scholarly journals THE CONTRIBUTION OF GOVERNMENT SPONSORED HEALTH INSURANCE SCHEMES TOWARDS INDIAN HEALTH SECTOR

2021 ◽  
pp. 165-171
Author(s):  
Dr.V.Pugazhenthi
Keyword(s):  
Health Insurance ◽  
Health Sector ◽  
Insurance Premium ◽  
Insurance Companies ◽  
Export Credit ◽  
Insurance Sector ◽  
Indian Health ◽  
Health Insurance Premiums ◽  
The Government ◽  
Health Insurers

Today, there are thirty four general insurance companies including the Export Credit Guarantee Corporation of India Ltd (ECGC) and Agriculture Insurance Corporation (AIC) of India and 24 life insurance companies operating in the country. Barring the AIC and ECGC, all other 32 insurers transact health insurance business, of whom six are stand-alone health insurers. Although there are number of insurers and different types of health insurance products available in the market, three-fourth health-insured Indians still gets covered only by a government-sponsored health insurance scheme (GSHIS) like PMJAY. Of all the health insurance premiums underwritten in the year 2019-20, 10 per cent came only from the GSHIS. In terms of number of persons covered, 73 per cent health-insured people are governed by one or other GSHIS. Looking at the profitability of the health insurer also, the incurred claims ratio is just 97.22 per cent in GSHISs. Thus, the health insurance premium, penetration and profitability—all of these are significantly sponsored and subsidized by the government through GSHIS, incorporating the public–private partnership (PPP) mode. This article details the role of GSHIS in the health insurance segment, taking the performances of the Indian health insurance sector in the year 2019-20. KEYWORDS: Government sponsored health insurance schemes, health insurance, health premium, incurred claims ratio, insurance, insurance regulatory and development authority, standalone health insurers.

scholarly journals The Effect of Stimulus Policies and Risk-Based Capital Levels on Solvency at PT. Indonesian Takaful using Sharia Principles during the Majeur Force Period (Covid-19 Pandemic) in Indonesia

2021 ◽  
Vol 2 (1) ◽  
pp. 24-31
Author(s):  
Nano Suyatna
Keyword(s):  
Financial Services ◽  
Positive Influence ◽  
Insurance Companies ◽  
Insurance Company ◽  
Insurance Sector ◽  
Islamic Principle ◽  
The Government ◽  
Company Sector ◽  
Descriptive Method ◽  
Level Of Risk

The Covid -19 pandemic is a massive disaster, impacting various sectors of the economy including the Islamic principle insurance sector. The government through the Financial Services Authority (OJK) in dealing with these problems has issued a stimulus policy so that the Islamic principle insurance sector is still able to maintain the level of solvency and risk based capital is maintained. The purpose of this study is to determine the influence of the Stimulus Policy and the level of Risk Based Capital on the level of solvency of sharia-based insurance companies during the Covid-19 Pandemic. The method used is descriptive method with a simple statistical approach. The results show: 1. There is a positive influence of the Stimulus Policy on the Solvency Level of the Islamic principle insurance company sector, 2. There is a positive influence on the Level of Risk Based Capital on the Solvency Level of the Islamic Principle Insurance Company sector, 3. There is an influence of the Stimulus Policy and Level of Risk Based Capital on Simultaneous level of solvency in Islamic principle insurance companies. From the research results, it can be concluded that the Stimulus Policy and Risk Based Capital Level that has been set by the regulator is right on target.

Application of digital technologies in health insurance for social good of bottom of pyramid customers in India

2019 ◽  
Vol 39 (9/10) ◽  
pp. 752-772
Author(s):  
Bishwajit Nayak ◽  
Som Sekhar Bhattacharyya ◽  
Bala Krishnamoorthy
Keyword(s):  
Risk Management ◽  
Health Insurance ◽  
Digital Technology ◽  
Social Health Insurance ◽  
Social Health ◽  
Strategic Choices ◽  
Content Type ◽  
Study Results ◽  
The Government ◽  
Health Insurers

Purpose Social health insurance framework of any country is the national identifier of the country’s policy for taking care of its population which cannot access or afford quality healthcare. The purpose of this paper is to highlight the strategic imperatives of digital technology for the inclusive social health models for the BoP customers. Design/methodology/approach A qualitative exploratory study using in-depth personal interviews with 53 Indian health insurance CXOs was conducted with a semi-structured questionnaire. Using MaxQDA software, the interview transcripts were analyzed by means of thematic content analysis technique and patterns identified based on the expert opinions. Findings A framework for the strategic imperatives of digital technology in social health insurance emerged from the study highlighting three key themes for technology implementation in the social health insurance sector – analytics for risk management, cost optimization for operations and enhancement of customer experience. The study results provide key insights about how insurers can enhance the coverage of BoP population by leveraging technology. Social implications The framework would help health insurers and policymakers to select strategic choices related to technology that would enable creation of inclusive health insurance models for BoP customers. Originality/value The absence of specific studies highlighting the strategic digital imperatives in social health insurance creates a unique value proposition for this framework which can help health insurers in developing a convergence in their risk management and customer delight objectives and assist the government in the formulation of a sustainable social health insurance framework.

Enterprise risk management for health insurance from an actuarial perspective

2012 ◽  
Vol 17 (2) ◽  
pp. 259-314 ◽  
Author(s):  
G. C. Orros ◽  
J. Smith
Keyword(s):  
Risk Management ◽  
Health Insurance ◽  
Solvency Ii ◽  
Enterprise Risk Management ◽  
Insurance Companies ◽  
Enterprise Risk ◽  
The Face ◽  
Known Unknowns ◽  
Over Time ◽  
Health Insurers

AbstractThis paper focuses on Enterprise Risk Management (ERM) and strategic business management for health insurance companies in our world of ‘unknown unknowns’ and the emergence of unexpected risks over time. It illustrates how Chief Risk Officers (CROs) can focus on ‘risk and opportunity management’ through an ERM framework, and thereby balance risks against opportunities, whilst being resilient against ‘unknown unknowns’ and their emergence over time as ‘known unknowns’ and ‘known knowns’. The paper has been designed to meet the broad requirements of health insurers that would like to implement an ERM framework for the effective risk management of their health insurance lines of business. Risk management for health insurers in the context of Solvency II and broader European Commission regulatory requirements is also discussed. The authors discuss how insurers can develop and apply risk management to build resilience in the face of the storms and shocks that may lie ahead.

scholarly journals Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda

2019 ◽  
Vol 8 (10) ◽  
pp. 593-606 ◽  
Author(s):  
Emmanuel Nshakira-Rukundo ◽  
Essa Chanie Mussa ◽  
Nathan Nshakira ◽  
Nicolas Gerber ◽  
Joachim von Braun
Keyword(s):  
Developing Countries ◽  
Health Insurance ◽  
Negative Binomial ◽  
Health Coverage ◽  
Network Information ◽  
Health Insurance Premiums ◽  
Insurance Programme ◽  
National Health Insurance Programme ◽  
The Government ◽  
Western Uganda

Background: The desire for universal health coverage in developing countries has brought attention to communitybased health insurance (CBHI) schemes in developing countries. The government of Uganda is currently debating policy for the national health insurance programme, targeting the integration of existing CBHI schemes into a larger national risk pool. However, while enrolment has been largely studied in other countries, it remains a generally under-covered issue from a Ugandan perspective. Using a large CBHI scheme, this study, therefore, aims at shedding more light on the determinants of households’ decisions to enrol and renew membership in these schemes. Methods: We collected household data from 464 households in 14 villages served by a large CBHI scheme in southwestern Uganda. We then estimated logistic and zero-inflated negative binomial (ZINB) regressions to understand the determinants of enrolment and renewing membership in CBHI, respectively. Results: Results revealed that household’s socioeconomic status, husband’s employment in rural casual work (odds ratio [OR]: 2.581, CI: 1.104-6.032) and knowledge of health insurance premiums (OR: 17.072, CI: 7.027-41.477) were significant predictors of enrolment. Social capital and connectivity, assessed by the number of voluntary groups a household belonged to, was also positively associated with CBHI participation (OR: 5.664, CI: 2.927-10.963). More positive perceptions on insurance (OR: 2.991, CI: 1.273-7.029), access to information were also associated with enrolment and renewing among others. Burial group size and number of burial groups in a village, were all significantly associated with increased the likelihood of renewing CBHI. Conclusion: While socioeconomic factors remain important predictors of participation in insurance, mechanisms to promote inclusion should be devised. Improving the participation of communities can enhance trust in insurance and eventual coverage. Moreover, for households already insured, access to correct information and strengthening their social network information pathways enhances their chances of renewing.

scholarly journals Determinants of Financial Performance of Insurance Companies: Empirical Evidence Using Kenyan Data

2021 ◽  
Vol 14 (12) ◽  
pp. 566
Author(s):  
Kamanda Morara ◽  
Athenia Bongani Sibindi
Keyword(s):  
Financial Performance ◽  
Fixed Effects ◽  
Insurance Industry ◽  
Insurance Companies ◽  
Random Effects Models ◽  
Insurance Sector ◽  
Life Insurers ◽  
Insurance Firms ◽  
Financial Performance Measures ◽  
The Government

The drivers of financial success of the insurance industry are of interest to several players in any economy including the government; policymakers; policyholders; and investors. In Kenya; there have been relatively few studies on this topic; most of which look at narrow elements that determine insurance companies’ performance. This article sought to explore the components contributing to the financial performance of insurance firms. We employed a sample consisting of 37 general insurers and 16 life insurers for the period running from 2009 to 2018 and utilised panel data methods in order to establish the determinants of financial performance of Kenyan insurers. The pooled OLS; fixed effects and random effects models were estimated with the financial performance measures (proxied by either ROA or ROE) as the dependent variables. The results of the study documented that insurer financial performance and size were positively related. The study also found that insurer financial performance was negatively related to the age variable. The study also unraveled that higher leveraged insurance companies performed better than their lowly geared peers. This article provides broad analyses of the various drivers of financial performance of the insurance industry in Kenya. The findings of this study contribute to the academic literature on the financial performance of the insurance sector in Kenya and Africa as a whole. Furthermore; it gives pointers to the management of insurance companies on the aspects of their business that would need greater attention to drive and sustain superior financial performance.

Information about Health Care Systems

2019 ◽  
pp. 6-53
Author(s):  
Alex Rajczi
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Systems ◽  
Insurance Companies ◽  
Private Companies ◽  
Single Payer ◽  
Before And After ◽  
Care Systems ◽  
The Government ◽  
Universal Health

One cannot discuss the ethics of health policy without understanding how health systems work, so this chapter provides background on the American health system before and after the Affordable Care Act. It also describes two universal health insurance systems the U.S. could adopt. In Canada’s single-payer system, the government serves as the basic insurer for the entire population. In the regulated-market systems of Switzerland and the Netherlands, citizens must purchase health insurance through private companies, and the government’s main jobs are providing subsidies to less wealthy individuals and ensuring that insurance companies deal fairly with citizens. The chapter concludes by examining the core ideas behind consumer-driven health care, a set of specific policies that conservatives often add to their health care proposals.

Life Insurance Potential in India: An Economic Approach

2002 ◽  
Vol 6 (2) ◽  
pp. 11-18
Author(s):  
Ashok Thampy ◽  
S. Sitharamu
Keyword(s):  
Life Insurance ◽  
Business Strategy ◽  
Insurance Coverage ◽  
Insurance Companies ◽  
Public Confidence ◽  
Insurance Sector ◽  
The People ◽  
Building Activities ◽  
The Government ◽  
The Individual

The market for life insurance in India has evolved in the context of the specific socio-economic and political environment that existed over the years. Prior to nationalisation, although the insurance business had grown considerably, it remained an essentially urban phenomena. This limited spread of life insurance was also marked by many malpractices, deficiencies and frequent liquidation of insurance companies, shaking public confidence in purchasing insurance. The objectives of nationalisation were to spread insurance coverage, to provide a stable environment thus increasing the confidence of the people in insurance, and to harness the resources generated for nation building activities as determined by the government. The purpose of this paper is to estimate the size of the individual life insurance market that exists in India. In this study, we have not provided an estimate of the potential for group life insurance. It is hoped that these estimates will help to plan the business strategy and set goals in the life insurance sector.

scholarly journals Adverse Selection in Health Insurance Coverage of High-Cost Cures

2016 ◽  
Vol 23 ◽  
pp. 59
Author(s):  
Paul Melmeyer
Keyword(s):  
Health Insurance ◽  
Adverse Selection ◽  
Market Failure ◽  
Pay For Performance ◽  
Insurance Coverage ◽  
Chronically Ill ◽  
Health Insurance Coverage ◽  
Insurance Companies ◽  
Gene Therapies ◽  
Health Insurers

The following paper examines adverse selection concerns facing health insurance companies from the coverage of high-cost, but highly-effective, cures for chronic diseases. This problem has arisen over the past several years with the development of Sovaldi, a cure for hepatitis C. However, it will become more prevalent as more expensive cures, particularly gene therapies, are developed and come to market. Health insurers, when deciding to cover the expensive cures, incur the risk that a disproportionate number of high-cost individuals will enroll in their plan while they are ill, but leave once they are cured and healthy. This adverse selection problem may lead health insurers to avoid risking this possibility, and as a result not cover the cures at all. Policymakers have posited several solutions to address this market failure. One potential policy solution is the establishment of a risk-stabilization program for insurance plans that cover these therapies. This risk-stabilization program would de-risk the potential adverse selection and allow chronically ill patients to access revolutionary, curative therapies. A second potential policy solution is the institution of annuity-like “pay-for-performance” models in which insurers pay for expensive but curative treatments over several years, contingent on the treatment’s performance.

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