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1
Wise, William. "Life insurance company efficiency: best method and proxies." Insurance Markets and Companies 9, no. 1 (May 10, 2018): 6–19. http://dx.doi.org/10.21511/ins.09(1).2018.02.
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Life insurance is a very important segment of the economy of most countries as demonstrated by the investments, premium revenue and numbers employed. Hence, it is paramount to determine accurately how well life insurance companies (LICs) perform and how viable they are for the benefit of both other industries and national economies.Three papers that investigate LIC efficiency directly analyze how efficiency affects LIC profits. One critical feature is that they show that the inefficiency of LICs can greatly affect their (financial) outcome and ultimately their survivorship. Thus, said research clearly indicates that life insurer efficiency is a crucial area to investigate and assess and that it could greatly enhance the ability to properly monitor and inspect the life insurers.This article co-ordinates information regarding life insurance efficiency studies to help researchers learn which approaches, methods and output/input proxies to use. While some papers do so for some of the aspects that are important and necessary for life insurance efficiency studies, this is the first to deal with said aspects together. More specifically, this paper especially considers and evaluates the different methods and output proxies used in life insurance efficiency studies, as they seem to be the elements where the most disagreement exists between researchers. In addition, this article is unique in examining how input (proxy) prices are used in life insurance efficiency studies.
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Gaskin, Darrell, Eric Roberts, Kitty Chan, Rachael McCleary, Christine Buttorff, and Benjo Delarmente. "No Man is an Island: The Impact of Neighborhood Disadvantage on Mortality." International Journal of Environmental Research and Public Health 16, no. 7 (April 9, 2019): 1265. http://dx.doi.org/10.3390/ijerph16071265.
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This study’s purpose is to determine if neighborhood disadvantage, air quality, economic distress, and violent crime are associated with mortality among term life insurance policyholders, after adjusting for individual demographics, health, and socioeconomic characteristics. We used a sample of approximately 38,000 term life policyholders, from a large national life insurance company, who purchased a policy from 2002 to 2010. We linked this data to area-level data on neighborhood disadvantage, economic distress, violent crime, and air pollution. The hazard of dying for policyholders increased by 9.8% (CI: 6.0–13.7%) as neighborhood disadvantage increased by one standard deviation. Area-level poverty and mortgage delinquency were important predictors of mortality, even after controlling for individual personal income and occupational status. County level pollution and violent crime rates were positively, but not statistically significantly, associated with the hazard of dying. Our study provides evidence that neighborhood disadvantage and economic stress impact individual mortality independently from individual socioeconomic characteristics. Future studies should investigate pathways by which these area-level factors influence mortality. Public policies that reduce poverty rates and address economic distress can benefit everyone’s health.
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Ramljaková, B. "Patient Empowerment in Rare Diseases Slovak Rare Disease Alliance − Contribution to the Creation of the National Plan of Rare Diseases in Slovakia Eurordis – Benefits of Membership / Pacientske organizácie v oblasti zriedkavých chorôb – ich činnosť aj pri príprave národného plánu v SR slovenská aliancia zriedkavých chorôb Eurordis - európska aliancia zriedkavých chorôb – výhody členstva." Acta Facultatis Pharmaceuticae Universitatis Comenianae 60, Supplementum-VIII (March 1, 2013): 41–45. http://dx.doi.org/10.2478/afpuc-2013-0009.
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After the endorsement of the National strategy of rare disease patient health care development for years 2012 - 2013 by the government of the SR on October 24, 2012, it is important for all participants in the process to get involved. (Who are all the participants? - doctors, pharmacists, scientist, national authorities, regulators, health insurance companies, social insurance company, health care and social workers, pharmaceutical industry, but also politicians, patients and patient organizations) Based on the experience and problems which are being solved by patients, it is necessary for POs to focus on areas important for the creation of NP RD in the SR. These are most of all: complex approach to patients based on a multidisciplinary team, inclusion of patients into decision making - an educated patient is a prerequisite for this; specialized services for RD patients and their families; integration of RD patients into existing health care and social system and help lines. Slovak Alliance of Rare Diseases (Alliance RD) was founded and registered at the Ministry of Interior of the SR on December 12, 2011. The reason for its foundation was the effort to solve problems in the area of RDs in a complex and systemic way, which is proved by its involvement in the creation of NP RD in the SR. It houses 12 POs working in the field of RD in Slovakia. The objective of the Alliance RD is to keep improving the health and social life conditions of rare disease patients and their families, to improve the quality of rare disease patients’ lives, and to support their social integration. In close cooperation with EURORDIS - Rare Disease Europe − it took part in EUROPLAN II (2012 - 2015), a project organized by the National conference for the support of the creation of National plan of rare disease patient health care development in Slovakia.
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Bachyurah, Bachyurah, Ikhsan Maulidi, Intan Syahrini, and Nurmaulidar Nurmaulidar. "ANALISIS CADANGAN MANFAAT DENGAN MENGGUNAKAN METODE RETROSPEKTIF PADA ASURANSI JIWA BERJANGKA." STATMAT : JURNAL STATISTIKA DAN MATEMATIKA 2, no. 1 (January 30, 2020): 1. http://dx.doi.org/10.32493/sm.v2i1.3884.
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The insurance company is a company that protects its customers from unwanted events in the future. A life insurance company should prepare a benefit reserve funds to be given to customers if the customers experience a risk of death in the future. Therefore, the insurance company must manage the benefit reserves so that the company does not have a loss. The purposes of this study are to calculate both the amount of annual net premiums and the amount of benefit reserves in term life insurance. The method used to calculate the value of the benefit reserve was a retrospective method. The results of the calculation of annual net premiums for large annual premiums for expenditures that are greater than those greater for the same period. While the value of insurance reserves will continue to increase at the beginning of the insurance contract begins and the value of insurance reserves will continue to increase towards 0 at the end of the insurance contract. This is because at the beginning of the company insurance payments obtained from annual net premium payments will be greater than the amount of benefits that must be approved.
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NUGRAHA, I. WAYAN SANDY BAYU, KETUT JAYANEGARA, and I. NYOMAN WIDANA. "POLICY VALUES ASURANSI JOINT LIFE SUAMI ISTRI DENGAN METODE PROSPEKTIF." E-Jurnal Matematika 8, no. 2 (June 6, 2019): 122. http://dx.doi.org/10.24843/mtk.2019.v08.i02.p243.
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Policy values are funds be held by insurance company that will be used for unexpected claims from insurance participants. The purpose of this work is to calculate constant annual premiums with and without pure endowment on joint life couple insurance, then determine and calculate formula policy values with prospective method. The policy values ??in joint life couple insurance, are affected by premium payments. Policy values ??benefit at the end of the 1st year until the end of the 11th year will increase, because the money received by insurance company from premium payments is more than the sum insured to be paid. Policy values ??benefit at the end of the 11th year until the end of the 66th year will decrease because there are no more premium payments.
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Chou, Pai-Lung, and Yu-Min Chang. "The effect of the Insurance Company Act on the capital benefit of investment in Taiwan’s life insurance industry." Journal of Statistics and Management Systems 14, no. 6 (November 2011): 1041–55. http://dx.doi.org/10.1080/09720510.2011.10701600.
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Gautama So, Idris, and Rosi Yosevie. "E-Proposal to Expedite Customer's Decision Making on Committing Insurance Transaction." Advanced Science Letters 21, no. 4 (April 1, 2015): 612–17. http://dx.doi.org/10.1166/asl.2015.5985.
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Objectives of this paper are to analyze the current system of policies selling in a particular Life Insurance company, especially for unit link life insurance product to understand the problems or gaps in the company. According to the result of Business Inteligence (Analysis of Insurance Industry) from the particular Life Insurance, assets of the company are big enough to do some investments in technology to gain more premium income, but the fact is premium income of said Life Insurance company was not good enough if it is compared with its competitors. So based on that problem, it is needed to find the requirements of new system as a solution, then the design a new web-based application of e-proposal to customer's decision making of the Life Insurance company. Methodology which is used in this research are colecting data by library research and field research. After that, analysis based on the theory Fishbone Diagram Analysis, Critical Success Factor Analysis, and Object Oriented Analysis will be carried out. On the design phase, Object Oriented Design is used and then evaluate the result of a new system design by Eight Golden Rules of designing user interface. Result of this research is a web based application to make the distribution of proposal faster and more simple. The procedure of new system will also make the information of policies benefit can be easily accessed by Customer and Insurance Agencies, so the company will also gain customer satisfaction and loyalty. In the end, we can conclude that e-proposal is the right solution for the company to drive customer's decision making and finally will improve Life Insurace company's product selling and also increase the premium income.
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Supriadi, Nanang. "PEMODELAN MATEMATIKA PREMI TUNGGAL BERSIH ASURANSI UNIT LINK SYARIAH." Al-Jabar : Jurnal Pendidikan Matematika 8, no. 2 (December 19, 2017): 165. http://dx.doi.org/10.24042/ajpm.v8i2.1883.
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The exact risk factor can be managed by transferring the risk to the other party (in this case the insurance company). In this paper will be discussed more life insurance, as the development now there are types of insurance combined with investment, which is popular with the term Unit Link insurance. Unit link Syariah began to be launched as one of the fulfilment of the high needs of the community, the privilege of the product Unit of Islamic links is actually located in the elements of the laws in accordance with Islamic Syariah. The issues that will be discussed are how to get a single premium model of life insurance unit link Syariah with life insurance and investment fund allocation invested in investment product with a big interest rate of risk (financial approach) and investment product with the value of return maximum (actuarial approach). The resulting model is then implemented in case of examples by comparing the two approaches to see the shortcomings and advantages of Unit link lifetime life insurance when compared to life insurance. The result obtained from this research is the benefit obtained from Unit-linked sharia insurance on average will be greater if compared with life insurance for life, maximum benefit will be obtained Insurance Unit Link of sharia using actuarial approach compared to financial, but benefit with a relative financial approach more stable than actuarial approaches that tend to fluctuate.
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Owen, C. F. "Guaranteed Wages and Unemployment Insurance in Canada." Relations industrielles 10, no. 4 (February 19, 2014): 237–54. http://dx.doi.org/10.7202/1022669ar.
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Summary The emergence of guaranteed wage plans in the automobile industry, likely to spread to other fields in the near future, poses the problem of the relationship between such plans and the national Unemployment Insurance system in Canada. This article is an attempt to indicate, by a comparative analysis of Canadian and U.S. Unemployment Insurance systems, to what extent problems associated with U.S. unemployment insurance systems, and the possible integration of these systems with company supplemental unemployment benefit plans, are applicable to Canada.
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Gong, Yikai, Zhuangdi Li, Maria Milazzo, Kristen Moore, and Matthew Provencher. "Credibility Methods for Individual Life Insurance." Risks 6, no. 4 (December 11, 2018): 144. http://dx.doi.org/10.3390/risks6040144.
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Credibility theory is used widely in group health and casualty insurance. However, it is generally not used in individual life and annuity business. With the introduction of principle-based reserving (PBR), which relies more heavily on company-specific experience, credibility theory is becoming increasingly important for life actuaries. In this paper, we review the two most commonly used credibility methods: limited fluctuation and greatest accuracy (Bühlmann) credibility. We apply the limited fluctuation method to M Financial Group’s experience data and describe some general qualitative observations. In addition, we use simulation to generate a universe of data and compute Limited Fluctuation and greatest accuracy credibility factors for actual-to-expected (A/E) mortality ratios. We also compare the two credibility factors to an intuitive benchmark credibility measure. We see that for our simulated data set, the limited fluctuation factors are significantly lower than the greatest accuracy factors, particularly for low numbers of claims. Thus, the limited fluctuation method may understate the credibility for companies with favorable mortality experience. The greatest accuracy method has a stronger mathematical foundation, but it generally cannot be applied in practice because of data constraints. The National Association of Insurance Commissioners (NAIC) recognizes and is addressing the need for life insurance experience data in support of PBR—this is an area of current work.
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Mladek, Tomas, Karl A. Stroetmann, Stanislava Bartova, Tom Jones, Alexander Dobrev, and Veli N. Stroetmann. "An economic evaluation of a Web-based national patient records system." Journal of Telemedicine and Telecare 13, no. 1_suppl (July 2007): 40–42. http://dx.doi.org/10.1258/135763307781645185.
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IZIP is a Web-based health record system for the general population which has been used in the Czech Republic since 2004. The system provides access to medical data for health-care providers and clients; only the latter can authorise health-care professionals to view their data. We conducted a cost-benefit analysis of the system. There was a strong positive overall economic return. The benefits to the clients were control and more effective care, estimated at about 10% of total gains. Professionals had the advantage of on-demand information and time savings, estimated to represent 37% of the benefits. The biggest partner of IZIP, the General Health Insurance Company of the Czech Republic was able to avoid duplicated tests and treatment, which amounted to 53% of the economic benefits. It took eight years to achieve a net cumulative benefit. The estimated annual net benefit exceeded €60 million in 2008.
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Wise, William. "The Finances of Slave Life Insurance: Did Life Insurers Act Appropriately from a Financial Perspective?" Ad Americam 20 (December 31, 2019): 45–66. http://dx.doi.org/10.12797/adamericam.20.2019.20.04.
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An important part of having slaves as a labor force is insuring their lives and their income. This paper explores whether antebellum life insurance companies insuring slaves did so appropriately and/or responsibly from a financial perspective. Determining whether antebellum life insurance companies did so is essential, as life insurance is a major segment of the economy of most countries and hence it is vital that life insurers perform well and are viable for the benefit of other industries and national economies, including with respect to the antebellum United States. This is the first study to investigate several critical financial elements, including premiums, expenses and mortality, of antebellum life insurance companies regarding feasibility. One characteristic of the results is that if firms employed a suitable expense assumption then the premium did not have a high enough mortality assumption and vice-versa. Additionally, most premium increases used regarding hazardous occupations, sum insured limits and location failed to adequately account for the associated increased mortality. The overall result is that, from a financial perspective, antebellum life insurers had trouble accounting for slave life insurance appropriately and/or responsibly.
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Dailey, Maceo Crenshaw. "The Business Life of Emmett Jay Scott." Business History Review 77, no. 4 (2003): 667–86. http://dx.doi.org/10.2307/30041233.
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Emmett Jay Scott was private secretary to Booker T. Washington and later became secretary treasurer of Howard University. He was involved in numerous business activities, ranging from the establishment of the National Negro Business League to the founding of an investment clearing-house, an insurance company, and an overseas trading firm. Scott also promoted the black township of Mound Bayou and backed African American entertainment enterprises. His business activities were largely unheralded, and the frustrations he encountered illustrate both the obstacles and the opportunities for black entrepreneurs in the first half of the twentieth century.
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Adams, M. B., and C. N. W. Scott. "Realistic reporting of life insurance company policy liabilities and profits: developments in Anglo-American countries." Journal of the Institute of Actuaries 121, no. 2 (1994): 441–58. http://dx.doi.org/10.1017/s0020268100020229.
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AbstractThis paper examines international developments in life insurance generally accepted accounting practice (GAAP) for policy valuation and profit recognition in four major Anglo-American markets—the U.K., Australia, the U.S.A. and Canada. Each valuation method examined has its advantages and disadvantages with respect to the needs of preparers and users of the annual corporate reports of life insurance companies. The paper documents that the statutory basis and U.S. GAAP are considered to have substantive deficiencies. In contrast, the U.K. accruals method, the Australian margin on services method and Canadian GAAP have much to commend them, particularly with regard to their flexibility to accommodate valuation adjustments for unexpected events. Nevertheless, from the preparers' point of view, the systems which would have to be developed to facilitate the U.K. accruals and Australian margin on services methods would be difficult and costly to implement. Profit reporting under Canadian GAAP is also sensitive to changes in actuarial reserving assumptions. The authors conclude that, since national preferences in actuarial and accounting practices are inevitable and because the product-market structures of life insurance markets are so distinctive, international harmonisation of life office GAAP is unlikely to occur for a very long time.
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Kwon, Yongjae, Myungho Park, and Jeongsun Yun. "Risk Margin Calculation for Lapse Risk in Guaranteed Minimum Accumulation Benefit of Variable Annuities-A Market-Consistent Approach." Journal of Derivatives and Quantitative Studies 22, no. 1 (February 28, 2014): 71–90. http://dx.doi.org/10.1108/jdqs-01-2014-b0004.
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In 2002, variable annuities were introduced in South Korea and have shown enormous success since then. They are life-insurance products with investment guarantees. Variable annuities allow policyholders to allocate premiums into a wide range of investment vehicles such as stocks, bonds, money market instruments, or some combinations of them. Due to the investment guarantee which is called guaranteed living benefits (GLBs), the benefit is always the greater of (1) the account value of the policyholder investment and (2) the guaranteed amount. Life insurance companies set aside reserves for the guarantees in the general account. Just as the account value depends on the performance of investments, VA lapses also rely on the performance of investments. For example, policyholders will not terminate the contracts when account value is way lower than the guaranteed amount. Considering that lapses determine the total benefit of VAs that a insurance company should pay, calculating risk margin for lapse is a key issue in the VA business. In this study, risk margin for VA lapses is estimated with Wang transform suggested by Wang (2000, 2002).
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Koch, Oliver. "How the German Pension System can benefit from insights of behavioural economics." Studenckie Prace Prawnicze, Administratywistyczne i Ekonomiczne 34 (February 22, 2021): 161–70. http://dx.doi.org/10.19195/1733-5779.34.11.
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Due to the demographic change that has been going on for several decades, the pension system in Germany is being heavily burdened. The German pension system can be described as a three-pillar system that includes not only the compulsory statutory pension insurance, but also the company pension schemes and the private pension schemes. However, the statutory pension insurance is particularly affected by the demographic crisis. The resulting declining birth rates and the rising life expectancy caused an unfavorable ratio between contributors and recipients of this system. Several pension reforms have already been introduced in Germany in order to manage this crisis, but the expected results did not occur. This article is therefore concerned with the findings of behavioral economics and what solutions it gives for this problem. In addition, a reform concept for Germany with behavioral economic elements is presented — “Deutschlandrente”.
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Kambali, Muhammad. "MEKANISME PENGELOLAAN DANA TABARRU’ ASURANSI SYARIAH PRUDENTIAL LIFE ASSURANCE." JES (Jurnal Ekonomi Syariah) 2, no. 1 (September 4, 2017): 91–101. http://dx.doi.org/10.30736/jes.v2i1.30.
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Sharia Insurance according to a binding ruling in religious matters (fatwa) of the National Shari'ah Board of the Indonesian Ulama Council no: 21 /DSN-MUI/ X / 2001 is a mutual effort to help among a number of people/parties through investment in assets or tabarru' which provides a pattern of return to face certain risks through engagement in accordance with the sharia. PRUlink sharia is an insurance product associated with sharia-based investment. PRUlink Syariah is designed to meet the society's need for future financial designs in accordance with Islamic principles of sharia. There are two types of product of PRUlink Syariah insurance, namely PRUlink Syariah Investor Account and PRUlink Syariah Assurance Account. Kind of Product in PRUlink Syariah is contract between policy holders using contract of tabarru which is called hibah and the owner of the policy/participant premises sharia insurance company using contract of tijarah called wakalah bin ujrah. In sharia insurance there is a surplus sharing that will be distributed to customers calculated at the end of the calendar year. This can be obtained if there are more funds than tabarru' accounts that have been reduced by claims and debt to the company if any. How is PRUlinksyariah managed in Prudential? The result of the research shows that PRUsyariah premium management in Prudential is separated by two accounts, namely tabarru' account and investment account. The own fund is managed by Eastpring Investment, that is manager company from Asia prudential, while allocation of fund is invested in stocks and obligation which is in accordance with sharia principles contained in the Jakarta Stock Exchange. For the choice of investment in PRUsariah, there are three options of investment, namely Sharia-Rupiah Equity Fund, Sharia-Rupiah Managed Fund or Sharia-Rupiah fixed Income fund, in accordance with the choice of the next participant. From the investment result the participant agrees to pay tabarru’ contribution directly input into tabarru' account. Tabarru’ funds are fully owned by participants and used to pay claims participants claim at any time, but if there is tabaaru’ funds excess with claims total in one year as of 31 December paid, then tabarru’ surplus or that is called surplus will be distributed participants that meet the requirements to get the surplus.
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Hearn, M. F. "A Japanese Inspiration for Frank Lloyd Wright's Rigid-Core High-Rise Structures." Journal of the Society of Architectural Historians 50, no. 1 (March 1, 1991): 68–71. http://dx.doi.org/10.2307/990547.
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Frank Lloyd Wright's rigid-core high-rise structures, initiated with the project for the National Life Insurance Company building of 1924, have their closest structural and iconographical analogue in one type of Japanese pagoda, exemplified by that at Horyu-ji. This association signals a previously undetected instance of Japanese influence on Wright's work.
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Bacinello, Anna Rita. "Fair Pricing of Life Insurance Participating Policies with a Minimum Interest Rate Guaranteed." ASTIN Bulletin 31, no. 2 (November 2001): 275–97. http://dx.doi.org/10.2143/ast.31.2.1006.
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AbstractIn this paper we analyse, in a contingent-claims framework, one of the most common life insurance policies sold in Italy during the last two decades. The policy, of the endowment type, is initially priced as a standard one, given a mortality table and a technical interest rate. Subsequently, at the end of each policy year, the insurance company grants a bonus, which is credited to the mathematical reserve and depends on the performance of a special investment portfolio. More precisely, this bonus is determined in such a way that the total interest rate credited to the insured equals a given percentage (participation level) of the annual return on the reference portfolio and anyway does not fall below the technical rate (minimum interest rate guaranteed, henceforth). Moreover, if the contract is paid by periodical premiums, it is usually stated that the annual premium is adjusted at the same rate of the bonus, and thus the benefit is also adjusted in the same measure. In such policy the variables controlled by the insurance company (control-variables, henceforth) are the technical rate, the participation level and, in some sense, the riskiness of the reference portfolio measured by its volatility. However, as it is intuitive, not all sets of values for these variables give rise to a fair contract, i.e. to a contract priced consistently with the usual assumptions on financial markets and, in particular, with no-arbitrage. We derive then necessary and sufficient conditions under which each control-variable is determined by a fair pricing of the contract, given the remaining two ones.
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O., Vilenchuk. "INNOVATIVE MANAGEMENT STRATEGIES BY ACTIVITIES OF INSURANCE COMPANIES: INTERNATIONAL AND NATIONAL CONTEXT." Scientific Bulletin of Kherson State University. Series Economic Sciences, no. 41 (March 31, 2021): 65–70. http://dx.doi.org/10.32999/ksu2307-8030/2021-41-12.
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This review article is devoted to the study of innovative strategies for managing the activities of insurance companies. In the condi-tions of risky environment, rather high probability occurrence of threats of natural and technogenic character, problems concerning the necessity of a scientific substantiation of the process of the insurance market stakeholders’ interaction aggravate. It is established that insurance in the world economic space is an indispensable financial and economic tool for neutralizing a variety of risks, especially given today’s the socio-economic, financial, epidemiological dangers. It is proved that despite the key parameters’ positive dynamics of the Ukrainian insurance market development for 2009-2019, there is a need to intensify business and investment activity of its participants. The competitive environment of the insurance market requires insurance companies to implement innovative management strategies focused primarily on solving two interrelated problems: firstly, the expansion of property risks’ insurance coverage, as well as risks related to citizens’ life, health and ability to work, secondly, the formation of the insurers’ solvency and ensuring an acceptable level of insurance operations’ profitability in terms of certain types of insurance. It is determined that one of the primary tasks of the insurance company’s management is the management of its business processes aimed at forming a model of customer-oriented behaviour in relation to potential customers. The article emphasizes the need to use a variety of innovative management strategies to achieve medium-term and long-term goals of the company in the insurance market. In particular, the expediency of diversification and the use of alternative pricing strategies for insurance services for long-term and general types of insurance is argued. Proposals aimed at digitalization of the insurance market and wide application of FinTech technologies in the field of insurance services are formulated: automated underwriting, IOT-technologies; blockchain in insurance. Summarizing the results of the study, the author’s vision of the further insurance relations’ functioning of in society is specified. Keywords: risks, insurance company, insurers, insurance protection, insurance market stakeholders, management. Статтю присвячено дослідженню інноваційних стратегій управління діяльністю страхових компаній. В умовах ризикогенного середовища, досить високої ймовірності виникнення загроз природного та техногенного характеру загострюються проблеми щодо необхідності наукового обґрунтування процесу взаємодії стейкхолдерів страхового ринку. Аргументовано, що страхування у світовому економічному просторі є незамінним фінансово-економічним інструментом нейтралізації найрізноманітніших ризиків, особливо зважаючи на соціально-економічні, фінансові та епідеміологічні небезпеки сучасності. Визначено, що одним із першочергових завдань менеджменту страхової компанії є управління її бізнес-процесами, спрямованими на формування мо-делі клієнтоорієнтованості відносно потенційних клієнтів. Наголошено на необхідності використання різноманітних інноваційних стратегій управління для досягнення середньострокових та довгострокових цілей компанії на страховому ринку. Зокрема, аргу-ментовано доцільність здійснення диверсифікації та використання альтернативних стратегій ціноутворення на страхові послуги з довгострокових та загальних видів страхування. Сформульовано пропозиції, спрямовані на цифровізацію страхового ринку та широке застосування FinTech-технологій у сфері страхових послуг: автоматизований андерайтинг, ІОТ-технології; блокчейн у страхуванні. Узагальнюючи результати проведеного дослідження, конкретизовано авторські підходи до подальшого функціонування страхових відносин у суспільстві.Ключові слова: ризики, страхова компанія, страхувальники, страховий захист, стейкхолдери страхового ринку, управління.
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JABBER, Shooroq Sabah. "THE ROLE OF KNOWLEDGE MANAGEMENT IN RAISING THE EFFICIENCY OF EMPLOYEES :APPLIED STUDY IN THE NATIONAL INSURANCE COMPANY." RIMAK International Journal of Humanities and Social Sciences 03, no. 06 (July 1, 2021): 337–49. http://dx.doi.org/10.47832/2717-8293.6-3.30.
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The issue of raising the efficiency of workers has gained great importance for business organizations, especially in light of the challenges facing institutions today and their ability to adapt to technological changes. The knowledge economy is also one of the most important means that raise the efficiency of workers and increase their productivity. Therefore, the researcher found that insurance companies suffer from not giving importance to the concept of knowledge management and how to take advantage of knowledge to improve the performance level of workers and raise the efficiency and productivity of the worker, which will be reflected on the performance of the bank as a whole. In order to find out the causes of the problem and develop solutions to it, a sample of 40 managers in the National Insurance Company was selected, which included general managers, heads of departments, and directors of departments and branches to test the research hypothesis, which stipulated (there is a moral relationship with statistical significance between knowledge management and raising the efficiency of workers’ performance). The aim of the research is to clarify the role of knowledge management in raising the efficiency of workers and increase their productivity and to reach proposals that try to help the bank in question to improve the concept of knowledge management and how to apply it. The research also reached a number of recommendations, the most prominent of which is that insurance companies try to draw a clear path for the application and development of knowledge management and how to benefit from it in raising the efficiency of workers, and the bank should work permanently to generate knowledge and try to apply it to individuals working in the bank.
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Bouk, Dan. "The Science of Difference: Developing Tools for Discrimination in the American Life Insurance Industry, 1830–1930." Enterprise & Society 12, no. 4 (December 2011): 717–31. http://dx.doi.org/10.1017/s1467222700010648.
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The Science of Difference examines life insurance companies' significant impact on the development of systems of human classification and discrimination in modern America. It pays closest attention to the tools employed by life insurance companies to enable and justify their discriminatory practices, tracing their evolution over the course of the nineteenth and early twentieth centuries. Companies used life tables to think about sectional difference prior to the civil war; they collected statistics to defend the propriety of racial discrimination; and they revolutionized risk by inventing the medical “impairment.” Drawing on company archives and personal papers, as well as a wide range of publications, the dissertation describes corporate research in the financial industry, argues for the importance of cultural factors in tracing business history, and shows how the industry built a national statistical community with tools designed to measure and price human difference.
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Galela, Muhammad Ridhwan. "ANALISIS PENYELENGGARAAN JAMINAN PENSIUN HARAPAN DAN TANTANGAN IMPLEMENTASI PP NO. 45 TAHUN 2015." INFO ARTHA 5 (May 24, 2017): 17–24. http://dx.doi.org/10.31092/jia.v5i1.58.
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In addition to mandated in the Constitution of 1945, the pension insurance program for all citizens is a necessity given Indonesian demographic projections that show significant change in the structure of the population of Indonesia. Demographic projections show that the dependency ratio is higher due to increasing in life expectancy and decreasing in fertility of women. Anticipating these conditions, Indonesian government implemented a national pension insurance program by issuing PP 45/2015. However, there are some problems in the implementation of the program. Problem related to national budget is the emergence of fiscal risks due to an imbalance of the amount of funds derived from contributions to the pension benefit payment liabilities. From the operational side, the concern arises from the ability of fund managers in implementing good corporate governance and their ability to provide adequate information technology infrastructure. Besides, informal sector workers and women should receive more attention in the pension insurance program.
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Khan, Mr Afroz. "Suicide Clause in Various Life Policies in India." IJOHMN (International Journal online of Humanities) 1, no. 1 (September 14, 2017): 1–14. http://dx.doi.org/10.24113/ijohmn.v1i1.1.
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Life insurance policy is a contract between the policy holder (assured) and the insurer (insurance company), where the insurer promises to pay a designated beneficiary a sum of money (a “premium”) upon the death of the insured person. In return, the policy holder agrees to pay a stipulated amount (at regular intervals or in lump sums). In nutshell, life policies are legal contracts and the terms of the contract describe the limitations of the insured events. Specific exclusions are often written into the contract to limit the liability of the insurer; common examples are claims relating to suicide, fraud, war, riot and civil commotion. Suicide means a wilful and intentional act on the part of the self-destroyer. It includes every act of self-destruction. Policies of life insurance contain conditions by which the liability of the insurer is modified and limited in case of suicide by the assured. Where there is such a clause in a policy, the insurer can avoid the policy. The position in England and in India is different on this issue. In England suicide is a crime and hence no money is payable if a person commits suicide while in a sane state of mind. On the other hand if the assured was insane at the time of committing suicide, the sum due can be recovered by his legal representatives. Under the Indian law, suicide in itself is not an offence, and as such a policy cannot be avoided on the ground of suicide, unless the policy otherwise provides. Suicide will, however, not affect the rights of assignee, if the policy holder had assigned the policy for valuable consideration. The burden of proving suicide is upon the insurers and where the cause of death is not known, the presumption is against suicide and the policy cannot be avoided. This same is followed in India. According to this approach, the claim would be barred on a contractual level because the assured cannot be the author of his own loss, and on a broader level, because the law will not allow him to benefit from his own criminal acts. This paper examines the development of law and policy in relation to claims on life insurance policy where the assured or insured has committed suicide after the commencement of the policy and the effect of suicide clause in life insurance contract. Is that the present practice of insurance companies to insert suicide clause in life policies, indirectly promotes commercial suicide in cases of intentional suicides.
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Wijaya, Anthony Dio. "TINJAUAN KEGIATAN ASURANSI KREDIT PEMILIKAN RUMAH OLEH LEMBAGA PERBANKAN BERDASARKAN PRINSIP PERSAINGAN USAHA TIDAK SEHAT." Mimbar Keadilan 13, no. 1 (January 24, 2020): 22–31. http://dx.doi.org/10.30996/mk.v13i1.2645.
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In running its business in the field of providing Homeownership Credit facilities by Bank Rakyat Indonesia as a banking institution, it is required to cooperate with insurance companies to bear the risks that might arise in the future for the applicant, in this case as KPR applicant customer. Therefore KPR applicant customers are required to use insurance services from Bank Rakyat Indonesia partner insurance companies for the housing for which the credit is requested. Customers should be given the freedom to choose the insurance product they will choose, rather than being required where the customer has no choice to use insurance other than a consortium between PT. Bringin Life and Heksa Eka Life Insurance, which is against Article 15 paragraph 2 of Law Number 5 of 1999 or often referred to as Business Competition Law. BRI, together with its partner insurance companies, have also conspired in determining the insurance company that will become BRI's partner, because this will benefit all three if there are no other insurance companies that become BRI partners. This certainly gives difficulties for other insurance companies that are not BRI's partners to run their business.Dalam menjalankan usahanya di bidang jasa pemberian fasilitas Kredit Pemilikan Rumah oleh Bank Rakyat Indonesia selaku lembaga perbankan diharuskan untuk bekerjasama dengan perusahaan asuransi guna menanggung resiko yang akan mungkin muncul di kemudian hari pada diri pemohon dalam hal ini selaku nasabah pemohon KPR. Oleh karena itu nasabah pemohon KPR diwajibkan untuk menggunakan jasa asuransi dari perusahaan asuransi rekan Bank Rakyat Indonesia untuk rumah yang diajukan kredit tersebut. Seharusnya nasabah diberikan kebebasan untuk memilih produk asuransi yang akan mereka pilih, bukannya diharuskan di mana nasabah tidak memiliki pilihan untuk menggunakan asuransi selain konsorsium antara PT. Bringin Life dan Heksa Eka Life Insurance, di mana hal tersebut adalah bertentangan terhadap Pasal 15 ayat (2) Undang-Undang Nomor 5 Tahun 1999 atau yang sering disebut dengan Undang-Undang Persaingan Usaha. BRI bersama sama dengan perusahaan asuransi rekanannya juga telah melakukan persekongkolan dalam hal penentuan perusahaan asuransi yang akan menjadi rekanan BRI, karena hal tersebut akan memberikan keuntungkan bagi ketiganya apabila tidak ada perusahaan asuransi lain yang menjadi rekanan BRI. Hal tersebut tentu memberikan kesulitan bagi perusahaan perusahaan asuransi lain yang bukan merupakan rekan dari BRI untuk menjalankan usahanya.
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Tysiachniouk, Maria, and Irina Olimpieva. "Caught between Traditional Ways of Life and Economic Development: Interactions between Indigenous Peoples and an Oil Company in Numto Nature Park." Arctic Review on Law and Politics 10 (2019): 56. http://dx.doi.org/10.23865/arctic.v10.1207.
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The paper examines the conflict between indigenous people living in Numto Nature Park in the Khanty-Mansy region of Russia and the oil company Surgutneftegaz, which is trying to expand to new areas of the Park for industrial development. We analyse this conflict by looking at different perceptions concerning the threats and benefits underpinning the conflicting parties’ arguments. We show that the oil company, whose approach is based on the principles of benefit sharing, seeks to provide economic benefits as well as infrastructure to ensure development in the indigenous community. In contrast, the indigenous people in Numto prioritise environmental safety and the possibility of maintaining their traditional ways of life, which means eliminating the negative impacts of oil development on fisheries, reindeer herding and the general state of the environment. The study indicates that focusing on indigenous peoples’ and oil companies’ differences concerning perceptions of threats and benefits provides a better understanding of desirable benefit-sharing arrangements between oil companies and indigenous peoples in areas that have so far only been marginally affected by industrialisation and modernisation. This insight suggests that the introduction of community-centred perspectives emphasising cultural and environmental security in benefit-sharing policies in oil companies could improve practices.1 The analysis draws on interviews with members of the indigenous Nenets and Khanty peoples of Numto Park as well as representatives of Surgutneftegaz, NGOs, the regional administration and the Numto Park administration. Responsible Editor: Noor Johnson, National Snow and Ice Data Center, University of Colorado Boulder, USA
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Hotimah, Hudriatul. "IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE AT PT AXA MANDIRI FINANCIAL SERVICES." Dinasti International Journal of Digital Business Management 1, no. 5 (August 22, 2020): 815–28. http://dx.doi.org/10.31933/dijdbm.v1i5.485.
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Good Corporate Governance (GCG) is a system that organizes and controls a company so that it can form added value for all stakeholders. This study aims to determine the application of GCG at PT AXA Mandiri Financial Services (AMFS) which is a joint venture Conventional Life Insurance company between PT Bank Mandiri (Persero) Tbk and National Mutual International Pty. Limited (AXA). The research method used is descriptive qualitative. The results of this study indicate that PT AMFS has implemented GCG in an integrated manner in all business processes. This is evidenced by the transformation in 10 line areas, namely digital services, distribution, health and protection, human resources and culture, information technology systems, data, efficiency, customer experience, and offers (documents and products). PT AMFS also applies the Three Lines of Defense principle to an internal control system that is integrated with risk management. The main line of defense is the directors and all employees of PT AMFS. Second, risk management, compliance and law. Third, internal and external audit.
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Wilson, Cynthia. "Patient Statement: Chemical Sensitivity One Victim's Perspective." Toxicology and Industrial Health 10, no. 4-5 (July 1994): 319–21. http://dx.doi.org/10.1177/074823379401000504.
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Not a day goes by that I don't miss my old life and the old me. To illustrate how my life has changed, I have two brief stories. In 1982, I developed a lending procedure in conjunction with Banker's Life Insurance Company that enabled commercial real estate developers to secure permanent financing for property that had not yet been developed in essence using a permanent loan in place of a construction loan. It fixed the interest rate, at a time when new construction rates were bankrupting many projects and it allowed the developer to invest the excess funds to offset interest expenses. I received national recognition for this loan. In 1989, the police found me wandering around in 15 inches of snow, in below zero weather with no shoes or coat. The officer took me to the hospital because I was obviously disoriented. I didn't even know my name or where I lived. These stories show the disparity between my life as a successful, independent business woman and my life as someone who is chemically disabled.
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Boo, Sunjoo, Jungah Lee, and Hyunjin Oh. "Cost of Care and Pattern of Medical Care Use in the Last Year of Life among Long-Term Care Insurance Beneficiaries in South Korea: Using National Claims Data." International Journal of Environmental Research and Public Health 17, no. 23 (December 4, 2020): 9078. http://dx.doi.org/10.3390/ijerph17239078.
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In Korea, a substantial proportion of long-term care insurance (LTCI) beneficiaries die within 1 year of seeking the benefit. This study was conducted to evaluate the pattern of medical care use and care cost during the last year of life among Korean LTCI beneficiaries between 2009 and 2013 using the national claims data. The National Health Insurance’s Senior (NHIS-Senior) cohort was used for this retrospective study. The participants were LTCI beneficiaries aged 65 or over as of 2008 who died between 2009 and 2013 (N = 30,433). Medical costs during the last year of life were highest for those who used both medical care services and long-term care (LTC) services and increased as death approached. About half of the participants were hospitalized at the time of death. The use of LTC services at the time of death increased from 13.0 to 22.8%, while those who died at home decreased from 34 to 20%. This study suggests that the use of LTC services did not reduce medical costs by substituting unnecessary inpatient hospitalization. Quality of dying should be considered one of the goals of older adult care, and provisions should be made for palliative care at home or LTC facilities.
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Antwi, Sampson. "State of Renal Replacement Therapy Services in Ghana." Blood Purification 39, no. 1-3 (2015): 137–40. http://dx.doi.org/10.1159/000368942.
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Introduction: Renal replacement therapy (RRT) in the form of dialysis and kidney transplantation is a life-saving intervention for patients with kidney disease in failure for both acute and chronic cases. Ghana is an emerging economy in West Africa with close to 27 million people. The limited data that is available indicates a significant burden of kidney disease in Ghana. I analyzed the state of RRT in Ghana in this report. Method: A situational analysis report conducted to establish the availability and type of renal replacement therapy services across the country. Information was obtained from records at dialysis centers and also by interview of staff at these centers. Results: Haemodialysis services are available in 3 public and 3 private health institutions for adults in kidney failure both acute and chronic. These centers are located in the southern half of the country leaving the northern two-thirds uncovered. National Health Insurance Scheme pays for the cost of acute dialysis for up to GHC 850 (∼USD 265). However, there is no insurance cover for any aspect of chronic RRT putting huge financial constraints on families, which sometimes plunge entire extended families into serious financial crisis. Kidney transplantation is available on a limited scale at the national capital. Children only benefit from peritoneal dialysis for acute kidney injury, thanks to the partnership with Sustainable Kidney Care Foundation. There is no rescue intervention as of now for children with end stage renal failure. Conclusion: The current state of RRT services in Ghana is inadequate and calls for serious national consideration.
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Butt, Thomas, Daniel Ollendorf, Renxing Zhao, and Gordon G. Liu. "OP414 The Influence Of Cost-Effectiveness Evidence And Other Factors On China's National Reimbursement Drug Listing Decisions." International Journal of Technology Assessment in Health Care 36, S1 (December 2020): 9. http://dx.doi.org/10.1017/s0266462320001099.
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IntroductionChina's National Reimbursement Drug List (NRDL) covers medicines that are included in national health insurance schemes. NRDL updates take into account evidence and recommendations of experts from the fields of medicine, health economics, pharmacy and health policy. A negotiation mechanism between the government and manufacturers was introduced in 2017 to include a more detailed evaluation and negotiation for high cost drugs. However, the values that are considered in NRDL decision making are not well-understood. This study aims to investigate the influence of available evidence and other factors on coverage decisions.MethodsOutcomes of the 2017 and 2018 NRDL negotiations were analyzed. Logistic regression was used to investigate factors associated with listing decisions. Ordinary least squares and Tobit regression were used to investigate factors associated with negotiated price discounts. Independent variables were published cost-effectiveness analysis (CEA), incremental cost-effectiveness ratio (ICER), disease area, burden of disease (disability-adjusted life years), company ownership (domestic or foreign) and regulatory approval year.ResultsTwenty-eight out of sixty-two negotiated drugs had one or more published CEA studies in the English or Chinese language, although neither the presence of a study nor the central ICER estimates were predictive of price discount or listing. A longer time since regulatory approval was a significant predictor of listing (p < 0.05). Disease area (oncology) and ownership (foreign) were significant predictors of a higher price discount (p < 0.01).ConclusionsThe NRDL plays a key role in providing access to healthcare for the 95 percent of China's population that is covered by public insurance. We found several factors that were associated with reimbursement decisions. Many of the medicines in the NRDL negotiation have CEA evidence, although the role of CEA in reimbursement decision making in China remains inconclusive.
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Schlicker, Sandra, Harald Baumeister, Claudia Buntrock, Lasse Sander, Sarah Paganini, Jiaxi Lin, Matthias Berking, Dirk Lehr, and David Daniel Ebert. "A Web- and Mobile-Based Intervention for Comorbid, Recurrent Depression in Patients With Chronic Back Pain on Sick Leave (Get.Back): Pilot Randomized Controlled Trial on Feasibility, User Satisfaction, and Effectiveness." JMIR Mental Health 7, no. 4 (April 15, 2020): e16398. http://dx.doi.org/10.2196/16398.
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Background Chronic back pain (CBP) is linked to a higher prevalence and higher occurrence of major depressive disorder (MDD) and can lead to reduced quality of life. Unfortunately, individuals with both CBP and recurrent MDD are underidentified. Utilizing health care insurance data may provide a possibility to better identify this complex population. In addition, internet- and mobile-based interventions might enhance the availability of existing treatments and provide help to those highly burdened individuals. Objective This pilot randomized controlled trial investigated the feasibility of recruitment via the health records of a German health insurance company. The study also examined user satisfaction and effectiveness of a 9-week cognitive behavioral therapy and Web- and mobile-based guided self-help intervention Get.Back in CBP patients with recurrent MDD on sick leave compared with a waitlist control condition. Methods Health records from a German health insurance company were used to identify and recruit participants (N=76) via invitation letters. Study outcomes were measured using Web-based self-report assessments at baseline, posttreatment (9 weeks), and a 6-month follow-up. The primary outcome was depressive symptom severity (Center for Epidemiological Studies–Depression); secondary outcomes included anxiety (Hamilton Anxiety and Depression Scale), quality of life (Assessment of Quality of Life), pain-related variables (Oswestry Disability Index, Pain Self-Efficacy Questionnaire, and pain intensity), and negative effects (Inventory for the Assessment of Negative Effects of Psychotherapy). Results The total enrollment rate with the recruitment strategy used was 1.26% (76/6000). Participants completed 4.8 modules (SD 2.6, range 0-7) of Get.Back. The overall user satisfaction was favorable (mean Client Satisfaction Questionnaire score=24.5, SD 5.2). Covariance analyses showed a small but statistically significant reduction in depressive symptom severity in the intervention group (n=40) at posttreatment compared with the waitlist control group (n=36; F1,76=3.62, P=.03; d=0.28, 95% CI −0.17 to 0.74). Similar findings were noted for the reduction of anxiety symptoms (F1,76=10.45; P=.001; d=0.14, 95% CI −0.31 to 0.60) at posttreatment. Other secondary outcomes were nonsignificant (.06≤P≤.44). At the 6-month follow-up, the difference between the groups with regard to reduction in depressive symptom severity was no longer statistically significant (F1,76=1.50, P=.11; d=0.10, 95% CI −0.34 to 0.46). The between-group difference in anxiety at posttreatment was maintained to follow-up (F1,76=2.94, P=.04; d=0.38, 95% CI −0.07 to 0.83). There were no statistically significant differences across groups regarding other secondary outcomes at the 6-month follow-up (.08≤P≤.42). Conclusions These results suggest that participants with comorbid depression and CBP on sick leave may benefit from internet- and mobile-based interventions, as exemplified with the positive user satisfaction ratings. The recruitment strategy via health insurance letter invitations appeared feasible, but more research is needed to understand how response rates in untreated individuals with CBP and comorbid depression can be increased. Trial Registration German Clinical Trials Register DRKS00010820; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010820.
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Gogineni, Keerthi, Katie Shuman, Derek Chinn, Carol Cosenza, Mary Ellen Colten, Floyd Jackson Fowler, and Ezekiel J. Emanuel. "Patient, public, and oncologists’ attitudes toward rationing medical care." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6518. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6518.
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6518 Background: Lowering health care costs is critical. Patients with cancer (PT) and oncologists (MD) regularly make decisions regarding interventions with potentially marginal benefit but substantial expense. What are the attitudes of PT, the public (GP), and MD on ways to control costs? Methods: In 2012, surveys were completed by 326 adult PT (Response Rate (RR)=72%), a random sample of 891 U.S. adults (RR=50%) and 245 MD (RR=55%). Results: A majority thought Medicare spending was a big or moderate problem (76% PT; 75% GP; 97% MD) and that Medicare could spend less without causing harm (66% PT; 70% GP; 74% MD). Respondents attributed rising costs to multiple factors including drug companies charging too much (94% PT; 90% GP; 94% MD) and insurance company profits (88% PT; 88% GP; 83% MD). Many also thought physicians and hospitals provided unnecessary tests and treatments (RX) (69% PT; 81% GP; 70% MD). Regarding solutions, most supported refusing to pay for expensive care if an equally effective, less expensive alternative was available or if therapy did not improve survival or quality of life (QOL). Few respondents were willing to refuse payment for RX that extend life by 4 months. Conclusions: The majority of those sampled view Medicare costs as a substantial problem and pharmaceutical and insurance companies as significant contributors. The GP in particular believe physicians and hospitals add considerably to the cost problem. A majority favor not paying for more expensive RX when cheaper ones are equally effective or if RX do not improve survival or QOL. MD were accepting of an independent oversight panel however this was met with resistance by PT and the GP. Currently, Medicare and other payers do not consistently follow such practices. [Table: see text]
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Karlin, David S. "Mindfulness in the workplace." Strategic HR Review 17, no. 2 (April 9, 2018): 76–80. http://dx.doi.org/10.1108/shr-11-2017-0077.
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Purpose This study aims to explore how a New Jersey-based, national vision insurance company and a Pennsylvania pharmacy benefits manager have incorporated mindfulness into the workplace. National Vision Administrators (NVA) and BeneCard PBF offer mindfulness to all employees, which has markedly improved productivity and morale, created empathy and stronger teamwork. The practice of mindfulness has been known to enhance results, decision-making skills and empower individuals to thrive under pressure both inside and out of the workplace. Design/methodology/approach To evaluate the benefit of a daily or weekly mindfulness practice, NVA tapped Free Form Minds, a training consultancy specializing in mindfulness, to conduct a series of group trainings and one-on-one sessions. To ensure optimal success and results, Fee Form Minds customized its programs for the companies and individuals they worked with. Findings The findings show team members have reported feeling more energized, with increased levels of concentration and decreased tendency of procrastination. Practicing employees found themselves regularly surpassing their goals while also allowing them to be more present with their families and less stressed at home. Originality/value The practice of mindfulness can help employees reduce stress and be more effective and focused. When utilizing this tool, ongoing, they are more likely to capitalize on their strengths and better handle stress. Incorporating the practice of mindfulness into NVA and BeneCard PBF has created a greater sense of community among employees leading to a more cohesive and happier work environment. Mindfulness has allowed individuals to be more focused, less impacted by stressors and improve both their professional and personal lives.
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Besseling, Joost, Jan Reitsma, Judith A. Van Erkelens, Maike H. J. Schepens, Michiel P. C. Siroen, Cathelijne M. P. Ziedses des Plantes, Mark I. van Berge Henegouwen, et al. "Use of Palliative Chemotherapy and ICU Admissions in Gastric and Esophageal Cancer Patients in the Last Phase of Life: A Nationwide Observational Study." Cancers 13, no. 1 (January 5, 2021): 145. http://dx.doi.org/10.3390/cancers13010145.
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Since intensive care unit (ICU) admission and chemotherapy use near death impair the quality of life, we studied the prevalence of both and their correlation with hospital volume in incurable gastroesophageal cancer patients as both impair the quality of life. We analyzed all Dutch patients with incurable gastroesophageal cancer who died in 2017–2018. National insurance claims data were used to determine the prevalence of ICU admission and chemotherapy use (stratified on previous chemotherapy treatment) at three and one month(s) before death. We calculated correlations between hospital volume (i.e., the number of included patients per hospital) and both outcomes. We included 3748 patients (mean age: 71.4 years; 71.4% male). The prevalence of ICU admission and chemotherapy use were, respectively, 5.6% and 21.2% at three months and 4.2% and 8.0% at one month before death. Chemotherapy use at three and one months before death was, respectively, 4.3 times (48.0% vs. 11.2%) and 3.7 times higher (15.7% vs. 4.3%), comparing patients with previous chemotherapy treatment to those without. Hospital volume was negatively correlated with chemotherapy use in the final month (rweighted = −0.23, p = 0.04). ICU admission and chemotherapy use were relatively infrequent. Oncologists in high-volume hospitals may be better equipped in selecting patients most likely to benefit from chemotherapy.
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KNEYSLER, Olha, and Lesia SHUPA. "VECTOR FOR THE DEVELOPMENT OF MEDICAL INSURANCE IN THE CONTEXT OF MODERN MEDICAL REFORM IN UKRAINE." WORLD OF FINANCE, no. 4(57) (2018): 148–56. http://dx.doi.org/10.35774/sf2018.04.148.
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Introduction. The current practice of functioning of the medical sector shows the existence of problems that impede the introduction of compulsory health insurance in Ukraine, the effective development of its voluntary form. At the same time, the problems of development of medical insurance under the influence of crisis phenomena of the national economy are deepening. The purpose of the article is to develop recommendations for improving medical reform in Ukraine. Results. The most controversial moment in the reform of health care was the rejection of free medicine, the right to which is enshrined in the Constitution of Ukraine. However, budget medicine in Ukraine will still remain, however, in what volumes and at what stages of provision of medical services or medical care is not yet defined in the Ministry of Health of Ukraine. The negative trend of the contracted health model is the creation of an authorized body that will not only implement health policy but, in fact, formulate this policy: to define state guarantees, needs for medical services and to check the quality of these services. And this is a huge threat, because Ukrainian medicine will be in a worse situation than it is now. We believe that the policy-making function should remain under the Ministry of Health of Ukraine. The negative aspect of modern medical reform in Ukraine is the lack of requirements for the formation of medical treatment protocols. This can be explained by the fact that patients will continue to prescribe treatment that is untrue. Instead, for the health insurance, the insurance company would monitor costs and control the appointment of treatment for the patient, the price of medical services. In this context, we propose to adopt the Law of Ukraine “On Compulsory Health Insurance”, which stipulates and clearly defines the rights and obligations of the insurer, the insurer, the list of services, their price, a single register of insured persons, the formation of the Social Health Insurance Fund and a differentiated approach to categories of the population. Conclusions. The experience of developed countries of the world proves that achieving this goal is possible through the introduction of insurance medicine. Insurance medicine is a real alternative to budget financing, which is no longer capable of ensuring the constitutional right of citizens to receive unpaid health care. The development of health insurance is an objective need, which is dictated by the need to ensure that healthcare receives funds. At the moment, the study of the question of the necessity of introducing compulsory health insurance is probably very relevant to all. Successful market reforms in Ukraine are impossible without the formation of an effectively organized health insurance market that can guarantee the preservation and strengthening of human health, improving the quality of medical services and the level of human life.
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Metcalfe, Leanne, E. Lenn Murrelle, Lan Vu, Andrew R. Joyce, Veronica Averhart Preston, Thomas Maryon, Conway McDanald, and Phillip Yoo. "Independent Validation in a Large Privately Insured Population of the Risk Index for Serious Prescription Opioid–Induced Respiratory Depression or Overdose." Pain Medicine 21, no. 10 (March 19, 2020): 2219–28. http://dx.doi.org/10.1093/pm/pnaa026.
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Abstract Objective To assess the generalizability of the overdose or serious opioid-induced respiratory depression risk index (VHA-RIOSORD), created by Zedler et al., using claims data from a large private insurer. Design A retrospective nested case–control analysis of health care claims data. Subjects Commercially insured individuals with a claim for an opioid prescription between October 1, 2014, and September 30, 2016 (N = 1,431,737). Methods An overdose or serious opioid–induced respiratory depression (OSORD) occurred in 1,097 patients. Ten controls were selected per case (N = 10,970). Items and the assignment of point values to predictors were consistent with those determined by Zedler et al. Modeling of risk index scores produced predicted probabilities of OSORD; risk classes were defined by the predicted probability distribution. Results All 15 items of the VHA-RIOSORD were used to determine a member’s risk of OSORD. The average predicted probability of experiencing OSORD ranged from 3% in the lowest risk decile to 90% in the highest, with excellent agreement between predicted and observed incidence across risk classes. The model’s C-statistic was 0.88. Conclusions Consistent with the findings of its developers, the VHA-RIOSORD performed well in identifying members of a large private insurance company who were medical users of prescription opioids at elevated risk of overdose or life-threatening respiratory depression, those most likely to benefit from preventive interventions.
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Tannous, N. "Call For Life, 2017 by the Children's Cancer Center of Lebanon." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 186s. http://dx.doi.org/10.1200/jgo.18.30700.
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Call for Life is a mini-telethon aims to spread awareness and calls for the support and instant donations from the community. Amount raised: The last campaign in 2017 raised: $1,463,018.84 with total expected revenues over the period of 3 years: $2,003,018.84. Background and context: The idea first started in year 2008. Four campaigns were done in the past years (2008, 2012, 2014 and 2017). The campaign has developed through the years in donation means, awareness, funds raised, partners, national engagement and has successfully become more efficient and successful due to the process adopted. The 4th edition was in celebration of the 15th anniversary, hence the slogan “Where We Were and Where We Have Become” and focusing on success stories. A special recognition wall was launched at the 4th edition, the “Guardians' Wall”, fitting 18 guardians' names who pledged to donate 15,000 USD yearly over 3 years period. At the D-day we had a special episode hosted by the famous talk show Kalam El Nas by Marcel Ghanem offered for free to CCCL along with all the air time whether for TVC or interviews and reports and outdoor media. A professional call center was activated during the special TV episode. Donation means: calling to register pledges and partner courier company to collect/money transfer company/online/at the center/banks. Aim: Call for Life is a nationwide campaign aims to spread awareness and calls for the support and instant donations from the community so CCCL continues its mission of saving children's lives. Strategy/Tactics: Reviewing previous campaigns exit reports to benefit from remarks Study the best means/mechanism of donations Free and strong media campaign Positive content of promotional material and reports of the episode Send letters to big donors prior to the launching; trying to ensure big donations prior Facilitating the donation means Full special episode on the D-day broadcasted live at peak hour of viewership. Program process: Brainstorming Deciding on means/mechanism and sponsorship packages Setting media campaign's concept, idea and promotional plan set Preparing campaign´s project details and project plan Ensuring call center, short code, and proper dissemination of campaign's information to agents Coordination and preparation of all material and content of a special episode Trying to ensure donations prior to the d-day. Costs and returns: Costs: $6484 Revenues: $1,463,018.84 with total expected revenues over the period of 3 years: $2,003,018.84 What was learned: Call For Life has to have easy and varied donation means. Massive free media campaign is a must with episode at night peak viewership hour. Patient and survivors involvement has an added value. Innovative Guardian´s Wall ensures an appealing recognition which encourages donations. A one week campaign with one main telethon day gives sense of urgency for quick responses. Expenses shall remain minimal.
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van der Plas, Annicka GM, Mariska G. Oosterveld-Vlug, H. Roeline W. Pasman, and Bregje D. Onwuteaka-Philipsen. "Relating cause of death with place of care and healthcare costs in the last year of life for patients who died from cancer, chronic obstructive pulmonary disease, heart failure and dementia: A descriptive study using registry data." Palliative Medicine 31, no. 4 (January 6, 2017): 338–45. http://dx.doi.org/10.1177/0269216316685029.
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Background: The four main diagnostic groups for palliative care provision are cancer, chronic obstructive pulmonary disease, heart failure and dementia. But comparisons of costs and care in the last year of life are mainly directed at cancer versus non-cancer or within cancer patients. Aim: Our aim is to compare the care and expenditures in their last year of life for Dutch patients with cancer, chronic obstructive pulmonary disease, heart failure or dementia. Design: Data from insurance company Achmea (2009–2010) were linked to information on long-term care at home or in an institution, the National Hospital Registration and Causes of Death-Registry from Statistics Netherlands. For patients who died of cancer ( n = 8658), chronic obstructive pulmonary disease ( n = 1637), heart failure ( n = 1505) or dementia ( n = 3586), frequencies and means were calculated, Lorenz curves were drawn up and logistic regression was used to compare patients with high versus low expenditures. Results: For decedents with cancer and chronic obstructive pulmonary disease, the highest costs were for hospital admissions. For decedents with heart failure, the highest costs were for the care home (last 360 days) and hospital admissions (last 30 days). For decedents with dementia, the highest costs were for the nursing home. Conclusion: Patients with dementia had the highest expenditures due to nursing home care. The number of dementia patients will double by the year 2030, resulting in even higher economic burdens than presently. Policy regarding patients with chronic conditions should be informed by research on expenditures within the context of preferences and needs of patients and carers.
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Yeh, Charlotte, Daniel Russell, and James Schaeffer. "AGING STRONG 2020: INTERVENTIONS TO IMPROVE LONELINESS AMONG OLDER ADULTS." Innovation in Aging 3, Supplement_1 (November 2019): S184. http://dx.doi.org/10.1093/geroni/igz038.657.
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Abstract Research confirms serious and concerning health implications for lonely and socially isolated older adults. Studies consistently demonstrate that older adults who are lonely or socially isolated have higher rates of depression, more health conditions, and greater mortality. AARP Services, Inc. (ASI) and UnitedHealthcare (UHC) are committed to the health and well-being of insureds in AARP® Medicare Supplement Plans insured by UnitedHealthcare Insurance Company (for New York certificate holders, UnitedHealthcare of New York), recognizing that health and wellness should be promoted on a holistic level to ensure successful aging. As part of this commitment, a research initiative entitled Aging Strong 2020 has been developed. Its purpose is to impact insureds’ personal and social investments in their well-being Thus a related series of interventions are aiming to increase resilience by focusing on enhanced purpose in life, social connectedness, and optimism. This symposium will specifically discuss these efforts related to social connectedness and how they have improved well-being among lonely older adults. First discussed is the prevalence and outcomes of loneliness in a large national survey. Interventions include use of animatronic pets, a telephonic reminiscent memory program, and an online self-compassion mindfulness program. Findings from these initiatives demonstrate that interventions designed to improve loneliness and well-being among lonely older adults can contribute to the holistic model of health.
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Armoiry, X., P. Auguste, C. Dussart, J. Guyotat, and M. Connock. "P14.12 The cost-effectiveness of tumor-treating fields in patients with newly diagnosed glioblastoma." Neuro-Oncology 21, Supplement_3 (August 2019): iii68—iii69. http://dx.doi.org/10.1093/neuonc/noz126.247.
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Abstract BACKGROUND The addition of novel therapy “Tumor-Treating fields” (TTF) to standard radio-chemotherapy with Temozolomide (TMZ) has recently shown superiority over conventional TMZ regimen in patients with glioblastoma. Despite the clinical benefit of TTF, there is a strong concern regarding the cost of this new treatment. A first cost-effectiveness analysis, which was published in 2016, was based on effectiveness outcomes from an interim analysis of the pivotal trial and used a “standard” Markov model. Here, we aimed to update the cost-effectiveness evaluation using a partitioned survival model design and using the latest effectiveness data. MATERIAL AND METHODS A partitioned survival model was developed with three mutually exclusive health states: stable disease, progressive disease, and dead. Parametric models were fitted to the Kaplan-Meier data for overall and progression-free survival. These generated clinically plausible extrapolations beyond the observed data. The perspective of the French national health insurance was adopted and the time horizon was 20 years. Base case results were expressed as cost/life-years (LY) gained (LYG). Secondary analyses were undertaken, with the results presented as cost/per quality adjusted life years (QALY) gained. Last, we undertook deterministic and probabilistic sensitivity analyses. RESULTS After applying 4% annual discounting of benefits and costs, the base case model generated incremental benefit of 0.507 LY at a incremental cost of €258,695 yielding an incremental cost effectiveness ratio (ICER) of €510,273 / LYG. Secondary analyses yielded an ICER of €667,173/QALY. Sensitivity analyses and bootstrapping methods showed the model was relatively robust. The model was sensitive to TTF device costs and the parametric model fitted to the Kaplan-Meier data for overall survival. The cost-effectiveness acceptability curve showed TTF has 0% of being cost-effective under conventional thresholds. CONCLUSION Using a partitioned survival model, uprated costs and more mature survival outcomes, TTF when compared to standard radio-chemotherapy with TMZ is not likely to be cost-effective. This has major implications in terms of access of newly eligible patients
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Alriksson-Schmidt, Ann, Johan Jarl, Elisabet Rodby-Bousquet, Annika Lundkvist Josenby, Lena Westbom, Kate Himmelmann, Kristine Stadskleiv, et al. "Improving the Health of Individuals With Cerebral Palsy: Protocol for the Multidisciplinary Research Program MOVING ON WITH CP." JMIR Research Protocols 8, no. 10 (October 9, 2019): e13883. http://dx.doi.org/10.2196/13883.
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Background Cerebral palsy (CP) is one of the most common early onset disabilities globally. The causative brain damage in CP is nonprogressive, yet secondary conditions develop and worsen over time. Individuals with CP in Sweden and most of the Nordic countries are systematically followed in the national registry and follow-up program entitled the Cerebral Palsy Follow-Up Program (CPUP). CPUP has improved certain aspects of health care for individuals with CP and strengthened collaboration among professionals. However, there are still issues to resolve regarding health care for this specific population. Objective The overall objectives of the research program MOVING ON WITH CP are to (1) improve the health care processes and delivery models; (2) develop, implement, and evaluate real-life solutions for Swedish health care provision; and (3) evaluate existing health care and social insurance benefit programs and processes in the context of CP. Methods MOVING ON WITH CP comprises 9 projects within 3 themes. Evaluation of Existing Health Care (Theme A) consists of registry studies where data from CPUP will be merged with national official health databases, complemented by survey and interview data. In Equality in Health Care and Social Insurance (Theme B), mixed methods studies and registry studies will be complemented with focus group interviews to inform the development of new processes to apply for benefits. In New Solutions and Processes in Health Care Provision (Theme C), an eHealth (electronic health) procedure will be developed and tested to facilitate access to specialized health care, and equipment that improves the assessment of movement activity in individuals with CP will be developed. Results The individual projects are currently being planned and will begin shortly. Feedback from users has been integrated. Ethics board approvals have been obtained. Conclusions In this 6-year multidisciplinary program, professionals from the fields of medicine, social sciences, health sciences, and engineering, in collaboration with individuals with CP and their families, will evaluate existing health care, create conditions for a more equal health care, and develop new technologies to improve the health care management of people with CP. International Registered Report Identifier (IRRID) DERR1-10.2196/13883
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Dutina, Aleksandra, Ivana Stasevic-Karlicic, Nikola Pandrc, Andjelka Prokic, and Slobodan Jankovic. "Cost/effectiveness of aripiprazole vs. olanzapine in the long-term treatment of schizophrenia." Srpski arhiv za celokupno lekarstvo 147, no. 7-8 (2019): 468–74. http://dx.doi.org/10.2298/sarh181012065d.
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Introduction/Objective. Although effectiveness of atypical antipsychotics in patients with schizophrenia is mostly similar, there are significant differences in adverse effects rate and treatment costs, making comparison of their cost/effectiveness ratios essential for optimal drug choice. The aim of this study was to compare cost/effectiveness of aripiprazole and olanzapine in long-term treatment of schizophrenia. Methods. A four-state, three-month cycle Markov model was built to compare aripiprazole and olanzapine. The model assumed that patients who relapse on treatment with both aripiprazole and olanzapine are further treated with clozapine. The perspective of the National Health Insurance Fund was chosen, and the period covered by the model was 10 years. The model results were obtained after Monte Carlo microsimulation of a sample with 1,000 virtual patients. Both multiple one-way and probabilistic sensitivity analysis was made. Results. After base-case analysis aripiprazole was dominated by olanzapine, as net monetary benefit was negative (-390,341.96 ?} 29,131.53 RSD) and incremental cost/effectiveness ratio (ICER) was above the willingness-to-pay line of one Serbian gross domestic product per capita per quality-adjusted life year (QALY) gained. Multiple one-way and probabilistic sensitivity analysis confirmed results of the base case simulation. Conclusion. Olanzapine has more beneficial cost/effectiveness ratio than aripiprazole for long-term treatment of schizophrenia in Serbian milieu.
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Thornburg, Courtney, Heidi Lane, Katharine Farrow, Rosalie Brooks, Mina Jahan, and Maria Scopelliti. "Increasing Quality Improvement Capability in a Hemophilia Treatment Center." Blood 128, no. 22 (December 2, 2016): 5908. http://dx.doi.org/10.1182/blood.v128.22.5908.5908.
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Abstract Introduction Persons with hemophilia require complex medical care by a multi-disciplinary team throughout life. There are opportunities for Hemophilia Treatment Centers (HTC) to enhance the care of persons with hemophilia through participation in quality improvement (QI) initiatives. Maintaining comprehensive care and excellent health outcomes are national priorities for Health Resources and Services Administration (HRSA) and the American Thrombosis and Hemostasis Network (ATHN), the National Hemophilia Program Coordinating Center (NHPCC). Rady Children's Hospital San Diego (RCHSD) HTC participated in the NHPCC Dartmouth Improvement Program pilot program with the aim to develop QI capabilities within the HTCs to enhance the care of persons with hemophilia. Methods RCHSD participated in the NHPCC Dartmouth Improvement Program starting in December 2015. A QI team was established including the HTC medical director, nurse case managers, pediatric social worker and the social worker of the collaborating adult HTC. The QI team was coached by an expert TDIMA coach and a "coach in training" from another HTC. The team learned QI methods through in person training, web-based training and weekly team meetings with the coaches. The team assessed HTC data (The 5Ps-purpose, patients, professionals, processes, and patterns) to gain system knowledge and insights to determine a QI theme, global aim, specific aims and associated PDSA cycles. Results The RCHSD HTC QI team established a QI theme to focus on the transfer from pediatric to adult care. The Global Aim of the team is to improve autonomous communication in RCHSD HTC. The process begins with the 12 year old comprehensive clinic visit and ends with a new patient visit at an adult HTC. By working on the process, we expect patients to have the communication skills to be able to arrange medical insurance, call the home care company to order factor and to communicate their health and personal care needs to adult health care providers. We developed four specific aims which are in various stages of testing in PDSA cycles (Table 1). For Aim 1, we found that patients have only basic knowledge of insurance information. For Aim 2, we found that we needed to adjust our clinic process to make sure that patients receive their "after visit summary" that includes the insurance information prior to leaving clinic. Conclusions We developed a QI program within RCHSD HTC focused on improving transfer of care. Once we have completed the specific aim PDSA cycles we will standardize the new and improved procedures. We will continue to develop the program based on internal needs assessment and family input. This training model may be adapted by other HTCs to enhance patient care. Disclosures Thornburg: Mast Pharmaceuticals: Research Funding; Bayer Pharmaceuticals: Research Funding; Shire: Consultancy; Biogen Idec: Other: Data Safety Monitoring Board; Bluebird inc: Other: Data Safety Monitoring Board.
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Bonastre, Julia, Sophie Marguet, Beranger Lueza, Stefan Michiels, Suzette Delaloge, and Mahasti Saghatchian. "Cost Effectiveness of Molecular Profiling for Adjuvant Decision Making in Patients With Node-Negative Breast Cancer." Journal of Clinical Oncology 32, no. 31 (November 1, 2014): 3513–19. http://dx.doi.org/10.1200/jco.2013.54.9931.
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Purpose To conduct an economic evaluation of the 70-gene signature used to guide adjuvant chemotherapy decision making both in patients with node-negative breast cancer (NNBC) and in the subgroup of estrogen receptor (ER) –positive patients. Patients and Methods We used a mixed approach combining patient-level data from a multicenter validation study of the 70-gene signature (untreated patients) and secondary sources for chemotherapy efficacy, unit costs, and utility values. Three strategies on which to base the decision to administer adjuvant chemotherapy were compared: the 70-gene signature, Adjuvant! Online, and chemotherapy in all patients. In the base-case analysis, costs from the French National Insurance Scheme, life-years (LYs), and quality-adjusted life-years (QALYs) were computed for the three strategies over a 10-year period. Cost-effectiveness acceptability curves using the net monetary benefit were computed, combining bootstrap and probabilistic sensitivity analyses. Results The mean differences in LYs and QALYs were similar between the three strategies. The 70-gene signature strategy was associated with a higher cost, with a mean difference of €2,037 (range, €1,472 to €2,515) compared with Adjuvant! Online and of €657 (95% CI, −€642 to €3,130) compared with systematic chemotherapy. For a €50,000 per QALY willingness-to-pay threshold, the probability of being the most cost-effective strategy was 92% (76% in ER-positive patients) for the Adjuvant! Online strategy, 6% (4% in ER-positive patients) for the systematic chemotherapy strategy, and 2% (20% in ER-positive patients) for the 70-gene strategy. Conclusion Optimizing adjuvant chemotherapy decision making based on the 70-gene signature is unlikely to be cost effective in patients with NNBC.
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CHEN, Chih-Ming, Di-Yu LEI, Tzu-Jiun YEH, and Jui-Hsi CHENG. "A Study on Critical Factors in the Service Innovation of Local Medical Care for Senior Citizens." Revista de Cercetare si Interventie Sociala 74 (September 15, 2021): 138–48. http://dx.doi.org/10.33788/rcis.74.9.
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The 21st century is a hundred-year century, when senior citizen related issues are derived along with enhancing life expectancy, declining concept of raising a child as the insurance for old age, and increasing index of aging. Aiming at the test for possible needs, national social policies and systems as well as relevant economic industries should make adjustment and innovation. People’s needs for health care used to be pure disease treatment and health acquisition. When the market system moved towards the trend of customer-oriented service, people did not simply ask for the enhancement of medical technology, but started to criticize the feelings in the medical process. It resulted in medical care institutions focusing on the quality of service. Service innovation is a critical factor for medical care institutions keeping the competitiveness and sustainable growth in the market. Aiming at senior citizens in Fujian Province, 480 copies of questionnaire are distributed, and 351 valid copies are retrieved, with the retrieval rate 73% . The research results are summarized as below: “Service type” is the most emphasized dimension in Hierarchy II, followed by “service delivery”, “customer interface”, and “technology choice”, Among 12 indicators, top five indicators are ordered diversified service, service channel point, customer relationship management, business model, and customer participation. According to the results to propose suggestions, it is expected to benefit medical care institutions as well as enhance the health care quality of domestic medical market.
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Esam, Fiona, Rachel Forrest, and Natalie Waran. "Locking down the Impact of New Zealand’s COVID-19 Alert Level Changes on Pets." Animals 11, no. 3 (March 10, 2021): 758. http://dx.doi.org/10.3390/ani11030758.
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The influence of the COVID-19 pandemic on human-pet interactions within New Zealand, particularly during lockdown, was investigated via two national surveys. In Survey 1, pet owners (n = 686) responded during the final week of the five-week Alert Level 4 lockdown (highest level of restrictions—April 2020), and survey 2 involved 498 respondents during July 2020 whilst at Alert Level 1 (lowest level of restrictions). During the lockdown, 54.7% of owners felt that their pets’ wellbeing was better than usual, while only 7.4% felt that it was worse. Most respondents (84.0%) could list at least one benefit of lockdown for their pets, and they noted pets were engaged with more play (61.7%) and exercise (49.7%) than pre-lockdown. Many respondents (40.3%) expressed that they were concerned about their pet’s wellbeing after lockdown, with pets missing company/attention and separation anxiety being major themes. In Survey 2, 27.9% of respondents reported that they continued to engage in increased rates of play with their pets after lockdown, however, the higher levels of pet exercise were not maintained. Just over one-third (35.9%) of owners took steps to prepare their pets to transition out of lockdown. The results indicate that pets may have enjoyed improved welfare during lockdown due to the possibility of increased human-pet interaction. The steps taken by owners to prepare animals for a return to normal life may enhance pet wellbeing long-term if maintained.
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Prasad, Sandip M., G. Caleb Alexander, and Scott E. Eggener. "Prostate-specific antigen testing among primary care physicians and urologists: Patterns of care and impact of professional society guidelines." Journal of Clinical Oncology 30, no. 5_suppl (February 10, 2012): 40. http://dx.doi.org/10.1200/jco.2012.30.5_suppl.40.
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40 Background: During the past decade, the incidence of prostate cancer in the United States has declined. We hypothesized this was related to lower rates of prostate-specific antigen (PSA) testing and sought to evaluate PSA testing rates nationally. Methods: Using the National Ambulatory Medical Care Survey, a nationally representative sample of outpatient visits in the United States, we analyzed rates of PSA testing in men age 40 years or older who visited PCPs or urologists from 1997 to 2008. Results: An estimated 26.6 million (95% CI: 24.8-28.4 million) PSA tests were ordered during 94.5 million (95% CI: 90.9-98.1 million) office visits to urologists and 95 million (95% CI: 87.5-102.8 million) tests were ordered during 1.17 billion (95% CI: 1.15-1.18 billion) visits to PCPs, with an annual increase of 3.4% and 6.0%, respectively (P=0.055 and P<0.001 for trend). After adjusting for year, race, ethnicity, region, insurance and provider type, testing by PCPs was more likely among older men and highest among men aged 60 to 69 years (reference: 40-49 years; OR 2.32, 95% CI: 1.88-2.85). Compared to men without a chronic medical condition, those with one chronic condition had greater odds of receiving a PSA test (OR 1.28, 95% CI: 1.08-1.52). Conclusions: Prostate cancer incidence has declined over the past decade despite increasing rates of office-based PSA testing by PCPs and urologists during the period. Increasing rates of PSA testing merit scrutiny, especially in men with limited life expectancies who are unlikely to benefit from screening.
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Machanguana, Constâncio A., and Idalina Dias Sardinha. "Exploring mining multinational resettlements and corporate social responsibility in emerging economies: the case of the company VALE, SA in Mozambique." Sustainability Accounting, Management and Policy Journal 12, no. 3 (May 5, 2021): 591–610. http://dx.doi.org/10.1108/sampj-11-2019-0414.
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Purpose This paper aims to contribute to the scientific and societal debates about the role of corporate social responsibility (CSR) and particularly on the resettlements’ processes as part of extractive multinational companies (MNCs)’s commitments where the host country is an emerging extractive economy. Design/methodology/approach It is an exploratory study based on the analysis of secondary data, few interviews and on-site observation and deals with the description of the assessment of VALE, SA resettlement processes and assumed CSR practices of VALE, SA, an MNC operating in the Moatize district, Tete province in Mozambique. Findings The MNC assumes resettlement processes to be part of the CSR arena and reveals that VALE, SA follows a reactive poor approach as to CSR. The weak institutional context in Mozambique is like others described in the literature. The empirical data together with the sense of an ethical responsibility approach associated with resettlement processes and the paradigm shift in aid for trade as to development supported by the MNC’s CSR leads to the conclusion that resettlement can be considered part of the CSR of a mining MNC. Research limitations/implications The difficult access to key informants of the resettled communities, local government and little interest in interview participation by VALE, SA, showed a current lack of confidence and communication limitations by the company as to this issue. Practical implications The failure of VALE, SA and other mining companies to meet their resettlement responsibilities and the inability of government supervision, requires local and national, as well as social and scientific communication processes and debate on this issue to be maintained on an ongoing basis during the mining life cycle to guaranty accomplishments of CSR. Social implications The controversy over whether mining MNCs will benefit Africa’s emerging economies as to their socio-economic development will continue until MNCs commit themselves and act to be economically, legally and ethically responsible for contributing to the sustainable development of the countries where they operate. Originality/value This paper contributes to the debate on whether CSR frames the resettlement process based on literature review and key stakeholder views.
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van Waalwijk van Doorn-Khosrovani, Sahar Barjesteh, Anke Pisters-van Roy, Haiko Bloemendal, and Hans Gelderblom. "National survey on access to new oncology drugs pending health technology assessment and financial arrangements." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e13599-e13599. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e13599.
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e13599 Background: In the Netherlands, the health insurance package usually covers cancer drugs after EMA approval and positive recommendation of the Dutch Society of Medical Oncology (NVMO). However, the government can temporarily exclude newly licensed indications with high budget impact from coverage until the national HTA-body advises on the clinical effectiveness and cost effectiveness. Based on the recommendations of the HTA-body, the government negotiates a financial arrangement with manufacturers. Because submitting value dossiers, assessments and negotiations takes time there have been concerns regarding patients’ access to these novel treatments, especially for life threatening conditions such as cancer. Due to a lack of transparency, it is not known to what extent patients are given access to ‘free of charge programmes’ (FCPs). Methods: A list of oncology drugs and indications which were temporarily excluded from reimbursement due to negotiations with the government (July 2015-Dec. 2020). We contacted all the pharmaceutical companies that were engaged in the process above, to inquire about access to their products during the HTA evaluation and negotiations. Results: In total 17 oncology drugs (46 EMA registered indications) of 11 companies were subjected to financial agreements by the government. In 41,3% (19/46) of cases, FCPs were available via individual prescriber requests in a selected number of hospitals. In all other cases such arrangements were not needed because alternative treatment options were available (15,2%; 7/46) or because treatment was not recommended by the NVMO (13,0%; 6/46). For one indication FCP was available but the treatment eventually received a negative recommendation. In 30,4% (14/46) of the cases there was immediate reimbursement in place following a positive NVMO recommendation through umbrella agreements. Such agreements cover existing indications but also all the indications that will be licensed in the future. Umbrella agreements were especially set up for immune checkpoint inhibitors that showed benefit across multiple indications. As anticipated, some patient-access programmes had already started prior to EMA approval. In 5 cases an official compassionate use programme was set up through the Dutch Medicines Evaluation Board prior to authorisation. Conclusions: Our survey indicates that all manufacturers are committed to enabling patients’ and clinicians’ early access to their products pending payers’ approval in a high income country such as the Netherlands. However, the lack of transparency regarding the hospitals offering these programmes may result in inequity in access. Besides, there is no structural data collection. Recently, the NVMO has established a platform (DRUG Access Protocol) to harmonise all compassionate use programmes and FCPs, generating real-world data and ensuring equal access for all patients.