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Objective: The aim of this study is to explore policy paths towards private health insurance (PHI) reform that might reduce out-of-pocket costs, restore public confidence and allow insurers to finance value-based care. Methods: This study used thematic analysis of semi-structured interviews with informed opinion holders, including a politician, three former senior public servants and an industry lobbyist. Critical analysis of peer reviewed and grey literature was also conducted. Results: PHI regulation is contributing to unexpected out-of-pocket expenses and low-value care. Modification of existing tax incentives would be incapable of significantly increasing PHI coverage. Regulatory reform could restore confidence among policy holders by promoting value-based care, wherein health outcomes are measured and incentivised with remuneration. Conclusions: Targeted relaxation of out-of-hospital restrictions should be explored to promote value-based competition and facilitate bundled payments for chronic disease management and community services. To address out-of-pocket diagnostic and procedural costs, insurers should have more responsibility for private specialist's fees, including by financing the entire provider's bill through insurance and redirecting the Medicare Benefits Schedule fee to the insurer. What is known about the topic?: Healthcare expenditure and out-of-pocket costs have grown rapidly, while confidence and depth of coverage in private health insurance has declined, as has the fiscal appetite for expanding public financing for health care. What does this paper add?: This paper outlines the regulatory and policy factors that are contributing to low-value care and unmet expectations from insurance policy holders. It also maps the strategic terrain of the non-government health sector and considers feasible policy options for reforming the PHI industry that do not increase drawings on the public purse. What are the implications for practitioners?: An appreciation of the ongoing challenges to financing value-based care provision will inform key stakeholders, including policymakers and health service providers, as reforms are debated and implemented. [ABSTRACT FROM AUTHOR]

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

The article focuses on the cybersecurity landscape in 2024. It highlighting the rising threat of cybercrime in Australia, particularly targeting small enterprises and the increasing sophistication of cyber attacks; supply chain attacks and social engineering campaigns; the surge in cybercrime reports; strategies for strengthening cybersecurity defenses for small to medium enterprises (SMEs); and the role of cyber insurance in mitigating the impact of cyber attacks.

In most of the United States, insurance companies may use gender to determine car insurance rates. In addition, several studies have shown that women over the age of 25 generally pay more than men for car insurance. Then, we investigate whether the distributions of claims for women and men differ in location, scale and shape by means of the GAMLSS regression framework, using microdata provided by U.S. and Australian insurance companies, to use this evidence to support policy makers' decisions. We also develop a parametric-bootstrap test to investigate the tail behavior of the distributions. When covariates are not considered, the distribution of claims does not appear to differ by gender. When covariates are included, the regressions provide mixed evidence for the location parameter. However, for female claimants, the spread of the distribution is lower. Our research suggests that, at least for the contexts analyzed, there is no clear statistical reason for charging higher rates to women. While providing evidence to support unisex insurance pricing policies, given the limitations represented by the use of country-specific data, this paper aims to promote further research on this topic with different datasets to corroborate our findings and draw more general conclusions., (© 2024. The Author(s).)

Purpose: This study aimed to explore individuals' experiences of return to work (RTW) following minor to serious road traffic injury (RTI) in Queensland, Australia; seek their recommendations if any, on how to provide support for RTW after RTI; and identify the strategies and resources used to return and remain at work after their RTI., Methods: The interpretive description methodological approach was used. Semi-structured interviews were conducted with eligible participants ( n  = 18) aged 18-65 y who had experienced a minor to serious RTI at least 6 months earlier. Thematic analysis was used to analyse the data., Results: Five themes emerged: (1) physical and mental consequences of RTI negatively impact RTW; (2) money matters; (3) RTW support makes a difference; (4) feeling alone and confused in the RTW process; and (5) several strategies and resources helped with return/stay at work after RTI. Regular contact and cooperation with employers and insurers, job modifications, and using social media to obtain information and social support were helpful RTW strategies. Participants recommended timely and appropriate medical care, financial assistance, and educational support., Conclusions: Policy changes to reduce financial stress, increase employer support, and improve injured individuals' knowledge following a RTI are recommended in jurisdictions operating a fault-based scheme.IMPLICATIONS FOR REHABILITATIONThis study identified several factors that can influence return to work (RTW) following minor to serious road traffic injuries (RTIs) in a jurisdiction operating a fault-based compensation scheme.Legislative changes that provide financial assistance to all injured people regardless of their fault-status could reduce financial stress arising from reduced work ability following a road traffic injury.Increasing employer' awareness of the importance of return to work for those with road traffic injuries and reimbursement for possible expenses of providing RTW support for these individuals could increase employability of injured people following RTI.Improving injured individuals' knowledge about return-to-work processes after a road traffic injury could accelerate recovery and return to work.

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]

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

The article discusses Australia an agricultural nation diverse climates which translates into significant sources of risk for agricultural production and subsequent farm revenues contributing to an increase in the vulnerability of crops. Topics include crop insurance products, including classical claim-based and index-based insurance, that allow exposed individuals to pool resources to spread risk; and the impact of multiple synoptic-scale climate mode indices on crop yield.

Australian health policy has prioritized efforts to close the ten-year life expectancy gap between indigenous and nonindigenous Australians, a disparity largely driven by cardiovascular disease and diabetes. Because out-of-pocket spending poses a barrier to accessing medications for chronic conditions, in 2010 the Australian government reduced or eliminated medication copayments for indigenous people with chronic disease or risk factors for chronic disease. In this quasiexperimental study we found that the copayment reductions were associated with a 39 percent relative increase in the use of medications and a 61 percent reduction in out-of-pocket spending. Among indigenous Australians who qualified for the largest copayment reductions, overall use of medications increased by 156 percent--including increases of 26-109 percent in the use of lipid-lowering, hypertension, and diabetes medications. These findings suggest that Australia's novel strategy of targeted copayment reductions improved access to prescription medications among indigenous Australians, a population with a high burden of chronic conditions and marked social disadvantage. [ABSTRACT FROM AUTHOR]

Trust is commonly understood as a mechanism that acts to improve transaction efficiency, or as a structural characteristic of organizations. It is a 'good' thing that can be built and harnessed for economic success. However, this type of conceptualisation maintains trust as a discrete and internally stable entity that is universally applied and cordoned off from socio-spatial complexities. In this paper, we present an empiric on trust in the insurance industry with an eye to reports on declining trust in banks, financial institutions and government. Analysing data from two Australian surveys, we map the social and political correlates of having house and contents insurance, consider how knowledge of insurance related issues and trust in insurance companies is associated with house and contents insurance, and measure how much trust Australians place in insurance companies relative to other public institutions. We use our findings as a spring broad for considering more spatialised understandings of trust and conclude by providing signposts for further geographical trust research - the first, qualitative investigations of the spaces and places of trust and its correlates, and the second, using geodemographics for mapping trust's socio-spatial variegations. In this we contribute to research into the socio-spatial variegations of financial processes and technologies, as well as contributing to work on institutional trust. [ABSTRACT FROM AUTHOR]

An editorial is presented on World Health Assembly Resolution. Emergency Care (EC) systems are poorly developed in a majority of low- and middle-income countries (LMICs), and there is a significant unmet need for acute care. To facilitate global EC capacity development, the World Health Organization (WHO) has devised a framework to describe the essential functions of EC systems.

Background: Current evidence suggests that preimplantation genetic testing for aneuploidy (PGT‐A) used during assisted reproductive technology improves per‐cycle live‐birth rates but cumulative live‐birth rate (CLBR) was similar to a strategy of morphological assessment (MA) of embryos. No study has assessed the cost‐effectiveness of repeated cycles with PGT‐A using longitudinal patient‐level data. Aim: To assess the cost‐effectiveness of repeated cycles with PGT‐A compared to MA of embryos in older women. Materials and Methods: Micro‐costing methods were used to value direct resource consumption of 2093 assisted reproductive technology‐naïve women aged ≥37 years undergoing up to three 'complete assisted reproductive technology cycles' (fresh plus cryopreserved embryos) with either PGT‐A or MA in an Australian clinic between 2011 and 2014. Incremental cost‐effective ratios were calculated from healthcare and patient perspectives with uncertainty assessed using non‐parametric bootstrap methods. Cost‐effectiveness acceptability curves were constructed to evaluate the probability of PGT‐A being cost‐effective over a range of willingness‐to‐pay thresholds. Results: The CLBR and mean healthcare costs per patient were 30.90% and $22 962 for the PGT‐A group, and 26.77% and $21 801 for the MA group, yielding an incremental cost‐effective ratio of $28 103 for an additional live birth with PGT‐A. At a willingness‐to‐pay threshold of $50 000 and above, there is more than an 80% probability of PGT‐A being cost‐effective from the healthcare perspective and a 50% likelihood from a patient perspective. Conclusion: This is the first study to use real‐world patient‐level data to assess the cost‐effectiveness of PGT‐A in older women from the healthcare and patient perspectives. The findings contribute to the ongoing debate on the role of PGT‐A in clinical practice. [ABSTRACT FROM AUTHOR]

• Presents a typology of emergent risk that highlights the iterative and inter-related nature of climate change risk, and propensity for impacts, such as legal action and reduced debt access, to emerge subsequent to, yet far removed from, initial physical impacts. • Highlights current practice and gaps in local government risk management concerning emergent risk. • Highlights the potential and need for local government to consider, the application of risk transfer mechanisms such as catastrophe bonds in the face of historical and conceivable climate change-perpetuated reduced access to, and increased cost of, traditional mechanisms such as insurance. • Provides insight into barriers and enablers to local government agencies gaining an appreciation of the potential application of alternative risk transfer mechanisms. Insurance represents an integral part of local government risk management strategy. As climate change progresses, increased loss and risk related to extreme weather events such as tropical cyclones, could motivate insurers to withdraw from certain markets. In some regions, such a withdrawal represents an emergent risk that, when coupled with increasing populations and other climate change impacts, could leave local governments and ratepayers particularly vulnerable. This paper investigates such a scenario and its ramifications in the context of a region particularly vulnerable to climate change, through an exploration of the degree that consideration of emergent risks, such as loss of insurance, and the potential application of insurance alternatives influence Queensland local government risk management. The study finds little appreciation amongst government officials of emergent risk implicit in extreme weather events such as cyclones, little understanding of the nuances of risk transfer mechanisms beyond familiar traditional insurance and disaster funding mechanisms, and by default, a lack of appreciation of the relationship between the two. A lack of resource and leadership with respect to emergent risk, and an absence of dialogue between insurance brokers and local government concerning climate change risk arise as the main reasons for this result. This research is significant because it challenges current local government risk management practice through an exploration of the risks inherent in the process itself. This has potential social, economic and ecological ramifications in drawing attention to aspects of possible "uninsurability" and prospects of alleviation thereto. Further research is recommended to consider the insurance industry's part in this study's findings in order to inform current industry practice and thinking and further enlighten the causes of local government disengagement in this critical area. [ABSTRACT FROM AUTHOR]

Background: Little is known about the sociodemographic and clinical characteristics of adverse drug events (ADEs) in patients with neurodevelopmental disorders (NDD). Objective: The objective of this study was to describe and compare the demographic details of people with and without NDD hospitalised due to ADEs. Methods: The all‐inclusive New South Wales Admitted Patient Data Collection from 2001 to 2014 was employed to identify ADE‐related hospitalisations in patients with NDD using the International Classification of Diseases 10th revision Australian modification codes. We derived case sets specific to different clinical groups and patient characteristics and compared proportional differences between patients with and without intellectual disability using chi squared tests. Results: A total of 2173 patients with NDD were admitted for acute care of ADEs, accounting for 0.7% of all ADE‐related hospitalisations. Hospitalised ADEs among patients with NDD increased by twofold over the 14‐year study period. Psychotropic medications and opioid analgesic medications were leading causes of ADE‐related hospitalisations in patients with NDD. Compared with their counterparts, patients with NDD were younger, experienced more socio‐economic disadvantage and less private insurance coverage, suffered with less severe but different co‐morbid clinical conditions and incurred more challenges in the acute hospital care setting. Conclusion: Although the pattern of ADE‐related hospitalisations in patients with NDD differed from that in patients without NDD, there is a lack of targeted healthcare programmes to meet their special needs. This study suggests the need for countermeasures in primary healthcare settings to reduce the burden of ADEs in this vulnerable group. [ABSTRACT FROM AUTHOR]

Purpose Many industrialised nations have systems of injury compensation and rehabilitation that are designed to support injury recovery and return to work. Despite their intention, there is now substantial evidence that injured people, employers and healthcare providers can experience those systems as difficult to navigate, and that this can affect injury recovery. This study sought to characterise the relationships and interactions occurring between actors in three Australian injury compensation systems, to identify the range of factors that impact on injury recovery, and the interactions and inter-relationships between these factors. Methods This study uses data collected directly from injured workers and their family members via qualitative interviews, analysed for major themes and interactions between themes, and then mapped to a system level model. Results Multiple factors across multiple system levels were reported by participants as influencing injury recovery. Factors at the level of the injured person's immediate environment, the organisations and personnel involved in rehabilitation and compensation processes were more commonly cited than governmental or societal factors as influencing physical function, psychological function and work participation. Conclusions The study demonstrates that injury recovery is a complex process influenced by the decisions and actions of organisations and individuals operating across multiple levels of the compensation system. Changes occurring 'upstream', for instance at the level of governmental or organisational policy, can impact injury recovery through both direct and diffuse pathways. [ABSTRACT FROM AUTHOR]

Background: Disease management programmes may improve quality of care, improve health outcomes and potentially reduce total healthcare costs. To date, only one very large population-based study has been undertaken and indicated reductions in hospital admissions > 10%.Objective: We sought to confirm the effectiveness of population-based disease management programmes. The objective of this study was to evaluate the relative impact on healthcare utilisation and cost of participants the Costs to Australian Private Insurance - Coaching Health (CAPICHe) trial.Design: Parallel-group randomised controlled trial, intention-to-treat analysis SETTING: Australian population PARTICIPANTS: Forty-four thousand four hundred eighteen individuals (18-90 years of age) with private health insurance and diagnosis of heart failure, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), diabetes, or low back pain, with predicted high cost claims for the following 12 months.Intervention: Health coaching for disease management from Bupa Health Dialog, vs Usual Care.Main Outcome Measures: Total cost of claims per member to the private health insurer 1 year post-randomisation for hospital admissions, including same-day, medical and prostheses hospital claims, excluding any maternity costs. Analysis was based on the intent-to-treat population.Results: Estimated total cost 1 year post-randomisation was not significantly different (means: intervention group A$4934; 95% CI A$4823-A$5045 vs control group A$4868; 95% CI A$4680-A$5058; p = 0.524). However, the intervention group had significantly lower same-day admission costs (A$468; 95% CI A$454-A$482 vs A$508; 95% CI A$484-A$533; p = 0.002) and fewer same-day admissions per 1000 person-years (intervention group, 530; 95% CI 508-552 vs control group, 614; 95% CI 571-657; p = 0.002). Subgroup analyses indicated that the intervention group had significantly fewer admissions for patients with COPD and fewer same-day admissions for patients with diabetes.Conclusions: Chronic disease health coaching was not effective to reduce the total cost after 12 months of follow-up for higher risk individuals with a chronic condition. Statistically significant changes were found with fewer same-day admissions; however, these did not translate into cost savings from a private health insurance perspective. [ABSTRACT FROM AUTHOR]

Objective: Provincial and territorial governments are considering how best to improve access to psychotherapy from the current patchwork of programmes. To achieve the best value for money, new funding needs to reach a wider population rather than simply replacing services funded through insurance benefits. We considered lessons for Canada from the relative uptake of private insurance and public funding for allied health psychotherapy in Australia.Method: We analysed published administrative claims data from 2003-2004 to 2014-2015 on Australian privately insured psychologist services, publicly insured psychotherapy under the 'Better Access' initiative, and public grant funding for psychotherapy through the 'Access to Allied Psychological Services' programme. Utilisation was compared to the prevalence of mental disorders and treatment rates in the 2007 National Survey of Mental Health and Wellbeing.Results: The introduction of public funding for psychotherapy led to a 52.1% reduction in private insurance claims. Costs per session were more than double under private insurance and likely contributed to individuals with private coverage choosing to instead access public programmes. However, despite substantial community unmet need, we estimate just 0.4% of the population made private insurance claims in the 2006-2007 period. By contrast, from its introduction, growth in the utilisation of Better Access quickly dwarfed other programmes and led to significantly increased community access to treatment.Conclusions: Although insurance in Canada is sponsored by employers, psychology claims also appear surprisingly low, and unmet need similarly high. Careful consideration will be needed in designing publicly funded psychotherapy programmes to prepare for the high demand while minimizing reductions in private insurance claims. [ABSTRACT FROM AUTHOR]

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

The expansion of genetic and genomic testing in clinical practice and research and the growing market for at home personal genome testing has led to increased awareness about the impact of this form of testing on insurance. Genetic or genomic information can be requested by providers of mutually rated insurance products, who may then use it when setting premiums or determining eligibility for cover under a particular product. Australian insurers are subject to relevant legislation and an industry standard that was updated in late 2016. In 2018, the Human Genetics Society of Australasia updated its position statement on genetic testing and life insurance to account for these changes and to increase the scope of the statement to include a wider scope of insurance products that are not rated according to community risk, such as life, critical care, and income protection products. Recommendations include that providers of professional education involving genetics should include ethical, legal, and social aspects of insurance discrimination in their curricula; that the Australian government take a more active role in regulating use of genetic information in personal insurance, including enacting a moratorium on use of genetic test results; that information obtained in the course of a research project be excluded; and that there is improved engagement between the insurance industry, regulators, and the genetics profession. [ABSTRACT FROM AUTHOR]

The article offers health fund news briefs in Australia as of December 2018. Australian Traditional Medicine Society (ATMS) membership does not equate with provider status with all health funds, as it is subject to eligibility requirements. A Certificate IV or higher from a registered training organisation is required for remedial and Chinese massage therapists who graduated after March 2002. Special provider numbers are required for Bowen Therapy, Kinesiology, and Reflexology providers.

In undertaking what we believe is the first national-scale study of its kind, we provide methodologically transparent, statistically robust insights into associations and potential unfolding effects of house and contents under-insurance. We identify new dimensions in the complex relationship between householders and insurance, including the salience of interpersonal – and likely institutional – trust. Under-insurance is (re)produced along socio-economic and geographical lines, with those of lower socio-economic status or living in cities more likely to be under-insured. Should a disaster strike, such communities are likely to suffer further disadvantage, especially if governments continue to shift the responsibility for risk onto households. Our findings support the observation that insurance can contribute to increasing socio-economic urban polarisation in light of natural disasters. We conclude by considering how under-insurance may contribute to growing urban social stratification, as well as how it may produce situated ethical and political responses that exceed neoliberal aspirations. [ABSTRACT FROM AUTHOR]

People with intellectual disability and complex support needs challenge human rights in the current disability policy and practice framework in Australia. With the implementation of the National Disability Insurance Scheme (NDIS) in Australia, it is pivotal to understand how human rights can offer a framework for understanding these challenges. There are complex issues and challenges in operationalising support for the human rights of people with intellectual disability. Their experience is characterised by overlapping and compounding forms of discrimination, abuse and vulnerability in their social and systemic interactions. This article uses qualitative content analysis to describe and articulate disadvantages and challenges of this group, and maps this onto the United Nations Convention on the Rights of Persons with Disabilities and current policies and practices in Australia. The article concludes that utilising human rights instruments helps to recognise the multiple disadvantages faced by people with intellectual disability and complex support needs and focus on the specific areas that need to be addressed in policy and practice. [ABSTRACT FROM AUTHOR]

The article presents the discussion on environmental sustainability being a key issue associated with pharmaceutical use in Australia. Topics include pharmaceutical pollution being well-established threat to ecosystems with harmful effects on animal and plant life, and human health; and minimising the effects of pharmaceuticals on the environment by optimising prescription practices and educating patients.

The article reports on the health insurance provider eligibility of Australian Traditional Medicine Society (ATMS) members. Topics discussed include the changes in the private health insurance coverage of natural therapies as of April 2019, the submission of the ATMS Health Fund Application and Declaration Form, and the eligibility requirements of insurers such as the Australian Health Management (AHM), Australian Regional Health Group (ARHG), and Doctors Health Fund (DHF).

The article offers natural medicine news briefs as of December 2021. The Australian government excludes certain natural therapies from private health insurance under implemented reforms. Also cited are the accreditation of Australian Traditional Medicine Society (ATMS) members as authorized providers, and the terms and conditions of provider status for individual health funds.

Objectives: To investigate the injury characteristics and insurance cost of anterior cruciate ligament injuries in sub-elite football players in New South Wales, Australia., Design: Descriptive epidemiological study., Methods: Three years of insurance records (2018-2020) was used to describe anterior cruciate ligament injury costs and characteristics. Concomitant injuries and the mechanism of injury were determined by analysing the injury descriptions. Claim characteristics and costs are presented by age group (junior = 7-17 years, senior = 18-34 years, and veteran = 35 + years) and sex. Categorical data (including age-groups and sex) are presented as counts and percentages and analysed using a Chi squared or Fisher's exact test. Cost data are reported as means ± standard deviation with 95 % confidence intervals., Results: Over the course of three football seasons (2018-2020), 786 anterior cruciate ligament injuries were reported to the injury insurance company. The total insurance cost was AU$3,614,742 with direct injury insurance costs accounting for 36.3 % of the total costs. The mean indirect insurance costs were six-fold higher than direct insurance costs (AU$11,458 vs AU$1914). Isolated injuries had an average cost of $4466 whilst concomitant injuries had an average cost of $4951. Surgical costs are excluded from direct cost calculations. The peak injury count occurred in the first month of all three football seasons, immediately after the pre-season., Conclusions: Anterior cruciate ligament injuries represent a substantial economic burden to the insurer and individual. The cost data provided can be used for future economic and modelling studies., Competing Interests: Declaration of interest statement None., (Copyright © 2023 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Purpose: Fertility preservation discussions with pediatric and adolescent cancer patients can be difficult for clinicians. This study describes the acceptability of a fertility clinician decision support system (CDSS). Methods: A cross-sectional study of clinicians at The Royal Children's Hospital, Melbourne. Participants were trained on CDSS purpose, contents, and use. A survey captured the perceived benefits and weaknesses of the CDSS. Results: Thirty-nine clinicians participated. Over 90% felt the CDSS aims and format were clear, and understood the components. Over 80% felt it would enable adherence to clinical pathways, policy, and standards of care. Conclusions: The CDSS provided significant perceived benefits to oncofertility care. [ABSTRACT FROM AUTHOR]

Utilising a large comparative survey across 11 countries, it is shown that country effects condition the individual uptake of income protection insurance and that shared attributes, including labour market status, are important factors in determining the take-up of income protection insurance, whatever the respondents' country of residence. We observed differences in the respondents' coping strategies, including self-reliance, and were able to distinguish between migrant workers and those who work in their country of origin, along with the "special" case of the Australian respondents. These findings have implications for the ongoing debate on the labour market effects of globalisation and the significance of national institutions and regulatory practices. [ABSTRACT FROM AUTHOR]

Although the role of companion animals within the dynamic of domestic violence (DV) is increasingly recognized, the overlap of animal harm and insurance discrimination for victims/survivors of DV has not been considered. Prompted by a case study presented in a National Link Coalition LINK-Letter, this research note examines “Pet Insurance” policies available in Australia and whether nonaccidental injury caused by an intimate partner would be covered. We discuss the implications of exclusion criteria for victims/survivors of DV, shelters providing places for animals within a DV dynamic, and, more broadly, for cross- or mandatory-reporting (of animal harm) initiatives. [ABSTRACT FROM AUTHOR]

Objective Although Australia's service and policy context differs from that of the US, studies have highlighted potential for individual placement and support (IPS) to support competitive employment outcomes for people with severe and persistent mental illness. The aim of the present study was to explore why the model is not yet widely available.Methods A document analysis was conducted to discern reasons for challenges in implementation of IPS practice principles within the Australian service context.Results The document analysis illustrated that although policy acknowledges the importance of increasing employment rates for people with severe and persistent mental illness, consistent measures, change indicators, direction and time frames are lacking in policy and strategy documentation. Further, IPS principles are not consistently evident in guiding operational documentation that government-funded Disability Employment Services (DES) programs are mandated to adhere to.Conclusions For IPS to be readily implemented, it is necessary for government to offer support to agencies to partner and formal endorsement of the model as a preferred approach in tendering processes. Obligations and processes must be reviewed to ensure that model fidelity is achievable within the Australian Commonwealth policy and service context for programs to achieve competitive employment rates comparable to the most successful international programs. [ABSTRACT FROM AUTHOR]

Lung cancer screening with low dose computed tomography (LDCT) is recommended in the USA and Canada for high-risk smokers but not in Australia. We administered a cross-sectional survey to Western Australian general practitioners (GP). The majority (64/93, 69%) reported requesting a screening chest X-ray (42/93, 45%) and/or LDCT (38/93, 41%) in the past year. LDCT screening was more common if the GP had received education from radiology practices (odds ratio (OR) 2.81, P = 0.03) or if they believed screening is funded by the Medical Benefits Scheme (OR 3.57, P = 0.02). Lung cancer screening with LDCT is occurring outside a coordinated programme, contrary to Australian guidelines. [ABSTRACT FROM AUTHOR]

Background: Leadership reform was one of the primary health care (PHC) reforms proposed by the World Health Organization (WHO) in response to the failures of the 'health for all' goals by the Declaration of Alma Ata. WHO had recommended a leadership approach that was interpreted as the persuasive democratic leadership style. The aim of this manuscript was to analyse leadership styles and functions of different countries, as well as to study the strategies by other countries in achieving leadership reform. Materials and Methods: Roemer's model was used to analyse leadership styles and functions between countries. Articles, reports and related publications from online databases such as PubMed, CINAHL and Google Scholar were used for the review. Result and Discussion: Malaysia, Indonesia, Nigeria and Australia are practising the persuasive democratic leadership style in the PHC system. This is shown by the prominent government role in PHC policy making, management and the financing mechanism to ensure universal health coverage. Element of democracy can be seen by the participation of various stakeholders from different levels of the countries' PHC system in the negotiation of the PHC services and resources allocation in order to meet the local needs in these four countries. However, government domination became one of the challenges identified as it leads to lack of decentralisation. Several countries had found the solutions towards PHC reform, much of it by the reform in leadership through implementing policy level interventions, aligning bottomup and top-down interventions, and distributed leadership concept among others. Conclusion: Different countries have different styles of leadership in its PHC reform, facing different types of challenges with its own set of solutions, approaches that many countries could learn from in enhancing their PHC services. [ABSTRACT FROM AUTHOR]

High-income countries are grappling with the challenge of caring for aging populations, many of whose members have chronic illnesses and declining capacity to manage activities of daily living. The 2017 Commonwealth Fund International Health Policy Survey of Older Adults in eleven countries showed that US seniors were sicker than their counterparts in other countries and, despite universal coverage under Medicare, faced more financial barriers to health care. The survey's findings also highlight economic hardship and mental health problems that may affect older adults' health, use of care, and outcomes. They show that in some countries, one in five elderly people have unmet needs for social care services--a gap that can undermine health. New to the survey is a focus on the "high-need" elderly (those with multiple chronic conditions or functional limitations), who reported high rates of emergency department use and care coordination failures. Across all eleven countries, many high-need elderly people expressed dissatisfaction with the quality of health care they had received. [ABSTRACT FROM AUTHOR]

Objectives There are few studies of dental service expenditure in Australia. Although dental insurance status is strongly associated with a higher probability of dental visiting, some studies indicate that there is little variation in expenditure by insurance status among those who attend for care. Our objective was to assess the overall impact of insurance on expenditures by modelling the association between insurance and expenditure accounting for variation in the probability of incurring expenses, that is dental visiting. Methods A sample of 3000 adults (aged 30-61 years) was randomly selected from the Australian electoral roll. Dental service expenditures were collected prospectively over 2 years by client-held log books. Questionnaires collecting participant characteristics were administered at baseline, 12 months and 24 months. Unadjusted and adjusted ratios of expenditure were estimated using marginalized two-part log-skew-normal models. Such models accommodate highly skewed data and estimate effects of covariates on the overall marginal mean while accounting for the probability of incurring expenses. Results Baseline response was 39%; of these, 40% ( n = 438) were retained over the 2-year period. Only participants providing complete data were included in the analysis ( n = 378). Of these, 68.5% were insured, and 70.9% accessed dental services of which nearly all (97.7%) incurred individual dental expenses. The mean dental service expenditure for the total sample (those who did and did not attend) for dental care was AUS$788. Model-adjusted ratios of mean expenditures were higher for the insured (1.61; 95% CI 1.18, 2.20), females (1.38; 95% CI 1.06, 1.81), major city residents (1.43; 95% CI 1.10, 1.84) and those who brushed their teeth twice or more a day (1.50; 95% CI 1.15, 1.96) than their respective counterparts. Conclusion Accounting for the probability of incurring dental expenses, and other explanatory factors, insured working-aged adults had (on average) approximately 60% higher individual dental service expenditures than uninsured adults. The analytical approach adopted in this study is useful for estimating effects on dental expenditure when a variable is associated with both the probability of visiting for care, and with the types of services received. [ABSTRACT FROM AUTHOR]

With technology changing the nature of risk and the way risk services are priced, this paper examines the key elements of a 'traditional' insurance business that are now open to challenge. It includes a stylised insurance value chain, which provides a framework for discussing how the disruptive forces in the industry are affecting incumbents. The paper also speculates on the form, or forms, which the insurance business model will take in the future. The paper was prepared for the Monash University and Australian Centre for Financial Studies' 22nd Melbourne Money and Finance Conference on 10-11 July 2017.1 [ABSTRACT FROM AUTHOR]

This study shows that, in an unregulated fee-setting environment, specialist physicians practise price discrimination on the basis of their patients' income status. Our results are consistent with profit maximisation behaviour by specialists. These findings are based on a large population survey that is linked to administrative medical claims records. We find that, for an initial consultation, specialist physicians charge their high-income patients AU$26 more than their low-income patients. While this gap equates to a 19% lower fees for the poorest patients (bottom 25% of the household income distribution), it is unlikely to remove the substantial financial barriers they face in accessing specialist care. There are large variations across specialties, with neurologists exhibiting the largest fee gap between the high-income and low-income patients. Several possible channels for deducing the patient's income are examined. We find that patient characteristics such as age, health concession card status and private health insurance status are all used by specialists as proxies for income status. These characteristics are particularly important to further practise price discrimination among the low-income patients but are less relevant for the high-income patients. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]