Insurance Research Articles

ESTIMATION OF EARTHQUAKE INSURANCE PREMIUM BY CONSIDERING EARTHQUAKE PROBABILITY AND THE DAMAGE RATIO OF BUILDINGS IN BANDA ACEH AND SIBOLGA CITY

Indonesia is one of the countries prone to earthquakes with significant damage. An area that is frequently hit by earthquakes is Sumatra Island. Several cities, such as Banda Aceh City and Sibolga City on Sumatra Island, quite often experience tremors. For this reason, mitigation efforts are needed through earthquake insurance in managing disaster risk in earthquake-prone areas such as Banda Aceh City and Sibolga City so that it can reduce the impact caused by earthquake disasters. This research aims to determine the probability of an earthquake occurring in Banda Aceh City and Sibolga City using the Probabilistic Seismic Hazard Analysis (PSHA) method. Apart from that, this research also aims to determine the value of the building damage ratio and the estimated value of pure earthquake insurance premiums in Banda Aceh City and Sibolga City. The analysis results show that the estimated pure premium value for residential commercial and industrial building types with less than nine floors in Banda Aceh City is around 2.96 and 21.03 times greater than that of Sibolga City. Meanwhile, the estimated pure premium value for commercial and industrial building types with more than nine floors in Banda Aceh City is more minor, around 6.42 times, compared to Sibolga City.

Equine insurance premiums and policies in the UK—What has changed in the last 5 years?

Equine insurance premiums and policies in the <scp>UK</scp>—What has changed in the last 5 years?

Building Bridges: Increasing Access to Care and Continuation of Medication for Opioid Use Disorder Through Community Partnerships

The opioid epidemic continues to pose a formidable challenge to public health, necessitating innovative approaches to enhance access to care and support continuity of treatment for individuals with opioid use disorder (OUD). Opioid overdose-related deaths in Detroit have increased over four-fold from 1999 to 2019, yet the rate of medication for opioid use disorder (MOUD) prescriptions in Detroit has been half the rate compared to Michigan as a whole. Limited access to care remains a major factor in continued opioid use, which is driven in part by an individual’s insurance coverage. As the largest payer of substance use disorder services in the United States, Medicaid plays a central role in efforts to address the opioid epidemic. Over half of the Detroit population is either enrolled in Medicaid or uninsured. Henry Ford Hospital (HFH) continues to treat hospitalized patients with OUD. Post-discharge follow-up appointments for continuation of MOUD have been shown to increase rates of prolonged abstinence, reduce rates of readmission, and decrease mortality rates. Despite HFH’s significant community impact, there have been limitations on which insurance carriers are accepted at our institution when patients try to establish outpatient primary care or specialty addiction medicine services for MOUD. This insurance-driven barrier has consequently limited our ability to provide best practices in supporting patients with OUD. To address this disparity, we aimed to investigate the impact of leveraging our partnership with Community Health and Social Services (CHASS) Clinic, a local Federally Qualified Health Center network, as an opportunity for underinsured and non-insured patients with OUD to have increased access to post-discharge follow-up appointments with qualified providers for continuation of MOUD. In collaboration with the HFH Addiction Medicine Consult team, HFH Primary Care Physicians, and CHASS MOUD providers, we designed a multifaceted intervention to improve the continuum of care for patients with OUD. We established a post-discharge referral pathway between HFH and CHASS, enhancing communication channels to facilitate care coordination. If a patient was admitted to HFH with a diagnosis of OUD and received an Addiction Medicine consult, the primary team was advised to arrange a post-discharge follow-up appointment for MOUD. The location of the appointment was determined by the patient’s insurance. Patients already established with HFH, or with commercial insurance, were scheduled with HFH providers for MOUD. Patients with Medicaid or no insurance were scheduled with CHASS MOUD providers. In the six months prior to implementation, only 3 of 60 (5%) of patients with a diagnosis of OUD that received an Addiction Medicine consult were scheduled to have a post-discharge follow-up for MOUD. In three months after implementation, 8 of 32 (25%) patients received post-discharge follow-up for MOUD. By utilizing the partnership between HFH and CHASS, our intervention was associated with a five-fold higher rate of follow-up appointments for continuation of MOUD. These findings underscore the effectiveness of community partnerships in addressing barriers to care and enhancing treatment for individuals with OUD.

일상생활배상책임보험의 보상요건 및 설명의무에 관한 종합적 고찰 - 청주지법 2022. 12. 22. 선고 2021나55269 판결을 중심으로

Daily life liability insurance is a personal liability insurance sold in the form of a special agreement in addition to long-term insurance products. It is a very useful insurance product that covers damages due to general activities that can occur widely in everyday life with an inexpensive insurance premium of less than 1,000 won. At this time, the concept of 'daily life' means life in 'normal times', and is distinguished from 'job performance' that is for 'maintaining a living' or requires professional knowledge, experience, and skills. Of course, the scope of 'daily life' will be determined according to specific circumstances, but at least in the process of determining it, the group performance and homogeneity of the risk consisting of a large number of unspecified general policyholders should not be impaired. In the case where the insured, who usually suffered from depression and paranoid schizophrenia, jumped from a high-rise building and shocked the victim (plaintiff), who just happened to pass under it, the damage caused by the insured's actions was judged as an accidental accident in the first trial. However, in the target judgment, it was judged that the act of the insured jumping out of the building with the intention of suicide or jumping off was not the “general act that may occur in everyday life” mentioned above, but was difficult to regard as being included in the category of “daily life”. The target judgment rejected the plaintiff's claim for damages, considering that it did not meet the former requirements among the usual life and accidental accidents, which are the representative compensation requirements of the daily life liability special agreement. The insured's above actions outside the certain boundaries of daily life are very valid in that they harm the homogeneity of insurance groups. Furthermore, in this paper, an analysis is conducted to clearly distinguish the concepts of 'daily life' and 'job performance' of the special agreement for daily life liability through various lower court rulings, and the purpose and meaning of a number of reasons for indemnification are considered for each type. The results of this review are linked to the obligation to explain the terms and conditions, which are sharp disputes between the insurer and the insured in the stage of exemption and liability for compensation after an insurance accident. Most of the reasons for exemption from the Special Agreement on Daily Liability for Compensation are subject to the obligation to explain as it directly affects the interests of the policyholder and determines whether or not to conclude a contract depending on whether or not to explain it. However, 'daily life' is a concept accepted by social norms as a daily activity of the general public. Even if the insurer does not explain separately, it is reasonable to assume that the insured can fully predict or understand the contents and is not subject to the obligation to explain. This is especially true considering that the Special Agreement on Daily Liability for Compensation, which is a liability guarantee incidental to long-term non-life insurance products, guarantees various risks in daily life with an insurance premium of less than 100 million won per month.

Outcome after total ankle replacement or ankle arthrodesis in end-stage ankle osteoarthritis on the basis of german-wide data: a retrospective comparative study over 10 years

BackgroundIn symptomatic end-stage osteoarthritis of the ankle joint, total ankle replacement and ankle arthrodesis are the two primary surgical options for patients for whom conservative treatment fails. Published revision rates are often biased and difficult to compare. In this study, unplanned reoperation rates and revision rates were determined for both surgical interventions based on a large dataset, and risk factors for unplanned reoperations were identified.MethodsGerman-wide health data of the largest German health-care insurance carrier between 2001 and 2012 were retrospectively analyzed, and unplanned reoperation rates within 10 years were determined for index surgeries conducted in 2001 and 2002. Unplanned reoperation rates within 5 years for index surgeries conducted in 2001/2002 were compared to index surgeries conducted in 2006/2007. Multivariate logistic regression was used to identify risk factors for unplanned reoperations.ResultsAfter ankle arthrodesis, 19% (95% confidence interval [CI], 16–22%) of 741 patients needed to undergo an unplanned reoperation within ten years. After total ankle replacement, the unplanned reoperation rate was 38% [95% CI, 29–48%] among 172 patients. For initial surgeries conducted at a later date, unplanned reoperation rates within five years were 21% [95% CI, 19–24%] for 1,168 ankle arthrodesis patients and 23% [95% CI, 19–28%] for 561 total ankle replacement patients. Significant risk factors for unplanned reoperations after ankle arthrodesis in the initial cohort were age < 50 years (odds ratio [OR] = 4.65 [95% CI 1.10;19.56]) and osteoporosis (OR = 3.72 [95% CI, 1.06;13.11]); after total ankle replacement, they were osteoporosis (OR = 2.96 [95% CI, 1.65;5.31]), Patient Clinical Complexity Level (PCCL) grade 3 (OR = 2.19 [95% CI, 1.19;4.03]), PCCL grade 4 (OR = 2.51 [95% CI, 1.22;5.17]) and diabetes mellitus (OR = 2.48 [95% CI, 1.33;4.66]). Kaplan-Meier analyses including 1,525 ankle arthrodesis patients and 644 total ankle replacement patients revealed an average unplanned reoperation-free time of approximately 17 years for both procedures.ConclusionsSimilar revision rates and unplanned reoperation rates for both procedures in the later-date cohort can likely be attributed to a learning curve for surgeons as well as advances in implant design. This analysis of billing health insurance data supports an increase in total ankle replacement surgeries.

A MODEL FOR DETERMINING PREMIUM RATES IN INDEXBASED CROP INSURANCE

The paper deals with index-based crop insurance as a tool for managing flood and drought risks in agriculture. We introduce a novel model for determining premium rates in index-based crop insurance which combines the loss cost method and the average yield method. The proposed model was applied to data related to the production of selected crops in Serbia to calculate unique premium rates for index-based insurance for cereals, industrial crops and fodder plants. The paper also outlines the prerequisites for index-based crop insurance to become technically, operationally, and financially feasible in Serbia. We propose the introduction of mandatory index-based crop insurance, along with necessary legislative amendments and subsidization of insurance premiums.

Insurance Sector Performance and the Nigeria’s Economic Growth

The study examines insurance industry’s contribution to economic growth in Nigeria. For estimation analysis, the study employed Autoregressive Distributive Lag (ARDL) bond test, Error Correction Mechanism (ECM) and Diagnostic test.). The findings revealed that at 5% level of significance in the short run, life premium (LP) related positively with growth rate (GR) in an insignificant manner while non-life premium (NLP) contributed negatively and insignificantly to growth rate. However, in the long run, life and nonlife insurance premium influences the growth of the Nigerian economy. Therefore, the study concludes that without insurance coverage, substantial emergency funds would be looked-for to protect firms against risks. Based on the findings, the study recommends among others that life insurance companies should come up with life products mainly designed for the low-paid earners to enhance penetration, deepen the market and to create more awareness to improve the participation of product industry and firms as this will intensify the activities of the insurance industry in Nigeria. Also, insurance companies should increase diversification of insurance products mostly in non-life businesses being embarked upon.

Sustainable Geoinformatic Approaches to Insurance for Small-Scale Farmers in Colombia

This article presents a low-cost insurance system developed for smallholder farms in disaster-prone regions, primarily using free Earth observation (EO) data and free open source software’s (FOSS), collectively termed “sustainable geoinformatics.” The study examined 30 farms in Risaralda Department, Colombia. A digital elevation model (12.5 m pixels) from the ALOS PALSAR satellite sensor was used with a geographic information system (GIS) to map the terrain, drainage, and geohazards of each farming district. Google Earth Engine (GEE) was used to carry out time-series analysis of 15 EO and weather datasets for 1998 to 2020. This analysis enabled the levels of risk from hydrometeorological hazards to be determined for each farm of the study, providing key data for the setting of insurance premiums. A parametric insurance product was developed using a proprietary mobile phone app that collected GPS-tagged, time-stamped mobile phone photos to verify crop damage, with further verification of crop health also provided by daily near-real-time satellite imagery (e.g., PlanetScope with 3 m pixels). Machine learning was used for feature identification with the photos and the satellite imagery. Key features of this insurance system are its low operational cost and rapid damage verification relative to conventional approaches to farm insurance. This relatively fast, low-cost, and affordable approach to insurance for small-scale farming enhances sustainable development by enabling policyholder farmers to recover more quickly from disasters.

Mutual aid insurance with a three-state Markov chain

ABSTRACT Mutual aid insurance is a collective type of insurance where the policyholders share the potential losses or risks that they may face. In this paper, we establish a mathematical structure for mutual aid insurance through a three-state (good, bad and death) process, which is driven by an inhomogeneous Markov chain. The objective of maximizing an individual's lifetime utility is achieved by addressing a stochastic control problem that involves both mutual aid insurance and life insurance. We obtain the explicit expressions for optimal consumption, investment strategies, and life insurance premiums by employing the corresponding Hamilton-Jacobi-Bellman equation. In the end, we carry out a numerical analysis to show the significance of mutual aid insurance and demonstrate the optimal mutual aid insurance premium.

Disparities in cause-specific mortality by health insurance type and premium: evidence from Korean NHIS-HEALS cohort study, 2002–2019

BackgroundAlthough one’s socioeconomic status affects health outcomes, limited research explored how South Korea’s National Health Insurance (NHI) system affects mortality rates. This study investigated whether health insurance type and insurance premiums are associated with mortality.MethodsBased on the National Health Insurance Service-Health Screening cohort, 246,172 men and 206,534 women aged ≥ 40 years at baseline (2002–2003) were included and followed until 2019. Health insurance type was categorized as employee-insured (EI) or self-employed-insured (SI). To define low, medium, and high economic status groups, we used insurance premiums at baseline. Death was determined using the date and cause of death included in the cohort. Cox proportional hazard models were used to analyze the association between insurance factors and the overall and cause-specific mortality.ResultsThe SI group had a significantly higher risk of overall death compared to the EI group (adjusted hazard ratio (HR) [95% confidence interval]: 1.13 [1.10–1.15] for men and 1.18 [1.15–1.22] for women), after adjusting for various factors. This trend extended to death from the five major causes of death in South Korea (cancer, cardiovascular disease, cerebrovascular disease, pneumonia, and intentional self-harm) and from external causes, with a higher risk of death in the SI group (vs. the EI group). Further analysis stratified by economic status revealed that individuals with lower economic status faced higher risk of overall death and cause-specific mortality in both sexes, compared to those with high economic status for both health insurance types.ConclusionThis nationwide study found that the SI group and those with lower economic status faced higher risk of overall mortality and death from the five major causes in South Korea. These findings highlight the potential disparities in health outcomes within the NHI system. To address these gaps, strategies should target risk factors for death at the individual level and governments should incorporate such strategies into public health policy development at the population level.Trial registrationThis study was approved by the Institutional Review Board of Chungbuk National University Hospital (CBNUH-202211-HR-0236) and adhered to the principles of the Declaration of Helsinki (1975).

Research on extreme weather insurance and real estate decision model based on AHP-EWM-CVM and K-Means clustering technology

Aiming at the challenge of extreme weather to insurance industries and real estate industries, this paper constructs an insurance model and a real estate decision model. The insurance model uses analytic hierarchy Process (AHP), entropy weight method (EWM), coefficient of variation method (CVM) and K-Means clustering algorithm to evaluate the risk level in different regions and predict the values of risk indicators up to the year 2035, and then calculate future insurance premiums. At the same time, multiple constraints are used to determine the future risk safety interval, which provides the basis for insurance companies to make decisions. In the case application, this paper finds that China is currently medium risk region and will be a medium risk region in the future, and obtains the time point when insurance companies can underwrite policies in this region. In addition, this paper also constructs a real estate decision model, which comprehensively considers three factors: risk, development potential and risk cost, and provides decision making basis for real estate developers through GE matrix. In the case application, this paper predicts that in the next nearly ten years, China is a medium willingness and medium risk area, suggesting that real estate developers should be cautious in deciding whether to develop. This study provides decision support for insurance industries and real estate industries to deal with extreme weather, which is of theoretical and practical significance.

Low-Code No-Code Approach to Build Applications for P and C Insurance Carriers

Low-Code No-Code Approach to Build Applications for P and C Insurance Carriers

The Roles of Insurance on Economic Growth in Malaysia: An ARDL Approach

Malaysia’s economic growth has been rising steadily over the years and one of the main contributors is the insurance sector. The literature has recorded mixed findings on the relationship between insurance and economic growth. This paper examines the relationship between the insurance sector and economic growth in Malaysia over an extended period of 1990-2021. This paper uses three proxies for the insurance sector i.e. life insurance premiums, nonlife insurance premiums, and total insurance premiums. The Autoregressive-Distributed Lag (ARDL) and Error Correction Model (ECM) approaches are employed to achieve the objective. While controlling for foreign direct investment, export, and import, this paper found that there is a positive long-run relationship between non-life insurance premiums and economic growth. Conversely, a negative short-run relationship is observed between life insurance premiums and economic growth. The total insurance premium has a negative short-run relationship with economic growth yet is insignificant for the long-run. The non-life insurance sector has a larger contribution compared to life insurance on Malaysia's economic growth as the market depends more on capital formation and investments, particularly in infrastructure, real estate, and capital markets. The insurance sector provides financial expansion in terms of payment for protection which results in an economic boost.

Health insurance plans offered at NCI-designated cancer centers.

9052 Background: The health insurance landscape in the US represents an expensive and complex challenge to patients and physicians alike. Little is known about health insurance plans (HIPs) offered to physicians, particularly at NCI-designated cancer centers, which represent centers seeking to meet the highest standards. Methods: We collected data on the HIPs offered to physicians at NCI-designated cancer centers by reviewing institution websites from 11/2023 - 01/2024. We abstracted data on the insurance premium, deductible, out-of-pocket (OOP) maximum, and coinsurance for hospitalizations, limited to three HIPs per institution. We derived estimates using the lowest charge. We calculated inpatient stay costs based on standard hospital stay costs ($2,883 per day over an average of 4.5 days). We compared HIPs between public and private cancer centers. We used US Census Bureau population density data and regression models to explore associations among population density and OOP costs. Results: Among 65 NCI-designated cancer centers reviewed, 61 (93.8%) had readily available information about HIPs provided. Most institutions provided HIPs for all hospital employees, while 2 institutions only covered physicians. On average, each cancer center offered 3.67 HIPs, involving 1.67 insurers (54.1% offered a single insurer). Among 153 HIPs overall, 51.6% were preferred provider organization (PPOs) and one-third (33.3%) were health maintenance organization (HMOs). Only 22.9% of HIPs were high-deductible health plans (HDHP). The majority of cancer centers offered PPO plans (75.4%), HMO plans (57.4%), HDHP plans (55.7%), and some (24.6%) offered other plans, such as point of service and exclusive provider organization. Average costs for different kinds of HIPs are presented in the Table. A higher percentage of public cancer centers provided HMOs (60.5% vs. 50.0%, p=0.76) and PPOs (84.3% vs. 60.5%, p=0.09) than private centers, yet differences did not reach significance. Centers located in regions with higher state population density were more likely to have higher HMO OOP costs (beta=2.72; p=.006) and lower PPO OOP costs (beta=-2.98; p=.012). Conclusions: We found that most NCI-designated cancer centers had readily available information about HIPs provided to physicians. For these centers, physicians had limited HIP options offered, particularly in private institutions, which offered fewer HMO and PPO plans. We also demonstrated associations among state population density and OOP max in HMO and PPO plans. Our study provides a current synopsis of HIPs and identifies disparities among them, contributing to a foundation for future research. [Table: see text]

Improving the Care and Cost of Treating Community-Acquired Stage 3 and 4 Decubitus Ulcers

Introduction The healthcare costs for treatment of community-acquired decubitus ulcers accounts for $11.6 billion in the United States annually. Patients with stage 3 and 4 decubitus ulcers are often treated inefficiently prior to reconstructive surgery while physicians attempt to optimize their condition (debridement, fecal/urinary diversion, physical therapy, nutrition, and obtaining durable medical goods). We hypothesized that hospital costs for inpatient optimization of decubitus ulcers would significantly differ from outpatient optimization costs, resulting in significant financial losses to the hospital and that transitioning optimization to an outpatient setting could reduce both total and hospital expenditures. In this study, we analyzed and compared the financial expenditures of optimizing patients with decubitus ulcers in an inpatient setting versus maximizing outpatient utilization of resources prior to reconstruction. Methods Encounters of patients with stage 3 or 4 decubitus ulcers over a 5-year period were investigated. These encounters were divided into two groups: Group 1 included patients who were optimized totally inpatient prior to reconstructive surgery; group 2 included patients who were mostly optimized in an outpatient setting and this encounter was a planned admission for their reconstructive surgery. Demographics, comorbidities, paralysis status, and insurance carriers were collected for all patients. Financial charges and reimbursements were compared among the groups. Results Forty-five encounters met criteria for inclusion. Group 1’s average hospital charges were $500,917, while group 2’s charges were $134,419. The cost of outpatient therapeutic items for patient optimization prior to wound closure was estimated to be $10,202 monthly. When including an additional debridement admission for group 2 patients (average of $108,031), the maximal charges for total care was $252,652, and hospital reimbursements were similar between group 1 and group 2 ($65,401 vs $50,860 respectively). Conclusions The data derived from this investigation strongly suggests that optimizing patients in an outpatient setting prior to decubitus wound closure versus managing the patients totally on an inpatient basis will significantly reduce hospital charges, and hence costs, while minimally affecting reimbursements to the hospital.

Ethnicity and health insurance disparities in rectal carcinoma.

e13732 Background: Ethnicity and insurance coverage affect healthcare delivery in rectal carcinoma (RC). RC pts (pts) with Medicaid or no insurance are more likely to present with distant stage RC compared to Medicare/private insurance pts, and have a worse prognosis even when stage is accounted for. To combat such issues, federal law requires that non-profit hospitals, which make up 58% of all community hospitals, to provide charity care, or financial assistance, to those eligible. As insurance status, ethnicity and race have been found to independently affect colon cancer care, we expect similar results for RC in our limited but diverse cohort. Methods: Trinitas Medical Center RWJBH is an urban, community hospital that predominantly treats a minority population and provides financial assistance to eligible underinsured pts. Due to this assistance, or Charity Care, we can provide access to cancer care for many who would not ordinarily have such means. With institutional IRB approval, we completed a retrospective chart review of 59 pts diagnosed with Stage I-IV RC from 2017-2023. We assessed ethnicity, insurance carriers and treatment choices. Results: We reviewed 59 pts with the following ethnic distribution: 22 Hispanic (H), 21 White (W), 11 Black (B) and 5 Asian (A) pts. The median age at diagnosis with RC was 57 in H, 64 in B, 71 in W and 71 in A pts. B pts were found to be diagnosed with more advanced disease: 36% at Stage III and 45% at Stage IV, with none diagnosed at Stage I or II. H pts had comparatively fewer distant stage diagnoses (23% at Stage III, 18% at Stage IV). Neoadjuvant chemotherapy and radiation therapy to 20 of 59 pts treated at our center, 15 of whom subsequently received surgery. Four of five of these declined surgical intervention post neoadjuvant therapy. H pts had the following primary insurance carriers: 36% Medicaid, 36% Medicare, 27% Charity care. 62% of W pts had Medicare and 14% Medicaid. 27% had B pts had Medicare, 27% Medicaid and 9% had Charity care. 50% of the 59 pts had Charity care, with most pts in this group being H. Conclusions: Research suggests that immigrants utilize healthcare facilities less than U.S. citizens and programs like Charity care may be underutilized. In our RC cohort, 38 of 59 (64%) pts were racial minorities, of these 50% received Charity care. Most did not receive screening prior to a diagnosis of rectal cancer and many applied for Charity Care only after their diagnosis. Despite offering significant financial assistance to our pts, we suggest education to immigrants regarding insurance coverage, broader screening efforts and the ability to offer improved subspecialty care to RC pts. In particular, we look to target B and H who present at younger ages and are not Medicare eligible. We believe this will lead to earlier staging of RC, which should lead to improved survival for minority pts.

Occupation and demand for health services in Italy: Ways and means to reduce the opportunity costs imposed on patients

This paper explores whether and to which extent employment condition and working hours influence individuals’ decision process in consuming primary care. The hypothesis is that the higher the workers’ opportunity cost in terms of earning forgone, the less the demand for General Practitioner (GP) visits. Using survey data provided by the Italian National Institute of Statistics (ISTAT), we estimate a negative binomial regression model of GP visits as a function of employment related variables, controlling for a rich set of individual demographic characteristics, socio-economic variables, health status, supply and geographical factors. We show that self-employed workers, managers and cadres use significantly less primary care services notwithstanding the access is free. We conclude that they have higher opportunity costs than white and blue collars since they suffer more from the loss of earnings related to the absence from work. Self-employed individuals often face barriers to accessing healthcare services, such as lack of employer-sponsored health insurance and concerns about lost income during time off for medical appointments. As a result, they may delay seeking healthcare until their condition becomes more severe, leading to poorer health outcomes. Managers and cadres, on the other hand, may have greater access to healthcare services due to higher income levels and better job benefits. However, they may still face challenges such as long working hours and job-related stress, which can impact their ability to prioritize their health and seek timely medical care.From a policy perspective, our results suggest potential policy interventions aimed at addressing barriers to healthcare access for self-employed workers and promoting equitable healthcare utilization across different employment groups. Policy recommendations may include measures to enhance financial support (tax deductions for medical expenses, subsidies for health insurance premiums, or grants to cover the costs of healthcare-related absences from work), increase healthcare accessibility (enhancing the availability of mobile clinics, and extending operating hours for primary care facilities to accommodate the needs of working individuals) and raise awareness about preventive care among self-employed workers (workplace wellness programs, and incentives for regular health check-ups, screenings and healthy lifestyle choices, can encourage managers and self-employed workers to prioritize preventive measures). These policy implications are essential for ensuring equitable and universal access to healthcare services for all workers, regardless of their employment status.

Factors Affecting Cattle Insurance Purchase and its Effects on the Financial Situation of Dairy Farmers

The results of the study indicated that the age of the respondents, the type of animals reared, herd size, and membership in dairy cooperatives and districts significantly influenced the adoption of cattle insurance. The education of the respondent, herd size, the type of animal holding, and membership in dairy cooperatives significantly influenced the willingness to pay for cattle insurance. Willingness to pay was found to be less than the actual payment for the cattle insurance premium, and it was more in the case of crossbreds than other categories of animals. The type of animal and membership in dairy cooperatives had a positive and significant influence on the actual level of payment for cattle insurance. The landholding size, animal herd size, and non-farm occupation, along with dairying, had a positive influence, and the loss of animals had a negative impact on the net- income of the farmers. Finally, it can be concluded that cattle insurance is one of the best risk mitigation strategies to help farmers stabilize their income under risks and uncertain situations.

Trends in the Diagnostic Prevalence of Mental Disorders, 2012-2022.

Evaluations by the statutory health insurance carriers in Germany have revealed a rising prevalence of diagnoses of mental disorders, at varying levels and to varying extents. For mental health surveillance purposes, we analyzed prevalence trends across health insurance carriers, before and during the COVID-19 pandemic and stratified by diagnosis group, sex and age. Nationwide outpatient claims data of all statutorily insured individuals for the years 2012-2022 (Nmin = 68.7 million people, Nmax = 73.7 million people) were used to determine the diagnostic prevalence of mental disorders (ICD-10 F00-F99 and five selected diagnosis groups), with stratification by sex and age. Changes over time in the spectrum of all documented mental disorders are described. Over the period 2012-2022, the percentage of people with outpatient diagnoses of mental disorders rose from 33.4% to 37.9% (a relative increase of 13.4%). In the selected diagnosis groups, the trends ranged from -11.6% to +115.8% and were generally steady over time, though stronger or stagnating trends were seen in some groups from 2020 onward. Diagnostic prevalence rose to a greater extent in male (+18.3%) than in female individuals (+10.8%) over the period 2012-2022. The greatest increases (> +15%) were seen among 11- to 17-yearolds and in 60- to 84-year-olds. The composition of the diagnosis spectrum was more stable in adults than in children and adolescents. Trends in diagnostic prevalence differ across mental disorders and population subgroups and have changed in some diagnosis groups since the COVID-19 pandemic. Contextualizing research is needed for a better understanding of these developments.

Why does the cost of employer-sponsored coverage keep rising?

Over the past 25 years, the gap between the increase in health insurance costs and workers' wages has significantly expanded. This trend has led to significant concerns about healthcare affordability, with surveys revealing conflicting opinions regarding whether hospitals or health insurance companies bear the blame for escalating costs. To better understand these dynamics, we examined consumer price indices for health insurance, hospital services, and professional services from 2006 to 2023 using Bureau of Labor Statistics data. Our analysis shows that the hospital price index rose steadily between 2006 and 2023, faster than insurance premiums or professional services. To examine whether differences in underlying costs are driving higher hospital price increases, we evaluated the profit margins of hospitals and health insurance companies using the National Academy for State Health Policy''s Hospital Cost Tool and National Association of Insurance Commissioners Industry Reports. Our findings reveal that hospitals (for-profit and nonprofit) have consistently maintained higher profit margins than insurance companies. As health insurance costs continue to weigh heavily on working Americans, our analysis suggests that high hospital prices drive insurance premiums.