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ABSTRACT This article calls attention to a difficulty with insurers' investment policies that seems to have been overlooked so far. There is the distinct possibility that insurers cannot satisfy the [...]

The use discrete-choice experiment to examine consumers' choice of products in the health care sector and their spending behavior is discussed.

I. Introduction Competition policy with regard to vertical restraints has been guided by the jurisdiction of the United States, and more recently, the European Union as well. As to the [...]

ABSTRACT Insurers traditionally use risk-specific characteristics of insureds to classify them according to risk. In this article, the practical relevance of information about multiple risks is demonstrated for the case [...]

Individuals must use their health, wealth and intelligence to make decisions about procuring roptimal health care. Public and private insurance programs in the US and several other countries are examined.

A principal-agent framework was utilized to analyze the unsuccessful market of long-term care (LTC) insurance in major developed countries. The framework revealed that the amount of LTC supplied by major caregivers tend to depreciate as a result of parent's LTC insurance purchase. Such outcome forces parents to give up the idea of purchasing LTC coverage in several situations.

Publicly provided long-term care (LTC) insurance with means-tested benefits is suspected to crowd out either private LTC insurance (Brown and Finkelstein 2008. The Interaction of Public and Private Insurance: Medicaid and the Long-Term Care Insurance Market. American Economic Review98(3):1083–102), private saving (Gruber and Yelowitz 1999. Public Health Insurance and Private Saving. Journal of Political Economy107(6):1249–74; Sloan and Norton 1997. Adverse Selection, Bequests, Crowding Out, and Private Demand for Insurance: Evidence from the Long-term Care Insurance Market. Journal of Risk and Uncertainty15:201–19), or informal care (Pauly 1990. The Rational Non-purchase of Long-term Care Insurance. Journal of Political Economy95:153–68; Zweifel and Strüwe 1998. Long-term Care Insurance in a Two-generation Model. Journal of Risk and Insurance65(1):13–32). This contribution predicts crowding-out effects for both private LTC insurance and informal care on the one hand and private saving and informal care on the other. These effects result from the interaction of a parent who decides about private LTC insurance before retirement and the amount of saving in retirement and a caregiver who decides about effort devoted to informal care. Some of the predictions are tested using a recent survey from China.

A simple model of bank behaviour is shown to have implications for solvency regulation of the Basel type. The investment division seeks to maximize RORAC, with higher solvency S lowering the cost of refinancing but tying costly capital. In period 1, exogenous changes in expected returns dμ¯ and in volatility dσ¯ occur, causing optimal adjustments dS*/dμ¯ and dS*/ dσ¯ in period 2. In period 3, the actual adjustment dS* creates an endogenous trade-off with slope dμ^/dσ^. Basel-type regulation modifies this slope, inducing senior management to opt for a higher value of σ in several situations. Solvency regulation can thus run counter its stated objective.

Best-Worst Scaling (BWS) is a method of multi-attribute preference measurement. Its objective is to determine the preferences with respect to certain properties and characteristics. It is a stated preference method and based on the assumption that people are able to select the best and worst or subjectively most and least important from a set of three or more elements. BWS avoids, like all discrete choice experiments, the known weaknesses of rating and ranking scales. However, BWS promises to generate additional information because participants choose two times, namely the best as well as the worst alternative. This paper describes the potentials of application, the underlying theoretical concepts, and the implementation of the three variants of BWS experiments. It also shows that at least the second variant of BWS (the so-called profile case) is subject to restrictive and unrealistic assumptions.

This study seeks to provide evidence for deciding whether or not a new preparation for the treatment of diabetes should be included in the benefit list of social health insurance. A discrete-choice experiment (DCE) was conducted in Germany to measure preferences for modern insulin therapy using long-acting insulin analogue “insulin detemir” in comparison to NPH insulin. The DCE contains two price attributes, co-payment and increased contributions to health insurance, as well as four properties of the insulin, i.e. risk of hypoglycemia, weight gain, need for preparing the insulin before injection, and flexibility in time of the injection. Of the 1,110 individuals interviewed in 2007, 202 suffered from type 1, 154 from insulin-treated type 2, and 152 from insulin-naive type 2 diabetes. This allows to compare ex-ante and ex-post willingness-to-pay (WTP). Non-diabetics and insulin-naive diabetics exhibit higher WTP values through co-payment, while affected type 1 and insulin-treated type 2 diabetics have higher WTP through increased contributions. However, WTP values exceed the extra treatment cost in both financing alternatives, justifying inclusion of the new drug in the benefit list from a cost-benefit point of view.

Das Ziel dieser Arbeit besteht in der Untersuchung der Skaleneffizienz von Gebietskörperschaften (Kantonen) in der Schweiz. Dazu dient eine Data Envelopment Analysisfür den Untersuchungszeitraum von 2000 bis 2004. Als Output werden aggregierte Outputindikatoren von vier öffentlichen Aktivitäten (Verwaltung, Bildung, Gesundheit, Verkehr) verwendet, um für die 26 Kantone technische Effizienzwerte und Skaleneffizienzwerte zu bestimmen. Die Resultate lassen vermuten, dass die Kantone in den vier untersuchten Aktivitäten keine Skalenerträge aufweisen. Dies widerspricht dem aktuellen Trend zugunsten einer Zentralisierung öffentlicher Aufgaben und spricht für die Möglichkeit, mittels Tiebout-Wettbewerb zwischen den Schweizer Kantonen die Wohlfahrt der Bürger zu verbessern.

The development of human papillomavirus (HPV)-related diseases is not understood perfectly and uncertainties associated with commonly utilized probabilistic models must be considered. The study assessed the cost-effectiveness of a quadrivalent-based multicohort HPV vaccination strategy within a Bayesian framework.

Background:Discrete-choice experiments (DCEs), while becoming increasingly popular, have rarely been tested for validity and reliability.

Background:A uniform package of benefits and uniform cost sharing are elements of regulation inherent in most social health insurance systems. Both elements risk burdening the population with a welfare loss if preferences for risk and insurance attributes differ. This suggests the introduction of more choice in social health insurance packages may be advantageous; however, it is widely believed that this would not benefit the elderly.

Health care may be similar to the work Sisyphus, a Greek hero who was condemned by the Gods to push a big rock up a hill only to see it slip out of his hands before making it to the top. To see why there my be a Sisyphus syndrome in health, consider an initial decision to devote more resources to health. The likely consequence is an increased number of survivors, who exert political pressure in favor of even more health care. If they succeed, the cycle goes into its next round and might even prove explosive. Earlier research failed to identify this political feedback in industrial countries. Using improved model formulation, data, and econometric methodology, this contribution does find evidence suggesting the existence of a Sisyphus syndrome. However, the good news is that the cycle seems to be dampened rather than explosive.

Ein erklärtes Ziel der Sozialpolitik ist es, aus temporärer keine permanente Armut werden zu lassen. Diesem Ziel steht häufig die Verschuldung des Haushalts entgegen, die zur Zeit im Zuge der Lohnpfändung dazu führt, daß das Einkommen, welches das betreibungsrechtliche Existenzminimum übersteigt, zu 100 % gepfändet wird. Davon dürften negative Auswirkungen auf das Arbeitsangebot des Schuldners ausgehen, weshalb zwei Reformvorschläge im Vordergrund stehen: Die Flexibilisierung des Existenzminimums und die vorzeitige Restschuldbefreiung. Numerische Berechnungen eines dynamischen Modells des Schuldnerverhaltens geben Anlaß zur Vermutung, daß diese Reformvorschläge keine Besserstellung sowohl der Schuldner wie auch der Gläubiger und der Steuerzahler (Pareto-Verbesserung) bewirken dürften.

The German Statutory Health Insurance System (Gesetzliche Krankenversicherung) has been in a continuous reform process for the past twenty years. Therefore this economic policy forum is assigned to the question: Health reform: End of the crisis or never-ending crisis?

This paper studies the relationship between health care expenditure (HCE) and age, using longitudinal rather than cross‐sectional data. The econometric analysis of HCE in the last eight quarters of life of individuals who died during the period 1983–1992 indicates that HCE depends on remaining lifetime but not on calendar age, at least beyond 65+. The positive relationship between age and HCE observed in cross‐sectional data may be caused by the simple fact that at age 80, for example, there are many more individuals living in their last 2 years than at age 65. The limited impact of age on HCE suggests that population ageing may contribute much less to future growth of the health care sector than claimed by most observers. Copyright © 1999 John Wiley & Sons, Ltd.

Zusammenfassung Im Gesundheitswesen wird die Existenz einer Kosten-Versicherungs-Spirale vermutet, die aus drei Einzelzusammenhängen besteht. Neben dem subjektiven Gesundheitszustand beeinflusst erstens der Versicherungsschutz die Wahrscheinlichkeit, mit der ein Individuum den Arzt erstmals aufsucht. Wird der Versicherungsschutz ausgebaut, so steigt die Nachfrage nach Erstkontakten, mit Auswirkungen auf den ärztlichen Behandlungsstil, vom ambulanten Aufwand je Fall bis hin zur Hospitalisierungstendenz. Wegen dieses zweiten Zusammenhangs sehen sich die Versicherten einem erhöhten finanziellen Risiko im Krankheitsfall ausgesetzt, und so ist drittens damit zu rechnen, dass sie ihren Versicherungsschutz weiter ausbauen. Damit geht aber die Kosten-Versicherungs-Spirale in ihre nächste Runde. Ob eine solche Spirale existiert, wie rasch sie sich dreht und wie sie gebremst werden könnte, das sind die wichtigsten Fragestellungen eines Forschungsprojekts, das 1982 zum Abschluss kommen wird. Eine schriftliche Befragung von Mitgliedern einer grösseren Krankenkasse ist bereits durchgeführt worden; sie soll die Angaben liefern, die zur Ergänzung der Krankenkassendaten über Inanspruchnahme von Leistungen und Entwicklung des Versicherungsschutzes notwendig sind.

This study starts from the observation that today’s Western trading nations are exposed to multiple risks of energy supplies, e.g. simultaneous shortage of oil and electricity supplies. To cope with these risks, oil can be stockpiled as well as domestic capacity for power production built up. Adopting the viewpoint of a policy maker who aims at minimizing the expected cost of security of supply, optimal simultaneous adjustments of oil stocks and electric production capacities to exogenous changes such as economic growth are derived. Against this benchmark, one-dimensional rules such as “oil reserves for 90 days” turn out to be not only suboptimal but also to foster adjustments that exacerbate suboptimality.

Several countries outside the European Union consider adopting its solvency regulation for their insurance industries. However, Solvency Iand (to a lesser extent) Solvency IIwere found to run the risk of inducing more rather than less risk-taking by insurers (Zweifel, Peter. 2014. “Solvency Regulation of Insurers: A Regulatory Failure?” Journal of Insurance Issues37 (2): 135–157.). Companies are led to neglect parameters that link them to developments in the capital market when determining their endogenous perceived efficiency frontier (EPEF), causing it to become steeper. Given homothetic risk preferences, senior management is predicted to opt for increased rather than reduced volatility. By way of contrast, if modeled after Basel IIIfor banks, planned Solvency IIIwill ask insurers to take developments in the capital market into account in their formulation of business strategies designed to ensure solvency (Principle 5 of Basel III). In addition, the stipulated decrease in their leverage ratio is shown to reduce the slope of the EPEF for insurers with little solvency capital. Contrary to its predecessors, Solvency IIIis therefore predicted to make insurers take on less risk, which argues for its for adoption beyond the European Union if properly implemented.

Salas and Raftery allege that in our paper, (1) remaining life expectancy is an endogenous explanatory variable of health care expenditure and (2) the parameter designed to correct for sample selection bias in fact represents a hidden relationship between health care expenditure and age. We argue that claim (1) is not supported by the available empirical evidence, while claim (2) seems to derive from a too cursory reading of our paper. Copyright © 2001 John Wiley & Sons, Ltd.