Search

Strong claims have been made about the significance of the concept of security in modern governance. The study of security has developed from its post-1945 focus on the state’s role in securing the population from external threat to include broader and critical perspectives, which seek to embed the concept of security in its cultural and historical contexts. This article traces the origins of contemporary security culture in Australia to the first half of the twentieth century. It examines the concept of security from debates about the provision of national insurance and the amelioration of the suffering of the Great Depression to the Curtin and Chifley Labor governments’ postwar reconstruction program in the 1940s. The article argues that the origins of national security culture in the present lie in mid-twentieth-century debates about the role of the state in securing the population from economic deprivation, unemployment and ill health. [ABSTRACT FROM AUTHOR]

The probability of ruin of an insurance company is one of the main risk measures considered in risk theory, and the problems of its calculation and approximation have attracted much attention. Statistical estimations have been developed on the ruin probability in infinite time for insurance loses from heavy-tailed distributions. However, these estimation suffer heavily from under-coverage or have a robustness problem. We therefore need another method for estimating the probability of ruin in infinite time for heavy-tailed losses. In this paper, we introduce a robust estimator of the infinite-time probability of ruin for such distributions. Our methodology is based on extreme value theory, which offers adequate statistical results for such distributions. Our approach is based on a sensitive distribution known as the t-Hill estimator (t-score or score moment estimation) for the index of any tail distribution and introduced in Fabiáan and Stehlík. We establish their asymptotic normality, and through a simulation study, illustrate their behaviour in terms of absolute bias and mean squared error. The simulation results show that our estimators perform well and that they are fairly robust to outliers. [ABSTRACT FROM AUTHOR]

AbstractIn the context of actuarial science, the second largest claim amount is crucial to insurance analysis since they provide useful information for determining annual premium. In this article, we provide sufficient conditions of the second largest claim amounts arising from two sets of dependent and heterogeneous individual risk models according to various stochastic orders. It is first shown that the reversed hazard order between the occurrence probabilities vectors implies the reversed hazard order of the second largest claim amounts under certain conditions. Second, sufficient conditions are established for the usual stochastic ordering of the second largest claim amounts arising from heterogeneous dependent individual risk models under copula dependence. Finally, several examples illustrating the theoretical results are presented as well. [ABSTRACT FROM AUTHOR]

This paper attempts to analyse the effect of insurance development on sophistication measured by the economic complexity index. Empirical analyses are carried out on a sample of 36 African countries over the period 2003-2019. In order to limit potential endogeneity biases, we run the two-step system Generalized Method of Moments and the Lewbel estimator. Empirical results, robust to a set of sensitivity analyses, show that insurance development can foster economic complexity in Africa. Moreover, when distinguishing between life and non-life insurance, empirical results remain globally unchanged, with a greater effect of non-life insurance as compared to that of life insurance. Furthermore, the mediation analysis enabled us to identify innovations and investments as some transmission channels through which insurance development may affect economic complexity in Africa. Thus, African leaders would do well to improve the regulation of the insurance business to enable it to participate effectively in financing the economy and managing risks, thereby stimulating economic complexity. [ABSTRACT FROM AUTHOR]

Objectives. The COVID-19 pandemic led to unemployment and associated health insurance loss, prompting an unprecedented adoption of emergency policies, including economic relief efforts and health insurance coverage expansion. We sought to understand pandemic-related challenges for people with asthma and how emergency policies served families facing both chronic disease management and health insurance loss.Study Design. Qualitative interview study.Methods. In 2021, we conducted semi-structured telephone interviews with 21 adults who had asthma and lost employment and employer-sponsored health insurance coverage during the COVID-19 pandemic. We used thematic analysis to assess how health and economic policies affected participants’ ability to access care and manage their asthma.Results. Participants reported reduced access to care and worry about heightened susceptibility to COVID-19 due to their asthma. While insurance loss exacerbated these challenges, participants indicated that economic relief efforts, including direct stimulus payments, helped them afford needed asthma care. Participants were more critical of enhancements to existing coverage policies such as the Affordable Care Act (ACA) Marketplace and Consolidated Omnibus Budget Reconciliation Act (COBRA) due to difficulty understanding, accessing, and affording such coverage.Conclusions. Our findings underscore that people affected by asthma and health insurance loss benefit from policies that provide flexible and easy-to-use assistance, such as direct payments, for meeting the diverse challenges posed by living with a chronic disease. Although policies that expand health insurance coverage are critical, more attention is needed to assist people with medically vulnerable conditions access these programs in a timely way. [ABSTRACT FROM AUTHOR]

Rural livelihoods worldwide are being transformed by the increasing financialization of agricultural production. Microlending and the deeper integration of production cycles in commodity markets are clearly at the vanguard of these transformations, but insurance and similar financial products have become a new frontier. Here, we explore index-based livestock insurance in Mongolia, where even in the face of disaster and worsening climatic conditions, herders have expressed limited interest in, and some outright rejection of, index insurance. Using a decade of ethnographic research, we explore herder perceptions of index insurance, its effects, and the contrast with local moral economies of mutual aid. [ABSTRACT FROM AUTHOR]

In previous decades, seminal theories were advanced addressing the problems of asymmetric information. These scholarly works confirmed a significant positive correlation between insurance coverage and risk in insurance markets. We showed that when regression models were used to analyze the asymmetric information problem, the sample selection bias and chosen regression methods could produce distinct results. Moreover, samples at different quantiles may lead to considerably different levels of information asymmetry. The present research suggests that quantile regression models be employed to better reveal the situation of the insurance market and reduce estimation errors. [ABSTRACT FROM AUTHOR]

Clinical rehabilitation and post-acute care (PAC) learning experiences are not uniformly required within medical school core curricula in the United States or internationally. This study aims to characterize what medical students might know/need to know to support patients in the transition from acute hospitalization to post-acute rehabilitation settings. The medical student cohort completing required clinical rotations in a United States quaternary care hospital system was provided a voluntary survey prompting reflection on experiences discharging patients to rehabilitation/PAC and related learning needs. Data were analyzed using descriptive statistics and qualitative grounded theory. Response rate was 72% (39/54). All respondents reported at least one gap in rehabilitation/PAC knowledge, falling into 8 themes: daily experience of rehabilitation/PAC; determination of eligibility/screening processes; distinctions among levels of rehabilitation/PAC; insurance coverage/equity; rehabilitation/PAC clinical practice environment; post-rehabilitation/PAC discharge support; medical capabilities within PAC settings; developing rehabilitation goals. Despite caring for patients discharged to post-acute rehabilitation settings, medical students lack essential knowledge about the process of rehabilitation and recovery, including patient eligibility for and service availability across PAC settings. Explicit rehabilitation/PAC education for medical students could enhance their ability to counsel and advocate for patients with disability and rehabilitation needs through care transitions. Medical students lack knowledge about rehabilitation and post-acute care that is important for helping patients navigate the acute to post-acute transition. Dedicated rehabilitation/post-acute care education could prepare trainees for counseling and advocating for patients during care transitions. Knowledge gaps identified in this study could inform development of curricular interventions to address medical student learning needs. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to explore 10-year trends in the use of Assistive Technology (AT). Using 2006 and 2015 Behavioral Risk Factor Surveillance System (BRFSS) data, univariate analysis were performed, and the rate of change was calculated. In both 2006 and 2015 data, a higher per cent of Blacks were using AT compared to Whites and Hispanics (p <.001); however, the rate of increase indicate that Blacks had the lowest per cent change (23.9%) compared to Whites (26.8%) and Hispanics (27.3%). Results indicated that AT use is statistically more prevalent in women, individuals who are not married (e.g. divorce, widowed, separated), the veteran population, lower educational attainment levels (e.g. some high school or less), lower income levels, the ageing population, unemployed (e.g. out of work, retired, unable to work) and individuals with limited functioning because of a disability. Similarly, individuals who have healthcare coverage, and individuals with concerns with medical costs used AT more. Even though most factors yielded higher utilisation rates when comparing 2006 to 2015 data, the rate of change had varying 'speeds' of improvement. [ABSTRACT FROM AUTHOR]

Farmworkers in Michigan face precarious and exploitative labor conditions that affect their access to affordable, fair, and quality housing, which are key social determinants of health. We sought to assess the health, working conditions, and housing access, affordability, and quality of farmworkers living in and outside of employer-provided housing during the COVID-19 pandemic. We conducted a mixed methods cross-sectional study in collaboration with community partners from the Michigan Farmworker Project and the Michigan Department of Civil Rights. We assessed housing, labor conditions, and general health through in-depth phone interviews with seasonal, migrant, and H-2A farmworkers (n = 63) during the height of the COVID-19 pandemic (2020–2021) in Michigan. Descriptive analyses of these data included comparisons by type of farmworker and type of housing (employer-provided or other). The majority of farmworkers interviewed were women and seasonal farmworkers and spoke primarily Spanish. A significant share of farmworker participants reported living in poverty (38.3%) and had low or very low food security (27.0%). Nearly half of farmworkers (47.6%) rated their health as "fair" or "poor" during the year prior to the interview, and more than a third reported 3 or more chronic conditions (39.6%) and lack of health insurance coverage (38.7%). Among the 43 workers tested, 25.6% reported testing positive for COVID-19. Farmworkers reported experiences of objectification and dehumanization. Three-quarters of workers reported feeling that they were treated as less than human by supervisors and one-third reported verbal abuse. Farmworkers also experienced challenges exacerbated by their social vulnerability that impeded them from finding affordable, quality housing. Regarding housing quality, the majority of workers (80.6%) reported one or more environmental hazards around their residence, and about a third reported not having air conditioning (33.%) and lacking a functioning washing machine (33.9%). Concerns about the quality of drinking water accessible to workers and exposure to chemicals were shared by participants. This study adds valuable knowledge to the understanding of the systemic barriers to housing and work conditions for female and male seasonal, migrant, and H-2A farmworkers in Michigan. Shortcomings in the regulatory and policy environment result in precarious housing and work conditions, including exploitative labor practices. These conditions negate equality, fairness, and health equity, important tenants for public health. [ABSTRACT FROM AUTHOR]

This study investigates the board's role in shaping insurers' risk-taking using data of 49 Indian insurance firms from 2014 to 2021. We captured the insurer's risk using four proxy measures: underwriting, investment, insolvency and total risks. To address potential endogeneity concerns in the relationship with board attributes, we employ a two-step Generalized Method of Moments (GMM) approach. Robustness checks are conducted using the panel quantile estimation approach. The empirical analysis reveals that life insurers face greater underwriting risk than non-life insurers. A larger board with duality appears to mitigate insurers' risk, particularly in the case of life insurers. The presence of independent directors on insurer boards, along with an optimal frequency of board meetings, effectively mitigates risk among Indian insurers. The study concludes that dual regulations erode regulatory discipline among public insurers, leading to an inadequate governance structure. [ABSTRACT FROM AUTHOR]

Zero-inflated bivariate Poisson regression (ZIBP) models are most often applied to correlated bivariate count data that contain a large proportion of zeros. These models have been applied in various fields, such as medical research, health economics, insurance, sports, etc. Because, in practice, some of the covariates involved in ZIBP regression modeling often have missing values, we propose methods for estimating the parameters of the ZIBP regression model with missing at random covariates. Assuming that the selection probability is unknown and estimated non parametrically (by a kernel estimator), we propose inverse probability weighting (IPW) and multiple imputation (MI) methods for estimating the parameters of the ZIBP regression model with missing at random covariates. Asymptotic properties of the proposed estimators are studied under certain regularity conditions. A simulation study is conducted to evaluate the performance of the proposed methods. Finally, the practical application of the proposed methodology is illustrated with data from the health-care field. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess health insurance acquisition awareness, knowledge, and associated emotions among college students preparing to enter the workforce. Methods: A 21-item survey was developed to gather data on knowledge, awareness, and emotions associated with health insurance acquisition conversations with future employers. Results: Most respondents (91.1%), indicated they have thought about obtaining their own health insurance. The study found that participants rated acquiring health insurance more important the closer the respondent was to graduation; F(4,96) = 3.84, p =.006. An increase in stress emotions was indicated (F(4,96)=14.41, p =.000) and a reduction in positive emotions (F(4,96) = 2.99, p =.035) regarding health insurance acquisition post-graduation. Conclusions: College students identify low knowledge and indicate high levels of stress regarding health insurance conversations with future employers post-graduation. These findings are important for developing self-efficacy-based health education content preparing students for engaging in these conversations confidently and effectively. [ABSTRACT FROM AUTHOR]

Objective: This study examined employment prior to discharge and the source of treatment payment as physical recovery capital that predicts the completion of treatment for cocaine use. Methods: The 2020 Treatment Episode Data Set: Discharges of the United States was analyzed using binary logistic regression to estimate the adjusted odds ratio of treatment completion with employment and the primary source of payment among those whose primary substance of use was cocaine. Results: A significant increase in the odds of completing treatment was observed among those with full-time or part-time employment. By contrast, those not in the labor force had significantly lower odds of treatment completion. Significantly high odds of treatment completion were also noted among those whose primary source of payment was private insurance or government payment schemes. Conclusions: Treatment services should include the promotion of employment or offer sub-services that assist in securing a job. Future studies should investigate the impact of Medicaid on treatment completion when the Institutions for Mental Diseases (IMD) service exclusion waivers for Medicaid funding are further adopted by states. The policy for substance treatment under Medicare needs to be improved for older people to access treatment facilities and options. [ABSTRACT FROM AUTHOR]

In this paper, we develop a conditional copula model to analyze the distribution of a claim that generates different types of costs and/or simultaneously impacts several guarantees. Our methodology is adapted to taking into account the particular structure of our data, since observations are subject to right-censoring. Right-censoring occurs since payment of a claim is not made instantaneously, and therefore unsettled claims only provide a partial information on the phenomenon that one wishes to model. The new methodology that we develop is supported by theoretical results that show the asymptotic normality of our estimators. A simulation study and a real data analysis illustrate the method. [ABSTRACT FROM AUTHOR]

Abstract.Given that insurance companies often operate across multiple lines of insurance business, where claim frequencies on different lines are often correlated, it often becomes advantageous to employ multivariate count modeling where dependence between lines of business can be included in the modeling. Due to the operation of bonus-malus systems where there is a reward to the insurance policyholder for not claiming, claims data in automobile insurance often exhibits an excess of common zeros, a characteristic known as multivariate zero-inflation. In this article, we propose two approaches to address this feature. The first approach involves utilizing a multivariate zero-inflated model, where we artificially enhance the probability of common zeros based on standard multivariate count distributions. The second approach applies a multivariate zero-modified model, which separately handles the common zeros and the number of claims incurred in each line given that at least one claim occurs. We present several models under these frameworks, along with detailed inference procedures. In the applications section, we conduct a comprehensive comparative analysis of these models using data from an automobile insurance portfolio. [ABSTRACT FROM AUTHOR]

Peter Burke´s Global History of Ignorance is acclaimed as an important contribution for teaching and for inspiring further in-depth research into the history of ignorance. The article reflects on some potentials of the examples provided by Burke and addresses a potential underdetermination of his approach: do we risk with global history narratives to loose precision and specifity of contexts, regions and periods, do we risk to loose the difference between human and non-human forms of ignorance? [ABSTRACT FROM AUTHOR]

Discrimination and fairness are major concerns in algorithmic models. This is particularly true in insurance, where protected policyholder attributes are not allowed to be used for insurance pricing. Simply disregarding protected policyholder attributes is not an appropriate solution as this still allows for the possibility of inferring protected attributes from non-protected covariates, leading to the phenomenon of proxy discrimination. Although proxy discrimination is qualitatively different from the group fairness concepts discussed in the machine learning and actuarial literature, group fairness criteria have been proposed to control the impact of protected attributes on the calculation of insurance prices. The purpose of this paper is to discuss the relationship between direct and proxy discrimination in insurance and the most popular group fairness axioms. We provide a technical definition of proxy discrimination and derive incompatibility results, showing that avoiding proxy discrimination does not imply satisfying group fairness and vice versa. This shows that the two concepts are materially different. Furthermore, we discuss input data pre-processing and model post-processing methods that achieve group fairness in the sense of demographic parity. As these methods induce transformations that explicitly depend on policyholders' protected attributes, it becomes ambiguous whether direct and proxy discrimination is, in fact, avoided. [ABSTRACT FROM AUTHOR]

Mutual aid insurance is a collective type of insurance where the policyholders share the potential losses or risks that they may face. In this paper, we establish a mathematical structure for mutual aid insurance through a three-state (good, bad and death) process, which is driven by an inhomogeneous Markov chain. The objective of maximizing an individual's lifetime utility is achieved by addressing a stochastic control problem that involves both mutual aid insurance and life insurance. We obtain the explicit expressions for optimal consumption, investment strategies, and life insurance premiums by employing the corresponding Hamilton-Jacobi-Bellman equation. In the end, we carry out a numerical analysis to show the significance of mutual aid insurance and demonstrate the optimal mutual aid insurance premium. [ABSTRACT FROM AUTHOR]

Agricultural microinsurance is a promising risk management tool for smallholder farmers. However, adoption rates remain low and only a small share of farmers renew their policy after the first period. With the increasing availability of cell phones, mobile-delivered insurance is gaining importance on the market. As for any agricultural microinsurance, it is essential for the longevity of a mobile-delivered insurance scheme to retain a solid customer base. To date, it is unknown what drives the decision to renew a mobile-delivered agricultural microinsurance policy. We address this question by performing mean comparisons and logistic regressions based on primary data collected from 479 smallholder farmers in Mali who purchased a mobile-delivered weather index-based insurance in 2020. Results show that the level of satisfaction with the insurance product was considerably higher among farmers who renewed. We found low levels of understanding of the product among all clients, but especially among those who did not renew. Both factors were confirmed as drivers for renewal. Consistent with previous findings, receiving a payout had the strongest effect on the decision to renew. We conclude that additional measures to foster client satisfaction as well as to promote understanding of agricultural insurance among smallholder farmers are highly recommended. [ABSTRACT FROM AUTHOR]

As in other countries, regulated savings in France are intricately woven into dense regulatory frameworks driven by explicit governmental objectives. The anticipated marketization of the French economy should have eradicated them; however, a substantial portion of regulated savings has managed to evade this process. Is this phenomenon attributable to the tenacious grip of the French state-led tradition? Not entirely, as another subset of these savings has indeed undergone marketization. The landscape of French regulated savings is notably distinguished by a growing dichotomy: on one side, non-marketized products offered by banks, and on the other, increasingly marketized products provided by insurers. Drawing upon process tracing, we contend that these ostensibly conflicting developments emanate from the distinct and precise institutional dependencies between state and private actors in which these products are enmeshed. The prevailing status quo within the banking sector is owed to banks' engagement in a mutually advantageous, long-term exchange of favors with state actors. Faced with the trade-off between offering less lucrative products and risking the endangerment of this relationship, banks have opted for the former. In contrast, an assertive strategy has gained traction in the insurance industry. Yet, strategies for the marketization of regulated savings aligned with state priorities have been implemented, even when insurers expressed opposition. [ABSTRACT FROM AUTHOR]

This paper proposes a new boosting machine based on forward stagewise additive modeling with cost-complexity pruned trees. In the Tweedie case, it deals directly with observed responses, not gradients of the loss function. Trees included in the score progressively reduce to the root-node one, in an adaptive way. The proposed Adaptive Boosting Tree (ABT) machine thus automatically stops at that time, avoiding to resort to the time-consuming cross validation approach. Case studies performed on motor third-party liability insurance claim data demonstrate the performances of the proposed ABT machine for ratemaking, in comparison with regular gradient boosting trees. [ABSTRACT FROM AUTHOR]

While term life insurance has historically been sold to income-earning men to secure the financial futures of their families, in India there is a growing number of life insurance products targeting women, particularly unwaged housewives. In marketing these financial products to Indian women, I show how life insurance companies incorporate the feminist critique of devalued domestic labor. Drawing on analysis of insurance policies, marketing and promotional materials, as well as personal advice articles, it goes on to show how there is, something uncanny or unsettling about the way life insurance not only commodifies and financializes domestic labor, but also focuses on the reproductive bodies of women through health riders. The article situates contemporary discourses of life insurance for women within a longer history of women's property and of mobilizing capital through rather than for women in India. [ABSTRACT FROM AUTHOR]

This study contributes to the literature by investigating the intervening role of information and communication technology (ICT) diffusion on insurance and economic growth in Sub-Saharan Africa (SSA). This study uses the generalized method of moments technique based on 36 countries, spanning 2007–2020. First, the empirical findings reveal that insurance penetration (i.e. total, life and nonlife) and ICT diffusion induce economic growth in SSA. Second, the evidence suggests that ICT boosts the role of insurance in affecting economic growth. Third, the individual ICT variables such as fixed broadband, telephone and internet propel the impact of total and life penetration on growth. Additionally, fixed broadband was remarkable in enhancing the effect of nonlife penetration on growth. The findings imply that though insurance enhances economic growth, its impact is more revealing through the intervening role of ICT infrastructure. Therefore, insurers must embrace technology and leverage ICT development to improve their performance on growth. [ABSTRACT FROM AUTHOR]

From 2018–2020, 19 states enacted Medicaid work requirements as a strategy for reducing program enrollment and overall cost. While these requirements were later rescinded, strategies to reduce Medicaid costs are likely to reemerge as states attempt to recover economically from the COVID-19 pandemic. Here, we evaluated the impact of Medicaid work requirements on adults aged > 50, a group that likely faces significant age-related chronic disease burden. Using 2016 Health and Retirement Study data, we evaluated the chronic disease burden of adult Medicaid beneficiaries aged 51–64 years (n = 1460) who would be at risk of losing their Medicaid coverage due to work requirements. We compared Medicaid beneficiaries working <20 hours per week (i.e. those at risk of coverage loss) to those working at least 20 hours per week on eight chronic health conditions, adjusting for demographic characteristics. Among those with chronic health conditions, we also evaluated differences in disease severity based on hours worked per week. Among those working fewer than 20 hours per week, odds of disease were greater for seven of eight chronic conditions, including history of stroke (OR: 5.66; 95% CI: 2.22–14.43) and lung disease (OR: 3.79; 95% CI: 2.10–6.85). Further, those with greater disease severity were likely to work fewer hours. Thus, the introduction of Medicaid work requirements would likely result in coverage loss and lower access to care among older Medicaid beneficiaries with multiple chronic health conditions. [ABSTRACT FROM AUTHOR]

Millions of older Americans rely on Medicaid because it is the largest payer of long-term services and supports. To qualify for the program, low-income individuals age 65 and over must meet income standards based on the dated Federal Poverty Level as well as asset tests that are often viewed as quite stringent. There has long been concern that current eligibility standards exclude many adults with significant health and financial vulnerabilities. We use updated household socio-demographic and financial information to simulate the impacts of five alternative financial eligibility standards on the number and profile of older adults that would gain Medicaid coverage. The study clearly demonstrates that a large number of financially- and health-vulnerable older adults are excluded from the Medicaid program under current policy. The study highlights the implications for policymakers of updating Medicaid financial eligibility standards to assure that Medicaid benefits are targeted to vulnerable older adults who need them. [ABSTRACT FROM AUTHOR]

As the second leading cause of death in teenagers, suicide has been a consistent public health issue for the past decade. Our goal is to understand the relationship between increasing teen suicide rates by state policies. We explore links between macro-level risk factors and state suicide rates. Risk factors explored include state behavioral health spending, child access policies for firearms, insurance coverage, tax revenue from tobacco and alcohol, school spending per pupil, pupil support services funding, and teacher spending. This research shows a relationship between pupil support spending, any child access law, required legislation, and lower teen suicide rates. The results from this study can aid in the understanding of macro-level influences on teen suicide; empowering advocates, lawmakers, and researchers to develop informed interventions and policies. Increasing multi-level understanding around suicide can provide an opportunity to slow or stop suicide rates. [ABSTRACT FROM AUTHOR]

This study compared three ethnic/racial groups of informal cancer caregivers on social determinants of health and tested social determinants of health as predictors of psychological distress and caregiver burden. This study was a secondary analysis of baseline data of a sequential multiple assignment randomized trial (SMART) testing symptom management interventions with caregiver-survivor dyads. Caregivers completed baseline measures of social determinants of health (SDoH), functional limitations, psychological distress, and caregiver burden. Hispanic, non-Hispanic White, and non-Hispanic other races caregivers were compared on these variables. Multivariate tests of associations between SDoH and caregiver burden and psychological distress were conducted in structural equation modeling with caregiver burden and psychological distress as latent variables. Hispanic caregivers reported significantly higher caregiver burden, specifically for finances, family, and schedules. Caregiver burden was significantly predicted by having income barely or not meeting needs, being female, socially isolated, married, Hispanic, and having poor physical functioning. Significant predictors of caregivers' psychological distress: being female, being socially isolated, and having poor physical functioning. Hispanic caregivers experience significant challenges associated with caregiver burden, especially if they are female, socially isolated, and have poor physical functioning. Assessment of these SDoH is important in caregiver health to provide supportive care during caregiving. NCT03743415 . [ABSTRACT FROM AUTHOR]

This study addresses the group-based nature of financial vulnerability in the low-income environment. Adopting a highly flexible stochastic dissemination model, we assess the impact of insurance on the resilience of a low-income group to wealth shocks. For this purpose, the transient wealth of a group of interacting uninsured and insured agents is considered. The model is extended to capture four types of transaction events: external arrivals, internal redistributions, wealth losses and premium payments. Risk-sharing mechanisms, mitigating the impact of financial losses that are otherwise uninsured, are widespread in low-income communities. Our modelling of redistribution events captures the wealth transactions associated with these mechanisms, alongside the purchase of commodities and services from within the group. Through this set-up, we present a method for incorporating the high level of wealth interaction characteristic of the low-income setting in the assessment of the effectiveness of insurance. The model is underlined by an exogenously evolving Markov background process that represents the state of the economy. To analyse the distribution of wealth jointly with the state of the background process, a system of coupled differential equations for the joint transient distribution of agent wealth is derived, and is reduced to a linear system of differential equations through consideration of the moments of agent wealth. Sensitivity analysis is performed to establish the impact of the system's structure and stochastic dynamics on the wealth of the group. The probability of falling below the poverty line is then determined through application of a normal approximation and the impact of insurance in reducing this probability considered under varying levels of subsidisation. [ABSTRACT FROM AUTHOR]

Imagine your insurer were an 'active life partner', even a guardian of your future, which engaged with you on a regular basis, through a complex system of digital technology and behavioural science, to ensure you were leading the healthiest, longest, most valuable life possible. This is the foundation for a growing model of 'behavioural insurance' that has become a major approach in the industry. By capturing constant streams of data about consumer behaviour, and creating incentive programmmes to modify how people behave, insurers hope to unlock a key source of value and risk management. We critically analyze this model through a detailed case study of a world leader in behavioural insurance: Discovery Limited and its Vitality ecosystem of data-driven, behaviour-based, interactive wellbeing programmes for life/health insurance. We detail the behavioural theory of risk and the moral economy of 'shared value', which underpins the model of insurance that Vitality champions and justifies its activist approach to social change. [ABSTRACT FROM AUTHOR]

This study examines the relationship between science and technology insurance (S&T insurance) and regional innovation from a macro innovation input-output perspective. Based on provincial panel data from 2010–2019, the impact of S&T insurance on regional innovation is examined using a dynamic panel regression model. The results indicate that S&T insurance has a significant promotion effect on innovation inputs with a lagged effect but a negative effect on innovation outputs. Further, there is regional and subject heterogeneity in the role of S&T insurance. S&T insurance has a significant effect on innovation input in the central and eastern regions, but not in the western regions; S&T insurance has a significant effect on innovation in enterprises, but not on non-enterprise organisations. This study also examines whether there is a spillover effect of S&T insurance on regional innovation. The results show a spillover effect on innovation inputs but no spillover effect on innovation outputs. Finally, the authors suggest promoting the development of the S&T insurance market to improve regional innovation capacity. [ABSTRACT FROM AUTHOR]

This study developed a new family of distributions, the Marshall-Olkin generalized distribution. A novel model, the Marshall-Olkin Lomax (NMOL) distribution, was introduced into this family. The NMOL distribution exhibited a variety of density forms, including symmetry, right-skewness, reversed-J shape, upside-down bathtub curves, and scenarios with growing, decreasing, and mixed trends. From a practical perspective, the NMOL model was used to assess the failure and insurance data. Furthermore, a group-acceptance sampling plan (GASP) was developed based on the NMOL distribution, with the median serving as a quality criterion. This analysis also included numerical and graphical representations of the expected shortfalls and values at risk. Simulation studies were conducted to evaluate the effectiveness of the proposed estimation methods, and the findings significantly validated the NMOL model. However, this new distribution family and model has wide-ranging applications in sectors such as engineering, survival analysis, hydrology, and economics. [ABSTRACT FROM AUTHOR]

To determine the distribution and quantity of ophthalmic care consumed on Affordable Care Act (ACA) plans, the demographics of the population utilizing these services, and the relationship between ACA insurance coverage plan tier, cost sharing, and total cost of ophthalmic care consumed. This cross-sectional study analyzed ACA individual and small group market claims data from the Wakely Affordable Care Act (WACA) 2018 dataset, which contains detailed claims, enrollment, and premium data from Edge Servers for 3.9 million individual and small group market lives. We identified all enrollees with ophthalmology-specific billing, procedure, and national drug codes. We then analyzed the claims by plan type and calculated the total cost and out-of-pocket (OOP) cost. Among 3.9 million enrollees in the WACA 2018 dataset, 538,169 (13.7%) had claims related to ophthalmology procedures, medications, and/or diagnoses. A total of $203 million was generated in ophthalmology-related claims, with $54 million in general services, $42 million in medications, $20 million in diagnostics and imaging, and $86 million in procedures. Average annual OOP costs were $116 per member, or 30.9% of the total cost, and were lowest for members with platinum plans (16% OOP) and income-driven cost sharing reduction (ICSR) subsidies (17% OOP). Despite stable ocular disease distribution across plan types, beneficiaries with silver ICSR subsidies consumed more total care than any other plan, higher than platinum plan enrollees and almost 1.5× the cost of bronze plan enrollees. Ophthalmic care for enrollees on ACA plans generated substantial costs in 2018. Plans with higher OOP cost sharing may result in lower utilization of ophthalmic care. [ABSTRACT FROM AUTHOR]

We examine the problem of determining Pareto-optimal (PO) insurance contracts when the insurer imposes an ex ante upper limit on disbursement. The problem is similar in spirit to that of Cummins & Mahul (2004), but it extends it in two directions: first, we use the more general and more flexible class of distortion premium principles; and second, we allow for heterogeneity in beliefs between the insurer and the insured. We unify the settings of Ghossoub (2019a, 2019b), and we adapt the approaches therein to encompass the case of a policy limit. First, we show that PO contracts are those that result from a budget-constrained optimization problem for the DM. We then provide a closed-form characterization of optimal contracts. Our result is similar in spirit to that of Cummins & Mahul (2004), who show that when policy limits are introduced to Arrow's model, PO contracts are limited deductible contracts. While Ghossoub (2019a, 2019b) shows that variable deductible contracts are optimal, the results of the present paper indicate that limited variable deductible contracts are optimal when policy limits are present. We illustrate our results via numerical examples. [ABSTRACT FROM AUTHOR]

It is documented that wheelchair failures occur frequently, repair times are lengthy, and users often experience adverse consequences. This study aims to gather evidence on efficiency of current wheelchair repair processes from the perspective of complex rehabilitation technology (CRT) suppliers who perform repairs within the United States. A 20 statement survey was developed to identify barriers and facilitators related to wheelchair repairs across the domains of administrative and operational factors as well as to identify future opportunities for improvement. Key statements in these areas included time to perform a repair, documentation requirements, tracking repair progress, reimbursement, technician competency, emerging strategies and preventative maintenance. The online survey was broadly disseminated to a nationwide network of CRT suppliers for data collection. A total of 127 responses were received. Results showed that administrative statements received the lowest scores while those statements dealing with future opportunities received the highest scores. Areas of the industry that suppliers were in most disagreement with included wait time for insurance approval, reimbursement for parts, reimbursement for technician travel time and lack of coverage for preventative maintenance. Telehealth system usage, preventative maintenance coverage, tracking repairs and repair scheduling were future opportunities that suppliers were in most agreement with. Administrative issues exist in the CRT industry due to restrictive insurance policies associated with repairs and maintenance. Future opportunities to improve the process exist including payment models and the application of telehealth, device monitoring and service-based performance incentives to reduce adverse consequences to the user. Highlights the direct importance and barriers faced within the wheelchair repair industry by CRT suppliers. In a sample of CRT suppliers, there is agreement there exists many administrative and operational issues related to wheelchair repairs. There is agreement among survey respondents of opportunities to investigate further telehealth and remote strategies, preventative maintenance coverage and online tracking for wheelchair repairs. [ABSTRACT FROM AUTHOR]

The only causal treatment for allergic rhinitis (AR) is allergen immunotherapy (AIT) including personalized liquid sublingual AIT (SLIT). We present the methodology for establishing the EfficAPSI cohort to further evaluate the real-life effectiveness and use of SLIT liquid. The EfficAPSI cohort was constituted by deterministic linkage of Stallergenes Greer dispensing and nationwide French healthcare insurance system (SNDS) databases. Data from 2006 to 2018 were extracted. All patients who initiated Stallergenes Greer SLIT liquid between 2010 and 2013 were considered as exposed and those dispensed with AR symptomatic treatment only as control. To limit the impact of confounding, the models will be weighted using the inverse probability of treatment weighting (IPTW). A total of 445,574 patients were included; median age was 38 years; 59.1% were female. Exposed patients (n = 112,492) were significantly younger, more frequently males, and less likely to have comorbidities than controls (n = 333,082). After IPTW, patients' characteristics from both groups were similar. To date, the EfficAPSI cohort has the largest number of person-years of follow-up in the field of AIT. The completeness of the data allows to evaluate SLIT liquid effectiveness with rigorous methodology, leading to important insights on personalized medicine in real-life. [ABSTRACT FROM AUTHOR]

This article analyses the factors that determined the choice of distribution channel within the Spanish insurance industry and its relation with growth strategies performed by firms. To achieve this goal, we have gone through documentary sources from the main companies to examine the relationships between companies and agents and their costs, namely: the design of agency contracts, the different procedures on the selection of agents, and the guidelines for inspection, supervision and control of agent networks. Using the framework of agency theory, this study aims to enhance our understanding of the conflicts and dynamics that determined the distribution of such a complex financial product as insurance in a late development economy. We show how insurance companies began the transition to the branch system in the 1920s to reduce the costs arising from the control and monitoring of agents and to mitigate agency conflicts. [ABSTRACT FROM AUTHOR]

Through analysis of archival research and in-depth interviews this article traces the development of the social expectation in the United States for perfected smiles, produced through orthodontic treatment, and discusses its implication for two dimensions of citizenship: rights and sense of belonging. Belonging is facilitated by normative embodiment. In the contemporary United States, an irregular smile is a mark of alterity, indicating poverty, parental neglect, or foreign birth. Decades of health care policy shaped by neoliberal ideology that limited the supply of medical personnel, thwarted efforts to develop universally available state-subsidized medical care and supported private medical insurance as the primary solution to medical need, contributed to the establishment of a dental system oriented toward the production of profit. Profit-oriented dentistry made the perfect smile emblematic of the American middle class and intensified the social and economic exclusion of people with irregular smiles. [ABSTRACT FROM AUTHOR]

The setting of a right-censored random sample subject to contamination is considered. In various fields, expert information is often available and used to overcome the contamination. This paper integrates expert knowledge into the product-limit estimator in two different ways with distinct interpretations. Strong uniform consistency is proved for both cases under certain assumptions on the kind of contamination and the quality of expert information, which sheds light on the techniques and decisions that practitioners may take. The nuances of the techniques are discussed – also with a view towards semi-parametric estimation – and they are illustrated using simulated and real-world insurance data. [ABSTRACT FROM AUTHOR]

Globally, assistive technology (AT) is used by over 1 billion people, but the prevalence of needs and access to AT in specific countries or regions is largely unknown. This scoping review summarises the evidence available on the prevalence of needs, access and coverage of AT in the World Health Organisation European Region and the barriers and facilitators to its use. Relevant publications were identified using a combination of two strategies: 1) a systematic search for AT publications in five scientific literature databases; and 2) consultations with 76 of the Region's AT experts. The search strategies yielded 103 publications, 62 of them identified by the systematic search. The included publications were predominantly from six countries, and 18 countries were unrepresented. Information on AT use for specific functional impairments was present in 57 publications: AT for hearing impairment in 14 publications; vision in 12; mobility, 12; communication, 11; self-care, 6; and cognition, 2. AT needs for vision and hearing impairment were more likely to be met (1–87% and 5–90%, respectively) compared with communication and cognition impairments (10–60% and 58%, respectively). The barriers and facilitators to AT access described were linked to accessibility, affordability and acceptability. Data on AT prevalence and coverage are limited in both quantity and quality. Agreed-upon definitions of functional impairment and assistive product categories and standards for data collection are needed to facilitate data comparisons and to build a more representative picture of AT needs and coverage. Comprehensive and disaggregated data concerning the prevalence of needs and coverage of AT is needed to enable the development of responsive policies and actions. The literature available on the prevalence of needs and coverage of AT in the WHO European Region is primarily focussed on a small subset of countries and comparisons between studies are limited due to the use of different data collection strategies. Evidence concerning barriers and facilitators to AT access across countries is more consistent and can be organised across the key themes of accessibility, affordability and acceptability of AT. There is a need for consensus among multiple AT actors on standardised definitions for functional impairment and assistive product categories and standards for data collection to enable a more representative picture to be built of AT needs and coverage across the WHO European Region and globally. [ABSTRACT FROM AUTHOR]

Over the second half of the twentieth century, the moral economy of insurance has shifted from solidarity and mutual support to individual responsibility. In this context, the French regime for the protection against natural catastrophes that took shape in the 1980s exemplifies a strong and almost anachronical political will to foster solidarity at the national level, thus questioning the moral economy of responsibility. This paper offers a textual analysis of the official debates that led to the launch of the regime. It shows how the representatives chose to separate compensation, financed by equal individual participation, from state prevention. This contrasts with other schemes worldwide that rely on rational decision theory to situate the responsibility for prevention at the individual level. In this alternative, risk-based premiums play a theoretically crucial role in risk signals. In practice, however, they lead to affordability issues while failing to govern prevention as theoretically expected. With the climate crisis exacerbating this phenomenon, the examination of the French regime thus allows to fruitfully revive other moral economies of insurance. [ABSTRACT FROM AUTHOR]

This study aimed to explore individuals' experiences of return to work (RTW) following minor to serious road traffic injury (RTI) in Queensland, Australia; seek their recommendations if any, on how to provide support for RTW after RTI; and identify the strategies and resources used to return and remain at work after their RTI. The interpretive description methodological approach was used. Semi-structured interviews were conducted with eligible participants (n = 18) aged 18–65 y who had experienced a minor to serious RTI at least 6 months earlier. Thematic analysis was used to analyse the data. Five themes emerged: (1) physical and mental consequences of RTI negatively impact RTW; (2) money matters; (3) RTW support makes a difference; (4) feeling alone and confused in the RTW process; and (5) several strategies and resources helped with return/stay at work after RTI. Regular contact and cooperation with employers and insurers, job modifications, and using social media to obtain information and social support were helpful RTW strategies. Participants recommended timely and appropriate medical care, financial assistance, and educational support. Policy changes to reduce financial stress, increase employer support, and improve injured individuals' knowledge following a RTI are recommended in jurisdictions operating a fault-based scheme. This study identified several factors that can influence return to work (RTW) following minor to serious road traffic injuries (RTIs) in a jurisdiction operating a fault-based compensation scheme. Legislative changes that provide financial assistance to all injured people regardless of their fault-status could reduce financial stress arising from reduced work ability following a road traffic injury. Increasing employer' awareness of the importance of return to work for those with road traffic injuries and reimbursement for possible expenses of providing RTW support for these individuals could increase employability of injured people following RTI. Improving injured individuals' knowledge about return-to-work processes after a road traffic injury could accelerate recovery and return to work. [ABSTRACT FROM AUTHOR]

We investigate the risk of claims using hazard models for house insurance for the three periods: prior to, during and after the financial crisis. The present study is based on the data provided by Property & Casualty Carrier for the Canadian Market. The semiparametric Cox proportional hazard model results suggest that Canada's house insurance options (Bronze, Silver, Gold, and Platinum) influence the risk of claims. The smaller coverage option, Bronze, has much fewer claims than the complete coverage option, Gold. This may suggest the presence of a moral hazard problem. The financial crisis however impacted the role of the type of coverage had on the risks of claims reducing the moral hazard problem, after controlling for the characteristics of the houses. [ABSTRACT FROM AUTHOR]

Black Alaskans face serious barriers to health care. This paper reports on qualitative results of a health needs assessment to understand the health challenges facing Black Alaskans. Utilizing exploratory thematic analysis, the findings indicate that Black Alaskans experience barriers such as high cost of care, underinsurance, lack of information and education, a shortage of BIPOC health providers, stigma, negative perceptions by health-care providers, and racism both in the community and in the health-care system. The paper concludes by discussing emerging health equity initiatives to advance responsive care for Black Alaskans. [ABSTRACT FROM AUTHOR]

Consider an insurer who operates two lines of businesses and hence receives two types of insurance net losses. In the bidimensional discrete-time risk model with a constant interest rate, the net loss vectors from the two business lines form a sequence of independent and identically distributed real-valued random vectors. We propose a bidimensional extended regularly varying structure in terms of survival copulas to model the dependence between the two components of each net loss vector, which includes not only asymptotic independence but also asymptotic dependence. Under the framework of consistent variation, we obtain several (uniformly) asymptotic formulas for various ruin probabilities. In particular, the investigation of random-time ruin probabilities unifies and extends the results on both finite-time and infinite-time ruin probabilities. Some numerical studies are also performed to check the accuracy of our obtained asymptotic results. [ABSTRACT FROM AUTHOR]

An influential cannabis lobby and its allies are engaged in an aggressive initiative to mandate health and worker's compensation insurance coverage for non-standardized, non-FDA-regulated cannabis products. If successful, mandated reimbursement would present a severe public health risk and force taxpayers to fund a risky and under-regulated industry. Leaders in psychiatry and other medical specialties have sounded the alarm about the marketing and sale of cannabis products for medical uses without prior review by the FDA. We echo their strong opposition to bills requiring workers' compensation carriers and health insurance plans to cover the cost of dispensary-purchased "medical" cannabis. Mandated insurance reimbursement of dispensary products is "a recipe for a public health disaster, as lowering or eliminating out-of-pocket costs will encourage more consumers to become certified under a state's medical cannabis program, and result in more frequent use of higher-potency cannabinoids (e.g., THC and CBD) that are associated with serious adverse events." Until there are thorough studies into these products, including adverse events, side effects and long-term concerns, these products should not be considered appropriate alternatives to FDA-approved medications. Their use should not be encouraged nor paid for through mandated reimbursement by public or private third-party payers. [ABSTRACT FROM AUTHOR]

This paper explores racial differences in maternal risk factors associated with adverse pregnancy outcomes across urban and rural geographies using 2019 data from the Behavioral Risk Factor Surveillance System. Bivariate chi-square tests and logistic regression were performed which showed statistically significant geographical differences among Non-Hispanic (NH) Black pregnant women across income levels (p =.016) and perceived health status (p =.003). Regression analyses indicated an increased racial gap between NH White pregnant women and other racial/ethnic groups. The findings support that there are statistically significant racial differences in maternal risk factors across urban and rural geographies for NH Black and Hispanic pregnant women. [ABSTRACT FROM AUTHOR]

Faced with defending against myriad online threats, businesses are increasingly turning to insurers to purchase cyber-insurance policies that will shield them from bearing the full costs of these incidents. Eager not to miss out on the expanding market, insurers have aggressively ramped up their cyber-insurance offerings, and in doing so, have assumed enormous responsibility—and power—as the arbiters of what types of state-sponsored cyber-attacks are covered by insurance. This article argues that insurance companies are influencing multilateral processes and setting de facto standards around responsible state behavior in cyberspace through their policies on risk and liability for serious cyber-operations and "cyber-war." It approaches this issue through the lens of the 2017 Russian NotPetya cyber-attack which led to significant legal disputes between many insurers and their policyholders about whether Russia's behavior constituted a "warlike action" and was therefore excluded from insurance coverage under standard war exclusions. [ABSTRACT FROM AUTHOR]

Agriculture is the most weather-dependent and risky sector where it is unpredictable when a season will be profitable during harvest. Droughts and floods may increase the risk of weather-related catastrophes in agriculture. Weather index Insurance has been widely recommended for decades to control weather risk. 600 Ashanti cocoa producers were surveyed to see how weather index insurance adoption affects cocoa output in Ghana. The endogenous switching regression (ESR) technique coupled with probit models were employed in this study. Cocoa bean production was 30.8 percent whiles only 15.8% of cocoa farmers knew about weather index insurance. The average annual farm income, off-farm, and remittances were 7.40, 7.26, and 6.61, respectively. Weather index insurance adoption and cocoa output were positively influenced by cocoa farm age, gender, education, awareness, and access to finance. We found that weather index insurance negatively influences cocoa output in Ghana due to inadequate information on insurance among farmers, lack of education, lack of awareness, and access to credit. Our findings will help Ghana Agricultural Insurance Pool and the government improve accessibility, affordability, and awareness for cocoa growers in the region and beyond. The findings will add to weather index insurance literature and improve agriculture risk. [ABSTRACT FROM AUTHOR]

Since the 2000s, hundreds of government-funded health insurance (GFHI) schemes were introduced in India. These schemes are meant to prevent poorer households from incurring catastrophic health expenditures. Through GFHIs, policy-makers want to mobilize the decision-making powers of private consumers in a liberalized healthcare market. Patients are called upon to act as 'co-creators' of healthcare value by optimizing supply through demand. Based on long-term ethnographic fieldwork with insurance users in South India, we argue that GFHIs fail because people experience the value of insurance in drastically different ways that only partly overlap with how the policy assumes they value insurance. In addition, the hollow promises of health coverage can be experienced as so frustrating that signing up for health insurance actually makes people feel devalued. [ABSTRACT FROM AUTHOR]