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One of the effective ways to increase the level of population coverage with medical services is health insurance. The paper aims to determine what type of health insurance (compulsory, social, or voluntary) has the greatest impact on a country’s ability to provide large-scale and timely medical services to citizens, as measured by the number of unmet needs for medical examination, treatable and preventable mortality. The control variables included a country’s population size, the level of economic well-being, and the scale of the public health system (number of doctors and hospital beds) based on EUROSTAT data for all 27 EU countries in 2012–2021. Modelling (regression models of panel data with fixed and random effects in STATA 18, Wald test, Hausman test, Breusch and Pagan test) proved that only one of three researched types of insurance – voluntary health insurance – positively influences a country’s ability to provide large-scale and timely medical services to citizens: an increase in its volume by 1% leads to a decrease in unmet needs in medical examination on average across all EU countries by 0.26%, treatable mortality rate by 0.08%, preventive mortality rate by 0.27%. The influence of the other two types – compulsory and social – was not confirmed (received regression coefficients for these variables are not statistically significant). This emphasizes the importance of citizens’ conscious attitude to their health (due to the increase in voluntary health insurance) both in strengthening public health and in ensuring faster and better access to medical services.

This paper reexamines the welfare economics of risk. It singles out a class of criteria, the “expected equally distributed equivalent,” as the unique class that avoids serious drawbacks of existing approaches. Such criteria behave like ex post criteria when the final statistical distribution of well-being is known ex ante and like ex ante criteria when risk generates no inequality. The paper also provides a new result on the tension between inequality aversion and respect of individual ex ante preferences, in the vein of Harsanyi’s aggregation theorem.

Following the passage and implementation of the Affordable Care Act (ACA), librarians are more frequently called upon to provide assistance with navigating the Health Insurance Marketplace and understanding health insurance terminology and forms. Libraries offer an ideal context for health insurance information seeking, as librarians have traditionally assisted with completing public assistance forms and are well-trained in ascertaining and meeting information needs. This book is designed to serve as a practical guide for librarians seeking to learn more about the ACA; locate authoritative, nonbiased information regarding the ACA; and serve patrons searching for ACA information for personal or research purposes. While the book focuses specifically on the unique role that health sciences librarians play in serving the general public, health care providers, biomedical researchers, and health sciences students, the book contains guidance relevant to any information professional working with ACA information. Tailored to a librarian audience, this authoritative guide from the Medical Library Association begins with a general introduction to the Affordable Care Act, highlighting the aspects of the ACA legislation most pertinent to librarians. The following chapter focuses on the role of the librarian in relation to ACA implementation. Next, a chapter on health insurance literacy provides a foundation for those seeking to familiarize themselves with research on individuals' understanding of health insurance concepts. The following chapter builds on this foundation, discussing how a librarian can breakdown an ACA question, including a step-by-step guide. The last part of the book focuses on trends in ACA and health insurance information provision. It begins with a general overview of the types of ACA information services librarians are providing. Next, ten librarians are highlighted as case studies of the types on information services provided by health sciences librarians responding to ACA information needs. These chapters are designed to serve as springboards for those librarians interested in learning best practices and recommendations. The last chapter contains an authoritative list of recommended, unbiased ACA resources. This annotated bibliography is an excellent place for librarians to familiarize themselves with ACA logistical information as well as locate authoritative resources on insurance terminology. As librarians are increasingly being called upon to address health insurance information needs from the general public as well as researchers, this text provides concrete, helpful advice in providing unbiased, evidence-based answers.

'Catastrophe Risk Financing in Developing Countries' provides a detailed analysis of the imperfections and inefficiencies that impede the emergence of competitive catastrophe risk markets in developing countries. The book demonstrates how donors and international financial institutions can assist governments in middle- and low-income countries in promoting effective and affordable catastrophe risk financing solutions. The authors present guiding principles on how and when governments, with assistance from donors and international financial institutions, should intervene in catastrophe insurance markets. They also identify key activities to be undertaken by donors and institutions that would allow middle- and low-income countries to develop competitive and cost-effective catastrophe risk financing strategies at both the macro (government) and micro (household) levels. These principles and activities are expected to inform good practices and ensure desirable results in catastrophe insurance projects. 'Catastrophe Risk Financing in Developing Countries' offers valuable advice and guidelines to policy makers and insurance practitioners involved in the development of catastrophe insurance programs in developing countries.

It is well known that when agents are fully rational, compulsory public insurance may make all agents better off in the Rothschild and Stiglitz (1976) model of insurance markets. We find that when sufficiently many agents underestimate their personal risks, compulsory insurance makes low-risk agents worse off. Hence, behavioral biases may weaken some of the well-established rationales for government intervention based on asymmetric information. (JEL D82, G22)

Dans un contexte de montée inexorable de la fréquence des risques climatiques et des catastrophes naturelles, les politiques publiques n’ont d’autre choix que de tâcher d’en contenir l’ampleur. Nous étendons le modèle de monopole d’assurance de Stiglitz [1977] pour étudier l’efficacité de trois schémas de couverture : la présence d’opportunités d’auto-assurance, les obligations d’assurance ou d’auto-assurance. Nous mettons en évidence trois résultats fondamentaux. Premièrement, l’existence d’opportunités d’auto-assurance crée un contre-pouvoir au pouvoir de marché d’un monopole d’assurance. Nous montrons en effet que, par rapport à un marché monopolistique avec assurance seule, les opportunités d’auto-assurance constituent, pour l’assureur, une menace qui a pour effet de réduire son pouvoir de marché et d’augmenter le bien-être des assurés. Deuxièmement, dans ce contexte, nous constatons qu’une obligation d’assurance aura des effets délétères sur l’assuré en dégradant sa situation et en rendant son pouvoir à l’assureur. Finalement, la propriété de substituabilité entre assurance et auto-assurance nous conduit à nous interroger sur les effets d’une obligation d’auto-assurance. Il ressort de notre modèle qu’auto-assurance obligatoire et assurance obligatoire ont des effets non équivalents. En effet, bien que l’obligation d’auto-assurance réduise la taille du marché de l’assureur, elle n’a aucun impact sur le bien-être de l’assuré. Les implications de ces politiques publiques sont discutées . Classification JEL  : D86, D42, G22. In a context of relentlessly increasing frequency of climate risks and natural disasters, public policy has no choice but to try to limit their magnitude. We extend Stiglitz’s insurance monopoly model (Stiglitz [1977]) to examine the effectiveness of three coverage schemes: the presence of self-insurance opportunities, mandatory insurance and mandatory self-insurance. We highlight three main findings . First, the market power of an insurance monopoly is challenged by the existence of self-insurance. We show that, compared to a monopoly market with insurance alone, self-insurance opportunities threaten the insurer, reducing its market power and increasing the welfare of policyholders. Second, in this context, we find that compulsory insurance has a detrimental effect on the insureds, worsening their situation and returning power to the insurer. Finally, the substitutability between insurance and self-insurance leads us to question the effects of self-insurance obligations. Our model shows that compulsory self-insurance and compulsory insurance do not have equivalent effects. While the compulsory self-insurance reduces the size of the insurer’s market, it has no effect on the welfare of the insured. The implications of these public policies are discussed .

The main aim of this paper is to analyse the singularity of the Spanish position with regard to coverage of the risk of sickness within the context of the different welfare models described in international literature. This analysis enables us to verify that in Spain, as in other countries, there were initially different forms of sickness coverage which coexisted, created by the market, by workers themselves and, gradually, by the state. Within this so-called mixed economy of welfare, the most extensive health coverage for the Spanish population was a result of the self-organization of workers, and this continued until the Civil War (1936–1939), not so much due to its efficacy and viability, as to the slow development of private insurance companies and the inability of the state to implement compulsory sickness insurance. The installation of the Franco dictatorship meant that the introduction of compulsory sickness insurance was further delayed, and when it was eventually passed, it offered only limited coverage, was enacted more for political than for social ends, and was to result in the virtual disappearance of friendly societies. Jerònia Pons Pons et Margarita Vilar Rodríguez. Sociétés de prévoyance, assurance commerciale et l’État dans la couverture du risque de maladie: le cas de l'Espagne (1880–1944). Le principal objectif de cet article est d'analyser la singularité de la position espagnole du point de vue de la couverture du risque maladie, dans le contexte des différents modèles de bien-être décrits dans la littérature internationale. Cette analyse nous permet de vérifier qu'en Espagne, comme dans d'autres pays, il exista initialement différentes formes de couverture maladie et qu'elles coexistèrent, créées par le marché, par les travailleurs eux-mêmes et, progressivement, par l’État. Dans ce que l'on nomme cette économie mixte de bien-être, la couverture santé la plus étendue pour la population espagnole fut un résultat de l'auto-organisation de travailleurs et ce mouvement continua jusqu’à la Guerre Civile (1936–1939), moins en raison de son efficacité et de sa viabilité que par suite du lent développement des compagnies d'assurance privées et de l'incapacité de l’État à mettre en œuvre une assurance maladie obligatoire. L'installation de la dictature franquiste signifia que l'introduction de l'assurance maladie obligatoire fut à nouveau reportée et lorsqu'elle fut finalement passée, elle n'offrit qu'une couverture limitée, fut promulguée à des fins plus politiques que sociales et résulta en fin de compte dans la disparition virtuelle de sociétés de prévoyance. Jerònia Pons Pons und Margarita Vilar Rodríguez. Versicherungsvereine, kommerzielle Versicherungsfirmen und die Rolle des Staates in der Krankenversicherung. Der Fall Spanien (1880–1944). Das Hauptziel dieses Beitrags besteht darin, die Besonderheiten Spaniens hinsichtlich der Absicherung gegen Krankheitsrisiken, wie sie in verschiedenen, in der internationalen Literatur beschriebenen Wohlfahrtsmodellen gewährleistet wird, zu analysieren. Diese Analyse bestätigt, dass es in Spanien, wie auch in anderen Ländern, zunächst verschiedene, miteinander koexistierende Formen von Krankenversicherung gab, die vom Markt, von den Arbeitern selbst und dann zunehmend vom Staat entwickelt wurden. Die weitreichendste Form der Krankenversicherung, die der spanischen Bevölkerung innerhalb dieser sogenannten wohlfahrtsstaatlichen Mischwirtschaft (mixed economy of welfare) zur Verfügung stand, war Ergebnis der Selbstorganisation der Arbeiter. Dies war bis zum spanischen Bürgerkrieg (1936–1939) der Fall – jedoch nicht etwa, weil das System besonders effektiv oder praktikabel gewesen wäre, sondern vielmehr aufgrund der nur sehr allmählichen Entwicklung privater Versicherungsfirmen sowie aufgrund der Unfähigkeit des Staates, eine Krankenversicherungspflicht einzuführen. Die Instaurierung der Franco-Diktatur verzögerte die Einführung einer solchen Pflicht noch zusätzlich; als es schließlich zur obligatorischen Krankenversicherung kam, unterlag diese noch verschiedenen Einschränkungen, wurde eher aus politischen denn aus sozialen Erwägungen eingeführt und zog das nahezu vollständige Verschwinden der auf Gegenseitigkeit beruhenden Versicherungsvereine (friendly societies) nach sich. Jerònia Pons Pons y Margarita Vilar Rodríguez. Sociedades de ayuda mutua, seguros comerciales y el Estado en la cobertura del seguro por enfermedad: el caso español (1880–1944). El principal propósito de este texto es analizar la singularidad española en relación a la cobertura del seguro por enfermedad en el contexto de diferentes modelos de bienestar descritos por la literatura internacional. Este análisis nos permite verificar que en España, como en otros países, inicialmente coexistieron formas distintas de cubrir la enfermedad, creadas por el mercado, por los propios trabajadores y, gradualmente, por el Estado. En estas denominadas economías mixtas de bienestar, la cobertura de salud más extensa entre la población española fue resultado de la propia organización de los trabajadores, manteniéndose hasta la Guerra Civil (1936–1939), no tanto por su eficacia y viabilidad, como por el lento desarrollo de las compañías de seguros privados y la incapacidad del Estado para instaurar seguros de enfermedad obligatorios. La instauración de la dictadura de Franco significó que esta cuestión se retrasará una vez más y, cuando se aprobó, ofrecía tan sólo una cobertura limitada. Su promulgación se debía más a fines políticos que sociales y provocó la desaparición virtual de las sociedades de ayuda mutua.

The discussion concerning long-term care insurance in Germany barely exceeds the financial state of the social system. The view of the insured involved is largely ignored. This paper analyses the effect of the introduction of compulsory long-term care insurance in 1995 in Germany on the perception of financial security when needing long-term care. Using different regression techniques on a subset of the German Socio-Economic Panel (SOEP) data, we show that the introduction led to a general positive shift of the assessment. Furthermore, experience with long-term care had no significant effect before the introduction but a positive effect afterwards. Also, the perception of financial security is found to be increasing with income at both times with similar magnitudes.

Insurance for long-term care (LTC) has developed only moderately compared to other areas of welfare, which has been explained variously as the result of market failures, public misconceptions of the risk of LTC needs, and intergenerational contracts. This paper offers a cultural explanation for the limited LTC insurance development in Europe. It argues that family ties, by enhancing informal care-giving duties, inhibit individuals' expected (public and private) insurance coverage. The empirical analysis of the paper exploits cross-country and sub-group variability of a representative database of European Union member states, containing records on LTC coverage and family structure. Drawing upon two measures of familistic culture or family ties, we find a negative association between family ties and expected coverage of LTC for different sub-samples. These results are robust to a set of checks for different definitions of family ties and controls, and for a sub-sample of first- and second-generation migrants. Policy implications suggest that widespread expansion of LTC coverage might need to accommodate existing familistic cultural norms to avoid insurance crowding out.