Application of Survival Analysis Methods to Long Term Care Insurance

With the introduction of compulsory long term care (LTC) insurance in Germany in 1995, a large claims portfolio with a significant proportion of censored observations became available. In first part of this paper we present an analysis of part of this portfolio using the Cox proportional hazard model (Cox, 1972) to estimate transition intensities. It is shown that this approach allows the inclusion of censored observations as well as the inclusion of time dependent risk factors such as time spent in LTC. This is in contrast to the more commonly used Poisson regression with graduation approach (see for example Renshaw and Haberman 1995) where censored observations and time dependent risk factors are ignored. In the second part we show how these estimated transition intensities can be used in a multiple state Markov process (see Haberman and Pitacco, 1999) to calculate premiums for LTC insurance plans