Insurance Authority Research Articles

Measuring the safety climate in an Australian emergency department

BackgroundThere are numerous intricate human, system and cultural factors that can impact upon the safe and effective implementation of patient safety systems (e.g. rapid response systems). Safety climate is one of these factors and is a measure of frontline healthcare workers’ shared perceptions, behaviours, beliefs and attitudes towards the organisation’s culture of safety. Safety climate scores are also associated with the frequency of errors and adverse events in the healthcare setting. However, there is little evidence regarding the relationships between attitudes to patient safety and staff characteristics such as emergency care expertise and experience. The aims of this study were to measure perceptions of the safety climate in an Australian metropolitan Emergency Department and examine relationships between safety climate perceptions and staff characteristics. MethodsThe Victorian Managed Insurance Authority Safety Climate Survey was administered to all doctors (n = 44) and nurses (n = 119) at an Australian emergency department. ResultsCompleted surveys were received from 127 (78%) respondents, 25 (52%) doctors and 100 (84%) nurses. Reliability analysis showed very good internal consistency of all 43-items of the survey (α = 0.94). With the exception of stress recognition, nurses rated the organisation’s commitment to patient safety higher than doctors in all remaining attitudinal domains (p < 0.05). Both groups acknowledge that fatigue, increased workload and stress recognition negatively impacts upon patient safety. There was a significant trend for declining safety climate ratings related to participants’ clinical competence level and experience across all domains except stress recognition (p < 0.05). ConclusionsThe Safety Climate Survey appears to be a reliable measure of patient safety climate for use in Emergency Departments. Emergency doctors and nurses did not perceive there to be a strong organisational commitment to patient safety in an Australian Emergency Department. Emergency Departments can provide a safer environment through genuine commitment to safety culture improvement which capitalises on the insights, intrinsic strengths and behaviours characteristic of the ED team’s expertise and experience. This kind of commitment can positively influence the effectiveness of actions taken to minimise risk to patient safety and improve ED staff job satisfaction and effectiveness.

Blood Pressure Control, Accessibility, and Adherence to Antihypertensive Medications: Patients Seeking Care in Two Hospitals in the Ashanti Region of Ghana.

Hypertension is the second leading cause of death in Ghana, partly accounting for two-thirds of all medical admissions and more than 50% of deaths. This study aimed to comparatively evaluate adherence and accessibility to antihypertensive medications at two different levels of healthcare facilities in Kumasi, Ghana, and determine factors associated with medicine accessibility and adherence. A cross-sectional study involving outpatient department (OPD) hypertensive patients, 143 at KNUST Hospital (UHS) and 342 at Komfo Anokye Teaching Hospital (KATH), was conducted using a semistructured questionnaire. Correlations were drawn to evaluate the effect of accessibility and adherence on blood pressure control. A face-to-face interview was also conducted with relevant stakeholders involved in procurement of medicines. Blood pressure was uncontrolled in 50.4% (n = 72) of participants at UHS and 52.9% (n = 181) at KATH. With respect to medicine accessibility, 98.8% (n = 338) and 42.9% (n = 61) received at least one medication from the hospital pharmacy of KATH and UHS, respectively. Using MARS-10, 49.2% (n = 70) and 52.9% (n = 181) were nonadherent in UHS and KATH, respectively. There was a significant association between adherence and BP control at both UHS (p=0.038) and KATH (p=0.043). At UHS, there was a significant association between accessibility to medicines at the hospital and BP control (p=0.031), whilst at KATH, no significant association was observed (p=0.198). Supply chain practices and delays in payment by the NHIA affected accessibility to antihypertensive medications. Blood pressure control was inadequate among participants in both facilities. Accessibility to medicines was better at the tertiary facility compared to the secondary facility. Increased accessibility and adherence to antihypertensives were related to blood pressure control in both facilities. Good supply chain practices and prompt payment by the National Health Insurance Authority would enhance accessibility to antihypertensive medications.

Factors Influencing Nonrenewal of Health Insurance Membership in Ejisu-Juaben Municipality of Ashanti Region, Ghana

Background. In the quest to prevent households from making catastrophic expenditures at the point of seeking healthcare, the government of Ghana introduced the National Health Insurance in 2003. However, people are reluctant to renew their membership. This study was, therefore, conducted to identify factors influencing the nonrenewal of National Health Insurance membership in the Ejisu-Juaben Municipality. Methods. A cross-sectional study was conducted among 427 respondents in the Ejisu-Juaben Municipality to ascertain factors influencing the nonrenewal of health insurance membership status. Data were entered and analyzed using Stata version 14. Univariate and multivariate analyses were performed to determine sociodemographic factors, household factors, and systemic factors influencing the nonrenewal of health insurance status. Statistical significance for all testing was set as p ≤ 0.05 . Results. Sociodemographic factors such as gender (AOR = 0.531; CI = 0.287–0.985) and educational level (AOR = 5.268; CI = 1.130–24.551)) were associated with the nonrenewal of health insurance membership. Income levels in Ghana Cedis were 500–1000 (AOR = 0.216; CI = 0.075–0.617) and 1001–2000 (AOR = 0.085; CI = 0.019–0.383). Systemic decision on factors such as clients’ satisfaction (AOR = 0.149; CI = 0.035–0.640), making copayment (AOR = 0.152; CI = 0,068–0.344), acquiring all prescribed drugs (AOR = 4.191; CI = 2.027–8.668), and awareness of mobile renewal (AOR = 3.139; CI = 1.462–6.739) was associated with nonrenewal of membership. Conclusions. The nonrenewal of health insurance membership was influenced by sociodemographic, household, and systemic factors. Therefore, the Municipal Health Directorate and the National Health Insurance Authority have to work on these factors to reach the target of 100% active coverage in the municipality.

Financial Stability of European Insurance Companies during the COVID-19 Pandemic

The European Insurance and Occupational Pensions Authority suggests that as the coronavirus disease 2019 (COVID-19) pandemic has caused significant disruption to the economy, businesses, and people’s lives, national supervisory authorities should mitigate the pandemic’s impact on the European insurance sector. The functioning of insurance companies is in danger as they must balance a drastic increase in the number of claims with their capital and solvency stability. In this study, we evaluate the effects of the COVID-19 pandemic on insurance companies using European insurance companies’ financial statement data from 2010 to 2020. The results unambiguously demonstrate that the pandemic has negatively affected the functioning of the insurance sector. In particular, the return on assets decreased in German and Italian insurance companies during the pandemic. Furthermore, the solvency ratio decreased in the Belgian, French, and German insurance sectors. Conversely, the Polish insurance sector was unaffected. Moreover, we did not find any effects on the Z-score ratio in our sample. Lastly, the value of receivables owed to Belgian insurance companies increased. Based on this evidence, we argue that European legislators should discuss how to manage the probable financial problems of insurance companies during the COVID-19 pandemic.

Management of chronic non-communicable diseases in Ghana: a qualitative study\xa0using the chronic care model

BackgroundWhile the burden and mortality from chronic non-communicable diseases (CNCDs) have reached epidemic proportions in sub-Saharan Africa (SSA), decision-makers and individuals still consider CNCDs to be infrequent and, therefore, do not pay the needed attention to their management. We, therefore, explored the practices and challenges associated with the management of CNCDs by patients and health professionals.MethodsThis was a qualitative study among 82 CNCD patients and 30 health professionals. Face-to-face in-depth interviews were used in collecting data from the participants. Data collected were analysed using thematic analysis.ResultsExperiences of health professionals regarding CNCD management practices involved general assessments such as education of patients, and specific practices based on type and stage of CNCDs presented. Patients’ experiences mainly centred on self-management practices which comprised self-restrictions, exercise, and the use of anthropometric equipment to monitor health status at home. Inadequate logistics, work-related stress due to heavy workload, poor utility supply, and financial incapability of patients to afford the cost of managing their conditions were challenges that militated against the effective management of CNCDs.ConclusionsA myriad of challenges inhibits the effective management of CNCDs. To accelerate progress towards meeting the Sustainable Development Goal 3 on reducing premature mortality from CNCDs, the Ghana Health Service and management of the respective hospitals should ensure improved utility supply, adequate staff motivation, and regular in-service training. A chronic care management policy should also be implemented in addition to the review of the country’s National Health Insurance Scheme (NHIS) by the Ministry of Health and the National Health Insurance Authority to cover the management of all CNCDs.

People’s Republic of China–Hong Kong Special Administrative Region: Financial Sector Assessment Program-Technical Note-Systemic Risk Oversight and Macroprudential Policies

The institutional framework for Macroprudential Policies (MaPP) in the Hong Kong Special Administrative Region (the Hong Kong SAR) is well established. According to the Basic Law, the Government of the Hong Kong SAR shall on its own formulate monetary and financial policies. The Financial Secretary (FS) and the Secretary for Financial Services and the Treasury (SFST) are responsible for policies for maintaining the stability and integrity of the financial system of the Hong Kong SAR. The Hong Kong SAR has a sector-based regulatory structure and the responsibilities and tools for safeguarding financial stability are spread across the Financial Services and the Treasury Bureau (FSTB) and three regulators (namely, the Hong Kong Monetary Authority (HKMA), Securities and Futures Commission (SFC) and Insurance Authority (IA)). There are good and well-structured interagency coordination and consultation mechanisms, through the Council of Financial Regulators (CFR) and the Financial Stability Committee (FSC), chaired by the FS and the SFST, respectively. Broad coordination between the CFR and government agencies on taxation and housing supply-side policies has also worked well. MaPP and risk assessment are communicated to the public openly and frequently through speeches, press releases and regular publications, including the Half-Yearly Monetary and Financial Stability Report of the HKMA and the Half-yearly Review Report of the Global and Local Securities Markets of the SFC.

Challenges experienced by patients with hypertension in Ghana: A qualitative inquiry.

BackgroundHypertension (HPT) is an essential public health problem affecting both lower and middle-income countries disproportionately. Evidence suggests that HPT is the leading risk factor for cardiovascular diseases and chronic kidney disease. Yet, challenges faced by patients with HPT in Ghana are not sufficiently explored. This study, documents the challenges patients with HPT face in Ghana.MethodsWe used an explorative descriptive qualitative design. Face-to-face in-depth interviews were conducted with 15 patients with HPT. Interviews were recorded and transcribed verbatim. A thematic content analysis procedure was followed to analyse the data.ResultsFour main themes emerged from interviews; three of which pertained to dimensions of challenges and a fourth which pertained to coping strategies. These include: [1] impairment in physical activities and mobility constraints [2]. Psychological challenges such as suicidal ideations, sadness, fear, anxiety, and reduced sexual affection [3]. Socio-economic challenges identified include loss of friends and social network, difficulty in job demands, and financial burden, and [4] coping strategies such as health system support, social support, and religiosity were identified.ConclusionPatients with HPT experience an array of challenges. We suggest that health care facilities incorporate post HPT diagnosis counseling sessions for HPT patients in the study area. Also, the National Health Insurance Authority (NHIA) should re-examine their scope of services; thus, drugs, laboratory services, and electrocardiogram services to avoid the issue of co-payment. Collaboration between healthcare professionals and family relations of patients with HPT ought to also be strengthened to ensure optimal care.

Employees Motivation and Job Productivity of National Health Insurance Authority in the Sunyani Municipality

Employees Motivation and Job Productivity of National Health Insurance Authority in the Sunyani Municipality

Policyholder protection for insurance companies with default claims: comparative analysis in Indonesia and the UK

The condition of insurance in Indonesia can be categorized as wildly chaotic because the rights of insurance policyholder cannot be secured by Indonesian insurance company. Jiwasraya and Bumiputera default case is clear evidence of the incompetence insurance company in managing insurance business in Indonesia. As a comparison, United Kingdom capable to manage insurance industry and be able to protect the rights of insurance policyholder. This study aims to compare the protection of insurance policyholders in Indonesia and the United Kingdom. The research method that is used in this study is a normative research method through a comparative way that compares two different legal systems. This study is carried out through a qualitative approach. This study's results are that Indonesia and the United Kingdom have similarities and differences in the protection of insurance policyholders. Through Law number 40 of 2014 concerning insurance and Financial Services Authority (OJK) decision regulation, Indonesia has governed the provision of insurance policyholder protection in the insurance company's condition failed to pay an insurance claim. The mechanism is by using Financial health Planning and Insolvency procedures through the bankruptcy of an insurance company that is regulated under Law no 37 of 2004. Whereas, in the United Kingdom, the legal basis of insurance policyholder protection is Financial Services and Market Act. FSCS must secure insurance claims when the insurance company has a financial problem paying insurance claims toward the policyholder.

Creating Ethics Guidelines for Artificial Intelligence (AI) and Big Data Analytics Customers: The Case of the Consumer European Insurance Market

The European Union (EU) has a strong reputation and track record for being proactive in the development of guidelines and regulations for the ethical use of AI generally. In this paper, we discuss the development of an AI and ethical framework by the European Insurance and Occupational Pensions Authority (EIOPA), for the European insurance market. EIOPA’s earlier report on big data analytics (EIOPA 2019) provided an important foundation to analyse and evaluate the complex range of issues and ethical problems associated with the wave of new AI technologies being deployed in insurance such as behavioural insurance, parametric products, novel pricing and risk assessment algorithms, e-service and claims management, which exploit big data and machine learning. In this paper we present an overview of the use of AI in insurance based on the full range of insurance applications throughout the insurance value chain. A general discussion of ethics and AI is illustrated with the specific use-case of insurance, and a new hierarchical model is presented that describes insurance as a complex system that can be analysed by taking a layered, multi-level approach, on which ethical issues can be mapped directly to specific level(s).

Creating Ethics Guidelines for Artificial Intelligence (AI) and Big Data Analytics: The Case of the European Consumer Insurance Market

The European Union (EU) has a strong reputation and track record for being proactive in the development of guidelines and regulations for the ethical use of AI generally. In this paper, we discuss the development of an AI and ethical framework by the European Insurance and Occupational Pensions Authority (EIOPA), for the European insurance market. EIOPA’s earlier report on big data analytics (EIOPA 2019) provided an important foundation to analyse and evaluate the complex range of issues and ethical problems associated with the wave of new AI technologies being deployed in insurance such as behavioural insurance, parametric products, novel pricing and risk assessment algorithms, e-service and claims management, which exploit big data and machine learning. In this paper we present an overview of the use of AI in insurance based on the full range of insurance applications throughout the insurance value chain. A general discussion of ethics and AI is illustrated with the specific use-case of insurance, and a new hierarchical model is presented that describes insurance as a complex system that can be analysed by taking a layered, multi-level approach, on which ethical issues can be mapped directly to specific level(s).

The Impact of Emerging Regulatory Regime on the Private Health Insurance Industry in Ghana

The study sought to examine how the current regulatory reforms in the insurance industry impact the services of insurance schemes in Ghana. The study used primary data comprising 60 employees in management positions in private health insurance companies in Ghana, and 5 personnel from the National Health Insurance Authority, the regulator. The employees were selected using purposive sampling technique, while the private health insurance companies that participated in the study were chosen using simple random sampling technique. Descriptive research, mean and standard deviation, as well as inferential statistics of ordinary simple linear regression analysis were used to analyze the data of the study. The results of the study revealed that the main reason for the current insurance regulatory framework in Ghana is to ensure safety and soundness of insurers; offer protection to consumers; bring sanity into insurance industry; promote best practices; mitigate industry associated risks, and to safeguard the interest of all stakeholders for socio-economic development. The findings of the study also revealed that the current insurance regulatory measures were established to manage systemic risks and market failures. The result of the study also revealed that the regulatory framework has both positive and negative impact on insurance companies’ activities in Ghana. Moreover, the findings of the study revealed that the regulatory challenges facing the insurers are logistical, education and training, human resource, legislative, and economic or financial ones. The results of the ordinary simple linear regression revealed that the regulatory challenges faced by insurers have a significant negative impact on the insurers’ overall satisfaction with the regulatory framework. Given these findings of the study, implication and recommendations are highlighted for policymakers, regulators and researchers.

시스템리스크 대응을 위한 과제와 예금보험공사의 역할 Systemic Risk and the Role of Deposit Insurance Authority in Korea

Korean Abstract: 2008년 글로벌 금융위기 이후 한국은행, 금융감독원, 예금보험공사 등 금융안전망 기구들은 거시건전성 제고를 위한 시스템리스크 대응체계를 지속적으로 정비해 왔지만 해외 주요국들과는 달리 법적 지위를 갖춘 거시건전성정책 총괄기구의 부재, 금융안전망기구들 간 정보공유 부족, 부실화 이전의 정상금융회사에 대한 자금지원체계 미비 등의 문제점은 여전하다.특히, 비은행권 리스크와 업권 간 상호연계성으로 인한 내생적 위험요인이 확대되고 있는 국내금융시스템 특성을 고려하면 위기대응체계 구축에 있어 예금보험공사의 역할이 긴요하다. 최근 COVID-19 팬데믹 선언과 함께 경기부양을 위한 전방위적인 통화･재정 정책이 동원되고 있지만, 실물경기 침체가 장기화될 경우 금융회사 부실로 인한 금융위기 재연의 우려도 커지고 있는 상황이기에 정상금융회사에 대한 자금지원체계 수립이 구체적으로 논의되어야 할 시점이다.English Abstract:Since the Global Financial Crisis in 2008, financial safety nets, such as the Bank of Korea, the Financial Supervisory Service, and the Korea Deposit Insurance Corporation (KDIC) have continued to improve their risk-response systems to improve the macroprudential measures. However, unlike other major countries, problems still remain in Korea; lack of a macroprudential policy authority with legal status, lack of information sharing system among financial safety nets, and lack of funding schemes for financial companies prior to their insolvency.Given the nature of the domestic financial industry, where endogenous risk factors continue to rise due to the risks in non-banking sectors and the interconnectedness among financial sectors, the role of the deposit insurance authority is crucial in building a crisis response system.Recently, with the COVID-19 pandemic declaration, all-round monetary and fiscal policies are being mobilized to stimulate the economy. However, if the economic downturn is prolonged, there will be a growing concern over the next financial crisis that may be triggered by the insolvencies of financial institutions. Therefore, an in-depth discussion should be held on setting up a funding scheme for financial companies.

Financial management skills of nurse managers in the Eastern Region of Ghana

BackgroundGhana’s healthcare sectors are faced with several financial challenges due to increased funding cuts and delayed reimbursement from the National Health Insurance Authority (NHIA). This has necessitated nurse manager to build financial management skills to enable them to lead in the provision of effective and efficient care while reducing cost. This demands adequate knowledge and skills in financial management. The study examined the financial management skills of nurse managers at the unit level. MethodsA quantitative approach using a cross-sectional design was employed using the census approach to collect data from 121 nurse managers in ten hospitals in the Eastern Region of Ghana. Data analyses were performed using descriptive and linear regression analyses. FindingsNurse managers showed a moderate level of knowledge and skills in financial management. Age, gender, qualification, experience as a nurse manager, and training in management jointly predicted nurse managerss’ financial management (R2 = 0.12, p = 0.029). However, only training in management significantly contributed to the financial skills of nurse managers. ConclusionNurse managers play a significant role in the financial management of hospitals but have inadequate knowledge, skills, and competence in financial management. Recommendations include well-structured training and education on financial management using a multidisciplinary approach to enable nurse managers to gain the required knowledge and skills. Continuous experiential learning and mentorship programs should be developed for nurses before the assumption of management positions.

Koncepcja ryzyka socjalnego w polskim prawie ubezpieczeń społecznych

Zarys koncepcji ryzyka socjalnego w polskim prawie ubezpieczeń społecznych stworzono przy wykorzystaniu amerykańskiego (ekonomicznego) podejścia do teorii ryzyka ubezpieczeniowego ujmującego to pojęcie w kategoriach niebezpieczeństwa postrzeganego jako przyczyna realnych zdarzeń. W konsekwencji istota ochrony ubezpieczeniowej sprowadza się do odczuwania komfortu psychicznego (poczucia bezpieczeństwa materialnego) zapewnionego przez sam fakt ubezpieczenia. Tym samym za świadczenie wzajemne z tytułu bezwarunkowo opłacanej składki uważa się przejęcie i ponoszenie ryzyka przez ubezpieczyciela, a nie ewentualne wypłacenie świadczenia ubezpieczeniowego. Mając to na uwadze, ryzyko socjalne należy rozpatrywać nie od strony zaspokojenia potrzeb, jakie ono niesie, gdy się ziści (teoria świadczenia pieniężnego), lecz w kontekście świadczenia ubezpieczeniowej gwarancji „na wypadek” zajścia określonych zdarzeń (teoria ponoszenia ryzyka).

The Pan-European Pension Product Regulation – Europe’s Solution to the ‘Pensions Gap’

In July 2012, the European Commission asked the European Insurance and Occupational Pensions Authority (‘EIOPA’), in the broader context of efforts to develop private funded pensions, to advise on a legal framework for a Single Market for PPPs. Following a Discussion Paper, a Preliminary Report, a draft advice and a Final Report published by EIOPA, Regulation (EU) 2019/1238 (‘PEPPR’) was adopted on 20 June 2019. The PEPPR establishes a 2nd regime (also known as the 29th regime) that serves as an alternative uniform European system to different national regimes allowing private parties (providers and PPP holders) to choose whether the European or a national regime governs their legal relationship. The PEPPR, that introduced a European (product) passport for Pan-European Pension Products (‘PEPPs’), is in line with the advice in the 2011 White Paper on Pensions that addresses enhancement of the development of private retirement savings in realizing efficiency gains through diversification, innovation and scales of economies on the side of pension providers. Apart from that, the introduction of the European product passport for PPPs might help to overcome the ‘financing gap’ for small and medium-sized enterprises (‘SMEs’). Developing complementary personal retirement savings is seen as a regulatory tool to develop third-pillar pension systems in EEA Member States where occupational pensions are not well-developed. The PEPPR seeks to create a regulatory framework for personal pensions that could play a role in securing pensions, reducing the burden on public pension schemes and increasing pension income. It serves as an answer to overcome the pressure being put by the low interest rates on funded schemes. Furthermore, the PEPPR has as an additional objective to diminish the obstacles to labour mobility and adapt to the general shift from defined benefit (‘DB’) to defined contribution (‘DC’) schemes. The PEPPR, thus, plays a major role in overcoming the ‘pensions gap’. This contribution discusses PEPPs as a ‘wrapper product’. Furthermore, this contribution explains the common regulatory framework for PEPPs in harmonizing regulation applying to PEPP providers/distributors, depositaries/custodians, the position of PEPP customers, the standardization of PEPP ‘product regulation’ and sales regulation. It concludes by explaining that the PEPPR establishes a ‘wrapper product’ investment triangle that is, depending upon the PEPP contract employed, based upon the underlying investment triangle under Directive 2011/61/EU (‘AIFMD’), Directive 2009/65/EC (‘UCITSD’) or the (optional) investment triangle under Directive (EU) 2016/2341 (‘IORPD II’).

Community utilisation and satisfaction with the community-based health planning and services initiative in Ghana: a comparative study in two system learning districts of the CHPS+ project

BackgroundTo strengthen the implementation of the Community-based Health Planning and Services (CHPS) programme which is Ghana’s key primary health care delivery strategy, the CHPS+ Project was initiated in 2017. We examined community utilisation and satisfaction with CHPS services in two System Learning Districts (SLDs) of the project.MethodsThis community-based descriptive study was conducted in the Nkwanta South Municipality and Central Tongu District of Ghana. Data were collected from 1008 adults and analysed using frequency, percentage, chi-square, and logistic regression models.ResultsWhile the level of utilisation of CHPS services was 65.2%, satisfaction was 46.1%. Utilisation was 76.7% in Nkwanta South and 53.8% in Central Tongu. Satisfaction was also 55.2% in Nkwanta South and 37.1% in Central Tongu. Community members in Nkwanta South were more likely to utilise (AOR = 3.17, 95%CI = 3.98–9.76) and be satisfied (AOR = 2.77, 95%CI = 1.56–4.90) with CHPS services than those in Central Tongu. Females were more likely to utilise (AOR = 1.75, 95%CI = 1.27–2.39) but less likely to be satisfied [AOR = 0.47, 95%CI = 0.25–0.90] with CHPS services than males. Even though subscription to the National Health Insurance Scheme (NHIS) was just 46.3%, NHIS subscribers were more likely to utilise (AOR = 1.51, 95%CI = 1.22–2.03) and be satisfied (AOR = 1.45, 95%CI = 0.53–1.68) with CHPS services than non-subscribers.ConclusionGhana may not be able to achieve the goal of universal health coverage (UHC) by the year 2030 if current levels of utilisation and satisfaction with CHPS services persist. To accelerate progress towards the achievement of UHC with CHPS as the vehicle through which primary health care is delivered, there should be increased public education by the Ghana Health Service (GHS) on the CHPS concept to increase utilisation. Service quality should also be improved by the GHS and other stakeholders in Ghana’s health industry to increase satisfaction with CHPS services. The GHS and the National Health Insurance Authority (NHIA) should also institute innovative strategies to increase subscription to the NHIS since it has implications for CHPS service utilisation and satisfaction.

Comparative analysis of interest rate term structures in the Solvency II environment

PurposeSolvency-II is the current regulatory framework of insurance companies in the European Union. Under this standard, European Insurance and Occupational Pension Authority (EIOPA), as a regulatory board, has established that the Smith–Wilson (SW) model can be used as the model to estimate interest rate curve. This paper aims to analyze whether this model adjusts to the market curve better than Nelson–Siegel (NS) and whether the values set for the parameters are adequate.Design/methodology/approachThis empirical study analyzes whether the SW interest rate curve shows lower root mean squared errors than the NS curve for a sample of daily prices of Spanish Government bonds between 2014 and 2019.FindingsThe results indicate that NS adjusts the market data better, the parameters recommended by the EIOPA correspond to the maximum values observed in the sample period and the current recommended curve for insurance companies underestimates company operations.Originality/valueThis paper verifies that the criterion of the last liquid point does not allow for selecting an optimal sample to adjust the curve and criteria based on prices without arbitrage opportunities are more appropriate.

Implementation of the policy protocol for management of surgical and non-surgical wounds in selected public health facilities in Ghana: An analytic case study.

BackgroundIt is estimated that millions of patients are affected by healthcare associated infections (HAIs) each year. In Ghana, high prevalence of HAIs in relation to non-surgical (also called contaminated wounds) and surgical wounds (also called sterile wounds) is largely attributed to poor adherence to policy protocols for wound management by frontline clinical staff especially nurses.ObjectiveInvestigate the extent to which nursing staff adhere to the policy protocol for management of non-surgical and surgical wounds in selected public health facilities in Ghana.MethodologyThis is an analytic case study among nursing staff (n = 140) in three government facilities in the Volta region of Ghana. Subjective and objective performance scores of staff on adherence proxies were compared using the Wilcoxon Signed-rank test, and univariate ordered logistic regression analysis used to predict staff likelihood of adherence to policy protocols on non-surgical and surgical wound management.FindingsOverall, staff self-rated themselves higher on subjective performance proxies relative to their objective scores (p<0.05). Staff with more years of work experience did not translate into a higher likelihood of adhering to standard protocol on wound management (Coef. = -0.49, CI = -0.93–0.05, p = 0.036). Being a senior nursing officer relative to lower nursing ranks increased staff likelihood of complying particularly with standard policy protocol for management of non-surgical wounds (Coef. 5.27, CI = 0.59 9.95, p = 0.027).ConclusionThere is the need for accelerated in-service training for staff on standard protocols for wound management coupled with supportive supervisions. Staff adherence to standard quality care protocols should be a pre-requisite for licensing of health facilities by regulatory bodies like Health Facilities Regulatory Agency and National Health Insurance Authority.

Black boxes and market efficiency: the effect on premiums in the Italian motor-vehicle insurance market

The paper addresses the research question of whether black boxes affect the market efficiency, particularly by reducing the level of premiums. The case analyzed is the Italian motor-vehicle insurance market, characterized by the greatest amount of black boxes in the world as a consequence of regulatory interventions that fostered the spread of these kinds of devices. Particularly, using the data provided by the Italian Insurance Authority (IVASS), we show a specific relation between the increasing number of these devices and the decreasing trend in average premium. Conclusive remarks outline that in the near future this efficiency effect may increase because of the specific use of information derived from the black box that reveals the behaviors of the drivers and allows for innovative ways of individually profiling the insurance policies.