Insurance Executives Research Articles

Fragmentation of payment systems: an in-depth qualitative study of stakeholders’ experiences with the neonatal intensive care payment system in Iran

BackgroundIran’s fee-for-service (FFS) payment model in neonatal intensive care units (NICUs) is contentious due to the involvement of multiple stakeholders with differing interests, leading to increased costs, fragmentation, and reduced quality of care. This study explores the experiences and challenges of stakeholders with the NICU payment system and considers alternative payment methods.MethodA qualitative research approach was used, involving key informant interviews with stakeholders at various levels of the health system. Data were collected between March 2022 to September 2023 using a purposive sampling method with a snowball strategy. The transcribed data were analyzed using an inductive thematic approach in MAXQDA, with themes and sub-themes emerged and assessed by two independent coders. Four trustworthiness criteria were applied to ensure the quality of the results.ResultsThe study involved 23 participants with diverse NICU payment backgrounds, identifying issues related to service accessibility, rising costs, neonatologists’ income, and service quality. Stakeholders held differing views on the best payment model: health insurance executives favored a prospective payment method, faculty members favored supported modified FFS or per diem, and neonatal specialists expressed concerns about low tariffs and delayed payments.ConclusionIran’s NICU payment system is unsatisfactory and requires urgent reform. Although stakeholders disagree on the best approach, reforms must be evidence-based and collaborative, addressing structural and cultural issues within the health system. The identification of an optimal payment system is essential for supporting neonatal care, benefiting newborns, families, society, and the broader health system.

Rationing by Inconvenience: How Insurance Denials Induce Administrative Burdens

Context: How do health coverage denials keep care out of reach for American patients by imposing unevenly distributed administrative burdens? This article argues that the process of appealing insurers’ denials imposes administrative burdens on patients inequitably, deepening the divide between those with meaningful access to health coverage and those for whom benefits are out of reach. Methods: The author conducted a nationwide survey of 1,340 US adults on their experiences with coverage denials; this was supplemented with 110 semistructured interviews with patients, physicians, and former health insurance executives. Findings: Those who were less affluent were significantly less likely than their wealthier counterparts to appeal denials of coverage. Patients who underestimated the rate at which patients prevail in insurance appeals were less likely to appeal their own denials. Black Medicaid patients and those who were in worse health were significantly less likely to prevail in the appeals they pursued. Many unappealed denials were attributable to the significant administrative burdens associated with appeal, including learning and psychological costs. Conclusions: Administrative burdens associated with appealing denials of coverage can deepen health inequities along class and race lines, suggesting a need for policy interventions to make it easier to navigate the health insurance bureaucracy.

Stakeholder outcome prioritization in the Biologic Abatement and Capturing Kids' Outcomes and Flare Frequency in Juvenile Spondyloarthritis (BACK-OFF JSpA) trial.

The Biologic Abatement and Capturing Kids' Outcomes and Flare Frequency in Juvenile Spondyloarthritis (BACK-OFF JSpA) study is a randomized, pragmatic trial investigating different tumour necrosis factor inhibitor de-escalation strategies for children with sustained inactive disease. In this project, we elicited concept rankings that aided in the selection of the patient-reported outcome (PRO) measures that should be examined as part of the BACK-OFF JSpA trial. We conducted a discrete choice experiment to evaluate individuals' preferences regarding PROs. Stakeholders assessed a discrete list of 21 outcome concepts, each of which had a Patient-Reported Outcome Measurement Information System (PROMIS) measure associated with it. PROMIS measures are self- or proxy-reported instruments that are universally applicable to the general population and all chronic conditions. Stakeholders were required to make choices instead of expressing the strength of a preference. Fourteen caregivers, 12 patients (9-22 years old), 16 rheumatologists and three executives from health insurance companies completed the exercise, which took approximately 10 min. The discrete choice experiment resulted in an estimate of the relative importance of each outcome and rank. All stakeholder groups agreed that the primary PRO should be 'Pain Interference', a measure that evaluates the effect of pain on a child's everyday activities, including its impact on social, emotional, mental and physical functioning. Patients and caregivers were mostly aligned in their top priorities, with patients valuing physical health (50% of the top 10) whereas caregivers were more interested in mental health (60% of the top 10). Rheumatologists and health insurance executives were most interested in physical health outcomes, which were ranked 80% and 60% of their top 10 PROs, respectively. Overall, the patients had the most diverse set of prioritized outcomes, including at least one of each category in their top 10 rank order of importance. Patients were also the only stakeholders to prioritize 'social' health. Patients and caregivers were mostly aligned in their outcome priority rankings. The rank-order list directly informed the creation of a profile of PRO measures for our upcoming trial. Stakeholder partners helped with acquisition of data and lead parent partners helped interpret data.

Instrumentation and control systems design for nuclear power plant: An interview study with industry practitioners

Instrumentation and Control systems (I&C) play a significant role in nuclear power plants (NPP) and other safety critical systems (SCS). We have conducted a rigorous study and discussions with experienced practitioners worldwide the strategy for the development of I&C systems to investigate the several aspects related to their dependability. We discussed with experienced practitioners that work on nuclear domain with the intention of knowing their approach, they use day-to-day for the development of such systems. The aim of this research is to obtain to provide guidance to those building I&C systems of NPP and have implications on state engineering licensure boards, in the determination of legal liability, and in risk assessment for policymakers, corporate governors, and insurance executives.

Democratizing health insurance services; accelerating social inclusion through technology policy of health insurance firms

AbstractTechnology plays an important role in reducing inequalities in health care delivery and enhancing quality of life. Health insurance firms require a potent technology policy to understand social determinants of health insurance that can lead to more innovative approaches to social inclusivity initiatives. This paper explicates critical factors of technology policy of health insurance firms that can contribute to better social inclusion and move towards universal health care. Through structured survey questionnaire, data were collected from 125 senior health insurance executives from India for identifying factors important for technology policy. A technology policy scale comprising six distinct factors is developed for health insurance firms using exploratory factor analysis. The factors are “organizational technology strategy,” “technology value drivers,” “technology utilization,” “firm agility in technology,” “firm technology capabilities,” and “customer focus through technology.” The factors identified in this study can be utilized and integrated with enabling technologies such as machine learning, internet of things, big data analytics, and digital phenotyping for creation of electronic health records that are critical for risk management of health insurance firms. This would help to promote healthy lifestyles and disease prevention strategies to strengthen universal health care for society. This paper looks at the factors that are essential in framing a technology policy for the health insurance sector. It provides reasons on how the factors contribute in the evolving health insurance field and can increase the rate of social inclusion for health care. And, finally, it helps in distinguishing how technology requirements and utilization in health insurance is different from other businesses.

Software Engineering of Safety-Critical Systems: Themes From Practitioners

This study addresses two important questions related to engineering of safety-critical software and software-intensive systems. The first question is: which software and software-intensive systems should be considered safety critical? The second question is: what processes, design practices, and tools have practitioners been using for building these systems? We answer these questions through an analysis of unstructured interviews with experienced engineers who self-describe as working on safety-critical systems. Then, a thematic analysis of these responses was conducted. The results of this study are intended to provide guidance to those building safety-critical systems and have implications on state engineering licensure boards, in the determination of legal liability, and in risk assessment for policymakers, corporate governors, and insurance executives.

Inside the Dream Palace: The Life and Times of New York's Legendary Chelsea HotelSherillTippins. Boston: Houghton Mifflin Harcourt, 2013.

Inside the Dream Palace: The Life and Times of New York's Legendary Chelsea Hotel S her ill Tippins. Boston: Houghton Mifflin Harcourt, 2013.Built between 1883 and 1885, the Chelsea Hotel has served as a center for artistic and creative activity, hosting luminaries such as Dylan Thomas, Virgil Thomson, and Allen Ginsberg. Sherill Tippins's exhaustively researched work is not just a celebratory roll-call of famous faces, as she demonstrates how the various periods in the hotel's checkered career offer a microcosm of American history.The hotel was designed by French emigre Philip Hubert in grand style, at the time the largest residential structure in the history of New York. In addition to its elegantly proportioned rooms and ornate lobbies, it boasted every conceivable modern amenity-pressurized steam for cooking, speaking tubes for easy communication, a dumb-waiter for room service. His approach to designing the hotel was highly influenced by the utopian philosopher Charles Fourier, who believed that human beings should be given the chance to pursue their interests unimpeded, so as to create a synergetic music of humanity spurring the population forward to spiritual and social evolution (39). In architectural terms, Fourier recommended that buildings should be created to house self-contained communities, or phalanxes, whose members could mingle freely, share intellectual interests, and divide domestic duties. Such experiments had already been attempted in mid-nineteenth century America: Brook Farm was established by a group of New England transcendentalists, what Nathaniel Hawthorne described as delectable visions of the spiritualization of labor (51). Hubert's building was praised by critics for the way in which it promoted a similar feeling of community; it was likened to a living temple of humanity offering limitless possibilities for improving urban life (66). At a time when America was undergoing profound social and economic change, the Chelsea offered a utopian vision of the future. It was hardly surprising that major figures such as William Dean Howells and Mark Twain chose to reside there.In spite of Hubert's expectations, the hotel at the end of the nineteenth century was largely patronized by the affluent middle class with their thin sentiment of parlors, parasols, piquesongs [and] tinkling rhymes (92). Within four decades, the clientele had become far more cosmopolitan. This was due partly to economic reasons: the hotel was bankrupted as a result of the 1893 and the 1903 recessions, forcing the directors to transform it into a residential hotel. By the 1920s, the hotel's management had passed into the hands of the Knott Corporation, which thoroughly modernized the building by subdividing many of the original apartments, closing the private dining room, and creating more budget-priced facilities. Many creative artists came to live and work there, including novelists Thomas Wolfe and Sherwood Anderson and painter Arthur B. Davies. By now, the Chelsea served as a lasting reminder of the old sweet things of the Victorian era, an antidote to the hard-boiled efficiency and commercialism of the Depression and beyond (138). Within its walls, artists could cultivate a fulfilling and productive existence in private. The Chelsea helped to nurture the Federal Art Project and the Federal Theatre Project, two New Deal initiatives that offered new forms of community for everyone, whether rich or poor.Within two decades, the hotel had new owners, a syndicate of Hungarians headed by David Bard and Frank Amigo. The order of the late nineteenth century had been replaced by a more chaotic environment; the hotel had become shabby, linoleum was laid over marble, and cheap paint had been slapped on the walls. The clientele now included bookies and office clerks, attorneys and insurance executives. …

Leadership role and employee acceptance of change

Purpose – The change management literature on strategy implementation identifies different dimensions of resistance to change. The contrary view – that of dimensions of acceptance of change when implementing strategy – has received less attention. The purpose of this paper is to explore the implementation of environmental sustainability strategies by Nordic insurers, the role of leadership in implementing these changes, and employee acceptance of change. Design/methodology/approach – For achieving this purpose, this paper reports on an explanatory case study of Nordic non-life insurers, where interviews with insurance executives and specialists were the primary source of data. Findings – The authors have developed simple strategy maps, focusing on insurers’ own operations, product offerings, loss prevention and claims settlements, investments and influence on stakeholders, to show how common elements of environmental strategies are implemented within the insurance industry. The importance of leadership in organizational change is evident in the data, as well as in employees’ positive attitudes towards implementation of environmental sustainability strategies. Originality/value – The scientific contribution of this paper is the empirical mapping of a hitherto unexplored area of the implementation of environmental sustainability strategies within the Nordic insurance industry, highlighting the leadership role in implementing environmental sustainability strategies and the elements shaping employee acceptance of change when implementing environmental sustainability strategies.

Bottling the “Collaboration Thing”

Many years ago, I was speaking to a group of insurance executives about how libraries handle the aftermath of disasters like floods or fires. I talked about the various collaborative arrangements that exist among libraries, how we back each one another up in times of trouble, the long history of interlibrary loan, cooperative agencies, and the myriad ways we’ve devised to cooperate. After a few minutes, it seemed that I’d suddenly begun speaking in Sanskrit, because I realized I’d lost my audience.

Insurance Perspective on Talent Management and Corporate Social Responsibility: A Case Study of Nordic Insurers

Insurers are facing a problem of attracting new talent. They are competing with other industries for talent while clients simultaneously demand more service from insurers. At the same time, the industry is regarded as 'un-sexy', having poor reputation, and the talent pool is limited. The aim of this paper is to explore whether corporate social responsibility/sustainability emphasis can be used to attract talent to the insurance sector. The paper is based on a multi-case study including 16 Nordic non-life insurance companies, focusing on the environmental factor of corporate social responsibility or environmental sustainability, depending on the company’s terminology. Qualitative methods were used to collect data, including 74 interviews with insurance executives and specialists. The paper suggest that focus on corporate social responsibility can be an enabling condition when attracting talent, i.e. if companies have a higher agenda than gaining more profit today than they did yesterday. Running a successful business requires companies to recognize the trends that will alter their business environment. If they incorporate and deal with issues of key concern for their future employees they are more likely to succeed in attracting talent.

The Case for Creating a Model Insurance Policy: Payer Coverage of Breastfeeding Counseling Services, Pumps, and Supplies

With the implementation of the Health Resources and Services Administration Women's Preventive Services Guidelines, which went into effective August 1, 2012, under the Affordable Care Act, healthcare insurance companies across the country have interpreted the breastfeeding support provision in a variety of ways. In order to improve benefit design and promote transparency and accountability, the National Breastfeeding Center and the United States Breastfeeding Committee co-authored a model insurance policy that seeks to educate insurance executives about appropriately supporting breastfeeding medicine for purposes of improving population health.

The new German Ringfencing Act establishing criminal liability of banking and insurance executives for failures in risk management

The German parliament recently approved a new law regarding individual criminal liability of banking and insurance executives, which will take effect as of January 2014. Under the new so-called Ringfencing Act (Trennbankengesetz), specific duties and responsibilities for risk management will be imposed on these executives. Failure to comply with these duties will be punishable by a maximum of five years’ imprisonment if it causes a threat to the viability as a going concern of a bank, or insolvency or over-indebtedness of an insurance company. This paper provides a description of the risk management duties and the corresponding criminal penalties. It also discusses the regulatory background and provides an initial assessment of the likely implications for risk management at German financial institutions.

31A. Integrative Health Coaching and Health Behavior Change

Focus Area: Supporting Behavioral ChangeAs the paradigm of healthcare financing and the reality of aging adults with multiple chronic conditions confront the healthcare work force, the role of members of the healthcare team who can assist in guiding patients in behavior change from their current state to a desired state is essential. Integrative health coaches are uniquely trained and qualified to provide this critical link between medical recommendations and patient engagement and activation. Duke Integrative Medicine developed a model of integrative health coaching professional education and launched the training in 2008. Integrative health coaching through Duke Integrative Medicine is based on personalized health planning using a “wheel of health” exploration with a patient using a 9-step patient engagement process. This session will allow attendees to experience and learn the key components of integrative health coaching and the training lessons learned within the Duke model. Application and understanding of these skills is valuable for any clinician, corporate or health HR professional and health insurance executives.

Empirical analysis of the problems and challenges confronting insurance companies in Saudi Arabia: Executives’ perspective

This study attempts to find out the problems and challenges confronting the insurance industry of Saudi Arabia from employees’ perspective. The study aims at highlighting the areas which need special attention of the insurance companies in particular and policy makers in general. The study is based on primary data collected from 80 insurance professionals currently working in various insurance companies of Saudi Arabia. To get diversified information, the insurance professionals have been categorized into the following three sub groups with special focus on marketing professionals such as insurance salesman, marketing executives, and other executives. A questionnaire originally developed into English and translated into Arabic in consideration of cultural factor was randomly administered to the insurance professionals. The collected data was analyzed on SPSS software for meaningful results. The findings of the study show that the industry is lacking qualified and experienced insurance professionals. There is huge requirement of specialized education and training in insurance area. The industry is highly dynamic and is going through high competition among the insurance companies. The findings further suggest that the people buy mainly compulsory insurance policies namely; motor insurance and health insurance, and the executives are facing the problem of low achievement against high targets. The industry as a whole is dominated by few large insurance companies, thus intensifying the competition among the others over the compulsory lines of insurance business. The code of conduct for the industry is good and supportive. Finally, the results show that there is positive change in the behaviour of the customers; they are becoming receptive towards insurance. Thus, from the findings, it can safely be suggested that the policymakers and those responsible for developing insurance industry in Saudi Arabia should find out ways of providing more educated and qualified professionals to the industry and promote professionalism in insurance industry. The policy makers should promote healthy competition among insurance companies and try to control the dominance in market by few insurance companies. Key words: Insurance, Saudi Arabia, motor insurance, health insurance, insurance executives.

The Insurance Industry's Talent Gap and Where We Go From Here

AbstractThere is concern among insurers and related firms in the United States and abroad that there will be a shortage of skilled insurance professionals in the next few years as current workers retire. Though there have been discussions among insurers, organizations, and academics as to how to address this issue, until recently, each group has been primarily working in isolation. The Insurance Education & Career Summit, which took place in September 2011, brought together 110 individuals across these groups for the purpose of creating a unified strategy to both attract and retain skilled workers to the insurance industry and work to create the next generation of insurance executives. This article provides a brief background on the talent gap issue. We also discuss its potential impact on the insurance industry. Finally, we summarize the main obstacles identified by Summit participants to both attracting and retaining skilled workers as well as the strategies developed to overcome these obstacles.

History for the Future (of Nursing)

On October 5, 2010, the Institute of Medicine (IOM)1 released the report The Future of Nursing: Leading Change, Advancing Health.2 Based on the two yearlong deliberations of a stellar committee chaired by former Health and Human Services Secretary Donna Shalala and vice chair Linda Burnes Bolton, CNO of Cedars Sinai Medical Center in Los Angeles, the report is positioned to serve as a blueprint for transforming the nursing profession. The report's main message directly addressed nursing and patient care: Health care reform could not be accomplished without better educated nurses who had the skills and knowledge to lead improvements in the quality of care and patient access. As the Nurse Scholar in Residence at the IOM3 in 2010, I proposed to work with the Future of Nursing committee as part of my residence commitment. When I first interviewed with a committee senior staff member, she was hesitant and questioned what I could contribute as a historian. My response was and context. Because all deliberations are confidential, I cannot relate specific contributions, but as you read the report, the historical perspective and the use of context as an explanatory framework is clear. As an historian I knew that numerous studies about the nursing profession had been conducted by many different groups, and that the reasons for and findings of each study reflected the politics (both local and national) of the time period and the participants. The Future of Nursing study followed this tradition. This does not mean that the members sought individual political gain, but that each had their own sense (and perhaps that of the groups they represented) of the nursing profession and its place in the health care system. Economists, political scientists, insurance executives, physicians and nurses themselves each came from their particular standpoint and place in terms of how they valued nurses' work and what they thought could and should be accomplished by the report. Each understood nursing's history from their own political, personal, and historical vantage point. The IOM conducted its last major study on nursing in 1983, which was situated in a different political and social context.4 Yet, some of the recommendations from the 1983 report seemed familiar-the need for better educated nurses, better workforce data, a more diverse workforce, and the need to remove practice barriers. But, context and contingency are time and place dependent and shape the work we do and the meaning that work holds for patients. We also know there is, indeed, historical continuity that gives shape to our values and our responsibilities as the largest group of caregivers in the health care arena. These perspectives implicitly shaped how the report and the recommendations were developed as historical evidence grounded modern data. But history also provides examples of opportunities and possibilities. We know that nurse leaders such as Dorothy Smith (University of Florida Gainesville) and Mary Elizabeth Carnegie (Florida A&M) changed how and where nurses were educated and how African American nurses negotiated their space in the professional association structures in the post War decades. And we know that nurses have been innovators in public and community health- types of care that will be the backbone of new delivery systems such as medical homes and accountable care organizations. We also see the worth and work of pioneer advanced practice nurses as they practiced in medically underserved areas or in collaboration with physician colleagues. As historians we can learn from these historical examples and use them to explain and to critique larger policy issues. For example, better quality, value, and access to health care services can be achieved only with the participation of nurses as leaders and as valued clinicians. This is as true today as it was with the passage of Medicare and Medicaid in 1965, but unlike previous health reform initiatives we now have the opportunity provided by explicit recognition of this relationship in the text of the legislation. …

Factors Critical in Marketing Strategies of

This paper attempts to find out the factors important in developing a suitable marketing strategy for insurance companies in Saudi Arabia. It investigates the reasons for buying insurance by the current users of insurance, reasons for not buying insurance by non-users of insurance and the issues and problems faced by Saudi Insurance industry.The study is based primarily on primary data collected randomly from 500 users of insurance, from 400 non-users of insurance and 80 insurance executives through structured questionnaire in Jeddah city of Saudi Arabia. The three questionnaires were developed in English and translated into Arabic for effective response due to Saudi Culture, and language. The response from the three groups of respondents were analyzed using simple statistical techniques such as percentages, mean, chi-square tests, factor analysis, and ANOVA analysis with the help of Statistical Package for the Social Sciences (SPSS).The results of the study show that the social and regulatory factors played crucial role in the consumer’s decision in purchasing insurance. However it was also found that the public at large is unaware about the benefits of insurance, and various types of insurance products. The insurance companies shall focus of promotional marketing strategies. The marketer’s primary focus should be on promotional activities.

Nursing Leadership From Bedside to Boardroom

: The purpose of this study was to examine how nursing is viewed by the nation's decision makers and opinion leaders. : Nurses comprise the largest subgroup of the health and healthcare workforce. The public recognizes nurses' contributions, consistently ranking them highest in honesty and ethics. Yet, significant barriers remain in nurses achieving substantial leadership positions in health and healthcare delivery and policy. : The study sampled a broad cross section of American opinion leaders in the public and private sector, academia, and trade organizations. More than 1,500 opinion leaders were interviewed by telephone interviewers. : The opinion leaders viewed government (75%) and health insurance executives (56%) as the groups most likely to exert a great deal of influence on health reform, compared with 14% for nurses. Government respondents were significantly different than all other respondents; 23% of these respondents said nurses have a great deal of influence in healthcare reform, compared with 14% of other individuals. : Although nurses are viewed as knowledgeable sources of health information, nurses are not viewed as leaders in the development of healthcare systems and delivery. The opinion leaders' survey identifies barriers to nurses assuming a greater leadership role, including management skills and knowledge.

Toward Health Reform for Seniors in Bermuda: Historical Constraints on Political Possibilities

In 2009, as the United States moved toward health care reform, the government of Bermuda implemented its FutureCare program to make health care for seniors more affordable. This article investigates how preferences for reform and its eventual design were shaped by the country's social history and commitment to free market values. Data derive from 36 in-depth interviews with key stakeholders deemed knowledgeable about health care financing and delivery in Bermuda, including government officials, provider representatives, insurance executives, and consumer advocates. Data also derive from a variety of documentary sources. Results indicate that although a clear need for health care and the ability to finance it for seniors exists in Bermuda, the scope of reform was circumscribed by preferences for prior policy decisions, creating a favorable tax and business environment for international corporations and a minimalist social welfare state for addressing racial and economic inequality. This suggests that widespread agreement on the challenges in meeting the health and long-term care needs of the elderly does not necessarily lead to equally commensurable solutions to addressing it.

Medicare Chief Vows System ‘Redesign’

Medicare Chief Vows System ‘Redesign’