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

Rationale, Aims and Objectives: Co‐morbidities in colorectal cancer patients complicate hospital care, and their relative importance to post‐operative deaths is largely unknown. This study was conducted to examine a range of clinical and sociodemographic factors in relation to post‐operative in‐hospital deaths in colorectal cancer patients and identify whether these contributions would vary by severity of co‐morbidities. Methods: In this multicentre retrospective cohort study, we used the complete census of New South Wales inpatient data to select colorectal cancer patients admitted to public hospitals for acute surgical care, who underwent procedures on the digestive system during the period of July 2001 to June 2014. The primary outcome was in‐hospital death at the end of acute care. Multilayer perceptron and back‐propagation artificial neural networks (ANNs) were used to quantify the relative importance of a wide range of clinical and sociodemographic factors in relation to post‐operative deaths, stratified by severity of co‐morbidities based on Charlson co‐morbidity index. Results: Of 6288 colorectal cancer patients, approximately 58.3% (n = 3669) had moderate to severe co‐morbidities. A total of 464 (7.4%) died in hospitals. The performance for ANN models was superior to logistic models. Co‐morbid musculoskeletal and mental disorders, adverse events in health care, and socio‐economic factors including rural residence and private insurance status contributed to post‐operative deaths in hospitals. Conclusion: Identification of relative importance of factors contributing to in‐hospital deaths in colorectal cancer patients using ANN may help to enhance patient‐centred strategies to meet complex needs during acute surgical care and prevent post‐operative in‐hospital deaths. [ABSTRACT FROM AUTHOR]

Background: People who sustain road traffic injuries often have poor health outcomes. While outcomes are often worse in people with a compensation claim, especially in fault-based schemes versus no-fault schemes, few studies have directly compared outcomes across scheme types.Objective: To compare health and work outcomes between people who had no compensation claim, a fault-based claim, or "no-fault" transport or workers compensation claim after hospitalisation for a road traffic injury.Methods: Participants aged >=18 years admitted to hospital in New South Wales or Victoria for >24 hours were recruited in two separate prospective cohort studies (N=1,034). People who died or sustained minor or very severe injuries were excluded. Groups included Compulsory Third Party (fault-based, n=128), no-fault Transport Accident Commission (TAC; n=454) and workers compensation claimants (n=73), or no claim (n=226). Outcomes at six, 12- and 24-months post-injury included health [SF-12 Mental Component Score (MCS) and Physical Component Score (PCS)], and return to work for people working pre-injury. Multivariable mixed effects linear and logistic regressions, adjusting for demographic and injury covariates, examined differences in health and work outcomes between claimant groups, with fixed effects of time and random effects of participant ID.Results: Health status was better in people with a no-fault TAC claim (MCS: m=50.62, 95%CI:49.62,51.62; PCS: m=40.49, 95%CI:39.46,41.52) or no claim (MCS: m=49.99, 95%CI:49.62,51.62; PCS: m=44.36, 95%CI:43.00,45.72), than people with a workers compensation (MCS: m=45.73, 95%CI:43.46,48.00; PCS: m=38.94, 95%CI:36.59,41.30) or fault-based CTP claim (MCS: m=41.34, 95%CI:39.54,43.13; PCS: m=35.64, 95%CI:33.78,37.49). Relative to fault-based CTP claimants, the odds of returning to work were higher for people with no claim (AOR=6.84, 95%CI:1.73,27.05) but did not differ for no-fault TAC (AOR=1.21, 95%CI:0.36,4.05) or workers compensation claimants (AOR=0.83,95%CI: 0.17,3.99). While people with a fault-based CTP claim had poorer mental and physical health and return to work after injury, they showed greater improvements in mental health, and similar levels of improvement in physical health and work participation over time to the other groups.Conclusion: The patterns of health and work across scheme types provide important insights against which we can contrast the effects of future scheme designs on client outcomes. [ABSTRACT FROM AUTHOR]

Background: Flooding is an increasingly prevalent natural hazard worldwide and can have a profound impact on the mental health of those directly and indirectly affected. Little is known about the impact on business owners, who may be particularly vulnerable to the mental health complications of flooding given the additional economic stressors. Methods: A large cross-sectional survey was conducted six months after severe flooding in the rural Northern Rivers region of New South Wales, Australia in 2017. The survey assessed demographics, probable depression (using the Patient Health Questionnaire-2), flood exposure, flood-related financial factors, prior flood exposure and support from various organisations. Logistic regression was used to identify predictors of probable depression in 653 of the 745 participants who identified as business owners. Results: The prevalence of probable depression in our sample was 17.0%. A quarter (25.1%) of business owners whose business was flooded suffered from probable depression, compared to 12.4% of non-flooded business owners. The multivariable model for probable depression demonstrated elevated adjusted odds ratios (AOR) for business owners who had to evacuate their business (AOR = 2.11, 95% Confidence Interval (CI) 1.25–3.57) compared to those who did not evacuate. Insurance disputes/rejections were a strong predictor for probable depression (AOR = 3.76, CI 1.86–7.60). Those whose income was reduced due to the flood and had not returned to normal six months post-flood demonstrated an increased AOR for probable depression (AOR 2.53, CI 1.26–5.07) compared to those whose income had returned to normal. The univariable analysis found elevated crude odds ratios (OR) for the cumulative effect of multiple flood exposures and unmet support needs by the state government (OR = 2.74, CI 1.12–6.68). The majority of business owners felt their needs were not met by most organisations providing flood-related support. Conclusion: The impact of flood exposure and flood-related financial factors on probable depression was highly significant for the business owner population. Furthermore, business owners felt under-supported by flood-related services. These findings highlight the vulnerability of exposed business owners and the need for increased support. Disaster planning programs in conjunction with system level changes such as infrastructure and education are vital for disaster preparedness. [ABSTRACT FROM AUTHOR]

Background: The influence of health insurance systems on the treatment of end‐stage kidney disease (ESKD) patients ispoorly understood. Aim: We investigated how supplemental private health insurance (PHI) coverage impacted ESKD treatment modalitiesand patient outcomes. The influence of health insurance systems on the treatment of end‐stage kidney disease (ESKD) patients is poorly understood. We investigated how supplemental private health insurance (PHI) coverage impacted ESKD treatment modalities and patient outcomes. Methods: All adult patients commencing ESKD treatment in New South Wales, Australia from 2000 to 2010 were identified using the Australia and New Zealand Dialysis and Transplant Registry. Data were linked to the state hospitalisation dataset to obtain insurance status, allowing the comparisons of mortality, ESKD treatment modality and health service utilisation between privately insured and public patients. Results: The cohort of 5737 patients included 38% (n = 2152) with PHI. At 1 year after ESKD treatment initiation, PHI patients had lower mortality (hazard ratio 0.84, 95% confidence interval (CI) 0.74–0.95, P = 0.01), were more likely to be receiving home haemodialysis (HD) (odds ratio (OR) 1.38, 95% CI 1.01–1.89, P = 0.04), to have been transplanted (OR 1.75, 95% CI 1.25–2.46, P = 0.001) and used fewer hospital days (incidence rate ratio 0.85, 95% CI 0.74–0.96, P = 0.01). After adjustment, PHI patients were more likely to initiate ESKD treatment with facility‐based HD (OR 1.22, 95% CI 1.01–1.46, P = 0.03) but were less likely to be started on peritoneal dialysis (OR 0.81, 95% CI 0.67–0.98, P = 0.03). Conclusion: Our findings suggest that supplemental PHI in Australia is associated with lower‐risk ESKD treatment attributes and improved health outcomes. A greater understanding of the treatment pathways that deliver these outcomes may inform treatment for the broader ESKD treatment population. [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 current study investigated whether we could encourage Australian residents to become better prepared for floods by inviting them to make a specific commitment to do so. We sampled 374 residents of the state of Victoria (56% male, 81% metropolitan) and 400 residents of the state of New South Wales (45% male, 59% metropolitan) who lived in locations that were potentially at risk of floods. They residents were sampled so that their distributions of ages, genders and living locations were as representative as possible of the population of those two states. These residents completed two surveys that ascertained their preparedness for floods at two points in time, separate by a two-week period. At the end of the first survey all residents received information about how they could better prepare for floods. In addition, approximately half the residents were randomly selected to be invited to commit to becoming better prepared for floods. We found that 74% of residents who were invited to commit to becoming better prepared for floods, were willing to make this commitment. We found that the group that was invited to commit to become better prepared for floods increased their preparedness for floods over the two-week period that separated the two surveys more than the group that was not invited to make this commitment, F(1, 772) = 4.53, p = .034, η2 = .006. We conclude that when emergency services inform residents of flood-prone areas how to better prepare for floods, they should also attempt to elicit from the residents a commitment to become better prepared for floods. [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]

We examined individual-level syringe coverage among 417 people who inject drugs who were recruited from pharmacies in New South Wales in 2009. There was a U-shaped distribution of syringe coverage with many people having very high (51%) or very low (23%) coverage. Overall, two-thirds of respondents (63%) reported adequate coverage (≥100%). Respondents who had not used a needle and syringe program in the previous month were more likely to report inadequate coverage (AOR 2.25, 95% CI 1.25-4.05) as were those who reported daily or more frequent injecting (AOR 3.69, 95% CI 2.00-6.81). Inadequate syringe coverage was not independently associated with receptive needle sharing. The level of syringe coverage was high among this sample, and met targets set out by UNAIDS and other organisations. We found that inadequate syringe coverage was not independently correlated with receptive needle sharing, possibly because coverage is sufficient to diminish the relationship between syringe availability and sharing behaviours. [ABSTRACT FROM AUTHOR]

Tort reform of the motor accident insurance compensation scheme in the Australian state of New South Wales in 1999 came about as a result of an untested experiment in regulatory negotiation. This article is a first-hand account of the successful attempt to craft a consensual modification of the scheme through deliberations among a working group of service provider representatives. The author, a Canadian lawyer, investigated the prospects for change, acted as chief negotiator, and observed the legislative process that led to the final law reform. [ABSTRACT FROM AUTHOR]

The article mentions the election of Dr Kerryn Phelps for a seat in Wentworth, Australia and her support for continued coverage of natural therapies within health funds, as of December 2018.