In 2017, Americans spent over $3.4 trillion-nearly 18% of gross domestic poduct-on health care. This spending is unevenly distributed: Almost a quarter is spent on the costliest 1% of patients, and almost half on the costliest 5%. Most of these patients soon return to a lower percentile, but many continue to incur health care costs in the top percentiles year after year. This Article focuses on the challenges that persistently expensive patients present for health law and policy, and how fairly (...) dividing their medical costs among payers illuminates fundamental normative choices about the design and reform of health insurance. In doing so, this Article draws on bioethical and health policy analyses of the fair distribution of medical costs, and examines how legal doctrine shapes health systems' options for responding to expensive patients. Part I of this Article discusses two real-world examples of expensive patients and the debate surrounding them, including the case of an Iowa teenager with hemophilia whose treatments cost more than $10 million per year. Part II then examines the normative question of how the costs of treating expensive patients' medical conditions should be shared and identifies three different dimensions of sharing: (1) scope, from narrow (plan members only) to broad (all of society); (2) boundedness, whether there are limits on the costs others can be asked to bear; and (3) progressivity, whether wealthier individuals are asked to bear more costs (similar to progressivity in tax). Part III then considers how health care reform choices could advance or hamper the adoption of broad, bounded, progressive sharing, with a focus on recent state-level reinsurance programs that legal scholarship has not yet analyzed in depth. -/- This Article contributes to the literature on health care reform in three interlocking ways. First, it develops a novel proposal for fairly sharing the cost of expensive patients' care that could usefully inform state- and federal-level policy discussions. Second, it provides a normative, rather than purely political or economic, analysis of existing and proposed options for sharing expensive patients' costs. Third, it bridges the disconnected literature on reinsurance, limit setting, and health care financing, identifying how proposals in these different areas intersect. (shrink)

ABSTRACT:Drawing a framework from strategic stakeholder theory and using 1999 to 2010 panel data from the United Kingdom’s (UK) non-life insurance industry, we examine the effect of reinsurance on the decisions to donate to charities, and the amount given. We find that reinsurance substitutes for charitable giving as it optimizes the interests of multiple stakeholders. We further note that corporate giving is directly related to the size and age of insurers, proportion of female directorships and insider ownership, but (...) generally inhibited by chief executive officer (CEO) bonus plans, dominant shareholders, and financial experts on the board. Interestingly, when reinsurance interacts with board-level variables we find that the donations decision is positively related to CEO bonus plans, and negatively linked with inside ownership and the proportion of female board members. Our research results could have important implications for stakeholders. (shrink)

Tort law and liability insurance have a complex interaction in which each shapes the evolution and effects of the other. This interaction and its many forms and facets in different international contexts must be comprehended to understand fully the ethical responsibilities of liability insurers. This essay builds on previous scholarship on the tort law–liability insurance interaction through a series of observations from the perspective of a global reinsurer. It seeks in part to extend previous analyses of this interaction by also (...) considering issues in the developing world. It seeks to make some normative questions and stances explicit concerning this interaction, as well as to identify some empirical questions that still need to be answered. The responsibility of liability insurers includes ethically shaping the responsibility of others in interaction with tort law in countless diverse situations. (shrink)

For quite some time, reinsurance companies have been pricing the ongoing climate change using weather- and catastrophe-related instruments and thus have been able to make money through climate change. Yet, at the same time, for reinsurance companies it is crucial that the likelihood of the events they underwrite is diminished as much as possible. Consequently, while profiting from the situation, these key actors of global capitalism also work to prevent climate change from taking place, and support the kinds (...) of measures, on all political scales, that diminish the likelihood of severe climate change destruction. This article analyzes the materials that the reinsurance company Munich Re has distributed to stakeholders and asks how climate change is objectified by the reinsurance industry. How are weather-related catastrophes made into a financial risk and opportunity? The key conceptual tools for answering these questions are provided by Michel Serres’s work on world-objects. (shrink)

European Journal of Philosophy, Volume 30, Issue 2, Page 488-502, June 2022.

Relevance of the article is determined that the effective functioning of the reinsurance market greatly depends on the development of its infrastructure because it creates opportunities for implementation of reinsurance services, mediates, accelerates and facilitates placement and execution of reinsurance contracts. Given the state of the domestic insurance market mediation necessary means to enhance its development and integration into the global reinsurance market. The article is a study of measures to enhance the role of mediation in (...) the insurance market of Ukraine. The article provided a critical assessment of the legal status of insurance mediation in Ukraine. Factors that determine its role in the insurance market of Ukraine. Established quantitative and cost indicators of intermediation of brokers in insurance and reinsurance, given their logical explanation. Suggestions to create appropriate conditions for the development of mediation in the insurance and reinsurance markets in Ukraine. Mediation plays an important role in the development of the insurance market of Ukraine since: helping the participants to choose the most optimal proposal for the establishment of additional guarantees of the insurance liabilities; strengthening partnerships and trust between the reinsurer and the reinsurer; improves the quality and dynamics of sales reinsurance services; supports a healthy competitive environment in the reinsurance market. It was established that the quantitative and cost indicators of intermediation of brokers in insurance and / or reinsurance in Ukraine do not match. By number of deals leadership position with insurers-residents, the cost - non-resident reinsurers. The most attractive segment for mediation turned provision of agreements with non-resident reinsurers for property insurance. To create the appropriate conditions for the development of mediation in the insurance and reinsurance markets of Ukraine should: increase transparency of brokers to introduce their professional liability insurance and the formation of guarantee funds. (shrink)

The Athenian expedition led against Macedonia by Archestratos, son of Lykomedes, early in 432 was not diverted from its destination by the revolt of Poteidaia. Archestratos had received additional instructions to enforce the Poteidaia ultimatum if he could, but, this being already impossible, he continued with the real object of his mission, the attack on Perdikkas II of Macedon. The widespread revolt among the Chalkidians had deprived the Athenians of the bases for this attack on which they might have reckoned, (...) and Archestratos had at the outset to make good this loss by recapturing Therme, at the head of the gulf to which it gave its name. Therme, or Serme, had been a tributary member of the Delian League since 450/449:2 it need not necessarily be said that it lay within Macedonia, as Poppo and Bergk inferred from Thucydides 1. 61. 2, but it is at least likely that it lay on the boundary, as it was handed over to Perdikkas under the agreement of 431 .3 However, that the Athenians could include in their Empire a city within Macedonian territory is shown from the position of Berge , and is likely in other cases, e.g. Haison. From Therme, Archestratos moved on to Pydna, presumably by sea, and laid siege to it. Here he was joined by substantial reinforcements, while at the same time the situation in Chalkidike became increasingly embarrassing, so that a peace and a reinsurance alliance were seen by both sides to be ‘imperative’ . When these had been concluded, the Athenians moved against Poteidaia. (shrink)

Whenever health care reform is debated, the state of the medical professional liability system in the United States re-emerges as an issue of importance. What exactly is broken with the MPL system and what the implications are is a point of contention among different stakeholder groups. Recent data demonstrate that medical liability premiums have been improving in recent years and the majority of premiums remained flat in 2010. General agreement still exists, however, that medical professional liability insurance premiums have become (...) unaffordable for many physicians, and coverage has become less available, especially for certain medical specialties and in specific areas of the country.Multiple factors go into the determination of medical professional liability insurance premiums including return on investments, reinsurance costs, claims frequency, average amount paid out on malpractice claims, defense expenses, and administrative costs such as underwriting expense. (shrink)

Spanish legislation on insurance and reinsurance mediation stipulates that intermediary can only receive commissions and fees for the management of their policies and prohibits any other form of remuneration. However, it is possible that financial intermediaries who manage larger risks wait until the end of the legal deadline to settle with insurance companies. This common practice in the insurance market hides additional remuneration in defiance of the law. It also means that the risk is not covered within the prescribed (...) period and would, involve a commercial payment to the client, and, on the other hand, affect sustainable claims management. (shrink)

Environmental politics needs more than piecemeal institutional efforts and more than calls for a set of 'new' values. It needs a realistic, comprehensive, and effective policy programme. Such a programme can be derived from a conjunction of Hardin's work on the 'tragedy of the commons' and Beck's analysis of the 'risk society', and involves exploiting the possibilities for the internalisation of risk provided by the insurance and reinsurance industries. Such exploitation requires tailored changes to the politico-legal environment, enforcing strict (...) liability for the production of risk, permitting any and all agents adversely effected by such negative externalities to initiate action for damages. The aim is not to clog up social and economic life with endless legal disputation, but through such a threat to ensure that environmentally significant investment and productive strategies are actively constrained by actuarially calculated strategies for risk internalisation. (shrink)

Most experts would agree that the current medical malpractice system in the United States does not work effectively either to compensate victims fairly or prevent injuries caused by medical errors. Policy responses to a series of medical malpractice crises have not resulted in effective reform and have not altered the fundamental incentives of the stakeholders. In Medical Malpractice, economist Frank Sloan and lawyer Lindsey Chepke examine the U.S. medical malpractice process from legal, medical, economic, and insurance perspectives, analyze past efforts (...) at reform, and offer realistic, achievable policy recommendations. They review the considerable empirical evidence in a balanced fashion and assess objectively what works in the current system and what does not. Sloan and Chepke argue that the complexity of medical malpractice stems largely from the interaction of the four discrete markets that determine outcomes--legal, medical malpractice insurance, medical care, and government activity. After describing what the evidence shows about the functioning of medical malpractice, types of defensive medicine, and the effects of past reforms, they examine such topics as scheduling damages as an alternative to flat caps, jury behavior, health courts, incentives to prevent medical errors, insurance regulation, reinsurance, no-fault insurance, and suggestions for future reforms. Medical Malpractice is the most comprehensive treatment of malpractice available, integrating findings from several different areas of research and describing them accessibly in nontechnical language. It will be an essential reference for anyone interested in medical malpractice.Frank A. Sloan is J. Alexander McMahon Professor of Health Policy and Management and Professor of Economics at Duke University. He is the coauthor of The Price of Smoking and author or editor of many other books on health economics. Lindsey M. Chepke, an attorney, is a Research Associate at the Center for Health Policy at Duke University. (shrink)

The Supreme Court of Idaho held, in Idaho Association of Chiropractic Physicians, Inc. v. Alcorn, No. 23787,1999 WL 134677, at *1, that insurance regulations of health care services must apply equally to all providers. The Idaho legislature enacted the Small Employer Health Insurance Availability Act, Idaho Code § 41-4701, and the Individual Health Insurance Availability Act, id. § 41-5201, which is to be implemented by the Idaho Small Employer and Individual Health Reinsurance Program. The goal of the legislation is (...) to make health insurance available and affordable to small employers and their employees, and to individuals who would not otherwise have health insurance. Accordingly, the Program promulgated the following rule: “Chiropractic services will be subject to one thousand dollars per year limit.” Idaho Ass’n of Chiropractic Physicians, 1999 WL 134677, at *1.The plaintiff, the Idaho Association of Chiropractic Physicians, sought declaratory judgment and injunctive relief against defendant, James M. Alcorn, director of the Idaho State Department of Insurance, on equal protection and due process grounds. (shrink)

This book presents startling evidence that state monopolies can produce better outcomes than the free market. It provides an empirical comparison of the property insurance market in five European countries: Britain, Spain, France, Switzerland, and Germany. The market and cost structures of insurers in each country are described, and particular features of each market and the outcomes for customers examined. The regulatory frameworks vary widely from country to country and so do the market outcomes, both in terms of premium level (...) and in terms of available insurance cover.In view of the increase in major floods and other forms of natural damage over the last decades, the non-availability of insurance cover in many competitive insurance systems is likely to become a major political issue. This book shows that state monopoly is an adequate policy response. Competitive insurance systems are shown to provide incomplete cover at a substantially higher cost. In mixed systems, where the private sector can obtain reinsurance from the state the state tends to end up paying most of the costs while the private insurance companies keep most of the premium income.The book will be of interest to academic economists interested in privatization, regulation, the theory of the firm, and insurance; Policy-makers concerned with regulation and privatization; Insurance companies, regulators, and analysts. (shrink)

Most experts would agree that the current medical malpractice system in the United States does not work effectively either to compensate victims fairly or prevent injuries caused by medical errors. Policy responses to a series of medical malpractice crises have not resulted in effective reform and have not altered the fundamental incentives of the stakeholders. In Medical Malpractice, economist Frank Sloan and lawyer Lindsey Chepke examine the U.S. medical malpractice process from legal, medical, economic, and insurance perspectives, analyze past efforts (...) at reform, and offer realistic, achievable policy recommendations. They review the considerable empirical evidence in a balanced fashion and assess objectively what works in the current system and what does not. Sloan and Chepke argue that the complexity of medical malpractice stems largely from the interaction of the four discrete markets that determine outcomes--legal, medical malpractice insurance, medical care, and government activity. After describing what the evidence shows about the functioning of medical malpractice, types of defensive medicine, and the effects of past reforms, they examine such topics as scheduling damages as an alternative to flat caps, jury behavior, health courts, incentives to prevent medical errors, insurance regulation, reinsurance, no-fault insurance, and suggestions for future reforms. Medical Malpractice is the most comprehensive treatment of malpractice available, integrating findings from several different areas of research and describing them accessibly in nontechnical language. It will be an essential reference for anyone interested in medical malpractice.Frank A. Sloan is J. Alexander McMahon Professor of Health Policy and Management and Professor of Economics at Duke University. He is the coauthor of The Price of Smoking and author or editor of many other books on health economics. Lindsey M. Chepke, an attorney, is a Research Associate at the Center for Health Policy at Duke University. (shrink)

У статті подано схему основних груп ризиків та виділено причини їх виникнення. Констатовано, що при управлінні ризиками страхових компаній доцільно виділити 4 групи методів оцінювання, які є найбільш результативними та реальними в практичній сфері: експертні, економіко-статистичні, розрахунково-аналітичні, аналогові. Розглянуто й обґрунтовано найбільш ефективні способи контролю за ризиками. Зроблено висновки щодо наведених способів та методів управління ризиками страхових компаній, які містять низку різноманітних заходів організаційно-фінансового характеру та дозволяють певною мірою передбачити наслідки та розмір збитку, який потрібно відшкодовувати.

У статті досліджено теоретико-прикладні підходи до формування системи управління фінансовими потоками страховика, охарактеризовано методи та етапи фінансового управління страховика, виявлено проблеми та окреслено напрямки їх розв'язання в контексті руху фінансових ресурсів за видами діяльності страхової компанії.