While a number of jurisdictions internationally prohibit insuring companies to be able to use genetic information in their risk classification, a voluntary code of practice permits insurers the limited use of predictive genetic test results in the UK. Jonathan Pugh1 offers a pluralist justice-based argument in support of the UK practice. Pugh’s position is developed to avoid what he sees as flaws with the current debate on insurers’ access to genetic information, including an alleged reliance on idealised assumptions about the (...) predictive power of genetic test results, revisionary implications for the provision of insurance suggested in the debate and failings of commentators to engage adequately with a conception of justice that undergirds the status quo approach in the UK. Pugh suggests that a quasi-libertarian approach to justice is implicit within the terms of the present Code and should be phrased as a principle of equity. Further, he argues that basic egalitarian and non-comparative concerns should be captured in broad principles: equal access and need. This leaves him with three principles that should be balanced in order to guide protection insurance policy. When the argument is applied to review …. (shrink)

We examine the relationship between social insurance contributions and earnings management for publicly listed firms in China. Our empirical results show that the social insurance contributions burden significantly reduces the degree of earnings management by reducing the level of free cash flow. Additionally, the negative relation between social insurance contributions burden and earnings management is more pronounced when the internal and external social insurance pressures are high and when the firms are large (...) non-state-owned enterprises. We also discuss the heterogeneity among firms for different financing constraints, external financing environment, regional marketization, and internal and external corporate governance. Finally, we further find that under the dual collecting system, although the social security administration is a better collecting agency, the local tax bureau acting with full responsibility is more effective than the collecting system. (shrink)

There are four basic models for health care systems: the private market insurance model, the national single-payer model, the national health service model, and the social insuranceSocial insurance model. The social justice debate over health care usually focuses on the comparative efficiency and quality of competitive private market insurance and the universal coverage and equity of national health care systems. It is a mistake, however, to think that a universal right to health care services requires (...) a single-payer, government-run, national health care system. The social insurance model of Germany, France, Japan, and many other countries, deserves more attention, as it incorporates the strengths of both market models and national health care models. (shrink)

With the increasing mobility of the rural population in China and the growing number of residents moving to the cities for work or study, rural society is forming a pluralistic, interest-centered, “open” social networks relations that follows the modern rule of law contract. Based on Chinese General Social Survey data, the results of the empirical study finds that social insurance can significantly enhance the social interactions of rural residents in China, that is, formal social (...) security system in rural areas promotes informal social security mechanisms such as social interactions. The results of the grouping test show that rural residents in China’s different regions were affected by social insurance in different ways. Social insurance has a greater impact on the social interactions in the eastern region than in the middle and western regions. The propensity score matching method was used to reduce the sample selection bias, and the findings of the paper were found to be robust. (shrink)

There are four basic models for health care systems: the private market insurance model, the national single-payer model, the national health service model, and the social insurance model. The social justice debate over health care usually focuses on the comparative efficiency and quality of competitive private market insurance and the universal coverage and equity of national health care systems. It is a mistake, however, to think that a universal right to health care services requires a (...) single-payer, government-run, national health care system. The social insurance model of Germany, France, Japan, and many other countries, deserves more attention, as it incorporates the strengths of both market models and national health care models. (shrink)

While in America most people think of “welfare” as means-tested programs such as Aid to Families with Dependent Children, in reality in the United States and other affluent democracies the heart of the welfare state is social insurance programs, such as health insurance, old-age or retirement pensions, and unemployment insurance. They are insurance programs in the sense that they protect against common risks of a loss of income if and/or when certain events come to pass (...) ; they are “social” because unlike market insurance they are not run on a sound actuarial basis, the premiums are not voluntarily incurred but compulsory, and there is very limited choice or flexibility concerning the type of policy one can purchase. Why have social insurance rather than market insurance? In this essay, I take up this question with regard to old-age or retirement pensions, which at present absorb around 9 percent of the gross domestic product and 25 percent of government spending of the affluent industrial countries comprising the Organization for Economic Cooperation and Development. My aim is to show that old-age or retirement social insurance is worse in virtually every relevant normative respect than its alternative, some form of market or private pensions. By relevant normative respect, I mean those values or principles which are used by contemporary political philosophers in their discussions and justifications of welfare-state policies, and which are applicable to assessments of different systems of old-age or retirement pensions. (shrink)

In recent years, critics have argued that, when inter-generational transfer programs such as Medicare are judged by the standard of "generational equity", these programs are seen to be unfair. It is argued that, under a pay-as-you-go system, future generations are committed to burdens without their consent; that claims are not contractually guaranteed; that early entrants reap windfalls gains; that successive cohorts are tempted to provide insupportably high benefit levels; and, finally, that fluctuations leave future generations at unacceptable risk. Attempts have (...) been made to defend social insurance programs by means of a "lifespan prudential model" of age-group resource allocation, but this defense does not adequately take account of uncertainties and inequities faced by historical birth cohorts. A deeper defense must acknowledge an element of risk-sharing and solidarity while trying to limit inequities within reasonable bounds. Keywords: elderly, health care, equity, social insurance CiteULike Connotea Del.icio.us What's this? (shrink)

Using a nationwide survey of randomly selected manufacturing firms in representative Chinese cities, we examine how firms’ compliance with social insurance policies is shaped by their historical imprinting, by their founding ownership structures, as well as by massive institutional changes. Our empirical results suggest that firms founded in the state socialist era and firms founded as Chinese state-owned enterprises (SOEs) were infused with socialist institutional logics of labor relations, and they tended to comply with social insurance (...) policies even in the present market socialist era. Chinese SOEs restructured into private and joint-ventured firms attenuated the lingering effect of organizational imprinting and provide social insurances for fewer workers. This research is among the first to probe the historical influence on labor protection in contemporary society. Through studying the stability and changes of socialist institutional logic of labor relations, our research leads to a better understanding of the situation of labor relations in contemporary China. (shrink)

_GPs serve in a double role of treatment provider and expert in certain social insurance systems, such as the Norwegian one. Some physicians assert that the ethical obligations of the two roles conflict with each other. The objective of this article is to show that social insurance medical ethics, which are based on recognised principles of medical ethics, unite the physicians’ obligations associated with these roles. The method applied is a medical ethics conceptual analysis. The material (...) consists of literature on normative SIME. The study shows that SIME expands the role of the treatment provider to a wider societal context. Here, physicians should attempt to balance the perspectives of sympathy with empathy, as treatment providers, with the impartiality in their role as experts. Five principles of medical ethics are fundamental. Respect for human dignity is the overarching principle of medical ethics. The four others are nonmaleficence, beneficence, autonomy, and social justice. The article discusses two areas where it is asserted that the roles of treatment provider and expert conflict with each other: the application of beneficence and justice, and the duty of confidentiality versus the duty to provide information to the National Insurance service. The study concludes that there are no basic ethical conflicts between the two roles. The ethical problems that may arise when exercising this duality should be viewed in the same way as other ethical problems in medicine. Actual application and balancing of the principles may necessitate negotiations between patients and physicians. _ _Keywords_: dual roles, professionalism, deliberation, impartiality, medical principle ethics, values of welfare state. (shrink)

abstract Individuals tend to change their behaviour as a response to insurance. Such behavioural responses to insurance are commonly seen as ethically and morally problematic. This is especially true of effects on behaviour from social insurance. These effects have been seen as an ethical problem, associated with irresponsibility, fraud and an immoral character. This article discusses the relevance of four different types of reasons for claims that behavioural responses to social insurance are immoral. These (...) reasons are independent reasons con‐tract related reasons reasons related to fraud and reasons related to justice. I argue that reasons related to justice are most relevant, but that this type of reason does not render the individual morally blameworthy. Hence, insofar as behavioural responses to social insurance are an ethical problem it is a problem that concerns the institution, i.e. what incentives social insurance exhibits, rather than the individual, i.e. the morality of the individual responding to it. Insofar as behavioural responses to social insurance are an ethical problem it is a problem for political philosophy rather than individual ethics. (shrink)

abstract Individuals tend to change their behaviour as a response to insurance. Such behavioural responses to insurance are commonly seen as ethically and morally problematic. This is especially true of effects on behaviour from social insurance. These effects have been seen as an ethical problem, associated with irresponsibility, fraud and an immoral character. This article discusses the relevance of four different types of reasons for claims that behavioural responses to social insurance are immoral. These (...) reasons are (1) independent reasons (2) con‐tract related reasons (3) reasons related to fraud and (4) reasons related to justice. I argue that reasons related to justice are most relevant, but that this type of reason does not render the individual morally blameworthy. Hence, insofar as behavioural responses to social insurance are an ethical problem it is a problem that concerns the institution, i.e. what incentives social insurance exhibits, rather than the individual, i.e. the morality of the individual responding to it. Insofar as behavioural responses to social insurance are an ethical problem it is a problem for political philosophy rather than individual ethics. (shrink)

Magna Carat is a highly significant document that found the way into the rights and the constitutions. Magna Carat is a symbol of human and constitutional rights. Social insurance is part of the social security and the recognition of social security as a basic human right is enshrined in the Universal Declaration of Human Rights adopted by the United Nations General Assembly on 10 December 1948 at the Palais de Chaillot, Paris and furthermore the European Conventions (...) on Human Rights, specially the article 6. Magna Carat demonstrated the limitations from the arbitrarily. Magna Carat is a foundation of the powers of Parliament and the legal principles, as the rule of law, the rule that everybody has equality before the law. It promised the access to justice. In that respect Magna Carta is still a challenge for many states and officials. The myth of Magna Carta is the protection of the personal rights and is held in great respect by the legal communities against the arbitrary of the authority In respect of the aim of this international conference to see the way how these principles have found their implementation in contemporary legislations as well as to identify the problems that occur regarding these rights, an overview of the Albanian right to appeal for the social insurance rights. The right to appeal to higher authorities against any decisions and the judicial review against the unfavorably resolved appeals. (shrink)

This paper asks whether statutory social insurance programs, which provide contributory tax-based income support to people with disabilities, are compatible with the disability rights movement's ideas. Central to the movement that led to the Americans with Disabilities Act is the insight that physical or mental conditions do not disable; barriers created by the environment or by social attitudes keep persons with physical or mental differences from participating in society as equals.The conflict between the civil rights approach and (...) insurance seems apparent. A person takes out insurance to deal with tragedy, such as premature death, or damage, such as accidental harm to an automobile or home. Social insurance, for example, the United States Social Security old-age and disability programs, consists of government-run insurance to cover risks of advanced age and disability for which the private market has not provided affordable coverage. But the civil rights approach to disability posits that disability is not a risk, not tragedy, and not a damage or defect. Instead it is a maladaptation of society to human variation. This paper argues that a justification remains for social insurance under the civil rights approach to disability, and further suggests that expansion of social insurance for disability is both compatible with disability rights principles and supported by wise public policy. (shrink)

Insurance claims fraud receives increasing attention in the insurance industry, in academic studies and in public policy spheres. Claims fraud is variously viewed as an economic-contractual problem, a moral-psychological problem, a moral-sociological problem or a criminal problem. This article discusses these theoretical perspectives on insurance claims fraud and reviews the empirical evidence on its nature and prevalence. Most research concludes that opportunistic soft fraud is more prevalent than planned criminal fraud, and that consumer ethics, attitudes and psychology (...) are important aspects of the insurance fraud problem. On the contrary, much of the policy focus on reducing fraud has been directed toward detecting and criminalizing fraud. In light of existing research, care must be taken in applying these approaches to address soft fraud. Greater focus on the social and psychological dimensions of insurance claims fraud may increase the success of soft fraud prevention and decrease the likelihood that the focus on fraud will impair insurance relationships. Improving such prevention efforts requires a better understanding of the various dimensions of fraud, the determinants of fraud behaviors and the relationship between fraud behavior and the institutional setting. (shrink)

What would be a fair model for flood insurance? Catastrophic flooding has become increasingly frequent in the UK and, with climate change, is likely to become even more frequent in the future. With the UK's current flood insurance regime ending in 2013, we argues that: -/- - there is an overwhelming case for rejecting a free market in flood insurance after 2013; - this market-based approach threatens to leave many thousands of properties uninsurable, leading to extensive (...) class='Hi'>social blight; - there are a number of possible flood insurance models that would be fairer and more sustainable. -/- We outline three approaches to 'fairness' in flood insurance, and argues that the second and third of these would be the most 'solidaristic' – i.e. those at lower risk of flooding would contribute to the support of people at higher risk: -/- 'pure actuarial fairness' – insurance costs directly reflect the level of risk faced by individuals; 'choice-sensitive fairness' – insurance costs should reflect only those risks that result from each individual's choices; 'fairness as social justice' – insurance should be provided independently of individuals' risks and choices when covering basic requirements of social justice. (shrink)

Business sustainability aims to combine market logic with social welfare logic. In literature, it is commonly assumed that sustainability and the social welfare logic associated with it are characterized by a long-term orientation. However, this assumption is problematic because this principle may not apply in certain contexts. This qualitative study challenges this assumption and focuses on the mechanisms by which time affects the adoption of sustainability practices in the context of socially responsible investing (SRI) practices in Swiss banks (...) and insurance companies. The article provides insights into the mechanisms associated with different time horizons and investigates their effects on the adoption of SRI in financial intermediaries. It also shows how the dimension of time shapes interactions between the two institutional logics underlying SRI in business organizations through specific mechanisms. (shrink)

In this review, I analyse how ‘behaviour-based personalisation’ in insurance – that is, insurers’ increased interest in tracking and manipulating insureds’ behaviour with, for instance, wearable devices – has been approached in recent social scientific literature. In the review, I focus on two streams of literature, critical data studies and the sociology of insurance, discussing the new insurance schemes that utilise sensor-generated and digital data. The aim of this review is to compare these two approaches and (...) to analyse what kinds of understandings, methodologies and theoretical perspectives they apply to so-called ‘behaviour-based insurance’. The critical data studies literature emphasises the exploitative aspects of these new technologies and mobilises behaviour-based insurance to exemplify the negative outcomes of digital health. Scholars from the field of the sociology of insurance empirically analyse the practices of behavioural-based personalisation and study how regulating and ‘doing’ insurance affect attempts to personalise it. I highlight the importance of approaching insurance as a specific financial technology and argue that more research is needed to understand the practices of developing behaviour-based insurance schemes and the insureds’ experiences. (shrink)

Experts discuss the economic, legal, and social issues surrounding the use of genetic testing in determining eligibility for life insurance. Insurance companies routinely use an individual's medical history and family medical history in determining eligibility for life insurance; this is part of the process of medical underwriting. Insurers have also long used genetic information, often derived from family history, in underwriting. But rapid advances in gene identification and genetic testing are changing the way we look at (...) genetic information. Should the results of genetic testing (which might identify a predisposition toward disease not related to medical history) be available to life insurance medical underwriters? Few if any life insurers currently require genetic testing, but there are no laws or regulations prohibiting its use. Genetics and Life Insurance examines the complex economic, legal, and social issues surrounding the use of genetic information in life insurance underwriting. The contributors are legal scholars, representatives of the life insurance industry (including an actuary and an insurance physician), a geneticist, a genetic counselor, a philosopher, and a consumer advocate. They explore all aspects of an issue that has only recently drawn the attention of policymakers and the public. The book opens with a report on the results of a public opinion poll on genetics and life insurance. Succeeding chapters present the insurer perspective, a discussion of the economics of risk selection in life insurance, background information on the process of underwriting, a scientific analysis of genetic risks and mortality rates, a philosophical discussion of fairness and genetic underwriting, the viewpoints of consumers and genetics counselors, a comparison of different international policy approaches to the issue, and a legal analysis of antitrust implications when insurers collaborate in setting standards for medical underwriting. In the final chapter the editor addresses various policy options, examining the pros and cons of each one and assessing their political feasibility. (shrink)

The use of algorithmic prediction in insurance is regarded as the beginning of a new era, because it promises to personalise insurance policies and premiums on the basis of individual behaviour and level of risk. The core idea is that the price of the policy would no longer refer to the calculated uncertainty of a pool of policyholders, with the consequence that everyone would have to pay only for her real exposure to risk. For insurance, however, uncertainty (...) is not only a problem – shared uncertainty is a resource. The availability of individual risk information could undermine the principle of risk-pooling and risk-spreading on which insurance is based. The article examines this disruptive change first by exploring the possible consequences of the use of predictive algorithms to set insurance premiums. Will it endanger the principle of mutualisation of risks, producing new forms of discrimination and exclusion from coverage? In a second step, we analyse how the relationship between the insurer and the policyholder changes when the customer knows that the company has voluminous, and continuously updated, data about her real behaviour. (shrink)

This volume is an exploration of the ethical issues raised by health insurance, which is particularly timely in the light of recent advances in medical research and political economy. Focusing on a wide range of areas, such as AIDS, genetic engineering, screening and underwriting, new disability legislation and the ethics of private and public health insurance, this comprehensive and sometimes controversial book provides an essential survey of the key issues in health insurance. Divided into two parts, the (...) first considers the ethics of underwriting, risk assessment and the acceptance and refusal of insurance risk by insurers. Discussing the unjust treatment of high-risk applicants, the authors identify sources of unfairness to both parties of the insurance contract, indicating how reasonable trade-offs can be made. The second part considers the argument for a mix of public and private insurance for acute and long-term care, offering recommendations for changes in the balance of social insurance, and discussing the shift toward long-term contracts in private health care and pension insurance. (shrink)

BackgroundTo prevent the planet from catastrophic global warming a reduction of greenhouse gas emissions to net zero is required. Thus, divestment from fossil fuels must be a strategic interest for health insurers. The aim of this study was to analyse the implementation of environmental, social and governance criteria in German private health insurers’ investments.MethodsIn 2019 a survey about ESG strategies was sent to German private health insurance companies. The survey evaluated investment strategies and thresholds for the exclusion of (...) sectors and business practices, as well as company strategies for sustainable business development.FindingsGiven their business reports, German private health insurers manage assets of more than €350 billion. 11 of 40 insurance companies provided quantitative data, 10 refused to answer. According to quantitative data, €66 billion of assets is managed according to any ESG criteria; this equals an average of 76% of each company’s bonds. None of these insurers excluded the production and sale of fossil fuels. All excluded coal mining but only at high thresholds. For €226 billion, no data were provided.InterpretationThe findings are in contrast to the expected intrinsic economic interest of the insurers to stop global warming and improve public health. The majority of assets are managed in a highly problematic manner, especially the absence of capital allocated in fields contrary to medical ethics cannot be presumed. Lack of transparency is a major problem that limits clients in choosing the insurer who has the most advanced ESG criteria. (shrink)

In recent years, the concepts of charity and development aid have changed significantly. Present concepts combine direct money transfer with co-production, knowledge sharing and the development of products and services designed for the need of developing and transition economies. The concept of micro-financing is a financial service which has proven to allow for entrepreneurs in the respective countries to start up their businesses. A relatively new financial product for these countries is micro-insurance. This article deals with the question whether (...) consumers in the Netherlands are willing to donate micro-insurances and which factors influence this willingness to contribute to the non-profit micro-insurance approach of an insurance company. The data were collected with questionnaires among a sample of the Dutch population. The data have been processed in a one-way between-groups ANOVA, a paired sample t test and an ordinal regression analysis. The results show that approximately half of the Dutch consumers are willing to pay an additional amount on their insurance premium for the donation of micro-insurances. The amount of the insurance premium did, however, not affect the willingness to donate. If consumers could choose the beneficiary less people are willing to donate, yet those people are willing to donate more money. In conclusion, there is readiness among consumers to contribute to micro-insurance via an insurance company that assists in setting up micro-insurance projects. This indicates a possible role for companies to act as an intermediary between philanthropic acts and consumers. (shrink)

This volume is an exploration of the ethical issues raised by health insurance, which is particularly timely in the light of recent advances in medical research and political economy. Focusing on a wide range of areas, such as AIDS, genetic engineering, screening and underwriting, new disability legislation and the ethics of private and public health insurance, this comprehensive and sometimes controversial book provides an essential survey of the key issues in health insurance. Divided into two parts, the (...) first considers the ethics of underwriting, risk assessment and the acceptance and refusal of insurance risk by insurers. Discussing the unjust treatment of high-risk applicants, the authors identify sources of unfairness to both parties of the insurance contract, indicating how reasonable trade-offs can be made. The second part considers the argument for a mix of public and private insurance for acute and long-term care, offering recommendations for changes in the balance of social insurance, and discussing the shift toward long-term contracts in private health care and pension insurance. (shrink)

Over the next 15 years, the government-funded human genome project will map and sequence each of the human cell’s estimated 100,000 genes. The project’s first fruits will be a vast quantity of information about genetic disease. This information will contribute to the design of quicker, cheaper and more accurate tests for identifying deleterious genes in individuals. Because genetic conditions are often regarded as “immutable, heritable taints that intrinsically implicate the bearer’s identity,” overly-deterministic interpretations of genetic information can readily distort genetic (...) risk and become enshrined in institutional policies of social isolation and discrimination. (shrink)

Over the next 15 years, the government-funded human genome project will map and sequence each of the human cell’s estimated 100,000 genes. The project’s first fruits will be a vast quantity of information about genetic disease. This information will contribute to the design of quicker, cheaper and more accurate tests for identifying deleterious genes in individuals. Because genetic conditions are often regarded as “immutable, heritable taints that intrinsically implicate the bearer’s identity,” overly-deterministic interpretations of genetic information can readily distort genetic (...) risk and become enshrined in institutional policies of social isolation and discrimination. (shrink)

How a Post-Materialist Social Order Can Solve the Challenges of Modern Life and Insure Our Survival.

The aim of this article is to refute Ronald Dworkin's claim that the provision of an equal opportunity to insure against risks is sufficient to render differences in people's circumstances that are the result of luck consistent with his theory of equality of resources. Section I addresses bad luck in the circumstances of individuals in the form of mental or physical incapacitation resulting from the vicissitudes of nature. Section II addresses bad luck which is the result of the choices of (...) other individuals to give or bequeath. (shrink)

Theorists of the welfare state increasingly recognize that social insurance programs are not well-justified by distributive egalitarianism—meaning concern for equality considered as a pattern in the distribution of some good. However, recent work by several relational egalitarian theorists suggests that these programs may be justified on relational egalitarian grounds. Relational egalitarians hold that the proper object of egalitarian concern is the way that citizens relate to one another. In this paper, I review the problems facing a distributive egalitarian (...) justification for social insurance before considering and rejecting three relational egalitarian justifications. I close by offering a justification for these programs grounded in efficiency, not equality. (shrink)

The background of this paper is the ongoing dismantling of the social insurance systems in favour of commercialisation and privatisation of insurances needed for illness, old age and premature death. This combined with the increased possibility of using genetic testing for differentiating personal insurance premiums has the potentiality of creating a ‘genetic proletariat’ — an uninsurable high-risk population. The common way of handling this problem in Sweden, and many other developed countries around the North Atlantic, has been (...) to regulate insurance companies’ right to ask for and use genetic information in various ways. There is a distinction between partial regulation (that allows insurance companies access to genetic information from genetic tests already made, sometimes only above a specified amount, but not to demand new tests) and total regulation (that forbids insurance companies to ask for or use any genetic information). I will argue that these forms of regulation probably will have adverse consequences given the dismantling of collective social insurance systems. If this is convincing, a better way to solve the problem of an uninsurable high-risk population (and other problems) is to resurrect the collective, obligatory insurance systems in which the individual risk profile does not constitute a basis for premium determination. Both arguments cast in terms of consequences and justice render support for this conclusion. (shrink)

Despite their common core in statistics, insurance and epidemiology propel two different forms of solidarity. In insurance, the collective is a source of protection, thanks to the pooling of risks; in epidemics by contrast, the group remains the source of danger for the individual. The aim of this paper is to highlight the conceptions of community and solidarity at play in epidemics in contradistinction to insurance, with a focus on the shift introduced by big data and algorithms. (...) Paradoxically, while the new technologies and epidemiology share a common view on the relation between the individual and the collective, tracing apps were not widely adopted in the Covid-19 crisis. This reluctance to use current technologies for the sake of epidemic containments highlights, beyond legitimate interrogations, a confusion between two imaginaries of the social: insurance solidarity where the interdependence is a source of rights, and epidemic solidarity that imposes duties. (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)

Insurance fraud and abuse—international concerns—are inherent in the proposition of insurance and prevalent in insurer–insured interactions. While the subject of considerable industry and regulatory attention, this little-researched area of consumer behavior and consumer ethics represents persistent social policy questions and problems at multiple levels. This article addresses the issue by first defining insurance fraud and its origins in contract, as well as consumer- and insurer-management. The authors conclude by re-envisioning the problem as one of co-creation by (...) the consumer-insured and insurer personnel, proposing a framework for its study and resolution. (shrink)

The result of two key social developments in recent years are examined here: the partial dismantling of the welfare state and the progress of genetics. Genetic insights are increasingly valuable for risk assessment, and insurers would like to use these insights to help determine premiums. Combined with the fact that social welfare is being curtailed, this could potentially create an uninsured high-risk population. Along with considerations of autonomy and privacy, this is the basis for an ethical critique of (...) insurer's access to information. The result has often been regulation of such information; but the authors argues that due to adverse selection, regulation will not solve these problems, and this may jeopardize the survival of private personal insurance. Instead, we should look towards the resurrection of social insurance, a key component of the welfare state. This will interest academic researchers as well as professionals involved with genetics and insurance. (shrink)

Genetic testing raises concerns that individuals will be denied health insurance (and thus, effectively, access to health care), or that employers will screen to eliminate potentially costly workers. Although we as a society do not yet concur on the degree to which private businesses have a responsibility to promote social justice, several different policy alternatives might allow us to weigh the interests of insurers, as businesses, against the interests of citizens in a responsible manner.