Impact of home and leisure accident rates on disability and costs of long term care in Spain

Home and leisure accidents are one of the main causes of mortality due to other causes than aging, and have a high impact on health systems. However, to date, the number of studies associated with measuring their socioeconomic impact is very limited, unlike those associated with other causes such as traffic accidents or work accidents. Our objective is to analyze the long-term care needs associated with home and leisure accidents (HLA) in Spain. We conclude that the care needs derived from these causes increase with age of people, with a high incidence in all those situations in which people see their mobility limited. The high socio-economic costs that result (approximately 781 million euros in 2016 in Spain for expenses in long-term care, 0.07% of the Gross Domestic Product) highlight the need to implement preventive policies. Taking into account the budgetary constraints that the public systems can have to address all costs, the development of insurance products that help to cover these specific situations could be justifie

Prediction of the economic cost of individual long-term care in the Spanish population

Pensions together with savings and investments during active life are key elements of retirement planning. Motivation for personal choices about the standard of living, bequest and the replacement ratio of pension with respect to last salary income must be considered. This research contributes to the financial planning by helping to quantify long-term care economic needs. We estimate life expectancy from retirement age onwards. The economic cost of care per unit of service is linked to the expected time of needed care and the intensity of required services. The expected individual cost of long-term care from an onset of dependence is estimated separately for men and women. Assumptions on the mortality of the dependent people compared to the general population are introduced. Parameters defining eligibility for various forms of coverage by the universal public social care of the welfare system are addressed. The impact of the intensity of social services on individual predictions is assessed, and a partial coverage by standard private insurance products is also explored. Data were collected by the Spanish Institute of Statistics in two surveys conducted on the general Spanish population in 1999 and in 2008. Official mortality records and life table trends were used to create realistic scenarios for longevity. We find empirical evidence that the public long-term care system in Spain effectively mitigates the risk of incurring huge lifetime costs. We also find that the most vulnerable categories are citizens with moderate disabilities that do not qualify to obtain public social care support. In the Spanish case, the trends between 1999 and 2008 need to be further explored

Accounting for severity of risk when pricing insurance products

We design a system for improving the calculation of the price to be charged for an insurance product. Standard pricing techniques generally take into account the expected severity of potential losses. However, the severity of a loss can be extremely high and the risk of a severe loss is not homogeneous for all policy holders. We argue that risk loadings should be based on risk evaluations that avoid too many model assumptions. We apply a nonparametric method and illustrate our contribution with a real problem in the area of motor insurance

The bivariate Sarmanov distribution for insurance claim frequencies and average severities

Real data studies emphasized situations where the classical independence assumption between the frequency and the severity of claims does not hold in the collective model. Therefore, there is an increasing interest in defining models that capture this dependence. In this paper, we introduce such a model based on Sarmanov’s bivariate distribution, which has the ability of joining different types of marginals in flexible dependence structures. More precisely, we join the claims frequency and the average severity by means of this distribution. We also suggest a maximum likelihood estimation procedure to estimate the parameters and illustrate it both on simulated and real data

Emergency care usage and longevity have opposite effects on health insurance rates

Purpose: To study the price of health insurance for individuals aged 65 years and over. Methodology: A sample of private health policyholders in Spain is analysed. Joint models are estimated for men and women, separately. A log-linear model of the transformed cumulated number of claims associated with emergency room occupation, ambulance use and hospitalization is estimated, together with a proportional hazard survival model. Findings: The association between the longitudinal process of severe medical care and the survival time process is positive and highly significant for both men and women. An increase in the price of health insurance due to the effect of a larger number of emergency care demand events is slightly offset by the decrease in expected longevity. Practical implications: The effect of an increase in the number of claims is small compared to the reduction in survival, so age still plays a central role in rate making. Originality: The proposed methodology allows dynamic rates to be designed, so that the price of health insurance can change as new usage information becomes available

A joint longitudinal and survival model with health care usage for insured elderly

We study longevity and usage of medical resources of a sample of individuals aged 65 years or more who are covered by a private insurance policy. A longitudinal analysis is presented, where the yearly cumulative number of medical coverage requests by each subject characterizes insurance intensity of care until death. We confirm that there is a significant correlation between the longitudinal data on usage level and the survival time processes. We obtain dynamic estimations of event probabilities and we exploit the potential of joint models for personalized survival curve adjustment

Joint Modelling of Survival and Emergency Medical Care Usage in Spanish Insureds Aged 65+

We study the longevity and medical resource usage of a large sample of insureds aged 65 years or older drawn from a large health insurance dataset. Yearly counts of each subject's emergency room and ambulance service use and hospital admissions are made. Occurrence of mortality is also monitored. The study aims to capture the simultaneous dependence between their demand for healthcare and survival

Impact of D-Vine Structure on Risk Estimation

In this paper, a sensitivity analysis using pair-copula decomposition of multivariate dependency models is performed on estimates of value-at-risk (VaR) and conditional value-at-risk (CVaR). To illustrate the results, we use four financial share portfolios selected to exemplify this purpose. For each share, we calculate filtered log returns using autoregressive moving average-generalized autoregressive conditional heteroscedasticity models and study their dependence. We analyze how selecting pairs of assets to define vines prior to pair-copula decomposition affects the estimated VaR and CVaR. Further, using bootstrap confidence intervals, we compare the results of different risk measures obtained by employing alternative measures of dependence to select the order in which the drawable vine (D-vine) is defined in different portfolios. Moreover, we carry out a simulation study to analyze the finite sample properties of the different criteria for selecting the pair-copula decomposition associated with the D-vine. We find some differences between the results obtained for VaR and CVaR

Impacto de los accidentes domésticos y de ocio en las tasas de discapacidad y costes de cuidados de larga duración en España

Los accidentes domésticos y de ocio son una de las principales causas de mortalidad por causa diferente al envejecimiento, y tienen un elevado impacto en los sistemas de salud. Sin embargo, hasta la fecha, el número de estudios asociados a la medición de su impacto socioeconómico es muy limitado, a diferencia de aquellos asociados a otras causas como los accidentes de tráfico o los accidentes laborales. Nuestro objetivo es analizar las necesidades de cuidados de larga duración asociadas a accidentes domésticos y de ocio (ADO, lesiones por accidentes domésticos y de ocio) en España. Concluimos que las necesidades de cuidados derivados de dichas causas se incrementan con la edad de las personas, con una elevada incidencia en todas aquellas situaciones en las que las personas ven limitada su movilidad. Los elevados costes socioeconómicos que se derivan (aproximadamente 781 millones de euros en 2016 en España por gastos en cuidados de larga duración, un 0,07% del Producto Interior Bruto) ponen de manifiesto la necesidad de que los gobiernos pongan en marcha políticas preventivas