Browsing by Subject "Pflegeversicherung"

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    Essays on long-term care and health insurance
    (2018) Schreckenberger, Christopher Karl Ludwig; Schiller, Jörg
    This thesis contributes to the literature on the impact of two individual options that may help to alleviate the financial pressure on the public sector with respect to health and long-term care expenditures. A particular focus is on the German health insurance and long-term care insurance (LTCI) system. The first option refers to the shifting of LTCI and health insurance coverage from a public system to markets for voluntary private health insurance (VPHI) and private LTCI. These private insurance markets may suffer from inefficiencies due to asymmetric information and selection effects, such as adverse selection. Hence, three papers in this thesis analyze selection effects in markets for VPHI and private LTCI. The first paper (chapter 2) reviews the empirical work on asymmetric information and related selection effects in markets for private LTCI and in the U.S. market for Medigap insurance. After providing an overview of the existence of selection effects in these markets, the review examines the evidence on several potential sources of selection. Regarding the latter, a focus is on the role of private information that individuals have on their risk type, on the role of the individual’s risk preferences and of sociodemographic characteristics. Following the review, two empirical papers analyze selection effects in the German markets for complementary private LTCI (chapter 3) and for supplemental dental insurance (chapter 4). Both markets have in common that they provide voluntary private insurance coverage for residual out-of-pocket expenditure risks not covered by statutory LTCI or health insurance in Germany. In addition, the ex-ante premium differentiation is rather limited in these markets. This makes these markets prone to selection effects. Using a large dataset on more than 98,000 individuals from a German private insurance company, the findings in chapter 3 suggest that advantageous selection is the dominating type of selection in the German market for complementary private LTCI. Examining potential drivers for selection, the analysis indicates that the occupation as well as the residential location are observable characteristics that are not used for pricing, but that contribute to advantageous selection through the socioeconomic status. The holding of supplemental health insurance policies is another observable attribute that affects the selection behavior. Analyzing the selection behavior within a dynamic framework, the analysis shows that the uptake and the cancellation of LTCI policies are associated with changes in health insurance payouts. Moreover, individuals with financial problems and with a lower socioeconomic status are more likely to drop complementary LTCI coverage. Based on survey data from the Healthcare Monitor of the Bertelsmann Stiftung, the findings in chapter 4 do not reveal a significant correlation between insurance coverage and risk in the market for supplemental dental insurance in Germany. Since one possible explanation for this finding is heterogeneous selection leading to an offsetting of adverse and advantageous selection, a large set of potential sources of selection effects is tested. The results indicate that the holding of other supplemental health insurance policies is a main driver for advantageous selection in this market. The findings in this chapter provide solid evidence that this insurance market suffers from asymmetric information and selection effects even though the correlation between insurance coverage and risk is not statistically significant. Instead of shifting insurance coverage to a private insurance system, another option to alleviate the financial burden in a public health insurance system, which is analyzed in this thesis, refers to the promotion of preventive health care. Specifically, the fourth paper (chapter 5) empirically examines the effectiveness of a nationwide population-based skin cancer screening (SCS) program that was implemented in Germany in 2008. To this end, panel data from 2000 to 2013 of the Eurostat database on subregions in 22 European countries are exploited. Using fixed effects methods, the results show a positive and robust effect of the German SCS program on the diagnosis rate for malignant skin neoplasms, but no significant impact on the melanoma mortality rate. The former suggests that this program is effective in terms of an increased diagnosis rate for malignant skin neoplasms and may therefore contribute to an improved detection of skin cancer at an early stage.
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    Mulitdimensionale Informationen im Kontext wertorientierte Unternehmensführung von Versicherern
    (2017) Trautinger, Max-Josef; Schiller, Jörg
    The cumulative dissertation analyzes how multi-dimensional information influences customer behavior and how insurers can use that information efficiently as a key factor in customer interaction. Information per se is multilayered and can be multidimensional. Multidimensional information in this context is understood as known or generally available information about customers, which should help in the interaction between the insurer and the customer to fulfill the customer expectations. As an additional research question, this dissertation analyzes how insurers can use the information economically profitably and generate added value. Provided that information can be used effectively value orientation can be generated. For example, having data in a pure form does not add value to insurers. If this information can at least be used to satisfy customer expectations, it can be assumed that customers want to use offered services and are disposed to a higher willingness to pay. In three analyzes this question is taken up separately and discussed. Analysis 1: In a competitive insurance market, claims settlement is a central task of insurers. Customers indicate after an event of loss specific expectations and further the adept service is of customers point of view a ‘moment of truth’. Insurers may align their claims settlement and optimise it. This paper analyse which determinants influence the customer satisfaction. The hypotheses were shown in a model and discussed by the author. Also, the hypotheses evaluated on the basis of empirical data which is derived from a set of interviews by a german insurer. The results of the analysis show variables which can be influenced in order to improve the customer satisfaction. Analysis 2: Customer behavior is managed by customer satisfaction in two dimensions: Insurer can profit by a higher customer loyalty und in addition, by a sensitive price behavior of customers. The findings of moderating effects are mean considered and thus, customer satisfaction is a too strong indicator of economic success in established concepts. To manage an insurance company effective, it is a good advice to implement a model that is specific for each company. This model should respect the heterogeneous factors of influence due to customer satisfaction by multidimensional instruments. Hence, insurer may identify drivers of service and work with analysis of correlations to describe the coherence between customer satisfaction and economic success exactly. The alignment for customer satisfaction is worth for traditional insurance companies, but only, if customer satisfaction is understood as an economic valued management that is culturally based in the firm. Manager should account for this suggestion to follow a sustainable story in a saturated competitive environment. Analysis 3: In this analysis we analyze in a project selection effects in the German market for private complementary long-term care insurance contracts (CompLTCI) within a static and dynamic framework. Using data on more than 98,000 individuals from a German insurance company, we provide evidence that advantageous selection is dominating in this market, with respect to both the decision to buy a CompLTCI policy and the decision about the extent of CompLTCI coverage. We identify occupational status, residential location and the holding of further supplementary health insurance policies as unused observables contributing to selection effects in this market. Our results suggest that non-linearities in the relationship of potential sources of selection to insurance coverage and risk should be considered. A panel data analysis shows that an increase in health insurance payouts is positively correlated with the uptake of CompLTCI, while a decrease in those costs is positively associated with the lapse of CompLTCI. In addition, we find that people in financial distress and of lower socioeconomic status are more likely to let their CompLTCI policies lapse.