scholarly journals Private Insurance, Social Insurance, and Tort Reform: Toward A New Vision of Compensation for Illness and Injury

2021 ◽  
pp. 161-204
Author(s):  
Kenneth S. Abraham ◽  
Lance Liebman
Keyword(s):  
Social Insurance ◽  
Private Insurance ◽  
Tort Reform ◽  
New Vision

Social versus Private Insurance

2018 ◽  
Author(s):  
Pierre Pestieau ◽  
Mathieu Lefebvre
Keyword(s):  
Social Insurance ◽  
Private Insurance ◽  
Population Ageing ◽  
Fiscal Competition ◽  
Public Insurance ◽  
The Public ◽  
Social Risks ◽  
The Family ◽  
Private And Public

This chapter looks at the role of the public versus the private sector in the provision of insurance against social risks. After having discussed the evolution of the role of the family as support in the first place, the specificity of social insurance is emphasized in opposition to private insurance. Figures show the extent of spending on both private and public insurance and the chapter presents economic reasons to why the latter is more developed than the former. Issues related to moral hazard and adverse selection are addressed. The chapter also discusses somewhat more general arguments supporting social insurance such as population ageing, unemployment, fiscal competition and social dumping.

DRGs and the Professional Independence of Physicians

2011 ◽  
pp. 173-191 ◽  
Author(s):  
Lorraine Frisina ◽  
Mirella Cacace
Keyword(s):  
Social Insurance ◽  
Diagnosis Related Groups ◽  
Private Insurance ◽  
Present Contribution ◽  
Social Insurance System ◽  
Hospital System ◽  
The Public ◽  
Insurance System ◽  
Medicare Program ◽  
Professional Independence

This chapter examines the effects of diagnosis related groups (DRGs) on the professional independence of physicians in three distinct types of healthcare systems: the U.S. private insurance system, where DRGs were first developed and subsequently implemented in the public Medicare program in 1983; the British National Health Service (NHS), which adopted an analogous version of DRGs referred to as Health Resource Groups (HRGs) in 1992; and the German social insurance system, which adopted its own DRG version (G-DRGs) based on a refined version of the Australian model that is to be fully phased into the hospital system by 2009. By examining these three cases, the present contribution asks (a) whether it is possible to identify any effects of DRGs on the professional independence of physicians; and (b) whether these effects are specific to the respective healthcare system and/or DRG version at hand.

scholarly journals Clinical audit as a tool to optimize contracted private healthcare provision: Testing the waters in resource-deprived Greece

2019 ◽  
Vol 7 ◽  
pp. 205031211983873
Author(s):  
Kyriakos Souliotis ◽  
Christina Golna ◽  
Vasiliki Mantzana ◽  
Sotirios Papaspyropoulos ◽  
Anastasios Koutsovasilis ◽  
...  
Keyword(s):  
Social Insurance ◽  
Best Practice ◽  
Clinical Audit ◽  
Private Insurance ◽  
Healthcare Services ◽  
Evidence Based ◽  
Care Organization ◽  
Healthcare Provision ◽  
Private Healthcare

Background and Aims: Clinical audit is applied to optimize clinical practice and quality of healthcare services while controlling for money spent, critically in resource-deprived settings. This case study reports on the outcomes of a retrospective clinical audit on private hospitalizations, for which reimbursement had been pending by the Health Care Organization for Public Servants (OPAD) in Greece. This case study is the first effort by a social insurance organization in Greece to employ external clinical audit before settling contracted private healthcare charges. Methods: One thousand two hundred hospitalization records were reviewed retrospectively and a fully anonymized clinical audit summary report created for each one of them by a team of clinical audit experts, proposing evidence-based cuts in pending charges where medical services were deemed clinically unnecessary. These audit reports were then collated and analysed to test trends in overcharges among hospitalized insureds per reason for hospitalization. Results: The clinical audit report concluded that 17.4% of a total reimbursement claim of €12,387,702.18 should not be reimbursed, as it corresponded to unnecessary or not fully justifiable according to evidence-based, best practice, medical service provision. The majority of proposed cuts were related to charges for medical devices, which are borne directly by social insurance with no patient or private insurance co-payment. Conclusion: Clinical audit of hospital practice may be a key tool to optimize care provision, address supplier-induced demand and effectively manage costs for national health insurance, especially in circumstances of budgetary constraints, such as in austerity-stricken settings or developing national healthcare systems.

Supplementary Health Insurance and Regulation of Healthcare Systems

2019 ◽  
Author(s):  
Brigitte Dormont
Keyword(s):  
Health Insurance ◽  
Cost Sharing ◽  
Social Insurance ◽  
Private Insurance ◽  
Social Health Insurance ◽  
Social Health ◽  
Managed Competition ◽  
Benefit Package ◽  
Care Services ◽  
Supplementary Health Insurance

Most developed nations provide generous coverage of care services, using either a tax financed healthcare system or social health insurance. Such systems pursue efficiency and equity in care provision. Efficiency means that expenditures are minimized for a given level of care services. Equity means that individuals with equal needs have equal access to the benefit package. In order to limit expenditures, social health insurance systems explicitly limit their benefit package. Moreover, most such systems have introduced cost sharing so that beneficiaries bear some cost when using care services. These limits on coverage create room for private insurance that complements or supplements social health insurance. Everywhere, social health insurance coexists along with voluntarily purchased supplementary private insurance. While the latter generally covers a small portion of health expenditures, it can interfere with the functioning of social health insurance. Supplementary health insurance can be detrimental to efficiency through several mechanisms. It limits competition in managed competition settings. It favors excessive care consumption through coverage of cost sharing and of services that are complementary to those included in social insurance benefits. It can also hinder achievement of the equity goals inherent to social insurance. Supplementary insurance creates inequality in access to services included in the social benefits package. Individuals with high incomes are more likely to buy supplementary insurance, and the additional care consumption resulting from better coverage creates additional costs that are borne by social health insurance. In addition, there are other anti-redistributive mechanisms from high to low risks. Social health insurance should be designed, not as an isolated institution, but with an awareness of the existence—and the possible expansion—of supplementary health insurance.

Long-Term Care

2018 ◽  
Author(s):  
Pierre Pestieau ◽  
Mathieu Lefebvre
Keyword(s):  
Social Insurance ◽  
Long Term Care ◽  
Private Insurance ◽  
Care Needs ◽  
Term Care ◽  
The Family ◽  
Two Factors ◽  
Long Term Care Insurance

This chapter is concerned with the rise in long-term care needs. Long-term care concerns individuals who are no longer able to carry out basic daily activities. Most of the care is currently provided by informal caregivers, mainly the family, while the role of formal care provided by the state or the market remains small. The chapter explains, however, why informal care is expected to decline and analyses the low private insurance development, the so-called long-term care insurance puzzle. These two factors, the decreasing role of the family and a thin insurance market, plead for the development of a full fledge social insurance for long-term care. The chapter then looks at the optimal design of such an insurance.

Imagining Insurance in Japanese High Schools during the Era of Rapid Modernisation: From ‘Distrust’ to the Japanese ‘Spirit’

2019 ◽  
Vol 22 (2) ◽  
pp. 229-246
Author(s):  
Piers R WILLIAMSON ◽  
Miori NAGASHIMA
Keyword(s):  
Social Insurance ◽  
Western Europe ◽  
Management Practice ◽  
Insurance Industry ◽  
Private Insurance ◽  
High Growth ◽  
Mutual Aid ◽  
High School Writing ◽  
The Us ◽  
Publicity Campaign

AbstractIndividual private insurance is a risk-management practice that plays an important role in many people’s lives. Despite its prominence in industrialised countries, it remains an understudied area in Japan studies, where most work has focused on social insurance. Using insights from the governmentality literature, and in particular François Ewald’s concept of an ‘insurantial imaginary’, we examine the changing perceptions towards private non-life insurance during Japan’s period of high growth and rapid modernisation (1964–1992). While individual private insurance developed in Western Europe and the US over hundreds of years, it did not take off in Japan until the early postwar era. We argue that, like in Western Europe and the US, individual private insurance in Japan had to overcome normative resistance. The norms in Japan, however, were different. To illustrate this, we look at winning essays from an annual high school writing competition run by the Japanese insurance industry as part of a wide-ranging publicity campaign. We conclude that private insurance in Japan passed through four stages of moral understanding to successfully incorporate existing counter norms centred on ‘sincerity’ and ‘mutual aid’. What was initially viewed with ‘distrust’ ended up as a supposed manifestation of the Japanese ‘spirit’.

scholarly journals OVERVIEW OF SOCIAL INSURANCE IN MALAYSIA: INVALIDITY PENSION SCHEME (IPS)

2021 ◽  
Vol 3 (7) ◽  
pp. 37-46
Author(s):  
Mohd Zaki Awang Chek ◽  
Isma Liana Ismail
Keyword(s):  
Social Security ◽  
Old Age ◽  
Social Insurance ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Pension Scheme ◽  
Cost Of Living ◽  
Public Insurance ◽  
The Social ◽  
Insurance Programme

Social insurance is a public insurance programme that provides protection against various economic risks such as loss of income due to sickness, old age, invalidity, death, or unemployment, where participation is made to be compulsory. Social insurance is regarded as a type of social security, and the two terms are sometimes used interchangeably. Social insurance programmes differ from private insurance in several ways. Firstly, the contributions are normally compulsory and may be made by the insured’s employer, by the state, as well as by the insured himself. Benefits are also not as strictly tied to contributions as is the case with private insurance. For example, to make the programmes serve certain social purposes, some contributors are included among the beneficiaries even though they may not have contributed for the required period of time. Next, benefits may be increased in response to the rising cost of living, which reduces the amount between contributions and benefits. The main objective of this study is to understand the contribution and benefits of social insurance coverage under the Social Security Organisation (SOCSO)’s Invalidity Pension Scheme (IPS).

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