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Across many countries, increases in inequality driven by rising top incomes and wealth have not been accompanied by growing popular concern. In fact, citizens in unequal societies are less concerned than those in more egalitarian societies. Understanding how the general public perceive richness is an essential step towards resolving this paradox. We discuss findings from focus group research in London, UK, a profoundly and visibly unequal city, which sought to explore public perceptions of richness and the rich. Participants from diverse socio-economic backgrounds discussed their views of the 'wealthy' and the 'super rich' with reference to both vast economic resources and more intangible aspects, including, crucially, security. High levels of wealth and income were perceived to be necessary for achieving security for oneself and one's family. The security of the rich was discussed in contrast to participants' own and others' insecurity in the context of a (neo)liberal welfare regime – specifically, insecurity about housing, personal finances, social security, health care and the future of the welfare state. In unequal countries, where insecurity is widespread, lack of confidence in collective welfare state provision may serve in the public imagination to legitimate private wealth accumulation and richness as a form of self-protection. [ABSTRACT FROM AUTHOR]

Purpose: In this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes. Design/methodology/approach: Our recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature. Findings: ROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised. Practical implications: This article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as "agents", "stewards" or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems. Originality/value: The article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance. [ABSTRACT FROM AUTHOR]

Introduction. New Zealand's health care system faces significant shortages in health care workers. To address workforce challenges and meet the population's health needs, health care systems around the world have introduced new clinical roles, such as physician associates/assistants (PAs) into existing health care teams. Aim. This article aims to examine the benefits, challenges, and broader implications of regulating PAs in the context of New Zealand's primary care sector, with a specific emphasis on how it may impact general practice. Methods. A range of literature surrounding the role, impact, and perception of PAs were selected and included in this article. Results. The PA profession can significantly strengthen New Zealand's primary care workforce, improving patient access and continuity of care. However, the global deployment of PAs has faced scrutiny due to concerns about its potential risks to patient safety and the overall viability of such a role. Discussion. If regulated, the PA profession can reshape New Zealand's primary care, offering a partial solution to current medical staff shortages. Trained under a generalised medical model similar to doctors, PAs possess the necessary skills to perform both routine and non-routine medical tasks. This dual capability can significantly improve primary care service provision, reduce existing workloads, and allow for a more efficient deployment of doctor expertise. However, medico-legal issues and the supervisory burden can impede widespread integration into general practice. Despite challenges, the success of the PA role relies on mutual trust, respect, and support from other clinical team members within primary health care. [ABSTRACT FROM AUTHOR]

We contribute to the literature on dividend policy by considering two largely ignored, yet important factors, namely CEO power and corporate risk management. We first disentangle CEO managerial ability from entrenchment - the two sources of leadership autonomy that are not normally distinguished in prior literature. Using UK (re)insurance data that allows us to objectively and reliably quantify risk management and to identify powerful stakeholders with monitoring incentives (e.g., shareholders and regulatory body), we find that risk management enables entrenched CEOs to increase dividends to avoid monitoring by shareholders without compromising financial resilience and increasing the risk of regulatory scrutiny. Further, we neither find the degree of CEO managerial ability nor its interaction with risk management to be related to dividends, suggesting that the competing incentives for talented CEOs to pay higher/lower level of dividends cancel out in cross-sectional tests. Nonetheless, we find that the signalling effects of dividends for future accounting earnings only exist in insurers with high ability CEOs. This is consistent with the view that talented CEOs are able to generate sustainable earnings, and when they choose to pay (more) dividends, they do so to externally signal their managerial ability. [ABSTRACT FROM AUTHOR]

This case law overview comments on significant UK environmental law cases for the period 1 April 2022–31 March 2023. It begins with an overarching introduction, which draws some general themes from our selection of cases, focussing on the scope of environmental law, connections between private and public law disputes, and the standard of review in the public law context. It then addresses 12 significant cases concerning statutory trusts over land under section 164 of the Public Health Act 1875 and section 10 of the Open Spaces Act 1906, public rights on Dartmoor Commons, private nuisance, climate change, insurance, environmental impact assessment, delay in judicial review, forestry, contaminated land, and habitats. It ends with some final thoughts on this year's cases and the year ahead. [ABSTRACT FROM AUTHOR]

This article considers the UK government’s proposals to implement a sector-specific insurance resolution regime, which would enable the Bank of England to manage the failure of a large insurer in an orderly manner with the aim of preserving UK financial stability. [ABSTRACT FROM AUTHOR]

Background: Continuous androgen deprivation therapy ± first-generation non-steroidal antiandrogen was previously the standard-of-care for patients with metastatic castration-sensitive prostate cancer (mCSPC). Treatment intensification with novel hormonal therapy (NHT) or taxane chemotherapy is now approved and guideline-recommended for these patients. Methods: Physician-reported data on adult patients with mCSPC from the Adelphi Prostate Cancer Disease Specific Programme were analyzed descriptively. We evaluated real-world treatment trends for patients with mCSPC in 5 European countries (United Kingdom, France, Germany, Spain, and Italy) and the United States (US), looking at differences between patients initiating treatment in 2016-2018 and in 2019-2020. We also investigated treatment trends by ethnicity and insurance status in the US. Results: This study found that most patients with mCSPC do not receive treatment intensification. However, greater use of treatment intensification with NHT and taxane chemotherapy was observed in 2019-2020 than in 2016-2018 across 5 European countries. In the US, greater use of treatment intensification with NHT in 2019-2020 than in 2016-2018 was observed for all ethnicity groups and those with Medicare and commercial insurance status. Conclusions: As the number of patients with mCSPC who receive treatment intensification increases, more patients who progress to metastatic castration-resistant prostate cancer (mCRPC) will have been exposed to intensified treatments. Treatment options for patients with mCSPC and mCRPC overlap, suggesting that an unmet need will emerge for new therapies. Further studies are needed to understand optimal treatment sequencing in mCSPC and mCRPC. This study evaluated real-world metastatic castration-sensitive prostate cancer (mCSPC) treatment trends between 2016 to 2020 across a large, diverse patient population. The study also investigated whether treatment trends vary by ethnicity and insurance status. [ABSTRACT FROM AUTHOR]

The onset of the COVID-19 pandemic constituted a large shock to the risk of acquiring a disease that represents a meaningful threat to health. We investigate whether individuals subject to larger increases in objective health risk – operationalized by occupation-based measures of proximity to other people – became more supportive of increased government healthcare spending during the crisis. Using panel data that track UK individuals before (May 2018–December 2019) and after (June 2020) the outbreak of the pandemic, we implement a fixed-effect design that was pre-registered before the key treatment variable was available to us. While individuals in high-risk occupations were more worried about their personal risk of infection and had higher COVID-19 death rates, there is no evidence that increased health risks during COVID-19 shifted either attitudes on government spending on healthcare or broader attitudes relating to redistribution. Our findings are consistent with recent research demonstrating the limited effects of the pandemic on political attitudes. [ABSTRACT FROM AUTHOR]

We examine the relation between board-level financial expertise and six measures of performance using panel data drawn from the United Kingdom's non-life insurance industry. We find that collectively, financial experts have a beneficial influence on the performance outcomes of insurers. We also observe that board-level qualified accountants and actuaries are linked with superior performance in all six of our selected financial outcome measures. Professional insurance underwriters are associated with sound solvency levels (low leverage) and underwriting results, but not positive earnings-based measures. This suggests that underwriters may not be as adept at group-level earnings enhancement as accountants and actuaries. In addition, we find that the introduction of IFRS 4 in 2004/2005 did not have a significant impact on board composition and financial outcomes. Finally, we consider that our results could have commercial and/or policy implications. [ABSTRACT FROM AUTHOR]

This article aims to analyse to what extent small and medium sized businesses (SMEs) in the United Kingdom (England, Scotland, Wales and Northern Ireland) utilise cyber risk insurance as a risk mitigation tool in their cyber security management systems. To this end, the authors, by adopting a systematic qualitative analysis, elaborate the nature and scope of cyber risk insurance products on offer for SMEs (the supply side of the cyber insurance market). They then by utilising the data obtained from SMEs randomly but purposively, attempt to gain an understanding of the attitude of SMEs to cyber security generally and to cyber risk insurance. The main conclusion of the article is that the insurance market should consider developing a new cyber risk insurance product that aligns cyber security closely with the principle of indemnity. It is discussed in the article how such a product will enhance SMEs' cyber security resilience (hence providing a social benefit for the society) and at the same time afford new opportunities for insurance providers to expand the size of their business and variety of their products. [ABSTRACT FROM AUTHOR]

In this paper, we analyse how cyber insurance influences the cost–benefit decision-making process of a ransomware victim. Specifically, we ask whether organisations with cyber insurance are more likely to pay a ransom than non-insureds. We propose a game-theoretic framework with which to categorise and distinguish different channels through which insurance may influence victim decision making. This allows us to identify ways in which insurance may incentivise or disincentivise payment of the ransom. Our framework is informed by data from semi-structured interviews with 65 professionals with expertise in cyber insurance, cybersecurity and/or ransomware, as well as data from the U.K. Cyber Security Breaches Survey. We find that perceptions are divided on whether victims with insurance are more (or less) likely to pay a ransom. Our model can reconcile these views once we take into account context specifics, such as the severity of the attack as measured by business interruption and restoration and/or the exfiltration of sensitive data. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to investigate the impact of risk disclosure practices (voluntary, mandatory and risk disclosure index) on stock return volatility, market liquidity and financial performance for insurance companies in the UK and Canada, before and after the International Financial Reporting Standards (IFRS) adoption. Design/methodology/approach: The panel data analysis covers 14 insurance companies in the UK and 12 in Canada over a six-year period, three years before and three years after the implementation of IFRS. The authors collected risk disclosure data manually from the annual reports and analyzed it through QSR NVivo software for each country. The other variables are secondary data collected from Thomson Reuters Eikon and Datastream. Findings: The results reveal that mandatory risk disclosure practices positively influence stock return volatility for UK insurers but not Canadian ones. Moreover, both mandatory and voluntary risk disclosures increase market liquidity for UK insurers. The outcomes also show a negative influence of risk disclosure practices on financial performance for both the UK and Canadian insurers. The adoption of IFRS enhances the impact of risk disclosure practices in both countries on market liquidity and financial performance. Research limitations/implications: The findings rationalize the impact of risk disclosure practices on volatility, liquidity and financial performance of UK and Canada insurers, and the effect of IFRS in triggering those results. Practical implications: The findings highlight the diverse effects of voluntary and mandatory risk disclosure practices in enhancing market discipline and mitigating information asymmetry problems to investors. Regulators and policymakers could rely on the findings to amend and develop disclosure standards more frequently to assure their effectiveness. The authors also offer insights to managers to determine the levels of mandatory and voluntary disclosure practices and disclosure strategies to gain their stakeholders' confidence. Originality/value: This study contributes to the literature of risk disclosure in the insurance industry for both the UK and Canada where scarce studies are conducted. It also offers interesting implementations to investors, managers and policymakers. [ABSTRACT FROM AUTHOR]

This article discusses the hidden risks that insurers face from reinsurance recaptures, specifically focusing on UK annuity writers. The authors highlight the increased activity among annuity writers to offload longevity risk and the potential consequences of such actions. The survey conducted as part of the report reveals that reinsurance recapture events can have a significant impact on solvency coverage, with the most widely held contracts being longevity swaps and longevity reinsurance. The article emphasizes the need to consider factors beyond risk margin when assessing the capital intensity of writing annuity business. The text also explores risk limits, the use of collateral in reinsurance contracts, and provisions for recapturing business in reinsurance treaties. Overall, the capital held against reinsurance counterparty risk is relatively small compared to the potential impact on the balance sheet. The article concludes by suggesting further examination of the capital requirements and management actions for asset-intensive and longevity reinsurance. [Extracted from the article]

• The flood insurance industry is facing an existential threat from climate change. • Effective governance of climate change adaptation cannot rely on markets alone. • In the UK, new forms of intervention are being developed by the Flood Re initiative. • Structural reform of the flood insurance industry is needed. Floods are one of the most commonly occurring natural hazard events globally, and present a significant threat to the UK from climate change. Operating since 2016, Flood Re is an industry-government initiative, set up with the goal of reforming the flood insurance market in order to provide universal, affordable cover for UK households. Principally providing reinsurance services to insurers and including mutualisation arrangements, it aims to withdraw from the market in 2039, having paved the way for risk-reflective pricing without subsidy. Drawing on the theoretical work of Francois Ewald, and empirical data from interviews with 12 key stakeholders and documentary analysis, this paper traces a shift in Flood Re's insurantial imaginary, exemplified by the development of several solutions which go beyond its initial remit of providing reinsurance to private insurers. Findings show that this shift has been driven by the growing realisation that climate change is not merely a complicating factor for the ability to achieve a thriving insurance market, but demands a paradigmatic change in the governance of flood risk. We argue that Flood Re has an opportunity to adopt a leadership role in the governance of climate adaptation, but that it must be expanded to include a wider variety of stakeholders covering land-use planning, housing, consumer and community representatives. That a market for flood insurance that delivers on risk reduction and affordability for all can be brought about without structural reform to the industry nor a strong role for the state, is a delusion in light of climate change. [ABSTRACT FROM AUTHOR]

'Insurantial imaginaries' describes the shared structures of comprehension and action that establishes the social value of insurance and its practical influence. As insurance is a bricolage of economic, legal, political, cultural and moral elements that vary across time and space, for insurance to be intelligible and functional, these imaginaries render this dynamic complexity into stable and discrete forms. In this paper, we explore one such imaginary constituted through the intersection of housing and insurance norms, vis a vis house and contents insurance, in home-owning democracies. Drawing on the cases of Australia and the United Kingdom, we observe how a rise in renting in these countries is resulting in an increase in underinsurance, with renters less likely to insure their assets. This is refashioning a long-standing insurantial imaginary shaped by socio-cultural aspirations for home-ownership, liberal norms of individual autonomy, and links between home-ownership and democracy, including participation in voting. In observing that this imaginary valorises home-ownership and insurance, and problematises renting and underinsurance, we draw attention to the covert power of insurance in co-constituting everyday practices and identify a novel spatialised insurantial imaginary. In grounding our analysis within home-owning democracies, we also make a broader contribution to economic and financial geography by extending understanding of the complex spatial nature of financial mechanisms and processes, and how market-based economies appear to be reconfiguring democracy. [ABSTRACT FROM AUTHOR]

Purpose: Due to stakeholders' concerns on the contribution of corporate governance in monitoring insurance companies during financial crisis, this study aims to investigate whether and how various corporate governance practices would have affected firm performance of listed and non-listed insurance firms in the UK during financial crisis. Design/methodology/approach: This study uses a unique manually collected data set from listed and non-listed insurance firms in the UK and applies different regressions models to test the hypotheses and to address the endogeneity problem. Findings: The findings show that board non-duality and the presence of a majority shareholder improve firm performance in insurance companies. Furthermore, the findings for the sub-samples indicate a stronger positive association between board of directors and firm performance in listed insurance companies after the financial crisis, while a positive impact has been found between large shareholders and external audit firms in non-listed insurance companies before and during the crisis. Practical implications: The results offer important practical implications for the government, management, shareholders and policymakers. For example, regulators and policymakers should benefit from these results to revise the recommendations for corporate governance mechanisms that prove to be effective on firm performance, as well as those mechanisms that have different or unexpected effects among listed or non-listed firms and/or during the turbulent periods. Investors should be aware of those specific corporate governance mechanisms that would have higher effect on performance of UK insurance firms in which they are considering to invest in. Originality/value: This study contributes to the current literature by exploring the effect of corporate governance on financial performance by comparing between listed and non-listed insurance companies during financial crisis. Further, to the best of the authors' knowledge, this is the first study to use two new insurance-related performance measures, the revenue growth ratio and the adjusted combined ratio, as performance proxies to explore whether these new variables create any insights. [ABSTRACT FROM AUTHOR]

What is the current state of home haemodialysis in UK, and what might be the impacts of the cost-of-living crisis? In this two-part article, Eleri Wood and Amanda Bevin draw together opinions from patients and professionals about home haemodialysis in the summer of 2022, and Fiona Loud and Karen Jenkins explain the challenges presented by rising utility costs and why people dialysing at home should have their costs covered [ABSTRACT FROM AUTHOR]

We study the volatility of sources of individual and household level income in the UK in the years 2009-2017, following the Great Recession and government austerity. We find that the volatility of (pre-tax) earnings and disposable income has fallen for the working-age in this period, largely due to fewer negative and large earnings shocks. For older individuals, we also find a fall in the volatility of private income, mainly due to fewer positive and large income shocks. Taxes and transfers help stabilise incomes, with social security cash benefits and income-dependent refundable tax credits reducing household private income volatility by around a quarter for the working age, and 40 percent for those aged 60 or over. However, over the sample period, taxes and benefits became less well correlated with earnings, reducing their ability to counteract swings in labour income. The findings illustrate the consequences of fiscal retrenchment and the cut-backs to welfare benefits on the stability of incomes. [ABSTRACT FROM AUTHOR]

A lapsed policy is an insurance policy that has become inactive due to non-payment of premiums. The word "lapse" is an insurance topic that constantly evolves, proven by the recent increase in publications on this topic. The study explores the life insurance lapse decision through a comprehensive bibliometric analysis throughout the years, concentrating on publication trends; co-authorship networks among countries, authors, and scientific journals; and the field's evolution. The research is based on the Scopus database. Ultimately, 178 documents were retrieved and analysed, demonstrating increased literature on insurance lapse from 1971 to 2021. The authors' keyword co-occurrence network was also analysed for possible future directions of the field. Journals originating from the United Kingdom dominate the publication on life insurance lapsation. In contrast, an author from the United States is at the first rank in terms of the co-authorship network's total link strength. The results may help researchers define the research objective and determine the aspects of the life insurance lapse for future research. [ABSTRACT FROM AUTHOR]

We investigate the effect of risk management (reinsurance) on the corporate cost of equity using panel data drawn from the United Kingdom's (UK) non-life insurance industry. Our results show that use of reinsurance lowers the cost of equity but that the relation is non-linear. We find that the rate of reduction declines as the level of premiums ceded relative to total gross premiums written increases. We also find that the reinsurance-cost of equity relation is moderated by the risk of financial distress/bankruptcy. This moderating relation is robust to the use of three alternative measures of financial distress and bankruptcy risk. [ABSTRACT FROM AUTHOR]

Conditions and warranties, which are generally referred to as policy terms in insurance contracts, are crucial in the determination of the rights and obligations of the contracting parties. The article examines the enforcement of policy terms in insurance contracts at common law and the legislative measures that have been deployed in some common law countries, including Nigeria, the United Kingdom and Australia, to ensure fairness as well as to balance the inequality in the bargaining power of the contracting parties. In as much as the principle of freedom of contract will generally be honoured by the court, the paper argues that through legislative intervention in policy terms in these countries, the principle is being discountenanced with, in appropriate cases, in order to effectuate the just and reasonable expectation of the insured. It concludes by proffering suggestions to identified lacunae in the Nigerian Insurance law. [ABSTRACT FROM AUTHOR]

Attracting and retaining loyal customers is a key driver of insurance profit. An important factor is the customers’ opinion of an insurer’s service quality. If a customer has a bad experience with an insurer, they will be less likely to buy from them again. Word-of-mouth networks allow information to spread between customers. In this paper we build an agent-based model with two types of agents: customers and insurers. Insurers are price-takers who choose how much to spend on their service quality, and customers evaluate insurers based on premium, brand preference, and their perceived service quality. Customers are also connected in a small-world network and may share their opinions with their network. We find that the existence of the network acts as a persistent memory, causing a systemic bias whereby an insurer’s early reputation achieved by random chance tends to persist and leads to unequal market shares. This occurs even when the transmission of information is very low. This suggests that newer insurers might benefit more from a higher service quality as they build their reputation. Insurers with a higher service quality earn more profit, even when the customer preference for better service quality is small. The UK regulator is intending to ban the practice of charging new customers less than renewing customers. When the model is run with this scenario, the retention rates increase substantially and there is less movement away from insurers with a good initial reputation. This increases the skewness in market concentrations, but there is a greater incentive for good service quality. [ABSTRACT FROM AUTHOR]

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Background: Patient and Public Involvement in research is important for citizenship, accountability and transparency, and has the practical benefit of helping to ensure its quality and applicability. Involving members of the public in research is becoming increasingly commonplace, in the UK and internationally. It is essential that public involvement is inclusive of individuals and their diverse life experiences, including challenging experiences that may be associated with stigma and social exclusion. The involvement of people with lived/living experience of substance use and homelessness in research is increasing in response to increased recognition of the importance of inclusion and the benefits conferred to research. Main body: In this commentary, we share our own experiences of being part of a Patient and Public Involvement group that was convened during a feasibility study of a peer-delivered harm reduction intervention. We are a diverse group but share experience of the field of substance use/homelessness, as people with lived/living experience, and as researchers and practitioners. We share our reflections and learning, as well as offer recommendations for researchers working in our field. Our group worked together to make a positive and deliberate contribution to the study. This did not happen by chance but required the development of mutual trust and respect, with each member having a commitment to support the group for its two-year duration. Short conclusion: It is important for researchers to appreciate that meaningful Patient and Public Involvement is very valuable but requires a commitment from all involved. Regarding our field of substance use and homelessness specifically, it is essential that people with these experiences have opportunities to contribute to research and can do so in a meaningful way. People with lived/living experience are able to bring to life the rich tapestry of others' experiences. However, the involvement must be neither tokenistic nor indifferent to the wider challenges common to these experiences. Plain English Summary: This article describes the activities and lessons learned from the involvement of an Experts by Experience group in a National Institute for Health Research (NIHR) study. The study was about peer support for people experiencing homelessness and substance use challenges. The Experts by Experience group was made up of research team members, and a range of individuals from across the UK who had experienced homelessness and/or drug use and/or alcohol use, and who were recruited from a range of services who currently worked with people experiencing homelessness and/or substance use. The purpose of the group was to 'sense check' the study throughout. The group was a requirement from NIHR who funded the project. These groups are usually known as PPI groups (Patient and Public Involvement), but members of the group felt that 'Experts by Experience' was a more accurate term to describe the membership. The lived/living experience members' knowledge of the topic, and experience of using the types of services and interventions involved in the study, helped to guide the study team. Study team members facilitated Experts by Experience group meetings, but everyone was equal. The group gelled and worked well together to oversee the study. This article describes the benefits of having Experts by Experience members as part of the project from the inception through to the end. Ensuring the group had autonomy enhanced the study and was a powerful and empowering experience for the lived/living experience members. [ABSTRACT FROM AUTHOR]

Policy-makers frequently neglect the ways in which social policies are funded through taxation. This relationship is of critical importance because misalignment can cause social policy failure and tax injustice. This is evident with National Insurance (NI): a tax used primarily to fund the UK's state pension entitlement. This paper explains how NI is failing women and poorer people, prompting questions of why such a poorly designed, unfair and ineffective tax has persisted for so long in the UK. The paper proposes a radical solution: the payment of a universal basic pension and the abolition of NI, with consequential adjustments in income and corporation taxes to compensate for revenue losses. This paper makes a rare contribution to understanding how taxation is used to fund social welfare, and the implications of that relationship. In the UK, National Insurance (NI) is a hypothecated tax used primarily to fund state old age pensions—a contributory welfare benefit. Through historical analysis, and the exemplar of the raising of the state pension age for women, this paper demonstrates that NI fails women and poorer people more than men and the better-off: creating serious problems of social equity. A solution is proposed: the abolition of NI with consequential adjustments to income and corporation taxes, and the introduction of a universal basic pension. [ABSTRACT FROM AUTHOR]

In 2017, the majority of the United Kingdom Supreme Court held in its judgment in the Gard Marine and Energy v China National Chartering (The Ocean Victory) case that, in bareboat charters under the 'BARECON 89' form, if both the owner and the charterer are jointly insured under a hull policy, the damages caused to the vessel by the charterer cannot be claimed by the insurer by way of subrogation after indemnifying the owner. The interpretation of the charter party leads to the conclusion that the liability between the parties is excluded. Faced with the Supreme Court's decision, the Baltic and International Maritime Council (BIMCO) adopted a new standard bareboat charter agreement only a few months later, the 'BARECON 2017' form, which amends, among other clauses, the one related to insurance. The present paper analyses (i) the new wording of the clause mentioned above and (ii) its incidence on the relationship between the parties of both the charter agreement and the insurance contract and its consequences for possible third parties. Despite BIMCO's attempt to change the solution adopted by the Supreme Court and his willingness to allow the insurer to claim in subrogation against the person who causes the loss, the consequences, as it will be seen, do not differ much in practice when the wrongdoer is the co-insured charterer. On the contrary, when the loss is caused by a time charter or a sub-charter, in principle, there will be no impediment for the insurer to sue him. [ABSTRACT FROM AUTHOR]

We investigate the determinants of financial performance of UK insurance companies based on their financial strength ratings. We use data from the A.M. Best Insurance for 49 UK insurers for 2006–2009. Our findings show that profitability, liquidity, size and organisational form are the significant determinants that affect financial performance of insurance companies in the UK. We recommend an effective, alternative variable to more effectively measure the size of an insurance company, which is based on the gross premium written. We find that gross premium written is more appropriate for measuring company size in the insurance industry. [ABSTRACT FROM AUTHOR]

This paper examines a new method for measuring reputational risk developed by the Customer Services Institute in 2018 for UK insurance markets. It sets out the way in which the model was constructed through in-depth qualitative work followed by detailed opinion surveys, and uses two case studies to compare the results from the research with perceptions about how the sector has performed through the lens of different stakeholders, including regulators. It finds that the index correctly identifies two areas where public trust in insurers has been reduced. These areas are renewal charging practices in retail insurance and payment of business interruption insurance claims for SMEs. The paper also concludes that the index gives strong practical guidance about how these reputational issues can be addressed. Two limitations of the model are as follows: first, because it is set up to express issues in consumer terms, it can be difficult to then draw lessons for different organisations within the value chain, and secondly, the survey approach can obscure the experiences of very small minorities, unless the survey is carefully focused on those groups. For very small groups, a more qualitative approach may be more effective. [ABSTRACT FROM AUTHOR]

Insurance industry is, and has been for a long time, characterized by a strong presence of customer-owned mutual insurance companies that account roughly one-third of the global annual premiums. As mutuals are owned by the communities they serve, one would expect them to display unique characteristics in how they create not only utilitarian but also hedonic value for their customer-owners. The aim of this study is to examine how managers communicate the hedonic value of ownership to their customer-owners. The data consist of 18 mutual insurance companies' annual reports from seven different countries: Finland, Ireland, the Netherlands, Sweden, Switzerland, the UK and the USA. The resulting framework, produced by a thematic analysis, illustrates how managers of mutuals communicate the hedonic value of customer ownership. Results as well as the limitations of the study point out several interesting and new research avenues and managerial implications. [ABSTRACT FROM AUTHOR]

From the early days of the first national lockdown in England, widespread concerns over many different types of insurance claims had been raised. The business interruption losses that the small businesses and enterprises suffered received particular attention and were covered broadly by the national media channels. The policy wordings in question were so varied that it was not possible for any party to provide a clear outcome that will have a widespread effect on such insurance claims. Through the Financial Conduct Authority's involvement, the UK Supreme Court delivered a much-awaited judgment in a test case on the twenty-one selected policy wordings, fourteen of which were held to respond to the Covid-19 related business interruption claims. The significant impact of the test case, which prevented an ongoing uncertainty and avoided protracted litigation for many, is that many thousands of policyholders should now have their claims for business interruption losses paid. [ABSTRACT FROM AUTHOR]

Default options may provide a low-cost way of influencing behaviour without modifying incentives and constraining choices between alternatives. However, an improved understanding is needed on whether they are effective when individuals have experience with making the choice in practice and have preferences for specific alternatives. We study whether defaults can be used to increase insurance coverage against low-probability/high-impact risks, like floods, and whether past flood insurance purchases and flooding experience moderate the effect of defaults. Our study uses a naturally occurring difference in experience, comparing the surveyed flood insurance choices of 1,187 homeowners, half of whom are in the Netherlands, where flood insurance penetration rates are low and recent flooding caused minor losses, and the other half of whom are in the United Kingdom (UK), where the opposite is true. We find defaults are effective amongst homeowners with little to no flood-related experience: in the Netherlands defaults increase the likelihood of insuring by between 17 and 18 percentage points. Although there is no overall effect of defaults in the UK, defaults increase flood insurance coverage for risk averse individuals, and those who have no reported previous flood experience and have not purchased flood insurance. Anticipated regret about not having insurance coverage in the event of a flood, and perceptions about the insurance cost explain between 34 and 37 percent of the relationship between the default and flood insurance demand. We discuss policy implications of our findings. [ABSTRACT FROM AUTHOR]

In this Article, we argue that the uncertainty of UK national motor vehicle insurance law—when viewed with respect to its European Union (EU) parent, the Motor Vehicle Insurance Directive (MVID)—was never satisfactorily addressed, primarily when using the remedy available through the non-contractual liability of the State. The EU enforcement mechanisms were equally haphazard in their effectiveness and success in affording rights to third-party victims. Given the link between the MVID and the free movement of persons and goods, on which the harmonization of insurance protection was based, we present the first Article establishing an argument that those offending aspects of UK national law should have been disapplied. The UK has concluded its agreement to withdraw its membership of the EU—and thus no longer to be bound by EU law and the jurisprudence of the Court of Justice. Yet until the transitional period ends, the UK remained aligned to EU law and those defects present in national law should have been remedied. Therefore, the remedy issued from the Factortame line of case authorities may have proven to be the most effective way to grant access to rights which were denied to third-party victims in the UK. Here we present a justification for its application. [ABSTRACT FROM AUTHOR]

A year after its launch, the results of the Department of Health & Social Care's (DHSC) consultation on 'appropriate clinical negligence cover' are still widely anticipated. In this article, we explore the benefits and disadvantages of regulated and discretionary indemnity cover as understood by the DHSC, the medical defence organisations (MDOs), insurance brokers and underwriters. We also turn to surgeons and clinicians with private practices to ask what they think about the current arrangements. Reforms to medical indemnity insurance forecast the passing of the UK's long-established medical defence and protection organisations. [ABSTRACT FROM AUTHOR]

In many countries, health technology assessment (HTA) organizations determine the economic value of new drugs and make recommendations regarding appropriate pricing and coverage in national health systems. In the US, recent policy proposals aimed at reducing drug costs would link drug prices to six countries: Australia, Canada, France, Germany, Japan, and the UK. We reviewed these countries' methods of HTA and guidance on price and coverage recommendations, analyzing methods and guidance documents for differences in (1) the methodologies HTA organizations use to conduct their evaluations and (2) considerations they use when making recommendations. We found important differences in the methods, interpretations of HTA findings, and condition-specific carve-outs that HTA organizations use to conduct evaluations and make recommendations. These variations have ethical implications because they influence the recommendations of HTA organizations, which affect access to the drug through national insurance and price negotiations with manufacturers. The differences in HTA approaches result from the distinct political, social, and cultural contexts of each organization and its value judgments. New cost-containment policies in the US should consider the ethical implications of the HTA reviews that they are considering relying on to negotiate drug prices and what values should be included in US pricing policy. [ABSTRACT FROM AUTHOR]

Aims: Uptake of childhood immunisations is lower among Gypsy, Roma and Traveller (GRT) communities than in the general UK population. This small-scale study aimed to elicit insights from GRT mothers on their interaction with health services in London around childhood immunisations. The purpose was to inform a larger piece of work by the NHS England and Improvement (London) Public Health Commissioning Team to inform their planning to improve access to vaccination services for GRT communities in London. Study design: An exploratory qualitative study using semi-structured interviews and a focus group. Methods: There was purposive sampling of mothers from any GRT background from south-west London using snowballing methods. One focus group and three interviews were conducted. A thematic analysis approach was used. Results: A total of nine women were recruited and seven participated between March and April 2018. Five themes were identified: adherence with antenatal care, self-declared parenting expertise, family support, childhood immunisations, keep children healthy but 'they say wait on the MMR until they are talking'. Conclusion: Compliance with antenatal care, strong parenting beliefs and cohesive family support are strong influences on decision-making regarding immunisations. The women interviewed emphasised their own expertise in child rearing. This was occasionally at odds with the health advice provided by health professionals. The women widely shared their experiences of health professionals with other family and community members and this impacted on others' intention to vaccinate. These are key issues that should be considered when trying to improve uptake of immunisations in GRT families in a face-to-face manner. Equally, it warrants further exploration in a larger-scale study to see whether this reflects the wider community and in order to tailor supplementary immunisation activities to improve uptake. [ABSTRACT FROM AUTHOR]

Despite many similarities, there are key differences in the ability of providers in the United States to assist homeless youth compared to their colleagues in the United Kingdom. However, legislation, and strategies to identify and advocate for youth experiencing homelessness can lead to improved health outcomes and other psychosocial improvements for youth. This article highlights, compares and contrasts the systems with a goal of greater understanding and opportunities to assist youth experiencing homelessness in either country. [ABSTRACT FROM AUTHOR]

For the last fifty years, the United States healthcare system has done an extremely poor job of delivering healthcare in a just and fair manner. The United States holds the dubious distinction of being the only industrialized nation in the world lacking provisions to ensure universal coverage. We attempt to provide some of the reasons this dysfunctional system has persisted and show that healthcare should not be a commodity. We begin with a brief historical overview of healthcare delivery in the United States since WWII. This is followed by a critical analysis of the for-profit model including reasons to support the view that healthcare should not be a free market commodity. We also demonstrate how special interest groups have been able to win support for their practices based on propaganda rather than fact. A brief analysis of the Affordable Care Act is offered along with critical comments regarding its ineffectiveness. We conclude with a brief overview of international approaches that have resulted in universal coverage and suggest the United States ought to adopt an approach similar to those outlined so that it no longer stands as the only industrialized nation to ignore the glaring problems that exist. [ABSTRACT FROM AUTHOR]

Disability insurance provides protection against health shocks that limit the ability to work. In most countries, these programmes are large and growing, both in expenditure and in number of recipients. We discuss the traditional trade‐off between insurance and incentives in providing this insurance, with a focus on the US and UK experiences. There is substantial evidence on the extent of the labour supply incentive costs of disability insurance, but there has been a lack of evidence on the insurance value until very recently. Further, evidence on errors in the disability insurance process suggests false rejections of genuine claimants is a substantial problem, and these are more serious than false acceptances of healthy applicants. We provide a life‐cycle framework for understanding the trade‐offs and to evaluate the welfare implications of policy reforms. We argue that reforms should be focused on reducing false rejections and supporting labour market attachment. The difficulty in considering reform is that the design of disability insurance has many aspects that interact and impact on outcomes. [ABSTRACT FROM AUTHOR]

The existing literature on modelling provides two main ways of viewing model migration: a modular view, which seeks to decompose models in their constitutive elements, and thus provides a view on what it is that migrates; and a practice-based view, which focuses on modelling as an activity, and understands a model as intricately entangled with its context of use. This article brings together these two sensitivities by focusing on ontologies of modelling. The paper presents a case study of the appropriation of modern finance theory's 'no-arbitrage' models by British actuaries – a process that gradually unfolded at around the turn of the century and led to significant friction within the UK's insurance industry. We can distinguish two main modelling ontologies: a 'risk-neutral ontology', which underpins no-arbitrage models and holds that the value of financial instruments is determined by 'arbitrage'; and, a 'real-world ontology', which assumes that the economic world consists of real probabilities that may be approximated through a combination of archival-statistical methods and expert judgment. The appropriation of the risk-neutral modelling ontology was made possible by the declining legitimacy of actuarial expertise as 'financial stewards' of life insurance companies. The risk-neutral modelling ontology provided an 'objective' alternative to the traditional actuarial models, which explicitly required actuaries to make 'prudent' judgments. Despite the fact that the no-arbitrage modelling was considered an 'objective' affair, the valuation models that insurers use today are strongly shaped by political compromises, a result of the 'rough edges' of models. [ABSTRACT FROM AUTHOR]