Compulsory Insurance System Research Articles

Detecting unexpected growths in health technologies expenditures: the case of MIPRES in Colombia

We developed an algorithm to explore unexpected growth in the usage and costs of health technologies. We exploit data from the expenditures on technologies funded by the Colombian government under the compulsory insurance system, where all prescriptions for technologies not included in an explicit list must be registered in a centralized information system, covering the period from 2017 to 2022. The algorithm consists of two steps: an outlier detection method based on the density of the expenditures for selecting a first set of technologies to consider (39 technologies out of 106,957), and two anomaly detection models for time series to determine which insurance companies, health providers, and regions have the most notorious increases. We have found that most medicines associated with atypical behavior and significant monetary growth could be linked to the use of recently introduced drugs in the market. These drugs have valid patents and very specific clinical indications, often involving high-cost pharmacological treatments. The most relevant case is the Burosumab, approved in 2018 to treat a rare genetic disorder affecting skeletal growth. Secondly, there is clear evidence of anomalous increasing trend evolutions in the identified enteral nutritional support supplements or Food for Special Medical Purposes. The health system did not purchase these products before July 2021, but in 2022 they represented more than 500,000 USD per month.

Некоторые размышления об эволюции и правовом значении статьи 15.33.2 Кодекса Российской Федерации об административных правонарушениях

The article discusses some issues that have arisen in practice regarding the simultaneous functioning of two mechanisms for bringing to public liability for violation of the procedure and deadlines for submitting information (documents) in the compulsory insurance system, one of which is provided for by Federal Law No. 27-FZ of April 1, 1996 “On Individual (Personalized) Accounting in Compulsory Pension Insurance systems and compulsory social insurance”, the other is Article 15.33.2 of the Code of Administrative Offences of the Russian Federation. The law enforcement practice of the implementation of both mechanisms is investigated, as well as some theoretical and practical issues of consistency and proportionality of legislative regulation establishing both mechanisms.

Modeling of anti-crisis development of agro-food enterprises in the system of innovation and investment management

The organization of modeling the anti-crisis development of agro-food enterprises in the system of innovation and investment management was significantly updated during the war. The study aimed to study the modeling of anti-crisis development of agro-food enterprises in the design of creation and investment management. It has been proven that the anti-crisis management system in organizing the practical work of personnel creates conditions that determine the exceptional priority of the development of professionalism and qualifications of personnel at all levels of agro-food enterprises in the innovation and investment management system. The task of anti-crisis management is to maximally facilitate programs of professional development of personnel based on the proposed model since these measures relate to the development of social capital without disrupting the economic mechanisms of economic regulation. A single agri-food information system will replace paper document flow with an electronic one and automate work processes at agro-food enterprises. In this way, a single information space will be created. When all agro-food enterprises are combined into a single information system, remote control is possible, the purpose of which is to obtain regulated reporting. Conclusions. Conclusions. Implementing the proposed model of formation of the organizational and economic mechanism of anti-crisis management of agro-food enterprises in the innovation and investment management system will allow them to overcome the crisis and stabilize their condition. A unique role in overcoming the problem in the agro-food sector belongs to the implementation of the compulsory insurance system. The functions of information and analytical support should not be underestimated, which includes an information system for forecasting the unfolding of a crisis in the development of agri-food enterprises, information support for a cluster analysis of the crisis state of agri-food enterprises by region, and a single information agri-food system. Keywords: modeling, anti-crisis development, enterprises in the agricultural sphere, systems, innovation and investment management.

Legal regulation of clinical application of artificial intelligence

With the wide application of artificial intelligence (AI) technology in clinical practice, more and more legal problems need to be solved. At present, although the legal status of AI is still controversial in academic and practical circles, its infringement risk in clinical diagnosis and surgery cannot be avoided. On the basis of the distinction between strong and weak AI liability subjects, those who meet the requirements of infringement, damage consequence, causal relationship, subjective fault, etc., can constitute tort liability, but the existence of exemption causes can also exempt liability. In addition to the ex post accountability of tort liability, it is also necessary to establish a complete administrative legal regulation system. At present, China needs to explore and establish the classification registration system, compulsory insurance system and reserve system of AI as soon as possible, so as to strengthen the legal regulation of the whole process of AI clinical application before, during and after the event.

Compulsory insurance for cruise vessels as a preparation for the next pandemic: Law of the sea perspective

During the COVID-19 pandemic, many port states faced difficulty when cruise vessels with COVID-19 patients tried to dock at their ports. Although they are basically not obliged to accept such vessels under international law, they cannot easily deny access because the refusal would be viewed as a lack of humanitarian consideration. On the other hand, accepting such vessels leads to the risk of exposing their own nationals to COVID-19 and incurring the financial cost of medical treatment for cruise passengers. In fact, in the cases of Diamond Princess, Costa Atlantica, and Zaandam and Rotterdam, the question of who should take on the financial burden for medical costs of crews and passengers on board these vessels was debated. The current international legal framework does not provide any answer to this question, and therefore, a new framework is needed. If the new framework allocates the economic burden to ensure the provision of tests and medical care so that an intolerably heavy burden is not imposed on port states, they will be more welcoming to cruise vessels with infected people. Such allocation could be realized by requesting that carriers provide a compulsory insurance system for medical care in a pandemic.

Problem Analysis and Improvement Plan for Compulsory Insurance System in Preparation for Social Disaster

This study aims to improve the disaster insurance system by examining issues related to compulsory insurance against social disasters, legal problems, and operational cases in major overseas countries. Korea operates about 30 types of disaster insurance, but there is a lack of prior reviews when introducing disaster insurance, so disaster insurance is continuously expanded. In addition, compared to major overseas countries, the insurance contract method is uniform and the management and supervision of insurance are insufficient. Therefore, when disaster insurance is introduced, it is necessary to accompany a professional review to determine if it is sufficiently helpful to the public interest, and it is essential to strengthen the management and supervision of insurance operations. In addition, to alleviate resistance to insurance purchases without infringing on individual freedom of contract, various insurance subscription methods should be devised, and it is necessary to strengthen liability for social disasters and to encourage the purchase of disaster insurance policy.

EPH115 Medical Cost and Prevalence of Diseases Across Different Health Insurance Systems in Japan

Japan has a compulsory insurance system ensuring citizens the universal access to affordable healthcare. Although the government runs the National Database incorporating all public health insurance systems, its poor accessibility eludes researchers. Alternative commercial claims databases have limitations in their generalizability. This research, using major commercial claims databases, assessed the characteristics of major health insurance systems; employee-based health insurance (EHI) for employees in mid-large companies and their families and the citizens’ health insurance (NHI) for non-/self-employed workers.

On the Need to Specify the Provisions of Article 36(1) and Article 52 of the Act of 22 May 2003 on Compulsory Insurance, the Insurance Guarantee Fund and the Polish Motor Insurers' Bureau

Compulsory insurance, especially compulsory civil liability insurance, plays an immensely important social role by protecting the property interests of both injured parties and perpetrators themselves. The Compulsory Insurance Act has laid the foundations for the compulsory insurance system, by specifying, among others, the following issues: the definition of compulsory insurance, rules of concluding and performing compulsory insurance contracts, including sums guaranteed in insurance types listed in the Act, as well as the method of controlling the performance of the obligation to conclude insurance contracts. Given the considerable importance and popularity of this insurance type, it is vital that the provisions regulating the scope of liability of the insurer and of the Insurance Guarantee Fund, including the amount of the sum guaranteed, are designed precisely and unambiguously. However, the wording used by the legislator in Article 36(1) and Article 52 of the Compulsory Insurance Act: "The sum guaranteed cannot be lower than the equivalent in PLN [...]" is related to a legal problem whether insurance with a sum guaranteed that is higher than the amount indicated in the above-mentioned provisions is compulsory or whether it is rather voluntary in terms of the amount of the sum guaranteed exceeding the indicated amounts. The present article focuses on the analysis of the practices of concluding insurance contracts with the amount of cover higher than in the above-mentioned regulations, without indicating the limits determining the compulsory or voluntary nature of an insurance in question.

Gloss to the Judgment of the Court of Justice of the European Union of 29 April 2021 in the Case of Ostrów County v the Insurance Guarantee Fund (C 383/19)

On 29 April 2021, the Court of Justice of the European Union in Case C 383/19 passed a preliminary ruling on the interpretation of Article 3 of Directive 2009/103/EC of the European Parliament and of the Council of 16 September 2009 on insurance against civil liability in respect of the use of motor vehicles and the enforcement of the obligation to insure against such liability. This judgment is of key importance for Polish insurance industry, especially for maintaining the coherence of the compulsory insurance system of motor liability insurance for motor vehicle owners for damage caused by the use of their vehicles. The social function of this obligatory insurance is inextricably linked with the protection of third parties against the effects of frequent adverse incidents resulting from the use of motor vehicles in the modern world. What is more, a compulsory insurance contract ought not to be treated as a financial burden for vehicle owners, because it both protects possible perpetrators of motor accidents from serious financial charges and prevents an excessive depletion of their assets due to civil liability. The above-mentioned judgment concerns the confirmation of the principle that in the current Polish legal system there is no possibility of either ignoring the obligation to conclude a civil liability insurance contract or being exempt from such obligation, where the owner is not able to use the vehicle for some period owing to its technical condition.

Implications of Compulsory Car Accident Insurance Comparative Study

Compulsory civil liability insurance on car accidents is one of the most important topics, which aims to achieve traffic safety and reduce car accidents. Today, car accidents constitute a great danger to human life as they cause different types of physical and moral damages. This study, however, attempts to highlight the effectiveness of compulsory insurance in providing legal protection for damages resulting from car accidents. Such protection can be achieved through the process of creating legal mechanism to enable injured people to refer to insurance companies. It is quite apparent that nobody can deny the importance of insurance and its influence on people’s lives. Insurance companies nowadays have become an essential cornerstone in the economy of any country. An insurance contract has legal consequences on the parties, which leads to corresponding obligations. These parties are committed to comply with these obligations otherwise, any violation will be treated as per the prescribed legal sanctions. In conclusion, any research or study on the compulsory insurance system whether in the Emirati law or in Islamic Sharia is highly recommended as part of the attempts to solve and rectify any legal and legitimate problems in this system. An essential objective of the Islamic Sharia is to achieve all fair interests of people. Arab and international legislation consider car insurance compulsory with some exceptions in order to compensate all those affected by a car accident. Arab and other foreign laws as well as the legitimate ones have differed in their choices of car insurance basis. Many legislations in the field of compulsory insurance have limited the right of compensation to body damage. Some other legislations have covered damages of property. Most legislations have not specified the amount of compensation that the insurer is obliged to pay in case of injury, death, or property damages. companies.

Features of the of tort risk implementation in the system of compulsory insurance of civil liability of vehicle owners

Features of the of tort risk implementation in the system of compulsory insurance of civil liability of vehicle owners

Исследование спроса на аграрное страхование в Республике Казахстан

The article presents the results of a study of the demand for agricultural insurance in the Republic of Kazakhstan. For about 16 years, Kazakhstan had a system of compulsory insurance in crop production, but the level of insured areas fluctuated from year to year, reaching their minimum value of 38% in 2019. Drawing on statistics from 2010 to 2018 of the two largest cereal growing regions (Kostanay and Akmola regions) and using the weighted least squares method, the author constructs an econometric model of the dependence of insured areas share on a number of factors. The determinants for the analysis were such indicators as the gross profit of agricultural producer, yield results, material costs, rainfall in winter and pre-sowing season.

Flood risk perceptions and the willingness to pay for flood insurance in the Veneto region of Italy

The floodplain of the Veneto region (north-east Italy) is one of the most inhabited and economically competitive urban landscapes in Europe. Moreover, recent flood events have caused millions of Euros in damage across the region. Due to the combined influence of climate change and socio-economic development, flood impacts are expected to grow. Therefore, it is important for all flood-prone individuals to actively manage and limit flood risk through property-level flood risk management as part of an integrated flood risk management strategy. This is in line with the calls for wider community engagement in risk management in the Sendai Framework for Disaster Risk Reduction and the Sustainable Development Goals. Therefore, an online-survey of Veneto region residents was conducted asking questions regarding flood risk perceptions, preparedness, and preferences towards flood insurance via self-stated willingness to pay (WTP). Our analysis provides an initial indication that while flood risk knowledge is high, it may not be sufficient to encourage proactive risk management. From the WTP values provided people seem reluctant to buy insurance. However, many respondents expressed that a compulsory insurance system may be acceptable. In such a scheme the estimated insurance premium could fall to between €26 and €42 per year, as compared to, potentially, €800 under risk-based premiums, which falls within the majority of WTP estimates provided (€0-€250). Overall, we identify areas of future research that are critical for the better design of risk management policies, supporting the insurance companies in risk management, and for recommendations regarding property-level risk management.

Competence Disputes Relating to Liability of the Insurance Guarantee Fund and an Insurance Undertaking on the Background of Compulsory Motor Liability Insurance - Practical and Legislative Solutions

The authors of this article, having analyzed the role of the Insurance Guarantee Fund in the compulsory insurance system, show the most significant differences in the liability of motor liability insurers and the IGF towards the injured. In their opinion, the identified differences in the liability principles and the differences in the interpretation of the applicable laws are the most frequent sources of competence disputes between insurance undertakings and the Fund, particularly about the competence of one of them in the claims settlement of victims of incidents involving unidentified perpetrators. On the one hand, these disputes are essentially held over formal issues, such as the existence or non-existence of insurance cover of the perpetrator and, on the other hand, over substantive ones, namely the recognition of the liability of either the IGF or the insurer in the circumstances of the event. Owing to their complex nature these disputes are frequently long-lasting, which results in the victims waiting for an extremely long time for their compensation. The authors emphasize that in the European Union the above problem has already been identified and was mostly regulated by the Directive 2009/103/EC of the European Parliament and Council of 16 September 2009 relating to insurance against civil liability in respect of the use of motor vehicles, and the enforcement of the obligation to insure against such liability. In Article 11 of the regulation it is stated that in the event of a dispute between the guarantee institution and the insurer, about determining who must compensate the victim, the Member States are required to designate one of those parties to be responsible in the first instance for paying the compensation to the victim without delay. The Insurance Guarantee Fund has repeatedly pointed to the negative effects of the lack of full implementation of this regulation to our national legislation. It consequently must have led to competence disputes and the need for conflict resolution in courts, at the expense of victims waiting long for being paid the compensation. Having recognized the importance of the above problems, the Polish legislator finally resolved this issue by the Act of 23 October 2018, amending the act on compulsory insurance, the Insurance Guarantee Fund and the Polish Motor Insurers’ Bureau in accordance with the directive. In the above amendment it has been indicated that in the event of a competence dispute the insurance undertaking is required to satisfy the justified claims, but at the same time the obligation has been imposed on the Fund to reimburse the paid compensation to the insurer, in the situation when the responsibility of the Fund to the victim of the accident was established. According to the authors, the entry into force of this regulation on 31 December 2018 should eliminate from the market the phenomenon of justified claims being not settled in due time.

Role of P&I Insurance in Implementing Amendments to Maritime Labour Convention 2014

Maritime Labour Convention (MLC), 2006 stipulates mandatory financial security for repatriation costs (Standard A 2.5), and contractual compensations related to death or longterm disability of seafarers due to an occupational injury, illness or hazard (Standard A 4.2) that is to be provided by the shipowner. However, financial security system set in the MLC was prescribed very broadly and insufficiently precise and, therefore, it opened a number of questions and doubts. Among others, the following questions are particularly interesting: what the legal nature of the MLC financial security is; from the insurance standpoint, whether this is life or accident insurance, or it is liability insurance; who has an insurable interest and what the nature of that interest is; which document proves fulfilment of MLC requirements. Due to the necessity of improving financial security provisions, in 2014 Amendments to the MLC were adopted that came into force in January 2017. Although the MLC does not explicitly prescribe a system of compulsory insurance, with the third injured party the right to a direct claim (actio directa) towards the liability insurer, marine insurance given its characteristic, appeared as a very suitable method of fulfilling MLC requirements – especially P&I insurance. All the clubs within the International Group of P&I Clubs have agreed to assist their members (shipowners) in complying with these additional financial security requirements under the Amendments to the MLC and issue MLC Certificates to their members. MLC Certificates refer to the MLC Extension Clause, 2016 and thus subject the insurance to conditions and limitations in the said clause. MLC Extension Clause provisions will be added to clubs P&I Rules which form the standard P&I cover.

The Development of Korea's New Long-Term Care Service Infrastructure and Its Results: Focusing on the Market-Friendly Policy Used for Expansion of the Numbers of Service Providers and Personal Care Workers

One of the main reasons for reforming long-term care systems is a deficient existing service infrastructure for the elderly. This article provides an overview of why and how the Korean government expanded long-term care infrastructure through the introduction of a new compulsory insurance system, with a particular focus on the market-friendly policies used to expand the infrastructure. Then, the positive results of the expansion of the long-term care infrastructure and the challenges that have emerged are examined. Finally, it is argued that the Korean government should actively implement a range of practical policies and interventions within the new system.

Professional liability insurance in Obstetrics and Gynaecology: estimate of the level of knowledge about malpractice insurance policies and definition of an informative tool for the management of the professional activity

BackgroundIn recent years, due to the increasingly hostile environment in the medical malpractice field and related lawsuits in Italy, physicians began informing themselves regarding their comprehensive medical malpractice coverage.MethodsIn order to estimate the level of knowledge of medical professionals on liability insurance coverage for healthcare malpractice, a sample of 60 hospital health professionals of the obstetrics and gynaecology area of Messina (Sicily, Italy) were recluted. A survey was administered to evaluate their knowledge as to the meaning of professional liability insurance coverage but above all on the most frequent policy forms ("loss occurrence", "claims made" and "I-II risk"). Professionals were classified according to age and professional title and descriptive statistics were calculated for all the professional groups and answers.ResultsMost of the surveyed professionals were unaware or had very bad knowledge of the professional liability insurance coverage negotiated by the general manager, so most of the personnel believed it useful to subscribe individual "private" policies. Several subjects declared they were aware of the possibility of obtaining an extended coverage for gross negligence and substantially all the surveyed had never seen the loss occurrence and claims made form of the policy. Moreover, the sample was practically unaware of the related issues about insurance coverage for damages related to breaches on informed consent. The results revealed the relative lack of knowledge--among the operators in the field of obstetrics and gynaecology--of the effective coverage provided by the policies signed by the hospital managers for damages in medical malpractice. The authors thus proposed a useful information tool to help professionals working in obstetrics and gynaecology regarding aspects of insurance coverage provided on the basis of Italian civil law.ConclusionItaly must introduce a compulsory insurance system which could absorb, through a mechanism of "distribution of risk", the malpractice litigation and its costs. This will provide compensation in accidental cases where it wouldn't be possible to demonstrate carelessness, imprudence and/or lack of skill.

A Legal Study on the Compulsory Insurance System about Automobile Traffic Accident in China

A Legal Study on the Compulsory Insurance System about Automobile Traffic Accident in China

Long term care financing in four OECD countries: Fiscal burden and distributive effects

This paper compares long term care (LTC) systems in four OECD countries (UK, Japan, Sweden and Germany). In the UK, provision is means tested, so that out of pocket payments depend on levels of income, savings and assets. In Sweden, where the system is wholly tax-financed, provision is essentially free at the point of use. In Germany and Japan, provision is financed from recently introduced compulsory insurance schemes, although the details of how each scheme operates and the distributive consequences differ somewhat. The paper analyses the effects of importing the other three countries’ systems for financing LTC into the UK, focussing on both the distributive consequences and the tax burden. It finds that the German system would not be an improvement on the current UK system, because it uses a regressive method of financing. Therefore, the discussion of possible alternatives to the present UK system could be restricted to a general tax-based system as used in Sweden or the compulsory insurance system as used in Japan. The results suggest that all three systems would imply increased taxes in the UK.

The Present and Future Organization of Medicine

The Present and Future Organization of Medicine