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Access to insurance, as part of a broad range of essential financial services, is especially important for poor households in order to smooth consumption, build assets, absorb shocks, and manage risks associated with irregular and unpredictable income. Without access to good formal insurance services, the poor depend on less reliable and often far more expensive informal sector mechanisms. Yet, in many majority Islamic countries, accessing and using insur-ance products has been quite limited, as many Muslims avoid such services over concerns about riba (interest), gharar (uncertainty and ambiguity in contracts), and maysir (speculative risk), among other factors. Takaful insurance products are emerging as a central part of the Shariah-compliant family of financial services, helping meet insurance needs in ways that are consistent with the local norms and beliefs of many majority Islamic countries. Takaful has been developing steadily since the first Shariah-compliant insurer was founded in 1979, based on a Shariah-compliant cooperative model resembling mutual insurance. This is based on a group of participants donating funds into a pool that members can then use in the event of specified unfavorable contingencies. While practitioners have applied varying business models and standardization remains a challenge, many policy makers recognize the potential of takaful to expand financial inclusion and have aimed to promote the industry with supportive legislation and effective regulation. The response has been strong, with premiums growing about 30 percent (inflation adjusted) annually between 2007 and 2010, reaching US$8.3 billion. This robust performance is expected to continue, based on substantial latent demand in Muslim majority countries and improvements in the industry, including better distribution capabilities.

The unanticipated spike in international food prices in 2007-08 hit many developing countries hard. International prices for food and other agricultural products increased by more than 100 percent between early 2007 and mid-2008. Prices for food cereals more than doubled; and those for rice doubled in the space of just a few months. The food price increases were particularly hard on the poor and near-poor in developing countries, many of whom spend a large share of their income on food and have limited means to cope with price shocks. An estimated 1.29 billion people in 2008 lived on less than $1.25 a day, equivalent to 22.4 percent of the developing world population. In addition, the Food and Agriculture Organization estimated that 923 million people were undernourished in 2007. Simulation models suggested that poverty rose by 100-200 million people and the undernourished increased by 63 million in 2008. The World Bank organized rapidly for short-term support in the crisis, launching a fast-track program of loans and grants, the Global Food Crisis Response Program (GFRP). The GFRP mainly targeted low-income countries, and provided detailed policy advice to governments and its own staff on how to respond to the crisis. The Bank also scaled up lending for agriculture and social protection to support the building of medium-term resilience to future food price shocks. The International Finance Corporation responded by sharply increasing access to liquidity for agribusinesses and agricultural traders in the short and medium term, as well as new programs to improve incentives for agricultural market participants. This evaluation assesses the effectiveness of the World Bank Group response in addressing the short-term impacts of the food price crisis and in enhancing the resilience of countries to future shocks.

Background According to the selection criteria outlined in China’s current basic medical insurance system, the majority of drugs for rare diseases fail to meet the requirements for inclusion. Consequently, patients with rare diseases lack sufficient protection for their fundamental rights to life and health. The purpose of this paper is to explore the construction of a multi-criteria decision analysis (MCDA) system for the inclusion of rare disease drugs in medical insurance. Methods A preliminary evaluation system was constructed through a systematic literature review, followed by the establishment of a formal evaluation system through expert investigation. Based on the formal system, expert surveys were conducted to score the system attributes, and the pairwise comparison method was used to calculate the weight contribution value of each attribute in the system. The robustness of the system was tested using the bootstrap method. Results A multi-criteria decision value evaluation system for the inclusion of rare disease drugs in medical insurance, comprising four primary attributes and 16 secondary attributes, was developed. The four primary attributes and their respective weight contributions are as follows: disease-related aspects (26.6%), treatment-related aspects (25.8%), economic-related aspects (24.0%), and social-related aspects (23.6%). Bootstrap validation confirmed the stability of the system results ( p  < 0.05). Conclusion This study initially constructed a value evaluation system for the inclusion of rare disease drugs in medical insurance, based on MCDA and multi-stakeholder perspectives. However, the system relied heavily on expert opinions and lacks empirical analysis. Given the complexity of real-world applications, further validation is necessary to assess the system’s applicability and feasibility.

Type of the article: Research Article AbstractThe study aims to explore the insurance profiles of SMEs and to identify access gaps across different firm categories, using the Ipsos European Public Affairs survey dataset, which consists of 8,187 SMEs from Europe. This dataset was analyzed using multiple correspondence analysis, cluster analysis, and discriminant analysis. Results show clear evidence of ownership concentration in a few insurance products: commercial motor (64.3% of SMEs own such an insurance), general liability (54.4%), and workers’ compensation (46.1%). On the other hand, uptake is lowest for cyber insurance (15.3%), non-damage business interruption (14.5%), and commercial insurance with business interruption (20.3%); notably, 8.2% report no insurance product ownership. Furthermore, three behavioral clusters were identified: minimally insured (n = 3,604; mean 1.58 policies), moderately insured (n = 2,603; mean 5.22), and broadly insured (n = 1,980; mean 6.73). Also, portfolios exhibit structured “baskets” with frequent co-ownership of general liability and motor (40%). Findings document systematic, demography-linked disparities and actionable access gaps. The study concludes that persistent disparities in access are linked to firm size, age, and turnover, underscoring the need for tailored policy measures and market solutions to address inclusion gaps. The practical value of this study lies in providing evidence-based insights for insurers, regulators, and policymakers seeking to expand SME risk protection. AcknowledgmentWe gratefully acknowledge EIOPA for providing access to the SME insurance dataset used in this study.

Background The high costs of innovative anticancer drugs hinder a number of cancer patients’ access to these drugs in China. To address this problem, in 2018, the medical insurance access negotiation (MIAN) policy was implemented, when the prices of 17 innovative anticancer drugs were successfully negotiated and they were therefore included in the reimbursement list. This study aimed to explore the impact of the MIAN policy on the utilization of innovative anticancer drugs. Methods With monthly data on drug expenditures and defined daily doses (DDDs) of each innovative anticancer drug from January 2017 to December 2019, interrupted time series analysis was employed to estimate both the instant (change in the level of outcome) and long-term (change in trends of outcomes) impacts of the MIAN policy on drug utilization in terms of drug expenditures and DDDs. Our sample consists of 12 innovative anticancer drugs. Results From January 2017 to December 2019, the monthly drug expenditures and DDDs of 12 innovative anticancer drugs increased by about 573% (from US$8,931,809.30 to US$51,138,331.09) and 1400% (from 47,785 to 668,754), respectively. Overall, the implementation of the MIAN policy led to instant substantial increases of US$8,734,414 in drug expenditures and 158,192.5 in DDDs. Moreover, a sharper upward trend over time was reported, with increases of US$2,889,078 and 38,715.3 in the monthly growth rates of drug expenditures and DDDs, respectively. Regarding individual innovative anticancer drugs, the most prominent instant change and trend change in drug utilization were found for osimertinib, crizotinib, and ibrutinib. In contrast, the utilization of pegaspargase was barely affected by the MIAN policy. Conclusions The MIAN policy has effectively promoted the utilization of innovative anticancer drugs. To ensure the continuity of the effects and eliminate differentiation, supplementary measures should be carried out, such as careful selection of drugs for medical insurance negotiations, a health technology assessment system and a multichannel financing mechanism.

Since the mid-1990s, Bangladesh's banking sector has grown considerably. Despite the boom and the government's efforts to increase access in rural areas, rural financial markets have shrunk in relative terms. As a result, access to finance by micro, small, and medium-size enterprises and marginal, small, and medium-size farmers - the \"missing middle\" - remains limited, which is significant because these groups are the engines of growth in rural Bangladesh in terms of employment, contribution to GDP, and prospects for future growth.

The medical security of orphan drugs faces difficulty in basic medical insurance access in China. Conventional cost-effectiveness analysis in the access process lacks broader value concerns and a value assessment framework is needed. This study aims to construct a multicriteria decision analysis value assessment framework for orphan drugs using the discrete choice experiment method from the perspective of basic medical insurance access in China. The attributes and levels of the framework were identified through literature and reports review. An unlabeled discrete choice experiment was employed to determine the relevance and relative importance weight of such attributes for decision-making. Questionnaire was designed based on D-efficient design. Survey was conducted anonymously using an online survey platform. A mixed logit model estimated the DCE responses. Seven attributes (disease severity, unmet needs, drug efficacy, improvement in health-related quality of life, drug safety, quality of drug evidence, and annual treatment cost per patient reimbursed by basic medical insurance) were selected with three levels for each. It formed three parallel questionnaires, each containing 11 paired choice sets. A total of 84 respondents completed the study, and 69 questionnaires were valid. The results showed that six of the seven attributes were significant, except for 'Unmet needs'. Among all attributes and levels, the respondents exhibited the highest WTP (567,900 RMB/year) for 'significant improvement in usual activities'. Based on discrete choice model, the most important attributes measured by their relative importance weights are: improvement in health-related quality of life (23.44%), disease severity (18.65%) and annual treatment cost per patient reimbursed by basic medical insurance (17.34%). Different types of respondents and weighting methods may lead to slight variations in the results. Our study provides a new research perspective and methodological support for the value assessment of orphan drugs. When establishing a value assessment framework for orphan drugs in China, overall, the medical insurance access prioritized disease severity, and improvement in health-related quality of life. The application of discrete choice experiment proves to be a powerful tool for weighting criteria in healthcare multicriteria decision analysis framework and should be further explored for the value assessment of orphan drugs. Our findings offer a structured, evidence-based framework to support access and reimbursement decisions for orphan drugs.

ObjectiveGuidelines recommend non-invasive ischaemia testing (NIIT) for the majority of patients with suspected ischaemic heart disease in a non-emergency setting. A substantial number of these patients undergo diagnostic coronary angiography (CA) without therapeutic intervention inappropriately due to lacking preceding NIIT. The aim of this study was to evaluate the effect of voluntary healthcare models with limited access on the proportion of patients without NIIT prior to elective purely diagnostic CA.DesignRetrospective cross-sectional analysis of insurance claims data from 2012 to 2015. Data included claims of basic and voluntary healthcare models from approximately 1.2 million patients enrolled with the Helsana Insurance Group. Voluntary healthcare models with limited health access are divided into gate keeping (GK) and managed care (MC) capitation models. Inclusion criteria: patients undergoing CA. Exclusion criteria: Patients<18 years, incomplete health insurance data coverage, acute cardiac ischaemia and emergency procedures, therapeutic CA (coronary angioplasty/stenting or coronary artery bypass grafting). The effect of voluntary healthcare models on the proportion of NIIT undertaken within 2 months before diagnostic CA was assessed by means of multiple logistic regression analysis, controlled for influencing factors.Results9173 patients matched inclusion criteria. 33.2% (3044) did not receive NIIT before CA. Compared with basic healthcare models, MC was independently associated with a higher proportion of NIIT (p<0.001, OR 1.17, CI 1.045 to 1.312), when additionally controlled for demographics, insurance coverage, inpatient treatment, cardiovascular medication, chronic comorbidities, high-risk status (patients with therapeutic cardiac intervention 1 month after or 18 months prior to diagnostic CA). GK models showed no significant association with the rate of NIIT (p=0.07, OR 1.11, CI 0.991 to 1.253).ConclusionsIn a non-GK healthcare system, voluntary MC healthcare models with capitation were associated with a reduced inappropriate use of diagnostic CA compared with GK or basic models.

Background Cancer has become the third cause of death in Mexico. Treatment for cancer is often complex and lengthy. New and better medicines enter the market at high prices, which may limit access. Like most Latin American countries, Mexico has an essential cancer medicines list that includes innovative medicines. Their accessibility and use in the public sector remains unknown. Therefore, we describe the use, as a proxy of access, of innovative and essential cancer medicines in the public sector in Mexico, by insurance institution, and by five regions between 2010 to 2016. Methods We used drug utilization research methods to assess the use of eight patented cancer medicines. Through the national transparency platform, we obtained data on the quantities of these medicines used in all public health facilities and social health insurance institutions and recalculated those figures into defined daily dose (DDD) per 1000 population per year. Results Overall, the use of all medicines increased over the years, especially for trastuzumab, rituximab and imatinib. The use of innovative medicines was higher per population covered in social health insurance institutions than in governmental facilities. Throughout the study period, the Central region (including Mexico City) has used more medicines per population than the other regions. Conclusions The use and access of some essential innovative cancer medicines has increased over the years, but remains unequal across insurance schemes and regions. Particularly, the Ministry of Health Insurance scheme and Northern and Western regions in the country would benefit from additional efforts to increase access to essential cancer medicines.

Background A major concern by the health decision makers in Gulf Cooperative Council (GCC) countries is the burden of financing healthcare. While other GCC countries have been examining different options, Saudi Arabia has endeavoured to reform its private healthcare system and control expatriate access to government resources through the provision of Compulsory Employment-Based Health Insurance (CEBHI). The objective of this research was to investigate, in a natural setting, the characteristics of uninsured expatriates based on their personal and workplace characteristics. Methods Using a cross-sectional survey, data were collected from a sample of 4,575 male expatriate employees using a multi-stage stratified cluster sampling technique. Descriptive statistics were used to summarize all variables, and the dependent variable was tabulated by access to health insurance and tested using Chi-square. Logistic analysis was performed, guided by the conceptual model. Results Of survey respondents, 30% were either uninsured or not yet enrolled in a health insurance scheme, 79.4% of these uninsured expatriates did not have valid reasons for being uninsured, with Iqama renewal accounting for 20.6% of the uninsured. The study found both personal and workplace characteristics were important factors influencing health insurance status. Compared with single expatriates, married expatriates (accompanied by their families) are 30% less likely to be uninsured. Moreover, workers occupying technical jobs requiring high school level of education or above were two-thirds more likely to be insured compared to unskilled workers. With regard to firm size, respondents employed in large companies (more than 50 employees) are more likely to be insured compared to those employed in small companies (less than ten employees). In relation to business type, the study found that compared to workers from the agricultural sector, industrial/manufacturing, construction and trading sectors, workers were, respectively, 76%, 85%, and 60% less likely to be uninsured. Conclusion Although the CEBHI is mandatory, this study found that the characteristics of uninsured expatriates, in respect of their personal and workplace characteristics have similarities with the uninsured from other private employment-sponsored health insurance schemes. Other factors influencing access to health insurance, besides employee and workplace characteristics, include the development and extent of the country’s insurance industry.