Hasil untuk "Insurance"

Peter Elia Mosha, Amina S. Msengwa, Majige Selemani

Abstract Background Healthcare accessibility remains a critical challenge in many low-and middle-income countries, where disparities between rural and urban areas persist. This study, conducted in Dodoma region, Tanzania, models the determinants of healthcare accessibility, aiming to generate evidence that informs policy interventions for equitable healthcare service delivery in underserved populations. Methods A cross-sectional survey design was adopted. Data were collected from 1,009 households (urban 556; rural 453) across four selected districts withing Dodoma region, Tanzania, using a structured questionnaire digitized and implemented through KoboToolbox. The bivariate analysis and binary logistics regression were used to assess the determinants of healthcare accessibility. Fairlie decomposition was also used to assess and explain the healthcare accessibility disparity between urban and rural areas. Results Among the 1,009 households surveyed, 45% had access to healthcare services, with urban households having higher access compared to rural households. Significant determinants of healthcare accessibility included healthcare insurance cover [(AOR = 72.006 p < 0.001), CI:19.573 – 264.895], household size [(AOR = 0.713, p < 0.05), CI: 0.536 – 0.947], age of the head of household [(AOR = 0.830 p < 0.001), CI:0.785 – 0.878], and Out-of-pocket costs used for the last illness episodes [(AOR = 0.404 p < 0.01), CI:0.139 –1.167]. Additionally, decision-making authority within households, payment methods, and the presence of chronic illness showed significant or partial influence on accessibility. Fairlie's decomposition revealed that health insurance and the age of the head of household account for the largest (93.4%) share of the disparity in healthcare accessibility between urban and rural households. These findings underscore the complexity of healthcare access, providing actionable insights for policy interventions to address rural–urban disparities. Conclusion The study highlights the importance of health insurance coverage in improving healthcare access, emphasizing the need for targeted policy interventions to address rural–urban disparities and improve health outcomes, considering unique rural household needs.

Probability models play crucial role in modeling loss in the finance and actuarial sciences. In this article, a new family of loss distributions known as the Tan F-Loss family of distributions is proposed with the Tan Weibull Loss distribution as a special case. The density exhibits decreasing, right skewed, symmetric, and approximately symmetric shapes. The hazard rate function shows decreasing and modified bathtub shapes. The statistical properties of the Tan Weibull Loss distribution including the quantile function, moments, expansion of the general rate, moment generating function, incomplete moment, and order statistics are studied. The maximum likelihood estimators of the distribution are also studied. Simulations are carried out to examine the behavior of the estimators. The results show that the estimators are consistent. The usefulness of the proposed distribution is demonstrated with two insurance loss datasets. The results show that the proposed distribution gives a better parametric to the two datasets compared with the competing distributions. © 2024 The Author(s)

T. Yarumba, G. R. Kassenga, N. F. Mwageni

Crop insurance is generally considered to be essential for managing agricultural risks and enhancing farmers' resilience to natural disasters,pests and climate change. This paper reviews the regulatory framework and identifies challenges and opportunities in accessing insurance products among smallholder farmers in Tanzania using appropriate techniques. Key findings include low premium penetration and adoption; limited uptake, low awareness, and limited demand. Despite the implementation of pilot projects, crop insurance has yet to achieve widespread adoption due to slow progression. Microinsurance initiatives struggle due to financial constraints, infrastructural deficiencies, and inadequate farmer education. However, significant constraints persist, including high minimum capital requirements and limited distribution channels, which disproportionately affect smallholder farmers. Traditional attitudes, economic constraints, and mistrust contribute to the limited effectiveness of crop insurance. Addressing these issues requires a re-evaluation of insurance frameworks to serve Tanzanian smallholder farmers better and facilitate affordable and accessible insurance products.

Gladys Honein-AbouHaidar, Cynthia Rizkallah, Imad Bou Akl et al.

Abstract Background A recommendation by the World Health Organization (WHO) was issued about the use of chest imaging to monitor pulmonary sequelae following recovery from COVID-19. This qualitative study aimed to explore the perspective of key stakeholders to understand their valuation of the outcome of the proposition, preferences for the modalities of chest imaging, acceptability, feasibility, impact on equity and practical considerations influencing the implementation of using chest imaging. Methods A qualitative descriptive design using in-depth interviews approach. Key stakeholders included adult patients who recovered from the acute illness of COVID-19, and providers caring for those patients. The Evidence to Decision (EtD) conceptual framework was used to guide data collection of contextual and practical factors related to monitoring using imaging. Data analysis was based on the framework thematic analysis approach. Results 33 respondents, including providers and patients, were recruited from 15 different countries. Participants highly valued the ability to monitor progression and resolution of long-term sequelae but recommended the avoidance of overuse of imaging. Their preferences for the imaging modalities were recorded along with pros and cons. Equity concerns were reported across countries (e.g., access to resources) and within countries (e.g., disadvantaged groups lacked access to insurance). Both providers and patients accepted the use of imaging, some patients were concerned about affordability of the test. Facilitators included post- recovery units and protocols. Barriers to feasibility included low number of specialists in some countries, access to imaging tests among elderly living in nursing homes, experience of poor coordination of care, emotional exhaustion, and transportation challenges driving to a monitoring site. Conclusion We were able to demonstrate that there is a high value and acceptability using imaging but there were factors influencing feasibility, equity and some practical considerations associated with implementation. We had a few suggestions to be considered by the expert panel in the formulation of the guideline to facilitate its implementation such as using validated risk score predictive tools for lung complications to recommend the appropriate imaging modality and complementary pulmonary function test.

Astrid de Wind, Birgit H. P. M. Donker-Cools, Lyanne Jansen et al.

Abstract Background Several occupational health disciplines are involved in return to work guidance, implying that good interdisciplinary collaboration is important. A shared conceptual framework and a common language for the assessment of work capacity and guidance in return to work is expected to be at the benefit of appropriate and sustainable employability of sick employees. The International Classification of Functioning, Disability and Health (ICF) can be considered a shared conceptual framework and is also promising in terms of a common language. The purpose of the current study is to reach multidisciplinary consensus among occupational health professionals on the content of an ICF-based instrument for the assessment of work capacity and guidance in return to work. Methods To obtain multidisciplinary consensus we conducted a modified Delphi study among twelve occupational health experts, including four occupational physicians, four insurance physicians and four labour experts. The study included two e-mail rounds and two virtual meetings. In the consecutive rounds the experts assessed ICF items as well as a list of non-ICF-based work-related environmental factors on their relevance for the assessment of the work capacity and guidance in return to work together with their interpretability. Results The four consecutive Delphi rounds resulted in 20 items that are minimally needed for the assessment of the work capacity and return to work possibilities of employees on sick leave. The final list included six items on personal functioning, seven items on social functioning and seven items on physical functioning. Conclusions This set of items forms the core of an ICF-based instrument, which is expected to facilitate interdisciplinary and intradisciplinary communication because of the use of a shared conceptual framework. As such, it should be of help in the guidance in return to work of employees on sick leave and contribute to appropriate and sustainable employability.

Liudmila I. Khoruzhy, Yuriy N. Katkov, Ekaterina A. Katkova et al.

The development of cloud technologies enables companies to actively implement technologies for cost management and risk reduction in their financial and economic activities. The use of cloud-based models of risk management in the financial and economic activities of the enterprise will help small and medium-sized companies in the agro-industrial sector in Russia to make structural and strategic changes, as well as discover new opportunities for business expansion. The purpose of the study is to develop models for cost management and reduction of risks in the financial and economic activities of companies based on the OLAP technology for application in Russian agro-industrial enterprises. The study employs a qualitative approach based on the case study methodology. The paper discloses and substantiates the authors’ conceptual model of a cost management system that allows executives to make decisions proceeding from four types of cost prices. The distinguishing feature of the management system is the use of a digital twin, which makes it possible to manage risks at the early stages of decision-making. The application of OLAP systems improves the quality of analysis and visualization methods as part of the cost management system. In addition, the study provides practical insight into how the applied model will help small and medium-sized agro-industrial enterprises to develop different business vision strategies based on cost reduction, manage the level of risk at the early stages of decision-making, and analyze information from a geographically dispersed logistics chain of divisions (production facilities, warehouses, stores).

Олег Семененко, Ігор Воронченко, Петро Онофрійчук et al.

У Збройних Силах (ЗС) України продовжується робота щодо підвищення ефективності оборонного планування та управління оборонними ресурсами. Алгоритм оборонного планування розвитку ЗС України крок за кроком використовує результати аналізу досвіду провідних країн світу, які перейшли від планування у галузі оборони на основі загроз до оборонного планування, орієнтованого на досягнення військами (силами) спроможностей, необхідних для виконання покладених на них завдань із урахуванням економічних можливостей держави. Перелік завдань ЗС України визначається на основі ймовірних сценаріїв їх застосування. Одним із ключових моментів ефективного планування застосування ЗС за відповідним сценарієм є вірне, обґрунтоване визначення обсягів необхідних оборонних ресурсів (людських, матеріально-технічних, фінансових). На сучасному етапі трансформації системи оборонного планування до стандартів НАТО та застосування методу планування на основі спроможностей необхідне удосконалення змісту та алгоритму оцінювання воєнно-економічних можливостей держави щодо ефективного утримання власних Збройних Сил, які є одним із головних факторів забезпечення необхідного рівня воєнно-економічної безпеки країни. Ефективність оцінювання залежить від повноти та якості оцінок основних воєнно-економічних факторів, які впливають на розвиток ЗС України. У статті автори запропонували свої погляди щодо удосконалення існуючих підходів до проведення розрахунків обсягів необхідних оборонних ресурсів для ефективного розвитку ЗС, а також визначили основні економічні фактори, які на нього впливають. Проведений у статті детальний аналіз воєнно-економічних умов розвитку ЗС країн світу та України у період 2012-2021 років дозволив сформувати рейтингові оцінки воєнно-економічних умов розвитку збройних сил цих країн у порівнянні з Україною та визначити їх вплив на достатність рівня воєнно-економічної безпеки для кожної країни із урахуванням ймовірних воєнних та економічних загроз для кожної із країн.

Zhiwei Zhong, Xiaoyuan Yao, Min Luo et al.

Background Protocatechuic aldehyde (PA) extracts from S. miltiorrhiza, which anti-oxidative and anti-inflammatory functions have been certified in diverse diseases. Nonetheless, the influence of PA in spinal cord injury (SCI) is still hazy. The research probed the function of PA in hydrogen peroxide (H2O2)-damaged PC12 cells.Methods The disparate dosages of H2O2 (0–400 µM) or PA (0–2 µM) were applied for stimulating PC12 cells, and subsequently cell viability, apoptosis, apoptosis- and autophagy-correlative factors were evaluated. After pc-MEG3 transfection, functions of MEG3 overexpression in H2O2 and/or PA-managed PC12 cells were reassessed. Western blot was conducted to determine Wnt/β-catenin and PTEN/PI3K/AKT pathways.Results H2O2 stimulation clearly triggered PC12 cell damage via prohibiting cell viability and accelerating apoptosis and autophagy. But, PA management mitigated H2O2-triggered PC12 cells damage. Down-regulated MEG3 triggered by PA was presented in H2O2-managed cells. What’s more, overexpressed MEG3 dramatically overturned the influences of PA in H2O2-damaged PC12 cells. Beyond that, PA activated Wnt/β-catenin and PTEN/PI3K/AKT via repression of MEG3 in H2O2-managed PC12 cells.Conclusions The results disclosed the protective impacts of PA on PC12 cells to resist H2O2-provoked damage. MEG3, Wnt/β-catenin and PTEN/PI3K/AKT pathways joined in adjusting the activity of PA in H2O2-damaged PC12 cells.

Sander W. K. van den Burg, Christine Röckmann, Jennifer L. Banach et al.

Spatial claims concerning the rapidly growing European offshore wind sector give rise to various ideas for the multi-use application of wind farms. Seaweed is considered a promising feedstock for food and feed that could be produced at offshore wind farms. Concerns about risks resulting in liability claims and insurance premiums are often seen as show-stoppers to multi-use at offshore wind farms. In this study, key environmental risks of seaweed cultivation at offshore wind farms, identified through literature review, are characterized based on stakeholder consultation. The current approach to risk governance is evaluated to assess how it can handle the uncertain, complex, and/or ambiguous risks of multi-use. It is concluded that current risk governance for multi-use is poorly equipped to deal with the systemic nature of risks. Risk governance should be a joint effort of governments and private regulators. It can improve if it is based on an adaptive framework for risk assessment that can deal with complex, systemic risks. Furthermore, it should be flexible and inclusive, i.e., open to new incoming information and stakeholder input, and taking into account and communicate about the different stakes and values of the various parties involved. The importance of communication and inclusion must be recognized, which promotes participation of concerned stakeholders.

Sophie Mathieu, Diane-Gabrielle Tremblay

Research Framework: The consensus established around the exceptionalism of Quebec family policy conceals certain issues and challenges related to the accessibility and availability of support measures for families.Objectives: Our objective is to propose a reflection on the universal character often attributed to Quebec family policy by documenting the evolution of the architecture of the three main measures of support to families since 1997, namely child care services, parental leave, and cash benefits.Methodology: The analysis is based on a systematic review of archives, government documents, and scientific research on the evolution and transformation of Quebec family policy. The starting point for the analysis is the examination of the White Paper Nouvelles dispositions de la politique familiale: les enfants au cœur de nos choix. Results: Despite its social democratic leanings, Quebec’s family policy is not universal as a whole and not all families are equal in the support they receive from the State. We show the historical existence of four childcare regimes, defined by the nature of the services being offered, their costs, and the possibility of having access to them. We also show that the architecture of the Quebec Parental Insurance Plan does not allow every parent to qualify to receive parental benefits. Finally, we show that while all families have received cash benefits since 2005, the amount of these benefits has varied by income.Conclusions: Although Quebec offers a generous family policy, the province is not entirely immune to the characteristics of the Canadian liberal welfare regime.Contribution: The article contributes to the reflection on the idea of Quebec having a universal family policy.

Thi Xuan Trinh Nguyen, Minji Han, Jin-Kyoung Oh

Introduction Associations between smoking, cancer and mortality are well established. Although cancer mortality rates have decreased in recent years, the economic burden of smoking-related cancers continues to increase. This study investigates the economic costs of cancers related to smoking in Korea in 2014. Methods Cancer patients were identified through National Health Insurance Services medical claims with ICD-10 cancer codes. We multiplied the costs by the population attributable fraction for each type of cancer and calculated direct and indirect costs, where direct costs comprise direct medical and non-medical costs of inpatients and outpatients, and indirect costs include estimates of future income loss due to premature death, productivity loss during hospitalization and outpatient visits, and job loss. Results In 2014, there were 79297 smoking-related cancer patients, accounting for 8.47% of all Korean cancer cases for that year. The direct cost of cancers due to smoking was approximately 595 million USD, whereas indirect costs were much higher, at nearly 2.2 billion USD. The average expenditure of a typical patient was 34815 USD. Lung, liver and stomach cancers were most prevalent and represented the most significant share of the economic burden, whereas the largest per-patient spending was for pancreatic, liver, and lung cancers. Lung, liver and stomach cancers had the highest economic impact on men, while lung, liver and ovarian cancers had the most significant economic impact on women. Conclusions It is imperative that more stringent steps be taken to reduce the huge economic burden of cancers linked to smoking.

SZARKA Arpad

The paper presents the impact of tax measures beginning in 2016 as regard to the frequent increase of the gross minimum salary, reduction of social insurance rates, the increase of the country's average gross incomes, as well as to changing the social insurance contribution support by employees only. The implementation of the governmental plan to move from a deficit budget strategy of public social insurance to one with a surplus budget, in the context of significant non-supplementation of the number of taxpayers, represents a crucial factor for new challenges of the financial management of the public pension system in Romania. The results are planned to be seen by 2021 and consist of the continuous increase of the minimum and average nominal pension value, in the context of modernizing the system and eliminating inequalities between different categories of retirees covered by the new pension law.

J.-P. Lagouarde, B. K. Bhattacharya, P. Crébassol et al.

The Indian and French Space Agencies, ISRO and CNES, have conceptualized a space-borne Thermal Infrared Reflectance (TIR) mission, TRISHNA (Thermal infRared Imaging Satellite for High-resolution Natural Resource Assessment). The primary design drivers of TRISHNA are the monitoring of (i) terrestrial water stress and use, and of (ii) coastal and continental water. A suit of four TIR bands and six optical bands is planned. The TIR bands will be centred at 8.6&thinsp;&mu;m, 9.1&thinsp;&mu;m, 10.3&thinsp;&mu;m and 11.5&thinsp;&mu;m to provide noon-night global observations at 57m nadir resolution over land and coastal regions. The field of view (FOV) is &plusmn;34&deg; and the orbit of 761&thinsp;km altitude was designed to allow 3 sub-cycle acquisitions during the 8-day cycle. The optical bands correspond to blue, green, red, and NIR plus two SWIR bands at 1.38&thinsp;&mu;m and 1.61&thinsp;&mu;m. The green, red, NIR and the 1.61&thinsp;&mu;m SWIR bands will have better radiometry quality than those of AWiFS. ISRO and CNES will develop optical and TIR payloads, respectively. Assessing evapotranspiration and furthermore Gross and Net Primary Productivity (GPP and NPP) will in turn assist in quantifying water use in rainfed and irrigated agriculture, water stress and water use efficiency, with expected applications to agricultural drought and early warning, crop yield prediction, water allocation, implementation of water rights, crop insurance business and agro-advisories to farmers. The other scientific objectives of TRISHNA are also briefly described. TRISHNA instrument will fly aboard a ISRO spacecraft scheduled to be launched from 2024 for a minimum period of 5 years’ mission lifetime.

Fernanda Dalla Libera Damacena

This article discusses the values and criteria of a compensation fund as a relevant tool for coping with losses and damages resulting from extreme weather events. The research was guided by a constructivist methodology, complemented by the exploratory and comparative auxiliary methods. Experiences of comparative law with respect to funds created to repair anthropogenic disasters are good sources of observation regarding the positives and negatives to be observed at the time of setting up a compensation fund. Individually or even as part of a larger strategy of layers of disaster risk management, since ex ante constituted, and by specific law, the fund is a worldwide trend nowadays and may be an alternative to Brazil. Numerous features make it more effective and relatively less complex than other compensatory instruments such as civil liability and insurance.

Han Deok Kwak, Jae Kyun Ju, Dong Woo Kang et al.

Purpose: Body mass index (BMI) may not be appropriate for different populations. Therefore, the World Health Organization (WHO) suggested 25 kg/m2 as a measure of obesity for Asian populations. The purpose of this report was to compare the oncologic outcomes of laparoscopic colorectal resection with BMI classified from the WHO Asia-Pacific perspective. Patients and Methods: All patients underwent laparoscopic colorectal resection from September 2006 to March 2015 at a tertiary referral hospital. A total of 2408 patients were included and classified into four groups: underweight (n = 112, BMI <18.5 kg/m2), normal (n = 886, 18.5–22.9 kg/m2), pre-obese (n = 655, 23–24.9 kg/m2) and obese (n = 755, >25 kg/m2). Perioperative parameters and oncologic outcomes were analysed amongst groups. Results: Conversion rate was the highest in the underweight group (2.7%, P < 0.001), whereas the obese group had the fewest harvested lymph nodes (21.7, P < 0.001). Comparing oncologic outcomes except Stage IV, the underweight group was lowest for overall (P = 0.007) and cancer-specific survival (P = 0.002). The underweight group had the lowest proportion of national health insurance but the highest rate of medical care (P = 0.012). Conclusion: The obese group had the fewest harvested lymph nodes, whereas the underweight group had the highest estimated blood loss, conversion rate to open approaches and the poorest overall and cancer-specific survivals.

Narayan Kumar, Shekhar Koirala, Mamta Varma

In the year 2001 the leaders of BPKIHS started a micro social insurance scheme; Social Health Insurance (SHI) for prospective research. It is a method of financing and managing health care using compulsory contributions from employers, employees and may be from the government. Household members from organized groups in catchment areas enrolled voluntarily. Photographed service cards were issued entitled for free IPD/OPD consultations, investigations and bed charges excluding CT scans and specialty treatment. Institute bore operation and medicine costs up to 10000 and 3500 respectively for IPD yearly. Premium was fixed after a research through focus group discussion in villages of Morang, Sunsari and Biratnagar. A flat rate premium of 15 and 50 NRS/adult/month for villagers, city dwellers and half for children was fixed. Marginalized community and handicapped paid 33% of premium, 33% by Institute and 33% by concerned VDC. As the client number increased from 2383 to 7392 in second and to 15779 in third year, Premium: Expenditure ratio moved from 225:222 to 198:391. Average cost sharing of premium to expenditure came to 226:332 showing a negative balance. This scheme completed its fourth year till this research in 2005 A.D. But it was closed due to deficit. As reinsured population occasionally concealed information by not incorporating all family members. They defaulted in subsequent year after utilizing the benefits of SHI and misused the card for uninsured ones. It may, in its optimized form, become a model to be widely adopted to bridge the gap between the cost of treatment and the ability to pay in developing countries.

Bach Xuan Tran, Victoria L. Boggiano, Cuong Tat Nguyen et al.

Abstract Background Methadone maintenance treatment (MMT) patients face unique costs associated with their healthcare expenditures. As such, it is important that these patients have access to health insurance (HI) to help them pay for both routine and unforeseen health services. In this study, we explored factors related to health insurance enrollment and utilization among MMT patients, to move Vietnam closer to universal coverage among this patient population. Methods A cross-sectional study was conducted with 1003 patients enrolled in MMT in five clinics in Hanoi and Nam Dinh provinces. Patients were asked a range of questions about their health, health expenditures, and health insurance access and utilization. We used multivariate logistic regressions to determine factors associated with health insurance access among participants. Results The majority of participants (nearly 80%) were not currently enrolled in health insurance at the time of the study. Participants from rural regions were significantly more likely than urban participants to report difficulty using HI. Family members of participants from rural regions were more likely to have overall poor service quality through health insurance compared with family members of participants from urban regions. Overall, 37% of participants endorsed a lack of information about HI, nearly 22% of participants reported difficulty accessing HI, 22% reported difficulty using HI, and more than 20% stated they had trouble paying for HI. Older, more highly educated, and employed participants were more likely to have an easier time accessing HI than their younger, less well educated, and unemployed counterparts. HIV-positive participants were more likely to have sufficient information about health insurance options. Conclusions Our study highlights the dearth of health insurance utilization among MMT patients in northern Vietnam. It also sheds light on factors associated with increased access to and utilization of health insurance among this underserved population. These results can help improve health insurance enrollment among MMT patients, a population that is at increased need of financial assistance in accessing health services.

Nicolino Ettore D’Ortona, Maria Sole Staffa

In the context of the stochastic models for the management of life insurance portfolio, the authors explore, with simulation approach, the effects induced by the application of a particular method of calculation of the surrender value. In the life insurance, the policyholder position is, at any moment, quantified by the mathematical reserve. In case the reserve amount results are positive, the insurance company can allow the contract surrender, consisting in an amount payment, called surrender value, commensurate with the mathematical reserve. Generally, the insurance company enforces some restrictions in the surrender value determination, in order to avoid, first of all, that an amount is disbursed to the policyholder while, on the contrary, he results to be indebted to the Company. In this paper the authors will consider a surrender value calculation method based precisely on the profit recovery concept which shall be supplied by the contract in case it remains in the portfolio. Additionally, the authors shall analyze, by simulation approach, the effects caused by the enforcement of the surrender value calculation concept on a life portfolio profitability, and on the penalties extent enforced to the policyholders which cancel from the contract. Keywords: surrender value, life insurance, internal risk model, stochastic simulation

Dae Ho Lee

Jonathan Gruber, Jonathan Gruber, B. Madrian et al.