scholarly journals An Analysis of Claim Experience in Private Health Insurance to Establish a Relation between Deductibles and Premium Rebates

1977 ◽  
Vol 9 (1-2) ◽  
pp. 257-266
Author(s):  
G. W. de Wit ◽  
W. M. Kastelijn
Keyword(s):  
Health Insurance ◽  
Social Insurance ◽  
Private Health Insurance ◽  
Claim Amount ◽  
Class Iii ◽  
The Social ◽  
Specialist Treatment ◽  
Class Iib ◽  
One Year ◽  
Image Position

Many studies concerning the frequency of claims by size in health insurance are not generally known). A possible explanation of this circumstance could be the fact that in most countries this line of insurance has been brought entirely within the ambit of social insurance. Also from the side of the social insurance very few investigations have been published).In this paper we will analyse the claim experience (relating, to the calendar year 1972) of a private health insurance business. The data have been subdivided according to three levels of coverage (in increasing order of benefits these are: class III, class IIb and class IIa). The claim payments comprise nursing costs, auxiliary costs and the fees for specialist treatment in and out of the hospital.We will use the following notations:Si: claim amount paid for the insured i in one year,n: number of claims,v: number of risks (policies insured).In many instances the premium is simply determined as a level premium. In other words each insured pays the premium p, calculated as follows:.Actually we make the assumption that the claims are normally distributed, the parameters of which can be estimated as follows:which permits the calculation of the premium according to:.

scholarly journals International Constructions of Social Security and Public Health: Policy Intersections 1920–1970

Gesnerus ◽  
2017 ◽  
Vol 74 (2) ◽  
pp. 205-215
Author(s):  
James A. Gillespie
Keyword(s):  
Health Policy ◽  
Health Insurance ◽  
Social Security ◽  
National Health Insurance ◽  
National Health ◽  
Social Insurance ◽  
Early Years ◽  
Health Security ◽  
Global Health Policy ◽  
The Social

The problems of national health insurance played a prominent, but shifting role in the formation of global health policy. This paper uses the work of Geneva based organizations from the end of the First World War to the 1970s to explore the crossing points between health policy and social security. From its formation the League of Nations Health Organisation had an uneasy dialogue with the social insurance and security approaches adopted by the International Labour Organization and the International Social Security Association. When the social insurance concerns of the interwar year broadened into ‘social security’, largely led by the ILO, this debate spilled over into conflicts over the leadership of global social policy and carried over into the early years of WHO. Conflicts centred on the difficult relationship between national health insurance and the other elements of what became the welfare state. The paper identifies the difficulties of constructing a global policy space for action on health security.

scholarly journals Reflections on the role of less-than-comprehensive (exclusionary) private health insurance hospital products in the Australian healthcare system

2012 ◽  
Vol 36 (3) ◽  
pp. 273 ◽  
Author(s):  
Peter E. Thomas
Keyword(s):  
Health Insurance ◽  
Social Insurance ◽  
Private Health Insurance ◽  
Insurance Scheme ◽  
Policy Issues ◽  
The Public ◽  
Insurance Policies ◽  
Exclusionary Policies ◽  
First Time

The number of people in Australia that are currently covered by a hospital private health insurance product continues to rise every quarter. In September 2010, for the first time since the introduction of the public universal social insurance scheme, Medicare, more than 10 million persons in Australia are covered by private health insurance. Although the number of persons covered by private health insurance continues to grow, the quality and level of cover that members are holding is changing significantly. In an effort to limit premium rises and to reduce the benefits paid for treatment, private health insurers have introduced, and moved a large number of existing members to, less-than-comprehensive private health insurance policies. These policies, known as ‘exclusionary’ policies, are changing the dynamics of private health insurance in Australia. After examining the emergence and prevalence of these products, this commentary gives three different examples to illustrate how such products are changing the nature of private health insurance in Australia and are now set to create a series of policy issues that will require future attention.

scholarly journals Opioid Use among Patients with Early Inflammatory Arthritides Compared to the General Population

2019 ◽  
Vol 47 (8) ◽  
pp. 1285-1292
Author(s):  
Paula Muilu ◽  
Vappu Rantalaiho ◽  
Hannu Kautiainen ◽  
Lauri Juhani Virta ◽  
Kari Puolakka
Keyword(s):  
General Population ◽  
Social Insurance ◽  
Index Date ◽  
Opioid Use ◽  
Undifferentiated Arthritis ◽  
Time Period ◽  
The Social ◽  
Before And After ◽  
Early Inflammatory Arthritis ◽  
One Year

Objective.To assess to what extent the worldwide opioid epidemic affects Finnish patients with early inflammatory arthritis (IA).Methods.From the nationwide register maintained by the Social Insurance Institution of Finland, we collected all incident adult patients with newly onset seropositive and seronegative rheumatoid arthritis (RA+ and RA–) and undifferentiated arthritis (UA) between 2010 and 2014. For each case, 3 general population (GP) controls were matched according to age, sex, and place of residence. Drug purchases between 2009 and 2015 were evaluated 1 year before and after the index date (date of IA diagnosis), further dividing this time into 3-month periods.Results.A total of 12,115 patients (66% women) were identified. At least 1 opioid purchase was done by 23–27% of the patients 1 year before and 15–20% one year after the index date. Relative risk (RR) of opioid purchases compared to GP was highest during the last 3-month time period before the index date [RR 2.81 (95% CI 2.55–3.09), 3.06 (2.68-3.49), and 4.04 (3.51–4.65) for RA+, RA–, and UA, respectively] but decreased after the index date [RR 1.38 (1.23–1.58), 1.91 (1.63–2.24), and 2.51 (2.15–2.93)]. Up to 4% of the patients were longterm users both before and after the diagnosis.Conclusion.During 2009–15 in Finland, opioid use peaked just before the diagnosis of IA but decreased rapidly after that, suggesting effective disease control, especially in seropositive RA. Further, opioids were used to treat arthritis pain of patients with incident RA and UA less often than previously reported from other countries.

scholarly journals FARMERS’ SOCIAL INSURANCE SYSTEM IN POLAND AS SEEN BY THE FARMERS

2019 ◽  
Vol 52 (2) ◽  
Author(s):  
Roman Kisiel ◽  
Wiesława Lizińska ◽  
Milena Tylman
Keyword(s):  
Health Insurance ◽  
Literature Review ◽  
Social Insurance ◽  
Objective Assessment ◽  
Insurance Fund ◽  
Social Insurance System ◽  
Insurance System ◽  
Social Insurance Fund ◽  
The Social ◽  
Regional Branch

The main purpose of this paper is to examine the farmers’ opinion on the functioning of their dedicated social insurance system. Particular attention was also paid to the development of different forms of social insurance and to the functioning of the Farmers’ Social Insurance Fund (Polish acronym: KRUS). The analysis was based on a literature review and a survey conducted with 114 farmers registered in KRUS offices located in Działdowo, Iława and Ostróda, with assistance from the Olsztyn Regional Branch. The data collected enables an objective assessment of the entire social insurance system and reflects the farmers’ views on the system and its reforms. The research shows that the accident insurance, health insurance and maternity insurance schemes work very well (41%) or well (34%) according to the farmers concerned. The respondents also expressed their satisfaction with activities undertaken by KRUS, especially in the social field (61%).

scholarly journals IMPACT OF PENSION SYSTEM REFORMS ON PUBLIC FINANCE EXPENDITURES IN POLAND

2019 ◽  
pp. 145-155
Author(s):  
Anna Owczarczyk
Keyword(s):  
Public Finance ◽  
Health Insurance ◽  
Social Security ◽  
Social Insurance ◽  
Pension System ◽  
Public Spending ◽  
Social Security System ◽  
The State ◽  
Security System ◽  
The Social

The social security system in each country, if it exists, plays a crucial role in supporting citizens and specific expenditures of the public finance system. Its importance in public spending depends on many factors; in particular, on its source and on its form of financing benefits or pensions. The social security system in Poland is composed of a social insurance and welfare system, a health insurance system, unemployment and family benefits, from which are enumerated an old-age pension, invalidity pension, sickness and maternity insurance, insurance against accidents at work and occupational diseases, and health insurance. The Polish social security system often changes due to implementation of improvements or limits on public spending. The most famous reform took place in 1999 and introduced the largest number of changes in the sphere of pension security. Because the scale of public funds that are passed on to the social security system is very large, pension reforms should are crucial for improving the state of public finances. The aim of the paper is to present changes that took place in the Polish pension system between 1999 and 2017 and how those changes influenced the amount of public expenditures. The study reviews the research hypothesis: frequent changes in the pension system have a negative impact on the state of Polish public finance. The study covers the years 1999-2017, as well as the previous four years before the implementation of the pension reform. Basic research materials used to conduct the research analysis were reports on implementation of the state budget, data prepared by the Social Insurance Institution and the Agricultural Social Insurance Fund as well as statistical data obtained from the Central Statistical Office.

scholarly journals Australia's private health insurance industry: structure, competition, regulation and role in a less than 'ideal world'

2011 ◽  
Vol 35 (1) ◽  
pp. 23 ◽  
Author(s):  
Ardel Shamsullah
Keyword(s):  
Health Insurance ◽  
Social Insurance ◽  
Private Health Insurance ◽  
Insurance Industry ◽  
Public Awareness ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Industry Structure ◽  
Funding Policy ◽  
Health Insurance Industry

Australia’s private health insurance funds have been prominent participants in the nation’s health system for 60 years. Yet there is relatively little public awareness of the distinctive origins of the health funds, the uncharacteristic organisational nature of these commercial enterprises and the peculiarly regulated nature of their industry. The conventional corporate responsibility to shareholders was, until recently, completely irrelevant, and remains marginal to the sector. However, their purported answerability to contributors, styled as ‘members’, was always doubtful for most health funds. After a long period of remarkable stability in the sector, despite significant shifts in health funding policy, recent years have brought notable changes, with mergers, acquisitions and exits from the industry. The research is based on the detailed study of the private health funds, covering their history, organisational character and industry structure. It argues that the funds have always been divorced from the disciplines of the competitive market and generally have operated complacently within a system of comprehensive regulation and generous subsidy. The prospect of the private health funds enjoying an expanded role under a form of ‘social insurance’, as suggested by the National Health and Hospitals Reform Commission, is not supported. What is known about the topic? Government policies promoting private health insurance have long been the subject of public debate and have received considerable academic analysis. The health funds have a high profile in the media and with the public, reflecting the extent of private health insurance coverage. What does this paper add? There is relatively little awareness of the unique nature of the private health insurance industry. This paper highlights the distinctive organisational origins of the health funds, the recent changes to the structure of the sector which have complicated their corporate identities and the complex role they play in an extraordinarily regulated private health insurance industry. What are the implications for practitioners? Awareness of the nature of the sector should take us beyond perennial concerns about premium rises and the level of private health insurance coverage to better appreciate the diverse nature of the industry, the constraints under which the funds operate and the potential they may have to deliver ‘social insurance’.

scholarly journals Social insecurity of freelance workers: objective position and subjective perception

Inter ◽  
2019 ◽  
Vol 11 (19) ◽  
pp. 62-80
Author(s):  
Galina G. Karpova ◽  
Anastasiya S. Ubogova ◽  
Anna A. Fedoseeva
Keyword(s):  
Social Vulnerability ◽  
Social Insurance ◽  
Well Being ◽  
Subjective Assessment ◽  
Subjective Perception ◽  
Subjective Assessments ◽  
The Social ◽  
Social Insecurity ◽  
One Year ◽  
The Moment

This article is devoted to the social vulnerability of freelance workers and the way it is represented in different dimensions of precariousness. According to the previous studies, we identifed the categories of social insurance (fnancial, juridical, lack of social guaranteesand lack of personal well-being) and the most common indicators within each. We conducted a qualitative research using in-depth semi-formal interviews with 21 employees older than 18 years, who are engaged in freelancing at the moment or had such experience in the last couple of years. The number of informants included employees for whom freelance is one of the main sources of income for at least one year. During the interview, the informants were speaking about the subjective assessment of social precariousness and also answered to some questions aimed at identifying the objective features of the precious situation in employment status. In the analysis of subjective assessments of social precariousness, it was revealed that informants cannot be divided into categories according to the degree of precariousness, because they can experience social vulnerability in one or several areas at the same time. According to the results of the study, we propose to consider precariousness as a certain scale from 0 to the maximum value of the insecurity parameters. This approach will take into account the importance of subjective assessment of freelancers’ position, while the dichotomy “precariat — free agent”, which is mostly shared by researchers, does not consider the complexity of this social phenomenon.

The Conflict of Interest Between the Enterprises and the Laborers for the Social Insurance (SI), Unemployment Insurance (UI) – Policy Suggestions

2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Do Kieu Oanh ◽  
Nguyen Thi Kim Trong ◽  
Nguyen Thi Chin ◽  
Nguyen Thu Huong
Keyword(s):  
Health Insurance ◽  
Unemployment Insurance ◽  
Conflict Of Interest ◽  
Social Insurance ◽  
Current Situation ◽  
Insurance Fund ◽  
Social Insurance Fund ◽  
The Social ◽  
Policy Suggestions

Each employee when working at enterprises is expected to be entitled to full benefits from social insurance, health insurance and unemployment insurance after years of contribution. However, this desire of the employees sometimes can not be achieved. Enterprises have taken advantage of the legal loophole to commit acts of evasion (avoidance) to fulfill these obligations to employees. Therefore, the benefits of employees are seriously damaged and the management agencies of the social insurance fund also lose. This article is about the current situation in Vietnam and point out some policy suggestions.

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