Compensation Insurance Research Articles

Flood-induced mobility in rural and urban coastal jurisdictions: a homeowner’s perspective

AbstractCoastal flooding often exceeds homeowners’ capacity to cope with repetitive damages and profoundly disrupts their livelihoods. Permanent relocation has been proposed as a solution for some coastal areas experiencing recurrent flooding and anticipating acceleration of impacts. However, it is unclear if homeowners living in such areas would support this strategy, where they would choose to go, and why. This study evaluates the willingness to relocate and the reasoning behind it among rural and urban homeowners residing in coastal high-risk areas. The rural versus urban comparison explores how attitudes toward relocation differ between these settings with distinct sociodemographic, economic, and cultural profiles. A mail survey administered on the Eastern Shore, Maryland, and in the Hampton Roads metropolitan area, Virginia, measured how willingness to relocate differs across the socioeconomic spectrum, prior flood exposure, concerns with flood impacts, and preferences for relocation destination. The survey responses were analyzed using descriptive and inferential statistics. The results show that more than one-third of respondents would consider relocating. The willingness to relocate was marginally influenced by socioeconomic factors and flood experiences and instead was significantly correlated with the risk of disastrous flooding, inadequate insurance compensation, and worsening crime. However, data show a clear shift in relocation support and the distance of the preferred destination from minor to significant flooding. Rural respondents are slightly less likely to relocate than urban ones. Descriptive statistics indicate nuanced differences in flood experiences, reasons to relocate, and preferences for a new destination between rural and urban populations.

Characterization of hydrometeorological events and flood impacts in the Basque Country

Abstract. In this study, the focus is on the characterization of floods in Basque Autonomous Community, considering damages, hydrometeorological aspects and others factors during the period 2000–2021. The ultimate goal is to contribute to understanding the processes of impact, enhancing awareness, and improving preparedness before flood events. To assess flood impact, damage data from the Spanish Insurance Compensation Consortium areexposureccccccc used as a proxy. For hydro-meteorological characterization and weather context, we use data from the Automatic Weather Station Network and various Euskalmet general and local ad-hoc weather context classifications. Different datasets are conveniently prepared to extract a range of indicators, taking into account: (1) physiographic and socio-economic factors, (2) damages and impact, (3) hydrometeorological aspects, and (4) weather context. Visual data analytics techniques are utilized for analysis, characterization, and presentation of findings. We integrate indicators with diverse temporal resolutions (daily and monthly) and spatial aggregations (primary watersheds and selected hydrological units) to facilitate discussions and derive conclusions. This work establishes a foundation for a semi-automatic procedure for data preparation, indicator extraction, analysis, and results presentation. Although it is a strategy specifically designed for its application in our context, we believe it can serve as inspiration for conducting similar free software based exercises in other parts of the world.

Floods in the Pyrenees: a global view through a regional database

Abstract. This paper shows the first systematic dataset of flood episodes referring to the entire Pyrenees massif, named PIRAGUA_flood, which covers the period 1981–2015 (available at http://hdl.handle.net/10261/270351, last access: 21 July 2024). First, the structure of the database is detailed so that it can be reproduced anywhere else in the world, adapting to the specific nature of each situation. Subsequently, the paper addresses the spatial and temporal distribution of flood episodes and events (including trends) that affected the Pyrenees regions of Spain (Catalonia, Aragon, Navarre, the Basque Country), France (Nouvelle-Aquitaine, Occitanie) and Andorra, as well as the massif as a whole, for a given period of time. In the case of the Spanish regions, it was also possible to analyse the compensation payments by the Spanish Insurance Compensation Consortium and the number of deceased. The weather types associated with flood episodes were also classified based on sea level pressure and 500 hPa geopotential height from ERA5. The results show 181 flood events and 154 fatalities, some of which affected more than one region. In the Spanish part of the Pyrenees, between 1996 and 2015, there was a total compensation payout amounting to EUR 142.5 million (2015). The eastern part of the area records more flood events than the western one, with Catalonia being the community that registered the highest number of events, followed by Andorra and Occitanie. Associated weather types are dominated by the southern component flow over the Pyrenees region, with a talweg on the Iberian Peninsula and a depression in the vicinity, either in the Atlantic or in the Mediterranean. In terms of the entire massif, there is a slight positive trend of 0.84 events per decade, driven by the evolution of ordinary and extraordinary floods but not significant at 95 %. At a regional level, flood behaviour is more heterogeneous, although not significant for the most part. Nouvelle-Aquitaine is the only region that shows a positive and significant trend of 0.34 events per decade.

The redemption of The Accidental Republic: 70 years of Chinese Workers’ Compensation Insurance

Abstract The Accidental Republic is a concern for all industrialised countries, and China is no exception. To solve this problem, Workers’ Compensation Insurance (WCI) is a perfect option. The redemption of The Accidental Republic can be understood through the development of WCI. However, little attention has been paid to the development of Chinese WCI. Starting from labour insurance regulations promulgated in 1951, this research explores over 70 years of reform and development of Chinese WCI, explicitly dividing reforms into three phases – establishment and implementation, exploration and practice, and adaptation and formation – that aligned with stages of China’s economic development. Further, the insurance fund performance in the last decade is evaluated by Data envelopment analysis and Malmquist (DEA-Malmquist), through the static and dynamic results, yielding generally average results. Subsequently, five major problems of WCI are identified and discussed and five suggestions offered drawing on international comparison and the national situation. Lastly, the accidental and inevitable aspects of China’s WCI system during the redemption of The Accidental Republic are summarised.

A study on the introduction of mixed payment compensation system through top-down cost information analysis in Korea

This study aims to identify the problems of the Korean health insurance fee system and to suggest a reasonable insurance fee construction alternative using the cost analysis data of hospitals. To this end, the characteristics of the medical fee payment system and hospital cost analysis were examined, and the cost data of one national public general hospital were used for the analysis. The cost allocation criteria were divided into labor costs, material costs, pharmaceutical costs, equipment costs, and overhead costs, and a top-down cost analysis was conducted. The analysis results showed that the cost was greater than the income in the case of outpatient and inpatient treatment performance, and the analysis results on the amount of physician workload showed that the relative value of physician workload calculated based on the cost was analyzed to require an increase of 1.52 times for hospitalization fees and 1.72 times for examination fees. The main factor affecting the cost compensation rate was that when the proportion of examination fees was high, the cost compensation level increased, while on the other hand, the cost compensation rate decreased as the proportion of physician labor costs increased or the length of stay increased. In order to resolve the ongoing complaints of medical service providers under the current fee-for-service system and secure the appropriateness of health insurance compensation rates, compensation for physician fees should be induced to realize the level of cost compensation through cost-based, per-service fee calculations, and the rationality of the payment compensation system can be secured by securing autonomy of providers through bundled fees for hospital costs and changing the payment method.

Financial Sustainability of Social Insurance: The Case of Korean Workers’ Compensation Insurance and Possibility of Triple Moral Hazard

Abstract This study examines the economic stability of Korean Workers’ Compensation Insurance (WCI), highlighting the system’s vulnerability to triple moral hazard. Korean WCI features more generous worker compensation, lower employer premiums, and more active government involvement in accident prevention in addition to a higher industrial accident rate, compared to the system in Germany and Japan. The negotiation process of the WCI among workers, employers, and insurance managers often prioritizes short-term benefits, undermining long-term financial health. Workers seek greater compensation, employers push for lower premiums, and insurance managers may prioritize collective interests, exacerbating the system’s economic instability. Over recent years, applications for occupational disease recognition have surged, and premium rates have decreased, indicating increasing strain. To mitigate these issues, the study proposes enhancing transparency and rationality, involving non-political experts in decision-making, and clearly defining the government’s role in managing WCI. These measures aim to balance stakeholder interests and ensure the WCI system’s sustainability for future generations.

Правовий статус страховика як учасника договірних страхових відносин

Despite the regulation of insurance relations by Ukrainian legislation, due attention from both scientists and legislators requires the issue of improving the legal status of participants in insurance relations, determining their place in such relations in order to effectively protect their rights and interests. The purpose of the article is to study the legal status of the insurer as a participant in insurance contractual relations, analyze existing approaches to its determination, establish the features of the insurer's legal personality and provide proposals for further improvement of legislation in this area. A characteristic feature of an insurance contract as an independent type of civil legal obligations within the group of contracts for the provision of services is that the conclusion of insurance contracts is directly the subject of activity of specially authorized participants in civil relations – insurance organizations (insurers). It has been established that the insurer, as a participant in insurance contractual relations, is a legal entity that, being specially created to provide insurance services and having received a license for this in the prescribed manner, undertakes the obligation, in accordance with the terms of the contract or an indication of the law, to provide insurance to the insured for a certain fee, to carry out an insurance payment (insurance compensation) to the insured or beneficiary as a result of the occurrence of a certain event (insured event). In insurance contractual relations, the insurer can only have a legal entity on its side, which is empowered to carry out insurance activities only after receiving a special permit (license), which indicates that legal entities - insurers have special legal personality. An insurance organization is endowed with the general legal capacity of a legal entity with a special scope of legal capacity as a financial institution. Attention is drawn to the fact that a significant factor in the modernization of the civil legislation of Ukraine today is the global trend towards unification and harmonization of private law regulation, the formation of optimal legal norms for many areas of private law relations, including insurance. In this regard, the need is justified to determine at the legislative level the requirements for the insurer when it carries out certain types of compulsory insurance, which have their own specifics and provide for the creation of increased guarantees of protection for those persons who, due to objective circumstances, are exposed to increased risk and the extension of insurance protection to cases possible violation of public interests by the method of guaranteeing receipt of insurance payment (insurance compensation). It is concluded that the recodification of the civil legislation of Ukraine opens up prospects for a qualitative update of the legal regulation of insurance contractual relations and will contribute to the development of the provision of insurance services, strengthening of legal institutions in the field of insurance, raising the standards of providing insurance services and ensuring adequate protection of the rights of participants in insurance relations

Is Farming a Risk Occupation for Cardio-cerebrovascular Diseases? A Scoping Review on Cardio-cerebrovascular Disease Risk in Farmers.

In the Republic of Korea, cardiocerebrovascular disease (CCVD) is recognized as an occupational disease when sufficient evidence of a work-related burden exists. In 2021, approximately 26.8% of the payments from occupational disease insurance under the Industrial Accident Compensation Insurance Act were allocated to CCVDs. However, due to the specific nature of insurance policies for farmers, CCVD is not acknowledged as an occupational disease in their case. We reviewed studies on the differences in the incidence, prevalence, and mortality rates of CCVDs between farmers and the general population or other occupations and described the exposure of farmers to risk factors for CCVDs. Several studies showed that farming is a high-risk occupation for CCVDs, with the following risk factors: long working hours, night work, lack of holidays, and strenuous physical labor; physical factors (noise, cold, heat, humidity, and vibration); exposure to hazardous gases (diesel exhaust, carbon monoxide, hydrogen sulfide, carbon disulfide, nitrogen oxides, and polycyclic aromatic hydrocarbons), pesticides, and dust (particulate matter, silica, and organic dust); exposure to a hypoxic environment; and job-related stress. Social isolation and lack of accessible medical facilities also function as additional risk factors by preventing farmers from receiving early interventions. Farmers are exposed to various risk factors for CCVDs and are an occupation at risk for CCVDs. More studies are needed in the future to elucidate this relationship. This study lays the groundwork for future research to develop guidelines for approving CCVDs as occupational diseases among farmers.

Data profile: the Korean Workers' Compensation-National Health Insurance Service (KoWorC-NHIS) cohort.

The Korean Workers' Compensation-National Health Insurance Service (KoWorC-NHIS) cohort was established to investigate the longitudinal health outcomes of Korean workers who have been compensated for occupational injuries or diseases. This cohort study, which utilized data spanning from 2004 to 2015, merged workers' compensation insurance claim data with the National Health Insurance Database (NHID), encompassing 858,793 participants. The data included socio-demographic factors such as age, sex, income, address, insurance type, and disability grade. It also covered the types of occupational accidents, International Classification of Diseases, 10th revision codes for diseases or accidents, work tenure, industry, occupation code, and company size. Additional details such as the occupational hire date, date of claim, date of recognition, and affected body parts were recorded. The cohort predominantly consisted of male workers (80.0%), with the majority experiencing their first occupational accident in their 40s (27.6%) or 50s (25.3%). Notably, 93.1% of the cases were classified as occupational injuries. By integrating this data with that from the NHID, updates on health utilization, employment status, and income changes were made annually. The follow-up period for this study is set to conclude in 2045.

Rotator Cuff Tears, Repairs, and Shoulder Arthroplasties Among Workers' Compensation Claimants: A 16-year study of workers' compensation claims from a large nationwide workers' compensation insurance carrier.

Rotator cuff repair (RCR) is increasingly being performed for both acute traumatic and degenerative tears of the rotator cuff, while total shoulder arthroplasty (TSA) is reserved for osteonecrosis of the humeral head, arthritis of the glenohumeral joint and failed RCR. To assess the incidence and patient characteristics of rotator cuff tears (RCTs), RCRs, and TSAs among workers' compensation (WC) claimants. 8,347 RCT indemnity claims filed to Accident Fund Group from 2007 to 2022 were studied. Over the study period, the percentages of RCTs increased from 41% to 65% among shoulder injury indemnity claimants, RCRs increased from 88% to 92% of RCTs and TSAs increased from 1% to 5%. RCT, RCR, and TSA have increased dramatically among WC claimants, age of the injured worker being the primary determinant of the increase.

Pre-injury methamphetamine use is associated with increased length of hospital stay in rural orthopaedic trauma patients

ObjectivesThe primary focus of this study is to determine if rural methamphetamine positive patients experience longer hospital length of stays compared to urban methamphetamine positive patients following an orthopaedic trauma. MethodsPatients presenting with traumatic orthopaedic injuries and urine drug screen were categorized into urban, suburban, and rural cohorts found in the Rural Urban Commuting Area codes based on home residence zip codes. Demographic, injury, hospital stay, and follow-up data were collected from the medical records. Comparisons between cohorts were determined by Chi square, Fisher exact, unpaired t-Tests, or ranked sum tests. DesignA retrospective cohort analysis. SettingAcademic Level I Trauma Center. Patient selection criteriaPatient records were examined between January 2013 to January 2023 for a traumatic orthopaedic injury and a urine drug screen result at the time of presentation to an academic Level I trauma center. Outcome measures and comparisonsMethamphetamine use status, patient age at time of admission, sex, marital status, insurance status, home zip code, orthopaedic injury location, complications, if the patient underwent surgery for orthopaedic injuries, admission date, discharge date, and discharge location were measured. Results249 patients met inclusion criteria for this analysis. Methamphetamine positive patients are significantly more likely to be younger, more likely to have surgery for orthopaedic injuries, experience a medical complication, or be discharged to home or a rehabilitation facility compared to methamphetamine negative patients. Urban patients experienced a shorter length of stay compared to suburban and rural patients, regardless of methamphetamine use status. Patients with Medicare, military, workers compensation, or commercial insurance are significantly more likely to attend follow-up appointments than patients with Medicaid or self-pay. ConclusionsMethamphetamine positive patients overall do not experience a longer length of hospital stay compared to methamphetamine negative patients. Rural methamphetamine positive patients experience a longer length of hospital stay compared to urban methamphetamine positive patients.

TO THE CONCEPT OF INSURANCE INDEMNITY UNDER MOTOR TPL CONTRACTS

The present study is devoted to the issue of defining the concept of insurance compensation under contracts of compulsory motor third party liability insurance (hereinafter - CMTPL) in the system of related concepts of CMTPL using the formal-legal method of research. The article considers various approaches of insurance organisations to the concept of insurance indemnity in the context of legal relations in the field of CMTPL insurance, as well as examines the practical problems faced by both professional participants of the insurance services market - insurers, and persons who apply to them, whose property, in particular vehicles, has suffered as a result of damage caused to them by the perpetrators of road accidents. The paper analyses both regulatory legal acts in the field of CMTPL insurance and the practice of insurance organisations in carrying out their obligations under CMTPL insurance contracts in terms of insurance indemnities and related concepts: ‘insurance payments', “organisation of vehicle repair”, “insurance amounts”, etc. The paper concludes that it is necessary to establish legally the definition of the concept of insurance indemnity, to include in the content of this concept the organisation or payment for repairs within the insurance sum, and to justify the need to increase the terms of insurance indemnity in the form of repairs under CMTPL insurance contracts from thirty to forty-five days.

PUBLIC AWARENESS OF DEPOSIT INSURANCE AND INVESTOR COMPENSATION SCHEMES IN BULGARIA

The purpose of deposit insurance and investor compensation schemes is to protect the clients of banks and investment intermediaries by providing compensation in the case of unavailability of clients’ deposits or assets. Generally, knowledge about the activities of both schemes is rather limited by the public. This is observed not only in developing countries, but also in the developed ones. This problem is called public awareness. The paper investigates the public awareness of the main components of the financial safety net in Bulgaria – the deposit insurance scheme and investor compensation scheme - based on a random distribution of a questionnaire among 232 people. The investigation is not considered as being representative but it indicates tendencies in the public awareness of both schemes in Bulgaria. The analysis in the paper is focused on the questions regarding the main activities of the deposit insurance and investor compensation schemes as well as the amount of guarantee, scope of both schemes, compensations payments events, the behavior of depositors and investors in cases of trouble events, etc. The survey shows that in terms of the deposit insurance the awareness of participants is above average, while regarding investor compensation, the results are well below average, one could even say that such awareness is lacking at all. The results of the survey provide information that the efforts of the regulators and financial safety net schemes should be directed to increasing the awareness of depositors and investors in Bulgaria about the benefits and limitations of both schemes.

Voluntary agricultural insurance in the Republic of Kazakhstan based on the example of perennial plantings

The goal is to assess the potential of voluntary agricultural insurance in Kazakhstan using the example of perennial crops, determine demand and market readiness, and identify difficulties faced by agricultural producers and insurance companies. Methods - to solve the problems, content analysis method was used, which is aimed at studying problems related to state support of agro-industrial complex, data, statistical indicators were considered as information base, as well as review of literature on the topic, legislative acts and state policy in the field of agriculture and agricultural insurance, experience of economically developed countries were studied. The results show the possibility of the presence of agricultural risks and uncertainties with focus on insurance of perennial crops, prospects and barriers that impede its development in conditions of sharply continental climate, scarcity of water resources and unstable economy. Conclusions - voluntary insurance protection is an effective tool for mitigating financial losses in agricultural production in Kazakhstan. The author notes the need to increase financial resources and strengthen consulting work focused on understanding the benefits of agricultural insurance by business entities; creating effective mechanisms for distributing insurance payments and developing affordable insurance products that take into account the needs of the farmers. The most flexible insurance conditions, minimum list of documents for concluding an agreement, transparent methods for establishing the amount of insurance compensation and settling losses, increasing investment attractiveness, and using international experience taking into account the needs of Kazakhstani agricultural producers are required. The role of insurance services as one of the most common methods of reducing farmers' losses from natural and climatic changes, will increase.

Worker's compensation and no-fault insurance are associated with decreased patient reported outcomes and higher rates of revision at 2 and 5 years follow-up compared to patients with commercial insurance undergoing hip arthroscopy for femoroacetabular impingement.

To investigate the patient reported outcomes (PROs) of patients undergoing hip arthroscopy (HA) for femeroacetabular impingement syndrome (FAIS), a condition where irregular bone growth in the hip joint leads to friction and pain during movement, who have worker's compensation (WC) or no-fault insurance (NF) versus commercial insurance (CI) at both 2year and 5year follow-up. This was a single center, single surgeon, retrospective analysis performed between August 2007 and May 2023 of consecutive patients that underwent HA, a minimally invasive surgical procedure used to diagnose and treat problems inside the hip joint through small incisions, for FAIS. Patients were divided into two cohorts-those with WC/NF and those with commercial insurance (CI). Patient reported outcomes (PROs), which included modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS), were collected preoperatively, as well as at least 2-year postoperatively. Additionally, other clinically relevant outcomes variables including prevalence of revision surgery and conversion to total hip arthroplasty were recorded. Three hundred and forty three patients met inclusion criteria. There were 32 patients in the WC/NF cohort and 311 patients in the commercial cohort. When controlling for age, sex, and Body Mass Index (BMI), WC/NF status was associated with lower mHHS at both 2year (β = - 8.190, p < 0.01, R2 = 0.092) and 5year follow-up (β = - 16.60, p < 0.01, R2 = 0.179) and NAHS at 5year follow up (β = - 13.462, p = 0.03, R2 = 0.148). The WC/NF cohort had a lower rate of achieving Substantial Clinical Benefit (SCB) for mHHS at 2-years follow-up (66.7% vs. 84.1%, p = 0.02).The rate of revision hip arthroscopy was significantly higher in the worker's compensation/no fault cohort than the commercial insurance cohort (15.6% vs. 3.5%, p < 0.01). The rate of conversion to total hip arthroplasty (THA) in the WC/NF cohort was not significantly different than the rate of conversion to THA in the commercial insurance cohort (0.0% vs. 3.2%, p = 0.30). Patients with WC/NF insurance may expect a significant improvement from baseline mHHS and NAHS following HA for FAIS at short-term follow-up. However, this improvement may not be as durable as those experienced by patients with CI. Additionally, WC/NF patients should be counseled that they have a higher risk of undergoing revision hip arthroscopy than similar CI patients. III, Retrospective Comparative Prognostic Investigation.

Workers’ compensation injuries in aviation manufacturing in the state of Kansas, 2014–2022

IntroductionWorkers’ compensation injuries entail burdensome financial and social costs. This study’s objective was to describe cost and frequency of workplace injuries in aviation manufacturing in the state of Kansas using workers’ compensation data. Manufacturing incurs more workers’ compensation claims in Kansas than any other industry, and aviation contributes more of those claims than any other sub sector. MethodWorkers’ compensation insurance and reporting are required in the state of Kansas. Data were provided by the Kansas Department of Labor (KDOL) and included all closed workers’ compensation claims entailing indemnity and medical costs filed in the state from 2014 to 2022. Cost of claim data were normalized to 2022 U.S. dollars and data were analyzed as a function of percentage and claim cost by body part, type of injury, cause of injury, specific musculoskeletal disorder type, and as a function of age and gender injury rates. ResultsAviation claims entailed a median total cost of $26,941 and represented 8% of all closed claims filed in the state from 2014 to 2022. The grand total direct cost over the nine-year period was $75,404,147. Medical costs comprised 48.6% of all costs, indemnity 45.0%, and legal 6.4%. The most frequently injured body part was the hand/wrist (35.9%) followed by the shoulder (20.6%), and the most expensive body parts were related to the back. Overexertion (38.6%) was the most common cause followed by repetitive motion (22.8%). Work-related musculoskeletal disorders were the most common type accounting for 67.4% of all claims. Men and workers aged 55–64 incurred slightly higher claim rates than average. A sharp decrease in number of claims closed in 2021 coincided with production shutdowns the previous year related to the Covid-19 pandemic and design issues. ConclusionsAviation manufacturing is a key industry in Kansas and this study is the first known to describe costs and frequencies of workplace injuries in the sector using workers’ compensation data. Practical applicationsThis guide to the most problematic and costly injuries in aviation manufacturing helps practitioners prioritize prevention strategies to most effectively reduce workplace injury and helps safety and health practitioners in prioritizing prevention efforts to reduce the most severe and costly aviation manufacturing injuries and illnesses. It also brings attention to some special considerations when working with safety data from 2020 to 2022 related to the Covid-19 pandemic.

Litigation and liability in concussion research and collaboration

ABSTRACT This paper explores, first, the common law principles of personal injury litigation explored through court decisions relating to sports injuries in (primarily) England and Wales and, second, the statutory schemes relating to concussion liability and young players in the United States. It explores the difficulties of using those strategies as a means of establishing liability for injuries arising from sports-related concussion (SRC) and explains why they are of such limited utility. While proposed class actions over historically acquired injuries or individual litigation over recent catastrophic injury may have some merit, and while future amendments to the US laws might remove some of their inherent flaws, the difficulties in establishing liability for personal injury will always be exacerbated by the specific characteristics of SRC and the legal, factual and evidential issues that arise. For those reasons, the paper considers the potential benefits of other means of concussion prevention and mitigation, including no-fault compensation and mandatory insurance, the more widespread use of effective, nuanced concussion protocols, and inter-disciplinary research that engages with doctrinal legal research.

In Patients With Rotator Cuff Tears, Female, Hispanic, African American, Asian, Socially Deprived, Federally Insured, and Uninsured Patients Are Less Commonly Treated Surgically

The purpose of the current study was to evaluate socioeconomic factors affecting whether a patient undergoes rotator cuff repair after a diagnosis of a rotator cuff tear. From 2009 through 2018, claims for adult (≥18 years of age) patients who were diagnosed with a primary rotator cuff injury were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database via International Classification of Diseases (ICD)-9th Revision-Clinical Modification (CM) and ICD-10-CM diagnostic codes. SPARCS is a comprehensive all-payer database collecting all inpatient and outpatient pre-adjudicated claims in New York. ICD-9-CM and ICD-10-CM codes were used to identify the initial diagnosis for each patient. Current Procedural Terminology codes were used to identify subsequent rotator cuff surgery. The procedures identified were linked with the initial diagnosis, and patients were noted as either having or not having rotator cuff surgery. Logistic regression analysis was performed for variables including age, sex, race, Social Deprivation Index (SDI), Charlson Comorbidity Index, and primary insurance type to determine the effect of patient factors on the likelihood of having surgery after a diagnosis of rotator cuff injury. Of the 67,584 rotator cuff patients included in the analysis, 19,770 (29.3%) of the patients underwent surgical intervention. From the logistic regression, females relative to males (odds ratio [OR]= 0.798, P < .0001), increased SDI (OR= 0.994, p < .0001), African American compared with White race (OR= 0.694, P < .0001), Asian compared with White (OR= 0.832, P < .0001), Hispanic compared with White (OR= 0.693, P < .0001), other race (OR= 0.58, P < .0001), those with Medicare (OR= 0.601, P < .0001) or Medicaid (OR= 0.614, P < .0001) relative to private insurance, and self-pay relative to private insurance (OR= 0.727, P < .0001) were all associated with decreased odds of undergoing rotator cuff surgery. Older patients (OR= 1.012, P < .0001) and Workers' Compensation relative to private insurance (OR= 1.664, P < .0001) had increased odds of undergoing surgery. The results of the current study identified disparities in the likelihood of undergoing rotator cuff repair after a diagnosis of a rotator cuff tear based on patient demographic and socioeconomic factors. Individuals with higher SDI; African American, Asian, Hispanic, or other non-White races; and those with Medicare, Medicaid, or self-pay insurance had decreased odds of surgery, whereas older age and Workers' Compensation insurance were associated with increased odds of undergoing surgery. Level IV, retrospective case series.

Hospital ownership changes and charge-to-cost shifts

We examine hospital-level CCR – charges to Medicare-allowable costs – from 2011 to 2022 among governmental, for-profit, and non-profit hospitals and identify hospitals that charged extreme CCR of over 1000% of the cost. We tracked hospitals that experienced ownership transitions and found that governmental and non-profit hospitals’ average CCR increased by 161% and 99.7%, respectively, after transitioning to become for-profits. These higher CCRs affect uninsured patients, out-of-network patients, and casualty and workers’ compensation insurers.

Gloss to a judgement of CJEU of 30th or March 2023, C-618/21 AR and others versus PK S.A. and others

Judgement of CJEU of 30th of March 2023, C-618/21 AR and others versus PK S.A. and others address the question referring to the possibility of estimation of insurance compensation for the damaged car due to the injured from insurance against civil liability in respect of the use of motor vehicle as hypothetical costs of repair. The author approves the judgement of CJEU which says that national law may limit the redress accessible to the injured party from the insurer to the monetary compensation, and that such compensation may not be lower than compensation accessible according to a national law on general basis. As far as admissibility of estimation of the insurance compensation as the hypothetical costs of repair in the Polish law the author adopts the compromise view pointing that it depends on the circumstances of the case. As a rule the insured party has the right to such compensation without the need of proving how much he has spent for the repair, but the injured does not have such right if the car was sold without repair