The purpose of this study is to establish whether digital literacy and insurtech adoption influence insurance inclusion in Uganda. Principally, we sought to determine whether insurtech adoption mediates the nexus between digital literacy and insurance inclusion. This study adopted a cross-sectional and quantitative correlational approach. The study’s sample was 391 individuals who had used digital platforms such as mobile phones and computers to access insurance products and services in Uganda. Data were collected using structured survey questionnaires. Partial Least Squares Structural Equation Modelling (PLSEM) was employed to test the hypothesised relationships. The results demonstrate that both digital literacy and insurtech adoption significantly and positively influence insurance inclusion. We also found digital literacy to be a significant and positive determinant of insurtech adoption. Markedly, it was found that insurtech adoption mediates the association between digital literacy and insurance inclusion in Uganda. However, this study was conducted in a developing country with an underdeveloped insurance market and with low technological advancement. This may affect generalisation of the study findings. This study’s novelty lies in establishing how digital literacy and insurtech adoption interplay to influence insurance inclusion in Uganda. This is the first study to examine the effect of digital literacy and insurtech adoption on insurance inclusion.

Insurance serves as a mechanism to effectively manage and transfer revenue-related risks. We conducted a study to explore the potential financial advantages of index insurance, which protects agricultural producers, specifically sugarcane, against excessive rainfall. Creation of the index involved utilizing generalized additive regression models, allowing for consideration of non-linear effects and quantile generalized additive regression to evaluate relationships with lower quantiles, such as low yield events. To quantify the financial benefits for farmers, should they opt for excessive rainfall index insurance, we employed efficiency analysis based on metrics such as Conditional Tail Expectation, Certainty Equivalence of Revenue, and Mean Root Square Loss. The results of the regression model demonstrate its accuracy in predicting sugar cane yields, with a split testing R2 of 0.691. Additionally, our study suggests that this type of insurance could also apply to sugarcane farmers and other crop producers in regions where extreme rainfall threatens the financial sustainability of agricultural production.

We analyze real telematics information for a sample of drivers with usage-based insurance policies. We examine the statistical distribution of distance driven above the posted speed limit – which presents a strong positive asymmetry – using quantile regression models. We find that, at different percentile levels, the distance driven at speeds above the posted limit depends on total distance driven and, more generally, on such factors as the percentages of urban and nighttime driving and on the driver’s gender. However, the impact of these covariates differs according to the percentile level. We stress the importance of understanding telematics information, which should not be limited to simply characterizing average drivers, but can be useful for signaling dangerous driving by predicting quantiles associated with specific driver characteristics. We conclude that the risk of driving long distances above the speed limit is heterogeneous and, moreover, we show that prevention campaigns should target primarily male, non-urban drivers, especially if they present a high percentage of nighttime driving.

As in other parts of the world, natural disasters are increasingly causing significant loss of life and economic damage in Turkey. Natural disasters such as earthquakes, floods, storms, fires, and hailstorms have been occurring since ancient times, but now they are being compounded by factors such as climate change and the deterioration of natural environments. This has led to an increase in the frequency and severity of natural disasters and the resulting damage. It is important to finance the economic consequences of natural disasters that threaten individuals, commercial enterprises, and the country's administration. The frequency of the public's exposure to natural disasters, insurance awareness, the financial size of the disasters, the risk management policies of insurance companies, and the competence and willingness of the state and local governments to cover the damage are decisive factors. Prior to the increase in natural disasters, the country's administration was active and involved in first aid, rescue, and damage financing. However, it now has difficulty in financing the damage caused by natural disasters to individual, commercial, industrial, and agricultural assets and does not want to provide full assurance. This is because the dangers awaiting humanity in the future cannot be fully predicted. Private insurance companies undertake the task of taking over and distributing the risk in financing natural disaster losses and ensuring sustainability. Although this is a modern and rational solution, the problem is the insufficient number of insurance policies and insufficient premium production in countries where insurance awareness is not sufficiently developed. To increase premium production and geographical distribution of the risk, the state includes natural disaster insurances within the scope of compulsory insurances and mandates pre-disaster insurance policies. Following the earthquake disaster in the Marmara Region on 17.08.1999, compulsory insurance against earthquakes was introduced in Turkey with the Decree Law No. 587, which entered into force on 27.09.2000. This eliminated the obligation of the state to pay earthquake-related payments for the buildings determined by Turkish Natural Catastrophe Insurance Pool (TNCIP). Citizens have obtained modern, reliable, and regular insurance protection against earthquake damage. Naturally, the success or failure of Compulsory Earthquake Insurance (CEI) and Turkish Natural Catastrophe Insurance Pool (TNCIP) can be questioned after a major disaster. Since TNCIP is a new institution and other countries have not yet adopted it as an example, precedent institutions and past data cannot be included in the literature.

In this paper we present an understanding of cyber risks in the Internet of Things (IoT), we explain why it is important to understand what IoT cyber risks are and how we can use risk assessment and risk management approaches to deal with these challenges. We introduce the most effective ways of doing Risk assessment and Risk Management of IoT risk. As part of our research, we also developed methodologies to assess and manage risk in this emerging environment. This paper will take you through our research and we will explain: what we mean by the IoT; what we mean by risk and risk in the IoT; why risk assessment and risk management are important; the IoT risk management for incident response and recovery; what open questions on IoT risk assessment and risk management remain.

In the rapidly evolving field of insurance, accurate risk measurement is crucial for effective claims management and financial stability. Therefore, this research presented a systematic literature review (SLR) on insurance claims risk measurement using Hidden Markov Model (HMM). Bibliometric analysis was conducted using VOSviewer and ResearchRabbit software to map research trends and collaboration networks in this topic. The review explored the implementation of HMM in predicting the frequency and magnitude of insurance claims, with a focus on the statistical distribution methods used. In addition, the research emphasized the influence of the number of hidden states in HMM on claims behavior, both in terms of frequency and magnitude, and provided interpretations of these hidden dynamics. Data sources for the review comprised three databases, namely Scopus, ScienceDirect, and Dimensions. The article selection process followed PRISMA guidelines, resulting in five key articles relevant to the topic. The results offered insights into the application of HMM for forecasting the frequency and severity of insurance claims and opened avenues for further investigation on distribution models and hidden state modeling.

In this study, a dynamic mixture copula is used to estimate the marginal expected shortfall in the South African insurance sector. While other studies assumed nonlinear dependence to be static over time, our model capture time-varying nonlinear dependence between institutions and the market. In order to capture time-varying nonlinear dependence, the generalized autoregressive score (GAS) is used to model the dynamic copula parameters. Furthermore, our study implements a ranking that expresses to what degree individual insurers are systemically important in South Africa. We use daily stock return of five South African insurers listed in the Johannesburg Stock Exchange (JSE) from November 13, 2007 to June 15, 2020. We find that Sanlam and Discovery contribute the most to systemic risk, while Santam is found to be the least contributor to the overall systemic risk in the South African insurance sector. Our findings would be of paramount importance for the South African regulators as they would be informed that not only banks are systemically important, but some insurers also are systemically important financial institutions. Hence, stricter regulation of these institutions in the form of higher capital and loss absorbency requirements could be required based on the individual business activities undertaken by the company.

This paper is focused on mapping the current evolution of Internet of Things (IoT) and its associated cyber risks for the Industry 4.0 (I4.0) sector. We report the results of a qualitative empirical study that correlates academic literature with 14 - I4.0 frameworks and initiatives. We apply the grounded theory approach to synthesise the findings from our literature review, to compare the cyber security frameworks and cyber security quantitative impact assessment models, with the world leading I4.0 technological trends. From the findings, we build a new impact assessment model of IoT cyber risk in Industry 4.0. We therefore advance the efforts of integrating standards and governance into Industry 4.0 and offer a better understanding of economics impact assessment models for I4.0.

This article presents a low-cost insurance system developed for small-hold farms in disaster-prone regions, primarily using free Earth Observation (EO) data and Free Open Source Software (FOSS) – collectively termed sustainable geoinformatics - with a proprietary mobile phone app that enables verification. The study examined 30 farms in Risaralda department, Colombia. A Digital Elevation Model (12.5m pixels) from the ALOS PALSAR satellite sensor was used with a Geographical Information System (GIS) to map the terrain, drainage and geohazards of each farming district. Google Earth Engine (GEE) was used to carry out Time Series Analysis of 15 EO and weather datasets for 1998 to 2020. This analysis enabled the levels of risk from hydrometeorological hazards to be determined for each farm of the study, providing key data for the setting of insurance premiums. A parametric insurance product was piloted using GPS-tagged, time-stamped mobile phone photos to verify crop health. Key features of this insurance system are its low operational cost and rapid damage verification, relative to conventional approaches to farm insurance. It is an affordable form of insurance for small-scale farmers, with the rapid verification and payment of claims. This relatively fast, low-cost and affordable approach to insurance for small-scale farming enhances sustainable development by enabling policy-holder farmers to recover more quickly from disasters.

Insurers act as institutional investors and underwriters of risk, therefore improving their own environmental, social, and governance (ESG) performance is important for the transmission of ESG values to all other economic sectors. We analyze ESG scores of worldwide Property and Casualty (P&C) insurers during 2012-2022, and show that more sustainable insurers have high operating leverage, although their combined ratios and z-scores reveal that they are financially stable. Additional results for the US subsample illustrate that stocks issued by sustainable insurers deliver positive excess returns. Overall, these findings suggest that sustainable practices are associated with the ability of insurers to execute business and create value. This is important for insurance managers, investors, and policy makers, as insurers play a prominent role in promoting economic growth and stability.

This study aimed to evaluate the early-childhood comorbidities of cerebral palsy (CP) in children with low birth weight (LBW) and assess the impact of maternal bio-psychosocial factors on the risk of CP in preterm infants across varying birth weights. Data for 15,181 prematurely born infants from 2009 to 2013 and 151,810 matched controls from Taiwan's National Health Insurance Research Database were analyzed. Period prevalence of CP, and comorbidities of LBW were verified, and odds ratios (ORs) were calculated. Results confirmed that increasing prematurity and low birth weight (LBW) rates in Taiwan. LBW was associated with higher CP prevalence. Maternal age extremes (<20 and >40 years) were significant risk factors of CP in LBW infants. LBW infants showed higher risks of respiratory, circulatory, and nervous system and psycho-developmental comorbidities compared to controls. Infants with the lowest birth weights had even higher ORs for these comorbidities. However, gastrointestinal and nutritional comorbidities were less prevalent in premature infants. Maternal factors such as family income, number of hospital admissions, and length of hospital stay were significantly correlated with birth weight and subsequent complications. Each additional gestational week significantly reduced the risk of complications in premature infants. Additionally, maternal bio-psychosocial factors were associated with birth weight and related outcomes in premature infants, emphasizing the importance of addressing these factors in prenatal care and interventions.

The growing concerns on sustainability urge insurance companies to incorporate Environmental, Social, and Governance (ESG) policies in order to remain competitive. As all dimensions of sustainability involve taxation, it is important to establish if this association reflects on financial performance. Our analysis of worldwide property and casualty (P&C) insurers during 2013-2022 reveals that high ESG insurers pay more taxes, while are less profitable compared to low ESG insurers. This pattern is confirmed using instrumental variable regressions and simultaneous equations systems. We argue that sustainable insurers are less tempted to avoid taxes, and don't shift their tax burdens on policyholders and investors. However, the interplay between taxes and sustainability seems to harm insurers' profitability, potentially sorting negative consequences on investment and economic growth. This is an important insight for tax authorities and insurance managers.

The insurance sector has undergone a transformative shift with the emergence of Insurtech, integrating technological innovations into the industry. This review aims to provide a comprehensive overview of the impact of Insurtech on the insurance sector, focusing on the case study of Lemonade. By placing the study in the context of the broader insurance landscape, the review explores the significance and relevance of this transformation. The article analyzes Lemonade's unique business model and its departure from traditional insurance practices. Furthermore, it examines the implications of Lemonade's approach on the industry and the challenges it faces. Through this analysis, the review sheds light on how Insurtech and the transformation of the insurance sector are redefining insurance services and consumer experiences. The future implications of these trends for insurance companies, consumers, and the industry as a whole are also explored. In summary, this review provides valuable insights into the transformative power of Insurtech, emphasizing the importance of technological advancements and innovative approaches in shaping the future of the insurance sector.

Artificial intelligence (AI) is a tool that financial intermediaries and insurance companies use in most cases or are willing to use it in almost all their activities. AI can have a positive impact on almost all aspects of the insurance value chain.: pricing, underwriting, marketing, claims management, after-sales services. While it is very important and useful, AI is not free of risks, including its robustness against cyber-attacks and so-called adversarial attacks. Adversarial attacks are conducted by external entities to misguide and defraud the AI algorithms. The paper is designed to provide a review of adversarial AI and discuss its implications for the insurance sector. The study starts with a taxonomy of adversarial attacks and presents a fully-fledged example of claims falsification in health insurance. Some remedies, consistent with the current regulatory framework, are presented.

There is a growing concern about climate change being a serious threat to insurance business sustainability. Knowing if climate warming is a cause for claims and losses increase, and how this cause-effect relationship will develop in the future are two open major questions. In this article, we answer both questions by particularizing the geographical area of Spain, and a precise risk, hailstorm in crop insurance in the line of business of wine grapes. We measure climate change thanks to the Spanish Actuarial Climate Index (SACI). We use a database containing all the claims caused by hail risk in Spain from 1990 to 2022. With homogenized data, we consider as dependent variables the monthly number of claims, monthly number of loss costs equal to one, and monthly total losses. The independent variable is the monthly Spanish Actuarial Climate Index (SACI). We try to explain the former through the latter using regression and quantile regression models. Our main finding is that climate change as measured by SACI explains these three dependent variables. We also give an estimation of the increase of the monthly total losses Value at Risk, corresponding to a future increase in climate change measured in units of SACI. Spanish crop insurance managers should carefully incorporate these conclusions into their decision-making process to keep this line of business sustainable in the future.

This paper explores the tuning and results of two-part models on rich datasets provided through the Casualty Actuarial Society (CAS). These data sets include BI (bodily injury), PD (property damage) and COLL (collision) coverage, each documenting policy characteristics and claims across a four year period. The datasets are explored, including summaries of all variables, then the methods for modeling are set forth. Models are tuned and the tuning results are displayed, after which we train the final models and seek to explain select predictions. All of the code will be made available on GitHub. Data was provided by a private insurance carrier to the CAS after anonymizing the data set. This data is available to actuarial researchers for well-defined research projects that have universal benefit to the insurance industry and the public. Our hope is that the methods demonstrated here can be a good foundation for future ratemaking models to be developed and tested more efficiently.

In Rwanda, more than 90% of the population is insured for health care. Despite the comprehensiveness of health insurance coverage in Rwanda, some health services at partner institutions are not available, causing insured patients to pay unintended cost. We aimed to analyze the effect of health insurance on health care utilization and factors associated with the use of health care services in Rwanda. This is an analysis of secondary data from the Rwanda integrated living condition survey 2016-2017. The survey gathered data from 14580 households, and decision tree and multilevel logistic regression models were applied. Among 14580 households only (20%) used health services. Heads of households aged between [56-65] years (AOR=1.28, 95% CI:1.02-1.61), aged between [66-75] years (AOR=1.52, 95% CI: 1.193-1.947), aged over 76 years (AOR=1.48, 95% CI:1.137-1.947), households with health insurance (AOR=4.57, 95% CI: 3.97-5.27) displayed a significant increase in the use of health services. This study shows evidence of the effect of health insurance on health care utilization in Rwanda: a significant increase of 4.57 times greater adjusted odds of using health services compared to those not insured. The findings from our research will guide policymakers and provide useful insights within the Rwanda context as well as for other countries that are considering moving towards universal health coverage through similar models.

The role of insurance in financial inclusion as well as in economic growth is immense. However, low uptake seems to impede the growth of the sector hence the need for a model that robustly predicts uptake of insurance among potential clients. In this research, we compared the performances of eight (8) machine learning models in predicting the uptake of insurance. The classifiers considered were Logistic Regression, Gaussian Naive Bayes, Support Vector Machines, K Nearest Neighbors, Decision Tree, Random Forest, Gradient Boosting Machines and Extreme Gradient boosting. The data used in the classification was from the 2016 Kenya FinAccess Household Survey. Comparison of performance was done for both upsampled and downsampled data due to data imbalance. For upsampled data, Random Forest classifier showed highest accuracy and precision compared to other classifiers but for down sampled data, gradient boosting was optimal. It is noteworthy that for both upsampled and downsampled data, tree-based classifiers were more robust than others in insurance uptake prediction. However, in spite of hyper-parameter optimization, the area under receiver operating characteristic curve remained highest for Random Forest as compared to other tree-based models. Also, the confusion matrix for Random Forest showed least false positives, and highest true positives hence could be construed as the most robust model for predicting the insurance uptake. Finally, the most important feature in predicting uptake was having a bank product hence bancassurance could be said to be a plausible channel of distribution of insurance products.

We use the theory of coherent measures to look at the problem of surplus sharing in an insurance business. The surplus share of an insured is calculated by the surplus premium in the contract. The theory of coherent risk measures and the resulting capital allocation gives a way to divide the surplus between the insured and the capital providers, i.e. the shareholders.

Background/Objectives: The purpose of this study was to evaluate the relationship between 1-year mortality and health insurance benefit extension policy items in severe pneumonia pa-tients requiring mechanical ventilation using a South Korean nationwide cohort. Methods: A nationwide population-based retrospective study was conducted using the Korean National Health Insurance database. A total of 1,099 patients (542 patients in the health insurance benefit item group and 557 patients in the control group) were included. The primary outcome was 1-year mortality. Results: Among patients with health insurance benefit extension policy items, 203 patients (37.5%) were diagnosed with hemato-oncological disease, who were categorized as group A, and 339 patients (62.5%) were diagnosed with cerebrovascular, cardiovascular, or rare diseases, who were categorized as group B. Group B had lower 1-year mortality (50.7% vs. 62.5%, P

Background and Objectives: Cancer as the second leading cause of death in the United States poses a huge healthcare burden. Barriers to access to advanced therapies influence the outcome of cancer treatment. In this study, we examined whether insurance types affect the quality of cancer clinical care regarding access to an important monoclonal antibody, ramucirumab. Materials and Methods: Data for 13,340 cancer patients with Purchased or Medicaid insurance from the All of Us Database were collected for this study. The Chi-square test of proportions was employed to determine the significance of patient cohort characteristics and ramucirumab usage between Purchased and Medicaid insurance groups. The independent t-test was utilized to assess the influences of other determinants on insurance types. Results: Cancer patients who are African American, with lower socioeconomic status, or with lower educational attainment are more likely to be insured by Medicaid. Analysis of survey questions demonstrated the relationship between income and education level with insurance type as Medicaid cancer patients were less likely to receive primary care and specialist physician access and more likely to request lower cost medications. In addition, those with Medicaid insurance were identified to have poorer access to expensive therapeutics like ramucirumab compared to those with Purchased insurance.  Conclusions: The inequities of the US healthcare system are observed for cancer patient care; access to physicians and therapeutics are highly varied and dependent on insurance types. Socioeconomic status determines insurance type, which unfortunately generates a significant impact on cancer treatment and disease outcome.

This work estimates yield losses due to drought events in mountain grasslands in north-eastern Italy, laying the groundwork for index-based insurance. Given the high correlation between Leaf Area Index (LAI) and grassland yield, we exploit LAI as a proxy for yield. We estimate LAI by the Sentinel-2 biophysical processor and we compare different gap-filling methods, including time-series interpolation and fusion with Sentinel-1 SAR data. We derive a Forage Production Index (FPI) as the growing season cumulate of the daily product between LAI and a meteorological water stress coefficient. Finally, we calculate the drought index as the anomaly of FPI. The validation of Sentinel-2 LAI with ground measurements showed RMSE of 0.92 [m2 m-2] and R2 of 0.81, on average over all the measurement sites. The comparison between FPI and yield showed R2 of 0.56 at the pixel scale and R2 of 0.74 at the parcel scale. The developed prototype FPI index was used at the end of the growing season of the year 2022 for calculating the payments of an experimental insurance scheme that was proposed to a group of farmers in Trentino-South Tyrol.

The insurance industry plays an important role for European economic stability and the threats and opportunities it faces should be carefully determined. In this paper we highlight the main challenges by using a PEST analysis. This work applies conventional actuarial thought on this area by focusing strictly on the European sector.

This study presents a novel predictive model to address the churn problem in the motor insurance sector using a dual-phase framework. The first phase employs a cave-degree perturbation technique for effective feature selection, while the second phase applies the Magnetic Force Perturbation Technique (MFPT) to optimize the search process and avoid local optima traps. Two metaheuristics are proposed: the Adaptive Random Forest-Assisted Large Neighborhood Feature Optimizer (ARALFO) and the Adaptive Random Forest Particle Swarm Optimizer (ARFPSO) to enhance churn prediction accuracy. The model was evaluated on two real-world motor insurance datasets, achieving a 95% accuracy rate and outperforming state-of-the-art algorithms. An ablation study confirmed the significant impact of the cave-degree and MFPT techniques in boosting predictive performance.

Despite the lack of evidence that suggests hemodiafiltration (HDF) offers a better survival outcome than standard hemodialysis (HD), the number of patients initiating HDF in Japan continues to rise. This study examined the temporal change in the number of HDF incidents, evaluated factors associated with all-cause mortality, and compared the mortality risk and survival time of patient on HDF with patients receiving standard HD in three sets of 2-year cohorts. The primary analyses included the insurance claims data of 460 HDF patients and propensity score-matched 903 standard HD patients who initiated dialysis therapy between April 1, 2012 and March 31, 2018. Patient follow-up was censored at the time of death or the end of the 2-year study period. The influence of comorbidities on all-cause mortality was investigated, and the survival outcomes between HDF and standard HD patient groups throughout cohorts were compared. The number of HDF patients was increasing throughout cohorts, but the proportions of mortality cases across cohorts slowly decreased. Dementia status increases the mortality risk of patients regardless of dialysis modality. The mortality risk among HDF patients with dementia was more significant than HD patients. Adjusting for all covariates, we observed that HDF patients had a reduced mortality risk and longer survival time than patients on standard HD. This study supports the notion that HDF reduces all-cause mortality compared with standard HD in an incident dialysis population in Fukuoka Prefecture, Japan.

Having sustained, over the course of more than two decades, record-breaking natural catastrophe losses, American insurers and reinsurers are justifiably questioning the potential linkage between anthropogenic climate change and extreme weather. Here, we explore issues pertaining to this linkage, looking at both the likely short-term implications for the insurance industry, as well as potential longer-term impacts on financial performance and corporate resilience. We begin our discussion with an overview of the implications that climate change is likely to have on the industry, especially as it relates to how catastrophic risks are construed, assessed, and managed. We then present the rudiments of an econometric analysis that explores the financial resilience of the property/casualty (P/C) industry in the face of both natural and man-made catastrophes. In this analysis, we explore the profitability consequences of several illustrative scenarios involving large-scale losses from extreme weather—specifically, a sequence of storms like those striking the U.S. in 2004—and a scenario that explores the prospect of a Katrina-scale storm in combination with a mass terror attack on the scale of 9/11. At systemic levels of aggregation, our analysis suggests a high degree of macro-resilience for the insurance industry. Moreover, we find that insurer resilience is higher for larger impacts, considering both the speed of recovery, as well as the inverse of the area under the unaffected system profile. We conclude with a summary of our findings and a closing commentary that explores the potential implications of these results for P/C insurers moving forward.

Insurance companies have a risk of bankruptcy if the funds disbursed exceed the reserves owned, or the surplus is negative. The risk of bankruptcy can be predicted using a mathematical model to anticipate the possibility of bankruptcy early on, so the surplus process needs to be observed in its evolution over time, assumed to be discrete time because it refers to the budget year period. The surplus process model is generally determined by three components, namely company capital, total premiums, and total claims. The sharia insurance scheme separates the management of the company's capital account from the premium and claim fund accounts, making it easier to monitor the evolution of its surplus process. This study systematically reviews the surplus process model for the sharia insurance scheme. The systematic review method is carried out by collecting scientific papers published in the Scopus, ScienceDirect, Dimensions, and Google Scholar databases. The PRISMA flowchart selects and then produces three scientific papers that are relevant to the topic. The results of this study provide insight into the form of the surplus process model and four sharia insurance schemes, namely mudharabah, wakalah, hybrid, and waqf. However, the scheme introduced is still a general description, there is no scheme based on needs or social problems in society such as the integration of productive waqf with welfare benefits for groups in need such as fishermen. This research was conducted towards the transition towards sustainable development of sharia insurance.

Objective: The long-term care insurance (LTCI) system was introduced in 2000 to provide financial support for long-term care services to older adults. What is known on this topic report focuses on a comparative analysis of how the LTCI system has affected older people in Japan. Methods: We obtained data from the literature about the LTCI system, compared and analysed the collected articles, and concluded. Results: The LTCI system has improved access to long-term care services, with more older adults receiving care than before the system’s implementation. This service has improved the quality of life for many elderly individuals who require assistance with daily activities. Furthermore, the LTCI system has alleviated the financial burden of long-term care services since the insurance covers a large portion of the costs. It has made older adults maintain their independence and dignity, as they can afford the necessary care without relying solely on their savings or burdening their families. Conclusions: Japan’s LTCI system has positively impacted older adults by improving access to long-term care services and alleviating financial burdens. However, challenges such as increasing demand and variations in service quality need to be addressed to ensure the system effectively supports older people in Japan.

In this dynamic 21st Century global economy, managers of insurance companies cannot afford to ignore the involvement of their employees in strategic change programmes. The employee's voice in strategic change programmes is now a prerequisite for organizational performance. This study seeks to determine the effect of employee involvement in strategic change programmes through participation in decision-making, teamwork, communication, creativity, and innovation. The research approach used was quantitative to collect data from 115 respondents using a 5-point Likert scale questionnaire. The study employed the multiple regression method to analyse data using the IBM SPSS V28 software. All five constructs of employee involvement had a significant effect on the performance of insurance companies in Zimbabwe. The study findings will convince top managerial leaders of the insurance industry to acknowledge and appreciate the importance of involving employees in strategic change programmes. Besides, industry regulatory authorities can advocate for policies that encourage employee involvement in decision-making.

Although the universal health coverage (UHC) is pursued by many countries, not all countries with UHC include dental care as their benefits. Japan, with its long-held tradition of UHC, has covered dental care as essential benefit and majority of dental care services are provided to all patients with minimal copayment. Being under the UHC, the scope of services as well as prices are regulated by the uniform fee schedule and dentists submit claims according to the uniform format and fee schedule. The author analyzes the publicly available dental health insurance claims data as well as a sampling survey on dental hygiene and illustrates how Japan’s dental care is responding to the challenges of the population ageing.

Medical insurance claims are becoming increasingly common data sources to answer a variety of questions in biomedical research. Although comprehensive in terms of longitudinal characterization of disease development and progression for a potentially large number of patients, population-based studies using these datasets require thoughtful modification to sample selection and analytic strategies, relative to other types of studies. Along with complex selection bias and missing data issues, claims-based studies are purely observational, which limits effective understanding and characterization of the treatment differences between groups being compared. All these issues contribute to a crisis in reproducibility and replication of comparative findings. This paper offers some practical guidance to the full analytical process, demonstrates methods for estimating causal treatment effects on several types of outcomes common to such studies, such as binary, count, time to event and longitudinally varying repeated measures outcomes, and aims to increase transparency and reproducibility. We provide an online version of the paper with readily implementable code for the entire analysis pipeline to serve as a guided tutorial for practitioners. The online version can be accessed at https://rydaro.github.io/. The analytic pipeline is illustrated using a sub-cohort of patients with advanced prostate cancer from the large Clinformatics TM Data Mart Database (OptumInsight, Eden Prairie, Minnesota), consisting of 73 million distinct private payer insurees from 2001-2016.

Objectives Asylum seekers in Germany represent a highly vulnerable group from a health perspective due to a variety of risk factors. At the same time their access to healthcare is restricted. While the introduction of the Electronic Health Insurance Card (EHIC) for asylum seekers instead of healthcare-vouchers is discussed controversially using politico-economic reasons, there is hardly any empirical evidence on its actual impact on the use of medical services Study design Thus, the aim of this study is to examine the influence of the possession of the EHIC on the use of medical services by asylum seekers as measured by their consultation rate of ambulant physicians (CR). For this purpose, a standardized survey was carried out to 260 asylum seekers in different municipalities of which some have introduced the EHIC for asylum seekers, while others have not. Methods Various CR were differentiated considering possible third variables as well as confounding factors. The period prevalence was compared between the groups "with EHIC" and "without EHIC" using a two-sided t-test. Multivariate analysis was done using a linear OLS regression model. Results Asylum seekers who are in possession of the EHIC are significantly more likely to seek ambulant medical care than those receiving healthcare-vouchers. Their CR, however, does not differ significantly from the age-corrected CR of the autochtonous population. Taking into account relevant covariables, the possession of the EHIC can be viewed as an independent influencing factor on the asylum seekers' use of medical care. Conclusions The results of this study suggest that having to ask for healthcare-vouchers at the social security office could be a relevant barrier for asylum seekers. Nevertheless, the ownership of the EHIC does not seem to lead to an overuse of medical services.

This article takes an approach to explaining the behavioral manifestations of the decision making in US companies’ offer of health insurance that is grounded not only on their cost minimizing behavior, but also in a humanness dimension based on the African concept of Ubuntu. In this way, we define an Ubuntu based Random Utility modeling framework, describing the choice process as a tripartite decision making, and implemented using a nationally representative random sample of 1,061 American companies from the Dunn and Bradstreet Business data, supplied by Survey Sampling International to the Associated Press-NORC Center for Public Affairs Research. The results from the three sequentially implemented specifications showed that the relationship between management culture and health plan offering strategy is dependent on other relevant co-variates, which when left out, leads to the problem of omitted variables bias. However, when all variables are included but assumed to enter the relationship exogenously, this results in management culture not having any statistically significant effect on companies' decisions about scope of health plan offering. When the exogeneity assumption is relaxed through a recursively Bivariate Probit model, the system of two equations produces a highly significant management culture effect. In fact, in this later case we see that companies with groups and formal committee management culture are 1.58 times less likely to choose a multiple plan strategy over a single plan strategy, hence failing to show the more wholesome plan offering that would theoretically prevail under Ubuntu style management.

The increasing prevalence and heightened severity of extreme weather events, which are consequences of climate change, pose significant challenges to the global property insurance sector. This study examines the concurrent crises faced by insurance companies in maintaining profitability and by property owners in affording coverage, thereby necessitating a reevaluation of current insurance paradigms. We present an innovative approach that utilizes a back-propagation (BP) neural network to forecast insurance losses and guide strategic underwriting decisions in regions prone to perils. Our advanced model combines crucial factors such as the likelihood of extreme meteorological phenomena, insurance risk premiums, and capital adequacy ratios to predict impending losses and inform insurance policy formulation. Through an extensive analysis of nearly two decades of catastrophe data from the United States and New Zealand, we determine the model's effectiveness in anticipating insurance-related losses and providing strategic guidance to insurance entities. The study concludes with recommendations for insurers to enhance risk assessment, innovate products, collaborate with governments, invest in green projects, and establish dedicated climate risk management teams. The study contributes to the discourse on climate change adaptation in the insurance industry and offers practical solutions for navigating the complexities of extreme weather risk.

This paper explores decision analysis on product integration of family security services and residential fire insurance in the London and Taiwan markets by using the proposed mathematical models for counting sustainable value. This paper shows the five main different results between London and Taiwan markets with ten different parameters of the family security market, to find out the optimal number of family security integrated services for each security company in London. The improvement of the risk aversion effect based on risk and financial management will enhance the market share of the private security industries in the London and Taiwan markets. The results of this research can serve as a reference for the decision-making of private security industries on product integration under sustainable value consideration. The research findings highlight the potential benefits for both the private security industry and the insurance industry in their design and negotiation for product integration to improve both of business operation and achieve corporate social responsibility goals to match the sustainability in the future.

Objective: Taiwan Government’s organizations have endeavored to promote the applications of big data and open data. The “My Health Bank” is one of the measures promoted by the National Health Administration, Ministry of Health and Welfare. This study proposes the perspective of the “value co-creation” with the attempt to extend the concept of service ecosystem and apply it on the platform of My Health Bank to examine whether people (patients, families, and caregivers) can promote their health literacy? Method: This cross-sectional study, with people that have registered at “My Health Bank” as subjects. Complying with the inclusion criteria, 401 questionnaires were delivered, with 391 valid ones, excluding those incompletely and inaccurately filled. Result: That the affecting factors of the co-creation of values: age, education level, annual income, and platform operation show to be significant ( p＜0.05); and gender, occupation, and resource exchange do not reach the significant level (p＞0.1). Conclusion: We found My Health Bank changed the inertia of “value creation” in the traditional medical value, it allows the traditional medical and healthcare industry to expose to the impacts of the mega trend of the internet, the transformation of the platform in a necessary trend.

Precision medicine seeks to use genomic data to help provide the right treatment to the right patient at the right time. Next-generation sequencing technology allows for the rapid and accurate sequencing of many genes at once. This technology is becoming more common in oncology, though the clinical benefit of incorporating it into precision medicine strategies remains under significant debate. In this manuscript, we discuss the early findings of the impact of next-generation sequencing on cancer patient outcomes. We investigate why not all patients with genomic variants linked to a specific therapy receive that therapy and describe current barriers. Finally, we explore the current state of health insurance coverage for individual genome sequencing and targeted therapies for cancer. Based on our analysis, we recommend increased transparency around the determination of “actionable mutations” and a heightened focus on investigating the variations in health insurance coverage across patients receiving sequencing-matched therapies.

For automobile insurance, it has long been implied that when a policyholder made at least one claim in the prior year, the subsequent premium is likely to increase. When this happens, the policyholder may seek to switch to another insurance company to possibly avoid paying for a higher premium. In such situations, insurers may be faced with the challenges of policyholder retention by keeping premiums low in the face of competition. In this paper, we seek to find empirical evidence of possible association between policyholder switching after a claim and the associated change in premium. In accomplishing this goal, we employ the method of association rule learning, a data mining technique that has its origins in marketing for analyzing and understanding consumer purchase behavior. We apply this unique technique in two stages. In the first stage, we identify policyholder and vehicle characteristics that affect the size of the claim and resulting change in premium regardless of policy switch. In the second stage, together with policyholder and vehicle characteristics, we identify the association among the size of the claim, the level of premium increase and policy switch. This empirical process is often challenging to insurers because they are unable to observe the new premium for those policyholders who switched. However, we used a 9-year claims data for the entire Singapore automobile insurance market that allowed us to track information before and after the switch. Our results provide evidence of a strong association among the size of the claim, the level of premium increase and policy switch. We attribute this to the possible inefficiency of the insurance market because of the lack of sharing and exchange of claims history among the companies.

Background: Health insurance (HI) run by government is providing health care service to large population. Due to poor accountability, participation and sustainability, cooperative health insurance is becoming more popular and effective in low and middle income and some high-income countries too. In Nepal, there are public and cooperative HI is in practice. The aim of this study is to compare the effectiveness of public (government) and cooperative HI in relation to benefit packages, population coverage, inclusiveness, health care utilization, and promptness for treatment in these two health insurance models in Nepal. Method: This is an institution based concurrent mixed study consists of qualitative and quantitative variables from public and cooperative groups. We included all public HI operated by government hospitals and cooperatives groups those purchased hospital service in contract. Two separate study tools were applied to access the effectiveness of insurance models. The key questions were asked for the representatives of government and private health insurance. The numeric information consisted of in quantitative data and subjective response was included in qualitative approach. Descriptive statistics and Mean Whitney U test was applied in numeric data and qualitative information were analyzed by inductive approach Results: The study revealed that new enrolment was not increased, health care utilization rate was increased and the benefit package was almost same in both groups. The overall inclusiveness was higher for the government HI, but enrolment from the religious minority, proportion of negotiated amount during treatment were significantly higher (p<0.05). During illness, the response time to reach hospital was significantly faster in cooperative health insurance than government health insurance. Qualitative findings showed that level of participation, accountability, transparency and recording system was better in cooperative health insurance than public. Conclusion: Cooperative HI could be more sustainable and accountable to the community for all; low, middle and high-income countries.

We examine worldwide Property and Casualty and Life and Health insurance companies from 2004 until 2023, implementing panel regression models and mediation analysis to show that insurers raise their reserves when they face increasing costs for their potential environmental damages, ultimately reducing their profitability and underwriting capacity. Our findings extend to the insurance sector the previous evidence on banks, demonstrating that environmental damages could affect profits and solvency of financial intermediaries. These insights are important especially for insurance managers and regulators.

Numerous researchers acknowledge that occupational pension protects employees. However, the total occupational pension is shared by employees and employers in China, which is a cost. This study aimed to explore the occupational pension on corporate social responsibility (CSR) and organizational resilience. We drew upon insights from cost-stickiness and resource-based theories to develop a model that illuminates how occupational pension affected firms’ stance toward CSR in the context of the COVID-19 pandemic and how this, in turn, has result organizational resilience. This study categorized CSR into strategic and responsive activities based on cost stickiness. We selected a total of 34,145 observations of Chinese listed companies over the period 2010-2023 as a sample to investigate whether occupational pension changes CSR strategies. The results showed that the cost pressure to contribute to occupational pension drove firms to reduce their responsive CSR and boost their strategic CSR. Moreover, strategic CSR improved organizational resilience, but responsive CSR did not. This relationship between occupational pension and CSR was significantly and negatively moderated by the minimum wage and population aging. Whereas, the relationship between CSR and organizational resilience was significantly and positively moderated by digital transformation and marketing capabilities. This study has implications for decision-making regarding high-quality firm development.

The ability to identify and rank risk is essential for efficient and effective supervision of financial service firms, such as banks and insurers. Risk ranking ensures limited resources are allocated where they are most needed. Today, automatic risk identification within insurance supervision primarily relies on quantitative metrics based on numerical data (e.g. returns). The purpose of this work is to assess whether Natural Language Processing (NLP) and cognitive networks can achieve similar automated risk ranking and identification by analysing textual data, i.e. NIDT=829 investor transcripts from Bloomberg. To this aim, this work explores and tunes 3 NLP techniques: (1) keyword extraction enhanced by cognitive network analysis; (2) valence/sentiment analysis; and (3) topic modelling. Results highlight that keyword analysis, enriched by term frequency-inverse document frequency scores and semantic framing through cognitive networks, could detect events of relevance for the insurance system like cyber-attacks or the COVID-19 pandemic. Cognitive networks were found to highlight events that related to specific financial transitions: The semantic frame of "climate" grew in size by +538% between 2018 and 2020 and outlined an increased awareness that agents and insurers expressed towards climate change. A lexicon-based sentiment analysis achieved a Pearson’s correlation of ρ=0.16 (p&lt;0.001,N=829) between sentiment levels and daily share prices. Although relatively weak, this finding indicates that insurance jargon is insightful to support risk supervision. Topic modelling is considered less amenable to support supervision, because of a lack of results’ stability and an intrinsic difficulty to interpret risk patterns. We discuss how these automatic methods could complement existing supervisory tools in automated risk ranking.

In nowadays conditions, insurance provides the opportunity for market system of economic management to work in any state. To provide economic security of the person it is needed to create a mechanism of protection against internal and external threats in modern Russia. That’s why the role of citizens insurance policy is increasing as the most effective risk management institute and achieving safety of health and private property of citizens. The goal of this research is to study Russian citizens’ attitudes towards insurance policy and investment using the conception of personal economic security. The preparatory study stage was focused on theoretical understanding of economic security problems taking insurance field as an example. Empirical research consisted of four stages. There were 1793 people taking part in this research. Results of this study can be proposed in the program of improving the functioning of the insurance market in the Russian Federation in The framework of the strategy of development of the insurance market - 2020. The obtained results can be used in Politics and Economics in the development of a set of measures related to lawmaking, control of financial institutions, promotion of financial literacy of the population, preparation of courses for universities and trainings for participants of the insurance market. The typologies of policyholders which were given can be the basis to create insurance programs for the citizens.

The universal health insurance system in Taiwan was formed with good intentions to help vulnerable groups. However, the possibility of bankrupting the system due to wasted medical resources. In this study, using the medical expenditures of the Taiwanese Government and gross domestic product (GDP) as variables, the wavelet analysis method was used to empirically study the correlations and leading-lagging relationships in quarterly data in the period from 1996 to 2016. In addition, the dependent population of the insured was used as the control variable. This population had no income and had high medical demands. Results: After the dependent population was included as a control variable, there was a period of low-frequency (one to four years short-term) linkage correlation, as well as a period of high-frequency (four to eight years long-term) linkage correlation. In addition, for more than eight years, there was also a high degree of linkage correlation, indicating that the linkage between medical expenditures and GDP occurred over the long term. Moreover, since medical expenditures positively affected GDP, one-way causality was observed. However, after 2008, regardless of whether a long or short term was examined, there was almost no linkage correlation. Before 2008, the medical expenditures of the government were positively correlated with economic growth; i.e., they enhanced economic growth. But, after 2008, this effect had already disappeared. The universal health insurance system has long been denounced as a waste of medical resources, and the waste must be immediately stopped. The government urgently needs to find a new solution.

Motivated by the theoretical model of health insurance choice with Flexible Spending Accounts (FSAs) presented in Cardon 2012, this study investigates the determinants of optional coverage (SSP) and flexible spending accounts (FSA) enrollment, among the privately insured in post-affordable-care-act (ACA) USA. To this end, we rely on semi-parametric bi-variate probit methods, along with a pooled cross-section of the 2015-2016 National Health Interview Surveys. As predicted by the theoretical model, we find that SSP and FSA are complement health solutions with a positive correlation. Our results emphasize that the most important trigger factors influencing the joint probability of SSP and FSA adoption include not only insurance premium cost, but also age, education, marital status, number of work hours, region of residency, citizenship status, and annual health expenditure level. We find that controlling for these latter factors, health status is not significant especially for FSA adoption. In addition, despite the fact that the relative frequency of individuals with FSA rises with increasing levels of medical expenditure, ACA restrictions on FSA tax exclusion to an annual adjusted maximum of $2600 (in 2017 $s) seems to adversely burden individuals with greater medical expenditure, thereby reducing their likelihood of FSA enrollment in post-ACA USA. Understanding these factors is very crucial to US health care market's stakeholders, including insurance companies, firms looking to design their health insurance offerings, but also policy-makers interested in providing new tailored health solutions for reducing health risks.

MEMS (Micro-electromechanical Systems) becomes important increasingly due to the smarter and smaller fuze used in OICW (Objective Individual Combat Weapon). MEMS Safety and Arming (S&A) device is employed in different platforms and regions for small caliber projectile. Therefore, it is necessary to make a parametric study of the MEMS S&A device in different apply environments and explore the main sensitive factors of the MEMS S&A device to provide reference for designs. In this paper, based on the MEMS S&A device designed by our term, theory and finite element models are established, and the centrifugal insurance mechanism of the MEMS S&A device is parametric studied under the different speeds, temperature and thickness of the model by nonlinear dynamic method. By comparing the experimental and predicted results, the established FEM model is verified, and the conclusion is that the temperature and the centrifugal force are the main sensitive factors in the centrifugal insurance mechanism. In summary, we can suggest that the application environment, which the MEMS S&A device is suitable for, is the temperature equal to or slightly greater than normal temperature and the rotating speed higher than35000r/min of small caliber projectile.

Abstract: Background: Viral hepatitis B and C (HBV and HCV) pose significant public health challenges globally, particularly in Nigeria, where access to healthcare and treatment affordability are major concerns. This study aims to identify sociodemographic and clinical predictors of health insurance coverage among patients with HBV and HCV in Nigeria. Methods: A cross-sectional facility-based study was conducted at two secondary hospitals in Nasarawa State, Nigeria. Par-ticipants included patients diagnosed with HBV, HCV, or both and are > 18 years old. Data were collected using a structured questionnaire covering sociodemographic and clinical information, health insurance details, and economic impact. Logistic multivariate regression analysis was used to analyze the relationship between sociodemographic/clinical variables and health insurance status. Results: Out of 295 participants included in the final analysis, 67.1% had health insur-ance, primarily covering hepatitis screening and vaccination. Being aged 31-45 years (adjusted Odds Ratio [aOR]: 5.72, 95% Confidence Interval [CI]: 1.4 - 23.28, p = 0.02), having post-secondary education (aOR: 11.73, CI: 4.09 - 33.66, p < 0.001), and being HIV-positive (aOR: 2.86, CI: 1.02 - 8.02, p = 0.046) were significant predictors of health insurance coverage. Being unemployed significantly reduced the likelihood of having health insurance (aOR: 0.04, CI: 0.01 - 0.11, p < 0.001).Conclusions: This study reveals high insurance coverage among patients seeking viral hepatitis services in Nasarawa state, Nigeria and provides critical insights into the sociodemo-graphic predictors of health insurance coverage. It also highlights the need for the expansion health insurance benefit package that covers for viral hepatitis diagnosis and treatment, espe-cially for the younger adults, unemployed and less educated populations. This should be followed with adequate budgeting and policy implementation monitoring efforts, which are crucial for Nigeria's journey towards universal health coverage and elimination of viral hepatitis.

Background: Patients with bipolar disorder (BD) receive traditional Chinese Medicine (TCM) for unmet clinical needs with psychotropic medications. However, the clinical characteristics of practices and outcomes of TCM in BD are not fully understood. This cohort study investigated the clinical characteristics, principal diagnoses, TCM interventions, and TCM prescriptions in patients with BD. Methods: 12,113 patients with BD were withdrawn from Taiwan's longitudinal health insurance database 2000 (LHID 2000) between 1996 and 2013. Chi-squared test for categorical variables and independent t-test for continuous variables. A p-value less than 0.05 indicated significance. Results: One-thousand and three hundred nineteen patients who visited TCM clinics after the diagnosis of BD were in the TCM group, while those who never visited TCM were in the non-TCM group (N= 1,053). Compared to the non-TCM group, patients in the TCM group had younger average age, a higher percentage of female individuals, more comorbidities of anxiety and alcohol use disorders, and higher mood stabilizer usage rates. The TCM group exhibited pain-related indications, including joint pain, myalgia, myositis, headache, and sleep disturbances. Corydalis yanhusuo and Shu-Jing-Huo-Xue-Tang were the most useful single herb and herbal formulas. Conclusions: Physicians need to be aware of the use of TCM in Patients with BD.

(1) Background: Targeted (TT) and immune checkpoint inhibitor (ICI) therapies have become available in the routine care of metastatic melanoma in recent years. (2) Objective: We compared mortality in patients with metastatic melanoma and different systemic therapies. (3) Methods: A retrospective cohort study, based on pseudonymized health insurance data of about 2 million individuals from Saxony, Germany, was conducted for the years 2010 to 2020. Only patients with an advanced stage, i.e. distant metastases were considered for the main analysis. Relative survival since metastasis and predicted survivor curves derived from a Cox model were used to assess potential differences in mortality. (4) Results: Relative survival was highest in the subgroup with sequential use of ICI and TT. All treatments except interferon had significant hazard ratios (HR) in the Cox model with time-dependent effects indicating a protective effect after treatment initiation (HR 0.01-0.146) but decreasing over time (HR 1.351-2.310). The predicted survivor curves revealed best survival under ICI-TT treatment and worst survival under TT treatment alone. (5) Conclusions: We found real-world evidence for survival benefits of patients with metastatic melanoma who received sequential ICI and TT treatment. It is conceivable that the observed high survival differences were overestimated due to bias, such as confounding by indication.

This article describes techniques employed in the production of a synthetic dataset of driver telematics emulated from a similar real insurance dataset. The synthetic dataset generated has 100,000 policies that included observations about driver’s claims experience together with associated classical risk variables and telematics-related variables. This work is aimed to produce a resource that can be used to advance models to assess risks for usage-based insurance. It follows a three-stage process using machine learning algorithms. The first stage is simulating values for the number of claims as multiple binary classifications applying feedforward neural networks. The second stage is simulating values for aggregated amount of claims as regression using feedforward neural networks, with number of claims included in the set of feature variables. In the final stage, a synthetic portfolio of the space of feature variables is generated applying an extended SMOTE algorithm. The resulting dataset is evaluated by comparing the synthetic and real datasets when Poisson and gamma regression models are fitted to the respective data. Other visualization and data summarization produce remarkable similar statistics between the two datasets. We hope that researchers interested in obtaining telematics datasets to calibrate models or learning algorithms will find our work valuable.

Objective: This study investigated the effect of the hierarchical medical system under the national health insurance program on resident’s healthcare-seeking behavior in Taiwan. Background: Healthcare authorities in Taiwan initiated the allowance reduction of outpatient visits at regional hospitals and higher hierarchical hospitals from 2018. The ultimate goal is to implement a hierarchical medical system and provide the residents accessible as well as consistent medical services. Methods: This research was conducted through the questionnaire survey method and data were collected between August and December 2018 from the records of subjects who had recently sought medical attention. A total of 1,340 valid questionnaires were returned. Results: Regarding the effect on healthcare-seeking behavior, the following factors were significant: being aged between 40 to 49 (p＜.1), subjects with an educational background of junior high school (p＜.05), those who were not aware of the policy (p＜.001), and an awareness about both the hierarchical medical system and the policy to reduce outpatient visits to large hospitals (p＜.001). Conclusion: The public should be made aware about the hierarchical medical system to improve healthcare.

The Affordable Care Act (ACA) is at the crossroads. It is important to evaluate the effectiveness of the ACA in order to make rational decisions about the ongoing healthcare reform, but existing research into its effect on health insurance status in the United States is insufficient and descriptive. Using data from the National Health Interview Surveys from 2009 to 2015, this study examines changes in health insurance status and its determinants before the ACA in 2009, during its partial implementation in 2010–2013, and after its full implementation in 2014 and 2015. The results of trend analysis indicate a significant increase in national health insurance rate from 82.2% in 2009 to 89.4% in 2015. Logistic regression analyses confirm the similar impact of age, gender, race, marital status, nativity, citizenship, education, and poverty on health insurance status before and after the ACA. Despite similar effects across years, controlling for other variables, youth aged 26 or below, the foreign-born, Asians, and other races had a greater probability of gaining health insurance after the ACA than before the ACA; however, the odds of obtaining health insurance for Hispanics and the impoverished rose slightly during the partial implementation of the ACA but somewhat declined after the full implementation of the ACA starting in 2014. These findings should be taken into account by the U.S. government in deciding the fate of the ACA.

The study delves into the critical examination of the Size of Loss distribution patterns in the context of auto insurance during pre- and post-pandemics, emphasizing their profound influence on insurance pricing and regulatory frameworks. Through a comprehensive analysis of the historical Size of Loss data, insurers and regulators gain essential insights into the probabilities and magnitudes of insurance claims, informing the determination of precise insurance premiums and the management of case reserving. This approach aids in fostering fair competition, ensuring equitable premium rates, and preventing discriminatory pricing practices, thereby promoting a balanced insurance landscape. The research further investigates the transformative impact of the COVID-19 pandemic on these Size of Loss patterns, given the substantial shifts in driving behaviors and risk landscapes. Also, the research contributes to the literature by addressing the need for more studies focusing on the implications of the COVID-19 pandemic on pre- and post-pandemic auto insurance loss patterns, thus offering a holistic perspective encompassing both insurance pricing and regulatory dimensions.

In the context of the economic and political uncertainty associated with the 2019-nCoV pandemic, it is necessary to determine the socio-psychological factors involved in the transformation of the behavior of insurance consumers under the influence of a biogenic threat. This study measures financial anxiety and its impact on the insurance behavior of Russian citizens. The correlation, comparative, and regression analyses of the financial anxiety of Russian citizens cover three stages of observation: before the start of the 2019 nCoV pandemic (“FA up to 19 nCoV; N = 766), during the period of quarantine measures announced in Russia in March 2020 (“FA 19-nCoV-1”; N = 856), and after the relaxation of quarantine measures at the end of April 2020 (“FA 19-nCoV-2”; N = 963).Psychological analysis data were obtained from the online survey “Financial anxiety (in the context of insurance)”. The questionnaire is psychometrically reliable and easy to use. It includes five measurement scales: MR1—Physical manifestations of financial incentive anxiety, MR2—With money shortages and financial uncertainty, MR3—The value of insurance coverage, MP4—Financial Confidence, and MR5—Perception of insurance and investment risks. It was found that Russian citizens consider it important to have insurance coverage for a “rainy day”, and they showed confidence in the insurance market during the biogenic crisis. However, unfortunately, during the 19-nCoV-1 and 19-nCoV-2 periods, Russian citizens did not feel financially secure, unlike in the period before 19-nCoV. Women showed high scores for physical manifestations of financial anxiety and low financial confidence in the future, in contrast to men, regardless of the observation period.

In the context of economic and political uncertainty associated with the 2019-nCoV pandemic, it is necessary to determine the socio-psychological factors in the transformation of the behavior of insurance consumers under the influence of the biogenic threat. This study is devoted to measuring financial anxiety and its impact on the insurance behavior of Russian citizens. Correlation, comparative and regression analyzes of financial anxiety of Russian citizens cover three stages of observation: before the start of the 2019 nCoV pandemic (“FA up to 19 nCoV; N = 766), during the period of quarantine measures announced in Russia in March 2020 (“ FA 19- nCoV-1 "; N = 856) and after the relaxation of quarantine measures at the end of April 2020 (" FA 19-nCoV-2 "; N = 963). Psychological analysis data were obtained from the online survey "Financial anxiety (in the context of insurance)". The questionnaire is psychometrically reliable and easy to use, including 5 measurement scales: MR1. Physical manifestations of financial incentive anxiety, MR2. With money shortages and financial uncertainty, MR3. The value of insurance coverage, MP4. Financial Confidence, MR5. Perception of insurance and investment risks. Russian citizens considered it important to have insurance coverage on a “rainy day” and showed confidence in the insurance market during the biogenic crisis. But, unfortunately, Russian citizens during the 19-nCoV-1 and 19-nCoV-2 periods did not feel financially secure in the future, unlike the period before 19-nCoV. ”Women showed high scores for physical manifestations of financial anxiety and low financial confidence in the future, in contrast to men, regardless of the observation period.

A copula is a useful tool for constructing bivariate and/or multivariate distributions. In this article, we consider a new modified class of (Farlie-Gumbel-Morgenstern) FGM bivariate copula for constructing several dierent bivariate Kumaraswamy type copulas and discuss their structural properties, including dependence structures. It is established that construction of bivariate distributions by this method allows for greater flexibility in the values of Spearman's correlation coefficient rho,  and Kendall's tau . For illustrative purposes, one representative data set is utilized to exhibit the applicability of these proposed bivariate copula models.

As a result of decades of austerity, the economies of the Eurozone are experiencing under-investment and crumbling infrastructures in an era of extremely severe emergencies as the cli-mate change and aggressive global competition. The private savings glut of the rich and the strict fiscal rules suggest a crowding-in approach in partnership with big finance in a new age of in-fra-structures. If governments mint public infrastructures into investable assets, they can gen-erate steady returns for investors and asset managers who look after pensions and insurances schemes and unlock trillions now devoted to welfare state. For the big finance to accept to be partner, however, governments must take the task of de-risking returns. Innovation technology and macro-financial literacy can synergically act to enhance this new de-risking role to address in a financially sustainable way the intense phenomena of Natural Hazards (NHs) that can severely compromise economic growth. This is precisely the aim of our Public-Private Partnership (PPP) among the Department of Economics, Management and Institutions of the University of Naples and a Knowledge Transfert Management, the Department of Engineering and the Aca-demic Spin-Off “STRAIN”, of the University of Campania. Our PPP has been contributing to the eval-uation and mitigation of NHs such as floods, landslides and earthquakes since 2012. The ex-tremely advanced results of this multi-stakeholder partnership ensure a better knowledge of NHs which, as evidenced in the paper, is the fundamental input for the desired Public-Private In-surance Programmes (PIPPs).

Background: Pet ownership is a common wellbeing enhancing practice globally, offering com-panionship and emotional support. However, it also entails financial responsibilities that can pose challenges and have negative wellbeing impacts for both human and animal. Aims/Purpose: This study aimed to explore pet owners' the financial aspects of pet ownership in New Zealand, including the importance of pet insurance, the impact of veterinary costs, and the ethical considerations of owning a pet. Understanding these aspects of pet ownership is crucial for promoting responsible pet ownership and ensuring animal welfare. Study Designs: Data was collected through a nationwide online survey conducted in 2019 as part of the Furry Whānau Wellbeing research project. The survey included questions about the financial aspects of pet ownership, and respondents were asked to indicate their level of agreement with various statements. Findings: The study found that the cost of veterinary care is a significant concern for many pet owners, with 83.9% of respondents agreeing that expense is a factor in the level of healthcare their pets receive. While pet insurance can mitigate financial burdens, only a third of respondents considered it essential due to high costs and exclusions. The study also revealed disparities for rural and low-income households. Conclusions: The financial aspects of pet ownership present a complex challenge, impacting both pet and owner wellbeing. This research highlights the need for comprehensive strategies to promote sustainable and equitable pet ownership, including improving access to affordable vet-erinary care, enhancing financial literacy among pet owners, and providing support systems for those facing economic hardship.

In the current socio-economic context, pension systems have become a crucial topic in the agenda of governments and international bodies. In this paper, an empirical study regarding the economic and social sustainability of pension systems in Central and Eastern European Countries was performed. The goal of the research is to establish the sustainability of pension systems with econometric modeling techniques on three dimensions as the research hypotheses are revealed: first, by strengthening the financial soundness of pension systems; second, consolidating the economic environment of pension systems; third, increasing the degree of social security systems with a direct effect of reducing poverty. The results led to relevant insights emphasizing the need for more inclusive economic, financial, and social reforms. From a policy perspective, these findings could be a starting point for the enhancement of the financial adequacy and economic and social sustainability of pension systems in Central and Eastern European Countries. The econometric techniques in this study highlight those modern pensions systems that need to be addressed in a more complex and empirical context that must encompass the main technical aspects. The conclusions suggest that in the future it needs judicial, economic, and social adjustments for the enhancement of the financial soundness of the pension systems.

This research focuses on the customer orientation of insurance brokers, whose activity is regulated by the Law of 26/2006 of July 17 on the mediation of private insurances and reinsurances. The goal is to ascertain whether the intermediation inherent in the insurance broker’s activity, which implies a customer-oriented service, entails a positive behaviour that transcends the immediate environment, reaching society. This study presents a comparative analysis between the insurance brokerage society, characterised by providing a personalised customer service, and banks’ advisory services on insurance. To this end, we study the evolution of the total volume of business and new production, compared for a portfolio of insurance products. The results presented in this research suggest that the customer values the advisory service provided by the broker. However, for a particular business segment in standardised insurance products and products related to banking assets, customers are more likely to resort to the bank’s services. In addition, the results indicate that the commission percentages applied by the entities operating in the banking insurance channel exceed those perceived by the insurance broker. With all this, intermediation in the development of the insurer’s activity can entail an ethical and social behaviour that involves customer-orientation and, possibly, social service, which does not always benefit the insurer.

In actuarial practice, the modeling of total losses tied to a certain policy is a non-trivial task. Traditional parametric models to predict total losses have limitations due to complex distributional features such as extreme skewness, zero inflation, multi-modality, etc., and the lack of explicit solutions for log-normal convolution. In the recent literature, the application of the Dirichlet process mixture for insurance loss has been proposed to eliminate the risk of model misspecification biases; however, the effect of covariates as well as missing covariates in the modeling framework is rarely studied. In this article, we propose novel connections among covariate-dependent Dirichlet process mixture, log-normal convolution, and missing covariate imputation. Assuming an individual loss is log-normally distributed, we develop a log skew-normal Dirichlet process to approximate the log-normal sum. As a generative approach, our framework models the joint of outcome and covariates, which allows to impute missing covariates under the assumption of missingness at random. The performance is assessed by applying our model to several insurance datasets, and the empirical results demonstrate the benefit of our model compared to the existing actuarial models such as the Tweedie-based generalized linear model, generalized additive model, or multivariate adaptive regression spline.

In this paper, we study a generalised CIR process with externally-exciting and self-exciting jumps, and focus on the distributional properties and applications of this process and its aggregated process. The first and second moments of this jump-diffusion process are used to calculate the insurance premium based on mean-variance principle. The Laplace transform of the aggregated process is derived, and this leads to an application for pricing default-free bonds which could capture the impacts of both exogenous and endogenous shocks. Illustrative numerical examples and comparisons with other models are also provided.

Long COVID is a persistent symptom that appears in many COVID-19 patients, regardless of whether they are asymptomatic, mild, or severe. At least 10% worldwide are suffering from long COVID. The anti-inflammatory effect was evaluated in LPS-treated RAW264.7 cells using six Korean national insurance-covered herbal prescriptions with therapeutic potential for mitigating inflammation in the respiratory tract, and additional network pharmacology analysis was performed. Soshihotang (SST) significantly downregulated iNOS and COX2 expression, reduced the production of NO (nitric oxide) and inflammatory cytokines, such as TNFα, IL-1β, and IL-6, and inhibited IκBα phosphorylation and reduced the nuclear translocation of NF-κB in LPS-treated RAW264.7 cells. Network pharmacological analysis showed that SST was closely related to the NF-κB signaling pathway. Further study on the potential of herbal prescriptions will be needed before they can be used clinically by long COVID patients.

Panel data of our interest consist of a moderate number of panels, while the panels contain a small number of observations. An estimator of common breaks in panel means without a boundary issue for this kind of scenario is proposed. In particular, the novel estimator is able to detect a common break point even when the change happens immediately after the first time point or just before the last observation period. Another advantage of the elaborated change point estimator is that it results in the last observation in situations with no structural breaks. The consistency of the change point estimator in panel data is established. The results are illustrated through a simulation study. As a by-product of the developed estimation technique, a theoretical utilization for correlation structure estimation, hypothesis testing, and bootstrapping in panel data is demonstrated. A practical application to non-life insurance is presented as well.

In the following article, we estimate the Renunciation of Healthcare Services-RHS in Italian regions in the context of the Environmental, Social and Governance-ESG model during the period 2004-2022. The data were acquired from the ISTAT-BES dataset. The data were analyzed using the following econometric techniques: Panel Data with Fixed Effects, Panel Data with Random Effects, Pooled Ordinary Least Squares-OLS, Weighted Least Square-WLS,. Results show that RHS tends to growth with the E-Component, is negatively associated to the S-Component, and positively associate with the G-Component within the ESG model. Furthermore, a clusterization with the unsupervised k-Means algorithm is presented and the results are discussed with a confrontation between optimal and suboptimal k values optimized with the Silhouette Coefficient. Finally, a confrontation among eight different machine-learning algorithms is performed to predict the future value of RHS. Outcomes show that the Simple Regression Tree is the best predictive algorithm and that the level of RHS is predicted to growth on average of 4.4% for the Italian regions. Results are critically discussed.

In this article, we analyse the ESG determinants of the “Elderly People Treated in Integrated Home Care”-EPIHC in the Italian regions between 2004 and 2022. We used data from the ISTAT-BES database. We used different econometric techniques i.e.: Panel Data with Random Effects, Panel Data with Fixed Effects, Pooled Ordinary Least Squares-OLS and Weighted Least Squares-WLS. The results show that the EPIHC is positively associated with “Nurses, midwives, and Soil sealing by artificial cover" and negatively associated with "Museum heritage density and relevance" and "Trust in law enforcement agencies and firefighters fire". Furthermore, we have applied a k-Means algorithm with the Silhouette Coefficient and we find the presence of two clusters. Finally, we propose a confrontation among eight different machine-learning algorithms and we find that Linear Regression is the best predictive algorithm.

In the following article, it is presented an investigation of the determinants of Beds for High-Care Specialties-BHCS in the Italian regions in the context of Environmental, Social and Governance-ESG approach. Data from ISTAT-BES for 20 countries in the period 2004-2021 are been used. Different econometric techniques have been applied i.e.: Pooled Ordinary Least Squares, Panel Data with Fixed Effects, Panel Data with Random Effects, Dynamic Panel at 1 stage. Furthermore, a cluster analysis performed with a k-Means algorithm optimized with the Silhouette Coefficient indicated the presence of three clusters. Finally, eight different machine-learning algorithms are analysed to predict the future value of BHCS. The results show that the Artificial Neural Network-ANN algorithm is the best algorithm. The future value of BHSC is expected to growth on average of 4.88% for the analysed regions.

The following article presents an analysis of the impact of the Environmental, Social and Governance-ESG determinants on Hospital Emigration to Another Region-HEAR in the Italian regions in the period 2004-2021. The data are analysed using Panel Data with Random Effects, Panel Data with Fixed Effects, Pooled Ordinary Least Squares-OLS, Weighted Least Squares-WLS, and Dynamic Panel at 1 Stage. Results show that HEAR is negatively associated to E, positively to S and negatively associated to the G within the ESG model. The data were subjected to clustering with a k-Means algorithm optimized with the Silhouette coefficient. The optimal clustering with k=2 is compared to the sub-optimal cluster with k=3. The results suggest a negative relationship between the resident population and hospital emigration at regional level. Finally, a prediction is proposed with machine learning algorithms classified based on statistical performance. The results show that the Artificial Neural Network-ANN algorithm is the best predictor. The ANN predictions are critically analyzed in light of health economic policy directions.

In the following article, we analyse the determinants of the number of physicians in the context of ISTAT BES-Benessere Equo Sostenibile data among twenty Italian regions in the period 2004-2022. We apply Panel Data with Random Effects, Panel Data with Fixed Effects, and Pooled OLS-Ordinary Least Squares. We found that the number of Physicians among Italian regions is positively associated, among others, to “Trust in the Police and Firefighters”, “Net Income Inequality”, and negatively associated, among others, to “Research and Development Intensity” and “Soil waterproofing by artificial cover”. Furthermore, we apply the k-Means algorithm optimized with the Silhouette Coefficient and we find the presence of two clusters. Finally, we confront eight different machine-learning algorithms to predict the future value of physicians and we find that the PNN-Probabilistic Neural Network is the best predictive algorithm.

Historical maps constitute unique sources of retrospective geographic information. Recently, several map archives containing map series covering large spatial and temporal extents have been systematically scanned and made available to the public. The geographic information contained in such data archives allows extending geospatial analysis retrospectively beyond the era of digital cartography. However, given the large data volumes of such archives and the low graphical quality of older map sheets, the processes to extract geographic information need to be automated to the highest degree possible. In order to understand the salient characteristics, data quality variation, and potential challenges in large-scale information extraction tasks, preparatory analytical steps are required to efficiently assess spatio-temporal coverage, approximate map content, and spatial accuracy of such georeferenced map archives across different cartographic scales. Such preparatory steps are often neglected or ignored in the map processing literature but represent highly critical phases that lay the foundation for any subsequent computational analysis and recognition. In this contribution we demonstrate how such preparatory analyses can be conducted using classical analytical and cartographic techniques as well as visual-analytical data mining tools originating from machine learning and data science, exemplified for the United States Geological Survey topographic map and Sanborn fire insurance map archives.