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Statistics published by the U. S. Department of Commerce (1980) indicate that in 1977 we spent 8. 1% of our gross national product (GNP) on life, health, property-casualty, and other forms of insurance. An additional 5. 7% was used to pay the Social Security tax, which is another form of insurance premium, for a total of 14. 8% of the GNP. \ Although insurance had its historical origin in marine insurance, it has now developed into one of the major industries of the American economy and extends into many areas of economic activity. One area where growth has been particularly strong is the medical sector. Health insurance is a major institution in all industrialized countries. It became a government responsibility in 1883 when Bismarck intro duced a compulsory program of health insurance for industrial workers in Germany. Programs for workers in various industrial and income categories soon followed in other European countries-Austria (1888), Hungary (1891), Norway (1909), Servia (1910), Great Britain (1911), and Russia and Romania (1912) (Rubinow, 1913:250). Programs in these countries were extended in subsequent years, and other countries in Europe followed with their own programs. Consequently, today most industrial countries have universal or near-universal health insurance coverage. In the United States the issue of national health insurance has been seriously debated since just prior to World War I, and polling data since the 1930s show that a substantial majority of the public has been supportive of such a program (Erskine, 1975).
Specialist groups have often advised health ministers and other decision makers in developing countries on the use of social health insurance (SHI) as a way of mobilizing revenue for health, reforming health sector performance, and providing universal coverage. This book reviews the specific design and implementation challenges facing SHI in low- and middle-income countries and presents case studies on Ghana, Kenya, Philippines, Colombia, and Thailand.
Economic and financial research on insurance markets has undergone dramatic growth since its infancy in the early 1960s. Our main objective in compiling this volume was to achieve a wider dissemination of key papers in this literature. Their significance is highlighted in the introduction, which surveys major areas in insurance economics. While it was not possible to provide comprehensive coverage of insurance economics in this book, these readings provide an essential foundation to those who desire to conduct research and teach in the field. In particular, we hope that this compilation and our introduction will be useful to graduate students and to researchers in economics, finance, and insurance. Our criteria for selecting articles included significance, representativeness, pedagogical value, and our desire to include theoretical and empirical work. While the focus of the applied papers is on property-liability insurance, they illustrate issues, concepts, and methods that are applicable in many areas of insurance. The S. S. Huebner Foundation for Insurance Education at the University of Pennsylvania's Wharton School made this book possible by financing publication costs. We are grateful for this assistance and to J. David Cummins, Executive Director of the Foundation, for his efforts and helpful advice on the contents. We also wish to thank all of the authors and editors who provided permission to reprint articles and our respective institutions for technical and financial support.
The articles in this volume were first presented at the Seventh and Eighth Conferences on Economic Issues in Workers' Compensation sponsored by the National Council on Compensation Insurance. A principal objective of the Conference series has been for workers' compensation insurance researchers to apply state-of-the-art research methodologies to policy questions of interest to the workers' compensation insurance community. This community is a rather diverse group--it includes employers, insurers, injured workers, regulators, and legislators, as well as those who service or represent these groups (e.g., physicians, rehabilitation specialists, labor unions). Despite this diversity and the variety of agendas, the Conference series continues to address many important policy questions. Readers familiar with the Conference series and the four previously published volumes should notice an evolution in terms of the topics addressed in this volume. In the earlier conferences, the topics were more often concerned with the underlying causes of the tremendous increase in workers' compensation benefit payments. In the present volume, h- ever, only four of the fourteen chapters directly concern workers' c- pensation insurance benefits, while the other ten concern the pricing of workers compensation insurance. This is not to suggest that workers' compensation cost increases have abated. In 1989, workers' compensation incurred losses exceeded $45 billion to continue the annual double-digit cost increases. Two explanations can be offered for the somewhat altered focus of this volume. First, despite the continued increase in prices, the financial results for the workers' compensation insurance line continue to be poor.
For a number of years, I have been teaching and doing research in the economics of uncertainty, information, and insurance. Although it is now possible to find textbooks and books of essays on uncertainty and in formation in economics and finance for graduate students and researchers, there is no equivalent material that covers advanced research in insurance. The purpose of this book is to fill this gap in literature. It provides original surveys and essays in the field of insurance economics. The contributions offer basic reference, new material, and teaching supple ments to graduate students and researchers in economics, finance, and insurance. It represents a complement to the book of readings entitled Foundations of Insurance Economics - Readings in Economics and Finance, recently published by the S.S. Huebner Foundation of Insurance Education. In that book, the editors (G. Dionne and S. Harrington) disseminate key papers in the literature and publish an original survey of major contributions in the field.
Two different applications have been considered, automobile claims from Massachusetts and health expenses from the Netherlands. We have fit 11 different distributions to these data. The distributions are conveniently nested within a single four parameter distribution, the generalized beta of the second type. This relationship facilitates analysis and comparisons. In both cases the GB2 provided the best fit and the Burr 3 is the best three parameter model. In the case of automobile claims, the flexibility of the GB2 provides a statistically siE;nificant improvement in fit over all other models. In the case of Dutch health expenses the improvement of the GB2 relative to several alternatives was not statistically significant. * The author appreciates the research assistance of Mark Bean, Young Yong Kim and Steve White. The data used were provided by Richard Derrig of The Massachusetts Automobile Rating and Accident Prevention Bureau and by Bob Van der Laan and The Silver Cross Foundation for the medical insurance claim data. 2~ REFERENCES Arnold, B. C. 1983. Pareto Distributions. Bartonsville: International Cooperative Publishing House. Cummins, J. D. and L. R. Freifelder. 1978. A comparative analysis of alternative maximum probable yearly aggregate loss estimators. Journal of Risk and Insurance 45:27-52. *Cummins, J. D., G. Dionne, and L. Maistre. 1987. Application of the GB2 family of distributions in collective risk theory. University of Pennsylvania: Mimeographed manuscript. Hogg, R. V. and S. A. Klugman. 1983. On the estimation of long tailed skewed distributions with actuarial applications.
The First International Conference on Insurance Solvency was held at the Wharton School, University of Pennsylvania from June 18th through June 20th, 1986. The conference was the inaugural event for Wharton's Center for Research on Risk and Insurance. In atten dance were thirty-nine representatives from Australia, Canada, France, Germany, Israel, the United Kingdom, and the United States. The papers presented at the Conference are published in two volumes, this book and a companion volume, Classical Insurance Solvency Theory, J. D. Cummins and R. A. Derrig, eds. (Norwell, MA: Kluwer Academic Publishers, 1988). The first volume presented two papers reflecting important advances in actuarial solvency theory. The current volume goes beyond the actuarial approach to encom pass papers applying the insights and techniques of financial economics. The papers fall into two groups. The first group con sists of papers that adopt an essentially actuarial or statistical ap proach to solvency modelling. These papers represent methodology advances over prior efforts at operational modelling of insurance companies. The emphasis is on cash flow analysis and many of the models incorporate investment income, inflation, taxation, and other economic variables. The papers in second group bring financial economics to bear on various aspects of solvency analysis. These papers discuss insurance applications of asset pricing models, capital structure theory, and the economic theory of agency.
The problem of solvency is, in fact, as old as insurance. The history of the industry knows many ways to meet the risks involved with underwriting, such as spreading the risk portfolio (Cato, Senior already applied it), risk selection, reserve funds, reinsurance, etc. Whilst these measures too often proved ineffective, the establish ment of legislative control and public supervision ensued. However, not until the last few decades has the solvency issue become an ob ject of intensive studies, very much thanks to the progress of related empirical and theoretical knowledge, and in the under standing of the concerned complicated processes. The research activities have grown extensively in many countries in recent years. The more the studies advance the more new relevant aspects are detected and a great variety of alternative proposals have come up for discussion. Therefore, it has become necessary to attempt a survey of the whole problem area in order to be able to place the quite numerous pieces of knowledge in their proper context, and also, among other things, to avoid the pitfalls of handling isolated problems omitting vital tie-ins to the environment. Many of the rele vant problems and subproblems are still lacking adequate and well tested solutions. Therefore, a survey of the whole problem area can also hopefully serve as guidance for future research efforts.