Search Results (125)

This study evaluates the current Spanish insurance framework for catastrophic flood risk, administered by the Consorcio de Compensación de Seguros (CCS), based on nationwide loss data reported by the CCS for the period 1996–2020. The analysis of historical claims data enables a clear differentiation between frequent, low-cost events and infrequent, high-impact catastrophes. While the CCS has fulfilled a critical role in post-disaster compensation, the findings highlight the parallel need for ex ante risk mitigation strategies. The study proposes a more efficient, two-tier risk coverage model. Events whose impacts can be managed through standard insurance mechanisms should be underwritten by private insurers using actuarially fair premiums. In contrast, events with catastrophic implications—due to their scale or financial impact—should be addressed through general solidarity mechanisms, centrally managed by the CCS. Such a risk segmentation would improve the financial sustainability of the system and create fiscal space for prevention-oriented incentives. The current design of the CCS scheme may generate moral hazard, as flood exposure is not explicitly priced into the premium structure. Empirical findings support a shift towards a more transparent, incentive-aligned model that combines collective risk sharing with individual risk responsibility—an essential balance for effective climate adaptation and long-term resilience. Full article

As technologies such as Building Information Modeling, the Internet of Things, and cloud computing spread, digital transformation in construction is widely seen as a path to greater efficiency and sustainability. Yet multiple stakeholders and persistent information asymmetry often hamper genuine cooperation, undermining digitalization’s potential. This study constructs an evolutionary game model involving government, contractor, and service providers under incomplete information. A combined subsidies-and-penalties mechanism is introduced to derive replicator dynamics and identify conditions for an evolutionary stable strategy. Numerical simulations show that insufficient subsidies and weak penalties typically result in a “low-level equilibrium,” with superficial or absent cooperation. Strengthening government subsidies and imposing more stringent penalties triggers a threshold effect, significantly increasing contractors’ and service providers’ willingness to participate, thereby leading to a stable cooperative equilibrium. Service providers, in particular, influence success or failure through their cost–benefit structures, which affect contractors’ confidence in adopting digital solutions. This research extends evolutionary game theory to a three-party construction digitalization context, providing practical guidance for balanced subsidy–penalty strategies and incentive-compatible mechanisms. Overall, it underscores how coordinated policies and stakeholder alignment can overcome moral hazard and achieve sustainable digital transformation in the construction sector. Full article

Amid accelerating population aging and the rapid evolution of digital technologies, the digital transformation of rural elderly care services has become a pivotal strategy for restructuring the rural elderly care system. This study identified the local government, rural elderly care service centers, and the elderly population as the principal stakeholders, and developed a tripartite evolutionary game-theory model to examine the dynamic strategic interactions among these actors under the influence of digital technologies. The model further investigated the evolutionary trajectories and equilibrium conditions of their behavioral strategies. Numerical simulations conducted via MATLAB were employed to validate and visualize the model outcomes. The findings revealed the following. (1) The evolutionary equilibrium of digital elderly care service development in rural areas is jointly determined by the strategic choices of the three parties, with its stability shaped by a complex interplay of cost structures, incentive mechanisms, and utility outcomes. (2) Cost factors exhibit heterogeneous effects across stakeholders. Specifically, excessive regulatory costs diminish the performance incentives of local governments, digital infrastructure and operational expenditures influence service centers’ capacity for precision-oriented service delivery, and the participation of the elderly is constrained by affordability thresholds. (3) Local government behavior demonstrates a pronounced sensitivity to incentives. In particular, rewards and social reputation conferred by higher-level governmental bodies exert a significantly stronger influence than punitive measures. (4) Government subsidies for digital transformation enhance cross-stakeholder synergy through dual transmission channels. Nonetheless, excessive subsidies may escalate fiscal risk, while moderately calibrated penalty mechanisms effectively curb moral hazard within service centers. This study advances theoretical understanding of multi-stakeholder coordination in the context of digitally enabled rural elderly care and provides actionable insights for policymakers aiming to formulate interest-aligned strategies and construct resilient, intelligent governance systems for elderly care. Full article

Moral hazard in health insurance arises when insured individuals are incentivized to over-utilize healthcare services, especially when they face low out-of-pocket costs. While existing literature primarily addresses moral hazard through qualitative studies, this paper introduces a quantitative approach by developing a mathematical model based on quasi-arbitrage conditions. The model optimizes health insurance design, focusing on the transition from Low-Deductible Health Plans (LDHPs) to High-Deductible Health Plans (HDHPs), and seeks to mitigate moral hazard by aligning the interests of both insurers and insured. Our analysis demonstrates how setting appropriate deductible levels and offering targeted premium reductions can encourage insured to adopt HDHPs while maintaining insurer profitability. The findings contribute to the theoretical framework of moral hazard mitigation in health insurance and offer actionable insights for policy design. Full article

Corruption in public procurement remains a challenge to good governance, especially in developing nations. Blockchain technology has been espoused as a new paradigm for achieving sustainable public procurement practices for effective service delivery and, by extension, promoting sustainable development. Given the potential of blockchain technology, its implementation has been slow in developing countries. Additionally, there is an inadequate decision support framework to prioritize corruption-prone stages of the public procurement cycle for strategic blockchain integration at the most critical corruption-prone stages of the public procurement cycle given the scarce resources available in developing countries. Therefore, we employed a matured theory that is the principal-agent theory to identify key agency problems related to public procurement in developing countries. An interview with 25 experts and a thorough review of Ghana’s Auditor General produced seven public procurement cycle stages. Further, a survey was designed for experts and stakeholders to prioritize the identified procurement stages under the agency problems through the Analytic Hierarchy Process (AHP). Our results revealed that tender evaluation was the most critical stage susceptible to corruption, followed by contract management and procurement planning in the public procurement stages. Additionally, for the relative importance of the criteria, information asymmetry was ranked first, followed by moral hazard, and then adverse selection. This study offers a targeted framework for blockchain deployment in public procurement from an African country perspective. The outcome of this study provides insights for policymakers and procurement practitioners to know the most critical stages of public procurement stages and leverage blockchain technology given the scarcity of resources in developing countries to aid sustainable public procurement. The proposed blockchain framework can enhance service delivery, citizens’ trust, and international donor confidence in partnership and funding for public procurement projects in developing countries. Full article

Background: The main data basis for the Diagnosis-Related Group (DRG) payment methodology is the disease diagnosis and clinical codes in the Medical Record (MR). Problems such as up-coding have arisen during implementation in many countries, and problems with MR quality and solutions have been studied mostly from the physician’s perspective. We investigated and analyzed the main influences on clinical coding from the perspectives of directors and coders in Medical Records Section (MRS) to provide recommendations for improvements in data quality. Methods: The questionnaire was developed, revised and improved using literature research and expert consultation methods. From 13 to 19 June 2024, the electronic questionnaire survey was conducted among the directors and coders of medical records department in healthcare organization. A total of 484 directors and coders were included in this study. And relevant statistics were computed and analyzed by non-parametric tests. Results: Coders should possess strong job responsibilities (92.36%), coding skills (91.33%), knowledge of clinical medicine (90.70%), and other comprehensive qualities and abilities. When encountering difficult problems, the clinical coders should first communicate with clinical doctors (91.95%). The two main factors affecting the quality of MR and clinical coding are the individual factors of doctors (88.84%) and the individual factors of coders (85.54%). Conclusions: Doctors and coders are the primary factors influencing the quality of clinical coding. It is recommended to establish a systematic training program for doctors to enhance the connotative quality of MR, for coders to solidify professional coding skills, strengthen communication and exchange, adopt reasonable behaviors, avoid moral hazards, and effectively improve the quality of clinical coding. Full article

This study selects the Inner Mongolia Autonomous Region (IMAR), among the most crucial beef-cattle farming areas in China, to obtain data from the micro-surveys of 447 beef-cattle farmers. Utilizing an endogenous switching regression (ESR) model, this research empirically investigates the effect of farmers’ beef-cattle insurance enrollment behavior on their input of disease prevention. This study finds that farmers adopting beef-cattle insurance reduce beef-cattle disease-prevention input. Based on counterfactual assumptions, if insured farmers had not adopted insurance, their input in disease prevention would increase by 33.45%. Further research confirms that a decrease in the market purchase price of beef cattle enhances the negative effect of farmers’ insured behavior on input for beef-cattle disease prevention. The heterogeneity analysis leads to two more conclusions. One is that insured farmers have the largest reduction in shed-disinfection input, the smallest reduction in voluntary vaccination input, and an intermediate reduction in deworming input. The other is that the act of adopting insurance reduces disease-prevention input to a greater extent for farmers who are far from the core areas of beef-cattle farming or who have not experienced beef-cattle deaths. Full article

This study investigates the relationship between ownership structure (foreign and domestic) and bank risk-taking over the period 2014–2022. The analysis includes 66 banks operating in the GCC, divided into 44 domestically owned, and 22 foreign-owned banks. The research examines the relationship across two distinct periods: the pre-pandemic and the COVID-19 pandemic era, using the two-stage least squares (2SLS) method, and panel data techniques for robust analysis. The findings reveal that, in both periods, foreign-owned banks exhibited lower credit risk, greater cost efficiency, and less risk-taking compared to domestic counterparts. Domestic banks, while maintaining profitability, relied heavily on capital absorbency, which resulted in elevated credit risk and operational inefficiencies. These inefficiencies, observed among domestic banks, stem from inadequate monitoring of borrowers’ information and the occurrence of moral hazard. Foreign banks played a crucial role in supporting banking sector stability, as their presence enhanced the GDP growth. The results are in line with the “global advantage hypothesis”. Full article

This paper studies the impact of crisis management mechanisms (bailouts and bail-ins) on moral hazard. Through an econometric study of financial crises in emerging countries since 1993, the results indicate that recurrent bailouts exacerbate moral hazard, while bail-ins have only a minor impact due to their perceived lack of credibility. The results highlight the impact of crisis management measures on financial stability and the scale of the mobilised resources. Analysed in the context of efforts to support sustainable development, the study recommends reassessing the fundamentals of the bailout approach, developing a robust and sustainable bailout framework that aligns immediate interventions with sustainability objectives towards sustainable recovery strategies. Full article

Background/Objectives: Soluble αKlotho (sαKlotho) and fibroblast growth factor 23 (FGF-23) are increased in acute heart failure (AHF). This study aimed to assess changes in serum sαKlotho and FGF-23 concentrations during an episode of AHF as well as the usefulness of both biomarkers for predicting long-term prognosis. Methods: The study included 104 consecutive patients hospitalized in t he intensive cardiac care unit due to AHF (mean age, 65.8 ± 14.6 years; mean ejection fraction, 31.4% ± 14). New-onset AHF was reported in 43.3% of the population. Blood samples were measured at entry and on discharge from hospital. The main clinical outcomes assessed in this study were all-cause mortality or rehospitalization due to HF during a 3-year follow-up. Results: At admission sαKlotho, FGF-23, and NT-pro BNP levels, compared with discharge, were significantly higher at p < 0.001, p < 0.001, and p < 0.001 respectively. The 3-year Kaplan–Meier analysis, based on tertiles, revealed, for sαKlotho levels from Tertile 1 on admission and at discharge, a 2-fold higher rate of all-cause mortality or rehospitalization for HF compared with Tertile 3 (p = 0.006 and p = 0.028, respectively). One-third of patients showed an increase in FGF-23 and sαKlotho levels during hospitalization. Patients with the highest percentage increase in the levels of both biomarkers had an elevated risk of all-cause morality or hospitalization for HF (hazard ratio, 2.75; confidence interval, 1.19–6.35; p = 0.02). Conclusions: sαKlotho and FGF-23 levels are elevated during an episode of AHF. Low sαKlotho levels are associated with an increased risk of all-cause mortality or rehospitalization for HF. Increases in sαKlotho and FGF-23 values during hospitalization identify patients with poor prognosis. Full article

Construction sites are among the most hazardous workplaces, making safety a critical concern in the sector. This study investigates the interplay between safety leadership, employee morale, harmonious safety passion, and safety performance through the lens of the social exchange theory. This research aims to assess how safety leadership impacts safety performance directly and indirectly, with employee morale acting as a mediator while harmonious safety passion moderates these relationships. A quantitative approach was employed, with data collected through structured questionnaires administered to construction workers in Istanbul and Ankara, Turkey. A total of 438 valid responses were analyzed using the Statistical Package for the Social Sciences (version 25) and Analysis of Moment Structures (version 24) for reliability, validity, and hypothesis testing. The findings confirm that safety leadership positively influences both safety performance and employee morale. Employees with high morale directly contribute to improved safety performance and act as a mediator between safety leadership and safety performance. Additionally, harmonious safety passion moderates the relationship between employee morale and safety performance, strengthening the link for workers with higher levels of passion. However, its moderating effect on the relationship between safety leadership and safety performance was not significant. These insights offer practical implications for designing safety training programs, leadership development initiatives, and policies aimed at improving safety outcomes in construction. Future research should explore longitudinal designs and diverse contexts to further validate these findings. Full article

The European Funds market is a key mechanism for fostering regional development and economic growth within the European Union, yet its efficiency can be undermined by information asymmetry, which complicates fund absorption processes. This paper investigates the European Funds market and explores how adverse selection and moral hazard impact the dynamics of the fund allocation. Through qualitative research, the authors assess the European Funds market, identify its key stakeholders, and explore factors influencing funds absorption. Findings reveal complex interactions among European Union institutions, managing authorities, beneficiaries, and consultants. The research highlights economic, administrative, institutional, and social factors that affect fund absorption rates and pinpoint adverse selection and moral hazard as primary consequences of information asymmetry in the European Funds market. By emphasizing the importance of effective communication processes and describing the experiences of various actors in European-funded projects, the study provides actionable insights for policymakers and stakeholders. This paper offers a new perspective on the European Funds market and links information asymmetry to inefficiencies in fund allocation. These findings contribute to a better understanding of the European Funds market, fostering transparency, enhancing institutional capacities, and promoting sustainability in the governance of public funds. Full article

Background/Objectives: Moral hazard represents a significant challenge in healthcare systems globally, reflecting the tendency of insured individuals to over-utilize medical services when shielded from the full costs of care. Methods: This paper investigates the dynamics and implications of moral hazard within the Romanian public hospital sector, offering practical recommendations for healthcare policymakers to mitigate the financial risks associated with excessive healthcare utilization and ensure long-term sustainability. To achieve the objectives of this study, a quantitative research approach utilizing vignettes was employed. Vignettes allow for the simulation of real-world decision-making under conditions of insurance coverage, capturing nuanced behaviors that traditional surveys may overlook. Results: The study examined patient behaviors in the context of moral hazard in public hospitals in Romania, employing a quantitative approach based on vignettes. A total of 303 valid responses were collected. The findings indicate a significant tendency among insured patients, both publicly and privately insured, to opt for more expensive treatments compared to uninsured patients, who preferred more affordable options such as medication or physiotherapy. In the case of treatments for severe conditions, insured patients frequently chose combinations of higher-cost therapies, while uninsured individuals either delayed treatment or opted for less expensive alternatives. These results highlight the impact of moral hazard, driven by a reduced sensitivity to costs in the presence of insurance, and underscore the need for cost-sharing policies to mitigate the overutilization of medical resources. Conclusions: This paper uniquely contributes to the understanding of moral hazard by integrating insights from both Romanian public hospitals and international case studies, offering practical policy recommendations for mitigating the financial risks associated with excessive healthcare utilization. Full article

This study investigates how an increase in the quality of business ventures, measured as their success probability, affects trust and return on investment (ROI) in situations where the investor–entrepreneur interaction is affected by moral hazard and asymmetric information. We model a repeated trust problem between investors and entrepreneurs, featuring moral hazard and adverse selection. Hidden Markov techniques and computer simulations are used to derive the main results. We find that trust and ROI may decline as quality improves. Although lenders tend to reduce the requirements for granting initial credit, they nevertheless become less tolerant of current borrowers who fail to pay back. Additionally, we demonstrate a novel substitution effect, where lenders prefer new borrowers over existing borrowers that experienced early failures. The main conclusions of our study are that while impressing early on is effective in gaining first access to credit, it may nevertheless hurt the cause of getting credit in subsequent periods, following an early failure. In business environments plagued with ex post moral hazard, entrepreneurs might do better by gaining trust first and impressing later. Furthermore, our results imply that in a thriving economy, not only are bad loans made, but good loans are lost as well. Full article

In health insurance, “moral hazard” describes the concept that coverage without an out-of-pocket cost to consumers could result in health care utilization beyond economically efficient levels. In response, payers in the United States (US) have designed pharmaceutical benefit plans with significant cost exposure (e.g., co-pays, co-insurance, or deductibles). While substantial evidence links patient cost exposure to reduced drug spending, it remains unclear to what degree this translates into greater efficiency or an indiscriminate drop in overall consumption also reducing needed utilization. We conducted a systematic literature review to understand whether commonly implemented utilization management (UM) strategies and insurance designs with a behavioral or value-based (BID/VBID) component have been explored as tools to mitigate moral hazard and to assess how cost-sharing policies and innovative insurance designs impact consumer spending. Eligible studies compared conventional cost-exposure policies to BID/VBID, including tiered cost-sharing and other UM strategies. We found that broad implementation of patient cost exposure is not well supported by empirical evidence assessing efficiency—defined as the use of clinically appropriate services with value at or above the marginal cost of health care utilization in the contemporary US setting. As a result, payers and policy makers alike ought to explore insurance alternatives that more closely align health care consumption incentives to value of care. Full article