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Home and contents insurance is framed as key to Australia's national strategy for disaster resilience. Despite the perceived importance of financial indemnity, ambiguity characterises the ways in which it facilitates both short‐ and long‐term everyday household recovery when disaster strikes. Addressing such ambiguity, this article explores how insurance impacts upon households' capacities to rebuild and recover after disastrous bushfire. In‐depth interviews conducted with residents in the Blue Mountains of New South Wales four years after they were affected by the October 2013 bushfires show that insurance was fundamental to recovery. Swift claims handling and payouts allowed participants to access rental accommodation, material necessities, and sufficient finances to repair, rebuild, and refurnish their houses—essentials in restoring everyday routines and a sense of normalcy. Yet, many people were underinsured and used alternative strategies to stretch "adequate" insurance coverage, which had practical and emotional implications. Importantly, while insurance reduced post‐disaster stress and trauma, the length and depth of recovery were more closely determined by the impacts of personal and situational circumstances than by insurance. On that basis, analysis points to the conclusion that while insurance is a crucial tool for disaster resilience, greater levels of psychosocial support are needed to improve households' short‐ and longer‐term recovery. [ABSTRACT FROM AUTHOR]

Home and contents insurance is integral to household and community resilience against disasters. Yet many households are underinsured. While causes for underinsurance have been widely researched, changes to Australian building regulations in the last decade has established a new source of insurance miscalculations. Bushfire Attack Level (BAL) ratings can inflate rebuilding costs by 20% or more, yet BAL ratings remain obfuscated to homeowners and are notoriously confusing to navigate. After the October 2013 bushfires in New South Wales, the Blue Mountains Local Recovery Steering Group found that 'information on the BAL process, the guidelines, the expected costs, the consulting experts and a property's bushfire-prone status is literally all over the place'. This paper aims to provide clarity on the subject, tracing the precise socio-technical means through which disaster risk is perceived and assessed. The paper conceptualises insurance and risk ratings as calculative devices that provide both a technical solution to reduce financial losses and a philosophical tool for risk rationalisation. It then builds on interviews conducted with residents in the Blue Mountains affected by the 2013 bushfires, to ascertain how such calculative devices practically affect communities at risk. The paper concludes by outlining potential solutions to a confusing and costly problem in Australia, highlighting critical public awareness issues surround BAL ratings, which have profound insurance and wellbeing implications for people rebuilding and recovering from bushfire. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to explore the service and policy structures that impact open disclosure (OD) practices in New South Wales (NSW), Australia. Participants and methods: An explorative study using semi-structured interviews was undertaken with 12 individuals closely involved in the implementation of OD in hospitals at policy or practice levels within the state of NSW, Australia. Interviews explored the service and policy structures surrounding OD and the perceived impact of these on the implementation of the OD policy. These data were thematically analyzed to understand the factors facilitating and creating barriers to openness after adverse events. Results: The data identified three key areas in which greater alignment between OD policy and the wider service and policy structures may enhance the implementation of OD practice: 1) alignment between OD and root cause analysis processes, 2) holistic training that links to other relevant processes such as communicating bad news, risk management, and professional regulation and insurance, and 3) policy clarification regarding the disclosure of incidents that result in no or low-level harm. Conclusion : Evidence from this study indicates that formal OD processes are not routinely applied after adverse events in NSW, despite clear guidelines for OD. The reasons for this are unclear as the service-level and policy-level phenomena that support or hinder OD are understudied. This knowledge is critical to addressing the policy-practice gap. Our paper provides insights regarding the influence of current service-level and policy-level phenomena on the delivery of OD and how policy clarification may contribute to addressing some of the challenges for implementing OD policy. The principles of virtue ethics – specifically, openness and the involvement of service users – may contribute to progressing in this area. [ABSTRACT FROM AUTHOR]

Background: The influence of health insurance systems on the treatment of end-stage kidney disease (ESKD) patients ispoorly understood., Aim: We investigated how supplemental private health insurance (PHI) coverage impacted ESKD treatment modalitiesand patient outcomes. The influence of health insurance systems on the treatment of end-stage kidney disease (ESKD) patients is poorly understood. We investigated how supplemental private health insurance (PHI) coverage impacted ESKD treatment modalities and patient outcomes., Methods: All adult patients commencing ESKD treatment in New South Wales, Australia from 2000 to 2010 were identified using the Australia and New Zealand Dialysis and Transplant Registry. Data were linked to the state hospitalisation dataset to obtain insurance status, allowing the comparisons of mortality, ESKD treatment modality and health service utilisation between privately insured and public patients., Results: The cohort of 5737 patients included 38% (n = 2152) with PHI. At 1 year after ESKD treatment initiation, PHI patients had lower mortality (hazard ratio 0.84, 95% confidence interval (CI) 0.74-0.95, P = 0.01), were more likely to be receiving home haemodialysis (HD) (odds ratio (OR) 1.38, 95% CI 1.01-1.89, P = 0.04), to have been transplanted (OR 1.75, 95% CI 1.25-2.46, P = 0.001) and used fewer hospital days (incidence rate ratio 0.85, 95% CI 0.74-0.96, P = 0.01). After adjustment, PHI patients were more likely to initiate ESKD treatment with facility-based HD (OR 1.22, 95% CI 1.01-1.46, P = 0.03) but were less likely to be started on peritoneal dialysis (OR 0.81, 95% CI 0.67-0.98, P = 0.03)., Conclusion: Our findings suggest that supplemental PHI in Australia is associated with lower-risk ESKD treatment attributes and improved health outcomes. A greater understanding of the treatment pathways that deliver these outcomes may inform treatment for the broader ESKD treatment population., (© 2019 Royal Australasian College of Physicians.)