Objectives: The purpose of this study was to analyze the health insurance status and medical utilization and its related factors for foreigners at Kaohsiung-Pingtung area in Taiwan. Methods: The study used secondary data to attain the research purposes. Data from Bureau of National Health Insurance Kao-Ping Branch between 2004 to 2007 were used. A total of 119,100 cases were analyzed. Descriptive analysis was used to examine foreigners¡¦ health insurance and medical utilization. T -test was used to investigate the differences between medical utilization and personal characteristics, such as demography, nationality and insured payrolls. Regression analysis was applied. Logistic regression was employed to examine whether the foreigners used the services both from inpatients or outpatients. Multiple regressions were applied to predict the medical expenditures and times. Results: Most of cases were aged from 21 to 40, females, category 1 insured, low income, dangerous work and seeking medical care for pregnancy and maternity care. The results from logistic regression revealed that males had lower odds to use medical care (OR=0.636 CI: 0.616 to 0.657), outpatient care (OR=0.634 CI: 0.614 to 0.655) and inpatient care (OR=0.804 CI: 0.757 to 0.853) compared with females. Insured came from mainland have higher odds to use inpatient care (OR=1.184 CI: 1.124 to 1.246) compared with other countries. People had 2 to 3 insured years used higher medical care (OR=5.873 CI: 5.636 to 6.119) and outpatient care (OR=5.886 CI: 5.649 to 6.314) compared with those whose insured under 1 year. If insured period over 3 years, they would have 5 more times probabilities to inpatient care than whose time under 1 year (OR=5.017 CI: 4.664 to 5.398). Category 5, low-income insured, had more than 8 times probabilities to use inpatient services than category 1 who had stable work. Results from multiple linear regressions indicated longer insured period, came from mainland and catastrophic illnesses patients would have more outpatient and inpatient visiting times significantly. So did the medical expenditures. Conclusions: Gender, age, nationality, insurers¡¦ category, qualified, the insured payroll, catastrophic illness and occupational accidents were the determination of medical utilization among foreigners at Kaohsiung-Pingtung Area in Taiwan. Future researchers could use questionnaire to get more complete relevant factors and follow the medical utilization and health status of foreigners. To provide the policymakers facilitate the planning of public health interventions.

<p>Den viktigaste uppgiften vid avtalstolkning är att försöka fastställa vad parterna hade för avsikt vid avtalsslutet. Av vikt vid fastställandet av den gemensamma partsviljan är hur parterna har handlat i tidigare liknande avtal. Försäkringsgivaren har enskilt utformat försäkringsavtalet så någon gemensam partsvilja kan i dessa fall sällan fastställas.</p><p>Då det inte kan fastställas vad parterna hade för avsikt vid avtalets ingående, så ska avtalet tolkas med utgångspunkt i avtalets lydelse. Det vill säga hur en utomstående part uppfattar avtalet. Uttryck med juridisk innebörd antas vara använda i sin allmänna rättsliga betydelse. Fackuttryck tolkas mot bakgrund av den allmänna uppfattningen inom branschen.</p><p>Tolkningsregler såsom oklarhetsregeln används som en sista utväg då avtalet inte har kunnat tolkas med hjälp av de vanliga tolkningsmetoderna. Tolkningsreglernas uppgift är att fastställa vad som ska anses vara det korrekta innehållet i det avtal som har ingåtts. Traditionellt sett har oklarhetsregeln inneburit att tolkning ska ske till nackdel för den part som har haft skuld till otydligheten, eller som har haft störst möjlighet till att förhindra oklarheten. Då det inte kan urskiljas vilken part som har haft störst möjlighet till att förhindra oklarheten så ska klausulen tolkas till nackdel för den som har författat den.</p><p>Till grund för oklarhetsregelns uppkomst låg behovet av att kompensera försäkringstagaren för sitt underläge, eftersom försäkringstagaren inte hade något inflytande över avtalets formulering.</p><p>I svensk rätt är oklarhetsregeln lagstadgad i AVLK som har sitt ursprung i EGdirektivet om oskäliga villkor i konsumentavtal (93/13/EEG). Oklarhetsregeln lyder enligt 10 § AVLK:</p><p><i>”Om innebörden av ett avtalsvillkor som inte har varit föremål för individuell förhandling är oklar, skall vid en tvist mellan en näringsidkare och en konsument villkoret tolkas till konsumentens förmån.”</i></p><p>Oklarhetsregelns tillämpningsområde utgörs oftast av förtryckta standardiserade avtalsvillkor som ena parten tillhandahåller, exempelvis försäkringsavtal. Oklarheten måste inte bero på en otydlighet i texten utan det kan också föreligga en oklarhet i avtalet på grund av att det har redigerats på ett sätt som gör läsaren förvirrad. Oklarhetsregeln</p><p>utformas ofta som en culparegel vilket innebär att den part som formulerat otydligheten borde ha utformat avtalet tydligare. I försäkringsavtal förekommer det ofta allmänna fraser som kan uppfattas som oklara. Typiska exempel på oklara fraser är försäkringen täcker endast direkta och omedelbara skador samt lämna kvar och genom.</p><p>Den svenska 10 § AVLK, den danska § 38 b DAvtL, den norska § 37 NAvtL samt den brittiska artikeln 7 i the Unfair Terms in Consumer Contracts Regulations bygger på ett EG-direktiv om oskäliga villkor i konsumentavtal. Anmärkningsvärt är att samtliga länders lagstadgade oklarhetsregel har en begränsad räckvidd. Detta innebär att oklarhetsregeln med stöd av lagtexten endast kan tillämpas på avtal mellan näringsidkare och konsument, andra avtal faller utanför. De avtal som inte rör konsument och näringsidkare får istället stödjas av rättspraxis då oklarhetsregeln tillämpas. I både Danmark, Norge, Sverige och Storbritannien tillämpas oklarhetsregeln i stort sett endast på avtal som är av standardkaraktär.</p>

Thesis (Ph. D.)--School of Public Policy, Georgia Institute of Technology, 2004. Directed by Gregory B. Lewis, Georgia State University. / Vita. Includes bibliographical references (leaves 252-261).

Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2001. / Includes bibliographical references.

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This dissertation contains three chapters in macroeconomics that study the financing and provision of unemployment insurance. The first chapter studies cross-sectional differences in U.S. state provision of unemployment insurance and the distortionary effects of federal unemployment benefit subsidies in a dynamic labor search model. The paper has two main findings. First, differences in the job-separation rate and the job-finding rate within the model can generate the negative correlation between the average benefit provided by a state and the state's unemployment rate, as observed in the data. Secondly, the model shows how the federal subsidization of unemployment benefit extensions in high-unemployment states causes an over-provision of the benefit, which in turn increases the unemployment rate in those states. Because the extensions are federally subsidized, however, the welfare loss due to the distortion is offset by the benefits of redistribution between states. The second chapter studies the optimal government monitoring of job search effort by unemployment insurance recipients. The theoretical model is a labor search economy with imperfectly observable search effort. The government observes a signal that is correlated with job search effort and must decide the threshold level of the signal that determines continued UI eligibility. The results of the numerical analysis show that the government increases this threshold level at each duration of the unemployment spell. Further, an increasing threshold profile can generate a sharp increase and subsequent drop-off in search effort near the expiration of benefits as observed in the data. The third chapter studies the optimal mix of distortionary capital and labor taxes in an altruistic economy. This problem is addressed by solving a dynamic general equilibrium model with production, in which finitely-lived individuals are linked inter-generationally through altruistic preferences. The government is tasked with financing an exogenous stream of government spending by levying distortionary capital and labor income taxes in a way that minimizes welfare loss in the economy. The numerical results show that nearly all government revenue should be raised through the labor income tax. / text

The three chapters of this dissertation explore the ties among health insurance, changing cultural institution, and labor economics. The first chapter focuses on the relationship between health insurance and wages by taking advantage of states that extended health insurance dependent coverage to young adults before the Patient Protection and Affordable Care Act. Using American Community Survey and Census data, I find evidence that extending health insurance to young adults raises their wages, both while they are eligible for insurance through their parents' employers and afterwards. The increases in wages can be explained by increases in human capital and increased flexibility in the labor market that comes from people no longer having to rely on their own employers for health insurance. The second chapter focuses on understanding the impact of allowing coverage of spouses through employer-sponsored health insurance. The fact that people choose to enter into marriage makes comparing the differences between married and unmarried couples uninformative. To get around this, I examine how shocks to access to insurance through a spouse's employer brought on by extensions in legal recognition have influenced health insurance and labor force decisions for same-sex couples. I find extending legal recognition to same-sex couples results in female same-sex couples being more likely to have one member not in the labor force. The third chapter examines what extending legal recognition to same-sex couples has done to marriage rates in the United States using a strategy that compares how marriage rates change after legal recognition in states that alter legal recognition versus states that do not. Despite claims that allowing same-sex couples to marry will reduce the marriage rate for opposite-sex couples, I find no evidence that allowing same-sex couples to marry reduces the opposite-sex marriage rate. The opposite-sex marriage rate does decrease, however, when domestic partnerships are available to opposite-sex couples. / text

In recent years, general risk measures have played an important role in risk management in both finance and insurance industry. As a consequence, there is an increasing number of research on optimal reinsurance problems using risk measures as yard sticks beyond the classical expected utility framework. In this thesis, the stop-loss reinsurance is first shown to be an optimal contract under law-invariant convex risk measures via a new simple geometric argument. This similar approach is then used to tackle the same optimal reinsurance problem under Value at Risk and Conditional Tail Expectation; it is interesting to note that, instead of stop-loss reinsurances, insurance layers serve as the optimal solution in these cases. These two results hint that law-invariant convex risk measure may be better and more robust to expected larger claims than Value at Risk and Conditional Tail Expectation even though they are more commonly used. In addition, the problem of optimal reinsurance design for a basket of n insurable risks is studied. Without assuming any particular dependence structure, a minimax optimal reinsurance decision formulation for the problem has been successfully proposed. To solve it, the least favorable dependence structure is first identified, and then the stop-loss reinsurances are shown to minimize a general law-invariant convex risk measure of the total retained risk. Sufficient condition for ordering the optimal deductibles are also obtained. Next, a Principal-Agent model is adopted to describe a monopolistic reinsurance market with adverse selection. Under the asymmetry of information, the reinsurer (the principal) aims to maximize the average profit by selling a tailor-made reinsurance to every insurer (agent) from a (huge) family with hidden characteristics. In regard to Basel Capital Accord, each insurer uses Value at Risk as the risk assessment, and also takes the right to choose different risk tolerances. By utilizing the special features of insurance layers, their optimality as the first-best strategy over all feasible reinsurances is proved. Also, the same optimal reinsurance screening problem is studied under other subclass of reinsurances: (i) deductible contracts; (ii) quota-share reinsurances; and (iii) reinsurance contracts with convex indemnity, with the aid of indirect utility functions. In particular, the optimal indirect utility function is shown to be of the stop-loss form under both classes (i) and (ii); while on the other hand, its non-stop-loss nature under class (iii) is revealed. Lastly, a class of nonzero-sum stochastic differential reinsurance games between two insurance companies is studied. Each insurance company is assumed to maximize the difference of the opponent’s terminal surplus from that of its own by properly arranging its reinsurance schedule. The surplus process of each insurance company is modeled by a mixed regime-switching Cramer-Lundberg approximation. It is a diffusion risk process with coefficients being modulated by both a continuous-time finite-state Markov Chain and another diffusion process; and correlations among these surplus processes are allowed. In contrast to the traditional HJB approach, BSDE method is used and an explicit Nash equilibrium is derived. / published_or_final_version / Mathematics / Master / Master of Philosophy

To enable high-risk individuals to have access to private health insurance, the Hong Kong government has announced the establishment of a high-risk pool reinsurance mechanism. Under the voluntary and government-regulated insurance program, “Health Protection Scheme”, the high-risk pool will accept individuals with pre-existing medical conditions or higher health risks. Critics have long expressed their concerns regarding the financial sustainability of Hong Kong’s healthcare system due to its heavy reliance on government subsidies and publicly funded services. Patients with pre-existing conditions are denied coverage by the private insurance sector, and have to rely heavily on the overburdened public healthcare system. Following the United States, the Hong Kong government suggests that a high-risk pool proposal will offer a relatively simpler approach compared to other alternatives. However, little is known about its applicability in Hong Kong or potential problems. Therefore, the objective of this study is to evaluate the effectiveness of high-risk pool in promoting healthcare efficiency, equity, and to make recommendations for the operations in Hong Kong. A systematic literature review was conducted on the MEDLINE database to study the overseas experience of high-risk insurance pools. Of the 52 articles included in the systematic review, the majority of the studies cover the operations in the United States. Results are analysed from the following eight perspectives. For efficiency, the studied areas include (1) fiscal sustainability, (2) adverse selection, (3) risk sharing and (4) cost containment. For equity, (5) insurance premium, (6) out-of-pocket expense, (7) enrolment barrier and (8) program awareness of the high-risk pools are analysed. Results of the systematic review show the inadequacies of the high-risk pool mechanisms in all of the above studied areas. In the United States, while industry assessment and government subsidization intend to facilitate risk sharing for high-risk population, insufficient funding and the industry’s deteriorated risk sharing capabilities undermine system efficiency. In addition, adverse selection and cost containment add to the already lengthy list of problems that high-risk pools have yet to address. Limited subsidies, high out-of-pocket payments, strict eligibility rules, and insufficient program awareness remain the four major barriers to health equity for the uninsurable. While studies on the overseas healthcare system have revealed several inadequacies regarding the high-risk pool mechanism, these uncertainties have to be resolved before Hong Kong can move forward to improve its healthcare efficiency and equity. More thoughts should be given on how the risk sharing capability can be enhanced within the insurance industry. Without a clear definition or a standardized underwriting rule that clearly defines “high-risk”, the high-risk pool could become a platform to practice adverse selection and further deteriorate the already limited risk sharing among the population. For addressing the issue of cost containment, the DRG charging system and chronic disease management programs are pivotal components to be incorporated. The government should perform a concrete assessment to justify how the spending on high-risk pool can essentially promote a more equitable system in Hong Kong. By considering the impact on both private insurance market and the public healthcare system, the government should further consider how to implement a high-risk pool that can effectively improve the healthcare efficiency and equity in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health

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