scholarly journals CONTINUOUS-TIME SEMI-MARKOV INFERENCE OF BIOMETRIC LAWS ASSOCIATED WITH A LONG-TERM CARE INSURANCE PORTFOLIO

2017 ◽  
Vol 47 (2) ◽  
pp. 527-561 ◽  
Author(s):  
Guillaume Biessy
Keyword(s):  
Continuous Time ◽  
Long Term Care ◽  
Likelihood Method ◽  
Estimation Of Parameters ◽  
Term Care ◽  
Insurance Portfolio ◽  
The Disabled ◽  
Reliable Knowledge ◽  
Access To Data

AbstractUnlike the mortality risk on which actuaries have been working for more than a century, the long-term care (LTC) risk is relatively new and as of today hardly mastered. Semi-Markov processes have been identified as an adequate tool to study this risk. Nevertheless, access to data is limited and the associated literature still scarce. Insurers mainly use discrete time methods directly inspired from the study of mortality in order to build experience tables. Those methods however are not perfectly suited for the study of competing risk situations. This article provides a theoretical framework to estimate biometric laws associated with a LTC insurance portfolio. The presented method relies on a continuous-time semi-Markov model with three states: autonomy, disability and death. The process describing the state of disability is defined through its transition intensities. We provide a formula to infer the mortality of autonomous people from the mortality of the whole portfolio, on which we have more reliable knowledge. We then propose a parametric expression for the remaining intensities of the model. In particular, incidence in LTC is described by a logistic formula. Under the assumption that the disabled population is a mixture of two latent populations with respect to the category of pathology that caused LTC, we show that the resulting intensity of mortality in LTC takes a very peculiar form and depends on time spent in the LTC state. Estimation of parameters relies on the maximum likelihood method. Our parametric approach, while inducing model uncertainty, eliminates issues related to segmentation in age categories, smoothing or extrapolation at higher ages and thus proves very convenient for the practitioner. Finally, we provide an application using data from a real LTC insurance portfolio.

scholarly journals Calibration of Transition Intensities for a Multistate Model: Application to Long-Term Care

Risks ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 37
Author(s):  
Manuel L. Esquível ◽  
Gracinda R. Guerreiro ◽  
Matilde C. Oliveira ◽  
Pedro Corte Real
Keyword(s):  
Markov Chain ◽  
Continuous Time ◽  
Long Term Care ◽  
Transition Probabilities ◽  
Markov Chain Model ◽  
Chain Model ◽  
Chain Process ◽  
Term Care ◽  
National Network

We consider a non-homogeneous continuous time Markov chain model for Long-Term Care with five states: the autonomous state, three dependent states of light, moderate and severe dependence levels and the death state. For a general approach, we allow for non null intensities for all the returns from higher dependence levels to all lesser dependencies in the multi-state model. Using data from the 2015 Portuguese National Network of Continuous Care database, as the main research contribution of this paper, we propose a method to calibrate transition intensities with the one step transition probabilities estimated from data. This allows us to use non-homogeneous continuous time Markov chains for modeling Long-Term Care. We solve numerically the Kolmogorov forward differential equations in order to obtain continuous time transition probabilities. We assess the quality of the calibration using the Portuguese life expectancies. Based on reasonable monthly costs for each dependence state we compute, by Monte Carlo simulation, trajectories of the Markov chain process and derive relevant information for model validation and premium calculation.

Economic Well-Being of the Chronically Disabled Elderly: Practice and Policy Implications

1993 ◽  
Vol 74 (8) ◽  
pp. 460-467 ◽  
Author(s):  
Jean W. Bauer ◽  
Marlene S. Stum ◽  
Paula J. Delaney
Keyword(s):  
Stepwise Regression ◽  
Long Term Care ◽  
Well Being ◽  
Policy Implications ◽  
Term Care ◽  
Disabled Elderly ◽  
The Disabled ◽  
Care Survey ◽  
Economic Well Being

The 1982 Long-Term Care Survey (N = 5,670) was used to gain an understanding of predisposing, need, and enabling variables that influence the economic well-being of disabled elderly. Stepwise regression results suggest that a combination of enabling and predisposing factors best explained differences in economic well-being. Implications of the findings for practitioners are discussed within the context of practice and policy for the disabled elderly.

scholarly journals Review of evolution of the public long-term care insurance (LTCI) system in different countries: influence and challenge

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Linhong Chen ◽  
Lu Zhang ◽  
Xiaocang Xu
Keyword(s):  
Long Term Care ◽  
The Elderly ◽  
Term Care ◽  
The Public ◽  
Disabled Elderly ◽  
The Disabled ◽  
Long Term Care Insurance ◽  
The Relationship

Abstract Background The growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China’s public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China. Methods This review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist. Results The review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited. Conclusion Some policy implications on the future development of China’s LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China.

The Effect of Long-Term Care Insurance on Home Care Use Among the Disabled Elders

2012 ◽  
Vol 33 (3) ◽  
pp. 353-362 ◽  
Author(s):  
So-Yun Kim ◽  
Gong-Soog Hong ◽  
Catherine P. Montalto
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
Term Care ◽  
The Disabled ◽  
Long Term Care Insurance
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