Search

Risk management and insurance (RMI) is facing a talent gap that is exacerbated by an increasing employer demand for technology-based skills. This research explores whether an undergraduate curriculum-based professional certificate influences college students' RMI career choices. Using a mixed-methods research approach, the researcher surveyed a sample of 95 college graduates who, as undergraduates, were enrolled in one or more risk management and insurance courses that fulfilled both their degree coursework requirements and the requirements toward an RMI-industry certification. Through analysis of both survey data and interview data, the researcher investigated whether an RMI certification was viewed as important, the influence such a certification has on students' career choices, students' perceptions of the RMI certificate as influencing their time-to-placement, graduates' decisions to remain in RMI 3 years after graduation, and the motivating factors behind why graduates who pursued and obtained careers in RMI intend to remain in them. The study finds that graduates perceived having a curriculum-based risk management and insurance certification to be important. A majority of participants felt that having a curriculum-based certificate shortened their time to placement, and they stated they are more likely to remain in their careers three years post-graduation and into the future when asked to consider a next hypothetical job search. Additionally, students who graduate with the certificate achieve their desired RMI careers (versus careers in other industries), have a capacity to learn and take leadership roles in RMI's digital transformation, and will seek out and remain with employers who will financially support them in their journey to continue their attainment of credentialing and professional development. Implications of the study are further discussed. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This applied dissertation study compared the effectiveness of the iPad-assisted and traditional flashcard-assisted instruction for teaching receptive labeling skills to learners with autism. A lack of access to certified service providers and insurance coverage and the inability to receive a diagnosis of autism prevent families from accessing applied behavior analysis (ABA) services. The problem addressed in this applied dissertation was a lack of access to ABA services for children with autism. Two school-aged learners with a medical diagnosis of autism served as participants in this study. The study utilized an adapted alternating treatments design to compare the effectiveness of the iPad app-assisted and flashcard-assisted instructions in the following dimensions: rate of the acquisition of the receptive labeling skills, generalization and maintenance of the receptive labeling skills, frequency of the prompts needed to acquire the skill, and frequency of the challenging behaviors associated with each intervention. The study included a baseline phase, instructional phase, generalization phase, final probe phase, and a maintenance phase. A visual analysis of the data was used to compare the effectiveness of the interventions. Also, the researcher compared the data between the two interventions using the nonoverlapping data (PND) points. Results indicated iPad-assisted instruction was associated with lower rates of challenging behaviors, lower rates of prompts, and a slightly higher rate of acquisition of the receptive labeling skills when compared to the traditional flashcard-assisted instruction. Furthermore, the results showed iPad-assisted instruction took a shorter time to implement when compared to traditional flashcard instruction. The results of the study have implications on the effectiveness of the instruction, potential time and cost efficiency for the practitioners and caregivers, and an improvement of the quality of life for individuals with autism. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The insurance industry is onboarding large numbers of new employees as the baby boomers retire. At the same time, the industry is shifting to more analytical and agile processes requiring significant upskilling. Many companies are too small to build their own training programs. Existing national associations can help but students currently prefer classroom training, requiring expensive travel and accommodations. We need to significantly improve student satisfaction with online courses to improve the affordability of and demand for training. The Community of Inquiry framework is commonly used to design and evaluate online courses that increase student satisfaction. The framework shows teaching presence, social presence, and cognitive presence as essential elements that combine to build productive educational experiences. The Mindfulness Awareness Attention Scale (MAAS) is a well-researched scale that quantifies an individual's awareness of and attention to the present. Combining questions from the Community of Inquiry framework and the MAAS Scale with questions on satisfaction, this study used a quantitative approach with a descriptive research design. Employees in the insurance industry that have taken online courses from national carriers were surveyed, to identify how a student's mindfulness tendencies moderate the relationship between the Community of Inquiry scores and their satisfaction with online courses. The study concludes that industry courses would benefit by increasing cognitive presence through improved teacher and social presence. The study concludes that mindfulness may affect student's future use of online learning but could not be determined to impact student's satisfaction with online courses. The study provides findings and recommendations for online course changes and for future research. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

In this dissertation, I present three distinct topics on labor economics that can be read independently from one another. In the first chapter, using matched mother-child data from the National Longitudinal Survey of Youth, I investigate the impact of mothers' involuntary job loss on children's academic achievement. In the next chapter, I examine the impact of eye and hair color on wages-at-first-job after schooling. In addition, I investigate whether hair color has an impact on the wage-at-the-first-job if the individual resides among people who have similar features. In the last chapter, I examine the impact of unemployment insurance benefit generosity on benefit duration and labor market transitions in Turkey with a regression discontinuity design. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

BACKGROUND: In the wake of Goal 3 (ensuring healthy lives and promoting well-being for all at all ages) of the Sustainable Development Goals (SDGs) and the resulting push for Universal Health Coverage (UHC), Pakistan's Federal and Provincial Governments launched three large-scale social health protection (SHP) schemes. Sehat Sahulat Programme (SSP), Sehat Hifazat Programme (SHiP) and the Prime Minister's National Health Programme (PMNHP) were initiated by the provincial governments of Khyber Pakhtunkhwa (GoKP), Gilgit Baltistan (GB) and the Federal Government of Pakistan (GOP), respectively. SSP was publicly inaugurated on 15 December 2015, while SHiP and PMNHP started in June and November 2016, respectively. The Federal and Gilgit Baltistan schemes implemented the SSP model. On 20 August 2020, SSP was expanded to cover 100% of the population of KP. GoKP considered SSP an important pillar in achieving UHC in the province. There was a dearth of research about the key drivers behind the initiation and expansion of the programme, the challenges it faced and its contextualisation in the province's strides towards achieving UHC. I sought to describe the evolution of SSP in KP through stakeholders' accounts and explore potential ways for leveraging SSP to contribute towards achieving UHC in the province. SSP was selected as a case study for its advanced stage of implementation and its influence on the design of SHiP and PMNHP. METHODOLOGY AND METHODS: I used an instrumental case study design. My study received ethics approval from the University of Edinburgh (Scotland, UK) and Khyber Medical University (Pakistan). I complied with the ethics regulations of informed consent, participants' autonomy, confidentiality, and their right to withdraw. I used three complementary data collection methods. First, I collected official programme documents. I then conducted in-depth interviews and non-participant observations. Programme documents were used to describe the chronology of events in SSP evolution and the changes in its policy parameters - for example, population, services and financial coverage. I acquired the documents from the SSP head office and its official website. The included documents were either authored or commissioned by GoKP, including Planning Commission Form 1 (PC-1) and the contracts between GoKP and the insurance company implementing SSP. I used purposive (maximum variation) sampling for conducting interviews and observations in order to compare and contrast views from various stakeholders on the programme's strategy and implementation. Through these interviews with diverse stakeholders, I explored the reasons behind changes in the policy parameters, their practical implications and the future directions to harness the programme's role in achieving UHC. These stakeholders were the officials who attended the policy meetings or were involved with the programme implementation. These included officials from GoKP, the insurer, providers (hospitals), public advocacy groups and international development agencies (partners). I recruited participants through direct (face-to-face or emails) and open invitations (displaying a poster at the stakeholder offices). I conducted policy level observations at meetings convened by the SSP head office and implementation level observations at SSP desks in the programme hospitals. Entry to the observation sites was facilitated by the gatekeeper, i.e., the Director of SSP. Equal representation was ensured by the type of hospital (public and private) and level of care (secondary and tertiary).The observations enabled me to explore how SSP policy decisions were made and how they were (or were not) translated into implementation practices. I collected data from March 2021 to December 2021. I stopped data collection when data saturation was achieved. I conducted thematic analysis of these data. The Multiple Streams Theory (MST), the UHC Box and the Health Systems Strengthening (HSS) Frameworks informed my initial coding and major themes. I refined the broader themes through repeated iterations of the data analysis. I analysed the data with the help of NVivo 12. Using the World Health Organization's (WHO) UHC Box Framework, I explored the coverage components of SSP, while MST helped me tease out the problem and policy streams that led to SSP initiation and the potential policy options to address its current problems. The HSS Framework enabled me to understand how SSP and the broader health system influenced each other. FINDINGS: My final dataset comprised of 20 official documents, transcripts of 62 interviews and field notes from 63 hours of observations. The PC-1 defined SSP as an insurance programme designed for improving the population's health status and poverty reduction. Interviewees credited the German Development Bank (KfW) as the major driving force behind SSP for its advocacy, technical assistance and financial support. Other reasons leading to SSP, as described by the respondents, were poor health indicators, rising health care costs, widespread poverty and the pessimism of the supply-side health care financing. GoKP paid an annual premium to the insurer, who purchased health services for the covered population from both public and private hospitals. SSP had set three stated objectives, i.e., improving access to care, quality of services and financial protection for the covered population. These objectives resonated with the UHC definition by WHO, i.e., access to health services of sufficient quality to be effective without financial hardships. The development partners and advocacy groups suggested that SSP improved the affordability and availability components of access, but that challenges with geographical accessibility and acceptability persisted. The programme documents (PC-1 and contracts) showed an incremental enhancement in the population, services and cost coverage, making inpatient health care affordable (free). In Phase 1 (2015), SSP covered 3% of the province population for secondary care. Each family had financial protection of up to 240,000/- Pakistani Rupees (PKR) per year. In Phases 2 and 3, population coverage was expanded to 51% and 69% of the province population, respectively. Tertiary care was added, and the financial coverage was enhanced to PKR 540,000/ per family per annum. In Phase 4 (2020), coverage was extended to 100% population; organ transplants were added to the benefits package and financial coverage was increased to PKR 600,000/ per family per annum. The basic design features of SSP, as proposed by KfW, were solidarity, subsidiarity, and equity. SSP had plans to provide free health insurance to low-income families and raise revenue through paid enrollment of the wealthy (solidarity). GoKP deviated from this model and covered the entire population of KP free of cost. Through SSP, GoKP envisaged service provision through private hospitals (subsidiarity). However, in Year 3, GoKP included public sector hospitals in the programme. According to the advocacy groups, what started as social protection initiative for the poor was extended to 100% population with 100% subsidy. The advocacy groups noted that they perceived the rich to be subsidised by the poor. They expressed fear that the rich, as a result of their connections and better understanding of the health system, would crowd out the poor. The stakeholders (GoKP, development partners and the insurer) had different interpretations of the programme's rapid expansion. GoKP officials called the 100% population coverage a success, but the partners called it overdoing (in terms of financial implications for GoKP). The development partners noted that the rapid expansion of the programme compromised its financial viability and implementation feasibility. The insurer likened the rapid expansion to riding a roller-coaster, allowing them little time to establish the implementation processes. During my field observations, I saw the insurance staff at SSP desks struggling with enrollment and verification of patients. Similarly, the partners (especially the WHO representatives) considered the benefits package concerning, as it covered costly surgeries like cardiac bypass, but excluded mental health and primary care (which the partners considered cost-effective). Moreover, despite its claim to protect against catastrophic inpatient expenditure, SSP had protection gaps, as reported by the advocacy groups and the insurance officials. Finally, initiatives like SSP were seen as contributing towards UHC, but how much is the question. SSP and related initiatives, in view of the development partners, should report on globally recognised and comparable indicators.

Despite the global efforts to confront the increasing prevalence of obesity worldwide, many countries failed to bend or even plateau their uptrend. Researchers have always seen obesity as a modifiable risk factor for many chronic diseases and some types of cancer and believed that reducing weight would reduce the risk of obesity-related comorbidities and healthcare expenditure. However, other observed and unobserved characteristics of the patients may interfere with their risk of developing obesity-related comorbidities and/or their ability to access healthcare services. Therefore, it is important to expand our understanding of the different dimensions of obesity. This thesis examined the phenomena of obesity from three different angles - the relationship between obesity and its comorbidities, accessibility to weight reduction (bariatric) surgeries and post-bariatric contouring surgeries, and cost-effectiveness analysis of a novel obesity treatment. Chapter 2 examined the impact of obesity on specific comorbidities including type 2 diabetes, hypertension, and vitamin D deficiency. Utilizing data from Saudi Arabia, two studies were conducted. In the first study, a series of biprobit regression analysis were used to explore unobserved heterogeneity across the obesity-related comorbidities. Unobserved heterogeneity was evident in the relationship between type 2 diabetes and hypertension. However, vitamin D was not found to predict type 2 diabetes risk nor hypertension risk. While the use of categorical dependent variables in the first study may not display the whole picture of the relationship between vitamin D and other obesity-related comorbidities, a second study was undertaken in chapter 2 with the aim to explore unobserved heterogeneity among subpopulations whose 25(OH)D level vary without recourse to an exogenously defined threshold. Using a relatively uncommon analysis known as the Finite Mixture Models, latent population subgroups and their relationship between vitamin D levels and sources of vitamin D were examined. Three latent classes were identified and their distinct patterns of associations with nutrition, behaviour and socio-demographic variables were presented. Weight reduction is a widely accepted intervention to prevent/delay the incidence of obesity-related comorbidities. However, access to weight reduction surgeries continues to be a challenge for ethnic minorities and socioeconomically disadvantaged groups. Ethnic minority groups such as Native Americans have a higher risk of developing obesity-related comorbidities. The small number of Native Americans in surveys makes it more challenging to investigate comparative ethnic group experiences. Nevertheless, the lack of research with respect to this group gives rise to a clear gap in our understanding regarding their comparative experience. Thus, the first study in chapter 3 examined disparities in access to bariatric surgeries with a particular focus on the experience of Native Americans utilizing one the largest dataset in the USA. Compared to White Americans, Native Americans were less likely to receive bariatric surgeries even when controlled for their clinical needs. The increasing popularity of bariatric surgeries as an impact of the insurance coverage expansion in 2011 have led to increasing demand for post-bariatric contouring surgeries. As rapid weight reduction can cause sagging skin, contouring (constructive or cosmetic) surgeries are seen as the best solution by most of those who have had bariatric surgeries in the past. However, not all types of contouring surgeries are covered by healthcare insurance. In fact, different insurance companies have their eligibility criteria for the covered procedures. The second study in chapter 3 examined the relationship between the use of contouring procedures on post-bariatric surgery patients, clinical need, and sociodemographic factors. Self-payers were more likely to receive post-bariatric contouring surgeries, which indicates that access could be predicted by the ability to pay rather than clinical need. Aside from invasive, costly surgeries, new less invasive procedures such as Aspiration therapy and gastric balloon have been introduced as competitors to bariatric surgeries. However, the decision-maker would not adopt a new procedure unless it have been assessed in terms of its cost-effectiveness and ensured that the cost-effectiveness analysis was unbiased. Chapter 4 examined the replicability of a published cost-effectiveness model comparing the Aspiration therapy with the bariatric surgeries. Two different reporting checklists were used. Both checklists show weak points in the paper, particularly in the parameter inputs. After updating the model's input parameters, the model was used to explore the cost-effectiveness of gastric balloon therapy. Overall, this thesis demonstrates a number of economic aspects of obesity including: i) obesity is a modifiable risk factor for costly chronic diseases and subsequent cost saving is associated with weight reduction; ii) failure of the health insurance system in the USA to meet patients' needs; and iii) adoption of rigor reporting checklist would improve the quality of published economic evaluations.

Insurance is a bilateral contract whose execution is premised on executory express promises of the insured called warranties, and the insurer's implied promises called indemnity. Whereas the making of the warranty is a condition precedent to the inception of the contract the execution of the indemnity is dependent upon the warranty being exactly complied with. This gives rise to instances whereby the insured's purpose of entering the contract are defeated thereby perpetuating unfairness against the consumer. Accordingly, in line with consumerism many countries including Nigeria, the UK, Australia, and New Zealand have had to reform the law of insurance warranty to mitigate unfairness to the insured, but Nigeria's leaves much to be desired, and it seems to impede on insurance development in the country. This thesis seeks to propose a way forward. Accordingly, the thesis traces the historical origin of insurance warranty, its cradle, practice, and reform in the UK, and some significant common law jurisdictions such as Australia, and New Zealand, with a view to pinpointing where and how Nigeria may have missed it. The issues with the traditional warranty and the approaches to its reform in the selected jurisdictions are evaluated. Surprisingly, in this regard, Nigeria appears to be in tandem with the others, except that insurance penetration is still exceptionally low, which in this thesis has necessitated an in-depth examination, where Nigeria's exceptionalism is implicated as one of the main causative factors. To resolve the issue, and since 'normal' approaches to reform appear to have failed, the thesis goes 'out of the box' to propose a hybrid model of reform that combines the strengths and modern approaches of three advanced common law jurisdictions - the UK's, Australia's, and New Zealand's. These are blended with the traditional age-long exceptionalism of the Nigerian peoples to chart a way forward for the reform of Nigeria insurance warranty law.

This dissertation investigates how the financial risk management practice of catastrophe modelling is redefining the ontology of natural catastrophe. Drawing from and developing the concept of the 'Anthropocene', referring to co-production of the 'social' and the 'natural' on a planetary scale, the dissertation argues that simulation-based risk modelling of future 'natural' disasters in insurance and reinsurance markets is not just affecting how catastrophe is interpreted by economic agents, economised and financialised, but is also driving changes in the realisation of actual disasters. The thesis calls this recursive dynamic the 'financial ontology of Anthropocene catastrophe'. In developing the argument, the thesis extends actor-network theoretical perspectives on the Anthropocene to take fuller account of market devices, performativity and calculative practices in finance. Documentary research, 62 interviews and 14 participant observation episodes serve to reconstruct current practices of catastrophe modelling and its history since it emerged as a boutique risk management practice in the 1980s. Ultimately, it has become embedded in the calculative practices of some of the largest insurance and financial companies in the world and underpinning a specialist disaster securities market. Adding conceptual depth and fine-grained empirical detail to literature on the financialisation-Anthropocene nexus, the dissertation asks us to reconsider the boundaries between economic representations of the world and the meaning and occurrence of catastrophes in market societies. In an age of anthropogenic climate change, the thesis also serves as an analytical and historical underpinning of epistemic practices in climate finance in the emerging, even more encompassing, 'financial ontology of the Anthropocene'.

This thesis looks at the development and evolution of UK insurance companies over the last two centuries. It explores the following interrelated issues: the development of the asset portfolios of life assurance companies, the disappearance of shareholder liability in insurance companies, and the introduction of the first regulatory framework for insurance companies with the Life Assurance Companies Act of 1870.

This dissertation investigates the development of General Average (GA) and adjacent forms of 'averages' in the Southern Netherlands during the fifteenth and sixteenth centuries, mainly in the two commercial cities of Bruges and Antwerp. GA, a technical instrument that already existed in Roman law, redistributes extraordinary, deliberate damages for the common benefit over anyone involved in a maritime venture pro rata. It has been largely disregarded by historians in their study of early modern risk management, in contrast to marine insurance. The dissertation is situated at the intersection of maritime, economic and legal history, whereby the source material is primarily legal in nature. This research aims to contribute to three long-running debates in legal and economic history: first, the assumed existence of an autonomous medieval maritime law (the so-called lex maritima); second, strategies of merchants to manage maritime risk; and third, the effects of averages as an institution on transaction and protection costs. GA was mainly declared for jettison in Roman and medieval law. During the sixteenth century developments in formal legal sources (such as princely legislation and Antwerp municipal law) incorporated new acts from mercantile practice, including costs to avoid greater damages, such as voluntarily running aground during a storm. Two developments were of great importance: the possibility of holding insurers liable to pay for GA payments; and the development of adjacent forms of averages for cost management, such as Common Average for operational costs and the contractualisation of averages before a venture to provide legal security. 'Spanish' merchants such as the Castilians and Biscayers, united in so-called nationes, also developed various forms of compulsory contributions, paid ex ante, to share mutual protection costs. The dissertation argues that the development of averages contributed to an operationally efficient combination of different institutions, notwithstanding the complex stakeholder environment of the crucial maritime sector.

This study contributes the conceptualisation of 'safe' insecurity to existing literatures in critical Security Studies. To achieve this, this dissertation renders many concepts of International Relations that have developed to suit a terrestrial and solid understanding of the world as amphibious. This means that perils experienced at sea, particularly piracy, are represented to seafarers in tools that guide their transit of the 71% of the earth's surface that constitutes our oceans and seas subjectively and relatively - taking stock of the fluidity of the sea and human mobilities aboard merchant vessels as they propel the maritime spaces and places that are produced between ports. I explore literary and historical representations of maritime risk, such as Odysseus' lengthy journey home from Troy and Sir Francis Drakes role as a spatial disruptor through the Colonial construct of the 'privateer'. These discussions reveal that sea space has been represented and therefore lived differently based on its representation relative to the moment it is being experienced, which leads to specific rules of participation at sea that may be covert or overtly defined. These rules accentuate a binary of 'God' and 'Monster' relative to who is authenticated and excluded at sea. The empirical aspect of this dissertation applies this conceptual argument by drawing on the contemporary experience of navigating Somali piracy. It draws on the role of third-party maritime insurers (P&I Clubs) and seafarers to document how experiences of piracy have been used on land as the core knowledge that is mobilised to reproduce and refine practical deterrence measures that are used onboard merchant vessels. This analysis reveals that through exchanges of knowledge and expertise of life at sea, guidance is refined to embody the everyday norms of seafaring but, most importantly, pursues security without posing further risk to the merchant mariner. Drawing on personal testimonies of seafarers who have transited the aptly named High-Risk Area and the experience of elite, expert representatives of the maritime insurance industry, this study contributes the documentation of experiencing, representing and deterring piracy as part of a more extended, unfinished history of navigating risks at sea.

This thesis examines how economic shocks and policies spillover in the economy. In the first chapter, I examine how banks reallocate credit across borrowers as a result of stronger creditor rights. In 2004, the Brazilian government introduced a new collateral contract for home-equity loans, with much quicker repossession by creditors in case of default. I find an increase in credit availability in areas with higher homeownership at the expense of lower credit supply in areas with lower homeownership as a result of this law. In addition to credit being reallocated, there are relevant heterogeneous real economic effects in these regions, and ultimately workers migrate from low to high homeownership. In the second chapter, I analyze whether institutional quality explains the propagation of shocks in the supply chain. I use natural disasters as initial shocks and then see what happens to firms that had a supplier directly affected by the disaster against firms that are not connected to the shock. I find that connected firms experience a significant drop in cash inflow, cash outflow, and employment relative to unconnected firms in the same local industry. The propagation is particularly severe for connected firms located in areas with congested courts. Connected firms outsource credit risk through factoring and firms with unused credit lines suffer less. The third chapter documents that a more generous unemployment insurance (UI) system shifts labor supply from safer to riskier firms and reduces compensating wage differentials risky firms need to pay. Consequently, a more generous UI system increases risky firms' value and fosters entrepreneurship by reducing new firms' labor costs. Exploiting a UI reform in Brazil that affects only part of the workforce, the empirical strategy compares labor supply for workers with different degrees of UI protection within the same firm, sharpening identification of the results. Altogether, the results suggest that UI provides a transfer system from safe to risky firms. Overall, my thesis provides evidence that indirect effects of shocks and economic policies can be relevant in the economy.

The aim of this research project is to adopt a two-stage approach for empirically measuring and determining the level of cost efficiency in the UK Life Insurance industry during and after the Global Financial Crisis (GFC). Stage one employs a Data Envelopment Analysis (DEA) technique with Variable Returns to Scale (VRS) to estimate the cost efficiency scores for the whole UK Life Insurance Industry for the period 2007 to 2015. In the second stage, a panel Tobit regression technique is used to examine the effects on cost efficiency of a set of determinants that are largely drawn from the recent literature on Financial and Risk Management (FRM). The findings suggest that the average cost efficiency in this period was lower than the level previously reported in the literature, but, by 2015, a clear improvement is noted. The findings also suggest that some potentially effective measures to improve operational efficiency include the reduction of the use of reinsurance, increasing firm size and relocation of office space away from Central London.

This dissertation examines the evolution of UK life insurance arrangements by investigating how the ways in which life insurers evaluate the economic worth of insurance contracts have changed since the early 1970s. It draws on a set of 44 oral-history interviews, supplemented by an extensive set of documents, to describe how, in addition to traditional forms of 'diversifiable' insurance risk, insurers have increasingly sought to quantify forms of 'non-diversifiable' risk such as financial market risk. The central question is how changes in insurers' evaluation practices shaped and were shaped by broader developments in UK life insurance. In addressing this question, the dissertation combines insights from field-theoretical perspectives in 'conventional' economic sociology, the recent literature on the performativity of economics, the sociology of insurance and the sociology of scientific knowledge. Field theory is a useful tool for understanding how meso-level social orders emerge as a function of the strategic behaviour of actors in social domains such as markets. The assumption of 'technological determinism' prevalent in field-theoretical perspectives, however, conflicts with insights from the sociology of scientific knowledge and recent literature on the performativity of economics. This tension may be alleviated, I argue, by conceptualising both the market for life insurance and actuarial science as fields (a 'market field' and an 'epistemic field') and by investigating the interrelations between the two. In deploying this field-theoretical perspective, the dissertation finds, on the one hand, that developments in the market field may lead to new opportunities and challenges in the epistemic field. Particularly important in the epistemic field, for instance, was the ascendancy of modern finance theory's no-arbitrage models as key exemplars for the modelling of insurance liabilities in actuarial science. However, only when the jurisdictional claims of the actuarial profession were threatened and when supervisors required insurers to evaluate their liabilities using techniques already used in banking did these models become dominant in the actuarial field. x On the other hand, I argue that the ways in which life insurers evaluate the economic worth of insurance contracts matters for what life insurance is and does. Evaluations of 'value' and 'risk' inform decision making about the distribution of financial surplus and risk across different groups of policyholders and shareholders, the types of products that life insurers choose to underwrite, and the way in which they invest their assets in capital markets. Since the 1970s, the emergence of novel evaluation practices has contributed to the individualisation of financial risk in insurance arrangements, a shift in insurers' asset allocations from equities to fixed-income investments, and a declining willingness from insurers to underwrite traditional mortality-related risks. The business of life insurance, in other words, increasingly revolves around investment intermediation rather than protection. The findings of this dissertation draw attention to the politics of seemingly technical issues such as the discounting of future cash flows to present values. Overall, I suggest that the evolution of UK life insurance can be fully understood only by paying attention to tensions and conflicts in the epistemic field of actuarial science, attempts to influence the 'rules of the game' in the market field and the interrelations between the two.

Coastal regions are some of the most exposed to environmental hazards, yet the coast is the preferred settlement site for a high percentage of the global population, and most major global cities are located on or near the coast. This research adopts a predominantly anthropocentric approach to the analysis of coastal risk and resilience. This centres on the pervasive hazards of coastal flooding and erosion. Coastal management decision-making practices are shown to be reliant on access to current and accurate information. However, constraints have been imposed on information flows between scientists, policy makers and practitioners, due to a lack of awareness and utilisation of available data sources. This research seeks to tackle this issue in evaluating how innovations in the use of data and analytics can be applied to further the application of science within decision-making processes related to coastal risk adaptation. In achieving this aim a range of research methodologies have been employed and the progression of topics covered mark a shift from themes of risk to resilience. The work focuses on a case study region of East Anglia, UK, benefiting from the input of a partner organisation, responsible for the region’s coasts: Coastal Partnership East. An initial review revealed how data can be utilised effectively within coastal decision-making practices, highlighting scope for application of advanced Big Data techniques to the analysis of coastal datasets. The process of risk evaluation has been examined in detail, and the range of possibilities afforded by open source coastal datasets were revealed. Subsequently, open source coastal terrain and bathymetric, point cloud datasets were identified for 14 sites within the case study area. These were then utilised within a practical application of a geomorphological change detection (GCD) method. This revealed how analysis of high spatial and temporal resolution point cloud data can accurately reveal and quantify physical coastal impacts. Additionally, the research reveals how data innovations can facilitate adaptation through insurance; more specifically how the use of empirical evidence in pricing of coastal flood insurance can result in both communication and distribution of risk. The various strands of knowledge generated throughout this study reveal how an extensive range of data types, sources, and advanced forms of analysis, can together allow coastal resilience assessments to be founded on empirical evidence. This research serves to demonstrate how the application of advanced data-driven analytical processes can reduce levels of uncertainty and subjectivity inherent within current coastal environmental management practices. Adoption of methods presented within this research could further the possibilities for sustainable and resilient management of the incredibly valuable environmental resource which is the coast.

The existence of complexity, uncertainty and ambiguity in current business environment promotes corporates need to establish good risk governance. Enterprise Risk Management (ERM) has been considered as a way to achieve good risk governance to deal with both upside (e.g. exploit opportunities) and downside (e.g. reduce insolvency) of risk and uncertainty. ERM holistically treats all risk to achieve organisation objective in normal, volatile and crisis situations. The thesis tackles issues in the implementation of ERM and how it has been adopted and implemented in Indian and UK insurance market. Mixed research methods have been employed from a qualitative stand point to explore the research issues, consisting of two surveys in UK and India, over 50 interviews and two case studies in the Indian and UK insurance markets. The research revealed that there is an ambiguity in the understanding of the definitions of ERM and risk appetite across both countries. Major issues in ERM implementation in Indian insurance market are fraud, under-risk reporting and insufficient resources to develop an appropriate risk culture. In the UK insurance market issues are related to customer complaints, fines/penalties, over-risk reporting and lack of capital efficiency. Regulatory risk seen as a major risk in both market, though, in the Indian market lack of regulation is the issue whereas in the UK insurance market lack of clarity in insurance regulation has been emphasised. From intuitional theory and strategic change perspective, the research presents cross-country comparative case studies highlighting four emerging ERM strategies based on the different state of development and maturity of companies: ‘Rudimentary’, ‘Anticipatory’, ‘Resilient’ and ‘Transformatory’ strategies. The case studies highlight the issues within the two insurance companies both internally and externally in a nascent and a mature market. Before companies can adopt a transformatory strategy, both companies require a fundamental understanding of strategic change that eventually can pave the way to good risk governance. Adopting the cognitive lens of strategic change will not only enhance company specific risk-based capabilities but it will improve industry risk-based capabilities through development of professional competence.

1. There are two major pieces of work (the Code Review and Sutton) and a number of themes that are the subject matter for this submission. The Insurance Council of Australia appointed me as the Independent Reviewer of the General Insurance Code of Practice, under the Code and the Terms of Reference, on 3 May 2012. 2. The Code Review work took about two years and involved the Code Issues Paper in October 2012 of 111 pages and the Code Review Report in May 2013 of 205 pages. The majority of my recommendations were accepted and the report has made a contribution to the rethinking of self-regulation and the place of voluntary codes in financial services. By then I was writing, with Professor Robert Merkin QC Sutton on Insurance Law for its 4th Edition. It is two volumes, 24 chapters and about 2100 pages excluding tables and index; my contribution was 12 chapters totalling about 960 pages. 3. The Code Review work, particularly on government agency regulation and self-regulation, influenced the pervasive material in Sutton on regulation. It was the subject of the AIDA Rome paper in 2014 on Principles for Self-Regulation; the paper was published by AIDA. 4. Sutton was published in 2015. Its themes are set out below. Those themes are in turn influences in the other work for this submission. There are seven main themes in the publications which I present in this submission. 5. The historical influences in relation to my Code Review and the historical contextual material in Sutton stimulated my interest in the wider influences on the development of commerce, insurance and law, with a central interest in the ethical foundations of the law and regulation. This aspect was also developed in the Masel Lecture and the article William Murray, Lord Mansfield: His Life, Times and Legacy – Good Faith and Good Works. 6. There had been a number of issues raised in my Code Review about mental illness, insurance and discrimination. I spoke at AIDA in Rome 2014 on Insurance Discrimination Law and the paper was published by AIDA. Then in 2016, the Australian Centre for Financial Studies commissioned me to write the ACFS MID Paper on the use by insurers of mental illness data. The historical perspective and the regulatory framework were important features of both papers. 7. A number of the Sutton themes were first opened out in my Professional Indemnity Insurance Law. The main themes were, in decreasing order of connection with Professional Indemnity Insurance Law, as follows. The first theme is the identification, development and application of the indemnity principle. The second is the adaptation and application of the analysis of contracts by primary and secondary obligations. This theme is in Sutton on the main concepts in insurance as well as liability insurance issues. The Liability Disputes Chapter condenses this thinking and account. The third theme was a renovation of how life insurance issues should be analysed and presented. This life insurance material was then adapted and infused with practical guidance on the decision making process on some issues for the FOS Life Insurance Manual. I developed an aspect of life insurance in the TPD Article. Each of these themes are in my submission original in concept and execution. Each has influenced the development of the law by legisation and the courts.

Zurich North America (ZNA) commissioned this report to explore the rapidly evolving climate tech landscape and identify opportunities for the insurance industry to support and capitalize on the growth of key sectors, with a focus on offshore wind and carbon capture and storage (CCS). The report analyzes market trends, risks, and challenges in these sectors and provides actionable recommendations for ZNA to position itself as a leader in the climate tech insurance space. Key Findings: 1. Offshore wind and CCS are poised for significant growth in the coming decades, driven by supportive government policies, technological advancements, and the urgent need to decarbonize the energy sector. 2. The global offshore wind capacity is projected to reach 330 GW by 2030, with the US and European markets leading the way. CCS is expected to play a critical role in achieving net-zero emissions targets, with the potential to capture and store up to 15 Gt of CO2 annually by 2050. 3. Both sectors face unique risks and challenges, including high capital costs, supply chain constraints, regulatory uncertainties, and potential environmental and safety hazards. Insurers can develop specialized expertise and products to effectively manage these risks. Recommendations: 1. Develop tailored insurance solutions for offshore wind and CCS projects, covering construction, operation, and decommissioning phases, as well as third-party liabilities and environmental risks. 2. Invest in data analytics and digital capabilities to better assess and price risks, monitor asset performance, and optimize underwriting processes. 3. Forge strategic partnerships with key stakeholders, including project developers, technology providers, and research institutions, to stay at the forefront of industry developments and collaboratively address challenges. 4. Enhance risk engineering and loss control services to help clients minimize risks and improve project performance, while incentivizing the adoption of best practices and safety standards. 5. Establish a dedicated Climate Tech Insurance Innovation Lab to foster cross-functional collaboration, develop innovative products and services, and explore new business models and revenue streams. Potential Impact: By implementing these recommendations, ZNA can establish itself as the go-to insurer for offshore wind and CCS projects, capturing a significant share of these growing markets. This will not only drive premium growth and profitability but also contribute to the global transition to a low-carbon economy. Additionally, ZNA's expertise and innovative solutions in these sectors can be leveraged to explore opportunities in other climate tech domains, such as solar energy, electric transportation, and energy storage. Ultimately, the climate tech revolution presents a unique opportunity for ZNA to align its business objectives with the urgent need for climate action. By proactively adapting to the changing risk landscape and developing innovative solutions for offshore wind and CCS, ZNA can secure its position as a market leader and make a meaningful contribution to a more sustainable future.

The determinants that affect the financial performance of an insurance company are complicated due to the intangible nature of insurance products and the lack of transparency in the market. Consequently, the financial performance of insurance companies is important to various stakeholders such as policyholders, insurance intermediaries and policymakers. This study aims to investigate the determinants of financial performance of insurance companies based on their financial strength rating performance. The empirical data are drawn from A.M. Best Insurance Report Online: Non- US Database. The sample consists of 57 insurers in the United Kingdom over the period of 2006 to 2010. The analyses include eight firm-specific variables, which are leverage, profitability, liquidity, size, reinsurance, growth, type of business and organisational form. Rating transition matrices and regression models are employed in this study. Rating transition analysis demonstrates a significant degree of rating changes, as reflected in the rating fluctuations. Based on the empirical results, this study establishes that profitability, liquidity, size and organisational form are statistically significant determinants of financial performance of insurance companies in the United Kingdom. This study recommends an alternative to measure the size of an insurance company, which is based on the gross premium written. In addition, this study provides insights into the effects of the global financial crisis on the financial performance of the insurance companies.

Blockchain technology is a public ledger that offers transparency and trust due to “immutable” (unchangeable) and auditable data. The industry for blockchain-based insurance only first reached scale recently. The ability of applications to automatically execute on the blockchain leads to cost reductions and scale advantages. In this thesis, we demonstrate the claims process is more (cost) efficient and transparent however lacks standardization and trustworthiness when benchmarked against traditional insurance products. To address these limitations, we developed the Blockchain Claims Standard Application (BCSA). The BCSA application is a novel solution that enables a standardized approach to claims management for blockchain-based insurance products. Access to the application is available through a user interface as well as ABIs (Contract Application Binary Interface) for integration with existing blockchain-based insurance products. The solution enables improvements for claims management over existing solutions in terms of standardization, efficiency, and trustworthiness to allow the adoption of blockchain-based insurance.

Insurance loss is an unpredicted event that stands at the forefront of the insurance industry. Loss in insurance represents the costs or expenses incurred due to a claim. An insurance claim is a request for the insurance company to pay for damage caused to an individual’s property. Loss can be measured by how much money (the dollar amount) has been paid out by the insurance company to repair the damage or it can be measured by the number of claims (claim count) made to the insurance company. Insured events include property damage due to fire, theft, flood, a car accident, etc. An actuary aims to calculate the probability of an insured event occurring. In this paper we take a set of existing auto insurance data and model it using the Gamma and Weibull distributions. We use method of moments and maximum likelihood estimation to obtain parameter estimates for each distribution. We divide the data into different attributes where we found that the 60+ age group has slightly different shape/scale parameters and there is no real difference between male and female drivers.

The three essays that compose this dissertation are on the topic of risk in agriculture in developing countries, where farmers are completely exposed to these risks. The first two chapters focus on price risk and the third focuses on the risk derived from atypical rainfall levels. In the first essay, I address the impacts of a temporary price support policy (a policy that stabilizes and increases prices), in Peru, on the welfare of farmers it aimed to benefit. I exploit the geographical discontinuity of the policy to casually estimate its impacts using differences-in-differences. I find that although the average potato farmer did not significantly change their total consumption due to the policy, the groups of net consumers, farmers with larger shares of potato on total farm sales, and larger farmers increase their consumption due to the price support. Moreover, I find these positive impacts vanish or become negative one year after the policy implementation, suggesting that price support policies are only effective in the short run and for farmers with certain characteristics. In the second essay, I study the production behavior of farmers when introducing a price insurance, i.e., an insurance that stabilizes prices and increases low prices. To assess the causal and pure impact of price risk and price insurance on production behavior, I run an artefactual lab-in-the-field experiment with farmers in Peru. In the experiment, farmers played three games in random order: a baseline game where only price risk exists and it is introduced randomly; a second game where both price risk and an actuarially fair mandatory price insurance exist; and a third game where price risk and the price insurance exist, but the insurance is voluntary and random discounts (of 0%, 50%, or 100%) on the premium are offered. My results suggest that, on average, (i) price risk does not significantly change production relative to price certainty and (ii) neither does the provision of compulsory insurance against price risk, but (iii) the introduction of voluntary insurance causes the average producer on the market to produce more in situations of price risk than in situations of price certainty. Additionally, I find that even in the absence of premium discounts, the insurance against price risk would have a large (i.e., 70-percent) take-up rate. In the third essay, I study how rainfall shocks (i.e., rainfall deviations from the mean) affect rural labor and child health, and I assess the role of mothers’ time use on child nutrition, among rural families in Uganda. My results show that less rainfall in the last month decreases mothers’ timeshare in housework, increases her share in other household-related activities (e.g., fetching water), and does not change her timeshare at the household farm. Less rainfall in the last month also decreases child nutrition. Nonetheless, using mediation analysis, I find that none of the mother’s time-use variables appears to be a mediating factor between rainfall variability and child nutrition. These results suggest that mothers adjust their time-use due to rainfall variability with the objective of preserving their children’s nutrition levels.

This dissertation consists of three chapters. In chapter 1, I provide a cross-country perspective on the prevalence of market restrictions and review the literature that investigates the misallocation costs of these policies. In chapter 2, I summarize the microdata that I use in the analysis of customary land in Malawi. In this chapter, I also estimate the main objects that are used as inputs into an indirect inference exercise in chapter 3. In chapter 3, I investigate whether replacing use it or lose it land institutions with land markets triggers productivity growth and reallocation of labor towards non-agriculture. I build a model where households face risk in non-agriculture and maintain rights to agricultural land via the principle of use it or lose it. When markets are incomplete but land is easily accessible, households can partially self-insure by returning to agriculture when non-agricultural opportunities fail. As land becomes less accessible, productive farmers disproportionately forgo profitable opportunities in non-agriculture to limit their exposure to uninsurable risk. I use moments from the Malawi microdata to estimate key model parameters via indirect inference. With only 1.3% of landless households accessing land each year in Malawi, the prospect of long landless spells pushes productive farmers to stay in agriculture. I use the model in a policy experiment where land is privatized and landholders at the time of the reform earn income on the land. While the policy yields an increase in aggregate output of 28%, patterns of entry and exit attenuate the productivity gains in agriculture by 16%. Productivity grows by 22% in agriculture and 15% in non-agriculture. Although all households benefit from higher productivity in agriculture, the welfare gains for landless households are on average 10 times lower than those of landowners.

Objective: To evaluate an association between race/ethnicity on healthcare and medication utilization, as well as obesity-related clinical measures across weight categories in patients who are overweight or obese within an employee-based commercial insurance plan. Methods: This retrospective cohort study used administrative claims and electronic health record data from an integrated delivery network in Texas. Patients that were 18 years or older at index, BMI ≥ 25 or greater at index, had continuous health plan enrollment throughout the study period, and did not die during the study period were included in the study. Patients were divided into 4 race/ethnicity groups and categorized by obesity classification. The primary outcome of this analysis was healthcare utilization as measured by inpatient, outpatient, and emergency department visits. Kruskal-Wallis tests and chi-square tests were employed to analyze overall differences in continuous and categorical data, respectively. Results: Among 6,051 patients, 4,384 patients were White, 892 were Black, 439 were Hispanic or Latino, and 336 were categorized as Other. Additionally, 2,386 patients were overweight at index, followed by 1,914 obese class I patients, 928 obese class II patients, and 823 obese class III patients. The composite outcome of outpatient visits, inpatient visits, and emergency department visits were significantly different across race/ethnicity groups for all patients (p

The insurance industry is a very complex segment of the macroeconomy. An explain will be given as to how these companies are able to maintain and maximize their profits, allowing them to remain in business. A key area in this process is the setting of premiums. This activity draws from many areas of the business model. This paper will start with a birds-eye view and telescope in, starting with standard business practices and ending with specific undertakings of insurance companies. Companies must keep adequate liquid funds. This is done mainly through forecasting cash outflows and investing their assets under management. Within the realm of investing, insurance companies also use hedging techniques to maintain a healthy cashflow.

An individual's worldview has an effect on all aspects of their life. Worldview affects the decisions people make, the clothes they wear, the people they interact with, and so much more. What is often overlooked is the impact of worldview on one's view and use of money. Money is universal and everyone has some form of currency or assets. However, the way money is used, whether it is saved, spent, or invested, is often determined by an individual's own concept of money. Additionally, relationships between people are often chosen or influenced by an individual's worldview. Human beings are seen differently through the lens of the culture than they are through the eyes of God or the Bible. Furthermore, in a financial planning relationship between a client and advisor, worldview plays an important role. The purpose of this thesis is to note the impact of worldview in holistic financial planning and analyze the concept of behavioral finance to understand why people make the investment decisions that they do.

PurposeDespite the large number of genetic tests available, their diagnostic yield, and their cost- effectiveness, not all patients have access to genetic tests. One barrier to genetic testing is insurance coverage, as out of pocket costs can be prohibitively expensive. Our current study reviewed and analyzed provider-insurance interactions about coverage of genetic testing in order to determine the frequency and outcomes of these interactions. MethodsWe retrospectively reviewed provider-insurance interactions for 322 patients at CCHMC from 2020-2021. We identified 356 genetic tests for which providers initiated preauthorization. Reported findings include preauthorization outcomes, appeals pursued, and factors associated with preauthorization approval.ResultsThe majority of preauthorization requests were approved by insurance (77.5%). Patient insurance provider and type of genetic test ordered were associated with preauthorization approval (p

The Zurich Insurance Group is a Swiss-based company that is dedicated to being among the most impactful and responsible businesses across the globe. As such, Zurich Insurance was the first insurance company to sign the UN Compact Business Ambition for 1.5 Pledge. That said, Switzerland’s largest insurance company has encountered problems across its employees in their knowledge of and comfort with sustainability and climate change. Zurich Insurance has recognized that to better influence and serve its clients in their transition towards a 1.5C future, its underwriting team needs to be able to understand how sustainability impacts their work. Currently, the firm does not have the ability to advise clients on industry specific transition pathways towards a 1.5C future and is looking to develop a product or service to meet this need. To assist Zurich Insurance in identifying and developing these capabilities, the UM SEAS team conducted primary and secondary research in the project’s three main phases. The first phase of the project involved developing easily interpretable overviews of the transition pathways across ten industries of interest for underwriters to reference. The second phase explored the current state of Zurich Insurance’s underwriting team’s climate change and sustainability awareness. To do this, the UM SEAS team conducted internal interviews with members of the underwriting team and collecting results of an internal survey, After establishing the baseline of Zurich Insurance employees’ knowledge and comfort with sustainability, the team set forth on the final phase of the project, which involved researching and benchmarking best education practices for climate change across academia and companies. Insights gleaned from interviews with academic experts and sustainability professionals guided the team’s recommendations for Zurich Insurance on how to approach engaging and empowering employees in becoming sustainability champions.

This dissertation reconsiders the history of modern architecture through the use of ornament manufactured by dissenter Elanor Coade at her Artificial Stone Manufactory in Lambeth from 1769 to 1821. Tracing the construct of ownership and identity through the ornament of architecture as it was sold internationally by Coade’s mail order catalog, eighteenth-century material experiments in the applied arts and exports from the British Empire reveal a transnational history of modern architecture predicated upon replication, cheapness, and abstraction. Relying upon archival evidence, this dissertation examines experiments in architecture, insurance, and material science which sought to redress defects in nature through the work of intellectual property. Beginning with a study of artificial ontologies and the use of proof in building, artificial stone ornament constructs a history of modern architecture from the intangible substance of experiments that dramatically changes the duration of construction. With the aid of artifice, architecture could be built to exist beyond non-natural durations of time. Following this experimental substance as it was sold through the eighteenth century, this study considers the value of intellectual property as a means to secure both mental and manual labor. In this dissertation, I demonstrate the value of artificial stone ornament to alleviate risk to the built environment from fire, frost, and accident. Lastly, this study examines the curation, exhibition, and exchange of intangible property through craft epistemologies that disseminate technical knowledge across artisans, manufactories, builders, craftspersons, and architects. What at first appears paradoxical reveals a startling reality. The more we know about the risks posed to the built environment, the less capable we are of managing potential catastrophic failure. In the haste to declare Nature defective and capable of replacement by cheaper things made to last longer in the eighteenth century, artificial substances bore the seed of human prosperity and the possibility of our catastrophic demise. Within a political climate fracturing amidst a discourse on the value of facts, the inability to predict total failure becomes imminent. Or, when natural stone becomes replaced by its artificial counterpart, we consign catastrophe to an outdated model.

Background: Public hospitals are expected to provide high quality services and also reduce or maintain the costs. Therefore, every aspect of healthcare service delivery has to be thoroughly examined. One of the ways to conduct a research inquiry into the organisation of healthcare service delivery is to analyse the interactions between healthcare providers. Game theory and the theory of mechanism design have been used to analyse the interactions between different parties that may have a principal-agent relationship. The delivery of healthcare services by public hospitals has policy implications because their activities are controlled by politicians and bureaucrats. Purpose: This study seeks to investigate the strategic interaction-driven organisation or organising of healthcare services delivery by public hospitals by integrating: (a) institutional design, system thinking, and a structure-based approach; and (b) game theory, the theory of mechanism design and the principal-agent paradigm (delegation, policy implementation and bureaucratic capacity). Methodology: This study uses average length of stay (ALOS) data for game theoretic policy implementation modelling. MATLAB was used to operationalise two game theoretic models: (1) a simplified social or prisoner’s dilemma game; and (2) a prisoner’s dilemma game with evolving cooperation in a social network. Findings: The results of the two models presented in this study indicate that the more that hospitals play (interact or engage with each other), the more the defection rate decreases. Also, competition increases due to their interactions because the players’ performance is relative to the maximum points scored at the conclusion of a set of rounds. Therefore, early cooperation increases a player’s scores and also the overall performance, yielding a higher benefit. In a public hospital system, hospitals do not need to compete with each other because all patients are covered by public insurance cover. However, it is in their best interest (and the interests of the general public) that they engage with each other and reduce the policy implementation error (PiE). These results also indicate that the higher the size of a group (N) is, the lower the cooperation rate would be. Theoretical Implications: This research study brings together theories (game theory and the theory of mechanism design) and the three approaches to organisation or organising using game theoretical modelling. This study implicitly advances the goal of innovation in techniques and applications of empirical game theory (with the use of hospital data for simulation) by extending it to the healthcare research domain from computer sciences. It also extends the models of delegation, policy implementation error and bureaucratic capacity to healthcare research. Practical implications: The models used in this research study simulate the results based on average length of stay (ALOS) in a hospital. A reduction in not only reduces spending, it also frees up beds for patients on the waiting list. It could become a foundation of a new regulatory framework. Originality: There have been demands for theory integration both in organisational and healthcare research domains. This study integrates three approaches to organisation, game theory, the theory of mechanism design and the principal-agent paradigm to operationalise two game theoretic models of policy implementation. To the best of the researcher’s knowledge, it is the first game theoretic study on the organisation of healthcare service delivery by public hospitals.

The young adult provision of the Affordable Care Act (ACA) requires health insurance providers to offer dependent child coverage until the child of the enrollee turns 26 years old. The purpose of this provision is to increase health care access to a historically underinsured group. Abramowitz (2017) investigates the effect of the ACA’s young adult provision on the abortion rate. I will build on this foundation by including 2014-2018 data, extending the number of years examined. Using a difference-in-difference regression, I find the effect of the young adult provision on abortion rates to have a larger magnitude over an increased time period. The further decline in the abortion rates, from 2014 to 2018, is attributable to the effects of the young adult provision, not simply a return to the previous trend line.

This dissertation consists of three chapters. In the first chapter, with coauthors Roger Feldman and Stephen Parente, I use a novel data set from a private online marketplace to estimate the demand for individual health insurance among a set comprising many high-income consumers across 18 states. We find that consumers earning more than 4 times the federal poverty level are willing to pay $30 to $135 per month to increase the actuarial value of their insurance by 10 percentage points, much less than low-income consumers. In the second chapter, I show that regulations to address adverse selection and competition policy should be considered complements. To see the relationship, consider the incentive for a firm to offer a product that appeals to low-risk consumers and leads high-risk consumers to purchase insurance elsewhere. This incentive problem, which leads to inefficient consumer sorting, is worst in highly competitive markets and absent in a monopoly. I estimate a model of the individual insurance market by combining the data from chapter one with a risk prediction model to relate preferences to marginal cost. I find that the largest welfare cost in the non-group market comes from high markups. Distortions coming from extensive margin selection and inefficient sorting are significantly addressed by current policies targeting adverse selection which are successful in improving total welfare. However, in the most concentrated markets, insurance firms recapture most of the added surplus through higher markups. In the final chapter, I study the effect of competition on medical consumption through the cost-sharing terms---e.g. copays and coinsurance rates--- of the insurance products. These terms determine the out-of-pocket price of medical care, which affect a patient's medical decisions and thus the patient's health outcomes. Using medical claims data linked to insurance products, I estimate a model of imperfect competition that incorporates adverse selection, moral hazard, and selection on moral hazard. First, I show that, on average, less competition leads to higher levels of cost-sharing but multi-product firms respond by increasing the cost-sharing levels of some products and decreasing others. Second, I find that medical consumption and health respond to cost-sharing terms. A $10 increase in the primary care copay leads to a 5.4% decrease in medical consumption and a 0.1 percentage point increase in inpatient mortality. Putting these results together, I find that a reduction in competition via a merger leads to up to a 4% increase in the primary care copay, an average reduction in medical spending of $17 per person, and an additional six inpatient deaths per year. At estimates of the statistical value of a life, the reduction in spending is more than outweighed by the cost of additional deaths.

Дисертація є першим у вітчизняній науці спеціальним системним дисертаційним дослідженням, в якому проаналізовано теоретико- правові і практичні проблеми запровадження страхування професійної відповідальності адвоката і шляхи його удосконалення. Аргументовано доцільність застосування конструкції «професійна відповідальність адвоката» і запропоновано авторські визначення «професійна відповідальність адвоката» та «страхування професійної відповідальності адвоката». Сформульовано визначальні риси страхування професійної відповідальності адвоката та запропоновано критерії класифікації страхування професійної відповідальності адвоката на моделі. Здійснено комплексне дослідження сутності кожного із структурних елементів договору страхування професійної відповідальності адвоката, запропоновано механізм позасудового порядку виплати страхового відшкодування шкоди клієнтові. Обґрунтовано основні шляхи удосконалення законодавства про адвокатуру та адвокатську діяльність з метою запровадження страхування професійної відповідальності адвоката.

The implementation of autonomous vehicles, or self-driving cars, promises to radically change much of the normal way of life. While it may seem inconsequential to start small with a vehicle of relatively low level of automation, there are many factors to consider. Some of these factors include security, moral dilemmas, and even the insurance field. One can look back at previous implementations of new technology, such as air bags, and see that it can be difficult to predict consequences and adapt. However, actuaries have been suggesting solutions to make autonomous vehicles a safe reality. While the solutions may vary, one thing is clear: communication between the vehicle and the insurance field is imperative.

BACKGROUND: The utilization of genomics in healthcare has increased rapidly over the last decade, making the diagnosis of complex genetic conditions more achievable than ever before. However, many barriers to genetic testing utilization exist including financial barriers in the form of payor denial. The lack of coverage impacts patients’ ability to undergo genetic testing, particularly exome sequencing (ES). Reasons often cited for payor denial of ES include financial burden coupled with lack of data supporting clinical utility. In Ohio, Children with Medical Handicaps (CMH) is a government-funded organization which provides supplemental financial aid when insurance providers deny payment coverage or out-of-pocket costs are high, increasing access to care for Ohioans under the age of 21. Although research exists regarding the diagnostic yield of ES and its impact on medical management, there is minimal information about the impact of financial barriers on accessibility of ES. The purpose of this study was to determine if utilization of CMH helped obtain ES services by overcoming insurance barriers within a single institution’s pediatric population.METHODS: A retrospective chart review was conducted comparing the reported results of clinical ES in patients who had testing covered by insurance to those who utilized CMH. The study sample consisted of Ohio residents 21 years or younger who had ES completed as an outpatient at the Steve and Cindy Rasmussen Institute for Genomic Medicine at Nationwide Children’s Hospital between January 1, 2017 to December 31, 2019.RESULTS: For patients who had ES performed and met inclusion criteria (n=488), 256 (52.5%) were approved for coverage of testing by insurance and 232 (47.5%) were denied coverage. Among those who utilized CMH coverage as an alternative way to pay for ES when faced with financial barriers (n=193), 84 (43.5%) received a pathogenic or likely pathogenic result related to their phenotype compared to 27 (18.2%) who had testing coverage approved by insurance (n=148) (p < 0.001). CONCLUSION: These data demonstrate that around 29% (84/288) of this pediatric population may have not received diagnostic results due to insurance barriers if the option of supplemental CMH coverage was not available. These results highlight the impact of insurance barriers and validate the important role CMH plays in overcoming these barriers present in a pediatric population undergoing ES. Not only could this information be used to justify insurance coverage by outlining diagnoses missed due to insurance barriers, it can also be used as a template for other state legislatures to promote access to genetic testing services by offering government-funded supplemental coverage such as CMH.

Chronic disease is a growing burden in the United States. The greatest risk factors for the leading causes of death include high BMI, high fasting plasma glucose, high cholesterol and kidney disease known as cardiometabolic risk factors. Behavioral interventions are recommended by leading professional health groups in doses ranging 12-26. Ideally, chronic diseases are best managed in primary care settings, but primary care providers report barriers to providing nutrition counseling. Registered Dietitian Nutritionists (RDN) are experts skilled at facilitating lifestyle modification through the practice of medical nutrition therapy but are not often employed in primary care settings. There is a paucity of research regarding referral and appointment types for RDNs. This IRB exempt study identified 3,770 referrals for 3,599 individual patients that resulted in 8,576 appointment types with a 46% completion rate. Overall, $904,605 were charged for 9,548 units of service with a 36% collection rate which covers salary costs for the average mid-western RDN.

The US healthcare system faces numerous challenges. In this dissertation I study issues of access to care, healthcare costs, and responses to the opioid epidemic. I take an applied economic approach, using causal inference methods to examine the effects of recent policies and changes to landscape of healthcare providers. In the first chapter, I study urgent care centers (UCCs), which provide timely care for nonchronic, low-severity health conditions. Over the past decade, UCCs have disrupted the market for outpatient healthcare. The entry of these new providers may reduce healthcare spending by diverting care from higher cost emergency departments. Alternatively, if UCC entry increases healthcare utilization, total spending may increase. I use administrative insurance claims data from Massachusetts to estimate the effect of UCC entry on healthcare utilization and spending. The data span 2012 to 2015, during which the number of UCCs increased by 88 percent. In the months immediately following UCC entry, patients substitute away from other outpatient providers. Patients substantially reduce visits to physician offices and outpatient clinics, and slightly reduce visits to emergency departments. Overall, UCC entry increases the efficiency of the healthcare system. Aggregate spending appears to modestly decline, while in areas with few primary care providers, UCC entry increases the total number of healthcare visits. The second chapter examines the effect of insurance coverage on utilization of prescription drugs that treat ADHD. It uses a regression discontinuity design that exploits the change in eligibility for dependent insurance coverage at age 26. From 2014-2017, the probability of insurance coverage decreased by 5 percentage points at this threshold. I examine the effect on central nervous system stimulant expenditures using an administrative database that captures all prescriptions filled at Kentucky pharmacies. At the eligibility threshold, the probability of purchasing a prescription drops by 5-7 percentage points and expenditures fall by 18-27 percent. Only 30 percent of the decrease in prescriptions purchased with insurance is offset by an increase in prescriptions purchased out-of-pocket. People also decrease expenditures by switching from branded medications to a category of similar generics that costs $104 (43 percent) less per prescription. The probability of filling a prescription recovers as people regain insurance, but decreases in expenditures persist longer-term. The third chapter studies opioid control policies that target the prescribing behavior of health care providers. In this chapter, (co-authored by Thomas Buchmueller and Colleen Carey), we study the first comprehensive state-level policy requiring providers to access patients' opioid history before making prescribing decisions. We compare prescribers in Kentucky, which implemented this policy in 2012, to those in a control state, Indiana. Our main difference-in-differences analysis uses the universe of prescriptions filled in the two states to assess how the information provided affected prescribing behavior. We find that a significant share of low-volume providers stopped prescribing opioids altogether after the policy was implemented, though this change accounted for a small share of the reduction in total volume. The most important margin of response was to prescribe opioids to fewer patients. While providers disproportionately discontinued treating patients whose opioid histories showed the use of multiple providers, there were also economically-meaningful reductions for patients without multiple providers and single-use acute patients.

Product and data science teams for the auto insurance industry have been trying to increase pricing segmentation with validated rating variables to decrease rate subsidization. The criminal background data availability provided a new behavior variable to test against insurance-based credit scores as a potential predictive variable in the generalized linear rating model. Criminal background was analyzed using a Poisson Log Linear model and other key insurance rating variables for predicting loss costs. The study supported the inclusion of the criminal background data in combination with insurance-based credit score as the variable’s addition could improve the overall fit of the predictive model. The study also acknowledged there was a statistically significant association between criminal background and insurance-based credit score, but the overall size of the effect was small and weak. The overall contribution of value criminal background variable needs to be considered with a full rating dataset to determine if other, less powerful variables could be removed from the generalized linear to reduce the overall model complexity.

In this paper we will examine how to apply parametric modeling with some simulation techniques to generate potential frequency and severity of claims distributions. The paper outlines the general theory of selecting appropriate statistical distributions for claims data and in maximizing model accuracy or fit. Two specific exposures, critical customer loss and supply chain disruption loss, are used as illustrations. From these distributions, an aggregate loss model is then proposed. The paper will discuss: 1. Possible ways to develop claims data from available market information for obscure insurance risks with application to specific examples. 2. Outline of the theory of parametric estimation. 3. Applying primarily parametric techniques to optimize the ‘fit’ of the estimated distributions for severity and frequency of claims distributions. 4. Development of possible aggregate loss models for the two specific exposures. 5. Proposed areas for further study.

This dissertation consists of three essays that evaluate how consumers make decisions in settings where the researcher may not know the set of alternatives from which observed choices were selected. Many empirical analyses in economics presume the researcher knows the full set of alternatives an individual compared when selecting their most preferred. In practice, this assumption may fail to hold for a variety of reasons. In the first chapter, I introduce the economic setting of unobserved choice sets and consideration sets defining to this work. In the second chapter, my coauthors and I propose a robust method of discrete choice analysis when agents' choice sets are unobserved. Our core model assumes nothing about agents' choice sets apart from their minimum size. Importantly, it leaves unrestricted the dependence, conditional on observables, between agents' choice sets and their preferences. We first establish that the model is partially identified and characterize its sharp identification region. We then apply our theoretical findings to learn about households' risk preferences and choice sets from data on their deductible choices in auto collision insurance. The third chapter evaluates the prescription drug insurance choices of Medicare beneficiaries. I propose an empirical model of demand for prescription drug plans where non-monetary plan attributes stochastically determine the composition of the set of plans that an individual considers, and monetary plan attributes determine the individual's expected utility over contracts in her consideration set. This model reconciles the classic view of insurance contracts as lotteries with purely monetary outcomes with the empirical finding that choice among insurance plans is driven by their non-monetary attributes and financial attributes beyond their impacts on costs. I estimate the model using data from Medicare Part D allowing for unobserved heterogeneity in risk aversion and in consideration sets. I find that the latter plays a crucial role in plan choices, and in contrast to previous literature that assumes full consideration of all plans, I uncover an important role for risk aversion in determining individual choices.

Climate change is the paramount challenge of today for a sustainable future. Mitigation of greenhouse gas (GHG) emissions is necessary to reduce the associated risks and impacts on society. Using the EPA’s SIT and literature review, comprehensive GHG-emissions inventories were developed for the state of Nebraska over 25 years (1990-2015) and agricultural GHG emissions inventories were developed for the Midwest U.S for one year (2016). Nebraska’s net emissions increased from 56.2 million metric tons of carbon dioxide equivalent (MMtCO2e) in 1990 to 87.4 MMtCO2e in 2016. Agriculture was found to be the sector with the most emissions (36 MMtCO2e), primarily from beef cattle, followed by electricity generation (21 MMtCO2e), primarily from coal. Total emissions in Nebraska were found to be 47.4 MtCO2e per capita in 2015, compared to 20.6 in the U.S. due to concentrated agricultural emissions and low population. Total agricultural GHG emissions per state in the Midwest in 2016 were found to range from 10.3 MMtCO2e (Michigan) to 41.0 MMtCO2e (Iowa), with an average of 23.3 MMtCO2e. In 2016, Wisconsin was the least efficient state (0.86 MtCO2e/kg product) and Illinois was the most efficient (0.34 MtCO2e/kg product) in terms of emissions per product, which aligned with these states having the highest (71.5%) and lowest (21%) percentage of livestock out of total agriculture. Agricultural emissions per capita ranged from 1.0 MtCO2e (MI) to 26.2 MtCO2e (SD), driven by cattle and state population. A review of literature was also conducted to explore the interactions between climate change and the insurance industry. Climatic events accounted for 91% of $1.05 trillion in insured costs for global catastrophic events from 1980 to 2016. Insurance feedbacks in response to disaster events caused by climate change include changes in 1) premiums and insurance policies, 2) non-coverage, and 3) policy making and litigation. Alongside a suite of strategies, including government policies, insurance feedbacks could be used to facilitate and manage climate change mitigation. Advisors: Adam Liska and Michael Hayes

This thesis will investigate the growing problem of head trauma in contact sports like football, hockey, and soccer through medical studies, implications to the insurance industry, and ongoing litigation. The thesis will investigate medical studies that are finding more evidence to support the claim that contact sports players are more likely to receive head trauma symptoms such as memory loss, mood swings, and even Lou Gehrig’s disease in extreme cases. The thesis will also demonstrate that these medical symptoms and monetary losses from medical claims are convincing insurance companies to withdraw insurance coverage for sports leagues, which they are justifying through mathematics. Finally, the thesis will explore the ongoing litigation against sports leagues for alleged negligence against their players and their failure to communicate the sports’ dangers to their players

Policymakers need to rediscover the organizational form of business entity as a tool of financial regulation. Recent and classic scholarship has produced evidence that financial institutions organized as alternative entity forms – including investment bank partnerships and banks and insurance companies organized as mutual or cooperatives – tend to take less risk, exploit customers/consumer less, or commit less misconduct compared to counterparts organized as investor-owned corporations. This article builds off the work of Hill and Painter on investment banks organized as partnerships, Hansmann on the history and economics of banks and insurance companies organized as mutuals and cooperatives, and other scholars. Encouraging either financial institutions to convert to alternative entity forms or more capital and business to flow to these firms can mitigate systemic risk, dampen risk-taking, and further consumer protection. Systemic risk can also be mitigated by organizing firms across a financial industry in an entity that mutualizes risk and encourages firms to police one another’s conduct. Omarova’s and Saguato’s work in this vein recalls the bank clearinghouse of the 19th century. The entity form furthers these policy objectives without the need for policymakers to specify standards for conduct. Instead, alternative entity forms work by changing the relationships among various claimants on the firm and the firm’s management. Beyond control and liability rules, alternative organizational forms affect manager behavior by changing the identity of the residual claimant on the firm. Management behavior shifts because they are not responsive to investors whose principal interest is maximizing their return on capital. Alternative entity forms may come with agency costs, as the residual claimants face difficulty in organizing collectively to monitor and discipline management. However, evidence from mutual insurance companies suggests that agency costs are not severe. Other costs associated with partnerships, mutuals, and collectives include limitations on the ability of firms to raise capital. However, this drawback has the benefit of creating an embedded check on the size and complexity of financial firms and providing an alternative to breaking up large financial conglomerates for too-big-to-fail and other concerns. Similarly, alternative entities better serve the interests of residual claimants when those claimants have homogenous interests, creating disincentives for firms to expand across business lines. Policymakers could encourage financial firms to convert their organizational form or promote more capital or business flowing to alternative entities by providing or restoring historical tax incentives or creating regulatory preferences in the policy areas in which alternative entities outperform investor-owned corporations. In some cases, such as risk-adjusted deposit insurance premiums, regulators may be required to provide this treatment. Regulators and prosecutors should consider requiring financial institutions that have committed serious violations of laws to convert to an alternative organizational form as an alternative to imposing fines or revoking a charter or license.

PURPOSE: Retinal and choroidal ischemic retinopathies such as retinal-vein occlusion (RVO), diabetic retinopathy (DR), and age-related macular degeneration (AMD) are ocular diseases caused by abnormal changes in the microvasculature. The ischemia can lead to macular edema or neovascularization, which can affect vision. Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) can help to reduce macular edema and improve visual acuity. Lost to follow-up (LTFU) after anti-VEGF injections increases the risk of vision loss in patients with RVO, DR, and AMD. METHODS: Patients scheduled for an IVI of anti-VEGF between September 2009 and September 2019 with either RVO, DR, or AMD were included in the analysis. LTFU was defined as missing an appointment without another evaluation for at least one interval exceeding 180 days. All patients were seen by a single provider at an urban, hospital-based, single-site retina practice in Boston, MA. RESULTS: Among the 698 patients (mean [SD] age, 70.23 [14.2] years; 373 [53.4%] female) identified as receiving an IVI, 121 (17.3%) were LTFU. Age was not found to be statistically different between the LTFU and not LTFU groups (mean difference, -1.67; 95% CI, -4.66¬–1.32; P=.27). Odds of LTFU was lower among patients with AMD (odds ratio [OR], 0.57; 95% CI, 0.36-0.92; P=.02). Odds of LTFU was greater among patients with Medicaid insurance (OR, 2.31; 95% CI, 1.22-4.33; P=.01), compared with patients with Medicare insurance. A trend towards higher risk of LTFU was seen in patients with DR (OR, 1.42; 95% CI, 0.94-2.15; P=.09) and a toward lower risk in patients with two or more eye diseases (OR, 0.53; 95% CI, 0.24-1.15; P=.10). Medicaid insurance was the only significant (P=.02) independent risk factor of LTFU in the multivariate regression. CONCLUSION: We found a high rate of LTFU after anti-VEGF injections among patients with RVO, DR, AMD, and identified risk and protective factors associated with LTFU among this population. Although our results may not be generalizable, data on LTFU in a clinical practice setting are needed to understand the scope of the problem so that interventions may be designed to improve outcomes.

Climate action failure, extreme weather, natural disasters, biodiversity loss and human-made environmental disasters all rank as top 10 business risks in both magnitude of impact and likelihood (WEF, 2020). This reality presents a myriad of challenges and opportunities for the private sector. The insurance sector, in particular, is in a unique stakeholder position to understand, predict, model and react to the emerging and evolving risks that accompany climate change. Insurers play two key roles for the purposes of this discussion, as both risk managers actively protecting global assets, and as long-term investors, funding the future of our economy (Golnaraghi, 2018). These factors make the insurance industry a critical part of the climate change adaptation and resiliency solution landscape. Zurich Insurance is one insurance company at the epicenter of this issue. Working in collaboration with Zurich Insurance, our team explored corporate climate risk management strategies and the role that insurance companies, as service providers, can play to support these transitions. Special attention was paid to climate risk disclosure processes and physical and transition risks and opportunities. Through secondary research, we analyzed academic literature, sector-specific frameworks, company reports, and countless other sources on climate change risks and management approaches. Additionally, we researched climate adaptation best practices, capability maturity models, insurance sector strategies in advancing climate resilience, and corporate climate risk management. We also consulted with over 20 subject-matter experts at Zurich Insurance and other organizations involved in the climate risk value chain. To answer this research question, our team developed a climate risk maturity model and leadership model, built from guidelines and best practices, including TCFD resources, that can be used by companies to assess their readiness to identify and address climate risks and opportunities, and to identify gaps in their capability. Building from the climate risk maturity model, our team then identified more than 100 key organizations in the evolving climate risk value chain. A value chain can be defined as a connected series of organizations and areas of expertise involved in the development and delivery of value to end customers (Oxfam, 2012). For this context, the climate risk value chain is composed of data providers, risk insights providers, research and thought leadership organizations, advisory and consulting firms, risk engineering firms, and knowledge hubs. The climate risk value chain enabled our team to analyze the feasibility and benefits of creating an ecosystem of service providers that corporations can collaborate with to fill gaps in their climate risk management approach, as identified through their assessment using the climate risk maturity model. This research fills a critical gap in the literature on climate risk management and climate adaptation aimed at the private sector. Moreover, the perspective of financial-sector stakeholders, like investors and insurance firms, can offer a strategic angle and interest area for companies to act.

This dissertation consists of three essays examining the role of risk diversification in European markets. At the economy level the first two essays seek to identify whether economic integration efforts among European countries result in sharing risks to consumption with regional neighbors, as opposed to global partners. At the firm level, the third essay seeks to understand whether managers of large companies in the United Kingdom choose less financial leverage if they are specifically compensated with more cash bonus as opposed to other forms of performance incentives. In Essay 1, I assess the extent to which European countries diversify consumption risks and share them both within the European region and with major non-European countries. I identify that an empirical model can be obtained from a standard theoretical risk sharing framework, that allows for a direct evaluation of the extent of dependence of a country's own consumption on its own output growth, on regional output growth, and on output growth of the rest-of-world (ROW). The empirical model helps to understand whether growing European regional economic integration changes the patterns of regional and world risk sharing. Using data for 45 European and 15 ROW countries over the 1960 - 2017 sample period, I find that higher levels of risk sharing are associated with growing European Union (EU) and Eurozone (EZ) membership, but Europe's risk sharing with the ROW declines, a possible "competition effect." In Essay 2, I point out how the long run average increase in risk sharing due to growing financial integration is often taken as given. Yet decoupling financial integration from economic integration at large may lead to very conflicting consequences on risk sharing for economically integrated countries. Using stock, money and bond markets, as well as industrial production and CPI data for European countries, I show that financial integration and real integration point in different directions, minimizing the ability to share consumption risks within Europe. Specifically I find that the European Central Bank may have made progress towards integrating money and bond markets, but stock markets are still highly globally influenced. Also real integration in production and prices is low and do not differ among advanced EU and non-EU countries. The findings give a new perspective as to why inter-country consumption risk sharing appears low in several empirical studies. Finally, in Essay 3, the aim of the study is to investigate whether managerial earnings-based incentive influence firms' leverage policy and the extent to which this relationship is conditional on the firm earnings performance. Further, we show how firms' growth opportunities affect managerial cash compensation - leverage relationship. The paper utilize a sample of 213 non-financial and non-utility U.K. FTSE350 firms for the period 2007 – 2015. In examining these issues, we employ several econometric techniques: OLS, FE, Predicted method, and three-stage least squares (3SLS) to robustly deal with the existing leverage – cash bonus simultaneity problem. We find empirical support for our theoretical contention that managerial cash bonus induces managers to implement lower leverage policy. We further observe that the effect of managerial cash bonus on leverage is more pronounced in a well-performing firm. In addition, we find that cash-motivated executives with huge unexploited growth opportunities tend to keep low leverage level. Overall, our analyses show that the widespread usage of earnings-based incentives in the U.K executives’ compensation contract, partly explains the conservative debt policy of the U.K firms.

This dissertation examines the operation of Islamic insurance (Takaful) in the Kingdom of Saudi Arabia. Its focus is on business and retail insurance. Health and life insurance which involve unique considerations are not considered. Islamic insurance had been debated since 1961 and was accepted only very recently by the International Islamic Fiqh Academy (IIFA) conference held in Saudi Arabia in 1985. The first Takaful insurance company was officially established in Sudan in 1979. Consequently, the principles and standards that govern Takaful are still being established in Islamic scholarship with no uniform or fixed Takaful standards accepted by all Islamic countries at this point in time. A key issue for the thesis is how Takaful can operate under the umbrella of a joint-stock company (required by legislation) whilst simultaneously maintaining Sharia compliance. Takaful principles, unlike conventional (commercial) insurance, do not involve risk transfer, and policyholders share risk under the mutuality principle. Takaful principles set strict rules relating to profit sharing, and give primacy to the interests of policyholders. The modern conventional stock company, in contrast, operates for profit and has a duty to act in the best interests of its shareholders. The main focus of this thesis is whether Takaful insurance as practiced in Saudi Arabia is Sharia-compliant. To answer this question, this thesis critically analyses Saudi insurance laws and regulations, Saudi insurance companies, and Takaful principles based on Sharia (Islamic law). A general finding of this thesis is that Saudi insurance laws and insurance companies do not appear to be in the line with Takaful principles and that the operation of Takaful under joint-stock companies (JSCs) is problematic to the point where it is probably impossible to achieve in practice. There is the added problem that Takaful principles are not enforced or implemented in practice. This poses particular difficulties for the Saudi insurance market, as Saudi insurance laws require insurance companies to operate though JSCs and to comply with Sharia.

This dissertation consists of three essays on the U.S. Health care policy. Each paragraph below refers to the three abstracts for the three chapters in this dissertation, respectively. I provide quantitative evidence on how much Prescription Drug Monitoring Programs (PDMPs) affects the retail opioid prescribing behaviors. Using the American Community Survey (ACS), I retrieve county-level high dimensional panel data set from 2010 to 2017. I employ three separate identification strategies: difference-in-difference, double selection post-LASSO, and spatial difference-in-difference. I compare how the retail opioid prescribing behaviors of counties, that are mandatory for prescribers to check the PDMP before prescribing controlled substances (must-access PDMPs), vary from the counties where such a PDMP check is voluntary. I find must-access PDMP reduces about seven retail opioid prescriptions dispensed per 100 persons per year in each county. But, when I compare must-access PDMPs counties with bordering counties without such law, I find a reduction of three retail opioid prescriptions dispensed per 100 persons per year suggesting the possibility of spillovers of retail opioid prescribing behaviors. As of 2019, all U.S. states, except Missouri, have enacted voluntary Prescription Drug Monitoring Programs (PDMPs). In response to the relatively low uptake of voluntary access, several states have strengthened their PDPMs by requiring providers to access information regarding prescription drug use under certain circumstances. These “must-access” PDPMs require states to view a patient's prescription history to facilitate the detection of suspicious prescription and utilization behaviors. This paper develops causal evidence of the effectiveness of “must-access PDPM laws in reducing prescription opioid overdose death rates relative to voluntary PDMP states. I find that PDMPs are ineffective in reducing prescription opioid overdose deaths overall, but the effects are heterogeneous across states with “must-access” PDMP states. I find that marijuana and naloxone access laws, poverty level, income, and education confound the impact of must-access PDMPs on prescription opioid overdose deaths. The optional provision of Medicaid expansion, through the Affordable Care Act (ACA), has triggered a national debate among diverse stakeholders regarding the impacts of Medicaid coverage on various dimensions of public health, costs, and benefits. Randomized experiments like the Rand Health Insurance Experiment and the Oregon Health Insurance Experiment have generated some credible estimates of the average treatment effects of insurance access. However, identical policy interventions can have heterogeneous effects on different subpopulations. This paper uses data from the Oregon Health Insurance Experiment to estimate the heterogeneous treatment effects of access to Medicaid on health care utilization, preventive care utilization, financial strain, and self-reported physical and mental health. I detect heterogeneous treatment effects using a cluster-robust generalized random forest, a causal machine learning approach. I find that the impact of Medicaid is more pronounced among relatively older non-elderly and poorer households, consistent with standard adverse selection theory. Furthermore, I implement the “efficient policy learning," another machine learning strategy, to identify policy changes that prioritize providing Medicaid coverage to the subgroups that are likely to benefit the most. On average, the proposed reforms would improve the average probability of outpatient visits, preventive care use, overall health outcomes, having a personal doctor and clinic, and happiness by a range of 2% to 9% over a random assignment baseline. These findings help design Medicaid Section 1115 waiver.

The addition of decentralised, renewable energy generation to the electric power system helps reduce the overall carbon intensity of electricity; however, the variability in energy supply also creates operational challenges within the electricity network and can increase the risk of power outage if not properly managed. Electrical energy storage has the potential to provide back-up supply as well as other electricity services. Here, the value of back-up energy is quantified by calculating the difference in expected cost of outage provided by given energy reserve, a novel contribution in the field of energy storage optimisation. For the case of a small aluminium smelter in Australia’s National Electricity Market, considering the risk of power outage has little impact on the private investment decision or on operating strategy except in the most extreme cases, such as where the smelter were uninsured and the network degraded ten times beyond currently forecast conditions. This conclusion was reached using a linear programming optimisation model and consistent for the 12 technologies tested, including when accounting for forecast technological developments. Nonetheless, for cases where energy storage is available, minimal changes to the operating strategy could provide significant reductions in the expected cost of outage. This finding has novel implications for insurance providers, who could benefit from risk reduction across their portfolios by requiring small operational changes during high-risk periods. Generally, the study underlines the importance of a reliable energy supply in transitioning Energy-Intensive Industry (EII) from on-site thermal generation to network-based electric power supply and highlights some of the outstanding challenges inhibiting such a change.