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Does Public Health Insurance Expansion Influence Medical Liability Insurance Prices? The Case of the ACA’s Optional Medicaid Expansion 公共健康保险扩张是否影响医疗责任保险价格?ACA的可选医疗补助扩张案例
IF 1.4 Q3 BUSINESS, FINANCE Pub Date : 2022-09-21 DOI: 10.1080/10920277.2022.2106576
Jingshu Luo, Martin Grace
Medical liability insurance covers physicians’ liability, and its price could affect physicians’ practice. In this article, we use a unique county-level dataset to study how medical liability insurance prices of three specialties, internal medicine, general surgery, and obstetrics–gynecology (OB-GYN), changed after the Affordable Care Act (ACA) elective Medicaid expansion provision. The Medicaid expansion has largely increased the demand for health care services and potentially exposed physicians to higher medical liability risks. With higher expected losses, insurers could react by increasing medical malpractice insurance prices. We first study all counties in states that elected to expand Medicaid and compare them to counties in nonexpansion states. Then we narrow our analysis to consider differential effects in bordering counties with different Medicaid expansion statuses over the period 2010–2018. In both samples, we find significantly higher medical liability insurance prices 2 years after the expansion (on average) in expansion states in comparison to nonexpansion states, and the difference is larger for physicians practicing internal medicine (6–8% at 2 years after expansion) and general surgery (12–16% at 2 years after expansion) but less so for OB-GYN. Our OB-GYN results are likely because significant numbers of births were already covered under Medicaid and were not affected by the expansion. Our finding suggests that the expansion of health insurance increases liability costs to medical practitioners.
医疗责任保险涵盖了医生的责任,其价格可能会影响医生的执业。在本文中,我们使用一个独特的县级数据集来研究内科、普通外科和妇产科三个专业的医疗责任保险价格在《平价医疗法案》(ACA)选择性医疗补助扩大条款后是如何变化的。医疗补助计划的扩大在很大程度上增加了对医疗保健服务的需求,并可能使医生面临更高的医疗责任风险。随着预期损失的增加,保险公司可以通过提高医疗事故保险价格来应对。我们首先研究了选择扩大医疗补助的州的所有县,并将其与非扩大州的县进行了比较。然后,我们缩小分析范围,考虑2010-2018年期间不同医疗补助扩展状态的边境县的差异影响。在这两个样本中,我们发现,与非扩张州相比,扩张州扩张后2年的医疗责任保险价格(平均值)明显更高,内科医生(扩张后2年间为6-8%)和普通外科医生(扩张2年间为12-16%)的差异更大,而OB-GYN的差异更小。我们的OB-GYN结果可能是因为大量的出生已经纳入医疗补助计划,并且没有受到扩大的影响。我们的研究结果表明,医疗保险的扩大增加了医生的责任成本。
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引用次数: 0
Extrapolating Long-Run Yield Curves: An Innovative and Consistent Approach 外推长期收益率曲线:一种创新且一致的方法
IF 1.4 Q3 BUSINESS, FINANCE Pub Date : 2022-09-13 DOI: 10.1080/10920277.2022.2102040
T. Signorelli, C. Campani, C. Neves
This article proposes a method to build term structures that are consistent with market data and that provide interest rates for which the volatility, on average, decreases as maturities increase. The method is designed for continuous repetitive use and is consistent with work by Diebold and Li, providing reasonable extrapolated rates, with an appropriate level of volatility over time. The Svensson model is adopted, and its parameters are estimated by the combination of a genetic algorithm and a quasi-Newton nonlinear optimization method. We innovate with a new objective function that focuses on both parts of the estimated curves (interpolated and extrapolated). For this purpose, a stability component is added. The new objective function aims to solve the problem of estimating long-term rates not observable in the market, for which the estimates are usually artificially stable or excessively volatile. The results show that the estimation method is able to bring the volatility of extrapolated rates to levels consistent with those observed for the longest liquid rate. Estimation errors are small enough and there is no statistical evidence that they are biased. The method is useful for the insurance market, since it provides interest rates that do not lead to artificially stable or excessively volatile technical provisions.
本文提出了一种建立与市场数据一致的期限结构的方法,该方法提供的利率的波动性平均随着期限的增加而降低。该方法是为连续重复使用而设计的,与Diebold和Li的工作一致,提供了合理的外推速率,并具有随时间变化的适当波动水平。采用Svensson模型,结合遗传算法和拟牛顿非线性优化方法对其参数进行估计。我们创新了一个新的目标函数,它关注估计曲线的两个部分(插值和外推)。为此,添加了稳定性组件。新的目标函数旨在解决市场上无法观察到的长期利率估计问题,因为长期利率的估计通常是人为稳定或过度波动的。结果表明,该估计方法能够将外推速率的波动率提高到与最长流动速率下观察到的波动率一致的水平。估计误差很小,没有统计证据表明它们有偏差。这种方法对保险市场很有用,因为它提供的利率不会导致人为稳定或过度波动的技术条款。
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引用次数: 0
Payer-Addressable Burden of Crohn’s Disease in Members Treated with Biologics in the United States: Actuarial Analysis Findings from RAINBOW 美国接受生物制品治疗的会员克罗恩病的付款人可负担:RAINBOW的精算分析结果
IF 1.4 Q3 BUSINESS, FINANCE Pub Date : 2022-09-09 DOI: 10.1080/10920277.2022.2102041
Sabyasachi Ghosh, Ian Smith, James Davidson, T. Fan, N. Candela, Cynthia Tsang, Troy Koch, J. Fehr
Payer-addressable burden (PAB) reflects how real-world disease-associated costs impact the per member per month (PMPM) budget of a health plan, and can help to delineate drivers of PMPM costs and inform cost-management strategies for diseases with a high cost burden, such as Crohn’s disease (CD). We aimed to evaluate the U.S. PAB of CD managed with biologics. Weighted mean costs per member with CD in the commercial health plan population between 2017 and 2019 were evaluated from a health plan actuarial perspective. In addition to the overall population of members with CD treated with adalimumab, infliximab, vedolizumab, or ustekinumab, the subpopulations of members who were naive to biologic therapies at treatment initiation and/or treatment-adherent members were also analyzed. Members treated with vedolizumab contributed the lowest PMPM costs. A similar number of members were treated with vedolizumab and ustekinumab, yet PMPM costs associated with ustekinumab were more than double those of vedolizumab. Biologic naivety and treatment adherence drove lower CD-related PMPM costs. The analyses we present here highlight that treatments and patient subgroups with lower PMPM costs are important focus areas for payers in terms of identifying strategies to manage the budget for CD in a U.S. plan population. Video Abstract Read the transcript Watch the video on Vimeo © 2022 The Author(s). Published with license by Taylor & Francis Group, LLC
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引用次数: 0
Ensemble Economic Scenario Generators: Unity Makes Strength 集合经济场景生成器:团结造就力量
IF 1.4 Q3 BUSINESS, FINANCE Pub Date : 2022-08-26 DOI: 10.1080/10920277.2022.2100425
Jean‐François Bégin
Over the last 40 years, various frameworks have been proposed to model economic and financial variables relevant to actuaries. These models are helpful, but searching for a unique model that gives optimal forecasting performance can be frustrating and ultimately futile. This study therefore investigates whether we can create better, more reliable economic scenario generators by combining them. We first consider eight prominent economic scenario generators and apply Bayesian estimation techniques to them, thus allowing us to account for parameter uncertainty. We then rely on predictive distribution stacking to obtain optimal model weights that prescribe how the models should be averaged. The weights are constructed in a leave-future-out fashion to build truly out-of-sample forecasts. An extensive empirical study based on three economies—the United States, Canada, and the United Kingdom—and data from 1992 to 2021 is performed. We find that the optimal weights change over time and differ from one economy to another. The out-of-sample behavior of the ensemble model compares favorably to the other eight models: the ensemble model’s performance is substantially better than that of the worse models and comparable to that of the better models. Creating ensembles is thus beneficial from an out-of-sample perspective because it allows for robust and reasonable forecasts.
在过去的40年里,人们提出了各种框架来模拟与精算师相关的经济和金融变量。这些模型是有帮助的,但寻找一个能提供最佳预测性能的独特模型可能会令人沮丧,最终也是徒劳的。因此,这项研究调查了我们是否可以通过组合它们来创建更好、更可靠的经济情景生成器。我们首先考虑八个突出的经济情景生成器,并将贝叶斯估计技术应用于它们,从而使我们能够考虑参数的不确定性。然后,我们依靠预测分布叠加来获得最优模型权重,该权重规定了如何对模型进行平均。权重是以忽略未来的方式构建的,以构建真正的样本外预测。基于美国、加拿大和英国这三个经济体以及1992年至2021年的数据进行了广泛的实证研究。我们发现,最优权重随着时间的推移而变化,并且随着经济体的不同而不同。集成模型的样本外行为与其他八个模型相比是有利的:集成模型的性能明显好于较差模型的性能,也与较好模型的性能相当。因此,从样本外的角度来看,创建集合是有益的,因为它可以进行稳健合理的预测。
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引用次数: 1
Medicare Advantage, Medical Loss Ratio, Service Efficiency, and Efficiently Positive Health Outcomes 医疗保险优势、医疗损失率、服务效率和有效的积极健康结果
IF 1.4 Q3 BUSINESS, FINANCE Pub Date : 2022-08-18 DOI: 10.1080/10920277.2022.2099425
P. Brockett, L. Golden, Pengyu Wei, Charles C. Yang
Within the context of Medicare’s enunciated triple aims of better health, better care, and lower costs, we examine the effectiveness of medical loss ratio (MLR) on health outcomes of Medicare Advantage insurers. We simultaneously examine the effect of an efficiency measure for the insurer performance: medical service utilization efficiency (an assessment of how efficiently an insurer provides medical services). This research is based upon collection and integration of several data sources: health outcome data, financial data, and medical service utilization data. The assessment procedure employs a two-stage analytical approach: efficiency analysis followed by regressions. We quantify insurer efficiency using data envelopment analysis (DEA), which determines the relative efficiency of an insurer when the inputs and outputs can both be multivariate. We then run regressions with the dependent variables being functional health outcomes (“improving or maintaining mental health,” “improving or maintaining physical health,” and “improving or maintaining physical and mental health”) and health improvement efficiency (how cost-efficient the insurer is in improving functional health outcomes). Independent variables include MLR, medical service utilization efficiency, and a rich set of control variables. We find that neither MLR nor medical service utilization efficiency provides a good regulatory and evaluation indicator for stimulating/producing functional health outcomes. On the other hand, they do both significantly relate to health improvement efficiency, and hence are both reasonable regulatory and monitoring indicators for efficiently producing positive health outcomes. Our results suggest that to enhance health improvement efficiency, medical service utilization efficiency should be incorporated as a cost-efficient regulatory and monitoring indicator when evaluating Medical Advantage insurers.
在医疗保险阐明的更好的健康、更好的护理和更低的成本三重目标的背景下,我们研究了医疗损失率(MLR)对医疗保险优势保险公司健康结果的有效性。我们同时考察了效率指标对保险公司绩效的影响:医疗服务利用效率(评估保险公司提供医疗服务的效率)。这项研究基于对几个数据来源的收集和整合:健康结果数据、财务数据和医疗服务利用数据。评估程序采用两阶段分析方法:效率分析,然后进行回归。我们使用数据包络分析(DEA)来量化保险公司的效率,当输入和输出都可以是多元的时,数据包络分析确定了保险公司的相对效率。然后,我们进行回归,因变量是功能健康结果(“改善或保持心理健康”、“改善或维持身体健康”和“改善或维护身心健康”)和健康改善效率(保险公司在改善功能健康结果方面的成本效益如何)。自变量包括MLR、医疗服务利用效率和一组丰富的控制变量。我们发现,MLR和医疗服务利用效率都不能为刺激/产生功能性健康结果提供良好的监管和评估指标。另一方面,它们确实与健康改善效率密切相关,因此都是有效产生积极健康结果的合理监管和监测指标。我们的研究结果表明,为了提高健康改善效率,在评估medical Advantage保险公司时,应将医疗服务利用效率纳入成本效益监管和监测指标。
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引用次数: 3
Pay-As-You-Drive Insurance: Modeling and Implications 现收现付保险:模型及其启示
IF 1.4 Q3 BUSINESS, FINANCE Pub Date : 2022-08-11 DOI: 10.1080/10920277.2022.2077220
Jiang Cheng, Frank Y. Feng, Xudong Zeng
Pay-as-you-drive (PAYD) insurance is an exciting innovation. We develop a dynamic model to study PAYD insurance from the policyholder’s utility maximization perspective. We demonstrate that PAYD insurance does benefit the policyholder by reducing premium paid and increasing the total utility derived from auto usage and wealth. PAYD insurance may also improve overall social welfare by incentivizing customers to drive less. We illustrate that PAYD insurance is more efficient than fuel tax in reducing mileage due to the concavity relation of premium and driving distance. Finally, we derive a cut-off value of mileage below which policyholders who drive with traditional insurance should switch to a PAYD policy. Our research proposes a reliable theoretical framework, and confirms that PAYD insurance benefits both individual customers and society as a whole.
现收现付保险是一项令人兴奋的创新。我们从投保人效用最大化的角度建立了一个动态模型来研究PAYD保险。我们证明,PAYD保险确实通过减少支付的保费和增加汽车使用和财富带来的总效用而使投保人受益。付费保险还可以通过激励客户少开车来改善整体社会福利。我们说明,由于保费和行驶距离的凹度关系,PAYD保险在减少里程方面比燃油税更有效。最后,我们得出了里程的截止值,低于该值,使用传统保险的投保人应改用PAYD保单。我们的研究提出了一个可靠的理论框架,并证实了PAYD保险既有利于个人客户,也有利于整个社会。
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引用次数: 3
Products and Strategies for the Decumulation of Wealth during Retirement: Insights from the Literature 退休期间财富积累的产品与策略:来自文献的见解
IF 1.4 Q3 BUSINESS, FINANCE Pub Date : 2022-08-05 DOI: 10.1080/10920277.2022.2078374
Maximilian Bär, Nadine Gatzert
The question how individuals should (optimally) annuitize their wealth remains of high relevance in light of longevity risk and volatile capital markets. In this article, we first present traditional and innovative products and strategies for the decumulation of wealth during retirement, based on a review of 72 selected academic articles in peer-reviewed journals. We further identify relevant factors that generally influence the conception of these products from the retirees’ perspectives, and derive implications for product developers, before concluding with avenues of future research. Our results indicate that innovative suggestions often comprise tontine-like structures, exploit actuarial and accounting smoothing in various ways, defer annuitization to higher ages, or combine it with long-term care options, for instance. Key areas of future research in this field include the consideration of both insurer and retiree perspectives in the analysis of products, using behavioral considerations when evaluating the retirees’ perspective, and taking into account the impact of costs or expenses. While recent articles increasingly consider these aspects, manifold opportunities for future research remain.
考虑到长寿风险和动荡的资本市场,个人应该如何(最佳地)将自己的财富年金化的问题仍然具有高度相关性。在这篇文章中,我们首先介绍了传统的和创新的产品和策略,在退休期间积累财富,基于对同行评议期刊上的72篇精选学术文章的回顾。我们进一步从退休人员的角度确定了通常影响这些产品概念的相关因素,并得出了对产品开发人员的启示,最后得出了未来研究的途径。我们的研究结果表明,创新的建议通常包括类似tontini的结构,以各种方式利用精算和会计平滑,将年金化推迟到更高的年龄,或者将其与长期护理选择结合起来,例如。该领域未来研究的关键领域包括在产品分析中考虑保险公司和退休人员的观点,在评估退休人员的观点时使用行为考虑因素,并考虑成本或费用的影响。虽然最近的文章越来越多地考虑这些方面,但未来的研究仍有许多机会。
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引用次数: 4
A Two-Part Beta Regression Approach for Modeling Surrenders and Withdrawals in a Life Insurance Portfolio 人寿保险投资组合中退保和退保建模的两部分贝塔回归方法
IF 1.4 Q3 BUSINESS, FINANCE Pub Date : 2022-08-05 DOI: 10.1080/10920277.2022.2087679
Fabio Baione, D. Biancalana, Paolo De Angelis
Beta regression is a flexible tool in modeling proportions and rates, but is rarely applied in th actuarial field. In this article, we propose its application in the context of policyholder behavior and particularly to model surrenders and withdrawals. Surrender implies the expiration of the contract and denotes the payment of the surrender value, which is contractually defined. Withdrawal does not imply the termination of the contract and denotes the payment of a cash amount, left to the discretion of the policyholder, within the limits of the surrender value. Moreover, the Actuarial Standard of Practice 52 states that, for surrender and withdrawal estimation, the actuary should take into account several risk factors that could influence the phenomenon. To this aim, we introduce a two-part Beta regression model, where the first part consists in the estimate of the number of surrenders and withdrawals by means of a multinomial regression, as an extension of the logistic regression model frequently used in the empirical literature just to estimate surrender. Then, considering the uncertainty on the amount withdrawn, we express it as a proportion of surrender value; in this way, it assumes values continuously in the interval and it is compliant with a Beta distribution. Therefore, in the second part, we propose the adoption of a Beta regression approach to model the proportion withdrawn of the surrender value. Our final goal is to apply our model on a real-life insurance portfolio providing the estimates of the number of surrenders and withdrawals as well as the corresponding cash amount for each risk class considered.
贝塔回归是一种灵活的比例和比率建模工具,但很少应用于精算领域。在本文中,我们提出了它在投保人行为背景下的应用,特别是在退保和提款模型中。退让意味着合同的到期,表示退让价值的支付,这是合同规定的。撤回并不意味着合约终止,而是指在退保价值的限制内支付现金金额,由保单持有人自行决定。此外,《精算实务标准52》指出,对于退保和退保估计,精算师应考虑到可能影响这一现象的若干风险因素。为此,我们引入了一个两部分的Beta回归模型,其中第一部分包括通过多项回归估计投降和撤回的数量,作为经验文献中经常用于估计投降的逻辑回归模型的扩展。然后,考虑到提现金额的不确定性,我们将其表示为退保价值的比例;这样,它在区间内连续假设值,并且符合Beta分布。因此,在第二部分中,我们建议采用Beta回归方法对放弃值的撤回比例进行建模。我们的最终目标是将我们的模型应用于现实生活中的保险组合,为考虑的每个风险类别提供退保和提款数量的估计以及相应的现金金额。
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引用次数: 0
Discussion on “The Discriminating (Pricing) Actuary,” by Edward W. (Jed) Frees and Fei Huang 论Edward W. (Jed) Frees和黄飞的《区别(定价)精算师》
IF 1.4 Q3 BUSINESS, FINANCE Pub Date : 2022-07-27 DOI: 10.1080/10920277.2022.2078373
R. Thomas
I congratulate the authors on this enjoyable and timely article, which touches on several of my interests. I would like to offer some comments on nonrisk price discrimination, that is, individual price variations that do not reflect expected costs (sometimes described as “ price optimization ” )
我祝贺作者写了这篇令人愉快和及时的文章,它触及了我的几个兴趣。我想对非风险价格歧视提出一些意见,即不反映预期成本的个别价格变化(有时被描述为“价格优化”)。
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引用次数: 1
Smoothed Quantiles for Measuring Discrete Risks 测量离散风险的平滑分位数
IF 1.4 Q3 BUSINESS, FINANCE Pub Date : 2022-07-15 DOI: 10.1080/10920277.2022.2071741
V. Brazauskas, Ponmalar Ratnam
Many risk measures can be defined through the quantile function of the underlying loss variable (e.g., a class of distortion risk measures). When the loss variable is discrete or mixed, however, the definition of risk measures has to be broadened, which makes statistical inference trickier. To facilitate a straightforward transition from the risk measurement literature of continuous loss variables to that of discrete, in this article we study smoothing of quantiles for discrete variables. Smoothed quantiles are defined using the theory of fractional or imaginary order statistics, which was originated by Stigler (1977). To prove consistency and asymptotic normality of sample estimators of smoothed quantiles, we utilize the results of Wang and Hutson (2011) and generalize them to vectors of smoothed quantiles. Further, we thoroughly investigate extensions of this methodology to discrete populations with infinite support (e.g., Poisson and zero-inflated Poisson distributions). Furthermore, large- and small-sample properties of the newly designed estimators are investigated theoretically and through Monte Carlo simulations. Finally, applications of smoothed quantiles to risk measurement (e.g., estimation of distortion risk measures such as Value at Risk, conditional tail expectation, and proportional hazards transform) are discussed and illustrated using automobile accident data. Comparisons between the classical (and linearly interpolated) quantiles and smoothed quantiles are performed as well.
许多风险度量可以通过潜在损失变量的分位数函数来定义(例如,一类失真风险度量)。然而,当损失变量是离散或混合时,风险度量的定义必须扩大,这使得统计推断更加棘手。为了方便从连续损失变量的风险度量文献到离散损失变量的风险度量文献的直接转换,在本文中我们研究离散变量的分位数平滑。平滑分位数是由斯蒂格勒(1977)提出的分数阶或虚阶统计量理论定义的。为了证明光滑分位数的样本估计量的一致性和渐近正态性,我们利用Wang和Hutson(2011)的结果,并将其推广到光滑分位数的向量。此外,我们深入研究了该方法在具有无限支持的离散总体(例如泊松分布和零膨胀泊松分布)中的扩展。此外,通过蒙特卡罗模拟和理论研究了新设计估计器的大样本和小样本性质。最后,讨论了平滑分位数在风险度量中的应用(例如,估计失真风险度量,如风险值、条件尾期望和比例风险变换),并使用汽车事故数据进行了说明。经典(和线性插值)分位数和平滑分位数之间的比较也被执行。
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引用次数: 3
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North American Actuarial Journal
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