling all household members in the NHIS would account for 5.9% of household non-food expenditure or 2.0% of total expenditure but higher for households in the first (11.4%) and second (7.0%) socio-economic quintiles. All the households (29%) identified as unable to afford full insurance were in the two lower socio-economic quintiles and had large household sizes. Non-financial factors relating to attributes of the insurer and health system problems also affect enrolment in the NHIS. Affordability

HEALTH INSURANCE SCHEME -- announcement from the CHIS Board

CERN Document Server

2005-01-01

A number of members of our Health Insurance Scheme are currently experiencing difficulties getting reimbursement for consulting an acupuncture practitioner. The CHIS Board wishes to remind you that in order to be reimbursed, you must receive your acupuncture treatment from doctors recognised by the competent authorities of the country in which they have their medical practice. In Switzerland, these are people possessing the title of doctor of medicine recognised by the Swiss Medical Association (FMH). Treatment provided by medical auxiliaries must be prescribed beforehand by a recognised doctor. As the practitioner in question is currently not recognised as a doctor in Switzerland, his services are not reimbursed. In order to avoid any inconvenience, we advise you to contact uniqa before undergoing such treatment. You will find all details concerning reimbursement of complementary medicine (acupuncture, chiropractic, osteopathy and ethiopathy) in CHISbull’ No. 18 dated November 2004, which can ...

HEALTH INSURANCE SCHEME - announcement from the CHIS Board

CERN Multimedia

2005-01-01

A number of members of our Health Insurance Scheme are currently experiencing difficulties getting reimbursement for consulting an acupuncture practitioner. The CHIS Board wishes to remind you that in order to be reimbursed, you must receive your acupuncture treatment from doctors recognised by the competent authorities of the country in which they have their medical practice. In Switzerland, these are people possessing the title of doctor of medicine recognised by the Swiss Medical Association (FMH). Treatment provided by medical auxiliaries must be prescribed beforehand by a recognised doctor. As the practitioner in question is currently not recognised as a doctor in Switzerland, his services are not reimbursed. In order to avoid any inconvenience, we advise you to contact uniqa before undergoing such treatment. You will find all details concerning reimbursement of complementary medicine (acupuncture, chiropractic, osteopathy and ethiopathy) in CHISbull' No. 18 dated November 2004, which can also be co...

European insurance scheme to cover geological risk related to geothermal operations

Energy Technology Data Exchange (ETDEWEB)

Tiberi, U [European Community, General Directorate XVII, ALTERNER Program, Bruxelles (Belgium); Demange, J [BRGM, Orleans (France)

1997-12-01

The development of geothermal energy can contribute significantly to the growth of NRE (new and renewable energies that are non-nuclear and non-combustible) within the European Community and within Europe as a whole. However, the `mining risk` related to this type of operation still constitutes a major obstacle to its development. Operators find it difficult to raise the necessary financing without a guarantee against the risk of failure during the drilling stage. Standard insurance companies will not cover this type of risk, due to its very nature. We must thus therefore find a specific solution. As a result of the oil crises during the 1970s, the French Government decided promote the use of renewable energies in France. The support provided to these energies, or at least to geothermal energy, was to set up a scheme whereby the resource is guaranteed. Thus the operator, by subscribing to the scheme, benefits from a guarantee of the resource. The insurance works at two level: - in the first place, it covers the mining risk during the drilling stage, i.e. should the resource prove to be insufficient, whether in discharge or temperature, for an economically viable operation, then the totality of the costs are reimbursed, apart form the premium and any government subsidy that might have been received. - A second level of guarantee covers the risk of change in the resource`s parameters over a period of 15 years (a study is in progress to consider the possibility of extending this period to 25 years). (orig.)

National health insurance scheme: How receptive are the private healthcare practitioners in a local government area of Lagos state

OpenAIRE

Campbell Princess Christina; Taiwo Toyin Latifat; Nnaji Feziechukwu Collins; Abolarin Thaddeus Olatunbosun

2014-01-01

Background: National Health Insurance Scheme (NHIS) is one of the health financing options adopted by Nigeria for improved healthcare access especially to the low income earners. One of the key operators of the scheme is the health care providers, thus their uptake of the scheme is fundamental to the survival of the scheme. The study reviewed the uptake of the NHIS by private health care providers in a Local Government Area in Lagos State. Objective: To assess the uptake of the NHIS by privat...

The effects of China’s urban basic medical insurance schemes on the equity of health service utilisation: evidence from Shaanxi Province

Science.gov (United States)

2014-01-01

Introduction In order to alleviate the problem of “Kan Bing Nan, Kan Bing Gui” (medical treatment is difficult to access and expensive) and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively. This study aims to analyse the effects of UEBMI and URBMI on the equity of outpatient and inpatient utilisation in Shaanxi Province, China. Methods Using the data from the fourth National Health Services Survey in Shaanxi Province, the method of Propensity Score Matching was employed to generate comparable samples between the insured and uninsured residents, through a one-to-one match algorithm. Next, based on the matched data, the method of decomposition of the concentration index was employed to compare the horizontal inequity indexes of health service utilisation between the UEBMI/URBMI insured and the matched uninsured residents. Results For the UEBMI insured and matched uninsured residents, the horizontal inequity indexes of outpatient visits are 0.1256 and -0.0511 respectively, and the horizontal inequity indexes of inpatient visits are 0.1222 and 0.2746 respectively. Meanwhile, the horizontal inequity indexes of outpatient visits are -0.1593 and 0.0967 for the URBMI insured and matched uninsured residents, and the horizontal inequity indexes of inpatient visits are 0.1931 and 0.3199 respectively. Conclusions The implementation of UEBMI increased the pro-rich inequity of outpatient utilisation (rich people utilise outpatient facilities more than the poor people) and the implementation of URBMI increased the pro-poor inequity of outpatient utilisation. Both of these two health insurance schemes reduced the pro-rich inequity of inpatient utilisation. PMID:24606592

How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence.

Science.gov (United States)

van de Ven, Wynand P M M; van Vliet, René C J A; van Kleef, Richard C

2017-03-01

If consumers have a choice of health plan, risk selection is often a serious problem (e.g., as in Germany, Israel, the Netherlands, the United States of America, and Switzerland). Risk selection may threaten the quality of care for chronically ill people, and may reduce the affordability and efficiency of healthcare. Therefore, an important question is: how can the regulator show evidence of (no) risk selection? Although this seems easy, showing such evidence is not straightforward. The novelty of this paper is two-fold. First, we provide a conceptual framework for showing evidence of risk selection in competitive health insurance markets. It is not easy to disentangle risk selection and the insurers' efficiency. We suggest two methods to measure risk selection that are not biased by the insurers' efficiency. Because these measures underestimate the true risk selection, we also provide a list of signals of selection that can be measured and that, in particular in combination, can show evidence of risk selection. It is impossible to show the absence of risk selection. Second, we empirically measure risk selection among the switchers, taking into account the insurers' efficiency. Based on 2-year administrative data on healthcare expenses and risk characteristics of nearly all individuals with basic health insurance in the Netherlands (N > 16 million) we find significant risk selection for most health insurers. This is the first publication of hard empirical evidence of risk selection in the Dutch health insurance market.

Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana.

Science.gov (United States)

van der Wielen, Nele; Channon, Andrew Amos; Falkingham, Jane

2018-01-01

This paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare. With an ageing population, a specific assessment of whether the scheme has benefitted older adults, and also if the benefit is equitable, is needed. Using the Ghanaian Living Standards Survey from 2012 to 2013, this paper uses propensity score matching to estimate the effect of enrolment within the NHIS on the utilisation of inpatient and outpatient care among older people aged 50 and over. The raw results show higher utilisation of healthcare among NHIS members, which persists after matching. NHIS members were 6% and 9% more likely to use inpatient and outpatient care, respectively, than non-members. When these increases were disaggregated for outpatient care, the non-poor and females were seen to benefit more than their poor and male counterparts. For inpatient care, the benefits of enrolment were equal by poverty status and sex. However, overall, poor older adults use health services much less than the non-poor older adults even when enrolled. The results indicate that NHIS coverage does increase healthcare utilisation among rural older adults but that inequalities remain. The poor are still at a great disadvantage in their use of health services overall and benefit less from enrolment for outpatient care. The receipt of healthcare is significantly influenced by a set of auxiliary barriers to access to healthcare even where insurance should remove the financial burden of ad hoc out of pocket payments.

THE CERN HEALTH INSURANCE SCHEME AND THE EURO

CERN Document Server

Human Resources Division

2002-01-01

Since 1 January 2002, the euro is the common currency of 12 European countries and some 300 million people. Of course, such a change has some consequences on our Health Insurance Scheme. As you know, when filling in the medical expenses claim form, you are required to indicate a currency code, i.e. the currency in which you have incurred medical expenses. You may have noticed that the euro is not yet on the list of currencies which appear on the bottom left of the existing form. This will be changed very soon, once the stock of existing forms has been used up. Until then, please note that the currency code for the euro is 002 (easy to remember since the code for the Swiss franc is 001). If you forget this code, don't worry! Just indicate «euro» next to the amount of your medical bill, or simply use the euro symbol!

Insuring against Health Shocks: Health Insurance and Household Choices

OpenAIRE

Liu, Kai

2015-01-01

This paper provides empirical evidence on the role of public health insurance in mitigating adverse outcomes associated with health shocks. Exploiting the rollout of a universal health insurance program in rural China, I find that total household income and consumption are fully insured against health shocks even without access to health insurance. Household labor supply is an important insurance mechanism against health shocks. Access to health insurance helps households to maintain investme...

Switching benefits and costs in competitive health insurance markets: A conceptual framework and empirical evidence from the Netherlands.

Science.gov (United States)

Duijmelinck, Daniëlle M I D; Mosca, Ilaria; van de Ven, Wynand P M M

2015-05-01

Competitive health insurance markets will only enhance cost-containment, efficiency, quality, and consumer responsiveness if all consumers feel free to easily switch insurer. Consumers will switch insurer if their perceived switching benefits outweigh their perceived switching costs. We developed a conceptual framework with potential switching benefits and costs in competitive health insurance markets. Moreover, we used a questionnaire among Dutch consumers (1091 respondents) to empirically examine the relevance of the different switching benefits and costs in consumers' decision to (not) switch insurer. Price, insurers' service quality, insurers' contracted provider network, the benefits of supplementary insurance, and welcome gifts are potential switching benefits. Transaction costs, learning costs, 'benefit loss' costs, uncertainty costs, the costs of (not) switching provider, and sunk costs are potential switching costs. In 2013 most Dutch consumers switched insurer because of (1) price and (2) benefits of supplementary insurance. Nearly half of the non-switchers - and particularly unhealthy consumers - mentioned one of the switching costs as their main reason for not switching. Because unhealthy consumers feel not free to easily switch insurer, insurers have reduced incentives to invest in high-quality care for them. Therefore, policymakers should develop strategies to increase consumer choice. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Factors That Influence Enrolment and Retention in Ghana’ National Health Insurance Scheme

Science.gov (United States)

Millicent Kotoh, Agnes; Aryeetey, Genevieve Cecilia; der Geest, Sjaak Van

2018-01-01

Background: The government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2004 with the goal of achieving universal coverage within 5 years. Evidence, however, shows that expanding NHIS coverage and especially retaining members have remained a challenge. A multilevel perspective was employed as a conceptual framework and methodological tool to examine why enrolment and retention in the NHIS remains low. Methods: A household survey was conducted after 20 months educational and promotional activities aimed at improving enrolment and retention rates in 15 communities in the Central and Eastern Regions (ERs) of Ghana. Observation, indepth interviews and informal conversations were used to collect qualitative data. Forty key informants (community members, health providers and district health insurance schemes’ [DHISs] staff) purposely selected from two casestudy communities in the Central Region (CR) were interviewed. Several community members, health providers and DHISs’ staff were also engaged in informal conversations in the other five communities in the region. Also, four staff of the Ministry of Health (MoH), Ghana Health Service (GHS) and National Health Insurance Authority (NHIA) were engaged in in-depth interviews. Descriptive statistics was used to analyse quantitative data. Qualitative data was analysed using thematic content analysis. Results: The results show that factors that influence enrolment and retention in the NHIS are multi-dimensional and cut across all stakeholders. People enrolled and renewed their membership because of NHIS’ benefits and health providers’ positive behaviour. Barriers to enrolment and retention included: poverty, traditional risk-sharing arrangements influence people to enrol or renew their membership only when they need healthcare, dissatisfaction about health providers’ behaviour and service delivery challenges. Conclusion: Given the multi-dimensional nature of barriers to enrolment and retention

Deposit Insurance and Risk Shifting in a Strong Regulatory Environment

DEFF Research Database (Denmark)

Bartholdy, Jan; Justesen, Lene Gilje

This study provides empirical evidence on the moral hazard implications of introducing deposit insurance into a strong regulatory environment. Denmark offers a unique setting because commercial banks and savings banks have different ownership structures, but are subject to the same set...... of regulations. The ownership structure in savings banks implies that they have no incentive to increase risk after the implementation of a deposit insurance scheme whereas commercial banks have. Also, at the time of introduction, Denmark had high capital requirements and a strict closure policy. Using...... a difference-in-difference framework we show that commercial banks did not increase their risk compared to savings banks when deposit insurance was introduced. The results also hold for large commercial banks, indicating that the systemic risk did not increase either. Thus for a system with high capital...

Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges.

Science.gov (United States)

Ranson, Michael Kent

2002-01-01

To assess the Self Employed Women's Association's Medical Insurance Fund in Gujarat in terms of insurance coverage according to income groups, protection of claimants from costs of hospitalization, time between discharge and reimbursement, and frequency of use. One thousand nine hundred and thirty claims submitted over six years were analysed. Two hundred and fifteen (11%) of 1927 claims were rejected. The mean household income of claimants was significantly lower than that of the general population. The percentage of households below the poverty line was similar for claimants and the general population. One thousand seven hundred and twelve (1712) claims were reimbursed: 805 (47%) fully and 907 (53%) at a mean reimbursement rate of 55.6%. Reimbursement more than halved the percentage of catastrophic hospitalizations (>10% of annual household income) and hospitalizations resulting in impoverishment. The average time between discharge and reimbursement was four months. The frequency of submission of claims was low (18.0/1000 members per year: 22-37% of the estimated frequency of hospitalization). The findings have implications for community-based health insurance schemes in India and elsewhere. Such schemes can protect poor households against the uncertain risk of medical expenses. They can be implemented in areas where institutional capacity is too weak to organize nationwide risk-pooling. Such schemes can cover poor people, including people and households below the poverty line. A trade off exists between maintaining the scheme's financial viability and protecting members against catastrophic expenditures. To facilitate reimbursement, administration, particularly processing of claims, should happen near claimants. Fine-tuning the design of a scheme is an ongoing process - a system of monitoring and evaluation is vital.

SERVICE QUALITY MEASUREMENT AND DEMAND FOR INSURANCE: AN EMPIRICAL STUDY FROM NIGERIAN INSURANCE INDUSTRY

Directory of Open Access Journals (Sweden)

Abass, OlufemiAdebowale

2016-11-01

Full Text Available Insurance provides financial protection to the insured, though; its acceptance by Nigerian insuring public is still low. This can sharply be traced to low awareness of insurance service. More importantly, quality of service to the few who embraced it had been low. Therefore, insuring public perceives insurance service as defective because customers’ expectations are not met. The objective of this research is to find out whether application of service quality measurement will drive demand for insurance products. Hypothesis was tested to find out whether SERVQUAL measurement is not significantly related to demand for insurance products in Nigeria. The study adopts descriptive research design; hypothesis was tested using regression analysis. The study reveals that there is a significant relationship between application of SERVQUAL measurement and demand for insurance. It is recommended that insurance companies operating in Nigeria should adopt SERVQUAL measurement which will further increase customer retention and loyalty.

Ghana's National Health insurance scheme and maternal and child health: a mixed methods study.

Science.gov (United States)

Singh, Kavita; Osei-Akoto, Isaac; Otchere, Frank; Sodzi-Tettey, Sodzi; Barrington, Clare; Huang, Carolyn; Fordham, Corinne; Speizer, Ilene

2015-03-17

Ghana is attracting global attention for efforts to provide health insurance to all citizens through the National Health Insurance Scheme (NHIS). With the program's strong emphasis on maternal and child health, an expectation of the program is that members will have increased use of relevant services. This paper uses qualitative and quantitative data from a baseline assessment for the Maternal and Newborn errals Evaluation from the Northern and Central Regions to describe women's experiences with the NHIS and to study associations between insurance and skilled facility delivery, antenatal care and early care-seeking for sick children. The assessment included a quantitative household survey (n = 1267 women), a quantitative community leader survey (n = 62), qualitative birth narratives with mothers (n = 20) and fathers (n = 18), key informant interviews with health care workers (n = 5) and focus groups (n = 3) with community leaders and stakeholders. The key independent variables for the quantitative analyses were health insurance coverage during the past three years (categorized as all three years, 1-2 years or no coverage) and health insurance during the exact time of pregnancy. Quantitative findings indicate that insurance coverage during the past three years and insurance during pregnancy were associated with greater use of facility delivery but not ANC. Respondents with insurance were also significantly more likely to indicate that an illness need not be severe for them to take a sick child for care. The NHIS does appear to enable pregnant women to access services and allow caregivers to seek care early for sick children, but both the quantitative and qualitative assessments also indicated that the poor and least educated were less likely to have insurance than their wealthier and more educated counterparts. Findings from the qualitative interviews uncovered specific challenges women faced regarding registration for the NHIS and other

Social insurance for dental care in Iran: a developing scheme for a developing country.

Science.gov (United States)

Jadidfard, Mohammad-Pooyan; Yazdani, Shahram; Khoshnevisan, Mohammad-Hossein

2012-12-01

This study aimed to describe the current situation with regard to dental care provided under social insurance in Iran in qualitative terms and to assess it critically with regard to equity and efficiency. After a thorough review of the relevant literature, a template of topics, which included population coverage, range of treatment provided, contracting mechanisms, fees, level of co-payments and dental share of total health expenditures, was developed by a panel of Iranian health finance experts. It was used during interviews with informed persons from the different Iranian social funds. These interviews were recorded and transcribed. The transcriptions were checked for accuracy by those who had been interviewed and were then analysed. It was found that, currently, four major social funds are involved in health (including dental) insurance in Iran, under the supervision of The Supreme Council of Health Insurance, located at the newly integrated Ministry of Cooperatives, Labour & Social Welfare. Around 90% of Iranians are covered for health insurance within a Bismarckian system to which the employed, the employers, and the Government contribute. The system has developed piecemeal over the years and is characterised by a complexity of revenue-collection schemes, fragmented insurance pools, and passive purchasing of dental services. The dental sector of Iranian social insurance should establish a strategic purchasing plan for dental care with the aim of improving performance and access to care. Within the plan, there should be a basic benefit package of dental services based on the relative cost-effectiveness of interventions, educating an adequate number of allied dental professionals to provide simple services, and introducing mixed payment methods.

Health Insurance without Single Crossing

DEFF Research Database (Denmark)

Boone, Jan; Schottmüller, Christoph

2017-01-01

Standard insurance models predict that people with high risks have high insurance coverage. It is empirically documented that people with high income have lower health risks and are better insured. We show that income differences between risk types lead to a violation of single crossing...... in an insurance model where people choose treatment intensity. We analyse different market structures and show the following: If insurers have market power, the violation of single crossing caused by income differences and endogenous treatment choice can explain the empirically observed outcome. Our results do...

Insurance market development: An empirical study of African countries

Directory of Open Access Journals (Sweden)

Athenia Bongani Sibindi

2015-12-01

Full Text Available The insurance industry plays a very crucial role in an economy by fostering intermediation and by its mechanism of risk bearing. As such it could be argued that the insurance industry fosters economic growth. In this article we analyse the global insurance market development trends, particularly focusing on Africa. Our sample comprise of the 10 African countries namely—South Africa, Angola, Nigeria, Kenya, Mauritius, Namibia, Algeria, Tunisia, Morocco and Egypt. We employ three insurance market development metrics namely; premium volumes, insurance density and insurance penetrations ratios to establish trends in the level of development of global insurance markets. Our results document that the African countries (excluding South Africa have the least developed insurance markets. For most of the countries in our sample, the non-life insurance industry dominates the life-insurance industry. As such, it is imperative that their respective governments put in place measures that will grow their economies inorder to stimulate the development of insurance markets in Africa.

Impact of national health insurance scheme on blood pressure control in Zaria

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Albert Imhoagene Oyati

2016-01-01

Full Text Available Background: National Health Insurance Scheme (NHIS was commenced in Nigeria in 2001 to ensure wider access to health care services. This study determined the impact of NHIS implementation on blood pressure (BP control among patients with systemic hypertension, regularly attending the Cardiac Clinic, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria. Materials and Methods: Patients with systemic hypertension, both NHIS and non-NHIS beneficiaries attending a tertiary health facility in Zaria, Nigeria, were seen in a prospective cross-sectional study. Demographic and clinical characteristics were obtained. Access to treatment and relevant investigations were compared. BP levels were analyzed and compared in both groups at enrollment in the clinic and at the point of this study. Results: Sixty-five percent, (70/107 of the clinic attendees were on the NHIS scheme and were significantly younger than non-NHIS patients (t = 2.03, P = 0.03. Mean body mass index (BMI was equally high (t = −1.222, P = 0.22 and there was similar access to medications (χ2 = 0.08, P = 0.77. Mean systolic BP (SBP and diastolic BP (DBP at enrollment were significantly higher in NHIS patients (t = −3.064, P = 0.003 for mean SBP and t = −4.115, P = 0.0001 for mean DBP, respectively. However, BP control in both groups at the end of the study did not show any significant difference (χ2 = 0.02, P = 0.89. Conclusion: NHIS uptake among these patients is high. There was no difference in BP control among the insured and nonbeneficiaries. A study of a larger number of patients over a longer period is suggested.

Insuring against health shocks: Health insurance and household choices.

Science.gov (United States)

Liu, Kai

2016-03-01

This paper provides empirical evidence on the role of public health insurance in mitigating adverse outcomes associated with health shocks. Exploiting the rollout of a universal health insurance program in rural China, I find that total household income and consumption are fully insured against health shocks even without access to health insurance. Household labor supply is an important insurance mechanism against health shocks. Access to health insurance helps households to maintain investment in children's human capital during negative health shocks, which suggests that one benefit of health insurance could arise from reducing the use of costly smoothing mechanisms. Copyright © 2016 Elsevier B.V. All rights reserved.

Supplementary insurance as a switching cost for basic health insurance: Empirical results from the Netherlands.

Science.gov (United States)

Willemse-Duijmelinck, Daniëlle M I D; van de Ven, Wynand P M M; Mosca, Ilaria

2017-10-01

Nearly everyone with a supplementary insurance (SI) in the Netherlands takes out the voluntary SI and the mandatory basic insurance (BI) from the same health insurer. Previous studies show that many high-risks perceive SI as a switching cost for BI. Because consumers' current insurer provides them with a guaranteed renewability, SI is a switching cost if insurers apply selective underwriting to new applicants. Several changes in the Dutch health insurance market increased insurers' incentives to counteract adverse selection for SI. Tools to do so are not only selective underwriting, but also risk rating and product differentiation. If all insurers use the latter tools without selective underwriting, SI is not a switching cost for BI. We investigated to what extent insurers used these tools in the periods 2006-2009 and 2014-2015. Only a few insurers applied selective underwriting: in 2015, 86% of insurers used open enrolment for all their SI products, and the other 14% did use open enrolment for their most common SI products. As measured by our indicators, the proportion of insurers applying risk rating or product differentiation did not increase in the periods considered. Due to the fear of reputation loss insurers may have used 'less visible' tools to counteract adverse selection that are indirect forms of risk rating and product differentiation and do not result in switching costs. So, although many high-risks perceive SI as a switching cost, most insurers apply open enrolment for SI. By providing information to high-risks about their switching opportunities, the government could increase consumer choice and thereby insurers' incentives to invest in high-quality care for high-risks. Copyright © 2017 Elsevier B.V. All rights reserved.

[Part-time Work and Men's Health : Results based on Routine Data of a Statutory Health Insurance Scheme].

Science.gov (United States)

Grobe, Thomas G

2016-08-01

With the introduction of a new occupational classification at the end of 2011, employment characteristics are reported by employees to social insurance agencies in Germany in more detail than in previous years. In addition to other changes, the new classification allows a distinction between full- and part-time work to be made. This provided a reason to consider the health-related aspects of part-time work on the basis of data from a statutory health insurance scheme. Our analysis is based on the data of 3.8 million employees insured with the Techniker Krankenkasse (TK), a statutory health insurance scheme, in 2012. In addition to daily information on employment situations, details of periods and diagnoses of sick leave and the drugs prescribed were available. Although approximately 50 % of women of middle to higher working age worked part-time in 2012, the corresponding percentage of men employed in part-time work was less than 10 %. Overall, part-time employees were on sick leave for fewer days than full-time employees, but among men, sick leave due to mental disorders was longer for part-time employees than for full-time employees, whereas women working part time were affected to a lesser extent by corresponding periods of absence than those working full time. The results provide indications for the assertion that men in gender-specifically atypical employment situations are more frequently affected by mental disorders. Further evidence supports this assertion. With the long-term availability of these new employment characteristics, longitudinal analyses could help to clarify this cause-effect relationship.

Repackaging exemptions under National Health Insurance in Ghana: how can access to care for the poor be improved?

NARCIS (Netherlands)

Kanchebe Derbile, E.; van der Geest, S.

2013-01-01

For the past 10 years the Ghana Government has been trying to replace the old user fee system with an overall health insurance scheme, but one problem of the old system continues to bedevil the new policy: exemption of the poor. This paper presents data from empirical fieldwork and also puts forward

Influencers of Life Insurance Investments: Empirical Evidence from Europe

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Aditi Mitra

2017-09-01

Full Text Available This study analyzes the impact of economic, demographic and cultural factors on life insurance consumption in 28 European countries. The period of study is post financial crisis from 2009-2014, and the study considers many of the emerging Eastern European economies where there have been significant insurance sector reforms recently. Europe is the world’s largest insurance market with 35% of the overall insurance premium contribution, but ranks third in insurance per capita, hence Europe is an interesting region in which to study insurance demand. The study observed four economic parameters: GDP per capita, gross savings, competitiveness of the nation, and inflation, as significant impacts on the insurance consumption in the region. Two demographic factors, population and education, and two cultural factors, individualism and long term orientation, appear to impact insurance consumption in the selected countries.

Providing Universal Health Insurance Coverage in Nigeria.

Science.gov (United States)

Okebukola, Peter O; Brieger, William R

2016-07-07

Despite a stated goal of achieving universal coverage, the National Health Insurance Scheme of Nigeria had achieved only 4% coverage 12 years after it was launched. This study assessed the plans of the National Health Insurance Scheme to achieve universal health insurance coverage in Nigeria by 2015 and discusses the challenges facing the scheme in achieving insurance coverage. In-depth interviews from various levels of the health-care system in the country, including providers, were conducted. The results of the analysis suggest that challenges to extending coverage include the difficulty in convincing autonomous state governments to buy into the scheme and an inadequate health workforce that might not be able to meet increased demand. Recommendations for increasing the scheme's coverage include increasing decentralization and strengthening human resources for health in the service delivery systems. Strong political will is needed as a catalyst to achieving these goals. © The Author(s) 2016.

Supplementary contribution payable to the health insurance scheme for the spouse's coverage

CERN Multimedia

Human Resources Department

2005-01-01

Staff Members, Fellows and Pensioners are reminded that any change in the marital status of members of the personnel, as well as any change in the spouse's income or health insurance cover, shall be notified in writing to CERN, within 30 calendar days of the change, in accordance with Article R IV 1.17 of the Staff Regulations. Such changes may have consequences on the conditions of the spouse's affiliation to the CERN Health Insurance Scheme (CHIS) or on the payment of the supplementary contribution to the CHIS for the coverage of the spouse. Changes to the rules and simplification to the system are currently being prepared and should be operational by mid-2005. Meanwhile from 1.1.2005, for the following income brackets, the indexed amounts in Swiss francs of the monthly supplementary contribution are: more than 30'000 CHF and up to 50'000 CHF: 134.- more than 50'000 CHF and up to 90'000 CHF: 234.- more than 90'000 CHF and up to 130'000 CHF: 369.- more than 130'000 CHF: 459.- It is in the member o...

Employer-provided health insurance and the incidence of job lock: a literature review and empirical test.

Science.gov (United States)

Rashad, Inas; Sarpong, Eric

2008-12-01

The incidence of 'job lock' in the health insurance context has long been viewed as a potential problem with employer-provided health insurance, a concept that was instrumental in the passage of the United States Consolidated Omnibus Budget Reconciliation Act of 1986, and later, the Health Insurance Portability and Accountability Act in 1996. Several recent developments in healthcare in the USA include declining healthcare coverage and a noticeable shift in the burden of medical care costs to employees. If these developments cause employees with employer-provided health insurance to feel locked into their jobs, optimal job matches in the labor force may not take place. A summary of the seminal papers in the current literature on the topic of job lock is given, followed by an empirical exercise using single individuals from the National Health Interview Survey (1997-2003) and the 1979 cohort of the National Longitudinal Survey of Youth (1989-2000). Econometric methods used include difference in differences, ordinary least squares and individual fixed effects models, in gauging the potential effect that employer-provided health insurance may have on job tenure and voluntary job departure. Our findings are consistent with recent assertions that there is some evidence of job lock. Individuals with employer-provided health insurance stay on the job 16% longer and are 60% less likely to voluntarily leave their jobs than those with insurance that is not provided by their employers. Productivity may not be optimal if incentives are altered owing to the existence of fringe benefits, such as health insurance. Further research in this area should determine whether legislation beyond the Consolidated Omnibus Budget Reconciliation Act and Health Insurance Portability and Accountability Act laws is needed.

Dealing with drought in irrigated agriculture through insurance schemes: an application to an irrigation district in Southern Spain

Energy Technology Data Exchange (ETDEWEB)

Ruiz, M.; Bielza, J.; Garrido, A.; Iglesias, A.

2015-07-01

Hydrological drought is expected to have an increasing impact on both crop and fruit yields in arid and semi-arid regions. Some existing crop insurance schemes provide coverage against water deficits in rain-fed agriculture. The Prevented Planting Program in the USA covers against drought for irrigated agriculture. However, drought insurance for irrigated agriculture is still a challenge for companies and institutions because of the complexity of the design and implementation of this type of insurance. Few studies have attempted to evaluate the risk of loss due to irrigation water scarcity using both stand-alone production functions and crop simulation models. This paper’s contributions are that it evaluates the suitability of AquaCrop for calculating drought insurance premiums for irrigated agriculture and that it discusses contract conditions and insurance design for hydrological drought risk coverage as part of a traditional insurance product, with on-field loss assessment in combination with a trigger index. This method was applied to an irrigation district in southern Spain. Our insurance premium calculation showed that it is feasible to apply this method provided that its data requirements are met, such as a large enough set of reliable small-scale yield and irrigation time series data, especially soil data, to calibrate AquaCrop. The choice of a trigger index should not be underestimated because it proved to have a decisive influence on insurance premiums and indemnities. Our discussion of the contract conditions shows that hydrological drought insurance must comply with a series of constraints in order to avoid moral hazard and basis risk. (Author)

Dealing with drought in irrigated agriculture through insurance schemes: an application to an irrigation district in Southern Spain

Directory of Open Access Journals (Sweden)

Jorge Ruiz

2015-12-01

Full Text Available Hydrological drought is expected to have an increasing impact on both crop and fruit yields in arid and semi-arid regions. Some existing crop insurance schemes provide coverage against water deficits in rain-fed agriculture. The Prevented Planting Program in the USA covers against drought for irrigated agriculture. However, drought insurance for irrigated agriculture is still a challenge for companies and institutions because of the complexity of the design and implementation of this type of insurance. Few studies have attempted to evaluate the risk of loss due to irrigation water scarcity using both stand-alone production functions and crop simulation models. This paper’s contributions are that it evaluates the suitability of AquaCrop for calculating drought insurance premiums for irrigated agriculture and that it discusses contract conditions and insurance design for hydrological drought risk coverage as part of a traditional insurance product, with on-field loss assessment in combination with a trigger index. This method was applied to an irrigation district in southern Spain. Our insurance premium calculation showed that it is feasible to apply this method provided that its data requirements are met, such as a large enough set of reliable small-scale yield and irrigation time series data, especially soil data, to calibrate AquaCrop. The choice of a trigger index should not be underestimated because it proved to have a decisive influence on insurance premiums and indemnities. Our discussion of the contract conditions shows that hydrological drought insurance must comply with a series of constraints in order to avoid moral hazard and basis risk.

What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries? A Systematic Review and Meta-Analysis.

Directory of Open Access Journals (Sweden)

David Mark Dror

Full Text Available This research article reports on factors influencing initial voluntary uptake of community-based health insurance (CBHI schemes in low- and middle-income countries (LMIC, and renewal decisions.Following PRISMA protocol, we conducted a comprehensive search of academic and gray literature, including academic databases in social science, economics and medical sciences (e.g., Econlit, Global health, Medline, Proquest and other electronic resources (e.g., Eldis and Google scholar. Search strategies were developed using the thesaurus or index terms (e.g., MeSH specific to the databases, combined with free text terms related to CBHI or health insurance. Searches were conducted from May 2013 to November 2013 in English, French, German, and Spanish. From the initial search yield of 15,770 hits, 54 relevant studies were retained for analysis of factors influencing enrolment and renewal decisions. The quantitative synthesis (informed by meta-analysis and the qualitative analysis (informed by thematic synthesis were compared to gain insight for an overall synthesis of findings/statements.Meta-analysis suggests that enrolments in CBHI were positively associated with household income, education and age of the household head (HHH, household size, female-headed household, married HHH and chronic illness episodes in the household. The thematic synthesis suggests the following factors as enablers for enrolment: (a knowledge and understanding of insurance and CBHI, (b quality of healthcare, (c trust in scheme management. Factors found to be barriers to enrolment include: (a inappropriate benefits package, (b cultural beliefs, (c affordability, (d distance to healthcare facility, (e lack of adequate legal and policy frameworks to support CBHI, and (f stringent rules of some CBHI schemes. HHH education, household size and trust in the scheme management were positively associated with member renewal decisions. Other motivators were: (a knowledge and understanding of

What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries? A Systematic Review and Meta-Analysis

Science.gov (United States)

Hossain, S. A. Shahed; Pérez Koehlmoos, Tracey Lynn; John, Denny

2016-01-01

Introduction This research article reports on factors influencing initial voluntary uptake of community-based health insurance (CBHI) schemes in low- and middle-income countries (LMIC), and renewal decisions. Methods Following PRISMA protocol, we conducted a comprehensive search of academic and gray literature, including academic databases in social science, economics and medical sciences (e.g., Econlit, Global health, Medline, Proquest) and other electronic resources (e.g., Eldis and Google scholar). Search strategies were developed using the thesaurus or index terms (e.g., MeSH) specific to the databases, combined with free text terms related to CBHI or health insurance. Searches were conducted from May 2013 to November 2013 in English, French, German, and Spanish. From the initial search yield of 15,770 hits, 54 relevant studies were retained for analysis of factors influencing enrolment and renewal decisions. The quantitative synthesis (informed by meta-analysis) and the qualitative analysis (informed by thematic synthesis) were compared to gain insight for an overall synthesis of findings/statements. Results Meta-analysis suggests that enrolments in CBHI were positively associated with household income, education and age of the household head (HHH), household size, female-headed household, married HHH and chronic illness episodes in the household. The thematic synthesis suggests the following factors as enablers for enrolment: (a) knowledge and understanding of insurance and CBHI, (b) quality of healthcare, (c) trust in scheme management. Factors found to be barriers to enrolment include: (a) inappropriate benefits package, (b) cultural beliefs, (c) affordability, (d) distance to healthcare facility, (e) lack of adequate legal and policy frameworks to support CBHI, and (f) stringent rules of some CBHI schemes. HHH education, household size and trust in the scheme management were positively associated with member renewal decisions. Other motivators were: (a

Insurance Salespeople's Attitudes towards Collusion: The Case of Taiwan’s Car Insurance Industry

OpenAIRE

Lu-Ming Tseng; Wen-Pin Su

2014-01-01

Insurance researchers believe that the increase in insurance fraud may be associated with the unethical decisions made by some insurance salespeople. However, to date, research that has empirically investigated the link between insurance salespeople and collusion is scant. Using the car insurance industry in Taiwan as an example, this paper explores the impact of the opportunity to obtain the fraudulent claim and that of the size of actual loss on car insurance salespeople's attitudes towards...

Assessing responsiveness of health care services within a health insurance scheme in Nigeria: users' perspectives.

Science.gov (United States)

Mohammed, Shafiu; Bermejo, Justo Lorenzo; Souares, Aurélia; Sauerborn, Rainer; Dong, Hengjin

2013-12-01

Responsiveness of health care services in low and middle income countries has been given little attention. Despite being introduced over a decade ago in many developing countries, national health insurance schemes have yet to be evaluated in terms of responsiveness of health care services. Although this responsiveness has been evaluated in many developed countries, it has rarely been done in developing countries. The concept of responsiveness is multi-dimensional and can be measured across various domains including prompt attention, dignity, communication, autonomy, choice of provider, quality of facilities, confidentiality and access to family support. This study examines the insured users' perspectives of their health care services' responsiveness. This retrospective, cross-sectional survey took place between October 2010 and March 2011. The study used a modified out-patient questionnaire from a responsiveness survey designed by the World Health Organization (WHO). Seven hundred and ninety six (796) enrolees, insured for more than one year in Kaduna State-Nigeria, were interviewed. Generalized ordered logistic regression was used to identify factors that influenced the users' perspectives on responsiveness to health services and quantify their effects. Communication (55.4%), dignity (54.1%), and quality of facilities (52.0%) were rated as "extremely important" responsiveness domains. Users were particularly contented with quality of facilities (42.8%), dignity (42.3%), and choice of provider (40.7%). Enrolees indicated lower contentment on all other domains. Type of facility, gender, referral, duration of enrolment, educational status, income level, and type of marital status were most related with responsiveness domains. Assessing the responsiveness of health care services within the NHIS is valuable in investigating the scheme's implementation. The domains of autonomy, communication and prompt attention were identified as priority areas for action to improve

[Occupational health services as the insurance product and insurance economic instruments].

Science.gov (United States)

Rydlewska-Liszkowska, Izabela

2014-01-01

One of the most controversial issues in restructuring the Polish health insurance system is the implementation of private voluntary insurance and creation within it a new insurance product known as occupational health services (OHS). In this article some opportunities and dilemmas likely to be faced by providers and employers/employees, when contracting with insurance institutions, are considered as a contribution to the discussion on private insurance in Poland. The basic question is how private insurance institutions could influence the promotion of different preventive activities at the company level by motivating both OHS providers and employers. The descriptive qualitative method has been applied in the analysis of legal acts, scientific publications selected according to keywords (Pubmed), documents and expert evaluations and research project results. Taking into account the experiences of European countries, described in publications, international experts' opinions and results of research projects the solution proposed in Poland could be possible under the following several prerequisites: inclusion of a full scope of occupational health services into the insurance product, constant supervision of occupational medicine professionals, monitoring of the health care quality and the relations between private insurers and OHS provider and implementation of the economic incentives scheme to ensure an adequate position of OHS providers on the market. The proposed reconstruction of the health insurance system, comprising undoubtedly positive elements, may entail some threats in the area of health, organization and economy. Private voluntary health insurance implementation requires precisely defined solutions concerning the scope of insurance product, motivation scheme and information system.

Assessment of National Health Insurance Scheme's (NHIS) Effectiveness in a Tertiary Teaching Hospital in Southeast Nigeria

OpenAIRE

N. Ele Grace; O. Ogbonna Brian; M. Ochei Uche; U. Odili Valentine

2017-01-01

Background: The fundamental concept of health insurance is risk sharing and burden bearing. The scheme is undermined by limitations ranging from very frequent use of the services more than necessary by enrollees, to cost escalation, poor management, and skimming. Assessment of services is a quality control measure in patients’ care and service delivery. It helps to identify gaps for improvement of care and services. Objective: This study assessed the effectiveness of NHIS from the perspec...

On the management of life insurance company risk by strategic choice of product mix, investment strategy and surplus appropriation schemes

DEFF Research Database (Denmark)

Bohnert, Alexander; Gatzert, Nadine; Jørgensen, Peter Løchte

2015-01-01

The aim of this paper is to analyze the impact of management’s strategic choice of asset and liability composition in life insurance on shortfall risk and the shareholders’ fair risk charge. In contrast to previous work, we focus on the effectiveness of management decisions regarding the product...... mix and the riskiness of the asset side under different surplus appropriation schemes. We propose a model setting that comprises temporary life annuities and endowment insurance contracts. Our numerical results show that the effectiveness of management decisions in regard to risk reduction strongly...

Equitable access to health insurance for socially excluded children? The case of the National Health Insurance Scheme (NHIS) in Ghana.

Science.gov (United States)

Williams, Gemma A; Parmar, Divya; Dkhimi, Fahdi; Asante, Felix; Arhinful, Daniel; Mladovsky, Philipa

2017-08-01

To help reduce child mortality and reach universal health coverage, Ghana extended free membership of the National Health Insurance Scheme (NHIS) to children (under-18s) in 2008. However, despite the introduction of premium waivers, a substantial proportion of children remain uninsured. Thus far, few studies have explored why enrolment of children in NHIS may remain low, despite the absence of significant financial barriers to membership. In this paper we therefore look beyond economic explanations of access to health insurance to explore additional wider determinants of enrolment in the NHIS. In particular, we investigate whether social exclusion, as measured through a sociocultural, political and economic lens, can explain poor enrolment rates of children. Data were collected from a cross-sectional survey of 4050 representative households conducted in Ghana in 2012. Household indices were created to measure sociocultural, political and economic exclusion, and logistic regressions were conducted to study determinants of enrolment at the individual and household levels. Our results indicate that socioculturally, economically and politically excluded children are less likely to enrol in the NHIS. Furthermore, households excluded in all dimensions were more likely to be non-enrolled or partially-enrolled (i.e. not all children enrolled within the household) than fully-enrolled. These results suggest that equity in access for socially excluded children has not yet been achieved. Efforts should be taken to improve coverage by removing the remaining small, annually renewable registration fee, implementing and publicising the new clause that de-links premium waivers from parental membership, establishing additional scheme administrative offices in remote areas, holding regular registration sessions in schools and conducting outreach sessions and providing registration support to female guardians of children. Ensuring equitable access to NHIS will contribute substantially

DENSITY AND PENETRATION INSURANCE ON ACCIDENT & HEALTH PREMIUMS IN FUTURE IMPLEMENTATION OF SOLVENCY II – EMPIRICAL STUDY

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PODOABÃ LUCIA

2015-04-01

Full Text Available The purpose of this paper is to present an empirical study regarding density and penetrat ion on accident & health premiums. At the beginning, we have presented the motivations of this research, highlighting and explaining the specific factors which influence the density and insurance penetration. Implementation of Solvency Directive at European level, in the field of insurance is through specific consequences. The changes made to accounting legislation at national, European and international level, with consequences on specific information presented in the financial statements of insurance companies, was another reason of our research. The appearance of the IFRS 4 "Insurance contracts", followed by its evolution phases allowed the creation of XBRL's in as the international standard of publication, exchange and financial analysis of data reported . Also, we cannot forget that the legislative changes in accounting have interesting consequences on economic risk management specific to this field, in terms of huge efforts from national and European supervisory authorities to control and prevent the ban kruptcy of its firms. For planning and implementation of supervisors’ measures, the important tasks were established by the quantitative impact studies, the stress tests and the analyses of different scenarios, all performed in insurance companies. Thus, w e conduct an analysis on a sample of 32 countries and a horizon of 10 years (2004 -2013, being tested 2 linear regression models. The results will confirm the link between level of economic development and accident & health insurance activity, but exclude the relationship between penetration factor and this type of insurance

Affiliation of the beneficiaries of a deferred pension to the CERN Health Insurance Scheme

CERN Multimedia

2003-01-01

Subsequent to the modifications to the Rules and Regulations of the Pension Fund allowing members of the personnel having five years of affiliation to the Fund to opt for a deferred retirement pension, the Organization wishes to recall the rules relating to the affiliation of those beneficiaries to the CERN Health Insurance Scheme (CHIS). In accordance with Articles III 2.02 and VIII 4.02 of the CHIS Rules, beneficiaries of a deferred retirement pension can only be Members of the CHIS as CERN pensioners if they applied to remain Members of the Scheme upon termination of their compulsory membership as a member of the personnel and if their membership has been uninterrupted up to the moment they become CERN pensioners. The applicable contribution for this intermediate period is indicated in Articles III 5.03 and X 1.02 of the CHIS Rules. The amount is revised annually, and is set at 936 CHF/ month for 2003. Human Resources Division Tel. 73635

Supplementary contribution for spouses and registered partners payable to the health insurance scheme

CERN Multimedia

HR Department

2009-01-01

Staff members, fellows and pensioners are reminded that they must notify CERN of any change in their marital status and any change in the income or health insurance cover of their spouse or registered partner, in writing and within 30 calendar days of the change, in accordance with Articles III 6.01 to 6.03 of the Rules of the CERN Health Insurance Scheme (CHIS). Such changes may affect the conditions of the spouse or registered partner’s membership of the CHIS or the payment of the supplementary contribution to the CHIS. For more information see: http://cern.ch/chis/contribsupp.asp From 1.1.2009 onwards, the following indexed monthly supplementary contributions, expressed in Swiss francs, are payable for the various monthly income brackets: •\tmore than 2’500 CHF and up to 4’250 CHF: 134.- •\tmore than 4’250 CHF and up to 7’500 CHF: 234.- •\tmore than 7’500 CHF and up to 10’000 CHF: 369.- •\tmore than 10’000 CHF: 485.- It is in the member of...

REMINDER: SUPPLEMENTARY CONTRIBUTION PAYABLE TO THE HEALTH INSURANCE SCHEME FOR THE SPOUSE'S COVERAGE

CERN Document Server

2003-01-01

Staff Members, Fellows and Pensioners are reminded that any change in the marital status of members of the personnel, as well as any change in the spouse's income or health insurance cover, shall be notified in writing to CERN, within 30 calendar days of the change, in accordance with Article R IV 1.17 of the Staff Regulations. Such changes may have consequences on the conditions of the spouse's affiliation to the CERN Health Insurance Scheme (CHIS) or on the payment of the supplementary contribution to the CHIS for the coverage of the spouse. In 2003, for the following income brackets, the indexed amounts in Swiss francs of the supplementary contribution are : - more than 30'000 CHF and up to 50'000 CHF: 134.- - more than 50'000 CHF and up to 90'000 CHF: 234.- - more than 90'000 CHF and up to 130'000 CHF: 369.- - more than 130'000 CHF: 468.- It is in the member of the personnel's interest to declare as soon as possible a change in the annual income of his spouse in order that the contribution is adjusted w...

National health insurance scheme: Are the artisans benefitting in Lagos state, Nigeria?

Directory of Open Access Journals (Sweden)

Princess C Campbell

2016-01-01

Full Text Available Background: Health insurance (HI can serve as a vital risk protection for families and small businesses and also increase access to priority health services. This study determined the knowledge, attitude of artisans toward HI as well as their health-seeking pattern and willingness to join the HI scheme. Methodology: This descriptive cross-sectional survey used a multistage sampling technique to recruit 260 participants, using self-designed, pretested, interviewer-administered questionnaire. Data were analyzed using Epi-info version 7.0. Chi-square test, Fisher′s exact test, and logistic regression were used for associations; the level of significance was set at 5%. Results: The respondents were predominantly male, i.e., 195 (75.0%, with a mean age of 32.36 + 6.20 years and mean income of N 29,000 + 5798.5 ($1 ~ N 161. Majority of the respondents, i.e., 226 (86.9% were not aware of HI. The overall knowledge was poor (6.5% and the main source of information was through radio/television (41.2%. Nearly, half of the respondents (33 out of 67 identified the concept of HI as a pool of contributors′ fund for only healthcare service. A high proportion of the respondents (27 out of 34 were aware of the benefits of HI, although majority, i.e., 27 (79.4% identified access to medication as the benefit. The majority of the respondents, i.e., 228 (87.7% expressed negative attitude toward the scheme; however, 76.5% were willing to join the HI scheme. Conclusion: The artisans had low awareness/poor knowledge of HI which translated to a negative attitude toward the scheme. There is need for an aggressive stakeholders′ enlightenment campaign for increasing coverage.

Modifications to the Rules of the CERN Health Insurance Scheme (CHIS) on 1 January 2012

CERN Multimedia

HR Department

2011-01-01

Following the 2010 five-yearly review of the financial and social conditions of the members of the personnel, the Council decided to make a number of changes to the contributions to the CERN Health Insurance Scheme and to authorise the Director-General to take timely measures to limit the increase of CHIS expenses by encouraging the use of health care providers and treatments which provide the best quality-to-cost ratio. These decisions are intended to allow the general level of cover to be maintained in the future.   The CERN Health Insurance Supervisory Board subsequently gave careful consideration to measures which would not only allow costs to be contained but would also ensure a fairer distribution of benefits while simultaneously providing greater protection for those suffering from serious health problems and hence having to face substantial expenses. On the proposal of the CHIS Board, and following examination by the Standing Concertation Committee at its meetings on 27 April and 1 Septe...

A Hierarchical Agency Model of Deposit Insurance

OpenAIRE

Jonathan Carroll; Shino Takayama

2010-01-01

This paper develops a hierarchical agency model of deposit insurance. The main purpose is to undertake a game theoretic analysis of the consequences of deposit insurance schemes and their effects on monitoring incentives for banks. Using this simple framework, we analyze both risk- independent and risk-dependent premium schemes along with reserve requirement constraints. The results provide policymakers with not only a better understanding of the effects of deposit insurance on welfare and th...

The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana.

Science.gov (United States)

Dalinjong, Philip Ayizem; Laar, Alexander Suuk

2012-07-23

Prepayments and risk pooling through social health insurance has been advocated by international development organizations. Social health insurance is seen as a mechanism that helps mobilize resources for health, pool risk, and provide more access to health care services for the poor. Hence Ghana implemented the National Health Insurance Scheme (NHIS) to help promote access to health care services for Ghanaians. The study examined the influence of the NHIS on the behavior of health care providers in their treatment of insured and uninsured clients. The study took place in Bolgatanga (urban) and Builsa (rural) districts in Ghana. Data was collected through exit survey with 200 insured and uninsured clients, 15 in-depth interviews with health care providers and health insurance managers, and 8 focus group discussions with insured and uninsured community members. The NHIS promoted access for insured and mobilized revenue for health care providers. Both insured and uninsured were satisfied with care (survey finding). However, increased utilization of health care services by the insured leading to increased workloads for providers influenced their behavior towards the insured. Most of the insured perceived and experienced long waiting times, verbal abuse, not being physically examined and discrimination in favor of the affluent and uninsured. The insured attributed their experience to the fact that they were not making immediate payments for services. A core challenge of the NHIS was a delay in reimbursement which affected the operations of health facilities and hence influenced providers' behavior as well. Providers preferred clients who would make instant payments for health care services. Few of the uninsured were utilizing health facilities and visit only in critical conditions. This is due to the increased cost of health care services under the NHIS. The perceived opportunistic behavior of the insured by providers was responsible for the difference in the behavior

Insured without moral hazard in the health care reform of China.

Science.gov (United States)

Wong, Chack-Kie; Cheung, Chau-Kiu; Tang, Kwong-Leung

2012-01-01

Public insurance possibly increases the use of health care because of the insured person's interest in maximizing benefits without incurring out-of-pocket costs. A newly reformed public insurance scheme in China that builds on personal responsibility is thus likely to provide insurance without causing moral hazard. This possibility is the focus of this study, which surveyed 303 employees in a large city in China. The results show that the coverage and use of the public insurance scheme did not show a significant positive effect on the average employee's frequency of physician consultation. In contrast, the employee who endorsed public responsibility for health care visited physicians more frequently in response to some insurance factors. On balance, public insurance did not tempt the average employee to consult physicians frequently, presumably due to personal responsibility requirements in the insurance scheme.

An empirical comparison of alternative schemes for combining electricity spot price forecasts

International Nuclear Information System (INIS)

Nowotarski, Jakub; Raviv, Eran; Trück, Stefan; Weron, Rafał

2014-01-01

In this comprehensive empirical study we critically evaluate the use of forecast averaging in the context of electricity prices. We apply seven averaging and one selection scheme and perform a backtesting analysis on day-ahead electricity prices in three major European and US markets. Our findings support the additional benefit of combining forecasts of individual methods for deriving more accurate predictions, however, the performance is not uniform across the considered markets and periods. In particular, equally weighted pooling of forecasts emerges as a simple, yet powerful technique compared with other schemes that rely on estimated combination weights, but only when there is no individual predictor that consistently outperforms its competitors. Constrained least squares regression (CLS) offers a balance between robustness against such well performing individual methods and relatively accurate forecasts, on average better than those of the individual predictors. Finally, some popular forecast averaging schemes – like ordinary least squares regression (OLS) and Bayesian Model Averaging (BMA) – turn out to be unsuitable for predicting day-ahead electricity prices. - Highlights: • So far the most extensive study on combining forecasts for electricity spot prices • 12 stochastic models, 8 forecast combination schemes and 3 markets considered • Our findings support the additional benefit of combining forecasts for deriving more accurate predictions • Methods that allow for unconstrained weights, such as OLS averaging, should be avoided • We recommend a backtesting exercise to identify the preferred forecast averaging method for the data at hand

REMINDER CONCERNING THE SUPPLEMENTARY CONTRIBUTION PAYABLE TO THE HEALT INSURANCE SCHEME FOR SPOUSE COVERAGE

CERN Multimedia

Human Resources Division

2002-01-01

Staff members, fellows and pensioners are reminded that any change in the marital status of members of the personnel, as well as any change in the spouse's income or health insurance cover, shall be notified in writing to CERN, within 30 calendar days of the change, in accordance with Article R IV 1.17 of the Staff Regulations. Such changes may have consequences on the affiliation of the spouse to the CERN Health Insurance Scheme (CHIS) or on the payment of the supplementary contribution to the CHIS for the coverage of the spouse. In 2002, for the following income brackets, the indexed amounts in Swiss francs of the supplementary contribution are:   more than 30'000 CHF and up to 50'000 CHF: 134.- more than 50'000 CHF and up to 90'000 CHF: 234.- more than 90'000 CHF and up to 130'000 CHF: 369.- more than 130'000 CHF: 461.- It is in the member of the personnel's interest to declare a change in the annual income of his/her spouse as soon as possible in order to adjust contributions with the m...

Reducing medical claims cost to Ghana?s National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews

OpenAIRE

Nsiah-Boateng, Eric; Asenso-Boadi, Francis; Dsane-Selby, Lydia; Andoh-Adjei, Francis-Xavier; Otoo, Nathaniel; Akweongo, Patricia; Aikins, Moses

2017-01-01

Background A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana. Methods The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested fr...

Exposure as Duration and Distance in Telematics Motor Insurance Using Generalized Additive Models

Directory of Open Access Journals (Sweden)

Jean-Philippe Boucher

2017-09-01

Full Text Available In Pay-As-You-Drive (PAYD automobile insurance, the premium is fixed based on the distance traveled, while in usage-based insurance (UBI the driving patterns of the policyholder are also considered. In those schemes, drivers who drive more pay a higher premium compared to those with the same characteristics who drive only occasionally, because the former are more exposed to the risk of accident. In this paper, we analyze the simultaneous effect of the distance traveled and exposure time on the risk of accident by using Generalized Additive Models (GAM. We carry out an empirical application and show that the expected number of claims (1 stabilizes once a certain number of accumulated distance-driven is reached and (2 it is not proportional to the duration of the contract, which is in contradiction to insurance practice. Finally, we propose to use a rating system that takes into account simultaneously exposure time and distance traveled in the premium calculation. We think that this is the trend the automobile insurance market is going to follow with the eruption of telematics data.

HEALTH INSURANCE

CERN Multimedia

2000-01-01

The CERN-AUSTRIA Agreement, which implemented CERN's health insurance scheme, expired on 31 December 1999.In accordance with CERN's rules, a call for tenders for the management of the health insurance scheme was issued and the contract was once again awarded to AUSTRIA. In June 1999, the Finance Committee thus authorised the Management to conclude a new contract with AUSTRIA, which came into force on 1st January 2000.Continuity is thus assured on favourable conditions and the transition from one contract to the other will entail no substantial changes in the system for those insured at CERN except for a few minor and purely formal amendmentsWHAT REMAINS UNCHANGEDThe list of benefits, i.e. the 'cover' provided by the system, is not changed;Neither is the reimbursement procedure.AUSTRIA's office at CERN and its opening hours as well as its city headquarters remain the same. The envelopes containing requests for reimbursement have had to be sent (since the end of 1998) to :Rue des Eaux-Vives 94Case postale 64021...

An Empirical Study on User-oriented Association Analysis of Library Classification Schemes

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Hsiao-Tieh Pu

2002-12-01

Full Text Available Library classification schemes are mostly organized based on disciplines with a hierarchical structure. From the user point of view, some highly related yet non-hierarchical classes may not be easy to perceive in these schemes. This paper is to discover hidden associations between classes by analyzing users’ usage of library collections. The proposed approach employs collaborative filtering techniques to discover associated classes based on the circulation patterns of similar users. Many associated classes scattered across different subject hierarchies could be discovered from the circulation patterns of similar users. The obtained association norms between classes were found to be useful in understanding users' subject preferences for a given class. Classification schemes can, therefore, be made more adaptable to changes of users and the uses of different library collections. There are implications for applications in information organization and retrieval as well. For example, catalogers could refer to the ranked associated classes when they perform multi-classification, and users could also browse the associated classes for related subjects in an enhanced OPAC system. In future research, more empirical studies will be needed to validate the findings, and methods for obtaining user-oriented associations can still be improved.[Article content in Chinese

What factors affect voluntary uptake of community-based health insurance schemes in low- and middle-income countries? A systematic review and meta-analysis

NARCIS (Netherlands)

D.M. Dror (David); Shahed Hossain, S.A.; M. Majumdar (Manabi); Koehlmoos, T.L.P. (Tracey Lynn Pérez); John, D. (Denny); P. Panda (Pradeep)

2016-01-01

textabstractIntroduction: This research article reports on factors influencing initial voluntary uptake of community-based health insurance (CBHI) schemes in low- and middle-income countries (LMIC), and renewal decisions. Methods: Following PRISMA protocol, we conducted a comprehensive search of

Risk factors for oral diseases among workers with and without dental insurance in a national social security scheme in India.

Science.gov (United States)

Singh, Abhinav; Purohit, Bharathi M; Masih, Nitin; Kahndelwal, Praveen Kumar

2014-04-01

The target population for this cross sectional study comprises subjects with and without social security in a national social security scheme. The study aimed to compare and assess the risk factors for oral diseases among insured (organised sector) and non-insured workers (unorganised sector) in New Delhi, India. The sample comprised a total of 2,752 subjects. Of these, 960 workers belonged to the formal or organised sector with a social security and dental health insurance and 1,792 had no social security or dental insurance from the informal or unorganised sector. Significant differences were noted between the two groups for literacy levels, between-meal sugar consumption, tobacco-related habits and utilisation of dental care. Bleeding/calculus and periodontal pockets were present among 25% and 65.4% of insured workers, respectively. Similarly, 13.6% and 84.5% of non-insured workers had bleeding/calculus and periodontal pockets, respectively. The mean DMFT (decayed, missing, filled teeth) value among the insured workers and non-insured workers was 3.27 ± 1.98 and 3.75 ± 1.80, respectively. The association between absence of health insurance and dental caries was evident with an odds ratio (OR) of 1.94. Subjects with below graduate education were more prone to dental caries (OR = 1.62). Subjects who cleaned their teeth two or more times a day were less likely to have dental caries (OR = 1.47). Utilisation of dental care was inversely related to dental caries (OR = 1.25). The major risk factors for oral diseases in both the groups with similar socio-economic status were the lack of social security and health insurance, low literacy levels, high tobacco consumption and low levels of dental care utilisation. © 2013 FDI World Dental Federation.

Value and Service Quality Assessment of the National Health Insurance Scheme in Ghana: Evidence from Ashiedu Keteke District.

Science.gov (United States)

Nsiah-Boateng, Eric; Aikins, Moses; Asenso-Boadi, Francis; Andoh-Adjei, Francis-Xavier

2016-09-01

Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to provide financial access to health care for all residents. This article analyzed claims reimbursement data of the NHIS to assess the value of the benefit package to the insured and responsiveness of the service to the financial needs of health services providers. Medical claims data reported between January 1, 2010, and December 31, 2014, were retrieved from the database of Ashiedu Keteke District Office of the National Health Insurance Authority. The incurred claims ratio, promptness of claims settlements, and claims adjustment rate were analyzed over the 5-year period. In all, 644,663 medical claims with a cost of Ghana cedi (GHS) 11.8 million (US $3.1 million) were reported over the study period. The ratio of claims cost to contributions paid increased from 4.3 to 7.2 over the 2011-2013 period, and dropped to 5.0 in 2014. The proportion of claims settled beyond 90 days also increased from 26% to 100% between 2011 and 2014. Generally, the amount of claims adjusted was low; however, it increased consistently from 1% to about 4% over the 2011-2014 period. The reasons for claims adjustments included provision of services to ineligible members, overbilling of services, and misapplication of diagnosis related groups. There is increased value of the NHIS benefit package to subscribers; however, the scheme's responsiveness to the financial needs of health services providers is low. This calls for a review of the NHIS policy to improve financial viability and service quality. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Corporate insurance and debt capacity: Empirical evidence from Italy

Directory of Open Access Journals (Sweden)

Fabrizio Santoboni

2012-11-01

Full Text Available In banks/enterprises relationships a key role is played by Basel II Framework, which accurately correlates banks’ capital requirement to risks, by stimulating a more precise creditworthiness assessment. As known, the containment of risks inherent in bank financing can be carried out ex ante, through an adequate screening, which allows the proper assessment of enterprises’ economic and financial situation and a sound composition of the total loan portfolio, and ex post, through guarantees, which allow benefiting from a loss reduction only after insolvency has occurred. From this perspective, Basel II Framework brings important changes, since life insurance and surety policy are “eligible” guarantees for Credit Risk Mitigation. Nevertheless, banks could offer a better pricing to borrowers not because they are less risky, but because the whole operation would need a lower capital requirement. Therefore, corporate risks reduction – which would allow, in the absence of credit rationing, a more profitable debt capacity – is necessarily achieved through an appropriate “umbrella insurance”, able to cope with both direct and indirect loss. This work aims at investigating the existence of a “virtuous” relationship among corporate insurance purchases, credit risk and debt capacity. Such aim has been pursued through different steps: review of literature, to identify the reasons of corporate demand for insurance; analysis of Italian enterprises’ corporate insurance purchases; drafting of a questionnaire, to submit to a sample of the main insurance companies working in Italy, intended to identify what kind of role they play in the relation with enterprises and which insurance products they offer; drafting of a questionnaire, to submit to a sample of the main banks working in Italy, intended to investigate whether and how the possession of corporate insurance is taken into consideration in the determination of enterprises�

Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage.

Science.gov (United States)

Nandi, Sulakshana; Schneider, Helen; Dixit, Priyanka

2017-01-01

Research on impact of publicly financed health insurance has paid relatively little attention to the nature of healthcare provision the schemes engage. India's National Health Insurance Scheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, public and private sectors provide hospital services in a context of extensive gender, social, economic and geographical inequities. This study examined enrolment, utilization (public and private) and out of pocket (OOP) expenditure for the insured and uninsured, in Chhattisgarh. The Chhattisgarh State Central sample (n = 6026 members) of the 2014 National Sample Survey (71st Round) on Health was extracted and analyzed. Variables of enrolment, hospitalization, out of pocket (OOP) expenditure and catastrophic expenditure were descriptively analyzed. Multivariate analyses of factors associated with enrolment, hospitalization (by sector) and OOP expenditure were conducted, taking into account gender, socio-economic status, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalization were 33/1000 population among the insured and 29/1000 among the uninsured. Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents, Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations. Although the insured were less likely to incur out of pocket (OOP) expenditure, 95.1% of insured private sector users and 66.0% of insured public sector users, still incurred costs. Median OOP payments in the private sector were eight times those in the public sector. Of households with at least one member hospitalized, 35.5% experienced catastrophic health expenditures (>10% monthly household consumption expenditure). The study finds that despite insurance coverage, the majority still incurred OOP expenditure. The public sector was nevertheless less expensive, and catered to the more vulnerable groups. It suggests the need to

National health insurance scheme: How receptive are the private healthcare practitioners in a local government area of Lagos state.

Science.gov (United States)

Christina, Campbell Princess; Latifat, Taiwo Toyin; Collins, Nnaji Feziechukwu; Olatunbosun, Abolarin Thaddeus

2014-11-01

National Health Insurance Scheme (NHIS) is one of the health financing options adopted by Nigeria for improved healthcare access especially to the low income earners. One of the key operators of the scheme is the health care providers, thus their uptake of the scheme is fundamental to the survival of the scheme. The study reviewed the uptake of the NHIS by private health care providers in a Local Government Area in Lagos State. To assess the uptake of the NHIS by private healthcare practitioners. This descriptive cross-sectional study recruited 180 private healthcare providers selected by multistage sampling technique with a response rate of 88.9%. Awareness, knowledge and uptake of NHIS were 156 (97.5%), 110 (66.8%) and 97 (60.6%), respectively. Half of the respondents 82 (51.3%) were dissatisfied with the operations of the scheme. Major reasons were failure of entitlement payment by Health Maintenance Organisations 13 (81.3%) and their incurring losses in participating in the scheme 8(50%). There was a significant association between awareness, level of education, knowledge of NHIS and registration into scheme by the respondents P-value NHIS were commendable among the private health care providers. Six out of 10 had registered with the NHIS but half of the respondents 82 (51.3%) were dissatisfied with the scheme and 83 (57.2%) regretted participating in the scheme. There is need to improve payment modalities and ensure strict adherence to laid down policies.

Prevalence and economic burden of cardiovascular diseases in France in 2013 according to the national health insurance scheme database.

Science.gov (United States)

Tuppin, Philippe; Rivière, Sébastien; Rigault, Alexandre; Tala, Stéphane; Drouin, Jérôme; Pestel, Laurence; Denis, Pierre; Gastaldi-Ménager, Christelle; Gissot, Claude; Juillière, Yves; Fagot-Campagna, Anne

2016-01-01

Cardiovascular diseases (CVDs) constitute the second leading cause of death in France. The Système national d'information interrégimes de l'assurance maladie (SNIIRAM; national health insurance information system) can be used to estimate the national medical and economic burden of CVDs. To describe the rates, characteristics and expenditure of people reimbursed for CVDs in 2013. Among 57 million general health scheme beneficiaries (86% of the French population), people managed for CVDs were identified using algorithms based on hospital diagnoses either during the current year (acute phase) or over the previous 5 years (chronic phase) and long-term diseases. The reimbursed costs attributable to CVDs were estimated. A total of 3.5 million people (mean age, 71 years; 42% women) were reimbursed by the general health scheme for CVDs (standardized rate, 6.5%; coronary heart disease, 2.7%; arrhythmias/conduction disorders, 2.1%; stroke, 1.1%; heart failure, 1.1%). These frequencies increased with age and social deprivation, and were higher in Northern and Eastern France and Réunion Island. The total sum reimbursed by all schemes for CVDs was € 15.1 billion (50% for hospital care and 43% for outpatient care [including 15% for drugs and 12% for nurses/physiotherapists]); coronary heart disease accounted for € 4 billion, stroke for € 3.5 billion and heart failure for € 2.5 billion (i.e. 10% of the total expenditure reimbursed by all national health insurance schemes for all conditions). CVDs constitute the leading group in terms of numbers of patients reimbursed and total reimbursed expenditure, despite a probable underestimation of both numbers and expenditure. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Publication Of Administrative Circulars: No. 4 (Rev. 4) – Unemployment Insurance Scheme No. 30 (Rev. 2) – Financial Benefits on Taking Up Appointment and on Termination of Contract

CERN Multimedia

HR Department

2008-01-01

Administrative Circular No. 4 (Rev. 4) – Unemployment insurance scheme Administrative Circular No. 4 (Rev. 4) – "Unemployment insurance scheme", approved following discussion in the Standing Concertation Committee meetings of 28 August 2007 and 27 February 2008, is now available on the intranet site of the Human Resources Department. It cancels and replaces Administrative Circular No. 4 (Rev. 3) – "Unemployment insurance" of October 1993. Copies will shortly be available in Departmental secretariats. Human Resources Department Tel. 78003 Administrative Circular No. 30 (Rev. 2) – Financial benefits on taking up appointment and termination of contract Administrative Circular No. 30 (Rev. 2) – "Financial benefits on taking up appointment and termination of contract", approved following discussion in the Standing Concertation Committee meetings of 28 August 2007 and 27 February 2008, is now available on the intranet site of the Human Resources De...

Publication Of Administrative Circulars: No. 4 (Rev. 4) – Unemployment Insurance Scheme No. 30 (Rev. 2) – Financial Benefits on Taking Up Appointment and on Termination of Contract

CERN Document Server

HR Department

2008-01-01

Administrative Circular No. 4 (Rev. 4) – Unemployment insurance scheme Administrative Circular No. 4 (Rev. 4) – "Unemployment insurance scheme", approved following discussion at the Standing Concertation Committee meetings of 28 August 2007 and 27 February 2008, is now available on the intranet site of the Human Resources Department. It cancels and replaces Administrative Circular No. 4 (Rev. 3) – "Unemployment insurance" of October 1993. Copies will shortly be available in Departmental secretariats. Human Resources Department Tel. 78003 Administrative Circular No. 30 (Rev. 2) – Financial benefits on taking up appointment and termination of contract Administrative Circular No. 30 (Rev. 2) – "Financial benefits on taking up appointment and termination of contract", approved following discussion at the Standing Concertation Committee meetings of 28 August 2007 and 27 February 2008, is now available on the intranet site of the Human Resources De...

Hospital-insurer bargaining: an empirical investigation of appendectomy pricing.

Science.gov (United States)

Brooks, J M; Dor, A; Wong, H S

1997-08-01

Employers' increased sensitivity to health care costs has forced insurers to seek ways to lower costs through effective bargaining with providers. What factors determine the prices negotiated between hospitals and insurers? The hospital-insurer interaction is captured in the context of a bargaining model, in which the gains from bargaining are explicitly defined. Appendectomy was chosen because it is a well-defined procedure with little clinical variation. Our results show that certain hospital institutional arrangements (e.g. hospital affiliations), HMO penetration, and greater hospital concentration improve hospitals' bargaining position. Furthermore, hospitals' bargaining effectiveness has diminished over time and varies across states.

Weak Form Efficiency of the Insurance Industry: Empirical Evidence from Nigeria

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Emenike Kalu Onwukwe

2018-02-01

Full Text Available This paper evaluated the insurance sector of Nigeria Stock Exchange (NSE for evidence weak-form efficiency using daily returns from January 2009 to February 2016. The study employs descriptive analysis, non-parametric runs test and autocorrelation function as well as Ljung-Box Q statistics in conducting the evaluation. Descriptive statistics of the insurance sector return series showed negative skewness and leptokurtic distribution. Estimates from the Jarque-Bera normality test showed that the insurance sector returns did not follow normal distribution. Results of the runs test reject null hypothesis of randomness in the return series of the insurance sector in the period studied. Furthermore, the autocorrelation functions and the Ljung-Box Q tests provide evidence of serial correlation in the stock returns of the insurance sector. Overall results from the study suggested that the insurance sector of NSE is not weak-form efficient. Consequently, technical analysis on the insurance sector of the NSE may not be fruitless.

Weak-form Efficiency of the Insurance Industry: Empirical Evidence from Nigeria

Directory of Open Access Journals (Sweden)

Emenike Kalu Onwukwe

2018-02-01

Full Text Available This paper evaluates the insurance sector of Nigeria Stock Exchange (NSE for evidence weak-form efficiency using daily returns from January 2009 to February 2016. The study employs descriptive analysis, non-parametric runs test and autocorrelation function as well as Ljung-Box Q statistics in conducting the evaluation. Descriptive statistics of the insurance sector return series show negative skewness and leptokurtic distribution. Estimates from the Jarque-Bera normality test show that the insurance sector returns do not follow a normal distribution. Results of the runs test reject the null hypothesis of randomness in the return series of the insurance sector in the period studied. Furthermore, the autocorrelation functions and the Ljung-Box Q tests provide evidence of serial correlation in the stock returns of the insurance sector. Overall results from the study suggest that the insurance sector of NSE is not weak-form efficient. Consequently, technical analysis on the insurance sector of the NSE may not be fruitless.

Benefit Reentitlement Conditions in Unemployment Insurance Schemes

DEFF Research Database (Denmark)

Andersen, Torben M.; Christoffersen, Mark Strøm; Svarer, Michael

and employment requirements are substitute instruments in affecting job search incentives and thus gross unemployment. We analyse the optimal design of the unemployment insurance system (benefit levels, duration and employment requirements) under a utilitarian social welfare function. Simulations show...

Firm performance and employment in the EU emissions trading scheme: An empirical assessment for Germany

International Nuclear Information System (INIS)

Anger, Niels; Oberndorfer, Ulrich

2008-01-01

This paper empirically investigates the role of the EU Emissions Trading Scheme (EU ETS) for firm performance and employment in Germany. We provide an overview of relative allowance allocation within the EU ETS as well as an econometric analysis for a large sample of German firms covered by the scheme in order to assess the impacts of EU emissions regulation on both firm revenues and employment. The dataset indicates that the EU ETS was in an overall long position in 2005, although allowance allocation was very heterogeneous across member states. Our econometric analysis suggests that, within the first phase of the EU ETS, relative allowance allocation did not have a significant impact on firm performance and employment of regulated German firms

Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China.

Science.gov (United States)

Wang, Hong; Zhang, Licheng; Yip, Winnie; Hsiao, William

2006-09-01

This study examines adverse selection in a subsidized voluntary health insurance scheme, the Rural Mutual Health Care (RMHC) scheme, in a poor rural area of China. The study was made possible by a unique longitudinal data set: the total sample includes 3492 rural residents from 1020 households. Logistic regression was employed for the data analysis. The results show that although this subsidized scheme achieved a considerable high enrollment rate of 71% of rural residents, adverse selection still exists. In general, individuals with worse health status are more likely to enroll in RMHC than individuals with better health status. Although the household is set as the enrollment unit for the RMHC for the purpose of reducing adverse selection, nearly 1/3 of enrolled households are actually only partially enrolled. Furthermore, we found that adverse selection mainly occurs in partially enrolled households. The non-enrolled individuals in partially enrolled households have the best health status, while the enrolled individuals in partially enrolled households have the worst health status. Pre-RMHC, medical expenditure for enrolled individuals in partially enrolled households was 206.6 yuan per capita per year, which is 1.7 times as much as the pre-RMHC medical expenditure for non-enrolled individuals in partially enrolled households. The study also reveals that the pre-enrolled medical expenditure per capita per year of enrolled individuals was 9.6% higher than the pre-enrolled medical expenditure of all residents, including both enrolled and non-enrolled individuals. In conclusion, although the subsidized RMHC scheme reached a very high enrollment rate and the household is set as the enrollment unit for the purpose of reducing adverse selection, adverse selection still exists, especially within partially enrolled households. Voluntary RMHC will not be financially sustainable if the adverse selection is not fully taken into account.

Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage.

Directory of Open Access Journals (Sweden)

Sulakshana Nandi

Full Text Available Research on impact of publicly financed health insurance has paid relatively little attention to the nature of healthcare provision the schemes engage. India's National Health Insurance Scheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, public and private sectors provide hospital services in a context of extensive gender, social, economic and geographical inequities. This study examined enrolment, utilization (public and private and out of pocket (OOP expenditure for the insured and uninsured, in Chhattisgarh. The Chhattisgarh State Central sample (n = 6026 members of the 2014 National Sample Survey (71st Round on Health was extracted and analyzed. Variables of enrolment, hospitalization, out of pocket (OOP expenditure and catastrophic expenditure were descriptively analyzed. Multivariate analyses of factors associated with enrolment, hospitalization (by sector and OOP expenditure were conducted, taking into account gender, socio-economic status, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalization were 33/1000 population among the insured and 29/1000 among the uninsured. Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents, Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations. Although the insured were less likely to incur out of pocket (OOP expenditure, 95.1% of insured private sector users and 66.0% of insured public sector users, still incurred costs. Median OOP payments in the private sector were eight times those in the public sector. Of households with at least one member hospitalized, 35.5% experienced catastrophic health expenditures (>10% monthly household consumption expenditure. The study finds that despite insurance coverage, the majority still incurred OOP expenditure. The public sector was nevertheless less expensive, and catered to the more vulnerable groups. It suggests

Reconciling research and implementation in micro health insurance experiments in India: study protocol for a randomized controlled trial

Directory of Open Access Journals (Sweden)

Doyle Conor

2011-10-01

Full Text Available Abstract Background Microinsurance or Community-Based Health Insurance is a promising healthcare financing mechanism, which is increasingly applied to aid rural poor persons in low-income countries. Robust empirical evidence on the causal relations between Community-Based Health Insurance and healthcare utilisation, financial protection and other areas is scarce and necessary. This paper contains a discussion of the research design of three Cluster Randomised Controlled Trials in India to measure the impact of Community-Based Health Insurance on several outcomes. Methods/Design Each trial sets up a Community-Based Health Insurance scheme among a group of micro-finance affiliate families. Villages are grouped into clusters which are congruous with pre-existing social groupings. These clusters are randomly assigned to one of three waves of implementation, ensuring the entire population is offered Community-Based Health Insurance by the end of the experiment. Each wave of treatment is preceded by a round of mixed methods evaluation, with quantitative, qualitative and spatial evidence on impact collected. Improving upon practices in published Cluster Randomised Controlled Trial literature, we detail how research design decisions have ensured that both the households offered insurance and the implementers of the Community-Based Health Insurance scheme operate in an environment replicating a non-experimental implementation. Discussion When a Cluster Randomised Controlled Trial involves randomizing within a community, generating adequate and valid conclusions requires that the research design must be made congruous with social structures within the target population, to ensure that such trials are conducted in an implementing environment which is a suitable analogue to that of a non-experimental implementing environment.

Migrant female head porters’ enrolment in and utilisation and renewal of the National Health Insurance Scheme in Kumasi, Ghana

OpenAIRE

Boateng, Simon; Amoako, Prince; Poku, Adjoa Afriyie; Baabereyir, Anthony; Gyasi, Razak Mohammed

2017-01-01

Purpose As a social protection policy, Ghana’s National Health Insurance Scheme (NHIS) aims to improve access to healthcare, especially for the vulnerable. Migrant female head porters (kayayoo), who are part of the informal economic workforce, are underscored as an ethnic minority and vulnerable group in Ghana. This study aimed to analyse the factors associated with enrolment in and renewal and utilisation of the NHIS among migrant female head porters in the Kumasi Metropolis. Method We purpo...

An investigation into onshore captive insurance companies

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ME Le Roux

2015-01-01

Full Text Available Insurance provided by captive insurers is one of various forms of risk financing.  The nature and main types of captive insurance companies are discussed.  This is followed by the results of an empirical study that focused on South African onshore captive insurance companies.  The objectives in establishing and operating a captive insurer, the factors which determine the decision of the parent company to establish and operate a captive insurer and the future and usefulness of insurance provided by captive insurers are some of the aspects that are addressed.

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran.

Science.gov (United States)

Bazyar, Mohammad; Rashidian, Arash; Kane, Sumit; Vaez Mahdavi, Mohammad Reza; Akbari Sari, Ali; Doshmangir, Leila

2016-02-11

There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper. © 2016 by Kerman University of Medical Sciences.

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran

Science.gov (United States)

Bazyar, Mohammad; Rashidian, Arash; Kane, Sumit; Vaez Mahdavi, Mohammad Reza; Akbari Sari, Ali; Doshmangir, Leila

2016-01-01

There are fragmentations in Iran’s health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper. PMID:27239868

How e-business influences on time customer delivery: An empirical investigation on insurance industry

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Naser Azad

2013-11-01

Full Text Available During the past few years, e-business has revolutionized insurance industry and it has become as one of the most important techniques to reach global market. This paper presents an empirical investigation to find important factors influencing on time delivery to customers. The proposed study of this paper designs a questionnaire consists of 28 items in Likert scale, which was reduced to 24 and using principle component analysis, the study finds different important factors. Cronbach alpha is calculated as 0.94. In addition, Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Approx. Chi-Square are 0.882 and 2462, respectively. The study determines four important factors including dynamic organization, environment opportunities, flexible structure and customer relationship management.

Who benefits from the Obio Community Health Insurance Scheme in Rivers State, Nigeria? A benefit incidence analysis.

Science.gov (United States)

Vaughan, Kelsey; Akwataghibe, Ngozi; Fakunle, Babatunde; Wolmarans, Liezel

2016-11-01

A key aspect of monitoring and evaluating health programs is ensuring that benefits are reaching their target population. We conducted a benefit incidence analysis (BIA) of a Shell-sponsored community health insurance scheme in Nigeria to determine the extent to which the target group (the poor) was benefitting. We examined a sample of 616 patients' hospital attendance, financial and administrative records from 2012-2013. We estimated annual utilization rates and average unit costs for inpatient and outpatient services. We multiplied the two to produce a total cost per patient, then deducted annual out-of-pocket expenditures to estimate the total community-based health insurance scheme benefit per person. Benefits were multiplied by the total number of persons in each socioeconomic group to aggregate benefits. We used concentration curves and dominance tests to determine statistical significance at 5% and 10% levels of significance. Collectively, the poorest 20% of the population received 12% of benefits while the richest quintile received the largest share (23%). Inpatient and outpatient benefits are weakly regressive (pro-rich), statistically significant at a 10% level of significance. Although the poor were found to benefit, this BIA revealed a tendency towards pro-rich distributions. Removing co-payments for the poorest, reducing long wait and visit times and using community volunteers to help increase access to health services may improve benefits for the poor. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Willingness to pay for health insurance: an analysis of the potential market for new low-cost health insurance products in Namibia.

Science.gov (United States)

Gustafsson-Wright, Emily; Asfaw, Abay; van der Gaag, Jacques

2009-11-01

This study analyzes the willingness to pay for health insurance and hence the potential market for new low-cost health insurance product in Namibia, using the double bounded contingent valuation (DBCV) method. The findings suggest that 87 percent of the uninsured respondents are willing to join the proposed health insurance scheme and on average are willing to insure 3.2 individuals (around 90 percent of the average family size). On average respondents are willing to pay NAD 48 per capita per month and respondents in the poorest income quintile are willing to pay up to 11.4 percent of their income. This implies that private voluntary health insurance schemes, in addition to the potential for protecting the poor against the negative financial shock of illness, may be able to serve as a reliable income flow for health care providers in this setting.

Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review.

Science.gov (United States)

Fadlallah, Racha; El-Jardali, Fadi; Hemadi, Nour; Morsi, Rami Z; Abou Samra, Clara Abou; Ahmad, Ali; Arif, Khurram; Hishi, Lama; Honein-AbouHaidar, Gladys; Akl, Elie A

2018-01-29

Community-based health insurance (CBHI) has evolved as an alternative health financing mechanism to out of pocket payments in low- and middle-income countries (LMICs), particularly in areas where government or employer-based health insurance is minimal. This systematic review aimed to assess the barriers and facilitators to implementation, uptake and sustainability of CHBI schemes in LMICs. We searched six electronic databases and grey literature. We included both quantitative and qualitative studies written in English language and published after year 1992. Two reviewers worked in duplicate and independently to complete study selection, data abstraction, and assessment of methodological features. We synthesized the findings based on thematic analysis and categorized according to the ecological model into individual, interpersonal, community and systems levels. Of 15,510 citations, 51 met the eligibility criteria. Individual factors included awareness and understanding of the concept of CBHI, trust in scheme and scheme managers, perceived service quality, and demographic characteristics, which influenced enrollment and sustainability. Interpersonal factors such as household dynamics, other family members enrolled in the scheme, and social solidarity influenced enrollment and renewal of membership. Community-level factors such as culture and community involvement in scheme development influenced enrollment and sustainability of scheme. Systems-level factors encompassed governance, financial and delivery arrangement. Government involvement, accountability of scheme management, and strong policymaker-implementer relation facilitated implementation and sustainability of scheme. Packages that covered outpatient and inpatient care and those tailored to community needs contributed to increased enrollment. Amount and timing of premium collection was reported to negatively influence enrollment while factors reported as threats to sustainability included facility

Effects of information, education, and communication campaign on a community-based health insurance scheme in Burkina Faso.

Science.gov (United States)

Cofie, Patience; De Allegri, Manuela; Kouyaté, Bocar; Sauerborn, Rainer

2013-12-06

The study analysed the effect of Information, Education, and Communication (IEC) campaign activities on the adoption of a community-based health insurance (CHI) scheme in Nouna, Burkina Faso. It also identified the factors that enhanced or limited the campaign's effectiveness. Complementary data collection approaches were used. A survey was conducted with 250 randomly selected household heads, followed by in-depth interviews with 22 purposively selected community leaders, group discussions with the project management team, and field observations. Bivariate analysis and multivariate logistic regression models were used to assess the association between household exposure to campaign and acquisition of knowledge as well as household exposure to campaign and enrolment. The IEC campaign had a positive effect on households' knowledge about the CHI and to a lesser extent on household enrolment in the scheme. The effectiveness of the IEC strategy was mainly influenced by: (1) frequent and consistent IEC messages from multiple media channels (mass and interpersonal channels), including the radio, a mobile information van, and CHI team, and (2) community heads' participation in the CHI scheme promotion. Education was the only significantly influential socio-demographic determinant of knowledge and enrolment among household heads. The relatively low effects of the IEC campaign on CHI enrolment are indicative of other important IEC mediating factors, which should be taken into account in future CHI campaign evaluation. The study concludes that an IEC campaign is crucial to improving the understanding of the CHI scheme concept, which is an enabler to enrolment, and should be integrated into scheme designs and evaluations.

Effects of information, education, and communication campaign on a community-based health insurance scheme in Burkina Faso

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Patience Cofie

2013-12-01

Full Text Available Objective : The study analysed the effect of Information, Education, and Communication (IEC campaign activities on the adoption of a community-based health insurance (CHI scheme in Nouna, Burkina Faso. It also identified the factors that enhanced or limited the campaign's effectiveness. Design : Complementary data collection approaches were used. A survey was conducted with 250 randomly selected household heads, followed by in-depth interviews with 22 purposively selected community leaders, group discussions with the project management team, and field observations. Bivariate analysis and multivariate logistic regression models were used to assess the association between household exposure to campaign and acquisition of knowledge as well as household exposure to campaign and enrolment. Results : The IEC campaign had a positive effect on households’ knowledge about the CHI and to a lesser extent on household enrolment in the scheme. The effectiveness of the IEC strategy was mainly influenced by: 1 frequent and consistent IEC messages from multiple media channels (mass and interpersonal channels, including the radio, a mobile information van, and CHI team, and 2 community heads’ participation in the CHI scheme promotion. Education was the only significantly influential socio-demographic determinant of knowledge and enrolment among household heads. The relatively low effects of the IEC campaign on CHI enrolment are indicative of other important IEC mediating factors, which should be taken into account in future CHI campaign evaluation. Conclusion : The study concludes that an IEC campaign is crucial to improving the understanding of the CHI scheme concept, which is an enabler to enrolment, and should be integrated into scheme designs and evaluations.

Projections of the number of Australians with disability aged 65 and over eligible for the National Disability Insurance Scheme: 2017-2026.

Science.gov (United States)

Biddle, Nicholas; Crawford, Heather

2017-12-01

To develop projections of the size of the Australian population aged 65 years and over eligible for disability support through the National Disability Insurance Scheme (NDIS) for the decade following its introduction, to support planning and costing of the scheme. We estimate disability and mortality transition probabilities and develop projections of the NDIS-eligible, ageing population from 2017 to 2026. An estimated 8000 men and 10 200 women aged 65 years and over will be eligible for support through the NDIS in 2017 (the scheme's first full year), increasing to 48 800 men and 56 900 women in 2026. Growth in the NDIS-eligible, ageing population has implications for relative budget allocations between the NDIS and the aged-care system, and projections of the size of this population are useful for calculating the overall cost of the NDIS. © 2017 AJA Inc.

Health insurance coverage, neonatal mortality and caesarean section deliveries: an analysis of vital registration data in Colombia.

Science.gov (United States)

Houweling, Tanja A J; Arroyave, Ivan; Burdorf, Alex; Avendano, Mauricio

2017-05-01

Low-income and middle-income countries have introduced different health insurance schemes over the past decades, but whether different schemes are associated with different neonatal outcomes is yet unknown. We examined the association between the health insurance coverage scheme and neonatal mortality in Colombia. We used Colombian national vital registration data, including all live births (2 506 920) and neonatal deaths (17 712) between 2008 and 2011. We used Poisson regression models to examine the association between health insurance coverage and the neonatal mortality rate (NMR), distinguishing between women insured via the contributory scheme (40% of births, financed through payroll and employer's contributions), government subsidised insurance (47%) and the uninsured (11%). NMR was lower among babies born to mothers in the contributory scheme (6.13/1000) than in the subsidised scheme (7.69/1000) or the uninsured (8.38/1000). Controlling for socioeconomic and demographic factors, NMRs remained higher for those in the subsidised scheme (OR 1.09, 95% CI 1.05 to 1.14) and the uninsured (OR 1.16, 95% CI 1.10 to 1.23) compared to those in the contributory scheme. These differences increased in models that additionally controlled for caesarean section (C-section) delivery. This increase was due to the higher fraction of C-section deliveries among women in the contributory scheme (49%, compared to 34% for the subsidised scheme and 28% for the uninsured). Health insurance through the contributory system is associated with lower neonatal mortality than insurance through the subsidised system or lack of insurance. Universal health insurance may not be sufficient to close the gap in newborn mortality between socioeconomic groups. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Challenges to the scale-up of the Nigerian National Health Insurance Scheme: Public knowledge and opinions in urban Kano, Nigeria

OpenAIRE

U M Lawan; Z Iliyasu; Abba Maryam Daso

2012-01-01

Background : This study examined the challenges in the implementation and scale-up of the National Health insurance Scheme (NHIS) in Nigeria. Materials and Methods : We designed this descriptive cross-sectional study to investigate the knowledge and opinions of 150 randomly selected adults in urban Kano regarding the NHIS. Data was analyzed using Epi Info™ 3.2.05 statistical software. Respondents′ knowledge of NHIS was scored and graded using a system adapted from previous studies. Results : ...

Equity of the premium of the Ghanaian National Health Insurance Scheme and the implications for achieving universal coverage.

Science.gov (United States)

Amporfu, Eugenia

2013-01-07

The Ghanaian National Health Insurance Scheme (NHIS) was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage.

Equity of the premium of the Ghanaian national health insurance scheme and the implications for achieving universal coverage

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Amporfu Eugenia

2013-01-01

Full Text Available Abstract The Ghanaian National Health Insurance Scheme (NHIS was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage.

Microinsurance: innovations in low-cost health insurance.

Science.gov (United States)

Dror, David M; Radermacher, Ralf; Khadilkar, Shrikant B; Schout, Petra; Hay, François-Xavier; Singh, Arbind; Koren, Ruth

2009-01-01

Microinsurance--low-cost health insurance based on a community, cooperative, or mutual and self-help arrangements-can provide financial protection for poor households and improve access to health care. However, low benefit caps and a low share of premiums paid as benefits--both designed to keep these arrangements in business--perversely limited these schemes' ability to extend coverage, offer financial protection, and retain members. We studied three schemes in India, two of which are member-operated and one a commercial scheme, using household surveys of insured and uninsured households and interviews with managers. All three enrolled poor households and raised their use of hospital services, as intended. Financial exposure was greatest, and protection was least, in the commercial scheme, which imposed the lowest caps on benefits and where income was the lowest.

China's Insurance Regulatory Reform, Corporate Governance Behavior and Insurers' Governance Effectiveness.

Science.gov (United States)

Li, Huicong; Zhang, Hongliang; Tsai, Sang-Bing; Qiu, Aichao

2017-10-17

External regulation is an important mechanism to improve corporate behavior in emerging markets. China's insurance governance regulation, which began to supervise and guide insurance corporate governance behavior in 2006, has experienced a complex process of reform. This study tested our hypotheses with a sample of 85 firms during 2010-2011, which was obtained by providing a questionnaire to all of China's shareholding insurance companies. The empirical study results generally show that China's insurance governance effectiveness has significantly improved through strict regulation. Insurance corporate governance can improve business acumen and risk-control ability, but no significant evidence was found to prove its influence on profitability, as a result of focusing less attention on governance than on management. State ownership is associated with higher corporate governance effectiveness than non-state ownership. Listed companies tend to outperform non-listed firms, and life insurance corporate governance is more effective than that of property insurers. This study not only contributes to the comprehensive understanding of corporate governance effectiveness but also to the literature by highlighting the effect of corporate governance regulation in China's insurance industry and other emerging economies of the financial sector.

National Health Insurance Scheme: How Protected Are Households in Oyo State, Nigeria from Catastrophic Health Expenditure?

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Olayinka Stephen Ilesanmi

2014-05-01

Full Text Available Background The major objective of the National Health Insurance Scheme (NHIS in Nigeria is to protect families from the financial hardship of large medical bills. Catastrophic Health Expenditure (CHE is rampart in Nigeria despite the take-off of the NHIS. This study aimed to determine if households enrolled in the NHIS were protected from having CHE. Methods The study took place among 714 households in urban communities of Oyo State. CHE was measured using a threshold of 40% of monthly non-food expenditure. Descriptive statistics were done, Principal Component Analysis was used to divide households into wealth quintiles. Chi-square test and binary logistic regression were done. Results The mean age of household respondent was 33.5 years. The median household income was 43,500 naira (290 US dollars and the range was 7,000–680,000 naira (46.7–4,533 US dollars in 2012. The overall median household healthcare cost was 890 naira (5.9 US dollars and the range was 10-17,700 naira (0.1–118 US dollars in 2012. In all, 67 (9.4% households were enrolled in NHIS scheme. Healthcare services was utilized by 637 (82.9% and CHE occurred in 42 (6.6% households. CHE occurred in 14 (10.9% of the households in the lowest quintile compared to 3 (2.5% in the highest wealth quintile (P= 0.004. The odds of CHE among households in lowest wealth quintile is about 5 times. They had Crude OR (CI: 4.7 (1.3–16.8, P= 0.022. Non enrolled households were two times likely to have CHE, though not significant Conclusion Households in the lowest wealth quintiles were at higher risk of CHE. Universal coverage of health insurance in Nigeria should be fast-tracked to give the expected financial risk protection and decreased incidence of CHE.

Optimal non-linear health insurance.

Science.gov (United States)

Blomqvist, A

1997-06-01

Most theoretical and empirical work on efficient health insurance has been based on models with linear insurance schedules (a constant co-insurance parameter). In this paper, dynamic optimization techniques are used to analyse the properties of optimal non-linear insurance schedules in a model similar to one originally considered by Spence and Zeckhauser (American Economic Review, 1971, 61, 380-387) and reminiscent of those that have been used in the literature on optimal income taxation. The results of a preliminary numerical example suggest that the welfare losses from the implicit subsidy to employer-financed health insurance under US tax law may be a good deal smaller than previously estimated using linear models.

Health Insurance – Affiliation to LAMal insurance for families of CERN personnel

CERN Multimedia

Staff Association

2017-01-01

On May 16, the HR department published in the CERN Bulletin an article concerning cross-border workers (“frontaliers”) and the exercise of the right of choice in health insurance: « In view of the Agreement concluded on 7 July 2016 between Switzerland and France regarding the choice of health insurance system* for persons resident in France and working in Switzerland ("frontaliers"), the Swiss authorities have indicated that those persons who have not “formally exercised their right to choose a health insurance system before 30 September 2017 risk automatically becoming members of the Swiss LAMal system” and having to “pay penalties to their insurers that may amount to several years’ worth of contributions”. Among others, this applies to spouses of members of the CERN personnel who live in France and work in Switzerland. » But the CERN Health Insurance Scheme (CHIS), provides insuranc...

Insuring Life : Value, Security and Risk

NARCIS (Netherlands)

Lobo-Guerrero, Luis

2016-01-01

This book is a contribution to the scholarly engagement with the wider problem of governing through risk and the politics of uncertainty. It takes life insurance as an empirical site from which to ask: what is the kind of governance created through insurance an instance of, and how does it

An empirical investigation on factors influencing customer loyalty and their relationships with quality of services: A case study of insurance firm

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Rostam Pourrahidi

2014-01-01

Full Text Available In this paper, we present an empirical investigation to study the effect of various factors influencing customer loyalty and quality of services on customer satisfaction and customer loyalty. The proposed study is implemented in one of Iranian insurance firms by choosing a sample of 171 randomly selected customers of this insurance firm. We use SERVQUAL standard questionnaire to measure customer satisfaction. The study examines three hypotheses associated with the proposed study using one-way t-student as well as path analysis, and the results have confirmed all three hypotheses. The study also uses Freedman test to rank the most important factors and detects that value was the most important issue followed by trust, customer satisfaction, empathy, value and resistance to change.

Demand for voluntary basic medical insurance in urban China: panel evidence from the Urban Resident Basic Medical Insurance scheme.

Science.gov (United States)

Chen, Gang; Yan, Xiao

2012-12-01

This paper investigates the key factors associated with the demand for Urban Resident Basic Medical Insurance (URBMI), which was established in 2007 and aims to cover all Chinese urban residents. Two waves of longitudinal household survey data are used, and a three-level random-intercept logit model is used for the analysis. Two different sets of explanatory variables were identified for adults and children, separately. Results suggest for both the adult and the child samples that income, health status, age and health risk behaviours are key influencing factors for basic medical insurance demand. The household head's characteristics are also significantly related to other household members' medical insurance demands. Specifically, household heads who are more educated or retired are more likely to purchase medical insurance for their children. These findings suggest that an expansion of the special subsidy to the poor or, probably more important, a risk-adjusted benefit package may be needed for voluntary basic medical insurance in China. In addition, adverse selection consistently exists and is a major challenge for the sustainability of medical insurance financing. To expand insurance coverage for children, especially those under school age, special efforts (possibly through health education or health promotion) should be focused on the household head, particularly those engaging in risky health behaviours.

Community Rating in Health Insurance : Trade-Off Between Coverage and Selection

NARCIS (Netherlands)

Bijlsma, M.; Boone, Jan; Zwart, G.T.J.

2015-01-01

We analyze the role of community rating in the optimal design of a risk adjustment scheme in competitive health insurance markets when insurers have better information on their customers’ risk profiles than the sponsor of health insurance. The sponsor offers insurers a menu of risk adjustment

Addressing healthcare needs of people living below the poverty line: a rapid assessment of the Andhra Pradesh Health Insurance Scheme.

Science.gov (United States)

Rao, M; Ramachandra, S S; Bandyopadhyay, S; Chandran, A; Shidhaye, R; Tamisettynarayana, S; Thippaiah, A; Sitamma, M; Sunil George, M; Singh, V; Sivasankaran, S; Bangdiwala, S I

2011-01-01

Families living below the poverty line in countries which do not have universal healthcare coverage are drawn into indebtedness and bankruptcy. The state of Andhra Pradesh in India established the Rajiv Aarogyasri Community Health Insurance Scheme (RACHIS) in 2007 with the aim of breaking this cycle by improving the access of below the poverty line (BPL) families to secondary and tertiary healthcare. It covered a wide range of surgical and medical treatments for serious illnesses requiring specialist healthcare resources not always available at district-level government hospitals. The impact of this scheme was evaluated by a rapid assessment, commissioned by the government of Andhra Pradesh. The aim of the assessment was to explore the contribution of the scheme to the reduction of catastrophic health expenditure among the poor and to recommend ways by which delivery of the scheme could be improved. We report the findings of this assessment. Two types of data were used for the assessment. Patient data pertaining to 89 699 treatment requests approved by the scheme during its first 18 months were examined. Second, surveys of scheme beneficiaries and providers were undertaken in 6 randomly selected districts of Andhra Pradesh. This novel scheme was beginning to reach the BPL households in the state and providing access to free secondary and tertiary healthcare to seriously ill poor people. An integrated model encompassing primary, secondary and tertiary care would be of greater benefit to families below the poverty line and more cost-effective for the government. There is considerable potential for the government to build on this successful start and to strengthen equity of access and the quality of care provided by the scheme. Copyright 2011, NMJI.

The spillover effects of health insurance benefit mandates on public insurance coverage: Evidence from veterans.

Science.gov (United States)

Li, Xiaoxue; Ye, Jinqi

2017-09-01

This study examines how regulations in private health insurance markets affect coverage of public insurance. We focus on mental health parity laws, which mandate private health insurance to provide equal coverage for mental and physical health services. The implementation of mental health parity laws may improve a quality dimension of private health insurance but at increased costs. We graphically develop a conceptual framework and then empirically examine whether the regulations shift individuals from private to public insurance. We exploit state-by-year variation in policy implementation in 1999-2008 and focus on a sample of veterans, who have better access to public insurance than non-veterans. Using data from the Current Population Survey, we find that the parity laws reduce employer-sponsored insurance (ESI) coverage by 2.1% points. The drop in ESI is largely offset by enrollment gains in public insurance, namely through the Veterans Affairs (VA) benefit and Medicaid/Medicare programs. Copyright © 2017 Elsevier B.V. All rights reserved.

Does the national health insurance scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?

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Maxwell Ayindenaba Dalaba

2014-05-01

Full Text Available Introduction: The Government of Ghana introduced the National Health Insurance Scheme (NHIS in 2003 to replace out-of-pocket (OOP payment for health services with the inherent aim of reducing the direct cost of treating illness to households. Objective: To assess the effects of the NHIS in reducing cost of treating malaria to households in the Kassena-Nankana districts of northern Ghana. Methods: We conducted a cross-sectional survey between October 2009 and October 2011 in the Kassena-Nankana districts. A sample of 4,226 households was randomly drawn from the Navrongo Health and Demographic Surveillance System household database and administered a structured interview. The costs of malaria treatment were collected from the patient perspective. Results: Of the 4,226 households visited, a total of 1,324 (31% household members reported fever and 51% (675 reported treatment for malaria and provided information on where they sought care. Most respondents sought malaria treatment from formal health facilities 63% (424, with the remainder either self-medicating with drugs from chemical shops 32% (217 or with leftover drugs or herbs 5% (34. Most of those who sought care from formal health facilities were insured 79% (334. The average direct medical cost of treating malaria was GH¢3.2 (US$2.1 per case with the insured spending less (GH¢2.6/US$1.7 per case than the uninsured (GH¢3.2/US$2.1. The overall average cost (direct and indirect incurred by households per malaria treatment was GH¢20.9 (US$13.9. Though the insured accounted for a larger proportion of admissions at health facilities 76% (31 than the uninsured 24% (10, the average amount households spent on the insured was less (GH¢4/US$2.7 than their uninsured counterparts (GH¢6.4/US$4.3. The difference was not statistically significant (p=0.2330. Conclusion: Even though some insured individuals made OOP payments for direct medical care, there is evidence that the NHIS has a protective effect

The National Health Insurance Scheme (NHIS): a survey of knowledge and opinions of Nigerian dentists' in Lagos.

Science.gov (United States)

Adeniyi, A A; Onajole, A T

2010-03-01

This study was designed to assess the knowledge and perceptions of Nigerian dentists to the National Health Insurance scheme (NHIS). A cross-sectional descriptive survey was conducted amongst 250 dentists employed in private and public dental clinics in Lagos State, Nigeria. The survey instrument was a self-administered questionnaire designed to assess their knowledge and attitudes towards the scheme. Data analysis was done using the Epi-Info statistical software (version 6.04). Statistical tools used included measures of central tendency, frequency distribution and chi-square test. A total of 216 dentists (response rate of 82.4%) participated in this study. Most 132 (61.1%) of the respondents had a fair knowledge of the NHIS, while 22 (10.2%) and 62 (28.7%) had poor and good knowledge respectively. Majority (70.4%) viewed the NHIS as a good idea that will succeed if properly implemented. Most (76.6%) respondents also believed that the scheme will improve access to oral health services, affordability of services (71.4%), availability of the services (68.3%) and recognition of dentistry as a profession (62.4%). Most of the respondents (66.2%) considered oral health care as not properly positioned in the NHIS and 154 respondents (74.4%) found the current position of oral health on the NHIS unacceptable. A good number of the respondents (77.3%) would like dentistry to operate at the primary care level on the NHIS. Majority of the dentists involved in this study had some knowledge of the NHIS and were generally positively disposed towards the scheme and viewed it as a good idea.

GLOBAL FINANCIAL CRISIS AND UNIT-LINKED INSURANCE MARKETS EFFICIENCY: EMPIRICAL EVIDENCE FROM CENTRAL AND EASTERN EUROPEAN COUNTRIES

Directory of Open Access Journals (Sweden)

Botoş Horia Mircea

2012-12-01

Full Text Available This paper empirically investigates the impact of the Global financial crisis on the efficiency of four Central and Eastern European emerging unit-linked insurance markets, applying the automatic variance ratio (AVR test of Kim (2009 and variance ratio tests using ranks and signs by Wright (2000 for entire, pre-crisis and crisis periods. This study contributes to the existing literature on efficient market hypothesis with several distinct features: it provides a systematic review of the weak-form market efficiency literature that examines return predictability of the daily ING unit-linked funds prices; also the article aims at monitoring any improvement in the degree of efficiency in time and also examines the relative efficiency of unit-linked insurance markets in pre-crisis and crisis periods. Unit linked insurance are life insurance policies with investment component. In the literature there are few studies investigating the effects of a financial crisis on the potential of predictability and implicitly on the degree of efficiency of financial markets. The occurrence of a market crash or financial crisis is a possible contributing factor of market inefficiency. Most of the studies are focused on the Asian crisis in 1997: Holden et al. (2005 examined the weak-form efficiency of eight emerging Asian stock markets using VR tests before, during and after the Asian crisis; Kim and Shamsuddin (2008 used three different types of multiple VR tests for nine Asian stock markets; the findings reported by Lim et al. (2008 are consistent with those reported by Cheong et al. (2007, in which the highest inefficiency occurs during the crisis period. Todea and Lazar (2010 investigated the effects of the Global crisis on the relative efficiency of ten CEE stock markets, using Generalized Spectral test of Escanciano and Velasco (2006. Wright (2000 proposes the alternative non-parametric variance ratio tests using ranks and signs of return and demonstrates that

Factors Influencing Support for National Health Insurance among Patients Attending Specialist Clinics in Malaysia

Science.gov (United States)

Almualm, Yasmin; Alkaff, Sharifa Ezat; Aljunid, Syed; Alsagoff, Syed Sagoff

2013-01-01

This study was carried out to determine the level of support towards the proposed National Health Insurance scheme among Malaysian patients attending specialist clinics at the National University of Malaysia Medical centre and its influencing factors. The cross sectional study was carried out from July-October 2012. 260 patients were selected using multistage sampling method. 71.2% of respondents supported the proposed National Health insurance scheme. 61.4% of respondents are willing to pay up to RM240 per year to join the National Health Insurance and 76.6% of respondents are of the view that enrolment in NHI should be made compulsory. Knowledge had a positive influence on respondent's support towards National Health Insurance. National Health Insurance when implemented in Malaysia can be used to raise funds for health care financing, increase access to health services and achieve the desired health status. More efforts should be taken to promote the scheme and educate the public in order to achieve higher support towards the proposed National Health Insurance. The cost to enroll in NHI as well as services to be included under the scheme should be duly considered. PMID:23985101

Effects of consumer and provider moral hazard at a municipal hospital out-patient department on Ghana's National Health Insurance Scheme.

Science.gov (United States)

Yawson, A E; Biritwum, R B; Nimo, P K

2012-12-01

In 2003, Ghana introduced the national health insurance scheme (NHIS) to promote access to healthcare. This study determines consumer and provider factors which most influence the NHIS at a municipal health facility in Ghana. This is an analytical cross-sectional study at the Winneba Municipal Hospital (WHM) in Ghana between January-March 2010. A total of 170 insured and 175 uninsured out-patients were interviewed and information extracted from their folders using a questionnaire. Consumers were from both the urban and rural areas of the municipality. The mean number of visits by insured consumers to a health facility in previous six months was 2.48 +/- 1.007 and that for uninsured consumers was 1.18 +/- 0.387(p-valueconsumers visited the health facility at significantly more frequent intervals than uninsured consumers (χ(2) = 55.413, p-valueconsumers received more different types of medications for similar disease conditions and more laboratory tests per visit than the uninsured. In treating malaria (commonest condition seen), providers added multivitamins, haematinics, vitamin C and intramuscular injections as additional medications more for insured consumers than for uninsured consumers. Findings suggest consumer and provider moral hazard may be two critical factors affecting the NHIS in the Effutu Municipality. These have implications for the optimal functioning of the NHIS and may affect long-term sustainability of NHIS in the municipality. Further studies to quantify financial/ economic cost to NHIS arising from moral hazard, will be of immense benefit to the optimal functioning of the NHIS.

Implementing Automotive Telematics for Fleet Insurance

Directory of Open Access Journals (Sweden)

Marika Azzopardi

2013-12-01

Full Text Available The advantages of Usage-Based Insurance for automotive covers over conventional rating methods have been discussed in literature for over four decades. Notwithstanding their adoption in insurance markets has been slow. This paper seeks to establish the viability of introducing fleet Telematics-Based Insurance by investigating the perceptions of insurance operators, tracking service providers and corporate fleet owners. At its core, the study involves a SWOT-analysis to appraise Telematics-Based Insurance against conventional premium rating systems. Twenty five key stakeholders in Malta, a country with an insurance industry that represents others in microcosm, were interviewed to develop our analysis. We assert that local insurers have interests in such insurance schemes as enhanced fleet management and monitoring translate into an improved insurance risk. The findings presented here have implications for all stakeholders as we argue that telematics enhance fleet management, TBI improves risk management for insurers and adoption of this technology is dependent on telematics providers increasing the perceived control by insurers over managing this technology.

Health insurance for "frontaliers"

CERN Multimedia

2013-01-01

The French government has decided that, with effect from 1 June 2014, persons resident in France but working in Switzerland (hereinafter referred to as “frontaliers”) will no longer be entitled to opt for private French health insurance provision as their sole and principal health insurance.   The right of choice, which was granted by the Bilateral Agreement on the Free Movement of Persons between Switzerland and the European Union and which came into force on 1 June 2002, exempts “frontaliers” from the obligation to become a member of Switzerland’s compulsory health insurance scheme (LAMal) if they can prove that they have equivalent coverage in France, provided by either the French social security system (CMU) or a private French insurance provider. As the latter option of private health insurance as an alternative to membership of LAMal will be revoked under the new French legislation that will come into force on 1 June 2014, current “...

Message from the CERN Health Insurance Supervisory Board (CHISB)

CERN Multimedia

2007-01-01

At the end of 2006, the Management of Clinique La Colline canceled its 2005 tariff agreement with the health insurance schemes of international organizations (CERN, ILO-ITU, WHO, UNOG). The proposed 2007 tariffs were unacceptable to these schemes as they included an average increase of 12%. No agreement was found and therefore this clinic is no longer approved by the CHIS, according to the definition given in the Rules of the CERN Health Insurance Scheme. Our Administrator, UNIQA, will no longer act as paying third party for any hospitalisation which has not already been planned and agreed. More information will appear in the next issue of the CHISBull'. Tel.74484

Extending health insurance coverage to the informal sector: Lessons from a private micro health insurance scheme in Lagos, Nigeria.

Science.gov (United States)

Peterson, Lauren; Comfort, Alison; Hatt, Laurel; van Bastelaer, Thierry

2018-04-15

As a growing number of low- and middle-income countries commit to achieving universal health coverage, one key challenge is how to extend coverage to informal sector workers. Micro health insurance (MHI) provides a potential model to finance health services for this population. This study presents lessons from a pilot study of a mandatory MHI plan offered by a private insurance company and distributed through a microfinance bank to urban, informal sector workers in Lagos, Nigeria. Study methods included a survey of microfinance clients, key informant interviews, and a review of administrative records. Demographic, health care seeking, and willingness-to-pay data suggested that microfinance clients, particularly women, could benefit from a comprehensive MHI plan that improved access to health care and reduced out-of-pocket spending on health services. However, administrative data revealed declining enrollment, and key informant interviews further suggested low use of the health insurance plan. Key implementation challenges, including changes to mandatory enrollment requirements, insufficient client education and marketing, misaligned incentives, and weak back-office systems, undermined enrollment and use of the plan. Mandatory MHI plans, intended to mitigate adverse selection and facilitate private insurers' entry into new markets, present challenges for covering informal sector workers, including when distributed through agents such as a microfinance bank. Properly aligning the incentives of the insurer and the agent are critical to effectively distribute and service insurance. Further, an urban environment presents unique challenges for distributing MHI, addressing client perceptions of health insurance, and meeting their health care needs. Copyright © 2018 John Wiley & Sons, Ltd.

Using the adaptive cycle in climate-risk insurance to design resilient futures

Science.gov (United States)

Cremades, R.; Surminski, S.; Máñez Costa, M.; Hudson, P.; Shrivastava, P.; Gascoigne, J.

2018-01-01

Assessing the dynamics of resilience could help insurers and governments reduce the costs of climate-risk insurance schemes and secure future insurability in the face of an increase in extreme hydro-meteorological events related to climate change.

How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?

Science.gov (United States)

Trish, Erin E; Herring, Bradley J

2015-07-01

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. We empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006-2011 KFF/HRET Employer Health Benefits Survey. We exploit a unique feature of employer-sponsored insurance, in which self-insured employers purchase only administrative services from managed care organizations, to disentangle these different effects on insurer concentration by constructing one concentration measure representing fully-insured plans' transactions with employers and the other concentration measure representing insurers' bargaining with hospitals. As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration. Copyright © 2015 Elsevier B.V. All rights reserved.

Hydrological drought index insurance for irrigation districts in Spain

Energy Technology Data Exchange (ETDEWEB)

Maestro, T.; Bielza, M.; Garrido, A.

2016-11-01

Hydrological droughts are a major risk for irrigated agriculture in many regions of the world. The aim of this article is to propose an insurance tool to help irrigators manage the risk of water scarcity in the framework of the Spanish Crop Insurance System (SCIS). Only the United States Insurance System provides this type of coverage, but has very restrictive conditions. To determine the type of insurance scheme that better fits with the SCIS and to the Spanish irrigated agriculture, an expert panel was held with the participation of all stakeholders involved in crop insurance. Following the expert panel conclusions, an hydrological drought index insurance (HDII) addressed to irrigation districts (ID) is proposed. It would compensate water deficits suffered in the whole ID. We detail the conditions that the ID should fulfill to be eligible for HDII. HDII is applied to the Bardenas Irrigation District V (ID-V) in Spain, and the hedging effectiveness of the instrument is analyzed comparing ID-V’s gross margins with and without the insurance contract. Results suggest that the proposed insurance scheme could provide an effective means of reducing farmers’ vulnerability to water shortages and there is no major impediment for it to be included as a new line in the SCIS. This type of insurance can be generalized to any ID fulfilling the conditions mentioned in this paper. (Author)

National health insurance reform in South Africa: estimating the implications for demand for private health insurance.

Science.gov (United States)

Okorafor, Okore Apia

2012-05-01

A recent health reform proposal in South Africa proposes universal access to a comprehensive package of healthcare services in the public sector, through the implementation of a national health insurance (NHI) scheme. Implementation of the scheme is likely to involve the introduction of a payroll tax. It is implied that the introduction of the payroll tax will significantly reduce the size of the private health insurance market. The objective of this study was to estimate the impact of an NHI payroll tax on the demand for private health insurance in South Africa, and to explore the broader implications for health policy. The study applies probit regression analysis on household survey data to estimate the change in demand for private health insurance as a result of income shocks arising from the proposed NHI. The introduction of payroll taxes for the proposed NHI was estimated to result in a reduction to private health insurance membership of 0.73%. This suggests inelasticity in the demand for private health insurance. In the literature on the subject, this inelasticity is usually due to quality differences between alternatives. In the South African context, there may be other factors at play. An NHI tax may have a very small impact on the demand for private health insurance. Although additional financial resources will be raised through a payroll tax under the proposed NHI reform, systemic problems within the South African health system can adversely affect the ability of the NHI to translate additional finances into better quality healthcare. If these systemic challenges are not adequately addressed, the introduction of a payroll tax could introduce inefficiencies within the South African health system.

Parental health shocks and schooling: The impact of mutual health insurance in Rwanda.

Science.gov (United States)

Woode, Maame Esi

2017-01-01

The goal of this study was to look at the educational spill-over effects of health insurance on schooling with a focus on the Rwandan Community Based Health Insurance Programme, the Mutual Health Insurance scheme. Using a two-person general equilibrium overlapping generations model, this paper theoretically analyses the possible effect of health insurance on the relationship between parental health shocks and child schooling. Individuals choose whether or not they want to incur a medical cost by seeking care in order to reduce the effect of health shocks on their labour market availability and productivity. The theoretical results show that, health shocks negatively affect schooling irrespective of insurance status. However, if the health shock is severe (incapacitating) or sudden in nature, there is a discernible mitigating effect of health insurance on the negative impact of parental ill health on child schooling. The results are tested empirically using secondary data from the third Integrated Household Living Conditions Survey (EICV) for Rwanda, collected in 2011. A total of 2401 children between the ages of 13 and 18 are used for the analysis. This age group is selected due to the age of compulsory education in Rwanda. Based on average treatment effect on treated we find a statistically significant difference in attendance between children with MHI affiliated parents and those with uninsured parents of about 0.044. The negative effect of a father being severely ill is significant only for uninsured household. For the case of the mother, this effect is felt by female children with uninsured parents only when the illness is sudden. The observed effects are more pronounced for older children. While the father's ill health (sever or sudden) significantly and negatively affects their working hours, health insurance plays appears to increase their working hours. The effects of health insurance extend beyond health outcomes. Copyright © 2016 Elsevier Ltd. All rights

The National Health Insurance Scheme (NHIS) in the Dormaa Municipality, Ghana: why some residents remain uninsured?

Science.gov (United States)

Amo, Thompson

2014-02-21

The paper presents a quantitative investigation on the national health insurance scheme (nhis) in dormaa municipality, Ghana: why some residents remain uninsured? Since its implementation has been a little over a decade now. The aim is to identify the obstacles to enrollment by the public which would enable policy direction to ensure that all residents are registered with the scheme. A descriptive and cross-sectional study was conducted between May and July, 2013. Both purposive and simple random sampling technique were used to select 210 respondents and data obtained through self-administered and face-to-face interviews guided by structured questionnaire. chi square (X2) test of independence was adopted to show the association between socioeconomic and demographic features and membership. Findings from the research suggest that residents' decision to enrol have significant associated with gender, education, number of children, place of residence, employment and income. It was also observed that membership is highly affected by premium level. The discussion of the findings and recommendations offered, if incorporated into the policy guideline of NHIS could maintain and at the same time increase enrollment level which would guarantee quality, accessible and affordable basic health care protection for the good people of Ghana.

Health Insurance without Single Crossing : Why Healthy People have High Coverage

NARCIS (Netherlands)

Boone, J.; Schottmuller, C.

2011-01-01

Standard insurance models predict that people with high (health) risks have high insurance coverage. It is empirically documented that people with high income have lower health risks and are better insured. We show that income differences between risk types lead to a violation of single crossing in

Partners in Recovery: paving the way for the National Disability Insurance Scheme.

Science.gov (United States)

Stewart, Victoria; Slattery, Maddy; Roennfeldt, Helena; Wheeler, Amanda J

2018-04-06

Australians experiencing severe and persistent mental illness and who require services from multiple agencies, experience a fragmented service delivery system. In 2014, the Commonwealth Government introduced the Partners in Recovery (PIR) service, which provides service coordination and flexible funding to improve outcomes for this group of people. This study presents qualitative findings from a research project that aimed to understand the experiences of PIR participants, including aspects of the planning process and the effectiveness of the PIR program in meeting their needs from the perspective of the participant, their carer or family member and other support people within their lives. Semi-structured interviews were conducted with 31 stakeholders involved in the PIR program, of which 14 were participants, 17 were members of the participant's support network and three were members of a consumer and carer advisory group. Overall participation in the PIR program had a positive effect on the participant's lives. Relationships with the support facilitators were seen as an important element of the process, along with a focus on recovery-oriented goals and advocacy and linking to other agencies. These findings are important for informing the roll-out of the National Disability Insurance Scheme in Australia, which will replace PIR.

Influence of biomedical sciences on National Health Insurance ...

African Journals Online (AJOL)

Health insurance becomes a viable alternative for financing health care amidst the high cost of health care. This study, conducted in 1997, uses a valuation method to assess the willingness of individuals from the working sector in Accra, Ghana, to join and pay premium for a proposed National Health Insurance Scheme ...

The claims handling process of liability insurance in South Africa

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Jacoline van Jaarsveld

2015-04-01

Full Text Available Liabilities play a very important financial role in business operations, professional service providers as well as in the personal lives of people. It is possible that a single claim may even lead to the bankruptcy of the defendant. The claims handling process of liability insurance by short-term insurers is therefore very important to these parties as it should be clear that liability claims may have enormous and far-reaching financial implications for them. The objective of this research paper embodies the improvement of financial decision-making by short-term insurers with regard to the claims handling process of liability insurance. Secondary data was initially studied which provided the basis to compile a questionnaire for the empirical survey. The leaders of liability insurance in the South African short-term insurance market that represented 69.5% of the annual gross written premiums received for liability insurance in South Africa were the respondents of the empirical study. The perceptions of these short-term insurers provided the primary data for the vital conclusions of this research. This paper pays special attention to the importance of the claims handling factors of liability insurance, how often the stipulations of liability insurance policies are adjusted by the short-term insurers to take the claims handling factors into consideration, as well as the problem areas which short-term insurers may experience during the claims handling process. Feasible solutions to address the problem areas are also discussed.

Customer loyalty in the South African long-term insurance industry

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Leon du Plessis

2013-04-01

Full Text Available The primary objective of this study is to investigate the influence of selected independent variables, two-way communication and conflict handling on intentional customer loyalty via Customer Relationship Management (CRM as the intervening variable within the South African long-term insurance environment. Primary data were gathered using a questionnaire, with items referring to Customer Relationship Management, customer loyalty, two-way communication and conflict handling. The sample consisted of 254 customers in four customer walk-in centres of a long-term insurance provider in South Africa. Data were factor-analysed. One independent variable, conflict handling, exerted a statistically significant positive influence on the intervening variable (CRM, whilst two-way communication exerted a statistically significant negative influence on the intervening variable. This variable (CRM positively influenced the dependent variable (customer loyalty. If long-term insurance organisations communicate timeously and accurately, and are skilled in conflict handling, greater loyalty will be created amongst customers. The study revealed that the majority of customers (51.53% strongly agree that two-way communication is an important dimension that underpins Customer Relationship Management and their relationship with a long-term insurance organisation. The empirical results indicate a negative relationship between the perceived two-way communication by a long-term insurance organisation and CRM at the insurance provider in South Africa. In terms of conflict handling, the study revealed that the majority of customers (45.69% strongly agree that conflict handling is an important dimension that underpins Customer Relationship Management and their relationship with a long-term insurance organisation. The empirical results indicate a positive relationship between perceived conflict handling by a long-term insurance provider and CRM at the organisation in South

The claims handling process of engineering insurance in South Africa

Directory of Open Access Journals (Sweden)

I.C. de Beer

2015-05-01

Full Text Available Due to technological developments, the complicated world of engineering and its associated products are continuously becoming more specialized. Short-term insurers provide engineering insurance to enable the owners and operators of engineering assets to combat the negative impact of the associated risks. It is, however, a huge challenge to the insurers of engineering insurance to manage the particular risks against the background of technological enhancement. The skills gap in the short-term insurance market and the engineering environment may be the main factor which inhibits the growth of the engineering insurance market. The objective of this research embodies the improvement of financial decision-making concerning the claims handling process of engineering insurance. Secondary as well as primary data were necessary to achieve the stated objective. The secondary data provided the background of the research and enabled the researchers to compile a questionnaire for the empirical survey. The questionnaire and a cover letter were sent to the top 10 short-term insurers in South Africa that are providing engineering insurance. Their perceptions should provide guidelines to other short-term insurers who are engaged in engineering insurance, as they are regarded as the market leaders of engineering insurance in South Africa. The empirical results of this research focus on the importance of various claims handling factors when assessing the claims handling process of engineering insurance, the problem areas in the claims handling process concerned, as well as how often the stipulations of engineering insurance policies are adjusted to take the claims handling factors into account.

Pricing of temperature index insurance

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Che Mohd Imran Che Taib

2012-01-01

Full Text Available The aim of this paper is to study pricing of weather insurance contracts based on temperature indices. Three different pricing methods are analysed: the classical burn approach, index modelling and temperature modelling. We take the data from Malaysia as our empirical case. Our results show that there is a significant difference between the burn and index pricing approaches on one hand, and the temperature modelling method on the other. The latter approach is pricing the insurance contract using a seasonal autoregressive time series model for daily temperature variations, and thus provides a precise probabilistic model for the fine structure of temperature evolution. We complement our pricing analysis by an investigation of the profit/loss distribution from the contract, in the perspective of both the insured and the insurer.

Assessing effectiveness of a community based health insurance in rural Burkina Faso

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Hounton Sennen

2012-10-01

Full Text Available Abstract Background Financial barriers are a recognized major bottleneck of access and use of health services. The aim of this study was to assess effectiveness of a community based health insurance (CBHI scheme on utilization of health services as well as on mortality and morbidity. Methods Data were collected from April to December 2007 from the Nouna’s Demographic Surveillance System on overall mortality, utilization of health services, household characteristics, distance to health facilities, membership in the Nouna CBHI. We analyzed differentials in overall mortality and selected maternal health process measures between members and non-members of the insurance scheme. Results After adjusting for covariates there was no significant difference in overall mortality between households who could not have been members (because their area was yet to be covered by the stepped-wedged scheme, non-members but whose households could have been members (areas covered but not enrolled, and members of the insurance scheme. The risk of overall mortality increased significantly with distance to health facility (35% more outside Nouna town and with education level (37% lower when at least primary school education achieved in households. Conclusion There was no statistically significant difference in overall mortality between members and non-members. The enrolment rates remain low, with selection bias. It is important that community based health insurances, exemptions fees policy and national health insurances be evaluated on prevention of deaths and severe morbidities instead of on drop-out rates, selection bias, adverse selection and catastrophic payments for health care only. Effective social protection will require national health insurance.

Partnerships for disaster risk insurance in the EU

Science.gov (United States)

Mysiak, Jaroslav; Dionisio Pérez-Blanco, C.

2016-11-01

With increasing costs inflicted by natural hazard perils, and amidst state budget cuts, concerns are mounting about the capacity of governments to design sustainable, equitable and affordable risk management schemes. The participation of the private sector along with the public one through public-private partnerships (PPPs) has gained importance as a means of providing catastrophic natural hazard insurance to address these seemingly conflicting objectives. In 2013 the European Commission launched a wide-ranging consultation about what EU action could be appropriate to improve the performance of insurance markets. Simultaneously, the EU legislator instigated major reforms in the legislation and regulations that pertain to how PPPs are designed or operate. This paper has a dual objective: first, we review and summarize the manifold legal background that influences the provision of insurance against natural catastrophes. Second, we examine how PPPs designed for sharing and transferring risk operate within the European regulatory constraints, illustrated using the example of the UK Flood Reinsurance Scheme (Flood RE) between the state and the Association of British Insurers.

The Antecedents of Customer Loyalty: An Empirical Investigation in Life Insurance Context

Directory of Open Access Journals (Sweden)

Srivastava Medha

2013-06-01

Full Text Available The present paper seeks to offer the most decipherable and widely applicable antecedents of customer loyalty. It explores the extant literature on customer loyalty and brings out seven variableswhich are responsible for formation of customer loyalty. Further, the relative importance of these variables has been ascertained through Multiple Regression Analysis which revealed that service quality and commitment are the strongest predictors of customer loyalty in theIndian life insurance industry. The paper also attempts to assess the loyalty status of life insurance customers in India and draw a comparison between public and private sector life insurancecompanies in order to provide significant insights to the life insurance companies that may assist them in devising better loyalty practices. The findings suggest that Indian customers do care about the public sector status of a financial service provider as it entails a sense of security and stability and thus creates a difference between customer loyalty of public sector life insurerand that of private sector life insurer. The paper holds significant implications for academicians interested in dynamics of customer loyalty as well as the marketers of life insurance services whoare concerned with customer relationships.

Private health insurance and the Pharmaceutical Benefits Scheme: how effective has recent government policy been?

Science.gov (United States)

Richardson, Jeff R J; Segal, Leonie

2004-01-01

The cost to government of the Pharmaceutical Benefits Scheme (PBS) is rising at over 10 percent per annum. The government subsidy to Private Health Insurance (PHI) is about $2.4 billion and rising. Despite this, the queues facing public patients - which were the primary justification for the assistance to PHI - do not appear to be shortening. Against this backdrop, we seek to evaluate recent policies. It is shown that the reason commonly given for the support of PHI - the need to preserve the market share of private hospitals and relieve pressure upon public hospitals - is based upon a factually incorrect analysis of the hospital sector in the last decade. It is similarly true that the 'problem' of rising pharmaceutical expenditures has been exaggerated. The common element in both sets of policies is that they result in cost shifting from the public to the private purse and have little to do with the quality or quantity of health services.

Stochastic Actuarial Modelling of a Defined-Benefit Social Security Pension Scheme: An Analytical Approach

OpenAIRE

Iyer, Subramaniam

2017-01-01

Among the systems in place in different countries for the protection of the population against the long-term contingencies of old-age (or retirement), disability and death (or survivorship), defined-benefit social security pension schemes, i.e. social insurance pension schemes, by far predominate, despite the recent trend towards defined-contribution arrangements in social security reforms. Actuarial valuations of these schemes, unlike other branches of insurance, continue to be carried out a...

Awareness and Coverage of the National Health Insurance Scheme ...

African Journals Online (AJOL)

Sub- national levels possess a high degree of autonomy in a number of sectors including health. It is important to assess the level of coverage of the scheme among the formal sector workers in Nigeria as a proxy to gauge the extent of coverage of the scheme and derive suitable lessons that could be used in its expansion.

Can health insurance improve access to quality care for the Indian poor?

Science.gov (United States)

Michielsen, Joris; Criel, Bart; Devadasan, Narayanan; Soors, Werner; Wouters, Edwin; Meulemans, Herman

2011-08-01

Recently, the Indian government launched health insurance schemes for the poor both to protect them from high health spending and to improve access to high-quality health services. This article aims to review the potentials of health insurance interventions in order to improve access to quality care in India based on experiences of community health insurance schemes. PubMed, Ovid MEDLINE (R), All EBM Reviews, CSA Sociological Abstracts, CSA Social Service Abstracts, EconLit, Science Direct, the ISI Web of Knowledge, Social Science Research Network and databases of research centers were searched up to September 2010. An Internet search was executed. One thousand hundred and thirty-three papers were assessed for inclusion and exclusion criteria. Twenty-five papers were selected providing information on eight schemes. A realist review was performed using Hirschman's exit-voice theory: mechanisms to improve exit strategies (financial assets and infrastructure) and strengthen patient's long voice route (quality management) and short voice route (patient pressure). All schemes use a mix of measures to improve exit strategies and the long voice route. Most mechanisms are not effective in reality. Schemes that focus on the patients' bargaining position at the patient-provider interface seem to improve access to quality care. Top-down health insurance interventions with focus on exit strategies will not work out fully in the Indian context. Government must actively facilitate the potential of CHI schemes to emancipate the target group so that they may transform from mere passive beneficiaries into active participants in their health.

On the economic risk capital of portfolio insurance

Directory of Open Access Journals (Sweden)

Werner Hürlimann

2004-09-01

Full Text Available A formula for the conditional value-at-risk of classical portfolio insurance is derived and shown to be constant for sufficiently small loss probabilities. As illustrations, we discuss portfolio insurance for an equity market index using empirical data, and analyze the more general multivariate situation of a portfolio of risky assets.

Challenges of medicines management in the public and private sector under Ghana's National Health Insurance Scheme - A qualitative study.

Science.gov (United States)

Ashigbie, Paul G; Azameti, Devine; Wirtz, Veronika J

2016-01-01

Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring more equitable financing of health care to improve access to health services. This qualitative study examines the challenges and consequences of medicines management policies and practices under the NHIS as perceived by public and private service providers. This study was conducted in health facilities in the Eastern, Greater Accra and Volta regions of Ghana between July and August 2014. We interviewed 26 Key Informants (KIs) from a purposively selected sample of public and private sector providers (government and mission hospitals, private hospitals and private standalone pharmacies), pharmaceutical suppliers and NHIS district offices. Data was collected using semi-structured interview guides which covered facility accreditation, reimbursement practices, medicines selection, purchasing and pricing of medicines, and utilization of medicines. Codes for data analysis were developed based on the study questions and also in response to themes that emerged from the transcripts and notes. Most KIs agreed that the introduction of the NHIS has increased access to and utilization of medicines by removing cost barriers for patients; however, some pointed out the increased utilization could also be corollary to moral hazard. Common concerns across all facilities were the delays in receiving NHIS reimbursements, and low reimbursement rates for medicines which result in providers asking patients to pay supplementary fees. KIs reported important differences between private and public sectors including weak separation of prescribing and dispensing and limited use of drugs and therapeutic committees in the private sector, the disproportionate effects of unfavorable reimbursement prices for medicines, and inadequate participation of the private sector providers (especially pharmacies and licensed chemical sellers) in the NHIS. Health providers generally perceive the NHIS to have had a

CERN Health Insurance Scheme (CHIS): Monthly Contributions for 2016

CERN Multimedia

HR Department

2015-01-01

For 2016, the contribution rate for active and retired CHIS members will be 4.86%. The amounts of the fixed contributions for voluntarily insured members (e.g. users and other associates), as well as the supplementary contributions for spouses with income from a professional activity or with a retirement pension (including a CERN pension), are thus as follows:   1. Voluntary contributions The full contribution based on Reference Salary II is 1218 CHF per month. This fixed contribution is applied to voluntarily affiliated users and other associates with normal coverage. Half of this amount, 609 CHF, is applied to voluntarily affiliated users and other associates with reduced coverage. Finally, an amount of 487 CHF is applied to children maintaining their insurance cover on a voluntary and temporary basis. 2. Supplementary contributions The supplementary contribution for the spouse or registered partner of a staff member, fellow or pensioner is now as follows, according to the spouse’s month...

Health insurance and health care in India: a supply-demand perspective

OpenAIRE

Perianayagam, Arokiasamy; Goli, Srinivas

2013-01-01

India’s health care and health financing provision is characterized by too little Government spending on health, meager health insurance coverage, declining public health care use contrasted by highest levels of private out-of-pocket health spending in the world. To understand the interconnectedness of these disturbing outcomes, this paper envisions a theoretical framework of health insurance and health care revisits the existing health insurance schemes and assesses the health insurance cove...

Urban health insurance reform and coverage in China using data from National Health Services Surveys in 1998 and 2003

Directory of Open Access Journals (Sweden)

Collins Charles D

2007-03-01

Full Text Available Abstract Background In 1997 there was a major reform of the government run urban health insurance system in China. The principal aims of the reform were to widen coverage of health insurance for the urban employed and contain medical costs. Following this reform there has been a transition from the dual system of the Government Insurance Scheme (GIS and Labour Insurance Scheme (LIS to the new Urban Employee Basic Health Insurance Scheme (BHIS. Methods This paper uses data from the National Health Services Surveys of 1998 and 2003 to examine the impact of the reform on population coverage. Particular attention is paid to coverage in terms of gender, age, employment status, and income levels. Following a description of the data between the two years, the paper will discuss the relationship between the insurance reform and the growing inequities in population coverage. Results An examination of the data reveals a number of key points: a The overall coverage of the newly established scheme has decreased from 1998 to 2003. b The proportion of the urban population without any type of health insurance arrangement remained almost the same between 1998 and 2003 in spite of the aim of the 1997 reform to increase the population coverage. c Higher levels of participation in mainstream insurance schemes (i.e. GIS-LIS and BHIS were identified among older age groups, males and high income groups. In some cases, the inequities in the system are increasing. d There has been an increase in coverage of the urban population by non-mainstream health insurance schemes, including non-commercial and commercial ones. The paper discusses three important issues in relation to urban insurance coverage: institutional diversity in the forms of insurance, labour force policy and the non-mainstream forms of commercial and non-commercial forms of insurance. Conclusion The paper concludes that the huge economic development and expansion has not resulted in a reduced disparity in

A logistic regression model for Ghana National Health Insurance claims

Directory of Open Access Journals (Sweden)

Samuel Antwi

2013-07-01

Full Text Available In August 2003, the Ghanaian Government made history by implementing the first National Health Insurance System (NHIS in Sub-Saharan Africa. Within three years, over half of the country’s population had voluntarily enrolled into the National Health Insurance Scheme. This study had three objectives: 1 To estimate the risk factors that influences the Ghana national health insurance claims. 2 To estimate the magnitude of each of the risk factors in relation to the Ghana national health insurance claims. In this work, data was collected from the policyholders of the Ghana National Health Insurance Scheme with the help of the National Health Insurance database and the patients’ attendance register of the Koforidua Regional Hospital, from 1st January to 31st December 2011. Quantitative analysis was done using the generalized linear regression (GLR models. The results indicate that risk factors such as sex, age, marital status, distance and length of stay at the hospital were important predictors of health insurance claims. However, it was found that the risk factors; health status, billed charges and income level are not good predictors of national health insurance claim. The outcome of the study shows that sex, age, marital status, distance and length of stay at the hospital are statistically significant in the determination of the Ghana National health insurance premiums since they considerably influence claims. We recommended, among other things that, the National Health Insurance Authority should facilitate the institutionalization of the collection of appropriate data on a continuous basis to help in the determination of future premiums.

A perverse 'net' effect? Health insurance and ex-ante moral hazard in Ghana

NARCIS (Netherlands)

Debebe, Z.Y.; Kempen, L.A.C.M. van; Hoop, T.J. de

2012-01-01

Incentive problems in insurance markets are well-established in economic theory. One of these incentive problems is related to reduced prevention efforts following insurance coverage (ex-ante moral hazard). This prediction is yet to be tested empirically with regard to health insurance, as the

Partnerships for disaster risk insurance in the EU

Directory of Open Access Journals (Sweden)

J. Mysiak

2016-11-01

Full Text Available With increasing costs inflicted by natural hazard perils, and amidst state budget cuts, concerns are mounting about the capacity of governments to design sustainable, equitable and affordable risk management schemes. The participation of the private sector along with the public one through public–private partnerships (PPPs has gained importance as a means of providing catastrophic natural hazard insurance to address these seemingly conflicting objectives. In 2013 the European Commission launched a wide-ranging consultation about what EU action could be appropriate to improve the performance of insurance markets. Simultaneously, the EU legislator instigated major reforms in the legislation and regulations that pertain to how PPPs are designed or operate. This paper has a dual objective: first, we review and summarize the manifold legal background that influences the provision of insurance against natural catastrophes. Second, we examine how PPPs designed for sharing and transferring risk operate within the European regulatory constraints, illustrated using the example of the UK Flood Reinsurance Scheme (Flood RE between the state and the Association of British Insurers.

The robustness of flood insurance regimes given changing risk resulting from climate change

Directory of Open Access Journals (Sweden)

Jessica Lamond

2014-01-01

Full Text Available The changing risk of flooding associated with climate change presents different challenges for the different flood insurance market models in use around the world, which vary in respect of consumer structure and their risk transfer mechanism. A review of international models has been undertaken against three broad criteria for the functioning and sustainability of a flood insurance scheme: knowing the nature of the insurable risk; the availability of an insurable population; and the presence of a solvent insurer. The solvency of insurance markets appears strong, partly because insurers and reinsurers can choose to exclude markets which would give rise to insolvency or can diversify their portfolios to include offsetting perils. Changing risk may threaten solvency if increasing risk is not recognised and adjusted for but insurability of flood risk may be facilitated by the use of market based and hybrid schemes offering greater diversification and more flexibility. While encouragement of mitigation is in theory boosted by risk based pricing, availability and affordability of insurance may be negatively impacted. This threatens the sustainability of an insurable population, therefore the inclusion of the state in partnership is beneficial in ensuring continuity of cover, addressing equity issues and incentivising mitigation.

Government health insurance for people below poverty line in India: quasi-experimental evaluation of insurance and health outcomes.

Science.gov (United States)

Sood, Neeraj; Bendavid, Eran; Mukherji, Arnab; Wagner, Zachary; Nagpal, Somil; Mullen, Patrick

2014-09-11

To evaluate the effects of a government insurance program covering tertiary care for people below the poverty line in Karnataka, India, on out-of-pocket expenditures, hospital use, and mortality. Geographic regression discontinuity study. 572 villages in Karnataka, India. 31,476 households (22,796 below poverty line and 8680 above poverty line) in 300 villages where the scheme was implemented and 28,633 households (21,767 below poverty line and 6866 above poverty line) in 272 neighboring matched villages ineligible for the scheme. A government insurance program (Vajpayee Arogyashree scheme) that provided free tertiary care to households below the poverty line in about half of villages in Karnataka from February 2010 to August 2012. Out-of-pocket expenditures, hospital use, and mortality. Among households below the poverty line, the mortality rate from conditions potentially responsive to services covered by the scheme (mostly cardiac conditions and cancer) was 0.32% in households eligible for the scheme compared with 0.90% among ineligible households just south of the eligibility border (difference of 0.58 percentage points, 95% confidence interval 0.40 to 0.75; Ppoverty line (households above the poverty line were not eligible for the scheme), with a mortality rate from conditions covered by the scheme of 0.56% in eligible villages compared with 0.55% in ineligible villages (difference of 0.01 percentage points, -0.03 to 0.03; P=0.95). Eligible households had significantly reduced out-of-pocket health expenditures for admissions to hospitals with tertiary care facilities likely to be covered by the scheme (64% reduction, 35% to 97%; PIndia. © Sood et al 2014.

Consumer mobility in social health insurance markets: A five-country comparison

NARCIS (Netherlands)

T. Laske-Aldershof (Trea); F.T. Schut (Erik); K. Beck (Konstantin); S. Greaß (Stefan); A. Shmueli (Amir); C. van de Voorde (Carine)

2004-01-01

textabstractDuring the 1990s, the social health insurance schemes of Germany, the Netherlands, Switzerland, Belgium and Israel were significantly reformed by the introduction of freedom of choice (open enrolment) of health insurer. This was introduced alongside a system of risk adjustment to

Patient satisfaction with primary health care - a comparison between the insured and non-insured under the National Health Insurance Policy in Ghana

DEFF Research Database (Denmark)

Fenny, Ama Pokuah; Enemark, Ulrika; Asante, Felix A

2014-01-01

Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative...... system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand...... for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics...

HEALTH INSURANCE: our money in a capitalized fund now

CERN Multimedia

Association du personnel

In ECHO no. 41 on 5 November “Health insurance: what is the current situation?” we explained to you the situation of our Health Insurance Scheme and the ideas currently being discussed to ensure its future balance. If you missed this episode, you should catch up on it now so that you understand what follows.

31 CFR 103.16 - Reports by insurance companies of suspicious transactions.

Science.gov (United States)

2010-07-01

..., such as terrorist financing or ongoing money laundering schemes, the insurance company shall... fraudulent submission relates to money laundering or terrorist financing. (e) Retention of records. An... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Reports by insurance companies of...

Financial protection effects of modification of China's New Cooperative Medical Scheme on rural households with chronic diseases.

Science.gov (United States)

Wang, Jing; Chen, Lina; Ye, Ting; Zhang, Zhiguo; Ma, Jingdong

2014-07-15

Several years have passed since the rural New Cooperative Medical Scheme (NCMS) in China was established and policies kept continuous improvement. Its policies on chronic diseases vary by county but have certain shared characteristics. Following this modification of medical insurance policy, this study reassesses the provision of insurance against expenditure on chronic diseases in rural areas, and analyzes its effect on impoverishment. We conducted an empirical study using multi-stage stratified random sampling. We surveyed 1,661 rural households in three provinces and analyzed the responses from 1,525 households that participated in NCMS, using descriptive and logistic regression analysis. The NCMS has reduced the prevalence of poverty and catastrophic health expenditure (CHE), as measured by out-of-pocket (OOP) payments exceeding 40% of total household expenditure, by decreasing medical expenditure. It provides obvious protection to households which include someone with chronic diseases. However, these households continue to face a higher financial risk than those without anyone suffering from chronic diseases. Variables about health service utilization and OOP payment differed significantly between households with or without people suffering from chronic disease. And CHE risk is commonly associated with household income, the number of family members with chronic diseases, OOP payment of outpatient and inpatient service in all three provinces. To reduce CHE risk for these households, it is critical to decrease OOP payments for health services by enhancing the effective reimbursement level of NCMS and strictly regulating the providers' behaviors. We recommend that a combinatory changes should be made to the rural health insurance scheme in China to improve its effect. These include improving the NCMS benefit package by broadening the catalogue of drugs and treatments covered, decreasing or abolishing deductible and increasing the reimbursement ratio of outpatient

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

Science.gov (United States)

Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F

2015-01-01

Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, pquality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. There is the need to intensify client education and balanced

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

Directory of Open Access Journals (Sweden)

Robert Kaba Alhassan

Full Text Available Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge.To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS in Ghana are also discussed.This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare.Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001. Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in

COGORT METHOD AND OTS APPLICATIONS TO INSURANCE STATICTICS

Directory of Open Access Journals (Sweden)

Yu. F. Kasimov

2014-01-01

Full Text Available The paper considers the so-called cohort method of accounting aggregates insurance portfolios. In insurance statistics systematization and processing of aggregate data on the issued policies, premiums and insurance payments are often made with gross errors, because ones don't set the criteria written policies and related payments to the analyzed statistical universe. Besides, it is often not clearly specify the scheme of calculation of aggregate statistical associated with these policies. The study gives a detailed and rigorous presentation as a method of formation of different cohorts data for a specified period of assessment the aggregated characteristics and methods of calculation of interest to insurance of indicators (absolute and relative for these cohorts. The knowledge of these methods is necessary for a correct assessment of insurance premiums and reserves.

Some questions of insurance in the field of radioactive waste management

International Nuclear Information System (INIS)

Barantseva, G.Eh.; Kolotushkina, S.P.; Ozhovan, M.I.; Turlak, E.A.

2001-01-01

The general approach scheme when preparing the insurance agreements for radioactive waste transportation is suggested. An algorithm for ecological insurance which includes determination of the insurance activity object, accident probability, possible radionuclide release in a case of an accident, maximum possible damage and insurance payments for all accident categories and types of transported wastes (liquid, solid wastes and ionizing radiation sources), responsibility limit upon insurance agreements depending on the waste type, as well as calculation of the insurance bonus and agreement documentation is described. The IAEA recommendations are used for accident classification. The concrete examples of insurance agreements are considered. It is shown that it is not desirable to make one insurance agreement for three types of radioactive wastes [ru

Determinants of health insurance and hospitalization

Directory of Open Access Journals (Sweden)

Tadashi Yamada

2014-12-01

Full Text Available Our paper empirically examines how the decision to purchase private insurance and hospitalization are made based on household income, socio-demographic factors, and private health insurance factors in both Japan and the USA. Using these two data-sets, we found some similarities and dissimilarities between Japan and the United States. As income of households rises, households have a positive effect on purchasing health insurance as a normal good. Another similarity between the two countries is seen in the income effect on risk of hospitalization, which is negative for both Japanese and US cases. For dissimilarity, the insurance premium effect on risk of hospitalization is positive for the Japanese case, while negative for the US case. Since the Japanese insurance data had variables such as payments per day of hospitalization if household gets hospitalized, insurance payments upon death of an insured person, and annuity payments at maturity, we tested to see if these characteristics affect the risk of hospitalization for households; we do not eliminate a possibility of adverse selection. For the US pure health issuance characteristics, an increase in premium of health insurance policies cause individuals to substitute more health capital investment which causes lower risk of hospitalization.

Income-related inequality in health insurance coverage: analysis of China Health and Nutrition Survey of 2006 and 2009

OpenAIRE

Liu, Jinan; Shi, Lizheng; Meng, Qingyue; Khan, M Mahmud

2012-01-01

Abstract Introduction China introduced the urban resident basic medical insurance (URBMI) in 2007 to cover children and urban unemployed adults, in addition to the new cooperative medical scheme (NCMS) for rural residents in 2003 and the basic health insurance scheme (BHIS) for urban employees in 1998. This study examined whether the overall income-related inequality in health insurance coverage improved during 2006 and 2009 in China. Methods The China Health and Nutrition Survey (CHNS) data ...

The continuous market cycle of the shortterm insurance industry

Directory of Open Access Journals (Sweden)

L Essel

2012-03-01

Full Text Available The short-term insurance industry is a cyclical type of business due to the impact of the continuous market cycle. This cycle has a growth phase, soft market phase, hard market phase and a break-even phase. The objective of the research paper focuses on the improvement of financial decision-making when executives of the short-term insurance industry are managing their business during the various phases of the continuous market cycle. Both a literature study and an empirical survey were necessary to achieve the research objective. The empirical survey included the contributions of the top nine commercial and corporate short-term insurers in South Africa. They represented more than 77% of the total gross written premiums in 2009 and can thus be considered as the leaders of the short-term insurance industry in this country. The conclusions of the study should be valuable to other developing countries with emerging market economies as South Africa is also classified as such. The study focused on the various factors which may cause the continuous market cycle, the problem areas which the executives experience concerning the continuous market cycle, and how often various factors are adjusted by the short-term insurers to account for changes in the continuous market cycle

The Impact of Health Insurance on Health Care Provision in ...

African Journals Online (AJOL)

This study assesses the impact of the NHIS scheme in promoting access to health care. It identifies a need for all stakeholders to engage in the active promotion of awareness on health insurance as option of health care provisioning. It argues that health insurance can make health care more accessible to a wider segment ...

HEALTH INSURANCE

CERN Multimedia

Division HR

2000-01-01

Change of name for AUSTRIA As of October 1, the AUSTRIA Assurances S.A. company will change its name to: UNIQA Assurances S.A. It inherits the same name as its parent Austrian company, which adopted it towards the end of 1999. This change has no effect on the contract which binds it to CERN for the administration of our Health Insurance Scheme. New insurance cards will be sent to you by UNIQA and the printed forms and envelopes will gradually be updated with the new name. Postal and phone addresses remain unaffected by the change. You should address your postal mail to: UNIQA Assurances rue des Eaux Vives 94 case postale 6402 1211 Genève 6 You may telephone your usual contact persons at the same numbers as before and send e-mails to the UNIQA office at CERN at: UNIQA.Assurances@cern.ch

Innovative insurance plan promises to leverage green power

International Nuclear Information System (INIS)

Edge, Gordon

1999-01-01

This article explains the gap between customers of green power signing short term (1-2 year) contracts and the banks wanting power purchase agreements for ten or more years before lending on new projects. Details are given of a new initiative from the US green power industry for a green premium for green power marketeers with the idea of an insurance product to take some of the risk and bridge the gap. Examples of coverage under the green power insurance proposal are discussed, and the funding and implementation of the scheme, and the effect of the insurance are considered

Why are the poor less covered in Ghana’s national health insurance? : A critical analysis of policy and practice

NARCIS (Netherlands)

Kotoh, A.M.; Van der Geest, S.

2016-01-01

Background: The National Health Insurance Scheme (NHIS) was introduced in Ghana to ensure equity in healthcare access. Presently, some low and middle income countries including Ghana are using social health insurance schemes to reduce inequity in access to healthcare. In Ghana, the NHIS was

Self-insurance and worksite alcohol programs: an econometric analysis.

Science.gov (United States)

Kenkel, D S

1997-03-01

The worksite is an important point of access for alcohol treatment and prevention, but not all firms are likely to find offering alcohol programs profitable. This study attempts to identify at a conceptual and empirical level factors that are important determinants of the profitability of worksite alcohol programs. A central question considered in the empirical analysis is whether firms' decisions about worksite alcohol programs are related to how employee group health insurance is provided. The data used are from the 1992 National Survey of Worksite Health Promotion Activities (N = 1,389-1,412). The econometric analysis focuses on measures of whether the surveyed firms offer Employee Assistance Programs (EAPs), individual counseling, group classes and resource materials regarding alcohol and other substance abuse. Holding other factors constant, the probability that a self-insured firm offers an EAP is estimated to be 59%, compared to 51% for a firm that purchases market group health insurance for its employees. Unionized worksites and larger worksites are also found to be more likely to offer worksite alcohol programs, compared to nonunionized smaller worksites. Worksites with younger work-forces are less likely than those with older employees to offer alcohol programs. The empirical results are consistent with the conceptual framework from labor economics, since self-insurance is expected to increase firms' demand for worksite alcohol programs while large worksite is expected to reduce the average program cost. The role of union status and workforce age suggests it is important to consider workers' preferences for the programs as fringe benefits. The results also suggest that the national trend towards self-insurance may be leading to more prevention and treatment of worker alcohol-related problems.

Big Data and Insurance: Advantageous Selection in European Markets

Directory of Open Access Journals (Sweden)

Francesco Corea

2017-06-01

Full Text Available Rothschild and Stiglitz (1976 argued that people signal their risk profile through their insurance demand, i.e. individuals with a high risk profile would buy insurance as much as they can, while people who are not going to buy any insurance are the ones with a lower risk profile. This issue is commonly known as adverse selection. Even if their prediction seems to work quite well in a lot of different markets, Cutler et al. (2008 proved that there exist some insurance markets in United States in which the expected result is completely different. In the wake of this study, we provide empirical evidences that there are some European insurance markets in which the low risk profile agents are the ones who buy more insurance.

CHALLENGES AND OPPORTUNITIES TH E INSURANCE INDU STRY FACING WITH IN RELATION TO CLIMATE CHANGE

Directory of Open Access Journals (Sweden)

Fekete Mária FARKASNÉ

2010-07-01

Full Text Available Apart from the financial risk the insurance industry are facing with in association with climate change, there are also opportun ities to the sector to develop new markets and provide coverage against weather related risks. This study presents a possible method to examine the potential for introducing a new insurance product, namely an agricultural flood insurance scheme in the United Kingdom. The investigation included the calculation of agricultural flood damage costs, the possible changes in flood risk, the description of farmers’ risk attitude and interests in insurance. In a small scale survey, farmers were asked their experiences related to flooding, farm management practices and thei r willingness to pay for flood insurance using a contingent valuation method. Using statistical analysis it was found the insurance demand is positively correlated with the damage cost predicted and association is likely between farm types and WTP for insurance. Linear regression model suggests that the demand for flood insurance is low amongst farmers in the present risk level. The findi ngs of this research highlight that there is little evidence for the viability of a farmer financed agricultural flood insurance scheme at the moment in the United Kingdom.

Asymmetric Information, Self-selection, and Pricing of Insurance Contracts

DEFF Research Database (Denmark)

Donnelly, Catherine; Englund, Martin Kristian; Nielsen, Jens Perch

2014-01-01

This article presents an optional bonus-malus contract based on a priori risk classification of the underlying insurance contract. By inducing self-selection, the purchase of the bonus-malus contract can be used as a screening device. This gives an even better pricing performance than both...... an experience rating scheme and a classical no-claims bonus system. An application to the Danish automobile insurance market is considered....

Reforming voluntary drug insurance in Russian healthcare: does social solidarity matter?

Science.gov (United States)

Gerry, Christopher J; Kaneva, Maria; Zasimova, Liudmila

2017-11-01

With low take-up of both private health insurance and the existing public drug reimbursement scheme, it is thought that less than 5% of the Russian population have access to free outpatient drug treatment. This represents a major policy challenge for a country grappling with reforms of its healthcare system and experiencing low or no economic growth and significant associated reductions in spending on social services. In this paper, we draw on data from a 2011 Levada-Center survey to examine the attitudes and social solidarity of the Russian population towards drug policies in general and towards the introduction of a proposed voluntary drug insurance system in particular. In addition to being among the first to explore these important questions in the post-Communist setting, we make three important contributions to the emerging policy debates. First, we find that, if introduced immediately and without careful planning and preparation, Russia's voluntary drug insurance scheme is likely to collapse financially due to the over-representation of high-risk unhealthy individuals opting in to the scheme. Second, the negative attitude of higher income groups towards the redistribution of wealth to the poor may further impede government efforts to introduce voluntary drug insurance. Finally, we argue that Russia currently lacks the breadth and depth of social solidarity necessary for implementing this form of health financing. Copyright © 2017 Elsevier B.V. All rights reserved.

Good governance for pension schemes

CERN Document Server

Thornton, Paul

2011-01-01

Regulatory and market developments have transformed the way in which UK private sector pension schemes operate. This has increased demands on trustees and advisors and the trusteeship governance model must evolve in order to remain fit for purpose. This volume brings together leading practitioners to provide an overview of what today constitutes good governance for pension schemes, from both a legal and a practical perspective. It provides the reader with an appreciation of the distinctive characteristics of UK occupational pension schemes, how they sit within the capital markets and their social and fiduciary responsibilities. Providing a holistic analysis of pension risk, both from the trustee and the corporate perspective, the essays cover the crucial role of the employer covenant, financing and investment risk, developments in longevity risk hedging and insurance de-risking, and best practice scheme administration.

Social deterministic factors to participation in the National Health Insurance Scheme in the context of rural Ghanaian setting

Directory of Open Access Journals (Sweden)

Stephen Manortey

2014-04-01

Full Text Available The primary purpose of this study is to identify predictors of complete household enrollment into the National Health Insurance Scheme (NHIS among inhabitants of the Barekese sub-district in the Ashanti Region of Ghana. Heads of households in 20 communities from the Barekuma Collaborative Community Project site were interviewed to gather data on demographic, socioeconomic status (SES indicators and complete household subscription in the NHIS. Logistic regression model was used to predict enrollment in the NHIS. Of the 3228 heads of households interviewed, 60 percent reported having all members of their respective households enrolled in the NHIS. Residents in the classified Middle and High SES brackets had 1.47 (95% CI: 1.21-1.77 and 1.66 (95% CI: 1.27- 2.16 times higher odds, respectively, of complete household enrollment compared to their counterparts in the Low SES category. The odds of enrolling in the program tend to increase progressively with the highest level of education attained by the head of the family unit. Eight years after the introduction of the national health insurance policy in Ghana, the reported subscription rate for complete households was about 60 percent in the 20 rural communities that participated in the study. This finding calls for the need to step up further national strategies that will help increase enrollment coverage, especially among the poor and less educated in the rural communities.

Migrant female head porters' enrolment in and utilisation and renewal of the National Health Insurance Scheme in Kumasi, Ghana.

Science.gov (United States)

Boateng, Simon; Amoako, Prince; Poku, Adjoa Afriyie; Baabereyir, Anthony; Gyasi, Razak Mohammed

2017-01-01

As a social protection policy, Ghana's National Health Insurance Scheme (NHIS) aims to improve access to healthcare, especially for the vulnerable. Migrant female head porters ( kayayoo ), who are part of the informal economic workforce, are underscored as an ethnic minority and vulnerable group in Ghana. This study aimed to analyse the factors associated with enrolment in and renewal and utilisation of the NHIS among migrant female head porters in the Kumasi Metropolis. We purposively sampled 392 migrant female head porters in the Kejetia, Asafo and Bantama markets. We used a binary logit regression model to estimate associations among baseline characteristics, convenience and benefit factors and enrolment in and renewal and utilisation of the NHIS. Age and income significantly increased the probability of NHIS enrolment, renewal and utilisation. Long waiting times at NHIS offices significantly reduced the likelihood of renewal, while provision of drugs highly significantly increased the tendency for migrant female head porters to enrol in, renew and use the NHIS. Consulting and surgery also significantly increased renewal and utilisation of the NHIS. Political commitment is imperative for effective implementation of the decentralisation policy of the NHIS through the National Health Insurance Authority in Kumasi. We argue that retail offices should be well equipped with logistic facilities to ensure convenience in NHIS initial enrolment and renewal processes by citizenry, and by vulnerable groups in particular.

Modelling the mortality of members of group schemes in South Africa

African Journals Online (AJOL)

In this paper, the methodology underlying the graduation of the mortality of members of group schemes in South Africa underwritten by life insurance companies under group life-insurance arrangements is described and the results are presented. A multivariate parametric curve was fitted to the data for the working ages 25 ...

Empirical Bayes Credibility Models for Economic Catastrophic Losses by Regions

Directory of Open Access Journals (Sweden)

Jindrová Pavla

2017-01-01

Full Text Available Catastrophic events affect various regions of the world with increasing frequency and intensity. The number of catastrophic events and the amount of economic losses is varying in different world regions. Part of these losses is covered by insurance. Catastrophe events in last years are associated with increases in premiums for some lines of business. The article focus on estimating the amount of net premiums that would be needed to cover the total or insured catastrophic losses in different world regions using Bühlmann and Bühlmann-Straub empirical credibility models based on data from Sigma Swiss Re 2010-2016. The empirical credibility models have been developed to estimate insurance premiums for short term insurance contracts using two ingredients: past data from the risk itself and collateral data from other sources considered to be relevant. In this article we deal with application of these models based on the real data about number of catastrophic events and about the total economic and insured catastrophe losses in seven regions of the world in time period 2009-2015. Estimated credible premiums by world regions provide information how much money in the monitored regions will be need to cover total and insured catastrophic losses in next year.

Adverse Selection in Community Based Health Insurance among Informal Workers in Bangladesh: An EQ-5D Assessment

Directory of Open Access Journals (Sweden)

Sayem Ahmed

2018-01-01

Full Text Available Community-based Health Insurance (CBHI schemes are recommended for providing financial risk protection to low-income informal workers in Bangladesh. We assessed the problem of adverse selection in a pilot CBHI scheme in this context. In total, 1292 (646 insured and 646 uninsured respondents were surveyed using the Bengali version of the EuroQuol-5 dimensions (EQ-5D questionnaire for assessing their health status. The EQ-5D scores were estimated using available regional tariffs. Multiple logistic regression was applied for predicting the association between health status and CBHI scheme enrolment. A higher number of insured reported problems in mobility (7.3%; p = 0.002; self-care (7.1%; p = 0.000 and pain and discomfort (7.7%; p = 0.005 than uninsured. The average EQ-5D score was significantly lower among the insured (0.704 compared to the uninsured (0.749. The regression analysis showed that those who had a problem in mobility (m 1.25–2.17; self-care (OR = 2.29; 95% CI: 1.62–3.25 and pain and discomfort (OR = 1.43; 95% CI: 1.13–1.81 were more likely to join the scheme. Individuals with higher EQ-5D scores (OR = 0.46; 95% CI: 0.31–0.69 were less likely to enroll in the scheme. Given that adverse selection was evident in the pilot CBHI scheme, there should be consideration of this problem when planning scale-up of these kind of schemes.

Switching insurer in the Irish voluntary health insurance market: determinants, incentives, and risk equalization.

Science.gov (United States)

Keegan, Conor; Teljeur, Conor; Turner, Brian; Thomas, Steve

2016-09-01

The determinants of consumer mobility in voluntary health insurance markets providing duplicate cover are not well understood. Consumer mobility can have important implications for competition. Consumers should be price-responsive and be willing to switch insurer in search of the best-value products. Moreover, although theory suggests low-risk consumers are more likely to switch insurer, this process should not be driven by insurers looking to attract low risks. This study utilizes data on 320,830 VHI healthcare policies due for renewal between August 2013 and June 2014. At the time of renewal, policyholders were categorized as either 'switchers' or 'stayers', and policy information was collected for the prior 12 months. Differences between these groups were assessed by means of logistic regression. The ability of Ireland's risk equalization scheme to account for the relative attractiveness of switchers was also examined. Policyholders were price sensitive (OR 1.052, p sensitivity declined with age. Age (OR 0.971; p Consumers appear price-responsive, which is important for competition provided it is based on correct incentives. Risk equalization payments largely eliminated the profitable status of switchers, although further refinements may be required.

A longitudinal study of the implementation experiences of the Australian National Disability Insurance Scheme: investigating transformative policy change.

Science.gov (United States)

Carey, Gemma; Dickinson, Helen

2017-08-17

Internationally there has been a growth in the use of publicly funded service markets as a mechanism to deliver health and social services. This has accompanied the emergence of 'self-directed care' in a number of different policy areas including disability and aged care - often referred to as 'personalisation' (Giaimo and Manow, Comp. Pol Stud 32:967-1000, 1999; Needham, Public Money Manage 30:136-8, 2010; [Hood], [The Idea of Joined-up Government: A Historical Perspective], [2005]; Klijn and Koppenjan, Public Manage 2:437-54, 2000, Greener, Policy Polit 36:93-108, 2008). These reforms are underpinned by an idea that individuals should be placed in control of their own service needs, given funding directly by government and encouraged to exercise choice and control through purchasing their own services. A major challenge for governments in charge of these reforms is determining the best way to structure and govern emerging service markets markets. Given the growing international embrace of market-based reform mechanisms to provide essential services to citizens, finding ways to ensure they promote, and not diminish, people's health and wellbeing is vital. The Australian National Disability Insurance Scheme (NDIS) is Australia's first national approach to the use of personalised budgets. The program of research outlined in this paper brings together streams from a range of different studies in order to investigate the implementation of the NDIS longitudinally across different administrative levels of government, service providers and scheme participants. This programme of research will make a contribution to our understanding of the Australian scheme and how individualised funding operates within this context, but will also generate much needed evidence that will have relevance to other jurisdictions and help fill a gap in the evidence base.

Health insurance in India: what do we know and why is ethnographic research needed.

Science.gov (United States)

Ahlin, Tanja; Nichter, Mark; Pillai, Gopukrishnan

2016-01-01

The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.

Health Insurance for Government Employees in Bangladesh: A Concept Paper

OpenAIRE

Hamid, Syed Abdul

2014-01-01

Introducing compulsory health insurance for government employees bears immense importance for stepping towards universal healthcare coverage in Bangladesh. Lack of scientific study on designing such scheme, in the Bangladesh context, motivates this paper. The study aims at designing a comprehensive insurance package simultaneously covering health, life and accident related disability risks of the public employees, where the health component would extend to all dependent family members. ...

The underwriting process of liability insurance in South Africa

Directory of Open Access Journals (Sweden)

Anderson, S. E.

2014-03-01

Full Text Available Liability risks may embody far-reaching financial consequences for individuals, business enterprises and professional people. This paper focuses on the underwriting process which should be taken into consideration by short-term insurers when they are underwriting the main types of liability insurance, which include employer’s, householder’s, personal, product, professional and public liability insurance. The improvement of financial decision-making by short-term insurers when underwriting liability insurance represents the objective of this research. A study of secondary data was done to identify the existing literature, which formed the basis for compiling a questionnaire to obtain primary data. The top 10 short-term insurers which are the market leaders of liability insurance in South Africa and who received more than 85% of the annual gross written premiums for liability insurance in South Africa, represented the sample of the empirical study. This paper highlights the importance of the underwriting factors concerning liability insurance, how often the stipulations of insurance policies should be adjusted by the short-term insurers to account for the underwriting factors, as well as the problem areas which the underwriters may experience when they are underwriting liability insurance. Possible solutions to solve the problem areas were also addressed

Using ITS to Create an Insurance Industry Application: A Joint Case Study.

Science.gov (United States)

Boies, Stephen J.; And Others

1993-01-01

Presents an empirical case study of the use of ITS, a software development environment designed by IBM, by Continental Insurance for underwriting applications. Use of a rule-based user interface style that made electronic forms look like standard insurance industry paper forms and worked according to Continental's guidelines is described.…

Willingness to join and pay for the newly proposed social health insurance among teachers in Wolaita Sodo Town, South Ethiopia.

Science.gov (United States)

Agago, Tesfamichael Alaro; Woldie, Mirkuzie; Ololo, Shimeles

2014-07-01

Cost-sharing between beneficiaries and governments is critical to achieve universal health care coverage. To address this, Ethiopia is currently introducing Social Health Insurance. However, there has been limited evidence on willingness to join the newly proposed insurance scheme in the country. The purpose of this study is to assess willingness to join and pay for the scheme among teachers in Wolaita Sodo Town government educational institutions, South Ethiopia. A cross-sectional study was conducted from February 5 to March 10, 2012 on 335 teachers. Stratified simple random sampling technique was used and data were collected using structured interviewer administered questionnaire. Binary and multiple logistic regressions were used to estimate the crude and adjusted odds ratios for willingness to pay. Three hundred twenty-eight teachers participated in the study with response rate of 98%. About 55% of the teachers had never heard of any type of health insurance scheme. However, 74.4% of them were willing to pay for the suggested insurance scheme. About 47% of those who were willing to pay agreed to contribute greater than or equal to 4% of their monthly salaries. Willingness to pay was more likely among those who had heard about health insurance, had previous history of inability to pay for medical bills and achieved higher educational status. The majority of the teachers were willing to join social health insurance; however, adequate awareness creation and discussion should be made with all employees at various levels for the successful implementation of the scheme.

Pension Benefit Insurance and Pension Plan Portfolio Choice

OpenAIRE

Thomas Crossley; Mario Jametti

2008-01-01

Pension benefit guarantee policies have been introduced in several countries to pro- tect private pension plan members from the loss of income that would occur if a plan was underfunded when the sponsoring firm terminates a plan. Most of these public insurance schemes face financial dificulty and consequently policy reforms are being discussed or implemented. Economic theory suggests that such schemes will face moral hazard and adverse selection problems. In this note we test a specific theor...

The social security scheme in Thailand: what lessons can be drawn?

Science.gov (United States)

Tangcharoensathien, V; Supachutikul, A; Lertiendumrong, J

1999-04-01

The Social Security Scheme was launched in 1990, covering formal sector private employees for non-work related sickness, maternity and invalidity including cash benefits and funeral grants. The scheme is financed by tripartite contributions from government, employers and employees, each of 1.5% of payroll (total of 4.5%). The scheme decided to pay health care providers, whether public or private, on a flat rate capitation basis to cover both ambulatory and inpatient care. Registration of the insured with a contractor hospital was a necessary consequence of the chosen capitation payment system. The aim of this paper is to review the operation of the scheme, and to explore the implications of capitation payment and registration for utilisation levels and provider behaviour. A key weakness of the scheme's design is suggested to be the initial decision to give employers not employees the responsibility for choosing the registered hospitals. This was done for administrative reasons, but it contributed to low levels of use of the contractor hospitals. In addition, low levels of use were also probably the result of the potential for cream skimming, cost shifting from inpatient to ambulatory care and under-provision of patient care, though since monitoring mechanisms by the Social Security Office were weak, these effects are difficult to detect conclusively. Mechanisms to improve utilisation levels were gradually introduced, such as employee choice of registered hospitals and the formation of sub-contractor networks to improve access to care. A beneficial effect of the capitation payment system was that the Social Security Fund generated substantial reserves and expenditures on sickness benefits were well stabilised. The paper ends by recommending that future policy amendments should be guided by research and empirical findings and that tougher monitoring and enforcement of quality of care standards are required.

Numerical schemes for explosion hazards

International Nuclear Information System (INIS)

Therme, Nicolas

2015-01-01

In nuclear facilities, internal or external explosions can cause confinement breaches and radioactive materials release in the environment. Hence, modeling such phenomena is crucial for safety matters. Blast waves resulting from explosions are modeled by the system of Euler equations for compressible flows, whereas Navier-Stokes equations with reactive source terms and level set techniques are used to simulate the propagation of flame front during the deflagration phase. The purpose of this thesis is to contribute to the creation of efficient numerical schemes to solve these complex models. The work presented here focuses on two major aspects: first, the development of consistent schemes for the Euler equations, then the buildup of reliable schemes for the front propagation. In both cases, explicit in time schemes are used, but we also introduce a pressure correction scheme for the Euler equations. Staggered discretization is used in space. It is based on the internal energy formulation of the Euler system, which insures its positivity and avoids tedious discretization of the total energy over staggered grids. A discrete kinetic energy balance is derived from the scheme and a source term is added in the discrete internal energy balance equation to preserve the exact total energy balance at the limit. High order methods of MUSCL type are used in the discrete convective operators, based solely on material velocity. They lead to positivity of density and internal energy under CFL conditions. This ensures that the total energy cannot grow and we can furthermore derive a discrete entropy inequality. Under stability assumptions of the discrete L8 and BV norms of the scheme's solutions one can prove that a sequence of converging discrete solutions necessarily converges towards the weak solution of the Euler system. Besides it satisfies a weak entropy inequality at the limit. Concerning the front propagation, we transform the flame front evolution equation (the so called

Illness Mapping: A time and cost effective method to estimate healthcare data needed to establish community-based health insurance

NARCIS (Netherlands)

E. Binnendijk (Erica); M. Gautham (Meenakshi); R. Koren (Ruth); D.M. Dror (David)

2012-01-01

textabstractBackground: Most healthcare spending in developing countries is private out-of-pocket. One explanation for low penetration of health insurance is that poorer individuals doubt their ability to enforce insurance contracts. Community-based health insurance schemes (CBHI) are a solution,

What influence Customer Patronage of Insurance Policies: An Empirical Assessment of Socio-Economic and Demographic Determinants of Insurance Patronage in Ghana

OpenAIRE

Fofie, Gloria A.

2016-01-01

The study attempts to explore and assess the social, economic and demographic factors that are likely to influence the patronage of insurance in Ghana. Employing a cross-sectional and convenient sampling method, 200 respondents were selected to answer semi-structured questionnaires. Using a Probit econometric regression model for analysis, the results indicate these socio-economic and demographic determinants are positively and significantly related to insurance demand, except that of religio...

A Two-Account Life Insurance Model for Scenario-Based Valuation Including Event Risk

DEFF Research Database (Denmark)

Jensen, Ninna Reitzel; Schomacker, Kristian Juul

2015-01-01

Using a two-account model with event risk, we model life insurance contracts taking into account both guaranteed and non-guaranteed payments in participating life insurance as well as in unit-linked insurance. Here, event risk is used as a generic term for life insurance events, such as death......, disability, etc. In our treatment of participating life insurance, we have special focus on the bonus schemes “consolidation” and “additional benefits”, and one goal is to formalize how these work and interact. Another goal is to describe similarities and differences between participating life insurance...... product types. This enables comparison of participating life insurance products and unit-linked insurance products, thus building a bridge between the two different ways of formalizing life insurance products. Finally, our model distinguishes itself from the existing literature by taking into account...

Health care utilisation amongst Shenzhen migrant workers: does being insured make a difference?

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Jiang Hanping

2009-11-01

Full Text Available Abstract Background As one of the most populous metropolitan areas in the Pearl River Delta of South China, Shenzhen attracts millions of migrant workers annually. The objectives of this study were to compare health needs, self-reported health and healthcare utilisation of insured and uninsured migrant workers in Shenzhen, China, where a new health insurance scheme targeting at migrant workers was initiated. Methods A cross-sectional survey using multi-staged sampling was conducted to collect data from migrant factory workers. Statistical tests included logistic regression analysis were used. Results Among 4634 subjects (96.54% who responded to the survey, 55.11% were uninsured. Disease patterns were similar irrespective of insurance status. The uninsured were more likely to be female, single, younger and less educated unskilled labourers with a lower monthly income compared with the insured. Out of 1136 who reported illness in the previous two weeks, 62.15% did not visit a doctor. Of the 296 who were referred for inpatient care, 48.65% did not attend because of inability to pay. Amongst those who reported sickness, 548 were insured and 588 were uninsured. Those that were insured, and had easier access to care were more likely to make doctor visits than those who were uninsured. Conclusion Health care utilisation patterns differ between insured and uninsured workers and insurance status appears to be a significant factor. The health insurance system is inequitably distributed amongst migrant workers. Younger less educated women who are paid less are more likely to be uninsured and therefore to pay out of pocket for their care. For greater equity this group need to be included in the insurance schemes as they develop.

Public views of health insurance in Japan during the era of attaining universal health coverage: a secondary analysis of an opinion poll on health insurance in 1967

Directory of Open Access Journals (Sweden)

Ikuma Nozaki

2017-07-01

Full Text Available While Japan’s success in achieving universal health insurance over a short period with controlled healthcare costs has been studied from various perspectives, that of beneficiaries have been overlooked. We conducted a secondary analysis of an opinion poll on health insurance in 1967, immediately after reaching universal coverage. We found that people continued to face a slight barrier to healthcare access (26.8% felt medical expenses were a heavy burden and had high expectations for health insurance (60.5% were satisfied with insured medical services and 82.4% were willing to pay a premium. In our study, younger age, having children before school age, lower living standards, and the health insurance scheme were factors that were associated with a willingness to pay premiums. Involving high-income groups in public insurance is considered to be the key to ensuring universal coverage of social insurance.

Determinants of Health Insurance Coverage among People Aged 45 and over in China: Who Buys Public, Private and Multiple Insurance

Science.gov (United States)

Jin, Yinzi; Hou, Zhiyuan; Zhang, Donglan

2016-01-01

Background China is reforming and restructuring its health insurance system to achieve the goal of universal coverage. This study aims to understand the determinants of public, private and multiple insurance coverage among people of retirement-age in China. Methods We used data from the China Health and Retirement Longitudinal Survey 2011 and 2013, a nationally representative survey of Chinese people aged 45 and over. Multinomial logit regression was performed to identify the determinants of public, private and multiple health insurance coverage. We also conducted logit regression to examine the association between public insurance coverage and demand for private insurance. Results In 2013, 94.5% of this population had at least one type of public insurance, and 12.2% purchased private insurance. In general, we found that rural residents were less likely to be uninsured (Relative Risk Ratio (RRR) = 0.40, 95% Confidence Interval (CI): 0.34–0.47) and were less likely to buy private insurance (RRR = 0.22, 95% CI: 0.16–0.31). But rural-to-urban migrants were more likely to be uninsured (RRR = 1.39, 95% CI: 1.24–1.57). Public health insurance coverage may crowd out private insurance market (Odds Ratio = 0.55, 95% CI: 0.48–0.63), particularly among enrollees of Urban Resident Basic Medical Insurance. There exists a huge socioeconomic disparity in both public and private insurance coverage. Conclusion The migrants, the poor and the vulnerable remained in the edge of the system. The growing private insurance market did not provide sufficient financial protection and did not cover the people with the greatest need. To achieve universal coverage and reduce socioeconomic disparity, China should integrate the urban and rural public insurance schemes across regions and remove the barriers for the middle-income and low-income to access private insurance. PMID:27564320

willingness to pay for voluntary health insurance in tanzania

African Journals Online (AJOL)

2011-02-02

Feb 2, 2011 ... insurance scheme and to see how they respond to changes in the benefit package. We also examined ... population, with national coverage remaining low at around 13% in ..... on subsistence farming activities. While income ...

Patient satisfaction with primary health care - a comparison between the insured and non-insured under the National Health Insurance Policy in Ghana.

Science.gov (United States)

Fenny, Ama Pokuaa; Enemark, Ulrika; Asante, Felix A; Hansen, Kristian S

2014-04-01

Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics, health insurance and the various dimensions of quality of care. This study employs logistic regression using household survey data in three districts in Ghana covering the 3 ecological zones (coastal, forest and savannah). It identifies the service quality factors that are important to patients' satisfaction and examines their links to their health insurance status. The results indicate that a higher proportion of insured patients are satisfied with the overall quality of care compared to the uninsured. The key predictors of overall satisfaction are waiting time, friendliness of staff and satisfaction of the consultation process. These results highlight the importance of interpersonal care in health care facilities. Feedback from patients' perception of health services and satisfaction surveys improve the quality of care provided and therefore effort must be made to include these findings in future health policies.

National health insurance scheme enrolment and antenatal care among women in Ghana: is there any relationship?

Science.gov (United States)

Dixon, Jenna; Tenkorang, Eric Y; Luginaah, Isaac N; Kuuire, Vincent Z; Boateng, Godfred O

2014-01-01

The objective of this study was to examine whether enrolment in the National Health Insurance Scheme (NHIS) affects the likelihood and timing of utilising antenatal care among women in Ghana. Data were drawn from the Ghana Demographic and Health Survey, a nationally representative survey collected in 2008. The study used a cross-sectional design to examine the independent effects of NHIS enrolment on two dependent variables (frequency and timing of antenatal visits) among 1610 Ghanaian women. Negative binomial and logit models were fitted given that count and categorical variables were employed as outcome measures, respectively. Regardless of socio-economic and demographic factors, women enrolled in the NHIS make more antenatal visits compared with those not enrolled; however, there was no statistical association with the timing of the crucial first visit. Women who are educated, living in urban areas and are wealthy were more likely to attend antenatal care than those living in rural areas, uneducated and from poorer households. The NHIS should be strengthened and resourced as it may act as an important tool for increasing antenatal care attendance among women in Ghana. © 2013 John Wiley & Sons Ltd.

Health insurance for Users and other Associated Members of the Personnel

CERN Multimedia

2015-01-01

A new health insurance option for Associated Members of the Personnel (including users): Allianz Worldwide Care Healthcare Plan for CERN MPAs.   Based on a survey conducted by the Users’ Office and a request by the Advisory Committee of CERN Users (ACCU), CERN has looked into health insurance products on the market and has identified a health insurance for MPAs and their accompanying family members which covers the financial consequences of illness and accidents and which is deemed adequate in CERN’s Host States. This insurance may be a useful option for MPAs who may not have adequate coverage in place from their home institution or who choose not to or cannot enrol in the CERN Health Insurance Scheme (CHIS). For the time being the insurance company can only offer limited duration policies to MPAs. We hope that this restriction can be removed in the future. The health insurance is offered by the insurance company Allianz WorldWide Care for a monthly fee of 139 euros per insure...

A note on macro-financial implications of mobile money schemes

OpenAIRE

Mas, Ignacio; Klein, Michael

2012-01-01

Across the world mobile money schemes are being launched. In such schemes financial service providers interact with clients via mobile phones or other mobile devices such as tablets. Service offerings include payments and saving as well as basic insurance products and sometimes credit based on scoring methods that use information about the client’s payment history. The world of mobile money is still in the experimental stage. Some schemes like M-PESA in Kenya have, at least initially, been ru...

Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?

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Mala Rao

Full Text Available Equity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for 'catastrophic' health expenditure (CHE, in many countries including India. Consequently, ways to address the education divide need to be explored. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education.We used the National Sample Survey Organization 2004 survey as our baseline and the same survey design to collect post-intervention data from 8623 households in the state in 2012. Two outcomes, hospitalisation and CHE for inpatient care, were estimated using education as a measure of socio-economic status and transforming levels of education into ridit scores. We derived relative indices of inequality by regressing the outcome measures on education, transformed as a ridit score, using logistic regression models with appropriate weights and accounting for the complex survey design.Between 2004 and 2012, there was a 39% reduction in the likelihood of the most educated person being hospitalised compared to the least educated, with reductions observed in all households as well as those that had used the Aarogyasri. For CHE the inequality disappeared in 2012 in both groups. Sub-group analyses by economic status, social groups and rural-urban residence showed a decrease in relative indices of inequality in most groups. Nevertheless, inequalities in hospitalisation and CHE persisted across most groups.During the time of the Aarogyasri scheme implementation inequalities in access to hospital care were substantially reduced but not eliminated across the education divide. Universal access to education and schemes such as Aarogyasri have the synergistic potential

SOCIAL WELFARE AND TAXATION EFFECTS ON INSURANCE. AN INTERNATIONAL EMPIRICAL STUDY

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VLADU ALINA BEATTRICE

2009-05-01

Full Text Available This paper analyzes the influence of the level of economic development as well as the level of taxation on insurance activity. To this purpose we reviewed the national and international literature and collected data on international level (for both year 2

Strategies for expanding health insurance coverage in vulnerable populations.

Science.gov (United States)

Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue

2014-11-26

evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions. At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis. We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence).In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence). Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies evaluating the effectiveness of different strategies for expanding health insurance coverage in vulnerable population are

Trade credit: Elusive insurance of firm growth

NARCIS (Netherlands)

Bams, Dennis; Bos, Jaap; Pisa, Magdalena

2016-01-01

Firms depend heavily on trade credit. This paper introduces a trade credit network into a structural model of the economy. In an empirical analysis of the model, we find that trade credit is an elusive insurance: as long as a firm is financially unconstrained and times are good, more trade credit

Dynamics Of Social Legislation In Russian Empire In The Beginnings Of XX Century

Directory of Open Access Journals (Sweden)

Natalya G. Semionkina

2014-09-01

Full Text Available In the present article regulations adopted in the Russian Empire at the beginning of the XX century and defining direction of social legislation development are considered. Norms that regulated state contempt of the lower ranks and members of their families in Russia, and also laws on social insurance are considered. There was no complete system of state social contempt in the Russian Empire. Help to needed was usually provided by numerous non-state charitable structures and societies, thus many of them were under patronage of the imperial family members. This help was provided, first - selectively, second - its size usually was very small. In general, specifics of the legislative ensuring of social support were defined by the features of development of entire legal system of the Russian Empire during this period, including, dynamics of normative legal acts adoption. Author draws a conclusion about preservation of the class character in the organization of the state contempt in the Russian Empire. In 1912 in the Russian Empire acts that directed creation of the system of social insurance for social protection of persons, victims of injuries and mutilations at the factory enterprises, and members of their family’s were adopted. Adoption of the acts regulating social insurance can be considered as a positive step in development of the social orientated legislation. But these acts were far from perfect, and first of all because their action extended on smaller part of the country's working population. According to the author, adoption of the legislation on social insurance became a basic step on the way of modern forms of the organization of the social help creation.

The effects of mandatory health insurance on equity in access to outpatient care in Indonesia.

Science.gov (United States)

Hidayat, Budi; Thabrany, Hasbullah; Dong, Hengjin; Sauerborn, Rainer

2004-09-01

This paper examines the effects of mandatory health insurance on access and equity in access to public and private outpatient care in Indonesia. Data from the second round of the 1997 Indonesian Family Life Survey were used. We adopted the concentration index as a measure of equity, and this was calculated from actual data and from predicted probability of outpatient-care use saved from a multinomial logit regression. The study found that a mandatory insurance scheme for civil servants (Askes) had a strongly positive impact on access to public outpatient care, while a mandatory insurance scheme for private employees (Jamsostek) had a positive impact on access to both public and private outpatient care. The greatest effects of Jamsostek were observed amongst poor beneficiaries. A substantial increase in access will be gained by expanding insurance to the whole population. However, neither Askes nor Jamsostek had a positive impact on equity. Policy implications are discussed.

Social long-term care insurance with two-sided altruism

OpenAIRE

Cremer, Helmuth; Pestieau, Pierre; Roeder, Kerstin

2015-01-01

This paper studies the design of a social long-term care (LTC) insurance when altruism is two-sided. The laissez-faire solution is not efficient, unless there is perfect altruism. Under full information, the first-best can be decentralized by a linear subsidy on informal aid, a linear tax on bequests when the parent is dependent and state specific lump-sum transfers which provide insurance. We also study a second-best scheme comprising a LTC benefit, a payroll tax on children's earnings and a...

Insurance Market Activity and Economic Growth: Evidence from Nigeria

Directory of Open Access Journals (Sweden)

Philip Chimobi Omoke

2012-04-01

Full Text Available The focus of this study is to empirically assess insurance market activities in Nigeria withthe view to determining its impact on economic growth. The period of study was 1970- 2008, thestudy made use of insurance density measures (premium per capita as a measure for insurancemarket activity and real GDP for economic growth. It also employed control variables such asinflation and savings rate as other determinants ofgrowth. The Johansen cointegration and vectorerror correction approach was used to estimate therelationship between the variables. All thevariables used were stationary at first differenceand the result showed a long term relationshipexisting among the variables. The hallmark findingof this study is that the insurance sector did notreveal any positively and significant affect on economic growth in Nigeria within the period of study.The result shows a low insurance market activity inNigeria and that Nigerians have not fully embracethe insurance industry despite its importance to the growth of theeconomy.

Health financing reform in Uganda: How equitable is the proposed National Health Insurance scheme?

Directory of Open Access Journals (Sweden)

Orem Juliet

2010-10-01

Full Text Available Abstract Background Uganda is proposing introduction of the National Health Insurance scheme (NHIS in a phased manner with the view to obtaining additional funding for the health sector and promoting financial risk protection. In this paper, we have assessed the proposed NHIS from an equity perspective, exploring the extent to which NHIS would improve existing disparities in the health sector. Methods We reviewed the proposed design and other relevant documents that enhanced our understanding of contextual issues. We used the Kutzin and fair financing frameworks to critically assess the impact of NHIS on overall equity in financing in Uganda. Results The introduction of NHIS is being proposed against the backdrop of inequalities in the distribution of health system inputs between rural and urban areas, different levels of care and geographic areas. In this assessment, we find that gradual implementation of NHIS will result in low coverage initially, which might pose a challenge for effective management of the scheme. The process for accreditation of service providers during the first phase is not explicit on how it will ensure that a two-tier service provision arrangement does not emerge to cater for different types of patients. If the proposed fee-for-service mechanism of reimbursing providers is pursued, utilisation patterns will determine how resources are allocated. This implies that equity in resource allocation will be determined by the distribution of accredited providers, and checks put in place to prohibit frivolous use. The current design does not explicitly mention how these two issues will be tackled. Lastly, there is no clarity on how the NHIS will fit into, and integrate within existing financing mechanisms. Conclusion Under the current NHIS design, the initial low coverage in the first years will inhibit optimal achievement of the important equity characteristics of pooling, cross-subsidisation and financial protection. Depending

Impacts of crop insurance on water withdrawals for irrigation

Science.gov (United States)

Deryugina, Tatyana; Konar, Megan

2017-12-01

Agricultural production remains particularly vulnerable to weather fluctuations and extreme events, such as droughts, floods, and heat waves. Crop insurance is a risk management tool developed to mitigate some of this weather risk and protect farmer income in times of poor production. However, crop insurance may have unintended consequences for water resources sustainability, as the vast majority of freshwater withdrawals go to agriculture. The causal impact of crop insurance on water use in agriculture remains poorly understood. Here, we determine the empirical relationship between crop insurance and irrigation water withdrawals in the United States. Importantly, we use an instrumental variables approach to establish causality. Our methodology exploits a major policy change in the crop insurance system - the 1994 Federal Crop Insurance Reform Act - which imposed crop insurance requirements on farmers. We find that a 1% increase in insured crop acreage leads to a 0.223% increase in irrigation withdrawals, with most coming from groundwater aquifers. We identify farmers growing more groundwater-fed cotton as an important mechanism contributing to increased withdrawals. A 1% increase in insured crop acreage leads to a 0.624% increase in cotton acreage, or 95,602 acres. These results demonstrate that crop insurance causally leads to more irrigation withdrawals. More broadly, this work underscores the importance of determining causality in the water-food nexus as we endeavor to achieve global food security and water resources sustainability.

The impact of the healthcare system in Barbados (provision of health insurance and the benefit service scheme) on the use of herbal remedies by Christian churchgoers.

Science.gov (United States)

Cohall, D H; Scantlebury-Manning, T; Cadogan-McLean, C; Lallement, A; Willis-O'Connor, S

2012-06-01

To determine the impact of health insurance and the government's Benefit Service Scheme, a system that provides free drugs to treat mostly chronic illnesses to persons aged 16 to 65 years, on the use of herbal remedies by Christian churchgoers in Barbados. The eleven parishes of Barbados were sampled over a six-week period using a survey instrument developed and tested over a four-week period prior to administration. Persons were asked to participate and after written informed consent, they were interviewed by the research team. The data were analysed by the use of IBM SPSS version 19. The data were all nominal, so descriptive statistics including counts, the frequencies, odds ratios and percentages were calculated. More than half of the participants (59.2%) were female, a little less than a third (29.9%) were male, and one tenth of the participants (10.9%) did not indicate their gender The majority of the participants were between the ages of 41 and 70 years, with the age range of 51-60 years comprising 26.1% of the sample interviewed. Almost all of the participants were born in Barbados (92.5%). Approximately 33% of the respondents indicated that they used herbal remedies to treat various ailments including chronic conditions. The odds ratio of persons using herbal remedies and having health insurance to persons not using herbal remedies and having health insurance is 1.01 (95% CI 0.621, 1.632). There was an increase in the numbers of respondents using herbal remedies as age increased. This trend continued until the age group 71-80 years which showed a reduction in the use of herbal remedies, 32.6% of respondents compared with 38.3% of respondents in the 61-70-year category. The data demonstrated that only a third of the study population is using herbal remedies for ailments. Health insurance was not an indicator neither did it influence the use of herbal remedies by respondents. The use of herbal remedies may not be associated with affluence. The reduction in

The Case for Insurance Reimbursement of Couple Therapy.

Science.gov (United States)

Clawson, Robb E; Davis, Stephanie Y; Miller, Richard B; Webster, Tabitha N

2017-08-22

A case is made for why it may now be in the best interest of insurance companies to reimburse for marital therapy to treat marital distress. Relevant literature is reviewed with a considerable focus on the reasons that insurance companies would benefit from reimbursing marital therapy - the high costs of marital distress, the growing link between marital distress and a host of related physical and mental health problems, as well as the availability of empirically supported treatments for marital distress. This is followed by a focus on the major reasons insurance companies cite for not reimbursing marital therapy, along with a discussion of advances in several growing bodies of research to address these concerns. Main arguments include the direct medical offset costs of couple and family therapy (including for high utilizers of health insurance), and the fact that insurance companies already find it cost effective to reimburse for prevention of other health and psychological problems. This is followed by implications for practitioners and researchers. © 2017 American Association for Marriage and Family Therapy.

Return Smoothing Mechanisms in Life and Pension Insurance

DEFF Research Database (Denmark)

Montserrat, Guillén; Jørgensen, Peter Løchte; Nielsen, Jens Perch

2006-01-01

pricing theory. We explore the properties of this pension scheme in detail and find that in terms of market value, smoothing is an illusion, but also that the return smoothing mechanism implies a dynamic asset allocation strategy which corresponds with traditional pension saving advice......Traditional with-profits pension saving schemes have been criticized for their opacity, plagued by embedded options and guarantees, and have recently created enormous problems for the solvency of the life insurance and pension industry. This has fueled creativity in the industry's product...... development departments, and this paper analyzes a representative member of a family of new pension schemes that have been introduced in the new millennium to alleviate these problems. The complete transparency of the new scheme's smoothing mechanism means that it can be analyzed using contingent claims...

The role of health system governance in strengthening the rural health insurance system in China.

Science.gov (United States)

Yuan, Beibei; Jian, Weiyan; He, Li; Wang, Bingyu; Balabanova, Dina

2017-05-23

Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. China's success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes' designs, coverage, and funding

CSR schemes in agribusiness

DEFF Research Database (Denmark)

Pötz, Katharina Anna; Haas, Rainer; Balzarova, Michaela

2013-01-01

of schemes that can be categorized on focus areas, scales, mechanisms, origins, types and commitment levels. Research limitations/implications – The findings contribute to conceptual and empirical research on existing models to compare and analyse CSR standards. Sampling technique and depth of analysis limit......Purpose – The rise of CSR followed a demand for CSR standards and guidelines. In a sector already characterized by a large number of standards, the authors seek to ask what CSR schemes apply to agribusiness, and how they can be systematically compared and analysed. Design....../methodology/approach – Following a deductive-inductive approach the authors develop a model to compare and analyse CSR schemes based on existing studies and on coding qualitative data on 216 CSR schemes. Findings – The authors confirm that CSR standards and guidelines have entered agribusiness and identify a complex landscape...

Is Business Failure Due to Lack of Effort? Empirical Evidence from a Large Administrative Sample

NARCIS (Netherlands)

Ejrnaes, M.; Hochguertel, S.

2013-01-01

Does insurance provision reduce entrepreneurs' effort to avoid business failure? We exploit unique features of the voluntary Danish unemployment insurance (UI) scheme, that is available to the self-employed. Using a large sample of self-employed individuals, we estimate the causal effect of

Risk classification and cream skimming on the deregulated German insurance market

OpenAIRE

Beschorner, Patrick F. E.

2003-01-01

In a two-stage model insurance companies first decide upon risk classification and then compete in prices. I show that the observed heterogeneous behavior of similar firms is compatible with rational behavior. On the deregulated German insurance market individual application of classification schemes induces welfare losses due to cream skimming. Classification costs and pricing above marginal cost can be prevented by common industry-wide loss statistics which already exist to a rudimentary ex...

Healthcare financing in Syria: satisfaction with the current system and the role of national health insurance--a qualitative study of householders' views.

Science.gov (United States)

Mershed, Mania; Busse, Reinhard; van Ginneken, Ewout

2012-01-01

This study aims to identify the satisfaction with the current public health system and health benefit schemes, examine willingness to participate in national health insurance and review expectations and preferences of national health insurance. To this end, qualitative semi-structured interviews were carried out with 19 Syrian householders. Our results show that a need for health reform exists and that Syrian people are willing to support a national health insurance scheme if some key issues are properly addressed. Funding of the scheme is a major concern and should take into account the ability to pay and help the poor. In addition, waiting times should be shortened and sufficient coverage guaranteed. On the whole, the people would support a national health insurance with national pooling and purchasing under a public set-up, but important concerns of such a system regarding corruption and inefficiency were voiced too. Installing a quasi non-governmental organisation as manager of the insurance system under the stewardship of the Ministry of Health could provide a compromise acceptable to the people. Copyright © 2012 John Wiley & Sons, Ltd.

Health insurance and care-seeking behaviours of female migrants in Accra, Ghana.

Science.gov (United States)

Lattof, Samantha R

2018-05-01

People working in Ghana's informal sector have low rates of enrolment in the publicly funded National Health Insurance Scheme. Informal sector workers, including migrant girls and women from northern Ghana working as head porters (kayayei), report challenges obtaining insurance and seeking formal health care. This article analyses how health insurance status affects kayayei migrants' care-seeking behaviours. This mixed-methods study involved surveying 625 migrants using respondent-driven sampling and conducting in-depth interviews with a sub-sample of 48 migrants. Analyses explore health status and health seeking behaviours for recent illness/injury. Binary logistic regression modelled the effects of selected independent variables on whether or not a recently ill/injured participant (n = 239) sought health care. Although recently ill/injured participants (38.4%) desired health care, less than half (43.5%) sought care. Financial barriers overwhelmingly limit kayayei migrants from seeking health care, preventing them from registering with the National Health Insurance Scheme, renewing their expired health insurance policies, or taking time away from work. Both insured and uninsured migrants did not seek formal health services due to the unpredictable nature of out-of-pocket expenses. Catastrophic and impoverishing medical expenses also drove participants' migration in search of work to repay loans and hospital bills. Health insurance can help minimize these expenditures, but only 17.4% of currently insured participants (58.2%) reported holding a valid health insurance card in Accra. The others lost their cards or forgot them when migrating. Access to formal health care in Accra remains largely inaccessible to kayayei migrants who suffer from greater illness/injury than the general female population in Accra and who are hindered in their ability to receive insurance exemptions. With internal migration on the rise in many settings, health systems must recognize the

Assessing the feasibility of introducing health insurance in Afghanistan: a qualitative stakeholder analysis.

Science.gov (United States)

Zeng, Wu; Kim, Christine; Archer, Lauren; Sayedi, Omarzaman; Jabarkhil, Mohammad Yousuf; Sears, Kathleen

2017-02-22

In the last decade, the health status of Afghans has improved drastically. However, the health financing system in Afghanistan remains fragile due to high out-of-pocket spending and reliance on donor funding. To address the country's health financing challenges, the Ministry of Public Health investigated health insurance as a mechanism to mobilize resources for health. This paper presents stakeholders' opinions on seven preconditions of implementing this approach, as their understanding and buy-in to such an approach will determine its success. Key informant interviews and focus group discussions were conducted with stakeholders. The interviews focused on perceptions of the seven preconditions of introducing health insurance, and adapting a framework developed by the International Labor Organization. Content analysis was conducted after interviews and discussions were transcribed and coded. Almost all of the stakeholders from government agencies, the private sector, and development partners are interested in introducing health insurance in Afghanistan, and they were aware of the challenges of the country's health financing system. Stakeholders acknowledged that health insurance could be an instrument to address these challenges. However, stakeholders differed in their beliefs about how and when to initiate a health insurance scheme. In addition to increasing insecurity in the country, they saw a lack of clear legal guidance, low quality of healthcare services, poor awareness among the population, limited technical capacity, and challenges to willingness to pay as the major barriers to establishing a successful nationwide health insurance scheme. The identified barriers prevent Afghanistan from establishing health insurance in the short term. Afghanistan must progressively address these major impediments in order to build a health insurance system.

Determinants of enrollment of informal sector workers in cooperative based health scheme in Bangladesh

Science.gov (United States)

Sarker, Abdur Razzaque; Sultana, Marufa; Mahumud, Rashidul Alam; Ahmed, Sayem; Islam, Ziaul; Morton, Alec; Khan, Jahangir A. M.

2017-01-01

Background Providing access to affordable health care for the informal sector remains a considerable challenge for low income countries striving to make progress towards universal health coverage. The objective of the study is to identify the factors shaping the decision to enroll in a cooperative based health scheme for informal workers in Bangladesh and also help to identify the features of informal workers without health schemes and their likelihood of being insured. Methods Data were derived from a cross-sectional in-house survey within the catchment area of a cooperative based health scheme in Bangladesh during April–June 2014, covering a total of 784 households (458 members and 326 non-members). Multivariate logistic regression model was used to identify factors associated with cooperative based health scheme and explanatory variables. Findings This study found that a number of factors were significant determinants of health scheme participation including sex of household head, household composition, occupational category as well as involvement social financial safety net programs. Conclusion Findings from this study can be suggestive for policy-makers interested in scaling up health insurance for informal workers in Bangladesh. Shared funding from this large informal sector can generate new resources for healthcare, which is in line with the healthcare financing strategy of Bangladesh as well as the recommendation of the World Health Organization for developing social health insurance as part of the path to Universal Health Coverage. PMID:28750052

Determinants of enrollment of informal sector workers in cooperative based health scheme in Bangladesh.

Directory of Open Access Journals (Sweden)

Abdur Razzaque Sarker

Full Text Available Providing access to affordable health care for the informal sector remains a considerable challenge for low income countries striving to make progress towards universal health coverage. The objective of the study is to identify the factors shaping the decision to enroll in a cooperative based health scheme for informal workers in Bangladesh and also help to identify the features of informal workers without health schemes and their likelihood of being insured.Data were derived from a cross-sectional in-house survey within the catchment area of a cooperative based health scheme in Bangladesh during April-June 2014, covering a total of 784 households (458 members and 326 non-members. Multivariate logistic regression model was used to identify factors associated with cooperative based health scheme and explanatory variables.This study found that a number of factors were significant determinants of health scheme participation including sex of household head, household composition, occupational category as well as involvement social financial safety net programs.Findings from this study can be suggestive for policy-makers interested in scaling up health insurance for informal workers in Bangladesh. Shared funding from this large informal sector can generate new resources for healthcare, which is in line with the healthcare financing strategy of Bangladesh as well as the recommendation of the World Health Organization for developing social health insurance as part of the path to Universal Health Coverage.

Workable Social Health Insurance Systems in Sub-Saharan Africa ...

African Journals Online (AJOL)

the private sector in Africa is embracing joint health insurance schemes for their ... the unemployed, the under-employed and the unemployable (who ...... Agyepong, A.I. and Adjei, S., 2008, 'Public Social Policy Development and Implementation: .... Johannesburg, South Africa', WBI Learning Resource Series: World Bank.

Patient Satisfaction with Primary Health Care – A Comparison between the Insured and Non-Insured under the National Health Insurance Policy in Ghana

Science.gov (United States)

Fenny, Ama P.; Enemark, Ulrika; Asante, Felix A.; Hansen, Kristian S.

2014-01-01

Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics, health insurance and the various dimensions of quality of care. This study employs logistic regression using household survey data in three districts in Ghana covering the 3 ecological zones (coastal, forest and savannah). It identifies the service quality factors that are important to patients’ satisfaction and examines their links to their health insurance status. The results indicate that a higher proportion of insured patients are satisfied with the overall quality of care compared to the uninsured. The key predictors of overall satisfaction are waiting time, friendliness of staff and satisfaction of the consultation process. These results highlight the importance of interpersonal care in health care facilities. Feedback from patients’ perception of health services and satisfaction surveys improve the quality of care provided and therefore effort must be made to include these findings in future health policies. PMID:24999137

Cancelable remote quantum fingerprint templates protection scheme

International Nuclear Information System (INIS)

Liao Qin; Guo Ying; Huang Duan

2017-01-01

With the increasing popularity of fingerprint identification technology, its security and privacy have been paid much attention. Only the security and privacy of biological information are insured, the biological technology can be better accepted and used by the public. In this paper, we propose a novel quantum bit (qbit)-based scheme to solve the security and privacy problem existing in the traditional fingerprint identification system. By exploiting the properties of quantm mechanics, our proposed scheme, cancelable remote quantum fingerprint templates protection scheme, can achieve the unconditional security guaranteed in an information-theoretical sense. Moreover, this novel quantum scheme can invalidate most of the attacks aimed at the fingerprint identification system. In addition, the proposed scheme is applicable to the requirement of remote communication with no need to worry about its security and privacy during the transmission. This is an absolute advantage when comparing with other traditional methods. Security analysis shows that the proposed scheme can effectively ensure the communication security and the privacy of users’ information for the fingerprint identification. (paper)

Risk selection and risk adjustment: improving insurance in the individual and small group markets.

Science.gov (United States)

Baicker, Katherine; Dow, William H

2009-01-01

Insurance market reforms face the key challenge of addressing the threat that risk selection poses to the availability, of stable, high-value insurance policies that provide long-term risk protection. Many of the strategies in use today fail to address this breakdown in risk pooling, and some even exacerbate it. Flexible risk adjustment schemes are a promising avenue for promoting market stability and limiting insurer cream-skimming, potentially providing greater benefits at lower cost. Reforms intended to increase insurance coverage and the value of care delivered will be much more effective if implemented in conjunction with policies that address these fundamental selection issues.

Health seeking behavior in karnataka: does micro-health insurance matter?

Science.gov (United States)

Savitha, S; Kiran, Kb

2013-10-01

Health seeking behaviour in the event of illness is influenced by the availability of good health care facilities and health care financing mechanisms. Micro health insurance not only promotes formal health care utilization at private providers but also reduces the cost of care by providing the insurance coverage. This paper explores the impact of Sampoorna Suraksha Programme, a micro health insurance scheme on the health seeking behaviour of households during illness in Karnataka, India. The study was conducted in three randomly selected districts in Karnataka, India in the first half of the year 2011. The hypothesis was tested using binary logistic regression analysis on the data collected from randomly selected 1146 households consisting of 4961 individuals. Insured individuals were seeking care at private hospitals than public hospitals due to the reduction in financial barrier. Moreover, equity in health seeking behaviour among insured individuals was observed. Our finding does represent a desirable result for health policy makers and micro finance institutions to advocate for the inclusion of health insurance in their portfolio, at least from the HSB perspective.

Sustainability of recurrent expenditure on public social welfare programmes: expenditure analysis of the free maternal care programme of the Ghana National Health Insurance Scheme.

Science.gov (United States)

Ankrah Odame, Emmanuel; Akweongo, Patricia; Yankah, Ben; Asenso-Boadi, Francis; Agyepong, Irene

2014-05-01

Sustainability of public social welfare programmes has long been of concern in development circles. An important aspect of sustainability is the ability to sustain the recurrent financial costs of programmes. A free maternal care programme (FMCP) was launched under the Ghana National Health Insurance Scheme (NHIS) in 2008 with a start-up grant from the British Government. This article examines claims expenditure under the programme and the implications for the financial sustainability of the programme, and the lessons for donor and public financing of social welfare programmes. Records of reimbursement claims for services and medicines by women benefitting from the policy in participating facilities in one sub-metropolis in Ghana were analysed to gain an understanding of the expenditure on this programme at facility level. National level financial inflow and outflow (expenditure) data of the NHIS, related to implementation of this policy for 2008 and 2009, were reviewed to put the facility-based data in the national perspective. A total of US$936 450.94 was spent in 2009 by the scheme on FMCP in the sub-metropolis. The NHIS expenditure on the programme for the entire country in 2009 was US$49.25 million, exceeding the British grant of US$10.00 million given for that year. Subsequently, the programme has been entirely financed by the National Health Insurance Fund. The rapidly increasing, recurrent demands on this fund from the maternal delivery exemption programme-without a commensurate growth on the amounts generated annually-is an increasing threat to the sustainability of the fund. Provision of donor start-up funding for programmes with high recurrent expenditures, under the expectation that government will take over and sustain the programme, must be accompanied by clear long-term analysis and planning as to how government will sustain the programme.

The Emergence of Flood Insurance in Canada: Navigating Institutional Uncertainty.

Science.gov (United States)

Thistlethwaite, Jason

2017-04-01

Flood insurance has remained unavailable in Canada based on an assessment that it lacks economic viability. In response to Canada's costliest flood event to date in 2013, the Canadian insurance industry has started to develop a framework to expand existing property insurance to cover flood damage. Research on flood insurance has overlooked why and how insurance systems transition to expand insurance coverage without evidence of economic viability. This article will address this gap through a case study on the emergence of flood insurance in Canada, and the approach to its expansion. Between 2013 and 2016, insurance industry officials representing over 60% of premiums collected in Canada were interviewed. These interviews revealed that flood insurance is being expanded in response to institutional pressure, specifically external stakeholder expectations that the insurance industry will adopt a stronger role in managing flood risk through coverage of flood damage. Further evidence of this finding is explored by assessing the emergence of a unique flood insurance model that involves a risk-adjusted and optional product along with an expansion of government policy supporting flood risk mitigation. This approach attempts to balance industry concerns about economic viability with institutional pressure to reduce flood risk through insurance. This analysis builds on existing research by providing the first scholarly analysis of flood insurance in Canada, important "empirical" teeth to existing conceptual analysis on the availability of flood insurance, and the influence of institutional factors on risk analysis within the insurance sector. © 2016 Society for Risk Analysis.

Perception of quality of health delivery and health insurance subscription in Ghana.

Science.gov (United States)

Amo-Adjei, Joshua; Anku, Prince Justin; Amo, Hannah Fosuah; Effah, Mavis Osei

2016-07-29

National health insurance schemes (NHIS) in developing countries and perhaps in developed countries as well is a considered a pro-poor intervention by helping to bridge the financial burden of access to quality health care. Perceptions of quality of health service could have immense impacts on enrolment. This paper shows how perception of service quality under Ghana's insurance programme contributes to health insurance subscription. The study used the 2014 Ghana Demographic and Health Survey (GDHS) dataset. Both descriptive proportions and binary logistic regression techniques were applied to generate results that informed the discussion. Our results show that a high proportion of females (33 %) and males (35 %) felt that the quality of health provided to holders of the NHIS card was worse. As a result, approximately 30 % of females and 22%who perceived health care as worse by holding an insurance card did not own an insurance policy. While perceptions of differences in quality among females were significantly different (AOR = 0.453 [95 % CI = 0.375, 0.555], among males, the differences in perceptions of quality of health services under the NHIS were independent in the multivariable analysis. Beyond perceptions of quality, being resident in the Upper West region was an important predictor of health insurance ownership for both males and females. For such a social and pro-poor intervention, investing in quality of services to subscribers, especially women who experience enormous health risks in the reproductive period can offer important gains to sustaining the scheme as well as offering affordable health services.

Introducing voluntary private health insurance in a mixed medical economy: are Hong Kong citizens willing to subscribe?

Science.gov (United States)

He, Alex Jingwei

2017-08-25

Struggling to correct the public-private imbalance in its health care system, the Hong Kong SAR Government seeks to introduce a government-regulated voluntary health insurance scheme, or VHIS, a distinctive financing instrument that combines the characteristics of private insurance with strong government regulation. This study examines citizens' responses to the new scheme and their willingness to subscribe. First-hand data were collected from a telephone survey that randomly sampled 1793 Hong Kong adults from September 2014 to February 2015. Univariate and multivariate methods were employed in data analysis. More than one third of the respondents explicitly stated intention of subscribing to the VHIS, a fairly high figure considering the scheme's voluntary nature. Multivariate analysis revealed moderate evidence of adverse selection, defined as individuals' opportunistic behaviors when making insurance purchasing decision based on their own assessment of risks or likelihood of making a claim. The excellent performance of Hong Kong's public medical system has had two parallel impacts. On the one hand, high-risk residents, particularly the uninsured, do not face a pressing need to switch out of the overloaded public system despite its inadequacies; this, in turn, may reduce the impact of adverse selection that may lead to detrimental effects to the insurance market. On the other hand, high satisfaction reinforces the interests of those who have both the need for better services and the ability to pay for supplementary insurance. Furthermore, the high-risk population demonstrates a moderate interest in the insurance despite the availability of government subsidies. This may offset the intended effect of the reform to some extent.

Strengthening insurance partnerships in the face of climate change - Insights from an agent-based model of flood insurance in the UK.

Science.gov (United States)

Crick, Florence; Jenkins, Katie; Surminski, Swenja

2018-04-25

Multisectoral partnerships are increasingly cited as a mechanism to deliver and improve disaster risk management. Yet, partnerships are not a panacea and more research is required to understand the role that they can play in disaster risk management and particularly disaster risk reduction. This paper investigates how partnerships can incentivise flood risk reduction by focusing on the UK public-private partnership on flood insurance. Developing the right flood insurance arrangements to incentivise flood risk reduction and adaptation to climate change is a key challenge. In the face of rising flood risks due to climate change and socio-economic development insurance partnerships can no longer afford to focus only on the risk transfer function. However, while expectations of the insurance industry have traditionally been high when it comes to flood risk management, the insurance industry alone will not provide the solution to the challenge of rising risks. The case of flood insurance in the UK illustrates this: even national government and industry together cannot fully address these risks and other actors need to be involved to create strong incentives for risk reduction. Using an agent-based model focused on surface water flood risk in London we analyse how other partners could strengthen the insurance partnership by reducing flood risk and thus helping to maintain affordable insurance premiums. Our findings are relevant for wider discussions on the potential of insurance schemes to incentivise flood risk management and climate adaptation in the UK and also internationally. Copyright © 2018. Published by Elsevier B.V.

Empirical essays on behavioral economics and lifecycle decisions

NARCIS (Netherlands)

Dillingh, Rik

2016-01-01

This dissertation consists of four empirical essays that study decisions on insurance, consumption and the accumulation and decumulation of wealth. The studies pay due attention to behavioral factors that may limit rationality, such as complexity and intertemporal choice. The first essay looks at

Optimization of a middle atmosphere diagnostic scheme

Science.gov (United States)

Akmaev, Rashid A.

1997-06-01

A new assimilative diagnostic scheme based on the use of a spectral model was recently tested on the CIRA-86 empirical model. It reproduced the observed climatology with an annual global rms temperature deviation of 3.2 K in the 15-110 km layer. The most important new component of the scheme is that the zonal forcing necessary to maintain the observed climatology is diagnosed from empirical data and subsequently substituted into the simulation model at the prognostic stage of the calculation in an annual cycle mode. The simulation results are then quantitatively compared with the empirical model, and the above mentioned rms temperature deviation provides an objective measure of the `distance' between the two climatologies. This quantitative criterion makes it possible to apply standard optimization procedures to the whole diagnostic scheme and/or the model itself. The estimates of the zonal drag have been improved in this study by introducing a nudging (Newtonian-cooling) term into the thermodynamic equation at the diagnostic stage. A proper optimal adjustment of the strength of this term makes it possible to further reduce the rms temperature deviation of simulations down to approximately 2.7 K. These results suggest that direct optimization can successfully be applied to atmospheric model parameter identification problems of moderate dimensionality.

Health insurance system and payments provided to patients for the management of severe acute pancreatitis in Japan

OpenAIRE

Yoshida, Masahiro; Takada, Tadahiro; Kawarada, Yoshifumi; Hirata, Koichi; Mayumi, Toshihiko; Sekimoto, Miho; Hirota, Masahiko; Kimura, Yasutoshi; Takeda, Kazunori; Isaji, Shuji; Koizumi, Masaru; Otsuki, Makoto; Matsuno, Seiki

2006-01-01

The health insurance system in Japan is based upon the Universal Medical Care Insurance System, which gives all citizens the right to join an insurance scheme of their own choice, as guaranteed by the provisions of Article 25 of the Constitution of Japan, which states: ?All people shall have the right to maintain the minimum standards of wholesome and cultured living.? The health care system in Japan includes national medical insurance, nursing care for the elderly, and government payments fo...

Competition in health insurance markets: limitations of current measures for policy analysis.

Science.gov (United States)

Scanlon, Dennis P; Chernew, Michael; Swaminathan, Shailender; Lee, Woolton

2006-12-01

Health care reform proposals often rely on increased competition in health insurance markets to drive improved performance in health care costs, access, and quality. We examine a range of data issues related to the measures of health insurance competition used in empirical studies published from 1994-2004. The literature relies exclusively on market structure and penetration variables to measure competition. While these measures are correlated, the degree of correlation is modest, suggesting that choice of measure could influence empirical results. Moreover, certain measurement issues such as the lack of data on PPO enrollment, the treatment of small firms, and omitted market characteristics also could affect the conclusions in empirical studies. Importantly, other types of measures related to competition (e.g., the availability of information on price and outcomes, degree of entry barriers, etc.) are important from both a theoretical and policy perspective, but their impact on market outcomes has not been widely studied.

Premium copayments and the trade-off between wages and employer-provided health insurance.

Science.gov (United States)

Lubotsky, Darren; Olson, Craig A

2015-12-01

This paper estimates the trade-off between salary and health insurance costs using data on Illinois school teachers between 1991 and 2008 that allow us to address several common empirical challenges in this literature. Teachers paid about 17 percent of the cost of individual health insurance and about 46 percent of the cost of their family members' plans through premium contributions, but we find no evidence that teachers' salaries respond to changes in insurance costs. Consistent with a higher willingness to pay for insurance, we find that premium contributions are higher in districts that employ a higher-tenured workforce. We find no evidence that school districts respond to higher health insurance costs by reducing the number of teachers. Copyright © 2015 Elsevier B.V. All rights reserved.

The Belgian deposit guarantee scheme in a European perspective

OpenAIRE

Ch. Van Nieuwenhuyze; M. D. Zachary

2010-01-01

During the recent financial crisis, the deposit guarantee scheme in Belgium – as in other European countries – played a role in preventing bank runs and restoring confidence : to that end, the intervention ceilings were raised substantially and the scope of the scheme was extended to include certain life insurance policies. Finally, the expansion of the system’s coverage had to be financed by a sharp increase in the contributions from financial institutions. First of all, that measure had a p...

Medical malpractice reform and employer-sponsored health insurance premiums.

Science.gov (United States)

Morrisey, Michael A; Kilgore, Meredith L; Nelson, Leonard Jack

2008-12-01

Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance. Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys. Damage caps were obtained and dated based on state annotated codes, statutes, and judicial decisions. Fixed effects regression models were run to estimate the effects of the size of inflation-adjusted damage caps on the weighted average single premiums. State tort reform laws were identified using Westlaw, LEXIS, and statutory compilations. Legislative repeal and amendment of statutes and court decisions resulting in the overturning or repealing state statutes were also identified using LEXIS. Using a variety of empirical specifications, there was no statistically significant evidence that noneconomic damage caps exerted any meaningful influence on the cost of employer-sponsored health insurance. The findings suggest that tort reforms have not translated into insurance savings.

Comparison of Chinese inpatients with different types of medical insurance before and after the 2009 healthcare reform.

Science.gov (United States)

Wang, Shan; Liu, Lihua; Li, Lin; Liu, Jianchao

2014-09-29

Since 1994, China has established three major basic medical insurance (MI) schemes that aim to provide greater financial protection to members. The 2009 Chinese medical reform emphasized the enhancement of basic medical insurance. This study aims to investigate changes in hospital services costs for inpatients with different types of MI before and after the new Chinese medical reform. A total of 532,120 inpatient medical records, completed by 11 different hospitals nationwide in 2008 and 2011, were collected from the Ministry of Health retrospectively. Median and mean values were calculated to describe costs and average length of stay, respectively. A chi-square test was used to compare the distribution of patient visits. Wilcoxon rank-sum tests were conducted to compare costs. The number of patients hospitalized increased. The average cost per stay in the three basic MI schemes increased, while out-of-pocket (OOP) spending decreased (P trends. The purchase of Western medication accounted for the largest proportion of costs in all MI schemes in both years; however, these ratios decreased from 2008 to 2011, while those for other social insurance and OOP patients almost doubled. The average length of stay remained unchanged, and the average lengths of stay in the MI schemes differed before and after the healthcare reform. Healthcare reform with multipartite policies may make interactional impacts on hospitalization services for patients enrolled in MI schemes.

Meal box schemes a convenient way to avoid convenience food? Uses and understandings of meal box schemes among Danish consumers.

Science.gov (United States)

Hertz, Frej Daniel; Halkier, Bente

2017-07-01

The term convenience food is subject to diversification, lack of clarity and moral ambiguity. In this paper we address these issues and critically discuss convenience food by using empirical findings from a Danish study that deals with practitioners' uses of meal box schemes. The methodological design consists of thirteen individual interviews, four focus groups and some observations of cooking practices. We combine the empirical findings with a particular definition of convenience food by Brunner et al. (2010) and selected practice theoretical concepts. This particular combination enables us to categorize meal box schemes as a new form of convenience food called convenient food. In addition, results suggest that meal box schemes reduce leftovers from dinner. Meal boxes also influence dinner related activities such as planning ahead in time and grocery shopping, which require less physical and mental effort. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluating viral marketing: isolating the key criteria in insurance industry

Directory of Open Access Journals (Sweden)

Maria Gooyandeh Hagh

2015-06-01

Full Text Available This paper presents an empirical investigation to determine the key criteria that viral marketing practitioners believe should be implemented to measure about the success of viral marketing campaigns in insurance industry. The study designs a questionnaire in Likert scale where the effects of four independent variables, personal, message, media and tools characteristics are measured on an Iranian insurance firm’s reputation as well as service expansion. Cronbach alphas were measured for all components of the survey and they were all well above the minimum acceptable level. Using regression analysis, the study has determined positive and meaningful relationships between insurance firm’s reputation as well as service expansion and four independent variables.

Employer contribution and premium growth in health insurance.

Science.gov (United States)

Liu, Yiyan; Jin, Ginger Zhe

2015-01-01

We study whether employer premium contribution schemes could impact the pricing behavior of health plans and contribute to rising premiums. Using 1991-2011 data before and after a 1999 premium subsidy policy change in the Federal Employees Health Benefits Program (FEHBP), we find that the employer premium contribution scheme has a differential impact on health plan pricing based on two market incentives: 1) consumers are less price sensitive when they only need to pay part of the premium increase, and 2) each health plan has an incentive to increase the employer's premium contribution to that plan. Both incentives are found to contribute to premium growth. Counterfactual simulation shows that average premium would have been 10% less than observed and the federal government would have saved 15% per year on its premium contribution had the subsidy policy change not occurred in the FEHBP. We discuss the potential of similar incentives in other government-subsidized insurance systems such as the Medicare Part D and the Health Insurance Marketplace under the Affordable Care Act. Copyright © 2014 Elsevier B.V. All rights reserved.

Is universal coverage via social health insurance financially feasible in Swaziland?

Science.gov (United States)

Mathauer, Inke; Musango, Laurent; Sibandze, Sibusiso; Mthethwa, Khosi; Carrin, Guy

2011-03-01

The Government of Swaziland decided to explore the feasibility of social health insurance (SHI) in order to enhance universal access to health services. We assess the financial feasibility of a possible SHI scheme in Swaziland. The SHI scenario presented is one that mobilises resources additional to the maintained Ministry of Health and Social Welfare (MOHSW) budget. It is designed to increase prepayment, enhance overall health financing equity, finance quality improvements in health care, and eventually cover the entire population. The financial feasibility assessment consists of calculating and projecting revenues and expenditures of the SHI scheme from 2008 to 2018. SimIns, a health insurance simulation software, was used. Quantitative data from government and other sources and qualitative data from discussions with health financing stakeholders were gathered. Policy assumptions were jointly developed with and agreed upon by a MOHSW team. SHI would take up an increasing proportion of total health expenditure over the simulation period and become the dominant health financing mechanism. In principle, and on the basis of the assumed policy variables, universal coverage could be reached within 6 years through the implementation of an SHI scheme based on a mix of contributory and tax financing. Contribution rates for formal sector employees would amount to 7% of salaries and the Ministry of Health and Social Welfare budget would need to be maintained. Government health expenditure including social health insurance would increase from 6% in 2008 to 11% in 2018.

The insurance business and the nuclear fuel cycle

International Nuclear Information System (INIS)

Multhaup, H.T.

1989-01-01

The legally required financial security is provided by the insurance business by way of liability insurance systems. Insurance coverage is given for the obligation to pay damages in compliance with section 13 Atomic Energy Act, which refers to all objects of legal protection also defined in section 823, sub-sec. (1) BGB. The legal provisions valid in the F.R.G. are very similar to the provisions in most western countries. They comply with the Paris Convention which determines the legal bases of the international third party liability system which have been supplemented by the Brussels Convention. The reactor accident at Chernobyl has induced discussions and changes in the insurance sector. A major conclusion was that liability criteria must have unambiguous definition and delimitation. A compensation system is feasible only on the basis of clear-cut definitions. A first step in this direction has been done by issuing maximum permissible limits for foodstuffs. Another major instrument for coping with a nuclear accident is the distribution scheme defined in section 35 Atomic Energy Act. (orig./HSCH) [de

Quality of uncomplicated malaria case management in Ghana among insured and uninsured patients

DEFF Research Database (Denmark)

Fenny, Ama P; Hansen, Kristian S; Enemark, Ulrika

2014-01-01

of health insurance on the quality of case management for patients with uncomplicated malaria, ascertaining any significant differences in treatment between insured and non-insured patients. METHOD: A structured questionnaire was used to collect data from 523 respondents diagnosed with malaria....... This is especially the case for parasitological confirmation of all suspected malaria patients before treatment with an antimalarial as currently recommended for the effective management of malaria in the country. The results show that about 16 percent of total sample were parasitologically tested. Effective......INTRODUCTION: The National Health Insurance Act, 2003 (Act 650) established the National Health Insurance Scheme (NHIS) in Ghana with the aim of increasing access to health care and improving the quality of basic health care services for all citizens. The main objective is to assess the effect...

Geographic variation in health insurance benefits in Qianjiang District, China: a cross-sectional study.

Science.gov (United States)

Wu, Yue; Zhang, Liang; Liu, Xuejiao; Ye, Ting; Wang, Yongfei

2018-02-05

Health insurance contributes to reducing the economic burden of disease and improving access to healthcare. In 2016, the Chinese government announced the integration of the New Cooperative Medical Scheme (NCMS) and Urban Resident Basic Medical Insurance (URBMI) to reduce system segmentation. Nevertheless, it was unclear whether there would be any geographic variation in health insurance benefits if the two types of insurance were integrated. The aim of this study was to identify the potential geographic variation in health insurance benefits and the related contributing factors. This cross-sectional study was carried out in Qianjiang District, where the NCMS and URBMI were integrated into Urban and Rural Resident Basic Medical Insurance Scheme (URRBMI) in 2010. All beneficiaries under the URRBMI were hospitalized at least once in 2013, totaling 445,254 persons and 65,877 person-times, were included in this study. Town-level data on health insurance benefits, healthcare utilization, and socioeconomic and geographical characteristics were collected through health insurance system, self-report questionnaires, and the 2014 Statistical Yearbook of Qianjiang District. A simplified Theil index at town level was calculated to measure geographic variation in health insurance benefits. Colored maps were created to visualize the variation in geographic distribution of benefits. The effects of healthcare utilization and socioeconomic and geographical characteristics on geographic variation in health insurance benefits were estimated with a multiple linear regression analysis. Different Theil index values were calculated for different towns, and the Theil index values for compensation by person-times and amount were 2.5028 and 1.8394 in primary healthcare institutions and 1.1466 and 0.9204 in secondary healthcare institutions. Healthcare-seeking behavior and economic factors were positively associated with health insurance benefits in compensation by person-times significantly

Community concepts of poverty: an application to premium exemptions in Ghana's National Health Insurance Scheme.

Science.gov (United States)

Aryeetey, Genevieve C; Jehu-Appiah, Caroline; Kotoh, Agnes M; Spaan, Ernst; Arhinful, Daniel K; Baltussen, Rob; van der Geest, Sjaak; Agyepong, Irene A

2013-03-14

Poverty is multi dimensional. Beyond the quantitative and tangible issues related to inadequate income it also has equally important social, more intangible and difficult if not impossible to quantify dimensions. In 2009, we explored these social and relativist dimension of poverty in five communities in the South of Ghana with differing socio economic characteristics to inform the development and implementation of policies and programs to identify and target the poor for premium exemptions under Ghana's National Health Insurance Scheme. We employed participatory wealth ranking (PWR) a qualitative tool for the exploration of community concepts, identification and ranking of households into socioeconomic groups. Key informants within the community ranked households into wealth categories after discussing in detail concepts and indicators of poverty. Community defined indicators of poverty covered themes related to type of employment, educational attainment of children, food availability, physical appearance, housing conditions, asset ownership, health seeking behavior, social exclusion and marginalization. The poverty indicators discussed shared commonalities but contrasted in the patterns of ranking per community. The in-depth nature of the PWR process precludes it from being used for identification of the poor on a large national scale in a program such as the NHIS. However, PWR can provide valuable qualitative input to enrich discussions, development and implementation of policies, programs and tools for large scale interventions and targeting of the poor for social welfare programs such as premium exemption for health care.

Historical extension of operational NDVI products for livestock insurance in Kenya

Science.gov (United States)

Vrieling, Anton; Meroni, Michele; Shee, Apurba; Mude, Andrew G.; Woodard, Joshua; de Bie, C. A. J. M. (Kees); Rembold, Felix

2014-05-01

Droughts induce livestock losses that severely affect Kenyan pastoralists. Recent index insurance schemes have the potential of being a viable tool for insuring pastoralists against drought-related risk. Such schemes require as input a forage scarcity (or drought) index that can be reliably updated in near real-time, and that strongly relates to livestock mortality. Generally, a long record (>25 years) of the index is needed to correctly estimate mortality risk and calculate the related insurance premium. Data from current operational satellites used for large-scale vegetation monitoring span over a maximum of 15 years, a time period that is considered insufficient for accurate premium computation. This study examines how operational NDVI datasets compare to, and could be combined with the non-operational recently constructed 30-year GIMMS AVHRR record (1981-2011) to provide a near-real time drought index with a long term archive for the arid lands of Kenya. We compared six freely available, near-real time NDVI products: five from MODIS and one from SPOT-VEGETATION. Prior to comparison, all datasets were averaged in time for the two vegetative seasons in Kenya, and aggregated spatially at the administrative division level at which the insurance is offered. The feasibility of extending the resulting aggregated drought indices back in time was assessed using jackknifed R2 statistics (leave-one-year-out) for the overlapping period 2002-2011. We found that division-specific models were more effective than a global model for linking the division-level temporal variability of the index between NDVI products. Based on our results, good scope exists for historically extending the aggregated drought index, thus providing a longer operational record for insurance purposes. We showed that this extension may have large effects on the calculated insurance premium. Finally, we discuss several possible improvements to the drought index.

An Asset Protection Scheme for Banks Exposed to Troubled Loan Portfolios: Application to the Danish Agricultural Sector

DEFF Research Database (Denmark)

Grosen, Anders; Jessen, Pernille; Kokholm, Thomas

while retaining an appropriate structure of incentives. Within the structural credit risk modeling framework we apply two alternative structural multivariate default risk models, the classical Gaussian Black-Scholes-Merton model and a model based on Normal Inverse Gaussian (NIG) processes, e.g. Barndorf...... as the underlying in the valuation of the corresponding APS in order to demonstrate the applicability of the APS as a regulatory tool. The contribution to the financial literature on credit risk is the empirical analysis of agricultural loans using our unique data set. The contribution to the banking literature......An Asset Protection Scheme (APS) is a portfolio insurance contract; a credit derivative used as a tool to restore financial stability and reestablish economic confidence. Opposed to most governmental bailout packages implemented all over the world recently, the APS can be a fair market contract...

Mitarbeiteranreizsysteme und Innovationserfolg (Employee suggestion schemes and innovation success)

OpenAIRE

Czarnitzki, Dirk; Kraft, Kornelius

2008-01-01

"We discuss the determinants of a successful implementation of an employee suggestion scheme and other measures to stimulate innovation success. Subsequently the effects of the employee suggestion schemes are investigated empirically. We analyse the realisation of cost reductions and alternatively sales expansion due to quality improvements. It turns out that employee suggestion schemes have a positive effect on cost efficiency and sales growth. Delegation of decision authority reduces produc...

Health seeking behavior in Karnataka: Does micro-health insurance matter?

Directory of Open Access Journals (Sweden)

S Savitha

2013-01-01

Full Text Available Background: Health seeking behaviour in the event of illness is influenced by the availability of good health care facilities and health care financing mechanisms. Micro health insurance not only promotes formal health care utilization at private providers but also reduces the cost of care by providing the insurance coverage. Objectives: This paper explores the impact of Sampoorna Suraksha Programme, a micro health insurance scheme on the health seeking behaviour of households during illness in Karnataka, India. Materials and Methods: The study was conducted in three randomly selected districts in Karnataka, India in the first half of the year 2011. The hypothesis was tested using binary logistic regression analysis on the data collected from randomly selected 1146 households consisting of 4961 individuals. Results: Insured individuals were seeking care at private hospitals than public hospitals due to the reduction in financial barrier. Moreover, equity in health seeking behaviour among insured individuals was observed. Conclusion : Our finding does represent a desirable result for health policy makers and micro finance institutions to advocate for the inclusion of health insurance in their portfolio, at least from the HSB perspective.

Differences in price elasticities of demand for health insurance: a systematic review.

Science.gov (United States)

Pendzialek, Jonas B; Simic, Dusan; Stock, Stephanie

2016-01-01

Many health insurance systems apply managed competition principles to control costs and quality of health care. Besides other factors, managed competition relies on a sufficient price-elastic demand. This paper presents a systematic review of empirical studies on price elasticity of demand for health insurance. The objective was to identify the differing international ranges of price elasticity and to find socio-economic as well as setting-oriented factors that influence price elasticity. Relevant literature for the topic was identified through a two-step identification process including a systematic search in appropriate databases and further searches within the references of the results. A total of 45 studies from countries such as the USA, Germany, the Netherlands, and Switzerland were found. Clear differences in price elasticity by countries were identified. While empirical studies showed a range between -0.2 and -1.0 for optional primary health insurance in the US, higher price elasticities between -0.6 and -4.2 for Germany and around -2 for Switzerland were calculated for mandatory primary health insurance. Dutch studies found price elasticities below -0.5. In consideration of all relevant studies, age and poorer health status were identified to decrease price elasticity. Other socio-economic factors had an unclear impact or too limited evidence. Premium level, range of premiums, homogeneity of benefits/coverage and degree of forced decision were found to have a major influence on price elasticity in their settings. Further influence was found from supplementary insurance and premium-dependent employer contribution.

Economic reforms and health insurance in China.

Science.gov (United States)

Du, Juan

2009-08-01

During the 1990s, Chinese state-owned enterprises (SOEs) and collective enterprises continually decreased coverage of public health insurance to their employees. This paper investigates this changing pattern of health insurance coverage in China using panel data from the China Nutrition and Health Survey (1991-2000). It is the first attempt in this literature that tries to identify precisely the effects of specific policies and reforms on health insurance coverage in the transitional period of China. The fixed effects linear model clustering at the province level is used for estimation, and results are compared to alternative models, including pooled OLS, random effects GLS model and fixed effects logit model. Strong empirical evidence is found that unemployment as a side effect of the Open Door Policy, and the deregulation of SOE and collective enterprises were the main causes for the decreasing trend. For example, urban areas that were highly affected by the Open Door Policy were associated with 17 percentage points decrease in the insurance coverage. Moreover, I found evidence that the gaps between SOE and non-SOE employees, collective and non-collective employees, urban and rural employees have considerably decreased during the ten years.

Perceptions of healthcare quality in Ghana: Does health insurance status matter?

Science.gov (United States)

Duku, Stephen Kwasi Opoku; Nketiah-Amponsah, Edward; Janssens, Wendy; Pradhan, Menno

2018-01-01

This study's objective is to provide an alternative explanation for the low enrolment in health insurance in Ghana by analysing differences in perceptions between the insured and uninsured of the non-technical quality of healthcare. It further explores the association between insurance status and perception of healthcare quality to ascertain whether insurance status matters in the perception of healthcare quality. Data from a survey of 1,903 households living in the catchment area of 64 health centres were used for the analysis. Two sample independent t-tests were employed to compare the average perceptions of the insured and uninsured on seven indicators of non-technical quality of healthcare. A generalised ordered logit regression, controlling for socio-economic characteristics and clustering at the health facility level, tested the association between insurance status and perceived quality of healthcare. The perceptions of the insured were found to be significantly more negative than the uninsured and those of the previously insured were significantly more negative than the never insured. Being insured was associated with a significantly lower perception of healthcare quality. Thus, once people are insured, they tend to perceive the quality of healthcare they receive as poor compared to those without insurance. This study demonstrated that health insurance status matters in the perceptions of healthcare quality. The findings also imply that perceptions of healthcare quality may be shaped by individual experiences at the health facilities, where the insured and uninsured may be treated differently. Health insurance then becomes less attractive due to the poor perception of the healthcare quality provided to individuals with insurance, resulting in low demand for health insurance in Ghana. Policy makers in Ghana should consider redesigning, reorganizing, and reengineering the National Healthcare Insurance Scheme to ensure the provision of better quality healthcare

Community rating in the absence of risk equalisation: lessons from the Irish private health insurance market.

Science.gov (United States)

Turner, Brian; Shinnick, Edward

2013-04-01

Ireland's private health insurance market operates on the basis of community rating, alongside open enrolment and lifetime cover. A risk equalisation scheme was introduced in 2003 to bolster community rating. However, in July 2008 the Irish Supreme Court set aside this scheme, on the basis of the interpretation of community rating in Irish legislation. This decision has significant implications for the Irish private health insurance market. This paper reviews the development of the market, focusing in particular on community rating. The breakdown of community rating in a market with multiple insurers with differing risk profiles is discussed. Applying this to the Irish market, it can be seen that the Irish Supreme Court judgment has significant implications for the application of community rating. Specifically, while community rating operates within plans, it no longer operates across the market, leading to high-risk lives paying more, on average, than low-risk lives. It has also led to greater opportunities for insurers to engage in market segmentation. This may have relevance for the design and operation of other community rated markets.

The effect of health insurance reform on the number of cataract surgeries in Chongqing, China

Directory of Open Access Journals (Sweden)

Yuan Rongdi

2011-03-01

Full Text Available Abstract Background Cataracts are the leading cause of blindness in China, and poverty is a major barrier to having cataract surgery. In 2003, the Chinese government began a series of new national health insurance reforms, including the New Cooperative Medical Scheme (NCMS and the Urban Resident Basic Health Insurance scheme (URBMI. These two programs, combined with the previously existing Urban Employee Basic Health Insurance (UEBMI program, aimed to make it easier for individuals to receive medical treatment. This study reports cataract surgery numbers in rural and urban populations and the proportion of these who had health insurance in Chongqing, China from 2003 to 2008. Methods The medical records of a consecutive case series, including 14,700 eyes of 13,262 patients who underwent age-related cataract surgery in eight hospitals in Chongqing from January 1, 2003, to December 31, 2008, were analysed retrospectively via multi-stage cluster sampling. Results In the past six years, the total number of cataract surgeries had increased each year as had the number of patients with insurance. Both the number of surgeries and the number of insured patients were much higher in the urban group than in the rural group. The rate of increase in the rural group however was much higher than in the urban group, especially in 2007 and 2008. The odds ratios of having health insurance for urban vs. rural individuals were relatively stable from 2003 to 2006, but it decreased in 2007 and was significantly lower in 2008. Conclusions Health insurance appears to be an important factor associated with increased cataract surgery in Chongqing, China. With the implementation of health insurance, the number of Chongqing's cataract surgeries was increased year by year.

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management.

Science.gov (United States)

Atinga, Roger A; Mensah, Sylvester A; Asenso-Boadi, Francis; Adjei, Francis-Xavier Andoh

2012-06-22

In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana's ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Study's findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation.

China’s Insurance Regulatory Reform, Corporate Governance Behavior and Insurers’ Governance Effectiveness

Science.gov (United States)

Zhang, Hongliang; Qiu, Aichao

2017-01-01

External regulation is an important mechanism to improve corporate behavior in emerging markets. China’s insurance governance regulation, which began to supervise and guide insurance corporate governance behavior in 2006, has experienced a complex process of reform. This study tested our hypotheses with a sample of 85 firms during 2010–2011, which was obtained by providing a questionnaire to all of China’s shareholding insurance companies. The empirical study results generally show that China’s insurance governance effectiveness has significantly improved through strict regulation. Insurance corporate governance can improve business acumen and risk-control ability, but no significant evidence was found to prove its influence on profitability, as a result of focusing less attention on governance than on management. State ownership is associated with higher corporate governance effectiveness than non-state ownership. Listed companies tend to outperform non-listed firms, and life insurance corporate governance is more effective than that of property insurers. This study not only contributes to the comprehensive understanding of corporate governance effectiveness but also to the literature by highlighting the effect of corporate governance regulation in China’s insurance industry and other emerging economies of the financial sector. PMID:29039781

China’s Insurance Regulatory Reform, Corporate Governance Behavior and Insurers’ Governance Effectiveness

Directory of Open Access Journals (Sweden)

Huicong Li

2017-10-01

Full Text Available External regulation is an important mechanism to improve corporate behavior in emerging markets. China’s insurance governance regulation, which began to supervise and guide insurance corporate governance behavior in 2006, has experienced a complex process of reform. This study tested our hypotheses with a sample of 85 firms during 2010–2011, which was obtained by providing a questionnaire to all of China’s shareholding insurance companies. The empirical study results generally show that China’s insurance governance effectiveness has significantly improved through strict regulation. Insurance corporate governance can improve business acumen and risk-control ability, but no significant evidence was found to prove its influence on profitability, as a result of focusing less attention on governance than on management. State ownership is associated with higher corporate governance effectiveness than non-state ownership. Listed companies tend to outperform non-listed firms, and life insurance corporate governance is more effective than that of property insurers. This study not only contributes to the comprehensive understanding of corporate governance effectiveness but also to the literature by highlighting the effect of corporate governance regulation in China’s insurance industry and other emerging economies of the financial sector.

Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana.

Science.gov (United States)

Akazili, James; Ataguba, John Ele-Ojo; Kanmiki, Edmund Wedam; Gyapong, John; Sankoh, Osman; Oduro, Abraham; McIntyre, Di

2017-05-22

There is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana's national health insurance scheme. Data come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen's parade of "dwarfs and a few giants" is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana. There was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones. It is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even

Effects of health insurance on labour supply: A systematic review

NARCIS (Netherlands)

Quynh, Nga Le Thi; Groot, Wim; Tomini, Sonila M.; Tomini, Florian

2017-01-01

This study provides a systematic review of empirical evidence on the labour supply effects of health insurance. The outcomes in the 63 studies reviewed include labour supply in terms of hours worked and the probability of employment, self-employment and the level of economic formalisation. One of

Empirical Models of Demand for Out-Patient Physician Services and Their Relevance to the Assessment of Patient Payment Policies: A Critical Review of the Literature

Directory of Open Access Journals (Sweden)

Olga Skriabikova

2010-06-01

Full Text Available This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.

Empirical models of demand for out-patient physician services and their relevance to the assessment of patient payment policies: a critical review of the literature.

Science.gov (United States)

Skriabikova, Olga; Pavlova, Milena; Groot, Wim

2010-06-01

This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.

Statistical methods with applications to demography and life insurance

CERN Document Server

Khmaladze, Estáte V

2013-01-01

Suitable for statisticians, mathematicians, actuaries, and students interested in the problems of insurance and analysis of lifetimes, Statistical Methods with Applications to Demography and Life Insurance presents contemporary statistical techniques for analyzing life distributions and life insurance problems. It not only contains traditional material but also incorporates new problems and techniques not discussed in existing actuarial literature. The book mainly focuses on the analysis of an individual life and describes statistical methods based on empirical and related processes. Coverage ranges from analyzing the tails of distributions of lifetimes to modeling population dynamics with migrations. To help readers understand the technical points, the text covers topics such as the Stieltjes, Wiener, and Itô integrals. It also introduces other themes of interest in demography, including mixtures of distributions, analysis of longevity and extreme value theory, and the age structure of a population. In addi...

Conditional selectivity performance of Indian mutual fund schemes: An empirical study

Directory of Open Access Journals (Sweden)

Subrata Roy

2015-06-01

Full Text Available The present study seeks to examine the stock-selection performance of the sample open-ended equity mutual fund schemes of Birla Sun Life Mutual Fund Company based on traditional and conditional performance measures. It is generally expected that inclusion of some relevant predetermined public information variables in the conditional CAPM provides better performance estimates as compared to the traditional measures. The study reports that after inclusion of conditioning public information variables, the selectivity performances of the schemes have dramatically improved relative to the traditional measure and also found that conditional measure is superior to traditional measure in statistical test.

Financing health care for all insurance the first step? is national h-ealth

African Journals Online (AJOL)

1990-08-04

Aug 4, 1990 ... supplemented by a national health insurance scheme, rather than through simply ... duals and families, and often unaffordable to individuals if they have to pay the .... Employees' contributions may be matched by employers.

Effect of Health Insurance on the Use and Provision of Maternal Health Services and Maternal and Neonatal Health Outcomes: A Systematic Review

Science.gov (United States)

Peterson, Lauren A.; Hatt, Laurel E.

2013-01-01

Financial barriers can affect timely access to maternal health services. Health insurance can influence the use and quality of these services and potentially improve maternal and neonatal health outcomes. We conducted a systematic review of the evidence on health insurance and its effects on the use and provision of maternal health services and on maternal and neonatal health outcomes in middle- and low-income countries. Studies were identified through a literature search in key databases and consultation with experts in healthcare financing and maternal health. Twenty-nine articles met the review criteria of focusing on health insurance and its effect on the use or quality of maternal health services, or maternal and neonatal health outcomes. Sixteen studies assessed demand-side effects of insurance, eight focused on supply-side effects, and the remainder addressed both. Geographically, the studies provided evidence from sub-Saharan Africa (n=11), Asia (n=9), Latin America (n=8), and Turkey. The studies included examples from national or social insurance schemes (n=7), government-run public health insurance schemes (n=4), community-based health insurance schemes (n=11), and private insurance (n=3). Half of the studies used econometric analyses while the remaining provided descriptive statistics or qualitative results. There is relatively consistent evidence that health insurance is positively correlated with the use of maternal health services. Only four studies used methods that can establish this causal relationship. Six studies presented suggestive evidence of overprovision of caesarean sections in response to providers’ payment incentives through health insurance. Few studies focused on the relationship between health insurance and the quality of maternal health services or maternal and neonatal health outcomes. The available evidence on the quality and health outcomes is inconclusive, given the differences in measurement, contradictory findings, and

Factors influencing the decision to drop out of health insurance enrolment among urban slum dwellers in Ghana.

Science.gov (United States)

Atinga, Roger A; Abiiro, Gilbert Abotisem; Kuganab-Lem, Robert Bella

2015-03-01

To identify the factors influencing dropout from Ghana's health insurance scheme among populations living in slum communities. Cross-sectional data were collected from residents of 22 slums in the Accra Metropolitan Assembly. Cluster and systematic random sampling techniques were used to select and interview 600 individuals who had dropped out from the scheme 6 months prior to the study. Descriptive statistics and multivariate logistic regression models were computed to account for sample characteristics and reasons associated with the decision to dropout. The proportion of dropouts in the sample increased from the range of 6.8% in 2008 to 34.8% in 2012. Non-affordability of premium was the predominant reason followed by rare illness episodes, limited benefits of the scheme and poor service quality. Low-income earners and those with low education were significantly more likely to report premium non-affordability. Rare illness was a common reason among younger respondents, informal sector workers and respondents with higher education. All subgroups of age, education, occupation and income reported nominal benefits of the scheme as a reason for dropout. Interventions targeted at removing bottlenecks to health insurance enrolment are salient to maximising the size of the insurance pool. Strengthening service quality and extending the premium exemption to cover low-income families in slum communities is a valuable strategy to achieve universal health coverage. © 2014 John Wiley & Sons Ltd.

RISK CORRIDORS AND REINSURANCE IN HEALTH INSURANCE MARKETPLACES: Insurance for Insurers

OpenAIRE

LAYTON, TIMOTHY J.; MCGUIRE, THOMAS G.; SINAIKO, ANNA D.

2016-01-01

In order to encourage entry and lower prices, most regulated markets for health insurance include policies that seek to reduce the uncertainty faced by insurers. In addition to risk adjustment of premiums paid to plans, the Health Insurance Marketplaces established by the Affordable Care Act implement reinsurance and risk corridors. Reinsurance limits insurer costs associated with specific individuals, while risk corridors protect against aggregate losses. Both tighten the insurer's distribut...

Crop insurance: Risks and models of insurance

Directory of Open Access Journals (Sweden)

Čolović Vladimir

2014-01-01

Full Text Available The issue of crop protection is very important because of a variety of risks that could cause difficult consequences. One type of risk protection is insurance. The author in the paper states various models of insurance in some EU countries and the systems of subsidizing of insurance premiums by state. The author also gives a picture of crop insurance in the U.S., noting that in this country pays great attention to this matter. As for crop insurance in Serbia, it is not at a high level. The main problem with crop insurance is not only the risks but also the way of protection through insurance. The basic question that arises not only in the EU is the question is who will insure and protect crops. There are three possibilities: insurance companies under state control, insurance companies that are public-private partnerships or private insurance companies on a purely commercial basis.

Insurance against climate change and flood risk: Insurability and decision processes of insurers

Science.gov (United States)

Hung, Hung-Chih; Hung, Jia-Yi

2016-04-01

1. Background Major portions of the Asia-Pacific region is facing escalating exposure and vulnerability to climate change and flood-related extremes. This highlights an arduous challenge for public agencies to improve existing risk management strategies. Conventionally, governmental funding was majorly responsible and accountable for disaster loss compensation in the developing countries in Asia, such as Taiwan. This is often criticized as an ineffective and inefficient measure of dealing with flood risk. Flood insurance is one option within the toolkit of risk-sharing arrangement and adaptation strategy to flood risk. However, there are numerous potential barriers for insurance companies to cover flood damage, which would cause the flood risk is regarded as uninsurable. This study thus aims to examine attitudes within the insurers about the viability of flood insurance, the decision-making processes of pricing flood insurance and their determinants, as well as to examine potential solutions to encourage flood insurance. 2. Methods and data Using expected-utility theory, an insurance agent-based decision-making model was developed to examine the insurers' attitudes towards the insurability of flood risk, and to scrutinize the factors that influence their decisions on flood insurance premium-setting. This model particularly focuses on how insurers price insurance when they face either uncertainty or ambiguity about the probability and loss of a particular flood event occurring. This study considers the factors that are expected to affect insures' decisions on underwriting and pricing insurance are their risk perception, attitudes towards flood insurance, governmental measures (e.g., land-use planning, building codes, risk communication), expected probabilities and losses of devastating flooding events, as well as insurance companies' attributes. To elicit insurers' utilities about premium-setting for insurance coverage, the 'certainty equivalent,' 'probability

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management

Science.gov (United States)

2012-01-01

Background In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. Methods A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana’s ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. Results The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Conclusion Study’s findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation. PMID:22726666

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management

Directory of Open Access Journals (Sweden)

Atinga Roger A

2012-06-01

Full Text Available Abstract Background In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. Methods A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana’s ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. Results The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Conclusion Study’s findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation.

Community concepts of poverty: an application to premium exemptions in Ghana’s National Health Insurance Scheme

Science.gov (United States)

2013-01-01

Background Poverty is multi dimensional. Beyond the quantitative and tangible issues related to inadequate income it also has equally important social, more intangible and difficult if not impossible to quantify dimensions. In 2009, we explored these social and relativist dimension of poverty in five communities in the South of Ghana with differing socio economic characteristics to inform the development and implementation of policies and programs to identify and target the poor for premium exemptions under Ghana’s National Health Insurance Scheme. Methods We employed participatory wealth ranking (PWR) a qualitative tool for the exploration of community concepts, identification and ranking of households into socioeconomic groups. Key informants within the community ranked households into wealth categories after discussing in detail concepts and indicators of poverty. Results Community defined indicators of poverty covered themes related to type of employment, educational attainment of children, food availability, physical appearance, housing conditions, asset ownership, health seeking behavior, social exclusion and marginalization. The poverty indicators discussed shared commonalities but contrasted in the patterns of ranking per community. Conclusion The in-depth nature of the PWR process precludes it from being used for identification of the poor on a large national scale in a program such as the NHIS. However, PWR can provide valuable qualitative input to enrich discussions, development and implementation of policies, programs and tools for large scale interventions and targeting of the poor for social welfare programs such as premium exemption for health care. PMID:23497484

Korean medicine coverage in the National Health Insurance in Korea: present situation and critical issues

Directory of Open Access Journals (Sweden)

Byungmook Lim

2013-09-01

Full Text Available National Health Insurance (NHI in Korea has covered Korean medicine (KM services including acupuncture, moxibustion, cupping, and herbal preparations since 1987, which represents the first time that an entire traditional medicine system was insured by an NHI scheme anywhere in the world. This nationwide insurance coverage led to a rapid increase in the use of KM, and the KM community became one of the main interest groups in the Korean healthcare system. However, due to the public's safety concern of and the stagnancy in demand for KM services, KM has been facing new challenges. This paper presents a brief history and the current structure of KM health insurance, and describes the critical issues related to KM insurance for in-depth understanding of the present situation.

Chinese nuclear insurance and Chinese nuclear insurance pool

International Nuclear Information System (INIS)

Gong Zhiqi

2000-01-01

Chinese Nuclear Insurance Started with Daya Bay Nuclear Power Station, PICC issued the insurance policy. Nuclear insurance cooperation between Chinese and international pool's organizations was set up in 1989. In 1996, the Chinese Nuclear Insurance Pool was prepared. The Chinese Nuclear Insurance Pool was approved by The Chinese Insurance Regulatory Committee in May of 1999. The principal aim is to centralize maximum the insurance capacity for nuclear insurance from local individual insurers and to strengthen the reinsurance relations with international insurance pools so as to provide the high quality insurance service for Chinese nuclear industry. The Member Company of Chinese Nuclear Pool and its roles are introduced in this article

An empirical investigation on factors influencing on insurance issued by export guarantee funds

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Naser Azad

2013-07-01

Full Text Available This paper attempts to find important factors influencing on insurance issued by export guarantee funds. The study uses factor analysis to detect important factors based on a questionnaire in Likert scale. The study has determined four factors including risk management, customer oriented, quality management and trade management. The first factor is associated with risk management and it includes four sub-factors. The factors include being responsive, reliability, service quality and customer detection and reliability plays the most important factor. The second factor is associated with being customer oriented where the factor includes four components including cost recognition, access, marketing knowledge and the level of management training. The third factor is associated with quality management, which includes four variables including responsiveness, reliability, quality of services and customer recognition. Finally, the last factor is associated with trade management, which includes three variables including trade risk, insurance premium and currency.

Who uses outpatient healthcare services under Ghana's health protection scheme and why?

Science.gov (United States)

Fenny, Ama P; Asante, Felix A; Arhinful, Daniel K; Kusi, Anthony; Parmar, Divya; Williams, Gemma

2016-05-10

The National Health Insurance Scheme (NHIS) was launched in Ghana in 2003 with the main objective of increasing utilisation to healthcare by making healthcare more affordable. Previous studies on the NHIS have repeatedly highlighted that cost of premiums is one of the major barriers for enrollment. However, despite introducing premium exemptions for pregnant women, older people, children and indigents, many Ghanaians are still not active members of the NHIS. In this paper we investigate why there is limited success of the NHIS in improving access to healthcare in Ghana and whether social exclusion could be one of the limiting barriers. The study explores this by looking at the Social, Political, Economic and Cultural (SPEC) dimensions of social exclusion. Using logistic regression, the study investigates the determinants of health service utilisation using SPEC variables including other variables. Data was collected from 4050 representative households in five districts in Ghana covering the 3 ecological zones (coastal, forest and savannah) in Ghana. Among 16,200 individuals who responded to the survey, 54 % were insured. Out of the 1349 who sought health care, 64 % were insured and 65 % of them had basic education and 60 % were women. The results from the logistic regressions show health insurance status, education and gender to be the three main determinants of health care utilisation. Overall, a large proportion of the insured who reported ill, sought care from formal health care providers compared to those who had never insured in the scheme. The paper demonstrates that the NHIS presents a workable policy tool for increasing access to healthcare through an emphasis on social health protection. However, affordability is not the only barrier for access to health services. Geographical, social, cultural, informational, political, and other barriers also come into play.

Medicines coverage and community-based health insurance in low-income countries

Directory of Open Access Journals (Sweden)

Wagner Anita K

2008-10-01

Full Text Available Abstract Objectives The 2004 International Conference on Improving Use of Medicines recommended that emerging and expanding health insurances in low-income countries focus on improving access to and use of medicines. In recent years, Community-based Health Insurance (CHI schemes have multiplied, with mounting evidence of their positive effects on financial protection and resource mobilization for healthcare in poor settings. Using literature review and qualitative interviews, this paper investigates whether and how CHI expands access to medicines in low-income countries. Methods We used three complementary data collection approaches: (1 analysis of WHO National Health Accounts (NHA and available results from the World Health Survey (WHS; (2 review of peer-reviewed articles published since 2002 and documents posted online by national insurance programs and international organizations; (3 structured interviews of CHI managers about key issues related to medicines benefit packages in Lao PDR and Rwanda. Results In low-income countries, only two percent of WHS respondents with voluntary insurance belong to the lowest income quintile, suggesting very low CHI penetration among the poor. Yet according to the WHS, medicines are the largest reported component of out-of-pocket payments for healthcare in these countries (median 41.7% and this proportion is inversely associated with income quintile. Publications have mentioned over a thousand CHI schemes in 19 low-income countries, usually without in-depth description of the type, extent, or adequacy of medicines coverage. Evidence from the literature is scarce about how coverage affects medicines utilization or how schemes use cost-containment tools like co-payments and formularies. On the other hand, interviews found that medicines may represent up to 80% of CHI expenditures. Conclusion This paper highlights the paucity of evidence about medicines coverage in CHI. Given the policy commitment to expand CHI

Making every Australian count: challenges for the National Disability Insurance Scheme (NDIS) and the equal inclusion of homeless Aboriginal and Torres Strait Islander Peoples with neurocognitive disability.

Science.gov (United States)

Townsend, Clare; White, Paul; Cullen, Jennifer; Wright, Courtney J; Zeeman, Heidi

2017-03-30

This article highlights the dearth of accurate evidence available to inform the National Disability Insurance Scheme (NDIS) regarding the extent and nature of neurocognitive disability amongst homeless Aboriginal and Torres Strait Islander people. Without accurate prevalence rates of neurocognitive disability, homeless Aboriginal and Torres Strait Islander people are in danger of not being counted by the NDIS and not receiving supports to which they are entitled. Addressing this knowledge gap is challenged by a range of factors, including: (1) the long-term effect of profound intergenerational disenfranchisement of Aboriginal and Torres Strait Islander people; (2) Aboriginal and Torres Strait Islander cultural perspectives around disability; (3) the generally unrecognised and poorly understood nature of neurocognitive disability; (4) the use of research methods that are not culturally safe; (5) research logistics; and (6) the absence of culturally appropriate assessment tools to identify prevalence. It is argued that an accurate evidence base that is informed by culturally safe research methods and assessment tools is needed to accurately guide the Commonwealth government and the National Disability Insurance Agency about the expected level of need for the NDIS. Research within this framework will contribute to the realisation of a truly inclusive NDIS.

Evaluating Labour Market Effects of Wage Subsidies for the Disabled -The Danish Flexjobs Scheme

DEFF Research Database (Denmark)

Datta Gupta, Nabanita; Larsen, Mona

2010-01-01

We evaluate the employment and disability exit effects of a wage subsidy program for the disabled in a setting characterized by universal health insurance and little employment protection. We focus on the Danish Flexjob scheme that was introduced in 1998 and targeted towards improving the employm......We evaluate the employment and disability exit effects of a wage subsidy program for the disabled in a setting characterized by universal health insurance and little employment protection. We focus on the Danish Flexjob scheme that was introduced in 1998 and targeted towards improving...... the employment prospects of the long-term disabled with partial working capacity. We find a substantial, positive employment effect of the scheme in the 1994-2001 period within the target group compared to a control group of closely matched ineligibles, but no discernable effects on the probability of disability...... exit. For the target group employment probability is raised by 33 pct. points after the scheme is introduced relative to a mean employment rate at baseline of 44%. One explanation for a strong employment entry effect concomitant with a non-existent disability exit effect could be that subsidized jobs...

PRICING AND ASSESSING UNIT-LINKED INSURANCE CONTRACTS WITH INVESTMENT GUARANTEES

Directory of Open Access Journals (Sweden)

Ciumas Cristina

2014-07-01

policyholder and involve no investment risk for the insurer. Although the Romanian legislation authorizes the Romanian insurers to offer unit-linked contracts without investment guarantees, this research provides a proposal of a theoretical and empirical basis for pricing the unit-linked insurance contracts with incorporated investment guarantees.

ROMANIAN DEPOSIT GUARANTEE SCHEME AND THE REQUIREMENTS OF THE ACQUIS COMMUNAUTAIRE

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Cristian Bichi

2002-12-01

Full Text Available This paper compares the Romanian and EU deposit insurance legislation in order to identify the changes, which are needed in order to obtain a full compatibility of the national regulations in the field of deposit protection with the corresponding European rules. The first part outlines the main features of the EU Directive 94/19/EEC on deposit guarantee schemes in order to find out to what extent Romania is bound to incorporate the relevant acquis communautaire into its national legislation. It results that the directive contains explicit harmonization provisions as regards the minimum level of protection (EUR 20,000, depositor co-insurance, types of depositors, instruments and currencies to be covered, nature of coverage, status of branches from EU and non-EU countries, the compensation period and information to depositors. The directive does not provide for the harmonization of the financial and administrative structure of the deposit guarantee schemes, Romania being free to choose from a wider range of options. The second part examines the legal environment of deposit protection in Romania. The third part identifies the measures to be taken by the Romanian authorities in order to fill in the remaining regulatory gaps in the area of deposit insurance. Finally, the fourth part contains the conclusions.

Insurance market penetration and economic growth in Eurozone countries: Time series evidence on causality

Directory of Open Access Journals (Sweden)

Saurav Dash

2018-06-01

Full Text Available This paper examines the causal relationship between insurance market penetration and per capita economic growth in 19 Eurozone countries for the period 1980–2014. We use three different indicators of insurance market penetration (IMP, namely life insurance penetration, non-life insurance penetration, and total (both life and non-life insurance penetration. We particularly emphasize on whether Granger causality exists between these variables both ways, one way, or not at all. Our empirical results perceive both unidirectional and bidirectional causality between IMP and per capita economic growth. However, these results are mostly non-uniform across the Eurozone countries during this selected period. The policy implication is that the economic policies should recognize the differences in the insurance market and per capita economic growth in order to maintain sustainable growth in the Eurozone. Keywords: IMP, Per capita economic growth, Granger causality, Eurozone countries, JEL codes: L96, O32, O33, O43

Time-Varying Estimation of Crop Insurance Program in Altering North Dakota Farm Economic Structure

OpenAIRE

Coleman, Jane A.; Shaik, Saleem

2009-01-01

This study examines how federal farm policies, specifically crop insurance, have affected the farm economic structure of North Dakota’s agriculture sector. The system of derived input demand equations is estimated to quantify the changes in North Dakota farmers’ input use when they purchase crop insurance. Further, the cumulative rolling regression technique is applied to capture the varying effects of the farm policies over time. Empirical results from the system of input demand functions in...

The effect of the National Health Insurance Scheme (NHIS) on health service delivery in mission facilities in Ghana: a retrospective study.

Science.gov (United States)

Aryeetey, Genevieve Cecilia; Nonvignon, Justice; Amissah, Caroline; Buckle, Gilbert; Aikins, Moses

2016-06-07

In 2004, Ghana began implementation of a National Health Insurance Scheme (NHIS) to minimize out-of-pocket expenditure at the point of use of service. The implementation of the scheme was accompanied by increased access and use of health care services. Evidence suggests most health facilities are faced with management challenges in the delivery of services. The study aimed to assess the effect of the introduction of the NHIS on health service delivery in mission health facilities in Ghana. We conceptualised the effect of NHIS on facilities using service delivery indicators such as outpatient and inpatient turn out, estimation of general service readiness, revenue and expenditure, claims processing and availability of essential medicines. We collected data from 38 mission facilities, grouped into the three ecological zones; southern, middle and northern. Structured questionnaires and exit interviews were used to collect data for the periods 2003 and 2010. The data was analysed in SPSS and MS Excel. The facilities displayed high readiness to deliver services. There were significant increases in outpatient and inpatient attendance, revenue, expenditure and improved access to medicines. Generally, facilities reported increased readiness to deliver services. However, challenging issues around high rates of non-reimbursement of NHIS claims due to errors in claims processing, lack of feedback regarding errors, and lack of clarity on claims reporting procedures were reported. The implementation of the NHIS saw improvement and expansion of services resulting in benefits to the facilities as well as constraints. The constraints could be minimized if claims processing is improved at the facility level and delays in reimbursements also reduced.

The future of flood insurance in the UK

Science.gov (United States)

Horn, Diane

2013-04-01

Approximately one in seven properties in the UK (3.6 million homes and businesses) are at risk of flooding. The Adaptation Sub-Committee of the UK Committee on Climate Change reported in 2012 that development on the floodplain grew at a faster rate than elsewhere in England over the past ten years, with one in five properties in the floodplain in areas of significant risk. They concluded that current levels of investment will not keep pace with the increasing risk, noting that without additional action, climate change could almost double the number of properties at significant risk by 2035. Flood insurance can contribute to risk reduction by using pricing or restrictions on availability of cover to discourage new development in flood risk areas, or to encourage the uptake of flood resilience measures. The UK insurance market currently offers flood cover as a standard feature of domestic and small business policies, with central government providing physical protection backed up by financial protection provided by the insurance industry. This approach is unusual in not passing all or part of the flood risk to government schemes. At present, flood insurance in the UK is conducted under a series of informal agreements established between the insurance industry and the Government known as the Statement of Principles. Members of the Association of British Insurers (ABI) currently agree to cover homes at risk of flooding in return for government commitment to manage flood risk. However, this arrangement is now under threat, as the insurance industry is increasingly reluctant to bear the financial burden of flooding alone. The current Statement of Principles ends on 30 June 2013 and will not be renewed. High-risk properties may be unable to obtain insurance after the Statement of Principles expires. Unusually, insurers are arguing against a free market solution, arguing that no country in the world provides universal flood cover without some form of government-led support

The use of data mining by private health insurance companies and customers' privacy.

Science.gov (United States)

Al-Saggaf, Yeslam

2015-07-01

This article examines privacy threats arising from the use of data mining by private Australian health insurance companies. Qualitative interviews were conducted with key experts, and Australian governmental and nongovernmental websites relevant to private health insurance were searched. Using Rationale, a critical thinking tool, the themes and considerations elicited through this empirical approach were developed into an argument about the use of data mining by private health insurance companies. The argument is followed by an ethical analysis guided by classical philosophical theories-utilitarianism, Mill's harm principle, Kant's deontological theory, and Helen Nissenbaum's contextual integrity framework. Both the argument and the ethical analysis find the use of data mining by private health insurance companies in Australia to be unethical. Although private health insurance companies in Australia cannot use data mining for risk rating to cherry-pick customers and cannot use customers' personal information for unintended purposes, this article nonetheless concludes that the secondary use of customers' personal information and the absence of customers' consent still suggest that the use of data mining by private health insurance companies is wrong.

Evaluating Labour Market Effects of Wage Subsidies for the Disabled – the Danish Flexjob Scheme

DEFF Research Database (Denmark)

Datta Gupta, Nabanita; Larsen, Mona

We evaluate the employment and disability exit effects of a wage subsidy program for the disabled in a setting characterized by universal health insurance and little employment protection. We focus on the Danish Flexjob scheme that was introduced in 1998 and targeted towards improving the employm......We evaluate the employment and disability exit effects of a wage subsidy program for the disabled in a setting characterized by universal health insurance and little employment protection. We focus on the Danish Flexjob scheme that was introduced in 1998 and targeted towards improving...... the employment prospects of the long-term disabled with partial working capacity. We find a substantial, positive employment effect of the scheme in the 1994-2001 period within the target group compared to a control group of closely matched ineligibles, but no discernable effects on the probability of disability...... exit. For the target group employment probability is raised by 33 pct. points after the scheme is introduced relative to a mean employment rate at baseline of 44%. One explanation for a strong employment entry effect concomitant with a non-existent disability exit effect could be that subsidized jobs...

Some empirical rules concerning the vapor pressure curve revisited

International Nuclear Information System (INIS)

Velasco, S.; White, J.A.

2014-01-01

Highlights: • A Claussius–Claperyron equation is obtained in the Pitzer corresponding states scheme. • Some well-known empirical rules for the vapor pressure are rewritten in terms of the Pitzer acentric factor. • The Guggenheim point follows the corresponding state scheme better than the normal boiling point. • The Ambrose–Walton vapor pressure equation yields excellent agreement with NIST data in all considered cases. -- Abstract: A form for the Clausius–Clapeyron vapor-pressure equation is obtained in the Pitzer corresponding states scheme. This equation allows one to rewrite the well-known Trouton, Guldberg, van Laar and Guggenheim rules in terms of the acentric factor ω. The original forms of these empirical rules are recovered for some particular values of ω. The proposed rules are checked by analyzing National Institute of Standards and Technology (NIST) data on the liquid-vapor coexistence curve for 105 fluids. These rules have been also analyzed by using the well-known Ambrose–Walton (AW) vapor pressure equation

Strategies for expanding health insurance coverage in vulnerable populations

Science.gov (United States)

Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue

2014-01-01

) studies and Interrupted time series (ITS) studies that evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions. Data collection and analysis At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis. Main results We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence). In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence). Authors' conclusions Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies

Association between supplementary private health insurance and visits to physician offices versus hospital outpatient departments among adults with diabetes in the universal public insurance system.

Science.gov (United States)

You, Chang Hoon; Choi, Ji Heon; Kang, Sungwook; Oh, Eun-Hwan; Kwon, Young Dae

2018-01-01

Diabetes mellitus is a chronic disease with a high prevalence across the world as well as in South Korea. Most cases of diabetes can be adequately managed at physician offices, but many diabetes patients receive outpatient care at hospitals. This study examines the relationship between supplementary private health insurance (SPHI) ownership and the use of hospitals among diabetes outpatients within the universal public health insurance scheme. Data from the 2011 Korea Health Panel, a nationally representative sample of Korean individuals, was used. For the study, 6,379 visits for diabetes care were selected while controlling for clustered errors. Multiple logistic regression models were used to examine determinants of hospital outpatient services. This study demonstrated that the variables of self-rated health status, comorbidity, unmet need, and alcohol consumption significantly correlated with the choice to use a hospital services. Patients with SPHI were more likely to use medical services at hospitals by 1.71 times (95% CI 1.068-2.740, P = 0.026) compared to patients without SPHI. It was confirmed that diabetic patients insured by SPHI had more use of hospital services than those who were not insured. People insured by SPHI seem to be more likely to use hospital services because SPHI lightens the economic burden of care.

Asset and Liability Composition in Participating Life Insurance: The Impact on Shortfall Risk and Shareholder Value

DEFF Research Database (Denmark)

Gatzert, Nadine; Bohnert, Alexander; Jørgensen, Peter Løchte

surplus appropriation schemes on the company’s shortfall risk and the shareholders’ fair risk charge. The range of products comprises temporary life annuities and endowment insurance contracts with varying surplus appropriation schemes that are modeled actuarially. We thereby also account for mortality...... risk and ensure a fair situation for shareholders. Our findings emphasize that management decisions can have a substantial impact on the company’s shortfall risk, and that their effectiveness in risk reduction varies substantially depending on the surplus appropriation scheme offered to the customer...

A matter of trust : clients' perspective on health and health insurance services in Ghana

NARCIS (Netherlands)

Fenenga, Christine

2015-01-01

Dit participatieve actie onderzoek (PAA) betreft percepties en ervaringen van zorgklanten van het National Health Insurance Scheme (NHIS) in Ghana (2011-2014). Het beantwoordt de onderzoeksvraag: Wat drijft zorgklanten gebruik te maken van de gezondheidszorg en het NHIS? De onderzoeker voert

Dynamics of social health insurance development: examining the determinants of Chinese basic health insurance coverage with panel data.

Science.gov (United States)

Liu, Jun-Qiang

2011-08-01

Social health insurance (SHI) is gaining popularity in many developing countries, but there are few systematic empirical studies on the dynamics of SHI development. This study investigates the determinants of coverage of the Basic Healthcare Insurance for Urban Employees (BHI) in China. Using a panel database ranging from 1999 to 2007, the study finds that: (1) economic development plays a valuable role in BHI development; (2) strong financial capacity and administrative capacity in the government contributes to BHI progress; (3) higher trade union density is closely related to more rapid BHI expansion; and (4) taxation agencies are better at collecting SHI premiums. These findings provide evidence-based lessons for new and ongoing SHI programs. In addition, this article aims to make a more general contribution to the study of social policy development by expanding the scope of current theories on social policy development. Copyright © 2011 Elsevier Ltd. All rights reserved.

BEHAVIORAL HAZARD IN HEALTH INSURANCE*

Science.gov (United States)

Baicker, Katherine; Mullainathan, Sendhil; Schwartzstein, Joshua

2015-01-01

A fundamental implication of standard moral hazard models is overuse of low-value medical care because copays are lower than costs. In these models, the demand curve alone can be used to make welfare statements, a fact relied on by much empirical work. There is ample evidence, though, that people misuse care for a different reason: mistakes, or “behavioral hazard.” Much high-value care is underused even when patient costs are low, and some useless care is bought even when patients face the full cost. In the presence of behavioral hazard, welfare calculations using only the demand curve can be off by orders of magnitude or even be the wrong sign. We derive optimal copay formulas that incorporate both moral and behavioral hazard, providing a theoretical foundation for value-based insurance design and a way to interpret behavioral “nudges.” Once behavioral hazard is taken into account, health insurance can do more than just provide financial protection—it can also improve health care efficiency. PMID:23930294

24 CFR 266.602 - Mortgage insurance premium: Insured advances.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Mortgage insurance premium: Insured... Contract Rights and Obligations Mortgage Insurance Premiums § 266.602 Mortgage insurance premium: Insured.... On each anniversary of the initial closing, the HFA shall pay an interim mortgage insurance premium...

Insurance against climate change and flooding in the Netherlands: present, future, and comparison with other countries.

Science.gov (United States)

Botzen, W J W; van den Bergh, J C J M

2008-04-01

Climate change is projected to cause severe economic losses, which has the potential to affect the insurance sector and public compensation schemes considerably. This article discusses the role insurance can play in adapting to climate change impacts. The particular focus is on the Dutch insurance sector, in view of the Netherlands being extremely vulnerable to climate change impacts. The usefulness of private insurance as an adaptation instrument to increased flood risks is examined, which is currently unavailable in the Netherlands. It is questioned whether the currently dominant role of the Dutch government in providing damage relief is justified from an economic efficiency perspective. Characteristics of flood insurance arrangements in the Netherlands, the United Kingdom, Germany, and France are compared in order to identify possible future directions for arrangements in the Netherlands. It is argued that social welfare improves when insurance companies take responsibility for part of the risks associated with climate change.

A Two-Account Life Insurance Model for Scenario-Based Valuation Including Event Risk

Directory of Open Access Journals (Sweden)

Ninna Reitzel Jensen

2015-06-01

Full Text Available Using a two-account model with event risk, we model life insurance contracts taking into account both guaranteed and non-guaranteed payments in participating life insurance as well as in unit-linked insurance. Here, event risk is used as a generic term for life insurance events, such as death, disability, etc. In our treatment of participating life insurance, we have special focus on the bonus schemes “consolidation” and “additional benefits”, and one goal is to formalize how these work and interact. Another goal is to describe similarities and differences between participating life insurance and unit-linked insurance. By use of a two-account model, we are able to illustrate general concepts without making the model too abstract. To allow for complicated financial markets without dramatically increasing the mathematical complexity, we focus on economic scenarios. We illustrate the use of our model by conducting scenario analysis based on Monte Carlo simulation, but the model applies to scenarios in general and to worst-case and best-estimate scenarios in particular. In addition to easy computations, our model offers a common framework for the valuation of life insurance payments across product types. This enables comparison of participating life insurance products and unit-linked insurance products, thus building a bridge between the two different ways of formalizing life insurance products. Finally, our model distinguishes itself from the existing literature by taking into account the Markov model for the state of the policyholder and, hereby, facilitating event risk.

Treatment-seeking behaviour and social health insurance in Africa

DEFF Research Database (Denmark)

Fenny, Ama P; Asante, Felix A; Enemark, Ulrika

2014-01-01

or user fees in Africa. Therefore, Ghana serves as in interesting case study as it has successfully expanded coverage of the National Health Insurance Scheme (NHIS). The study aims to establish the treatment-seeking behaviour of households in Ghana under the NHI policy. The study relies on household data...... as the concept of the NHIS grows widely in Ghana and serves as a good model for other African countries....

The Role of Wealth and Health in Insurance Choice: Bivariate Probit Analysis in China

Directory of Open Access Journals (Sweden)

Yiding Yue

2014-01-01

Full Text Available This paper captures the correlation between the choices of health insurance and pension insurance using the bivariate probit model and then studies the effect of wealth and health on insurance choice. Our empirical evidence shows that people who participate in a health care program are more likely to participate in a pension plan at the same time, while wealth and health have different effects on the choices of the health care program and the pension program. Generally, the higher an individual’s wealth level is, the more likelihood he will participate in a health care program; but wealth has no effect on the participation of pension. Health status has opposite effects on choices of health care programs and pension plans; the poorer an individual’s health is, the more likely he is to participate in health care programs, while the better health he enjoys, the more likely he is to participate in pension plans. When the investigation scope narrows down to commercial insurance, there is only a significant effect of health status on commercial health insurance. The commercial insurance choice and the insurance choice of the agricultural population are more complicated.

Implementing a participatory model of micro health insurance among rural poor with evidence from Nepal

NARCIS (Netherlands)

D.M. Dror (David); M. Majumdar (Manabi); P. Panda (Pradeep); D. John (Dominik); R. Koren (Ruth)

2014-01-01

textabstractThis paper reports on two voluntary, contributory, contextualised, community-based health insurance (CBHI) schemes, launched in Dhading and Banke (Nepal) in 2011. The implementation followed a four-stage process: initiating (baseline survey), involving (awareness generation and engaging

Reinsurance and the Cost of Equity in the United Kingdom’s Non-Life Insurance Market

OpenAIRE

Upreti, Vineet

2014-01-01

The link between the cost of equity and reinsurance purchased by insurers is examined in this study. This work extends the research on the economic value implications of corporate risk management practices. Utilising a framework based on the theory of optimal capital structure, this study puts forward two hypotheses to test empirically the cost of equity – reinsurance relation in the United Kingdom’s non-life insurance market. The first hypothesis tests the effect of the decision to reinsure ...

From war service to domestic service: ex-servicewomen and the Free Passage Scheme 1919-22.

Science.gov (United States)

Noakes, Lucy

2011-01-01

At the end of the First World War, the British government put into operation a Free Passage Scheme for ex-servicemen, ex-servicewomen and their dependants to emigrate to the colonies and dominions of the Empire. This scheme was driven by a complex network of interlinked beliefs and policies concerning both the relationship between the metropole and the Empire, and the perceived necessity for social stability in Britain and in the dominions and colonies. This article examines the Free Passage Scheme, paying particular attention to the ways in which it was envisaged as a means of restoring a gendered balance of the population in Britain, where young women outnumbered young men at the end of the war, and in the dominions, where men outnumbered women, and was also seen as a way of emigrating women whose wartime work experiences were understood to be in conflict with gendered identities in the post-war period. The article argues that the Free Passage Scheme needs to be understood as gendered, as it envisaged the transformation of female members of the auxiliary wartime services into domestic servants for the Dominions. The scheme's failure, it is argued, prefigures the failure of the far larger Empire Settlement Act of 1922 to emigrate large numbers of British women as domestic servants.

An exploration study to detect important factors influencing insurance firms

Directory of Open Access Journals (Sweden)

Farzaneh Soleimani

2013-11-01

Full Text Available The recent trend on competition among insurance firms has increased motivation to look for important factors influencing this industry. In this paper, we present an empirical investigation to find important factors shaping this industry. The proposed study designs a questionnaire in Likert scale and, using principal component analysis, detects important factors on the success of this industry. Cronbach alpha is calculated as 0.849, and Kaiser-Meyer-Olkin and Bartlett's Test are calculated as 0.873 and 12744 with (Sig. =0.000, respectively. The study has detected four important factors including quality of service casualties, sales improvement and advertisement, quality of issuance of insurance policies and quality of work force.

The Effects of Firm-Specific Factors on the Profitability of Non-Life Insurance Companies in Turkey

OpenAIRE

Kaya, Emine Öner

2015-01-01

This study investigates the firm-specific factors affecting the profitability of non-life insurance companies operating in Turkey. For this purpose, data of 24 non-life insurance companies operating in Turkey from the period 2006–2013 were brought together to obtain 192 observed panel data sets. In this study, profitability is measured by two different variables: technical profitability ratio and sales profitability ratio. According to the empirical results, the firm-specific factors affecti...

Income-related inequality in health insurance coverage: analysis of China Health and Nutrition Survey of 2006 and 2009

Directory of Open Access Journals (Sweden)

Liu Jinan

2012-08-01

Full Text Available Abstract Introduction China introduced the urban resident basic medical insurance (URBMI in 2007 to cover children and urban unemployed adults, in addition to the new cooperative medical scheme (NCMS for rural residents in 2003 and the basic health insurance scheme (BHIS for urban employees in 1998. This study examined whether the overall income-related inequality in health insurance coverage improved during 2006 and 2009 in China. Methods The China Health and Nutrition Survey (CHNS data of 2006 and 2009 were used to create the concentration curve and the concentration index. GEE logistic regression was used to model the health insurance coverage as dependent variable and household income per capita as independent variable, controlling for individuals' age, gender, marital status, educational attainment, employment status, year 2009 (Y2009, household size, retirement status, and geographic variations. The change in the income-related inequality in 2009 was estimated using the interaction term of income*Y2009. Results In 2006, 49.7% (4,712/9,476 respondents had health insurance: 13.4% with BHIS and 28.4% with NCMS. In 2009, 90.8% (8,964/9,863 had health insurance: 10.1% with URBMI, 18.3% with BHIS, and 57.6% with NCMS. The BHIS, URBMI, and NCMS programs had different patterns of population coverage over 10 income deciles. The concentration index was 0.15 in 2006 and 0.04 in 2009. The dominance test showed that the concentration curves were significantly different between 2006 and 2009 (p  Discussions Comparing 2009 to 2006, the income inequality in health insurance coverage was largely corrected in China through rapid expansion of CHNS in rural areas and initiation of URBMI in urban areas.

Optimum amount of an insurance sum in life insurance

Directory of Open Access Journals (Sweden)

Janez Balkovec

2001-01-01

Full Text Available Personal insurance represents one of the sources of personal social security as a category of personal property. How to get a proper life insurance is a frequently asked question. When insuring material objects (car, house..., the problem is usually not in the amount of the taken insurance. With life insurance (abstract goods, problems as such occur. In this paper, we wish to present a model that, according to the financial situation and the anticipated future, makes it possible to calculate the optimum insurance sum in life insurance.

Experiences of pathways, outcomes and choice after severe traumatic brain injury under no-fault versus fault-based motor accident insurance.

Science.gov (United States)

Harrington, Rosamund; Foster, Michele; Fleming, Jennifer

2015-01-01

To explore experiences of pathways, outcomes and choice after motor vehicle accident (MVA) acquired severe traumatic brain injury (sTBI) under fault-based vs no-fault motor accident insurance (MAI). In-depth qualitative interviews with 10 adults with sTBI and 17 family members examined experiences of pathways, outcomes and choice and how these were shaped by both compensable status and interactions with service providers and service funders under a no-fault and a fault-based MAI scheme. Participants were sampled to provide variation in compensable status, injury severity, time post-injury and metropolitan vs regional residency. Interviews were recorded, transcribed and thematically analysed to identify dominant themes under each scheme. Dominant themes emerging under the no-fault scheme included: (a) rehabilitation-focused pathways; (b) a sense of security; and (c) bounded choices. Dominant themes under the fault-based scheme included: (a) resource-rationed pathways; (b) pressured lives; and (c) unknown choices. Participants under the no-fault scheme experienced superior access to specialist rehabilitation services, greater surety of support and more choice over how rehabilitation and life-time care needs were met. This study provides valuable insights into individual experiences under fault-based vs no-fault MAI. Implications for an injury insurance scheme design to optimize pathways, outcomes and choice after sTBI are discussed.

Federal Environmental Remediation Contractual and Insurance-Based Risk Allocation Schemes: Are They Getting the Job Done?

National Research Council Canada - National Science Library

Momber, Amy L

2005-01-01

.... Recognizing they cannot specifically account for such unknown contingencies via contract, the Government and remediation contractors employ contractual and insurance-based methods to shift or reduce...

Income-related inequality in health insurance coverage: analysis of China Health and Nutrition Survey of 2006 and 2009.

Science.gov (United States)

Liu, Jinan; Shi, Lizheng; Meng, Qingyue; Khan, M Mahmud

2012-08-14

China introduced the urban resident basic medical insurance (URBMI) in 2007 to cover children and urban unemployed adults, in addition to the new cooperative medical scheme (NCMS) for rural residents in 2003 and the basic health insurance scheme (BHIS) for urban employees in 1998. This study examined whether the overall income-related inequality in health insurance coverage improved during 2006 and 2009 in China. The China Health and Nutrition Survey (CHNS) data of 2006 and 2009 were used to create the concentration curve and the concentration index. GEE logistic regression was used to model the health insurance coverage as dependent variable and household income per capita as independent variable, controlling for individuals' age, gender, marital status, educational attainment, employment status, year 2009 (Y2009), household size, retirement status, and geographic variations. The change in the income-related inequality in 2009 was estimated using the interaction term of income*Y2009. In 2006, 49.7% (4,712/9,476) respondents had health insurance: 13.4% with BHIS and 28.4% with NCMS. In 2009, 90.8% (8,964/9,863) had health insurance: 10.1% with URBMI, 18.3% with BHIS, and 57.6% with NCMS. The BHIS, URBMI, and NCMS programs had different patterns of population coverage over 10 income deciles. The concentration index was 0.15 in 2006 and 0.04 in 2009. The dominance test showed that the concentration curves were significantly different between 2006 and 2009 (p China through rapid expansion of CHNS in rural areas and initiation of URBMI in urban areas.

The provision of wage insurance by the firm: evidence from a longitudinal matched employer-employee dataset

OpenAIRE

Cardoso, Ana Rute; Portela, Miguel

2005-01-01

We evaluate the impact of product market uncertainty on workers wages, addressing the questions: To what extent do firms provide insurance to their workforce, nsulating their wages from shocks in product markets? How does the amount of insurance provided vary with firm and worker attributes? We use a longitudinal matched employer-employee dataset of remarkable quality. The empirical strategy is based on Guiso et al. (2005). We first estimate dynamic models of sales and wages to retriev...

Turkish Compulsory Earthquake Insurance and "Istanbul Earthquake

Science.gov (United States)

Durukal, E.; Sesetyan, K.; Erdik, M.

2009-04-01

The city of Istanbul will likely experience substantial direct and indirect losses as a result of a future large (M=7+) earthquake with an annual probability of occurrence of about 2%. This paper dwells on the expected building losses in terms of probable maximum and average annualized losses and discusses the results from the perspective of the compulsory earthquake insurance scheme operational in the country. The TCIP system is essentially designed to operate in Turkey with sufficient penetration to enable the accumulation of funds in the pool. Today, with only 20% national penetration, and about approximately one-half of all policies in highly earthquake prone areas (one-third in Istanbul) the system exhibits signs of adverse selection, inadequate premium structure and insufficient funding. Our findings indicate that the national compulsory earthquake insurance pool in Turkey will face difficulties in covering incurring building losses in Istanbul in the occurrence of a large earthquake. The annualized earthquake losses in Istanbul are between 140-300 million. Even if we assume that the deductible is raised to 15%, the earthquake losses that need to be paid after a large earthquake in Istanbul will be at about 2.5 Billion, somewhat above the current capacity of the TCIP. Thus, a modification to the system for the insured in Istanbul (or Marmara region) is necessary. This may mean an increase in the premia and deductible rates, purchase of larger re-insurance covers and development of a claim processing system. Also, to avoid adverse selection, the penetration rates elsewhere in Turkey need to be increased substantially. A better model would be introduction of parametric insurance for Istanbul. By such a model the losses will not be indemnified, however will be directly calculated on the basis of indexed ground motion levels and damages. The immediate improvement of a parametric insurance model over the existing one will be the elimination of the claim processing

Reform towards National Health Insurance in Malaysia: the equity implications.

Science.gov (United States)

Yu, Chai Ping; Whynes, David K; Sach, Tracey H

2011-05-01

This paper assesses the potential equity impact of Malaysia's projected reform of its current tax financed system towards National Health Insurance (NHI). The Kakwani's progressivity index was used to assess the equity consequences of the new NHI system (with flat rate NHI scheme) compared to the current tax financed system. It was also used to model a proposed system (with a progressive NHI scheme) that can generate the same amount of funding more equitably. The new NHI system would be less equitable than the current tax financed system, as evident from the reduction of Kakwani's index to 0.168 from 0.217. The new flat rate NHI scheme, if implemented, would reduce the progressivity of the health finance system because it is a less progressive finance source than that of general government revenue. We proposed a system with a progressive NHI scheme that generates the same amount of funding whilst preserving the equity at the Kakwani's progressivity index of 0.213. A NHI system with a progressive NHI scheme is proposed to be implemented to raise health funding whilst preserving the equity in health care financing. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Premium Forecasting of an Insurance Company: Automobile Insurance

OpenAIRE

Fouladvand, M. Ebrahim; Darooneh, Amir H.

2002-01-01

We present an analytical study of an insurance company. We model the company's performance on a statistical basis and evaluate the predicted annual income of the company in terms of insurance parameters namely the premium, total number of the insured, average loss claims etc. We restrict ourselves to a single insurance class the so-called automobile insurance. We show the existence a crossover premium p_c below which the company is loss-making. Above p_c, we also give detailed statistical ana...

Investigating the effect of corporate governance on risk of private banks and insurance firms

Directory of Open Access Journals (Sweden)

Mehdi Taghavi

2014-01-01

Full Text Available This paper presents an empirical investigation to study the effects of corporate governance on risk taking of private insurance firms and banks in Iran. The proposed study of this paper considers the financial information of 13 banks and 19 private insurance firms over the period 2006-2011 in Iran. The study investigates the effects of five variables including size, CEO duality task, composition of the board of directors, ownership concentration and having an internal auditing system on risk taking of private banks and insurance firms in Iran. Using some panel data and regression analysis, the study confirms the positive effect of the ownership concentration as well as negative impact of non-bound board members on risk taking.

Defining the key-parameters of insurance product in Islamic insurance

Directory of Open Access Journals (Sweden)

Galim Zaribzyanovich Vakhitov

2015-06-01

Full Text Available Objective to define the range of actuarial calculations in Islamic insurance to study the main differences of the traditional and Islamic insurance to define what changes in calculations entail the above differences. Methods mathematical modeling probabilistic analysis of insurance risks adaptation of methods of actuarial mathematics to the principles of Islamic insurance. Results the mathematical form of the takafulfund models is presented the distribution is analyzed of a random variable of the resulting insurance fund or the insurance company balance in a particular fixed insurance portfolio. Scientific novelty calculation are presented of the optimal tariff rate in takaful. Islamic insurance is an innovative area of insurance industry. Actuarial calculations that meet the Sharia rules are still being developed. The authors set the new tasks of actuarial calculations including the specified changes in the calculation of the optimal tariff rate imposed by the Islamic insurance principles. Practical value the results obtained can be used in the actuarial calculations of the Islamic insurance companies. nbsp

Why Does Emissions Trading under the EU ETS Not Affect Firms' Competitiveness? Empirical Findings from the Literature

OpenAIRE

Joltreau, Eugénie; Sommerfeld, Katrin

2017-01-01

Environmental policies may have important consequences for firms’ competitiveness or profitability. However, the empirical literature shows that hardly any statistically significant effects on firms can be detected for the European Union Emissions Trading Scheme (EU ETS). On the basis of existing literature, we focus on potential explanations for why the empirical literature finds hardly any significant competitiveness effects on firms, least not during the first two phases of the scheme (...

Exploring health insurance services in Sudan from the perspectives of insurers.

Science.gov (United States)

Salim, Anas Mustafa Ahmed; Hamed, Fatima Hashim Mahmoud

2018-01-01

It has been 20 years since the introduction of health insurance in Sudan. This study was the first one that explored health insurance services in Sudan from the perspectives of the insurers. This was a qualitative, exploratory, interview study. The sampling frame was the list of Social Health Insurance and Private Health Insurance institutions in Sudan. Participants were selected from the four Social Health Insurance institutions and from five Private Health Insurance companies. The study was conducted in January and February 2017. In-depth individual interviews were conducted with a convenient sample of key executives from the different health insurers. Ideas and themes were identified and analysed using thematic analysis. The result showed that universal coverage was not achieved despite long time presence of Social Health Insurance and Private Health Insurance in Sudan. All participants described their services as comprehensive. All participants have good perception of the quality of the services they provide, although none of them investigated customer satisfaction. The main challenges facing Social Health Insurance are achieving universal coverage, ensuring sustainability and recruitment of the informal sector and self-employed population. Consumers' affordability of the premiums is the main obstacle for Private Health Insurance, while rising healthcare cost due to economic inflation is a challenge facing both Social Health Insurance and Private Health Insurance. In spite of the presence of Social Health Insurance and Private Health Insurance in Sudan, the country is still far from achieving universal coverage. Moreover, the sustainability of health insurance is questionable. The main reasons include low governmental financial resources and lack of affordability by beneficiaries especially for Private Health Insurance. This necessitates finding solutions to improve them or trying other types of health insurance. The quality of services provided by Social

Meal box schemes as a convenient way to avoid convenience food?

DEFF Research Database (Denmark)

Hertz, Frej; Halkier, Bente

2017-01-01

to categorize meal box schemes as a new form of convenience food called convenient food. In addition, results suggest that meal box schemes reduce leftovers from dinner. Meal boxes also influence dinner related activities such as planning ahead in time and grocery shopping, which require less physical......The term convenience food is subject to diversification, lack of clarity and moral ambiguity. In this paper we address these issues and critically discuss convenience food by using empirical findings from a Danish study that deals with practitioners' uses of meal box schemes. The methodological...

Determinants of Customer Satisfaction and Loyalty in Vietnamese Life-Insurance Setting

Directory of Open Access Journals (Sweden)

Ha Thu Nguyen

2018-04-01

Full Text Available Sustainable services are often regarded as sustainable strategies and operations producing goods and services that satisfy customer needs and significantly improve social and environmental performance. To be sustainable, service providers must satisfy consumers’ needs or otherwise they will become redundant and economically irrelevant. This paper presents the results of an empirical study on the determinants of customer satisfaction and loyalty in life-insurance services in Vietnam based on a database collected through a questionnaire survey of 1476 customers during 2017. A path analysis technique is applied to test the proposed framework on the direct and indirect relationship between variables. The results of statistical analysis indicate that customer satisfaction in life-insurance services is significantly explained by such factors as corporate image, service quality and perceived value. Our findings suggest that a life-insurance service provider should focus on enhancing service quality and corporate image in order to obtain customer satisfaction that leads to customer loyalty.

24 CFR 266.600 - Mortgage insurance premium: Insurance upon completion.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Mortgage insurance premium... MULTIFAMILY PROJECT LOANS Contract Rights and Obligations Mortgage Insurance Premiums § 266.600 Mortgage insurance premium: Insurance upon completion. (a) Initial premium. For projects insured upon completion, on...

Impact of improved operation and maintenance on cohesive sediment transport in Gezira Scheme, Sudan

NARCIS (Netherlands)

Osman, I.S.E.

2015-01-01

Summary

Efficient operation and maintenance of irrigation schemes are needed for improving the hydraulic performance of the canals, enhancing the crop yields and insuring sustainable production. There is a great need to enhance the researches and for a variety of tools such as

Socio economic determinants of health insurance in India: the case of Hyderabad city

Directory of Open Access Journals (Sweden)

J. Yellaiah

2012-09-01

Full Text Available Health has been declared as a fundamental human right in India and several other countries. Theoretical works as well as empirical evidences clearly show the positive linkage between good health and economic development. The policy concern in developing countries including India is not only to reach the entire population with adequate healthcare services, but also to secure an acceptable level of health for all the people through the application of primary healthcare programs. Health insurance is one of the most important aspects of health care management system. This paper identifies the socio economic determinants of demand for health insurance in India taking Hyderabad as the case. For this purpose, a sample survey has been conducted taking 200 sample units in Hyderabad city. The logistic model has been used to identify the determinants of health insurance. We conclude that the main determinants of demand for health insurance in Hyderabad are the occupation, income, health expenditure and awareness. The other variables such as the age and education are positively associated with demand for health insurance but are not statistically significant. In view of these findings, some policy suggestions are made.

Knowledge and Implementation of Tertiary Institutions' Social Health Insurance Programme (TISHIP) in Nigeria: a case study of Nnamdi Azikiwe University, Awka.

Science.gov (United States)

Anetoh, Maureen Ugonwa; Jibuaku, Chiamaka Henrietta; Nduka, Sunday Odunke; Uzodinma, Samuel Uchenna

2017-01-01

Tertiary Institutions' Social Health Insurance Programme (TISHIP) is an arm of the National Health Insurance Scheme (NHIS), which provides quality healthcare to students in Nigerian higher institutions. The success of this scheme depends on the students' knowledge and awareness of its existence as well as the level of its implementation by healthcare providers. This study was therefore designed to assess students' knowledge and attitude towards TISHIP and its implementation level among health workers in Nnamdi Azikiwe University Medical Centre. Using a stratified random sampling technique, 420 undergraduate students of Nnamdi Azikiwe University, Awka were assessed on their level of awareness and general assessment of TISHIP through an adapted and validated questionnaire instrument. The level of implementation of the scheme was then assessed among 50 randomly selected staff of the University Medical Center. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 20 software. Whereas the students in general, showed a high level of TISHIP awareness, more than half of them (56.3%) have never benefited from the scheme with 52.8% showing dissatisfaction with the quality of care offered with the scheme. However, an overwhelming number of the students (87.9%) opined that the scheme should continue. On the other hand, the University Medical Centre staff responses showed a satisfactory scheme implementation. The study found satisfactory TISHIP awareness with poor attitude among Nnamdi Azikiwe University students. Furthermore, the University Medical Centre health workers showed a strong commitment to the objectives of the scheme.

Do beneficiaries' views matter in healthcare purchasing decisions? Experiences from the Nigerian tax-funded health system and the formal sector social health insurance program of the National Health Insurance Scheme.

Science.gov (United States)

Ibe, Ogochukwu; Honda, Ayako; Etiaba, Enyi; Ezumah, Nkoli; Hanson, Kara; Onwujekwe, Obinna

2017-12-28

Purchasing is a health financing function that involves the transfer of pooled resources to providers on behalf of a covered population. Little attention has been paid to the extent to which the views of that population  are reflected in purchasing decisions. This article explores how purchasers in two financing mechanisms: the Formal Sector Social Health Insurance Programme (FSSHIP) operating under the Nigerian National Health Insurance Scheme (NHIS), and the tax-funded health system perform their roles in light of their responsibilities to the populations. A case study approach was adopted in which each financing mechanism is a case. Sixteen (16) in-depth interviews with purchasers and eight (8) focus group discussions with beneficiaries were held. Agency and organizational behavioural theories were used to characterise the purchaser-citizen relationships. A deductive framework approach was used to assess whether actions identified in a model of 'ideal' strategic purchasing actions were undertaken in each case. For both cases, mechanisms exist to reflect people's health needs in purchasing decisions, including quantitative and qualitative needs assessment, mechanisms to raise awareness of benefit entitlements and allow choice. However, purchasers do not use the mechanisms to effectively engage with and hold themselves accountable to the people. In the tax-funded system, weak information systems and unclear communication channels between the purchaser and citizens constrain assessment of needs; while timeliness of health information and poor engagement practices of Health Maintenance Organisations (HMOs) are the main constraints in FSSHIP. Inadequate information sharing in both mechanisms limits beneficiaries' awareness of entitlements. Although beneficiaries of FSSHIP can choose providers, lack of information on the quality of services offered by providers constrains rational decision-making and the inability to change HMOs reduces HMO responsiveness to

National health insurance policy in Nepal: challenges for implementation

Directory of Open Access Journals (Sweden)

Shiva Raj Mishra

2015-08-01

Full Text Available The health system in Nepal is characterized by a wide network of health facilities and community workers and volunteers. Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. But the reality is a far cry. Only 61.8% of the Nepalese households have access to health facilities within 30 min, with significant urban (85.9% and rural (59% discrepancy. Addressing barriers to health services needs urgent interventions at the population level. Recently (February 2015, the Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme (SHS after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias. Mechanisms should be built for monitoring unfair pricing and unaffordable copayments, and an overall benefit package be crafted to include coverage of major health services including non-communicable diseases. Regulations should include such issues as accreditation mechanisms for private providers. Health system strengthening should move along with the roll-out of SHS. Improving the efficiency of hospital, motivating the health workers, and using appropriate technology can improve the quality of health services. Also, as currently a constitution drafting is being finalized, careful planning and deliberation is necessary about what insurance structure may suit the proposed future federal structure in Nepal.

76 FR 77442 - Mutual Insurance Holding Company Treated as Insurance Company

Science.gov (United States)

2011-12-13

... insurance industry traces its roots back to England, where, in 1696, the first mutual fire insurer was... FEDERAL DEPOSIT INSURANCE CORPORATION 12 CFR Part 380 RIN 3064-AD89 Mutual Insurance Holding Company Treated as Insurance Company AGENCY: Federal Deposit Insurance Corporation (FDIC). ACTION: Notice...

Utilization of healthcare services and renewal of health insurance membership : evidence of adverse selection in Ghana

NARCIS (Netherlands)

Duku, Stephen Kwasi Opoku; Asenso-Boadi, Francis; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

2016-01-01

Background: Utilization of healthcare in Ghana’s novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme’s financial sustainability. This paper investigates the presence of adverse selection by assessing the effect

Healthcare quality in Ghana : Improving healthcare quality and health worker motivation to promote sustainable health insurance

NARCIS (Netherlands)

Alhassan, R.K.

2017-01-01

This thesis is about promoting a sustainable National Health Insurance Scheme (NHIS) in Ghana through improved client-centred quality care and effective community engagement in quality care assessment. The thesis comprises of two main parts. Part one reports on findings from baseline surveys

Climate change and hailstorm damage: Empirical evidence and implications for agriculture and insurance

International Nuclear Information System (INIS)

Botzen, W.J.W.; Bouwer, L.M.; van den Bergh, J.C.J.M.

2010-01-01

There is much uncertainty about the effects of anthropogenic climate change on the frequency and severity of extreme weather events like hailstorms, and subsequent economic losses, while this is also relevant information for the design of climate policy. Few studies conducted indicate that a strong positive relation exists between hailstorm activity and hailstorm damage, as predicted by minimum temperatures using simple correlations. This relation suggests that hailstorm damage may increase in the future if global warming leads to further temperature increase. This study estimates a range of Tobit models of relations between normalized insured hailstorm damage to agriculture and several temperature and precipitation indicators for the Netherlands. Temporal dynamics are explicitly modelled. A distinction is made between damage costs for greenhouse horticulture and outdoor farming, which appear to be differently affected by variability in weather. 'Out of sample' forecast tests show that a combination of maximum temperatures and precipitation predicts hailstorm damage best. Extrapolations of the historical relations between hailstorm damage and weather indicators under climate change scenarios project a considerable increase in future hailstorm damage. Our estimates show that by 2050 annual hailstorm damage to outdoor farming could increase by between 25% and 50%, with considerably larger impacts on greenhouse horticulture in summer of more than 200%. The economic implications of more hailstorm damage for, and adaptation by, the agricultural and insurance sectors are discussed. (author)

A Kink that Makes you Sick: the Effect of Sick Pay on Absence in a Social Insurance System

OpenAIRE

Petri Bockerman; Ohto Kanninen; Ilpo Suoniemi

2014-01-01

We examine the effect of the replacement rule of a social insurance system on sickness absence. The elasticity of absence with respect to the benefit level is a critical parameter in defining the optimal sickness insurance scheme. A pre-determined, piecewise linear policy rule in which the replacement rate is determined by past earnings allows identification of the causal effect using a regression kink design. Using a large administrative dataset, we find a substantial and robust behavioral r...

Are tax subsidies for private medical insurance self-financing? Evidence from a microsimulation model.

Science.gov (United States)

López Nicolás, Angel; Vera-Hernández, Marcos

2008-09-01

This paper develops an empirical strategy to estimate whether subsidies to private medical insurance are self-financing in countries where public and private insurance coexist and the latter covers the same treatments as the former. We construct a simulation routine based on a micro-econometric discrete choice model that allows us to evaluate the impact of premium changes on the utilization of outpatient and inpatient health care services. As an application, we estimate the budgetary effects of scrapping a subsidy from the purchase of individual private policies, using micro-data from Catalonia. Our results suggest that the subsidy is not self-financing. This result is driven by the fact that private medical insurance holders make concurrent use of public and private services, and by the price inelasticity of the demand for private policies.

Sleeping money: investigating the huge surpluses of social health insurance in China.

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Liu, JunQiang; Chen, Tao

2013-12-01

The spreading of social health insurance (SHI) worldwide poses challenges for fledging public administrators. Inefficiency, misuse and even corruption threaten the stewardship of those newly established health funds. This article examines a tricky situation faced by China's largest SHI program: the basic health insurance (BHI) scheme for urban employees. BHI accumulated a 406 billion yuan surplus by 2009, although the reimbursement level was still low. Using a provincial level panel database, we find that the huge BHI surpluses are related to the (temporarily) decreasing dependency ratio, the steady growth of average wages, the extension of BHI coverage, and progress in social insurance agency building. The financial situations of local governments and risk pooling level also matter. Besides, medical savings accounts result in about one third of BHI surpluses. Although these findings are not causal, lessons drawn from this study can help to improve the governance and performance of SHI programs in developing countries.

Insurance premiums and insurance coverage of near-poor children.

Science.gov (United States)

Hadley, Jack; Reschovsky, James D; Cunningham, Peter; Kenney, Genevieve; Dubay, Lisa

States increasingly are using premiums for near-poor children in their public insurance programs (Medicaid/SCHIP) to limit private insurance crowd-out and constrain program costs. Using national data from four rounds of the Community Tracking Study Household Surveys spanning the seven years from 1996 to 2003, this study estimates a multinomial logistic regression model examining how public and private insurance premiums affect insurance coverage outcomes (Medicaid/SCHIP coverage, private coverage, and no coverage). Higher public premiums are significantly associated with a lower probability of public coverage and higher probabilities of private coverage and uninsurance; higher private premiums are significantly related to a lower probability of private coverage and higher probabilities of public coverage and uninsurance. The results imply that uninsurance rates will rise if both public and private premiums increase, and suggest that states that impose or increase public insurance premiums for near-poor children will succeed in discouraging crowd-out of private insurance, but at the expense of higher rates of uninsurance. Sustained increases in private insurance premiums will continue to create enrollment pressures on state insurance programs for children.

Nuclear insurance

International Nuclear Information System (INIS)

Anon.

1992-01-01

The yearbook contains among others the figures of the nuclear insurance line. According to these these the DKVG (German nuclear power plant insurance association) has 102 member insurance companies all registered in the Federal Republic of Germany. By using reinsurance capacities of the other pools at present property insurance amounts to 1.5 billion DM and liability insurance to 200 million DM. In 1991 the damage charges on account of DKV amounted to 3.1 (1990 : 4.3) million DM. From these 0.6 million DM are apportioned to payments and 2.5 million DM to reserves. One large damage would cost a maximum gross sum of 2.2 billion DM property and liability insurance; on account of DKVG 750 million DM. (orig./HSCH) [de

Willingness to pay for cattle and buffalo insurance: an analysis of dairy farmers in central India.

Science.gov (United States)

Khan, Mohd Ameer; Chander, Mahesh; Bardhan, Dwaipayan

2013-02-01

In India, insurance market especially in agricultural sector is usually underdeveloped. The idea of livestock insurance emerged in India before three decades, yet, it has not operated in a significant way till date. It is well noted that livestock insurance scheme is the relevant strategy in managing different risks related to livestock farming but very little attention has been paid to address the livestock insurance needs of the dairy farmers. This study, therefore, addresses the basic question that how many people and to what extent they are willing to pay for livestock insurance and determine the main factors which influence insurance participation of dairy farmers. The data was collected from Gorakhpur district of Uttar Pradesh in India with a sample survey of 120 cattle and buffalo farmers. For eliciting willingness to pay, a contingent valuation scenario was presented to dairy animal owners in the group of five to six. A logit discrete binary regression model was used to know the factors influencing adoption of livestock insurance. The results suggest that most of the farmers were willing to participate in cattle and buffalo insurance. The amount of premium varies across different breeds of dairy animals. The low level of education of many dairy farmers have negatively influenced the decision to purchase livestock insurance. Farmers having more experience in rearing dairy animals are more likely to be willing to pay for cattle and buffalo insurance.

Redistribution through social health insurance: evidence on citizen preferences.

Science.gov (United States)

Pfarr, Christian; Schmid, Andreas

2016-06-01

The extent of social health insurance (SHI) and supplementary private insurance is frequently analyzed in public choice. Most of these analyses build on the model developed by Gouveia (1997), who defines the extent of SHI as consequence of a choice by self-interested voters. In this model, an indicator reflecting individuals' relative income position and relative risk of falling ill determines the voting decision. Up to now, no empirical evidence for this key assumption has been available. We test the effect of this indicator on individuals' preferences for the extent of SHI in a setting with mandatory SHI that can be supplemented by private insurance. The data is based on a DCE conducted in the field with a representative sample of 1538 German citizens in 2012. Conditional logit and latent class models are used to analyze preference heterogeneity. Our findings strongly support the assumptions of the models. Individuals likely to benefit from public coverage show a positive marginal willingness to pay (MWTP) for both a shift away from other beneficiary groups toward the sick and an expansion of publicly financed resources, and the expected net payers have a negative MWTP and prefer lower levels of public coverage.

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

NARCIS (Netherlands)

Alhassan, R.K.; Duku, S.O.; Janssens, W.; Nketiah-Amponsah, E.; Spieker, N.; Van Ostenberg, P.; Arhinful, D.K.; Pradhan, M.P.; Rinke de Wit, T.F.

2015-01-01

Background: Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

NARCIS (Netherlands)

Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F.

2015-01-01

Background Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

NARCIS (Netherlands)

Alhassan, R.K.; Duku, S.O.; Janssens, W.; Nketiah-Amponsah, E.; Spieker, N.; van Ostenberg, P.; Arhinful, D.K.; Pradhan, M.; Rinke de Wit, T.F.

2015-01-01

Background Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients’ decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will

An exploration study to detect important factors influencing insurance firms

OpenAIRE

Farzaneh Soleimani; Fattaneh Alizadeh Meshkani; Abdullah Naami

2013-01-01

The recent trend on competition among insurance firms has increased motivation to look for important factors influencing this industry. In this paper, we present an empirical investigation to find important factors shaping this industry. The proposed study designs a questionnaire in Likert scale and, using principal component analysis, detects important factors on the success of this industry. Cronbach alpha is calculated as 0.849, and Kaiser-Meyer-Olkin and Bartlett's Test are calculated as ...

Knowledge and Implementation of Tertiary Institutions’ Social Health Insurance Programme (TISHIP) in Nigeria: a case study of Nnamdi Azikiwe University, Awka

Science.gov (United States)

Anetoh, Maureen Ugonwa; Jibuaku, Chiamaka Henrietta; Nduka, Sunday Odunke; Uzodinma, Samuel Uchenna

2017-01-01

Introduction Tertiary Institutions’ Social Health Insurance Programme (TISHIP) is an arm of the National Health Insurance Scheme (NHIS), which provides quality healthcare to students in Nigerian higher institutions. The success of this scheme depends on the students’ knowledge and awareness of its existence as well as the level of its implementation by healthcare providers. This study was therefore designed to assess students’ knowledge and attitude towards TISHIP and its implementation level among health workers in Nnamdi Azikiwe University Medical Centre. Methods Using a stratified random sampling technique, 420 undergraduate students of Nnamdi Azikiwe University, Awka were assessed on their level of awareness and general assessment of TISHIP through an adapted and validated questionnaire instrument. The level of implementation of the scheme was then assessed among 50 randomly selected staff of the University Medical Center. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 20 software. Results Whereas the students in general, showed a high level of TISHIP awareness, more than half of them (56.3%) have never benefited from the scheme with 52.8% showing dissatisfaction with the quality of care offered with the scheme. However, an overwhelming number of the students (87.9%) opined that the scheme should continue. On the other hand, the University Medical Centre staff responses showed a satisfactory scheme implementation. Conclusion The study found satisfactory TISHIP awareness with poor attitude among Nnamdi Azikiwe University students. Furthermore, the University Medical Centre health workers showed a strong commitment to the objectives of the scheme. PMID:29541317

Tackling Millennium Development Goals (MDGs 4 and 5: the National Health Insurance Scheme (NHIS approach in Nigeria

Directory of Open Access Journals (Sweden)

Shafiu Mohammed

2012-03-01

Full Text Available Developing countries are devising various strategies and mechanisms to accelerate their speed towards the Millennium Development Goals (MDGs by 2015. In Nigeria, different approaches have been used to address the tackling of health-related MDGs. One creative approach has been the implementation of the NHIS Maternal and Child Health (NHIS-MCH Project. The project aims to speed up the achievement of MDGs 4 and 5 (reducing child mortality and improving maternal health in the country. Little is known about the NHISMCH Project’s design and health insurance coverage activities. Project planning and monitoring could be hampered by lack of technical and managerial skills of health insurance most especially at middle and local levels. Challenging debates continue to emanate on the project’s sustainability.

Tackling Millennium Development Goals (MDGs) 4 and 5: The National Health Insurance Scheme (NHIS) Approach in Nigeria.

Science.gov (United States)

Mohammed, Shafiu; Dong, Hengjin

2012-03-07

Developing countries are devising various strategies and mechanisms to accelerate their speed towards the Millennium Development Goals (MDGs) by 2015. In Nigeria, different approaches have been used to address the tackling of health-related MDGs. One creative approach has been the implementation of the NHIS Maternal and Child Health (NHIS-MCH) Project. The project aims to speed up the achievement of MDGs 4 and 5 (reducing child mortality and improving maternal health) in the country. Little is known about the NHIS-MCH Project's design and health insurance coverage activities. Project planning and monitoring could be hampered by lack of technical and managerial skills of health insurance most especially at middle and local levels. Challenging debates continue to emanate on the project's sustainability.

Community-based health insurance knowledge, concern, preferences, and financial planning for health care among informal sector workers in a health district of Douala, Cameroon.

Science.gov (United States)

Noubiap, Jean Jacques N; Joko, Walburga Yvonne A; Obama, Joel Marie N; Bigna, Jean Joel R

2013-01-01

For the last two decades, promoted by many governments and international number in sub-Saharan Africa. In 2005 in Cameroon, there were only 60 Community-based health insurance (CBHI) schemes nationwide, covering less than 1% of the population. In 2006, the Cameroon government adopted a national strategy aimed at creating at least one CBHI scheme in each health district and covering at least 40% of the population with CBHI schemes by 2015. Unfortunately, there is almost no published data on the awareness and the implementation of CBHI schemes in Cameroon. Structured interviews were conducted in January 2010 with 160 informal sectors workers in the Bonassama health district (BHD) of Douala, aiming at evaluating their knowledge, concern and preferences on CBHI schemes and their financial plan to cover health costs. The awareness on the existence of CHBI schemes was poor awareness schemes among these informal workers. Awareness of CBHI schemes was significantly associated with a high level of education (p = 0.0001). Only 4.4% of respondents had health insurance, and specifically 1.2% were involved in a CBHI scheme. However, 128 (86.2%) respondents thought that belonging to a CBHI scheme could facilitate their access to adequate health care, and were thus willing to be involved in CBHI schemes. Our respondents would have preferred CBHI schemes run by missionaries to CBHI schemes run by the government or people of the same ethnic group (p). There is a very low participation in CBHI schemes among the informal sector workers of the BHD. This is mainly due to the lack of awareness and limited knowledge on the basic concepts of a CBHI by this target population. Solidarity based community associations to which the vast majority of this target population belong are prime areas for sensitization on CBHI schemes. Hence these associations could possibly federalize to create CBHI schemes.

Insurance crisis

International Nuclear Information System (INIS)

Williams, P.L.

1996-01-01

The article discusses the effects of financing and technology advances on the availability of insurance for independent power producers operating gas turbines. Combined cycle units which require new materials and processes make it difficult to assess risk. Insurers are denying coverage, or raising prices and deductibles. Many lenders, however, are requiring insurance prior to financing. Some solutions proposed include information sharing by industry participants and insurers and increased risk acceptance by plant owners/operators

The influence of gender and product design on farmers' preferences for weather-indexed crop insurance.

Science.gov (United States)

Akter, Sonia; Krupnik, Timothy J; Rossi, Frederick; Khanam, Fahmida

2016-05-01

Theoretically, weather-index insurance is an effective risk reduction option for small-scale farmers in low income countries. Renewed policy and donor emphasis on bridging gender gaps in development also emphasizes the potential social safety net benefits that weather-index insurance could bring to women farmers who are disproportionately vulnerable to climate change risk and have low adaptive capacity. To date, no quantitative studies have experimentally explored weather-index insurance preferences through a gender lens, and little information exists regarding gender-specific preferences for (and constraints to) smallholder investment in agricultural weather-index insurance. This study responds to this gap, and advances the understanding of preference heterogeneity for weather-index insurance by analysing data collected from 433 male and female farmers living on a climate change vulnerable coastal island in Bangladesh, where an increasing number of farmers are adopting maize as a potentially remunerative, but high-risk cash crop. We implemented a choice experiment designed to investigate farmers' valuations for, and trade-offs among, the key attributes of a hypothetical maize crop weather-index insurance program that offered different options for bundling insurance with financial saving mechanisms. Our results reveal significant insurance aversion among female farmers, irrespective of the attributes of the insurance scheme. Heterogeneity in insurance choices could however not be explained by differences in men's and women's risk and time preferences, or agency in making agriculturally related decisions. Rather, gendered differences in farmers' level of trust in insurance institutions and financial literacy were the key factors driving the heterogeneous preferences observed between men and women. Efforts to fulfill gender equity mandates in climate-smart agricultural development programs that rely on weather-index insurance as a risk-abatement tool are therefore

The Performance-based Funding Scheme of Universities

Directory of Open Access Journals (Sweden)

Juha KETTUNEN

2016-05-01

Full Text Available The purpose of this study is to analyse the effectiveness of the performance-based funding scheme of the Finnish universities that was adopted at the beginning of 2013. The political decision-makers expect that the funding scheme will create incentives for the universities to improve performance, but these funding schemes have largely failed in many other countries, primarily because public funding is only a small share of the total funding of universities. This study is interesting because Finnish universities have no tuition fees, unlike in many other countries, and the state allocates funding based on the objectives achieved. The empirical evidence of the graduation rates indicates that graduation rates increased when a new scheme was adopted, especially among male students, who have more room for improvement than female students. The new performance-based funding scheme allocates the funding according to the output-based indicators and limits the scope of strategic planning and the autonomy of the university. The performance-based funding scheme is transformed to the strategy map of the balanced scorecard. The new funding scheme steers universities in many respects but leaves the research and teaching skills to the discretion of the universities. The new scheme has also diminished the importance of the performance agreements between the university and the Ministry. The scheme increases the incentives for universities to improve the processes and structures in order to attain as much public funding as possible. It is optimal for the central administration of the university to allocate resources to faculties and other organisational units following the criteria of the performance-based funding scheme. The new funding scheme has made the universities compete with each other, because the total funding to the universities is allocated to each university according to the funding scheme. There is a tendency that the funding schemes are occasionally