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Objective: The authors sought to assess why patients use out-of-network health care providers and whether patients' reasons differ for mental and general medical health providers. Methods: In a national Internet survey of commercial plan enrollees (N=713) who used an out-of-network provider, participants indicated whether 12 reasons were "important" (vs. "not applicable" or "not important") in their decision to see an out-of-network provider. Results: Reasons for using out-of-network care were multifactorial. Six reasons were similarly important, including the three most-cited reasons: convenient location (66% vs. 69% for mental vs. general medical health, respectively), higher quality (65% vs. 69%), and affordability (70% vs. 71%). Reasons more commonly cited for using out-of-network mental health care were that in-network providers were not taking new patients (34% vs. 24%), confidentiality (33% vs. 19%), cultural competence (33% vs. 23%), and inaccurate in-network provider directories (30% vs. 22%). Conclusions: The most common reasons for using out-of-network care were cited with similar frequency for both mental health and general medical health providers. [ABSTRACT FROM AUTHOR]

In previous decades, seminal theories were advanced addressing the problems of asymmetric information. These scholarly works confirmed a significant positive correlation between insurance coverage and risk in insurance markets. We showed that when regression models were used to analyze the asymmetric information problem, the sample selection bias and chosen regression methods could produce distinct results. Moreover, samples at different quantiles may lead to considerably different levels of information asymmetry. The present research suggests that quantile regression models be employed to better reveal the situation of the insurance market and reduce estimation errors. [ABSTRACT FROM AUTHOR]

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This study estimates the prevalence of health insurance coverage and associated socioeconomic factors in the Democratic Republic of Congo (DRC). Using the nationally representative household survey of the 2017/2018 DRC Multiple Indicator Cluster Survey (MICS), we applied weighted logistic regression models to identify regions and subgroups with low health insurance coverage. The study's findings revealed a low insurance coverage of less than 5%, with significant disparities across provinces and socioeconomic status. Additionally, three factors were strongly associated with the low health insurance coverage rates: education, wealth, and financial inclusion proxied by bank account ownership. Consequently, we recommend that the government, the private sector, and donors prioritize programs targeting provinces with less coverage and individuals without formal education to increase health insurance coverage. This study encourages the government to establish national programs to improve financial inclusion, which could positively impact poverty reduction and health insurance coverage. We also propose that the government initiates pilot projects for premium exemptions and through subsidies for vulnerable populations in the short term, and ensure formal employment for the majority of the population in the long term to facilitate the proper collection of premiums for individuals. Overall, this study contributes to the literature on health insurance in the DRC and sub‐Saharan Africa by identifying the socioeconomic factors that explain the prevalence of health insurance coverage. The findings of this study have important policy implications for the government, the private sector, and donors to promote health insurance coverage and achieve universal health coverage. [ABSTRACT FROM AUTHOR]

Federally qualified health centers (FQHC) aim to improve cancer prevention by providing screening options and efforts to prevent harmful behavior. Patient portals are increasingly being used to deliver health promotion initiatives. However, little is known about patient portal activation rates in FQHC settings and the factors associated with activation. This study examined patient portal activation among FQHC patients and assessed correlations with demographic, clinical, and health service use variables. We analyzed electronic health record data from adults >18 years old with at least one appointment. Data were accessed from the electronic health records for patients seen between 1 September 2018 and 31 August 2022 (n = 40,852 patients). We used multivariate logistic regression models to examine the correlates of having an activated EPIC-supported MyChart patient portal account. One-third of patients had an activated MyChart portal account. Overall, 35% of patients with an activated account had read at least one portal message, 69% used the portal to schedule an appointment, and 90% viewed lab results. Demographic and clinical factors associated with activation included younger age, female sex, white race, English language, being partnered, privately insured, non-smoking, and diagnosed with a chronic disease. More frequent healthcare visits were also associated with an activated account. Whether or not a patient had an email address in the EHR yielded the strongest association with patient portal activation. Overall, 39% of patients did not have an email address; only 2% of those patients had activated their accounts, compared to 54% of those with an email address. Patient portal activation rates were modest and associated with demographic, clinical, and healthcare utilization factors. Patient portal usage to manage one's healthcare needs is increasing nationally. As such, FQHC clinics should enhance efforts to improve the uptake and usage of patient portals, including educational campaigns and eliminating email requirements for portal activation, to reinforce cancer prevention efforts. [ABSTRACT FROM AUTHOR]

In 2014, the Affordable Care Act (ACA) expanded the role of Medicaid by encouraging states to increase eligibility for lower-income adults. As of 2024, 10 states had not adopted the expanded eligibility provisions of the ACA, possibly due to concerns about the state's share of spending. Using the Medical Expenditure Panel Survey (MEPS), we documented how health care utilization, expenditures, and the overall health status of newly eligible enrollees compare with enrollees who would have been eligible under their states' rules before the ACA. Our estimates suggest that, during 2014–16, newly eligible Medicaid enrollees had worse health and greater utilization and expenditures than previously eligible enrollees. However, during 2017–19, newly and previously eligible enrollees had comparable per capita health expenditures across six types of health spending. We find some evidence that changes in Medicaid enrollment composition muted observed differences between eligibility groups. [ABSTRACT FROM AUTHOR]

Addressing housing insecurity contributes to health care programs as stable housing has positive health benefits. Home environmental hazards may reduce these potential health benefits and could increase morbidity for conditions such as asthma. This study examined housing and indoor air quality among urban low-income households in Colorado to inform housing-insecurity interventions. We conducted a community-engaged study among residents of motels, mobile homes, apartments, and single-family homes that included a survey on the home environment, health, and sociodemographic factors, spirometry, and indoor air quality measurement. We enrolled 60 households: 50% single-family homes, 37% apartments, and 13% residential motels. Perceived stress and depression were higher among motel residents compared with other housing types. We did not find differences in lung function by housing type. Indoor fine particulate matter (PM2.5) and black carbon concentrations were higher in motels than in other housing types. The differential health impacts of housing type support housing programs that jointly address security and quality. [ABSTRACT FROM AUTHOR]

Family considerations are known to influence the decision to buy long-term care (LTC) insurance. This paper uses a Swiss survey to identify the characteristics of individuals willing to purchase LTC insurance, either to protect their children's bequest or because they cannot rely on family for care. First, it shows that the presence or absence of children plays an important role in the two motivations for buying LTC insurance. Second, it shows that individuals from the French-speaking part of Switzerland and those with lower self-perceived health are more likely to buy LTC insurance because of the unreliability of family care. On the other hand, individuals with higher self-perceived health and those with a right and center political orientation are more likely to buy LTC insurance for reasons of bequest protection. The results provide insights into designing more targeted strategies to promote LTC insurance. [ABSTRACT FROM AUTHOR]

This article summarizes the main topics, findings, and avenues for future work from the workshop Fairness with a view towards insurance held August 2023 in Copenhagen, Denmark. [ABSTRACT FROM AUTHOR]

Background: Acupuncture is a promising treatment for common symptoms after traumatic brain injury (TBI). Our objectives were to explore knowledge, attitudes and beliefs about acupuncture, identify health service needs and assess the perceived feasibility of weekly acupuncture visits among individuals with TBI. Methods: We surveyed adults 18 years of age and older with TBI who received care at the University of Washington. Respondents were asked to complete 143 questions regarding acupuncture knowledge, attitudes and beliefs, injury-related symptoms and comorbidities, and to describe their interest in weekly acupuncture. Results: Respondents (n = 136) reported a high degree of knowledge about acupuncture as a component of Traditional Chinese Medicine, needle use and safety, but were less knowledgeable regarding that the fact that most conditions require multiple acupuncture treatments to achieve optimal therapeutic benefit. Respondents were comfortable talking with healthcare providers about acupuncture (63.4%), open to acupuncture concurrent with conventional treatments (80.6%) and identified lack of insurance coverage as a barrier (50.8%). Beliefs varied, but respondents were generally receptive to using acupuncture as therapy. Unsurprisingly, respondents with a history of acupuncture (n = 60) had more acupuncture knowledge than those without such a history (n = 66) and were more likely to pursue acupuncture without insurance (60%), for serious health conditions (63.3%) or alongside conventional medical therapy (85.0%). Half of all respondents expressed interest in participating in weekly acupuncture for up to 12 months and would expect almost a 50% improvement in symptoms by participating. Conclusion: Adults with TBI were receptive and interested in participating in weekly acupuncture to address health concerns. These results provide support for exploring the integration of acupuncture into the care of individuals with TBI. [ABSTRACT FROM AUTHOR]

Medicare beneficiaries' healthcare spending varies across geographical regions, influenced by availability of medical resources and institutional efficiency. We aimed to evaluate whether social vulnerability influences healthcare costs among Medicare beneficiaries. Multivariable regression analyses were conducted to determine whether the social vulnerability index (SVI), released by the Centers for Disease Control and Prevention (CDC), was associated with average submitted covered charges, total payment amounts, or total covered days upon hospital discharge among Medicare beneficiaries. We used information from discharged Medicare beneficiaries from hospitals participating in the Inpatient Prospective Payment System. Covariate adjustment included demographic information consisting of age groups, race/ethnicity, and Hierarchical Condition Category risk score. The regressions were performed with weights proportioned to the number of discharges. Average submitted covered charges significantly correlated with SVI (β = 0.50, p < 0.001) in the unadjusted model and remained significant in the covariates-adjusted model (β = 0.25, p = 0.039). The SVI was not significantly associated with the total payment amounts (β = −0.07, p = 0.238) or the total covered days (β = 0.00, p = 0.953) in the adjusted model. Regional variations in Medicare beneficiaries' healthcare spending exist and are influenced by levels of social vulnerability. Further research is warranted to fully comprehend the impact of social determinants on healthcare costs. [ABSTRACT FROM AUTHOR]

Agricultural production in developing countries is heavily rainfall dependent. Any unexpected variation in rainfall can affect the welfare of households. Using unit record data from India, this paper shows that households can insure against agricultural productivity (rainfall) shocks. Evidence suggests that they do so by varying the time allocation of individual members to different activities, particularly to regular wage work and human capital accumulation. There is a gender‐differentiated aspect to this response. Rainfall shocks adversely affect women's human capital accumulation. While there is no evidence that households use participation in NREGS to insure against rainfall shocks, the availability of NREGS helps reduce the impact of rainfall shocks on human capital accumulation. [ABSTRACT FROM AUTHOR]

Introduction: The health system in Sudan faces several challenges, including increasing numbers of patients, shortages of health supplies, and disparities in the distribution of health services. Guidelines implementation improves patients' outcomes and ensures efficient use of the resources in such a resource limited country. The study aimed to assess the implementation of the clinical practice guidelines among family medicine doctors working in the primary health care centers in Khartoum and Gezira states to provide baseline data about the current practice in Sudan. Methods: Descriptive cross-sectional facility-based survey, conducted from April to December 2021, on 373 of the practicing family-medicine doctors. A total of 101 Primary health care centers were surveyed (77 centers in Khartoum state and 24 in Gezira state). The questionnaire was pilot tested on a small group of physicians to improve clarity and reduce response bias. Descriptive statistics were used to summarize the data and analyzed by frequency tables. Chi square and logistic regression tests were used to determine the association between categorized variables. P value < 0.05 was considered statistically significant. Results: Most of the practicing family-medicine doctors (98.4%) reported implementation of the guidelines. Moreover, (68.6%) of them received training programs which were organized and funded by the Sudan Ministry of Health. The local Sudanese guidelines were difficult to access and not regularly updated. Services unavailability and inaccessibility (87.1%), health insurance factors (83.9%), and patient factors (81.2%) were the most frequent barriers to guidelines implementation. Service cost (79.9%), lack of regular training programs (79.9%), absence of local guidelines (77.2%), lack of continuity in the comprehensive care process (63.0%), and lack of time (57.1%) were also reported as barriers to guidelines implementation. Conclusion: Guidelines implementation is limited by unavailability and inaccessibility of the health services and the health insurance limited coverage. Expansion of the health insurance coverage, organization of continuous training programs, encouragement of regular auditing and issuing regulations to ensure the use of updated guidelines, dissemination of the updated national guidelines along with establishing clinical governance in Sudan can be useful tools for policymakers in the optimum allocation of public health resources. [ABSTRACT FROM AUTHOR]

This paper begins by establishing a three-party game model involving three key players: the insurer, the firm, and the government. This model is used to analyze the utility of each party in various scenarios, one of which encourages green innovation within the firm. According to this model, when the insurer rejects insurance coverage and the government maintains a neutral stance on environmental liability insurance, the firm may opt to engage in green innovation. Green innovation fundamentally serves as a mechanism to mitigate environmental pollution risks stemming from the firm's operational processes. In cases where the insurer declines underwriting, it becomes rational for the firm to enhance its risk management through green innovation, which can be viewed as a mitigating factor in the context of environmental liability insurance. To comprehensively examine the overall impact of environmental liability insurance on the green innovation endeavors of firms, we use a mediation effect model utilizing firm-level data from heavily polluting industries. This paper delves into the intricate relationship between environmental liability insurance and the capacity of heavily polluting firms to engage in green innovation, along with the mediating influence of financing constraints between these two factors. The findings of this analysis suggest that the acquisition of environmental liability insurance enhances the green innovation capabilities of firms operating in heavily polluting industries by alleviating financing constraints, serving as a mediating factor in this regard. [ABSTRACT FROM AUTHOR]

This paper employs a statistical mechanical model as a framework to investigate how socioeconomic factors of individuals such as gender and place of residence influence their decision when deciding between comprehensive and third-party motor insurance policies in Ghana. Data from a general insurance firm was used for this investigation taking five years' worth of transactions into account. The methods of partial least squares and the ordinary least squares are, respectively, used to estimate the parameters of the interacting and the non-interacting models in the Multipopulation Currie-Weiss model in a discrete choice framework. The findings showed that both location and gender have discernible influences on how people choose their motor insurance. We encourage insurance companies to intensify their campaign on the importance of motor insurance to all vehicle/car owners, especially those in rural areas in order to reduce the risk and associated losses in vehicular accidents on Ghanaian roads. [ABSTRACT FROM AUTHOR]

Background: The Family Physician Programme is a key health reform in Iran that faces significant challenges in urban areas, particularly in Mazandaran and Fars provinces The study aims to critically evaluate the challenges encountered in the Urban Family Physician Program, with a particular focus on the perspectives of insurance organizations. Methods: A qualitative approach was adopted, involving semi-structured interviews with 22 experts and managers from basic health insurance funds. Snowball sampling facilitated participant selection, and interviews proceeded until saturation. Data analysis utilized content analysis and Atlas-T software, adhering to COREQ criteria. Results: Implementation problems of the urban family physician program were categorized into ten Categories and 22 Subcategories, including financing, stewardship, human resources, structure, culture, information system, payment, monitoring and control, the function of insurance organizations, and implementation. Conclusion: The urban family physician program's implementation challenges, as viewed by health insurance organizations, underscore the necessity for strategic decision-making in financing, payment models, electronic system integration, structural adjustments, comprehensive monitoring, evaluation, cultural considerations, and appropriate devolution to insurance entities. [ABSTRACT FROM AUTHOR]

Clinical rehabilitation and post-acute care (PAC) learning experiences are not uniformly required within medical school core curricula in the United States or internationally. This study aims to characterize what medical students might know/need to know to support patients in the transition from acute hospitalization to post-acute rehabilitation settings. The medical student cohort completing required clinical rotations in a United States quaternary care hospital system was provided a voluntary survey prompting reflection on experiences discharging patients to rehabilitation/PAC and related learning needs. Data were analyzed using descriptive statistics and qualitative grounded theory. Response rate was 72% (39/54). All respondents reported at least one gap in rehabilitation/PAC knowledge, falling into 8 themes: daily experience of rehabilitation/PAC; determination of eligibility/screening processes; distinctions among levels of rehabilitation/PAC; insurance coverage/equity; rehabilitation/PAC clinical practice environment; post-rehabilitation/PAC discharge support; medical capabilities within PAC settings; developing rehabilitation goals. Despite caring for patients discharged to post-acute rehabilitation settings, medical students lack essential knowledge about the process of rehabilitation and recovery, including patient eligibility for and service availability across PAC settings. Explicit rehabilitation/PAC education for medical students could enhance their ability to counsel and advocate for patients with disability and rehabilitation needs through care transitions. Medical students lack knowledge about rehabilitation and post-acute care that is important for helping patients navigate the acute to post-acute transition. Dedicated rehabilitation/post-acute care education could prepare trainees for counseling and advocating for patients during care transitions. Knowledge gaps identified in this study could inform development of curricular interventions to address medical student learning needs. [ABSTRACT FROM AUTHOR]

Background: While insurance coverage for mastectomy-related breast reconstruction is mandated in the US, the impact of insurance type on breast reconstruction outcomes has not been explored. This study aimed to compare short-term outcomes of publicly versus privately insured patients who underwent autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR), respectively. Methods: Patients having ABR or IBR were identified in National Inpatient Sample from Q4 2015–2020. Multivariable logistic regressions were used to compare in-hospital outcomes between publicly (Medicare or Medicaid) versus privately insured patients, adjusted for demographics, socioeconomic status, comorbidities, and hospital characteristics. Results: In ABR, 2,687 patients were publicly insured and 9,770 were privately insured. In IBR, 4,566 patients used public insurance and 12,701 used private insurance. In ABR, publicly insured patients had higher risks of venous thromboembolism (aOR = 1.384, 95 CI = 1.006–1.905, p = 0.04) but were less likely to undergo flap revision (aOR = 0.438, 95 CI = 0.213–0.899, p = 0.02). In IBR, publicly insured patients had higher risks of systemic complications (aOR = 2.084, 95 CI = 1.471–2.951, p < 0.01) including respiratory (aOR = 1.723, 95 CI = 1.06–2.799, p = 0.03) and renal complications (aOR = 2.353, 95 CI = 1.445–3.832, p < 0.01), as well as dehiscence (aOR = 1.282, 95 CI = 1.008–1.631, p = 0.04) and vascular complications (aOR = 3.697, 95 CI = 1.027–13.315, p = 0.04). In both ABR and IBR, publicly insured patients had higher transfer out rates (p < 0.01), longer hospital stays (p < 0.01), but less hospital charge (p < 0.01). Conclusions: Despite extensive legislative efforts to ensure women's access to breast reconstruction services in the US, insurance status still profoundly associated with ABR and IBR outcomes. The probable cause for these disparities is selection bias due to the higher concentration of disadvantaged patients in the publicly insured group. Thus, efforts should focus on improving all quality-of-life metrics for this group. Level of evidence: Level III, Risk/Prognostic. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is a common, chronic, and non-contagious skin disease that has no known cause or treatment. Various medical costs for skin disorders, including psoriasis, can be expensive and lifelong. The purpose of the present study was to determine the economic burden of psoriasis in patients admitted to general hospitals affiliated with Shiraz University of Medical Sciences, Iran in 2022. Materials and methods: This research was a descriptive, cross-sectional, cost of illness study from a societal perspective. All psoriasis patients (N = 118) admitted to the hospitals affiliated with Shiraz University of Medical Sciences in 2022 were examined. 7 participants refused to cooperate and were excluded from the study and, the information of 111 patients was collected. A researcher-made data collection form was used to collect data. A prevalence-based approach was used to prepare cost data, and the costing approach was bottom-up. The productivity lost due to the absenteeism of patients and their companions was estimated using the human capital approach. Microsoft Excel ® 2016 was applied to analyze the data. Results: The mean annual cost per psoriasis patient was estimated to be US$ 30,374.21. Its highest and lowest share was related to direct medical costs (88.61%), direct non-medical costs (7.3%) and indirect costs (4.09%), respectively. Also, the highest mean direct medical, direct non-medical, and indirect costs per patient were related to those of medicine (93.11%), transportation (51.65%), and absenteeism of the patients' companions due to patient care (71.73%). Conclusion: Considering that the major contributor in the direct medical cost of treating psoriasis patients was related to medicine, designing appropriate mechanisms for insurance coverage, and allocating government subsidies for the purchase of medicine, are suggested. The result of the current study has important implications for policymakers in developing guidelines for early diagnosis of this disease and reducing the health economic burden. [ABSTRACT FROM AUTHOR]

Dispute resolution in marine cargo insurance often involves complex considerations related to applicable law. One of the crucial aspects in resolving this dispute is the application of the choice of law clause, which determines the law that will govern the insurance agreement. This research is juridical on the application of choice of law in resolving marine cargo insurance disputes in Indonesia to be relevant and important to be carried out. This study uses normative juridical law research. The approach used in this study is a legal and case approach. Researchers use secondary data sources by collecting data through document analysis or literature review. The data analysis method used in this study is qualitative with a deductive thinking framework. The results of this study reveal that adequate education and training for judges and lawyers is needed to improve the ability of judges to handle complex cases. In the context of the validity of marine cargo insurance agreements that use choice of law clauses in Indonesian civil law, several aspects need to be considered in depth. The principle of freedom of contract must be recognized, but it must be in accordance with the limits set by Indonesian civil law. Consumer protection must also be guaranteed, with insurance companies acting in good faith and providing clear information to policyholders. The enforcement of policyholder rights by courts and dispute resolution that pays attention to the principles of fairness and legal certainty are integral parts of consumer protection in insurance transactions. By carefully considering all of these aspects, the parties involved in an insurance agreement can ensure adequate protection and fair dispute resolution. [ABSTRACT FROM AUTHOR]

Cancer-related pain affects a large proportion of all patients with cancer yet remains inadequately managed, particularly among patients from certain racialized backgrounds. Recently, there has been increased research and clinical interest in the use of medical cannabis for cancer pain management, including its potential to ameliorate race-based disparities in cancer pain control. Although medical cannabis is not currently a US Food and Drug Administration–approved treatment option for cancer-related pain, many oncologists discuss and recommend its use with their patients, underscoring the need for researchers and clinicians to proactively identify barriers to cannabis for cancer pain management that may disproportionately affect patients from certain racial groups. In this commentary, we highlight challenges that patients from racialized backgrounds may face when incorporating cannabis into their palliative care regimens and discuss opportunities for researchers and clinicians to address these challenges should medical cannabis become a recommended treatment option for cancer pain management. In particular, we identify challenges at the structural (eg, lack of insurance coverage), clinician (eg, racialized stereotypes regarding addiction and pain), and individual (eg, internalized stigma) levels and emphasize the importance of multilevel approaches in combating these challenges as the evidence base regarding medical cannabis and its potential harms and therapeutic benefits continues to accumulate. [ABSTRACT FROM AUTHOR]

Aim: Extending working life is considered as an important initiative to respond to the population aging and pension payment dilemma. This study aimed to investigate whether work after retirement is related to improved health‐related quality of life. Methods: We used two waves of data from the China Health and Retirement Longitudinal Study in 2011 and 2018. Work after retirement was ascertained based on self‐reported retirement and work status, and health‐related quality of life (HRQOL) was measured with the three‐level EuroQol five‐dimensions. The impact of work after retirement on HRQOL was analyzed using the propensity score matching with difference‐in‐difference approach. Results: A total of 1043 retirees were included. The results showed that work after retirement was associated with significant improvement in HRQOL among retirees (β = 0.072, P < 0.001). Heterogeneity analyses did not show specificity on sex (P for sex interaction >0.05), but older‐aged retirees seemed more sensitive to the benefits of work after retirement on HRQOL than their younger‐aged counterparts (≥65 years: β = 0.167, P < 0.001 vs <65 years: β = −0.047, P > 0.05; P for age interaction = 0.010). Conclusions: Work after retirement shows a positive impact on HRQOL among community‐dwelling adults in China. Policy‐makers should take the health of retirees into account when implementing policies related to delayed retirement, and reduce health inequity. Geriatr Gerontol Int 2024; 24: 722–729. [ABSTRACT FROM AUTHOR]

When data exhibit a high frequency of small to medium values and a low frequency of large values, fitting a classical distribution might fail. This is why spliced models defined from different distributions on distinct intervals are proposed in the literature. In contrast to the intensive study of two-spliced distributions, the case with more than two components is scarcely approached. In this paper, we focus on three-spliced distributions and on their ability to improve the modeling of extreme data. For this purpose, we consider a popular insurance data set related to Danish fire losses, to which we fit several three-spliced distributions; moreover, the results are compared to the best-fitted two-spliced distributions from previous studies. [ABSTRACT FROM AUTHOR]

The article discusses the goal of ending the HIV epidemic in the U.S. by increasing preexposure prophylaxis (PrEP) use to at least 50 percent of the estimated 1.2 million people in the country who are at risk for acquiring HIV by 2023. Topics include opportunities and pitfalls in PrEP access, PrEP education for health care providers, and evidence-based implementation approaches.

The article discusses the substantial risk and impact of Medicaid disenrollment among enrollees older than 65 or with disabilities and recommend reforms to help these individuals maintain continuous Medicaid coverage. Topics include risk and consequences of Medicaid disenrollment faced by non-modified adjustment gross income (non-MAGI), factor that would improve the Medicaid redetermination process for people with vision and hearing disabilities, and ease asset testing for non-MAGI enrollees.

Maternal anaemia is a major public health problem. Developing maternal anaemia prevention and control policies is an important prerequisite for carrying out evidence‐based interventions. This article reviews maternal anaemia prevention and control policies in China, identifies gaps, and provides references for other countries. We examined policies concerning maternal nutrition and other related literature in China, identified through key databases and government websites, and conducted a narrative review of the relevant documentations guided by the Smith Policy‐Implementing‐Process framework. A total of 65 articles and documents were identified for analysis. We found that Chinese government has committed to reducing maternal anaemia at the policy level, with established objectives and a clear time frame. However, most of policies were not accompanied by operational guidelines, standardized interventions, and vigorous monitoring and evaluation mechanisms, and 85% of the policies don't have quantifiable objectives on anaemia. Maternal anaemia prevention and control services offered in clinical settings were primarily nutrition education and anaemia screening. Population‐based interventions such as iron fortification have yet to be scaled up. Furthermore, medical insurance schemes in some regions do not cover anaemia prevention and treatment, and in other regions that offer coverage, the reimbursement rate is low. The number and capacity of health professionals is also limited. Policy changes should focus on the integration of evidence‐based interventions into routine antenatal care services and public health service packages, standardization of dosages and provision of iron supplementation, streamline of reimbursement for outpatient expenses, and capacity building of health professionals. Key messages: The Government of China has established targets with a clear time frame for maternal anaemia prevention and control and identified several interventions at the national level.There are still gaps in policy‐binding forces, prevention strategies, reimbursement regulations of medical insurance schemes, and human resource.Policy changes should focus on the integration of evidence‐based interventions into routine antenatal care services and public health service packages, standardization of dosages and provision of iron supplementation, streamline of reimbursement for outpatient expenses, and capacity building of health professionals. [ABSTRACT FROM AUTHOR]

Cost-effectiveness analyses are required for therapies within Canada's universal healthcare system, leading to delays relative to U.S. healthcare. Patients with Hodgkin lymphoma (HL) generally have an excellent prognosis, but those who relapse after or are ineligible for transplant benefit from novel therapies, including brentuximab vedotin (BV). BV was FDA-approved in 2011 but not Canadian-funded until 2014. To assess the impact of access delays, we compared changes in survival for U.S. (by insurer) and Canadian patients in periods pre/post-U.S. approval. Patients were 16–64 years, diagnosed with HL in 2007–2010 (Period 1) and 2011–2014 (Period 2) from the U.S. SEER and Canadian Cancer Registries. Approval date (surrogate) was utilized as therapy was unavailable in registries. Kaplan-Meier survival curves and adjusted Cox regression models compared survival between periods by insurance category. Among 12,003 U.S. and 4210 Canadian patients, survival was better in U.S. patients (adjusted hazard ratio (aHR) 0.87 (95%CI 0.77–0.98)) between periods; improvement in Canadian patients (aHR 0.84 (95%CI 0.69–1.03) was similar but non-significant. Comparisons between insurers showed survival was significantly worse for U.S. uninsured and Medicaid vs. U.S. privately insured and Canadian patients. Given the increasingly complex nature of oncologic funding, this merits further investigation to ensure equity in access to therapy developments. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to explore 10-year trends in the use of Assistive Technology (AT). Using 2006 and 2015 Behavioral Risk Factor Surveillance System (BRFSS) data, univariate analysis were performed, and the rate of change was calculated. In both 2006 and 2015 data, a higher per cent of Blacks were using AT compared to Whites and Hispanics (p <.001); however, the rate of increase indicate that Blacks had the lowest per cent change (23.9%) compared to Whites (26.8%) and Hispanics (27.3%). Results indicated that AT use is statistically more prevalent in women, individuals who are not married (e.g. divorce, widowed, separated), the veteran population, lower educational attainment levels (e.g. some high school or less), lower income levels, the ageing population, unemployed (e.g. out of work, retired, unable to work) and individuals with limited functioning because of a disability. Similarly, individuals who have healthcare coverage, and individuals with concerns with medical costs used AT more. Even though most factors yielded higher utilisation rates when comparing 2006 to 2015 data, the rate of change had varying 'speeds' of improvement. [ABSTRACT FROM AUTHOR]

The article focuses on the oral health challenges faced by adults with intellectual and developmental disabilities (IDDs). It discusses how these individuals encounter significant barriers in maintaining proper oral hygiene and accessing dental care due to their physical, cognitive, and emotional limitations. It emphasizes the prevalence of dental diseases among adults with IDDs, such as untreated caries and periodontal disease.

Farmworkers in Michigan face precarious and exploitative labor conditions that affect their access to affordable, fair, and quality housing, which are key social determinants of health. We sought to assess the health, working conditions, and housing access, affordability, and quality of farmworkers living in and outside of employer-provided housing during the COVID-19 pandemic. We conducted a mixed methods cross-sectional study in collaboration with community partners from the Michigan Farmworker Project and the Michigan Department of Civil Rights. We assessed housing, labor conditions, and general health through in-depth phone interviews with seasonal, migrant, and H-2A farmworkers (n = 63) during the height of the COVID-19 pandemic (2020–2021) in Michigan. Descriptive analyses of these data included comparisons by type of farmworker and type of housing (employer-provided or other). The majority of farmworkers interviewed were women and seasonal farmworkers and spoke primarily Spanish. A significant share of farmworker participants reported living in poverty (38.3%) and had low or very low food security (27.0%). Nearly half of farmworkers (47.6%) rated their health as "fair" or "poor" during the year prior to the interview, and more than a third reported 3 or more chronic conditions (39.6%) and lack of health insurance coverage (38.7%). Among the 43 workers tested, 25.6% reported testing positive for COVID-19. Farmworkers reported experiences of objectification and dehumanization. Three-quarters of workers reported feeling that they were treated as less than human by supervisors and one-third reported verbal abuse. Farmworkers also experienced challenges exacerbated by their social vulnerability that impeded them from finding affordable, quality housing. Regarding housing quality, the majority of workers (80.6%) reported one or more environmental hazards around their residence, and about a third reported not having air conditioning (33.%) and lacking a functioning washing machine (33.9%). Concerns about the quality of drinking water accessible to workers and exposure to chemicals were shared by participants. This study adds valuable knowledge to the understanding of the systemic barriers to housing and work conditions for female and male seasonal, migrant, and H-2A farmworkers in Michigan. Shortcomings in the regulatory and policy environment result in precarious housing and work conditions, including exploitative labor practices. These conditions negate equality, fairness, and health equity, important tenants for public health. [ABSTRACT FROM AUTHOR]

In 2008, Oregon expanded its Medicaid program using a lottery, creating a rare opportunity to study the effects of Medicaid coverage using a randomized controlled design (Oregon Health Insurance Experiment). Analysis showed that Medicaid coverage lowered the risk of depression. However, this effect may vary between individuals, and the identification of individuals likely to benefit the most has the potential to improve the effectiveness and efficiency of the Medicaid program. By applying the machine learning causal forest to data from this experiment, we found substantial heterogeneity in the effect of Medicaid coverage on depression; individuals with high predicted benefit were older and had more physical or mental health conditions at baseline. Expanding coverage to individuals with high predicted benefit generated greater reduction in depression prevalence than expanding to all eligible individuals (21.5 vs 8.8 percentage-point reduction; adjusted difference = +12.7 [95% CI, +4.6 to +20.8]; P  = 0.003), at substantially lower cost per case prevented ($16 627 vs $36 048; adjusted difference = −$18 598 [95% CI, −156 953 to −3120]; P  = 0.04). Medicaid coverage reduces depression substantially more in a subset of the population than others, in ways that are predictable in advance. Targeting coverage on those most likely to benefit could improve the effectiveness and efficiency of insurance expansion. This article is part of a Special Collection on Mental Health. [ABSTRACT FROM AUTHOR]

Courts never tire of saying an insurance policy is "just a contract" and subject to ordinary rules of contract law. Contract here signals a plain language approach that strives for formal neutrality between the parties. Yet courts also frequently rely on a narrative that an insurance policy strives to be a 'just contract" with special pro-policy holder rules that reach beyond the plain language. How is insurance simultaneously "just a contract" and a 'just contract? " Prior scholarship has noted the confusion, but this Article aims to reconcile the dueling narratives. When the issue relates to scope or breadth of coverage--whether a loss is included within the bounds of the policy--strict construction gains the upper hand. But when the focus is on the suite of rights that flow from coverage--such as expanded remedies available upon an insurer breach--courts craft coverage rights which are deeper than what can be derived from the plain meaning of the policy. This distinction makes sense considering the degree of uncertainty posed in each setting. Broadening a policy to risks beyond its coverage base threatens to upend the match between risks and premiums. By contrast, the cost of deeper insurance is derivative of risks already assumed by the policy and thus more predictable to the insurer. This analysis gives courts a framework to understand when they should treat insurance law differently from contract law. Furthermore, because plain language exerts a strong pull over the entire landscape of contract law, clearly presenting counterexamples and their rationale should prevent courts from importing plain language concepts into areas of insurance law that are anchored on competing normative foundations. [ABSTRACT FROM AUTHOR]

Sleep disorders impact at least 10 % of children, pose risks to overall wellbeing, and are key targets of preventive interventions. The objectives of this study were to describe the prevalence of pediatric sleep disorder diagnoses across sociodemographic characteristics and co-occurring conditions, and to explore potential sociodemographic disparities. Cross-sectional analysis of 12,394,902 children (0–17 years; 50.9 % Medicaid-insured) in the 2017 MarketScan database. Prevalence was assessed utilizing ICD-10 codes, with multivariate logistic regressions examining disparities (insurance coverage; race and ethnicity in Medicaid-insured) for diagnoses in ≥0.10 % of children. The prevalence of sleep disorder diagnoses was 2.36 %. The most common diagnoses were obstructive sleep disordered breathing (oSDB, 1.17 %), unspecified sleep disorders (0.64 %), insomnia (0.52 %), and other SDB (0.10 %), with <0.10 % for all other diagnoses. Insomnia and parasomnias diagnoses were much lower than diagnostic estimates. Sleep diagnoses were more prevalent in Medicaid versus commercially insured youth, 2-5-year-olds, and in children with co-occurring medical, neurodevelopmental, or behavioral health conditions. Girls and boys were generally equally likely to be diagnosed with any sleep disorder. In Medicaid-insured children, white children were more likely to have any sleep diagnosis compared to all other racial and ethnic groups. Black/African American children were more likely than white children to have oSDB. Compared to diagnostic estimates, claims data suggest sleep disorders are under-diagnosed, with notable sociodemographic disparities. Findings suggest a need for clinical resources to identify and address sleep disorders and to understand biases potentially driving disparities, given that sleep is a modifiable determinant of child wellbeing. • Only 2.36 % of >12,000 children had a sleep disorder diagnosis on an insurance claim. • Diagnosis rates were especially low for insomnia and parasomnias. • Findings suggest an urgent need for equitable sleep disorder identification and care. [ABSTRACT FROM AUTHOR]

Objective Measles immunity testing, unlike that for rubella, is not currently part of prenatal screening even though immunity to both is conferred by the measles–mumps–rubella (MMR) vaccine. Although endemic transmission of measles was declared eliminated in the United States in 2001, outbreaks have continued to occur. Given the risks associated with measles infection during pregnancy, we sought to identify risk factors for measles nonimmunity (MNI) in rubella-immune (RI) pregnant individuals. Methods We performed a retrospective observational cross-sectional study of patients receiving prenatal care and delivering at two university hospitals and a county hospital in Southern California from April 1, 2019 to February 1, 2021. Inclusion criteria were pregnant individuals ≥18 years old who had serological testing for rubella and measles during pregnancy. Demographic data were extracted from electronic medical records, including results of serological testing and chronic medical conditions. All subjects were rubella immune, and we compared measles-immune (MI) with MNI groups. Results In total, 1,813 RI individuals were identified, with 1,467 (81%) MI and 346 (19%) MNI individuals. Variables associated with an increased risk of MNI included having public health insurance (adjusted relative risk [aRR]: 1.56; 95% confidence interval [CI]: 1.24, 1.97) and Hispanic ethnicity (aRR: 1.37; 95% CI: 1.06, 1.78). Black race was associated with a decreased risk of MNI (aRR: 0.52; 95% CI: 0.29, 0.91). Birth year before 1989 demonstrated a trend toward increased risk of MNI, but this did not reach statistical significance (aRR 1.23; 95% CI: 1.00, 1.52). No differences were seen between the two groups for medical comorbidities. Conclusion Our study is the first to demonstrate risk factors for measles MNI in patients with documented rubella immunity. In the absence of universal measles serological screening recommendations, the risk factors identified could help guide clinicians in selective screening for those at risk of needing postpartum MMR vaccination. Key Points The rate of measles nonimmunity is higher than previously reported. Hispanic ethnicity and use of public insurance are risk factors for measles nonimmunity. The current recommendation for history-based screening for measles immunity is likely insufficient. [ABSTRACT FROM AUTHOR]

Introduction: Despite advances in atopic dermatitis (AD) treatments, many patients face challenges obtaining medications. This study aimed to determine the frequency and causes of insurance coverage delays and denials for AD prescriptions and characterize the associated wait times and extent to which patients understand what to do when faced with a coverage issue. Methods: This was a cross-sectional, observational study in which adult U.S. residents (aged 18+ years) with AD or caregivers of pediatric U.S. patients with AD (aged 0–17 years) completed an online survey (3 June–16 July 2021). Results: Respondents (N = 978) were primarily adults with AD (81.8%), female (67.7%), and white (70.2%). There were 645 insurance delays or denials for AD prescriptions, with 48.1% (470/978) of respondents experiencing at least one delay/denial in the past year. Most delays/denials were for topical steroids (39.2%, 253/645), the most highly used prescription treatment class (83.9%, 821/978). However, the highest rate of delay/denials was for biologics, of which 43.6% (109/250) of all prescriptions faced a delay or denial. Denials were caused primarily by step therapy (27.6%) and delays by prior authorization (55.1%). Only 56.0% of respondents said they would know what to do if they faced an issue with AD prescription coverage. Conclusions: Patients with AD frequently experience insurance-related barriers to obtaining recommended therapies, and many do not know how to respond when these barriers arise. Strategies to improve timely therapeutic access are needed. [ABSTRACT FROM AUTHOR]

Climate change is fundamentally destabilizing the private insurance industry, with many high-profile insurance companies exiting states in the face of catastrophic, climate-induced risk. This rapid "insurance retreat" represents a major market signal in response to climate-exacerbated risks. Private businesses are making actuarial decisions, assessing that some locations are just too vulnerable to insure. At the same time, this insurance retreat also poses a policy challenge for states as they react to the mounting insurance gaps left by exiting private insurers. This Article analyzes insurance retreat, its attendant policy challenges, and the lessons that can be drawn from state responses. It first describes the causes and effects of private insurance retreat. Then, the Article examines different potential policy responses to insurance retreat, including interventions modeled after the federal National Federal Insurance Program (NFIP) as well as state insurance programs in California, Florida, and Louisiana. Finally, the Article offers a comparative analysis of these different policy response options. It observes that existing policies differ substantially along two important dimensions: 1) extent of government intervention, and 2) prioritization of physical risk concerns versus financial transition concerns. It also explores how the different state programs show surprisingly diverse policy approaches and how--contrary to assumptions--many do not actually subsidize insurance affordability. Through these observations, the Article uncovers unexpected examples of state insurance policies complementing, rather than contravening, pricing signals sent by private insurance retreat. [ABSTRACT FROM AUTHOR]

Private insurers are declining to issue or renew homeowner policies in California, Colorado, Florida, and Louisiana following massive payouts due to hurricane and wildfire damage in recent years. As climate change worsens, more private insurers will withdraw from property insurance markets. Governments, particularly at the state level, will likely expand their insurance programs to fill the gap. Just as the federal government now underwrites most flood insurance policies, public insurers will come to dominate the fire and wind insurance markets. Property insurance can generate price signals reflecting the risks of living in climate-vulnerable areas. However, public insurance programs often prioritize insurance availability and affordability while muting or eliminating accurate price signals. Because premiums collected by public insurance programs usually do not cover the payouts that follow a catastrophic event, expanding these programs could prove financially disastrous. Unfortunately, by offering underpriced coverage, such programs have encouraged development in climate-vulnerable areas, such as floodplains and the wildland-urban interface. Managed retreat policies aim to move people and communities out of climate-vulnerable areas. Typically involving public buyouts of private property, managed retreat can mitigate the damage associated with climate change, counter inefficient building practices, and facilitate disaster recovery. Yet managed retreat is logistically and politically challenging, and buyout programs thus far have had limited impact. Linking public insurance with buyouts can promote access to insurance coverage, break the disaster-rebuild cycle, and jump-start the relocation of people and communities from climate-vulnerable areas. This Article proposes that public insurance coverage in climate-vulnerable areas be made contingent on insureds agreeing to buyouts if property damage exceeds a predetermined threshold amount. If a covered event causes property damage above the threshold, the government will choose between paying on the insurance policy or purchasing the property. The government's choice would depend on funding availability, the value of the property as open space, the presence of other buyout properties nearby, the history of repetitive loss, and other relevant factors. The proposed mechanism, which can be incorporated into federal or state-backed insurance programs, would make the most of disaster-caused damage by compelling retreat after such damage has occurred. It would also sidestep some of the difficulties that have hampered voluntary buyout programs. Part I of this Article discusses the growing reluctance of private insurers to offer policies in climate-vulnerable areas, the accompanying rise of state-backed insurance, and ongoing managed retreat efforts. Part II considers the objectives of public insurance programs. Part III shows how governments might try to advance these objectives as climate change worsens. In the context of a dramatically expanded government role as an insurer of last resort, the proposal can facilitate managed retreat without compromising these objectives. [ABSTRACT FROM AUTHOR]

Economic freedom has central importance among the nations, however, Chinese economic freedom index declining continuously, leading to the several issues. Particularly, economic freedom is low among the Chinese female population. The world average of economic freedom index in 2022 based on 175 countries is 60 index points, but the Chinese index is 48. To address this issue, this study introduced green microfinance institutions based on Mayoux’s Feminist Empowerment Theory. The objective of this study is to examine the role of green microfinance institutions in women economic freedom in China. A survey questionnaire is used to collect data from female clients of microfinance institutions. 315 respondents responded to the survey and data analysis is carried out by using Structural Equation Modeling (SEM). Results of the study identified that, green microfinance institution’s services such as credit and insurance can facilitate green micro enterprises. The promotion of green micro enterprises causes to increase women economic security, leading to the economic freedom. Additionally, green microfinance policy is a critical factor to promote the positive relationship between green microfinance institution’s services and women economic freedom. Findings of this are helpful for the practitioners to increase women economic freedom in China by providing various services of green microfinance institutions. [ABSTRACT FROM AUTHOR]

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]

Background and Objectives Medicaid look-back periods are meant to prevent Medicaid applicants from gifting assets to meet eligibility requirements. These policies have the potential to affect families across generations given their ability to restrict the transfer of assets between parent and child. Research Design and Methods Using 2008–2018 data from the Health and Retirement Study, this study analyzed the estate planning and familial wealth transfer behaviors of a cohort of older adults aged 65 and older who became Medicaid recipients during a 10-year period. Results There were 8,347 respondents aged 65 and older in 2008 and 11.96% of respondents who were not Medicaid recipients at baseline became recipients over the study period. A little more than one third (36.47%) of Medicaid recipients participated in estate planning and asset transfer prior to becoming a recipient, with significant differences among select demographic characteristics. Married recipients were more likely to transfer money compared to their widowed counterparts (51.69% compared to 36.44%; p <.001) and transferred larger amounts compared to those unmarried ($16,286.94 compared to 5,379.13). White, well-educated, married, men participated in higher rates of estate planning, likely a reflection of who has access to resources to make necessary arrangements early. Discussion and Implications This analysis concludes that more structurally advantaged groups are more likely to engage in estate planning prior to Medicaid enrollment. This analysis demonstrates that some individuals may circumvent Medicaid policies like look-back periods and estate recovery, while others cannot. Policymakers should consider policies that promote the financial health of low-income families. [ABSTRACT FROM AUTHOR]

This article is the sixth in the Movement is Life series and focuses on insurance coverage and medication management in the perioperative period, 2 tangentially related variables that affect patient outcomes. Our aim is to use current practices and literature to develop recommendations for nurse navigators' execution of preoperative optimization protocols related to payer status and medication management. Discussions with nurse navigators and a literature search were used to gather information and develop recommendations specific to optimizing payer status and medication management. Nurse navigators connected patients to resources and provided education regarding financial concerns and medications, and findings from the literature discussed insurance status among TJA patients. Nurse navigators can contribute to payer status and medication management optimization by providing patient education and resource referrals. In addition, we recommend conducting repeated medication reconciliation and developing awareness of financial resources and perioperative medication management guidelines. [ABSTRACT FROM AUTHOR]

Background: Obtaining insurance approval is a necessary component of healthcare in the United States and denials of these claims have been estimated to result in a loss of 3% to 5% of revenue. Objective: Examine the trends in insurance denials for rhinological procedures. Methods: A retrospective review of deidentified financial data of patients who were treated by participating physicians across 3 institutions from January 1, 2021, to June 30, 2023. The data was queried for rhinological and non-rhinological procedures via CPT codes. Cumulative insurance denials were calculated and stratified by procedure and insurance type. Write-offs were dollar amounts associated with final denials. Results: A sample of 102,984 procedures and visits revealed a final denial rate between 2.2% and 2.9% across institutions (p =.72). The top three rhinological procedures for final write-offs were: nasal endoscopy (16.24%, $111,836.87), nasal debridement or polypectomy (6.48%, $79,457.51), and destruction of intranasal lesion (2.11%, $56,932.20). The write-off percentage for each procedure was highest among commercial insurance payers as opposed to Medicare or Medicaid. Conclusion: Final denial rates of rhinology procedures ranged between 2% and 3%. Common procedures such as nasal endoscopy and nasal debridement are among the highest written-off procedures. Insurance denials can lead to notable revenue loss. Rhinology practices must continue to remain knowledgeable of the changes and effects of insurance reimbursement on their practice. [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]

Yogyakarta, an Indonesian province prone to earthquakes, frequently suffers extensive damage to buildings, necessitating insurance coverage to mitigate potential losses. This study aims to forecast earthquake insurance premiums by predicting building damage levels resulting from earthquakes. Utilizing data from buildings affected by the June 30, 2023, earthquake in Yogyakarta, we employ K-Medoids Clustering and Support Vector Machine (SVM) to predict two categories of building damage: minor (labelled as 1) and heavy (labelled as 2). The total premiums for minor damage range from approximately USD 86.55 to USD 288.50, while for heavy damage, they range from USD 120.05 to USD 400.18 using the K-Medoids algorithm. Meanwhile, premiums for minor damage range from USD 83.14 to USD 277.13, and for heavy damage, they range from USD 223.67 to USD 745.55 using the SVM algorithm. [ABSTRACT FROM AUTHOR]

With the passage of IRDA Act 1999, Insurance Industry was opened to private companies and as of now we have 70+ Insurance Companies in India including Life, General and Reinsurance Branches. In order to encourage technological innovation IRDAI has constituted Sandbox committee which allows insuretech companies to innovate products and adopt Use and Tile instead of File and Use. Artificial Intelligence and Data Analytics started impacting businesses across spectrum positively. Insurance Industry is no exception. Role of Artificial Intelligence has only quadrupled in recent years. What started as a Sandbox moment approved by regulator has taken a giant leap with the advent of AI, Block chain and Analytics? This paper is to highlight key developments in Insurance Industry adopting Artificial Intelligence, Block chain and Analytics. [ABSTRACT FROM AUTHOR]

The main objective was to examine the various enforcement action (penalties) which were imposed by IRDAI on Life and General insurance industry for violation of various insurance rules and regulations. The research was a fact-finding descriptive research based on historical penalty orders published by IRDAI. After analysing the 67 orders published on IRDAI website, it was found that penalty amounting to Rs 1190 lakhs was imposed on general insurers and Rs 206 lakhs was imposed on life insurers. Total penalty amount combined for life and general insurers was 1396 lakhs. Out of which 607 lakhs (43.48%) was related to uncommon category violation and 789 lakhs (56.52%) was related to common category violation between life and general insurers. Total frequency of violation for general and life insurance industry combined was 127 times, with common category violation was 101 times (79.52%) and uncommon category violation was 26 times (20.48%). [ABSTRACT FROM AUTHOR]

The article describes the contribution of insurance in financial and social inclusion in society. The article presents a picture of past initiatives of the Indian insurance sector to promote financial and social inclusion in India, the future plans and the challenges ahead in achieving this aim. It also highlights the role of digital technology in helping the insurance sector achieve financial and social inclusion. [ABSTRACT FROM AUTHOR]

Insurance has proven to be a key driver of economic and social inclusion in India, with activities ranging from disaster management to empowering marginalized communities. This article examines the impact of insurance in several dimensions on financial empowerment and societal welfare. Discussing the case studies of various global programs, it highlights the transformative potential of insurance in this regard. In India's economic environment where a large portion of the population lacks adequate access to financial services, insurance is a powerful tool for promoting financial inclusion and addressing social disparities. The article discusses how insurance enhances financial resilience, promotes social welfare, and promotes inclusive growth. Furthermore, the article explores policy initiatives and industry innovations that have facilitated India's inclusive insurance journey. This article sincerely tries to establish the effectiveness of "the insurance pill" in managing risks and promoting economic and social inclusion in the Indian context. [ABSTRACT FROM AUTHOR]

Developed economies like USA, UK etc. have utilised insurance as a supplementary tool for creating a protected society by strengthening the existing social security net through affordable health insurance programmes, pension and annuity insurance plans, liability insurance etc. In comparison, insurance in India is still seen as an investment tool, rather than as a risk mitigation mechanism. Though Government has taken measures to replicate the model followed in West through social security schemes like Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY), Pradhan Mantri Suraksha Bima Yojana (PMSBY), Pradhan Mantri Jan Arogaya Yojana (PMJAY) etc., but still a large section of the society perceives insurance as a means to get tax benefits, instead of a buffer to protect against financial losses in case of an unfortunate event. Protection Gap which is a measure of the uninsured losses of a country, is significantly higher for India when compared to other developed or developing nations. The mortality protection gap in life insurance, which dominates the Indian insurance industry, is at staggering 87% as per a survey done by National Insurance Academy. Despite health insurance being the top contributor under non-life segment in India, the health protection gap stands at 73%. The estimated pension protection gap is even higher at 93%. Thus, it becomes imperative for the Indian insurance industry to bridge these gaps through high decibel awareness campaigns, so that citizens can leverage insurance as a tool for financial protection (and not as substitute for return-oriented investments) and reap its real benefits. [ABSTRACT FROM AUTHOR]