Following the Patient Protection and Affordable Care Act (ACA), annual financial reports by commercial health insurers include more detailed information on a Supplemental Health Care Exhibit. In this new exhibit, insurers illustrate spending on the provision of medical services and associated expenses. These expenses, which were commonly reported as “claims adjustment” and “general administrative” expenses, can now be allocated to several new categories of expenses associated with combatting fraud and improving patient health care quality. This article illustrates that quality improvement expenses have increased significantly in the individual, small group, and large group markets following implementation of the ACA. Of the five types of quality expenses reported, the greatest proportion of spending has been toward the improvement of health outcomes and the most pronounced increase from 2011 to 2017 has been spending toward increased wellness and health promotion activities, which include activities such as wellness assessments and coaching programs for patients with chronic diseases. Given that the ACA was designed not only to broaden access to health insurance but also to improve health, analysis of the allocations to various types of quality improvement activities highlights the private market's contribution to improving the health of the US population.
{"title":"New post‐ACA insurance data highlights health insurer spending on health care quality","authors":"E. Tice Sirmans, Petra Steinorth","doi":"10.1111/rmir.12144","DOIUrl":"https://doi.org/10.1111/rmir.12144","url":null,"abstract":"Following the Patient Protection and Affordable Care Act (ACA), annual financial reports by commercial health insurers include more detailed information on a Supplemental Health Care Exhibit. In this new exhibit, insurers illustrate spending on the provision of medical services and associated expenses. These expenses, which were commonly reported as “claims adjustment” and “general administrative” expenses, can now be allocated to several new categories of expenses associated with combatting fraud and improving patient health care quality. This article illustrates that quality improvement expenses have increased significantly in the individual, small group, and large group markets following implementation of the ACA. Of the five types of quality expenses reported, the greatest proportion of spending has been toward the improvement of health outcomes and the most pronounced increase from 2011 to 2017 has been spending toward increased wellness and health promotion activities, which include activities such as wellness assessments and coaching programs for patients with chronic diseases. Given that the ACA was designed not only to broaden access to health insurance but also to improve health, analysis of the allocations to various types of quality improvement activities highlights the private market's contribution to improving the health of the US population.","PeriodicalId":35338,"journal":{"name":"Risk Management and Insurance Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88530583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Li-ying Huang, Gene C. Lai, Erin P. Lu, Michael J. McNamara
Using a system of simultaneous equations, this study examines the relation among external audit monitoring, in the US life insurance industry. We find insurers with higher leverage risk and surplus risk are more likely to use Big‐4 auditors and to pay higher fees. In return, insurers hiring Big‐4 auditors and paying higher audit fees have lower leverage risk and surplus risk. Second, the results suggest that mutual life insurers have a higher leverage risk and surplus risk than stock life insurers. This evidence is in contrast to that for property–liability insurance companies. Third, we find insurers are less likely to hire Big‐4 auditors and to pay higher audit fees after implementation of the Sarbanes–Oxley Act (SOX). Finally, life insurers with Big‐4 auditors or paying higher audit fees are more likely to take lower risks after the implementation of SOX.
{"title":"Auditor quality, audit fees, organizational structure, and risk taking in the US life insurance industry","authors":"Li-ying Huang, Gene C. Lai, Erin P. Lu, Michael J. McNamara","doi":"10.1111/rmir.12145","DOIUrl":"https://doi.org/10.1111/rmir.12145","url":null,"abstract":"Using a system of simultaneous equations, this study examines the relation among external audit monitoring, in the US life insurance industry. We find insurers with higher leverage risk and surplus risk are more likely to use Big‐4 auditors and to pay higher fees. In return, insurers hiring Big‐4 auditors and paying higher audit fees have lower leverage risk and surplus risk. Second, the results suggest that mutual life insurers have a higher leverage risk and surplus risk than stock life insurers. This evidence is in contrast to that for property–liability insurance companies. Third, we find insurers are less likely to hire Big‐4 auditors and to pay higher audit fees after implementation of the Sarbanes–Oxley Act (SOX). Finally, life insurers with Big‐4 auditors or paying higher audit fees are more likely to take lower risks after the implementation of SOX.","PeriodicalId":35338,"journal":{"name":"Risk Management and Insurance Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82955551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rokhaya Dieye, A. Bounfour, A. Ozaygen, Niaz Kammoun
This paper estimates the macroeconomic losses related to the cyber‐attacks originating from the information and communications technology (ICT) and the financial sectors. The study accounts for the interdependency of various economic sectors and looks to the cascading effect of cyber‐attacks on production network in the United States and leading Organisation for Economic Co‐operation and Development countries with the help of the input–output methodology and the World Input–Output Database. Our results suggest that cyber‐attacks that affect the ICT and finance sectors result in losses which also impact different economic sectors, due to cascading effects.
{"title":"Estimates of the macroeconomic costs of cyber‐attacks","authors":"Rokhaya Dieye, A. Bounfour, A. Ozaygen, Niaz Kammoun","doi":"10.1111/rmir.12151","DOIUrl":"https://doi.org/10.1111/rmir.12151","url":null,"abstract":"This paper estimates the macroeconomic losses related to the cyber‐attacks originating from the information and communications technology (ICT) and the financial sectors. The study accounts for the interdependency of various economic sectors and looks to the cascading effect of cyber‐attacks on production network in the United States and leading Organisation for Economic Co‐operation and Development countries with the help of the input–output methodology and the World Input–Output Database. Our results suggest that cyber‐attacks that affect the ICT and finance sectors result in losses which also impact different economic sectors, due to cascading effects.","PeriodicalId":35338,"journal":{"name":"Risk Management and Insurance Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76978569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There has been a rise of innovative parametric insurance solutions in recent years covering a wide range of risks and serving clients from individuals, to businesses, and to governments. These parametric insurance products cover risks that are otherwise uninsured or underinsured, by simplifying product design and reducing transaction costs. This paper offers a comprehensive review of parametric insurance including a classification of the types of contract and an overview of market practices. We outline the benefits and concerns of parametric insurance in comparison with indemnity insurance, and discuss the legal principle and regulatory compliance matters. We then survey the current global market and identify areas where insurance and reinsurance companies can play important roles in offering or supporting parametric insurance operations. Lastly, we offer a case study on a type of parametric insurance designed to cover earthquake risk in California.
{"title":"Application of parametric insurance in principle‐compliant and innovative ways","authors":"Xiao Lin, W. Kwon","doi":"10.1111/rmir.12146","DOIUrl":"https://doi.org/10.1111/rmir.12146","url":null,"abstract":"There has been a rise of innovative parametric insurance solutions in recent years covering a wide range of risks and serving clients from individuals, to businesses, and to governments. These parametric insurance products cover risks that are otherwise uninsured or underinsured, by simplifying product design and reducing transaction costs. This paper offers a comprehensive review of parametric insurance including a classification of the types of contract and an overview of market practices. We outline the benefits and concerns of parametric insurance in comparison with indemnity insurance, and discuss the legal principle and regulatory compliance matters. We then survey the current global market and identify areas where insurance and reinsurance companies can play important roles in offering or supporting parametric insurance operations. Lastly, we offer a case study on a type of parametric insurance designed to cover earthquake risk in California.","PeriodicalId":35338,"journal":{"name":"Risk Management and Insurance Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76294586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Baggett, Cassandra R. Cole, George R. Crowley, E. Sirmans
{"title":"Spillover effects of increased health insurance enrollment on workers’ compensation insurance","authors":"C. Baggett, Cassandra R. Cole, George R. Crowley, E. Sirmans","doi":"10.1111/rmir.12142","DOIUrl":"https://doi.org/10.1111/rmir.12142","url":null,"abstract":"","PeriodicalId":35338,"journal":{"name":"Risk Management and Insurance Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80337936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A note on risk and value from an underutilized dataset: Consolidated disclosures","authors":"N. Scordis","doi":"10.1111/rmir.12141","DOIUrl":"https://doi.org/10.1111/rmir.12141","url":null,"abstract":"","PeriodicalId":35338,"journal":{"name":"Risk Management and Insurance Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87914564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Among the trends impacting most industries are new mobility concepts, digitalization, urbanization, rising environmental awareness, and demographic change. The automobile insurance industry, in particular, is strongly affected by new mobility concepts, including autonomous, shared, and electric vehicles, which are expected to increasingly impact the risk exposure and insurance demand in the future. Identifying and assessing the resulting risk and opportunity landscape from these trends thus becomes a major strategic challenge for insurers. The aim of this paper is to analyze the trends that impact the field of mobility and thus automobile insurers. Based on this, we derive a set of strategic response measures for insurers to enable them to be prepared for the future of mobility.
{"title":"The future of mobility and its impact on the automobile insurance industry","authors":"Nadine Gatzert, Katrin Osterrieder","doi":"10.1111/rmir.12140","DOIUrl":"https://doi.org/10.1111/rmir.12140","url":null,"abstract":"Among the trends impacting most industries are new mobility concepts, digitalization, urbanization, rising environmental awareness, and demographic change. The automobile insurance industry, in particular, is strongly affected by new mobility concepts, including autonomous, shared, and electric vehicles, which are expected to increasingly impact the risk exposure and insurance demand in the future. Identifying and assessing the resulting risk and opportunity landscape from these trends thus becomes a major strategic challenge for insurers. The aim of this paper is to analyze the trends that impact the field of mobility and thus automobile insurers. Based on this, we derive a set of strategic response measures for insurers to enable them to be prepared for the future of mobility.","PeriodicalId":35338,"journal":{"name":"Risk Management and Insurance Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83309782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Health insurance and its impact on the survival rates of breast cancer patients in Synthea","authors":"R. Scalfani, S. V. Bhada","doi":"10.1111/rmir.12138","DOIUrl":"https://doi.org/10.1111/rmir.12138","url":null,"abstract":"","PeriodicalId":35338,"journal":{"name":"Risk Management and Insurance Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73380992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Risk and risk management of spillover effects: Evidence from the literature","authors":"Christian Eckert","doi":"10.1111/rmir.12139","DOIUrl":"https://doi.org/10.1111/rmir.12139","url":null,"abstract":"","PeriodicalId":35338,"journal":{"name":"Risk Management and Insurance Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88718759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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