Insurance Organizations Research Articles

Hospitalization Expenses and Influencing Factors for Inpatients with Ischemic Heart Disease in Iran: A Retrospective Study

Background: Ischemic heart disease (IHD) is the leading cause of death and disability worldwide and in Iran, which imposes a heavy financial burden both on patient’s family and society. Objectives: This study aimed to analyze the direct medical costs of inpatients with IHD and its influencing factors in Iran in 2020. Methods: The sample of this cross-sectional study included 41,357 patients with IHD selected from the hospital information system (HIS) of the Iran Health Insurance Organization from August 23, 2019, to June 20, 2020. The study used the claims data of these patients, which included their demographics, length of stay (LOS), intensive care unit (ICU) admission, hospital accreditation grade, hospital ownership type, and patient discharge status. The multiple linear regression model was employed to evaluate the relationship between hospitalization costs and the associated factors. All statistical tests were conducted at the significance level of P < 0.05 using the R 3.6.3 software. Results: The mean age of patients was 63.95 ± 12.63 years old, and most of them were male (54.4%). The mean hospitalization cost per patient and per day was 586.42 ± 472.51 USD and 103.64 ± 100.29 USD, respectively. Moreover, the mean LOS was 4.92 days. Drugs and consumable medical supplies, as well as nursing and hoteling services, had the highest shares of hospitalization costs (29.54% and 29.4%, respectively). The hospitalization costs of patients with IHD were higher among men (β = 1.24), age 61 - 70 years (β = 1.38), LOS ≥ 5 (β = 2.92), ICU admission (β = 1.62), Iranian health fund (β = 1.21), and private hospitals (β = 1.91). Top-grade and first-grade hospitals had higher costs compared to grade 2 (β = 0.67), grade 3 (β = 0.35), and grade 4 (β = 0.72) hospitals. Deceased patients had also higher costs than patients with complete recovery (β = 0.63), relative recovery (β = 0.59), follow-up (β = 0.51), transfer to other medical centers (β = 0.44), and discharge against medical advice (DAMA) (β = 0.62). Conclusions: According to the results, shortening the LOS and controlling the high costs of drugs and consumable medical supplies are among the main strategies to reduce high hospitalization costs.

Cavernous ford pulmonary tuberculosis and kumis therapy

Questions of indications and contraindications for kumis treatment are still. are still in the center of attention of insurance and tuberculosis organizations. Existing instructions for the selection of patients and accounting for the results of sanatorium treatment, resp. kumis treatment, do not give satisfactory indications. For kumis treatment, tbc pulm is usually considered indicated. A I, II, III, B I, II, III. Any doctor working on TBK knows that each of these groups (A I, II, III, B I, II, III) can include and usually include pulmonary processes of different genesis, course and immuno-biological nature. So, for example, relatively benign forms of tbc tbc fibrosa densa, tbc fibro- nodosa and prognostically unfavorable phtisis fibro-caseosa and phtisis ulcero-fibrosa forms that are extremely different in clinical course and prognosis according to the existing classification, are included in the same group A II, III or B II, III.

Analysis of the peculiarities of the formation of the compliance system of an insurance organization

Analysis of the peculiarities of the formation of the compliance system of an insurance organization

Increase data sharing or die? An initial view for natural catastrophe insurance

ABSTRACT This article is an illustration of geography in action, recounting an investigation into an industry’s views of data sharing. The insurance sector is fundamentally analytics driven and based on geospatial data. One option for more effective and efficient insurance for natural hazard risks (e.g. flooding, earthquake) is, in theory, to increase the sharing of data between the various (re)insurance organisations. However, it remains unclear as to what extent this is desirable or practical for commercially sensitive data. This work creates a conceptual model of data sharing in (re)insurance, focusing on loss (claims) data for natural hazards as an illustrative microcosm, including the barriers and solutions to sharing. In light of this, an initial view on the future shape of insurance data sharing is given, finishing with an opinion on whether or not new external disruptors (e.g. start-ups in InsureTech or tech giants such as Google, Amazon and Tencent) pose an existential threat to incumbent firms.

Система обязательного страхования: понятие и особенности

The article is devoted to the study of the modern system of obligatory insurance in the Russian Federation. The author characterizes the functional subsystems included in the structure of obligatory insurance and defines their features. The relevance of the research topic of this article is determined by the fact that obligatory insurance in Russia is a growing type of financial activity that contributes to the economic stability of society. Obligatory insurance in modern Russia is a complex system with strategic goals and effective ways to achieve it. In confirmation of the above, it should be noted that during the financial crises of 2008, 2014 and the global pandemic of 2020, the organization of obligatory insurance has demonstrated its effectiveness. At this time, it was possible to maintain the stability of the socio-economic sphere of the country and avoid a sharp outflow of deposits, which contributed to the stability of the banking system. The social relations in the field of obligatory insurance implemented in the course of financial activity represent a certain system of economic relations having a strictly directed sequence regulated by the state. The formation of the obligatory insurance system is determined by the development of the insurance market. An important factor in this development is a balanced and consistent macroeconomic policy, which is based on financial stability. The article pays special attention to the structuring of the obligatory insurance system as the fundamental elements of the functioning of insurance activities. The author identifies the key subsystems that directly affect the organization of the insurance business in Russia, and also identifies the present modern problems and identifies ways to eliminate them. Special attention is paid to the control and supervisory subsystem of obligatory insurance, which determines the composition of the subjects of insurance supervision, the functions and tasks of implementing the control and supervisory powers of the executive and administrative bodies and the Central Bank of Russia. The author emphasizes the need to apply preventive measures in the implementation of insurance supervision to subjects of obligatory insurance.

К вопросу о развитии частной медицины в условиях ограничений и новых рисков

This article deals with issues that are directly related to the regulatory legal regulation of the health care system in the Russian Federation. The paper analyzes the norms regulating both the provision of medical services itself and the developing activities of entrepreneurs in the field of providing medical services on a paid basis. Today, the state's policy is aimed at forming a healthy lifestyle of civil society, at making them aware of the value of life and health. in the context of the emergence of new risks and, in this regard, the introduction of new restrictions in the life of society. In this light, the development of private medical practice already has a very different meaning. The fear of people when contacting doctors in state polyclinics, the need for a long time to stay in queues for tests, leads to the desire of people to increasingly turn to private clinics, in which the appointment is made by appointment at a certain set time, and tests can be passed not according to the strictly limited two hours in state medical institutions, but choose a more suitable and convenient time. Problems of providing medical services and medical care were analyzed during data collection through interviews and interviews with patients of polyclinics and ordinary citizens who want to express their opinions. The analysis of the legislation that changed in late 2020 - early 2021 brought some information on positive and not quite innovations that are already in effect on the territory of the state. The paper analyzes the regulatory legal acts that allow the state institution of the Russian healthcare system to provide medical services on a paid basis. The problems that require legislative regulation for the foundations of the activities of private medical institutions for the provision of medical care, medical services and counseling of citizens who have applied to them are considered. The results of the study show that it is possible to make certain changes in the activities of the health care system of the Russian Federation by organizing co-financing of patients from insurance organizations, associated with the use of a progressive taxation scale, as well as the obligation of private clinics to provide certain types of services, for example, counseling, in the direction issued by a state medical institution in the absence of a narrow specialist. Consequently, the development of domestic health care, taking into account a fairly wide range of services provided under compulsory health insurance policies, can be assessed positively. To regulate the activities and development of private business in the organization and operation of medical institutions, it is necessary to introduce rules that allow you to control the tariffs for services and assistance provided, contracts and agreements offered to those who apply, as well as to introduce a system of expert assessments to facilitate the resolution of disputes arising on the work of medical institutions on a commercial basis.

УПОЛНОМОЧЕННЫЙ ПО ПРАВАМ ПОТРЕБИТЕЛЕЙ ФИНАНСОВЫХ УСЛУГ: СТАТУС И ПРАКТИКА ДЕЯТЕЛЬНОСТИ НА СОВРЕМЕННОМ ЭТАПЕ

In this article, the author examines the features of the constitutional and legal status of the Commissioner for the rights of consumers of financial services and its place among the functioning commissioners in various fields of activity, as well as issues that arise in the courts when applying the provisions of the Federal Law » On the Commissioner for the Rights of Consumers of Financial Services», establishing the procedure for the pre-trial settlement by the financial commissioner of disputes between consumers of financial services and insurance organizations under contracts of compulsory insurance of civil liability of vehicle owners( CTP), voluntary insurance of vehicles( CASCO), voluntary insurance of civil liability of motor vehicle owners (DSAGO).

Identification of effective components and their determination to present complementary insurance for dental services in Iran

Background and aim: The inability of the government to finance the citizens' treatment in all therapy eras apparently shows the need for the presence and development of complementary insurance in the health field. This study aims to identify and determine the effective components to present complementary insurance of dental services in Iran. Materials and methodology: This research is applicable in terms of the goal and exploratory mixed in that of data, so 15 experts were used. The data analysis method is a theorethical coding taken from the meta-combination method. In this research, to identify the criteria after reviewing the literature of related studies and interviewing with studied elites and trustees, the meta-combination method was used. Finding: 39 papers associated with complementary health insurance were gathered by insurance organizations. The studied countries had complementary insurance coverage from private and public insurance organizations. Also, in most of the countries, the management and organization were mostly performed by the Ministry of Health at the national and supervision levels. After analyzing the data, variables were classified as nine different levels. Conclusion: Findings of the study showed that the presented complementary health model of dental services consists of 9 major dimensions, the most important of which are economic and service quality factors, and eventually using them, the customer satisfaction will increase.

ДЕЯТЕЛЬНОСТЬ СОВРЕМЕННЫХ ИНСТИТУТОВ РАЗВИТИЯ В РОССИИ С ПРИЗНАКАМИ СТРАХОВЫХ ОТНОШЕНИЙ

Insurance products and mechanisms with signs of insurance relations are used in the activities of Russian development institutions, often without an assessment of expediency and at least a formal assessment of effectiveness. In some cases, insurance organizations were created directly (for example, the Russian Agency for Export Credit and Investment Insurance — EXIAR) and companies engaged in organizing and supporting insurance in agriculture or mortgage lending, in most cases insurance mechanisms are used in the activities of development institutions without creating an organizational structure. The presence and variety of forms of use of insurance mechanisms actualize the task of developing a methodology for the use of insurance in the activities of Russian development institutions and criteria for evaluating the effectiveness of insurance.

МОНІТОРИНГ ФІНАНСОВОГО СТАНУ СТРАХОВОЇ КОМПАНІЇ

Theoretical and methodological approaches to assessing the financial condition of well-known insurance organizations for the purpose of monitoring their condition are considered in the article for the stable operation of insurance companies. Monitoring in the anti-crisis management of an insurance company still remains an underdeveloped problem, therefore the issues of developing a methodology and analytical apparatus for building financial monitoring models, developing analytical and predictive procedures for the strategic development of an insurance organization are urgent. Taking into account methodical approaches to the assessment of the financial condition of the insurance organization, an analysis of the activities of insurers and timely identification of weaknesses in the activities of insurers was carried out. At the same time, a SWOT analysis of insurers' activities was carried out in order to choose strategic directions for their development. SWOT analysis is a necessary element of research, a mandatory preliminary stage in the preparation of any level of strategic plans. Thus, a well-conducted SWOT analysis makes it possible to identify both tactical and strategic problems, the further analysis of which will be the basis for developing a system for managing the effectiveness of the insurance company's financial activities. In accordance with the obtained results, insurers are offered to choose a renewal strategy. It involves a continuous process of searching for and implementing new management methods aimed at the consistent improvement of various areas of the insurer's activity. Strategy development will take into account adaptation to the external environment, internal coordination and organizational foresight. Therefore, strategic programs should be made flexible enough to be reoriented or modified if necessary. The need to use the main approaches of financial monitoring to develop the insurance company's development strategy is substantiated.

Преимущества и недостатки конвергенции частного права в контрольно-надзорную деятельность как института публичного управления

As part of the tasks of limiting state interference in the economic activities of business entities, ending excessive state regulation, and developing the system of selfregulatory organisations in the economy, an administrative reform has been implemented, including in the sphere of control and oversight activities. As a result, Federal Law No. 248-FZ of 31.07.2020 "On State Control (Supervision) and Municipal Control in the Russian Federation" (hereinafter - the Law on Control) was adopted. State control (supervision) is a function of the state related to the sphere of public administration, which predetermines its public-law nature. At the same time, its goals set within the framework of the administrative reform have affected the content of the law and its nature - there has been a convergence of private law into control and supervision activities. A manifestation of this conclusion is Article 8 of the Control Law, devoted to the principle of incentives for good faith compliance with mandatory requirements, which implies that in its implementation preventive measures aimed at reducing the risk of harm are prioritised over control and oversight measures. The legal consequence of confirming the bona fides of a controlled person will be the reduction of the category of risk of harm, and separate legal means - independent assessment of compliance with mandatory requirements and conclusion by a controlled person with an insurance organization of voluntary insurance of risks of harm, if they are provided by the federal law on the type of control, act as grounds for exemption from planned control and oversight measures (respectively Art. 54 and part 9 of Article 25). Another example confirming the 'privatisation' of the institute of state control (supervision) are the provisions in the Control Act on the recognition of results of independent evaluation of compliance with mandatory requirements (Art. 54) and membership in self-regulatory organisations (Art. 55). Their legal consequence is the failure to carry out planned inspections in relation to controlled persons, unless otherwise provided for by the federal law on the type of control. This shows that the state has actually taken real measures to reduce excessive state regulation in the framework of control and supervisory activities. On the other hand, in the examined cases the transformation of public administration is taking place at the expense of businesses that incur additional financial expenses to implement the state's controlling function. However, doubts arise about the implementation by the business community of private law means of replacing planned inspections if this would cause them high financial costs. On this basis, the state should consider measures to stimulate their implementation, as is the case, for example, with environmental legislation for new technologies. The author declares no conflicts of interests.

ООБЛИВОСТІ ТА ПРОБЛЕМИ МЕХАНІЗМУ РЕАЛІЗАЦІЇ МОРСЬКОГО СТРАХУВАННЯ В УКРАЇНІ

The article reveals the problems in the organization of marine insurance in Ukraine that have arisen to date, the peculiarities of its development, analyzes the state of marine insurance in Ukraine, highlights the features of maritime compulsory and voluntary insurance, considers such a division of marine insurance as cargo insurance, marine insurance market of Ukraine. The advantages and disadvantages of sea transportation are revealed and it is noted that sea transportation, transportation of goods by sea are the activities of maritime transport enterprises, which belong to the risky activities of maritime transport enterprises. Hence the problem of forming such a mechanism for the implementation of marine insurance in Ukraine, which would provide compensation for losses in the event of an insured event, could regulate them on a legislative basis, prevent dangerous events and meet international marine insurance standards. Shipowners, consignees, shippers and insurance companies should be interested in ensuring the safety of navigation, the safety of cargo delivery and the safety of port operations. Therefore, an important condition for the development of domestic maritime and water transport, maritime transport enterprises is the development of marine insurance in Ukraine. Thus, in this article the current state of marine insurance in Ukraine was considered, personalities and shortcomings in the organization of the marine insurance mechanism were identified. During the study, it was found that in Ukraine the most common types of marine insurance are: - voluntary insurance of sea and river transport (water transport insurance); - cargo insurance; - insurance of risks (liability of shipowners). It was found that Ukrainian marine insurance does not meet international standards and modern requirements. Therefore, it is necessary to maintain and improve existing types of marine insurance by investing in the shipping industry and maritime transport enterprises, as the transportation of goods by sea and river transport is an important condition for the development of the country as a whole.

Studying the performance of the Greek public insurance organisations consolidation as a measure for their competitiveness and viability

Studying the performance of the Greek public insurance organisations consolidation as a measure for their competitiveness and viability

РАЗМЕР УСТАВНОГО КАПИТАЛА ИСПОЛНИТЕЛЯ КОНТРАКТА КАК ФАКТОР РИСКА В СИСТЕМЕ ЗАКУПОК СТРАХОВЫХ УСЛУГ

The article deals with the problem of including the size of the authorized capital in the criteria system for assessing the probability of bankruptcy of the insurer as the executor of the state contract. The trends in reducing the number of insurers in Russia are analyzed and a forecast is made for the list of those players in the insurance market that will not be able to increase the authorized capital to the standards stipulated by the instructions of the Central Bank of the Russian Federation. A proposal has been made on the need to introduce a minimum amount of the authorized capital as a mandatory requirement for contractors under contracts within the framework of the state contract system. The analysis of the geographic concentration of insurers was carried out and the need for the development of a regional insurance system based on the presence of local insurance organizations that take into account the risk characteristics of the regions is substantiated.

ТЕНДЕНЦИИ РАЗВИТИЯ СТРАХОВОГО РЫНКА РОССИИ В УСЛОВИЯХ ЦИФРОВИЗАЦИИ

The process of digital transformation of the financial market as a whole, in particular the insurance market, has significantly accelerated the coronavirus pandemic. The author of this study made an attempt, based on an analysis of the country’s domestic insurance market for 2020–2021, to show the level of development of innovative digitalization tools. The article also presents the main segments of the insurance market and the main insurance companies-leaders. The transformation of insurance organizations is not happening at such a fast pace as in the banking sector, which in recent years have reached the level of fintech companies. But still, it should be noted that the coronavirus epidemic gave an important impetus to the development of the insurance market. Therefore, this article presents the main trends in the digitalization of the insurance market and discusses the challenges and benefits of this process.

Incremental Healthcare Resource Utilization and Expenditures Associated with Cardiovascular Diseases in Patients with Diabetes: A Cross-Sectional Study.

Background: Cardiovascular disease (CVD) is the most prevalent comorbid condition among patients with diabetes. The objective of this study is to determine the incremental healthcare resource utilization and expenditures (HRUE) associated with CVD comorbidity in diabetic patients.Methods: In a cross-sectional study, patients receiving antidiabetic drugs were identified using the 2014 database of the Iran Health Insurance Organization of East Azerbaijan province (Iran). The frequency of HRUE was the main outcome. Outcome measures were compared between diabetic patients with and without CVD comorbidity during 2014-2016. The generalized regression model was used to adjust for cofounders because of a highly skewed distribution of data. Negative binomial regression and gamma distribution model were applied for the count and expenditure data, respectively.Results: A total of 34,716 diabetic patients were identified, of which 21,659 (63%) had CVD comorbidity. The incremental healthcare resource utilization associated with CVD compared to non-CVD diabetic patients for physician services, prescription drugs, laboratory tests, and medical imaging was 5.9±0.34 (28% increase), 46±1.9 (46%), 12.9±0.66 (27%), and 0.16±0.40 (7%), respectively (all P<0.001). Similarly, extra health care costs associated with CVD comorbidity for physician services, prescription drugs, laboratory tests, and medical imaging were 10.6±0.67 million IRR (294.4±18.6 USD) (50% increase), 1.44±0.06 million IRR (40±1.6 USD) (32%), 8.36±0.57 million IRR (232.2±15.8 USD) (58%), 0.51±0.02 million IRR (14.1±0.5 USD) (24%), and 0.29±0.02 million IRR (8±0.5 USD) (22%), respectively (all P<0.001).Conclusion: CVD comorbidity substantially increases HRUE in patients with diabetes. Our findings draw the attention of healthcare decision-makers to proactively prevent CVD comorbidity in diabetic patients.

Implementation of the Inter-facility Protocol Including a Company, a Health Insurance Organization, and a Health Check-up Facility Could Improve a Completion Rate of Specific Health Guidance, the Dietary and Exercise Educational Program Provided under the Workplace Annual Health Check-up for a High-risk Group of Metabolic Syndrome, to Nearly One Hundred Percent in a Large-scale Group Organization

Implementation of the Inter-facility Protocol Including a Company, a Health Insurance Organization, and a Health Check-up Facility Could Improve a Completion Rate of Specific Health Guidance, the Dietary and Exercise Educational Program Provided under the Workplace Annual Health Check-up for a High-risk Group of Metabolic Syndrome, to Nearly One Hundred Percent in a Large-scale Group Organization

РАЗРАБОТКА ФИНАНСОВОГО ПРОГНОЗА СТРАХОВОЙ ОРГАНИЗАЦИИ В СОВРЕМЕННЫХ ЭКОНОМИЧЕСКИХ УСЛОВИЯХ

The article examines the process of developing a financial forecast of an insurance company in the conditions of the modern economy. Among the main characteristics of the economic situation in the Russian Federation, instability, dynamism and crisis are determined. In this context, the work concretizes the specifics of the development of a financial forecast that identifies the main priorities and risks of insurance organizations. Their work is the object, and the financial forecast is the subject of research. Potential risks of insurance organizations and ways to overcome them in unstable economic conditions are identified.

The use and the cost of outpatient diagnostic procedures for cardiovascular diseases in Isfahan province: A utilization study.

BACKGROUND:Cardiovascular diseases (CVDs) are among the most important causes of premature death, disability, disease burden, and increasing the cost of healthcare worldwide. Having an overview of service utilization can help policymakers to plan more effective use of those services and to cut costs. Thus, this study aims to determine the amount of use as well as the cost of various outpatient diagnostic procedures for CVDs in Isfahan province of Iran from 2011 to 2017.MATERIALS AND METHODS:This descriptive study used insurance claim data (time period: 2011–2017) from Health Insurance Organization in Isfahan province to determine the amount of use and the cost of various outpatient diagnostic procedures for CVDs. Afterward, based on these data, the use and the cost of various outpatient diagnostic procedures for CVDs were estimated for the total population of Isfahan province. The list of outpatient diagnostic procedures for CVDs was carefully chosen according to experts' opinions.RESULTS:The use and the cost of outpatient diagnostic procedures for CVDs have drastically increased in the study period (2011–2017). Since 2011, the number of procedures and their related costs have increased 6.6 and 30.76 times (11.74 times, adjusted with PPP conversion factor), respectively. Per capita use (per thousand people) was 18.75 in 2011, reaching 116.51 in 2017. Per capita cost (per thousand people) was 1,887,660 IRR (355 PPP$) in 2011, reaching 54,660,365 IRR (3920 PPP$) in 2017. The highest cost and use were related to echocardiography and electrocardiography, respectively. A notable increase has been observed in the share of radionuclide myocardial perfusion scan and analysis of pacemakers and ICDs of the total cost.CONCLUSIONS:The use of outpatient diagnostic procedures for CVDs has drastically increased during the studied period. Consequently, the cost borne by the health system and the patients have notably increased. This may be because of the increase in the incidence and prevalence of CVDs during the study period. Greater access to related health services can be mentioned as another reason for this increase. Further research is needed to explain all potential reasons and their importance, which can provoke a suitable health policy reaction.

Facilitators and barriers to return to work in patients after heart surgery.

Recognition of the factors influencing returning to work by people after heart surgery is very significant in performing supportive interventions. Factors affecting return to work of Iranian patients after surgery are unknown. Therefore, a qualitative study is in demand in order to close this knowledge gap. This study was aimed to explore the facilitators and barriers of return to work after heart surgery. This qualitative study was conducted during 2020-2021. People after heart surgery were studied in this research. Nineteen interviews were performed with 17 participants. The main participants were selected from the cardiac surgery ward of Golestan Province Hospital. The sampling method was purposeful. Data were collected through semi-structured interviews. Questions were asked in an unguided and open-ended manner. Data analysis was performed by qualitative content analysis. According to the results, "perceived psychosocial support," "individual characteristics," and "occupational factors" were considered as facilitators and "effects of heart surgery" and "limited support of public and private institutions" were introduced as barriers to return to work in patients after heart surgery. The effects caused by heart surgery and limited support of public and private institutions were identified as barriers to return to work. Cardiac rehabilitation after surgery can reduce the impact of heart surgery and can help people to return to work. It is recommended that the planners of the Ministry of Labor and Social Welfare and Health, with the support of insurance organizations, help solve the work problems of people after heart surgery.