nep-ias New Economics Papers
on Insurance Economics
Issue of 2009‒02‒22
eight papers chosen by
Soumitra K Mallick
Indian Institute of Social Welfare and Bussiness Management

  1. Dependency insurance in Belgium By Karakaya, Güngör
  2. Optimal Risk Sharing Under Limited Commitment: Evidence From Rural Vietnam By Patrick Eozenou
  3. Can insurance reduce catastrophic out-of-pocket health expenditure? By Rama Joglekar
  4. Health Care Reform in the United States By David Carey; Bradley Herring; Patrick Lenain
  5. Long-term care: regional disparities in Belgium By Karakaya, Güngör
  6. The Reform of Unemployment Protection Insurance, 1993-2007: the Erosion of Legislated Rights in France, Germany, Portugal and Spain By Manuela Arcanjo
  7. Blind Optimism Challenging the Myths About Private Health Care in Poor Countries By Anna Marriott
  8. Time to death and health expenditure of the Czech health care system By Kateřina Pavloková

  1. By: Karakaya, Güngör
    Abstract: In this paper we analyze the system of long-term care insurance currently in place in Belgium or rather in Flanders (the Dutch-speaking part of the country), since the French and German-speaking parts have not yet such insurance. More precisely, we review the scope, benefits, financing and functioning of the Flemish dependency insurance (called the Vlaamse Zorgverzekering) and present some statistics regarding the number of persons affiliated to the Vlaamse Zorgverzekering, the number and percentage of approved applications, the grants awarded by the Government of Flanders and the revenue and expenditure/costs relating to the Flemish dependency insurance system in order to comprehend the key factors explaining some evolution related to the dependency in Belgium. Analyses show that the adjustments and successive changes that the dependency insurance has undergone are explained by its success in terms of claims for benefits. We also find that the problem of equity and adverse selection favorable to the inhabitants of Brussels at the expense of the Flemish people is reduced owing to the different treatments for the two regions.
    Keywords: Long-term care; Old age assistance; Subsidies; Revenue and Expenditures for health
    JEL: I12 I18 H75 H71
    Date: 2009
  2. By: Patrick Eozenou (European University Institute, Villa San Paolo, Via Della Piazzuola 43, 50133 Florence, Italy)
    Abstract: We use panel data from a household survey conducted in Vietnam to analyze the effectiveness of informal risk sharing arrangements in protecting household consumption from idiosyncratic income shocks. We focus on the effects of reported harvest shocks and of estimated shocks to agricultural revenues on adult equivalent consumption. The full-insurance allocation is tested against a specified alternative under which contracts are not fully enforceable ex-post. We find that farmers hit by unfavorable events stabilize their consumption level below the village aggregate level, irrespective of the level of realized shocks. At the same time, farmers experiencing more favorable shocks enjoy higher consumption in proportion to the realized value of idiosyncratic shocks. Together, these finding are consistent with a simple 2-period model of optimal risk sharing with one-sided limited commitment. These results hold for total consumption and for non-durable consumption. We also find however some evidence supporting the full insurance hypothesis for food consumption.
    Keywords: Consumption, Risk-sharing, Informal Insurance,Vietnam.
    JEL: D8 I3 O1
    Date: 2009
  3. By: Rama Joglekar (Indira Gandhi Institute of Development Research)
    Abstract: In India, the out-of-pocket health expenditure by households accounts for around 70 percent of the total expenditure on health. Large out-of-pocket payments may reduce consumption expenditure on other goods and services and push households into poverty. Recently, health insurance has been considered as one of the possible instruments in reducing impoverishing effects of large out-of-pocket health expenditure. In India, health insurance has limited coverage and the present paper studies whether it has been effective so far. Literature defines out-of-pocket health expenditure as catastrophic if its share in the household budget is more than some arbitrary threshold level. In the present paper, we argue that for households below poverty line any expenditure on health is catastrophic as they are unable to attain the subsistence level of consumption. Thus, we take zero percent as a threshold level to define catastrophic health expenditure and examine the impact of health insurance on probability of incurring catastrophic health expenditure.
    Keywords: Out-of-pocket health expenditure, Catastrophic health expenditure, Health insurance
    JEL: I12 I19
    Date: 2008–09
  4. By: David Carey; Bradley Herring; Patrick Lenain
    Abstract: In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending. This paper focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States: inequitable access to medical services and subsidized private insurance policies; and inefficiencies in public health insurance. It then suggests two sets of reforms likely to improve the US health-care system. The first is a package of reforms to achieve close to universal health insurance coverage. The second set of reforms relates to payment methods and coverage decisions within the Medicare programme to realign incentives and increase the extent of economic evaluation of different medical procedures.<P>Réforme du système de santé aux États Unis<BR>Malgré certains progrès, les États-Unis ne sont pas très bien placés parmi les pays de l’OCDE pour ce qui est de diverses mesures des résultats de la santé. Or, les dépenses de santé y sont sensiblement plus élevées que dans tout autre pays de l’OCDE. Cette situation contradictoire amène à penser qu’il est possible d’améliorer le système de santé du pays tout en réduisant, ou du moins en n’augmentant pas, les dépenses. Le présent papier examine plus particulièrement deux facteurs qui contribuent à la divergence entre les résultats et les dépenses en matière de santé aux États-Unis : accès inéquitable aux services médicaux et inefficience des subventions pour la souscription de polices d’assurance privées ; et manque d’efficacité de l’assurance de santé publique. Il propose ensuite deux séries de réformes propres à améliorer le système de santé des États-Unis. La première est un ensemble de mesures destinées à assurer la couverture universelle de l’assurance-maladie. La deuxième concerne les méthodes de paiement et les décisions de prise en charge au sein du programme Medicare et vise à réaligner les incitations et à renforcer l’évaluation économique des différents actes médicaux.
    Keywords: moral hazard, aléa moral, espérance de vie, health status, health oucomes, résultats de la santé, life expectancy, health costs, coûts de santé, health expenditure, health subsidies, individual market, marché individuel, adverse selection, sélection adverse, pooling, mandate, tax exclusion, exonération fiscale, avantage Medicare, comparative effectiveness, comparaison de l’efficacité, regroupement de risque, dépenses de santé, assurance santé, subventions pour l’achat des polices d’assurance santé, mandat, Medicare, Medicare advantage
    JEL: C23 H51 I12 O57
    Date: 2009–02–06
  5. By: Karakaya, Güngör
    Abstract: In this paper we analyze the problem of population ageing in terms of non-medical care needs of persons who are dependent or have lost their autonomy, in order to provide the various public and private administrations active in these fields with some food for thought. The anticipated increase in dependency poses significant challenges in terms of needs evolution and financing. Using administrative data on the Belgian population to build indicators on the prevalence of dependency at home in the three regions in 2001, we find that the likelihood of a sustained increase in the Flemish prevalence rates ultimately amplifies the magnitude of the financing problems that the Flemish dependency insurance scheme has experienced since its first years of operation. Results also show that the smaller increases or the decreases (according to the scenario selected) expected in Wallonia and Brussels are likely to mitigate concern about the sustainability of any long-term care insurance in Wallonia and therefore to facilitate its eventual introduction.
    Keywords: Long-term care; Old age assistance; Demographic changes; Regional inequalities; Projection
    JEL: J14 I12 I18 J11
    Date: 2009
  6. By: Manuela Arcanjo
    Abstract: In the extensive literature that has been dedicated during the past fifteen years to the analysis of the reform of the welfare states, a significant number of studies have focused on the characterisation of the nature and direction of the changes in the main social programmes. This article seeks to contribute to this debate by analysing the reform of unemployment insurance schemes between 1993 and 2007 in France, Germany, Portugal and Spain, as representative of the conservative regime. A comparative analysis is carried out by examining the major legislative amendments concerning eligibility criteria and entitlement conditions, as they are expressed by legislation in the four countries. The findings of the study indicate that the four countries have adopted different instruments at different moments in time, while no significant differences were detected between them, and that the legislative changes introduced in the four insurance schemes may be seen to constitute a real erosion of social rights.
    Keywords: Welfare state reform; Retrenchment; Unemployment insurance schemes; Social rights.
    Date: 2009–04
  7. By: Anna Marriott
    Abstract: There is an urgent need to reassess the arguments used in favour of scaling-up private-sector provision in poor countries. The evidence shows that prioritising this approach is extremely unlikely to deliver health for poor people. Governments and rich country donors must strengthen state capacities to regulate and focus on the rapid expansion of free publicly provided health care, a proven way to save millions of lives worldwide. [OXFAM Briefing Paper]
    Keywords: privae health care, public health care, health care, privatisation,institutional capacities, access to health care , Oxfam, Health Studies
    Date: 2009
  8. By: Kateřina Pavloková (Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic)
    Abstract: Growing concern about future sustainability of public budgets in the context of population ageing has given rise to a large debate on the role of age in the context of health care expenditure. Growing evidence on the so called death related costs hypothesis arguing that the positive relationship between age of the cohort and related health care expenditure is the result of growing probability of death changes in an important manner the results of the projections. The aim of this paper is to explore the importance of the death related costs hypothesis in the Czech health expenditure data and the impact of the hypothesis on the projection of the financial sustainability of the Czech health care system.
    Keywords: health care, last year of life, financial sustainability
    JEL: H51
    Date: 2009–02

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