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Regulated Lives explores the British life insurance industry's changing assessments of the values and risks of human life between 1800 and 1914. Timothy Alborn's unique study uses insurance practices to demonstrate how Victorian ideas about the lived experience altered both to accommodate and resist elements of modernity such as statistical thinking, medicalization, and capitalist bureaucracy. The nature of Victorian life insurance companies meant that their customers were both consuming subjects and objectified abstractions. Policyholders were active consumers of a product as well as passive objects which were evaluated for 'risk' in the objective and homogenizing terms determined by the industry. By examining how salesmen, actuaries, and doctors utilized their differing conceptions of what the various aspects of people's lives meant, Regulated Lives suggests that the very complexity of modern commercial and social institutions produces space where individuality can flourish.

This book examines some of the mechanisms which are currently conceived as affording individual security. The idea of security includes emotional and financial components. These interconnect so that such common concepts as 'trust' in someone and 'care taking' include both ideas of emotional and financial support. State policies on security rest on perceptions of two other institutions, the family and insurance, both of which are subject to change. At one time the extended family was seen as a major security-providing institution, but the contemporary nuclear family is more fragile. The concept of insurance originally entailed ideas of community and mutual aid; however, the institution has developed, in its modern private form, as a profit-driven entity. This book addresses various uses of state power in providing security for individuals, and outlines different ways in which this can be done.

The past decade has brought an increasing recognition to the importance of pension systems to the economic stability of nations and the security of their aging populations. During this time, the World Bank has taken a leading role in addressing this challenge through its support for pension reforms around the world. Old-Age Income Support in the 21st Century attempts to explain current policy thinking and update the World Bank’s perspective on pension reform. The Bank has been involved in pension reforms in nearly 60 countries, and the demand for its support continues to grow. This book incorporates lessons learned from recent Bank experiences and research that have significantly increased knowledge and insight regarding how best to proceed in the future. The book has a comprehensive introduction and two main parts. Part I presents the conceptual underpinnings for the Bank’s thinking on pension systems and reforms, including structure of Bank lending in this area. Part II highlights key design and implementation issues where it signals areas of confidence and areas for further research and experience, and includes a section on regional reform experiences, including Latin American and Europe and Central Asia. This book will be of interest to Bank clients, the international community, and anyone interested in pension systems and reform.

Background Quality of life (QoL) is an important component of individuals’ general well-being, particularly in older adults. However, factors influencing QoL among older adults in low- and middle-income countries (LMICs) have not been fully examined. Furthermore, the role of gender differences in relation to QoL in multiple LMICs has also not been examined in detail. Methods This study used data from the World Health Organization’s Study on global AGEing and adult health (SAGE), Wave-1. Based on a literature review of existing works, a set of variables—an independent variable and covariates—were selected. The study sample consisted of 33,019 participants aged 50 years and above from China, Ghana, India, Russia, and South Africa. Multivariate linear regression models were estimated with the World Health Organization QoL scores as the dependent variable. To preserve the analytical sample size, multiple imputation was used to account for missing data. Results The results showed that generally, male older adults reported a better QoL than female older adults across all of the countries. The associations between QoL and sociodemographic factors, health-related factors, and social support factors among older adults differed according to country. Conclusions This study provides a better understanding of QoL among older adults in LMICs, which can help prepare LMICs to better address the QoL of older adults. The results of this study can be used to develop programs to promote better living standards and services to reduce gender disparities and ultimately, to improve the QoL among older adults in LMICs.

Malaysia is widely credited to have achieved universal health coverage for citizens. However, the accessibility of healthcare services to migrant workers is questionable. Recently, medical fees for foreigners at public facilities were substantially increased. Mandatory health insurance only covers public hospital admissions and excludes undocumented migrants. This study explores barriers to healthcare access faced by documented and undocumented migrant workers in Malaysia. We use qualitative data from 17 in-depth interviews conducted with key informants from civil society organisations, trade unions, academia, medical professionals, as well as migrant workers and their representatives. We interviewed doctors working in public hospitals and private clinics frequented by migrants. Data were analysed using thematic analysis. We found that healthcare services in Malaysia are often inaccessible to migrant workers. Complex access barriers were identified, many beyond the control of the health sector. Major themes include affordability and financial constraints, the need for legal documents like valid passports and work permits, language barriers, discrimination and xenophobia, physical inaccessibility and employer-related barriers. Our study suggests that government mandated insurance for migrant workers is insufficient in view of the recent increase in medical fees. The perceived close working relationship between the ministries of health and immigration effectively excludes undocumented migrants from access to public healthcare facilities. Language barriers may affect the quality of care received by migrant workers, by inadvertently resulting in medical errors, while preventing them from giving truly informed consent. We propose instituting migrant-friendly health services at public facilities. We also suggest implementing a comprehensive health insurance to enable healthcare access and financial risk protection for all migrant workers. Non-health sector solutions include the formation of a multi-stakeholder migration management body towards a comprehensive national policy on labour migration which includes health.

Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

Background The increasing trend of senior citizens and their complex healthcare needs demands the improvised provision of healthcare services and strategies to improve health service utilization to ensure health for all. Although health service provision has been prioritized, health service utilization is also a prime aspect that should be addressed to target the chronic needs of senior citizens. This study aims to assess the status of health service utilization and its influencing factors among senior citizens in rural municipalities of the Kaski district, Nepal. Methods A cross-sectional study was carried out in selected wards of all rural municipalities of Kaski District (Annapurna, Machhapuchre, Madi and Rupa). The study included a sample size of 392 senior citizens. Data were collected using a semi-structured interview schedule based on the Andersen‒Newman behavioral model using the Study on Global Aging and Adult Health (SAGE) questionnaire to assess health service utilization. Data analysis included descriptive statistics to summarize participant characteristics and health service utilization patterns. Additionally, bivariate and multivariable logistic regression analyses were performed to identify key determinants of healthcare utilization, adjusting for potential confounders. All statistical analyses were conducted using Statistical Package for Social Sciences version 20, with a significance threshold set at p  < 0.05. Results More than half (54.6%) of the senior citizens in the study visited healthcare facilities in the 12 months. Health service utilization was significantly associated with awareness of free healthcare services, membership in social health insurance, family support, self–perceived health status, independence in activities of daily living, and having a chronic disease with a p-value less than 0.05 and 95% confidence interval. After controlling for confounders, membership in social health insurance (aOR = 3.85, 95% CI: 2.31–6.40, p  < 0.001), family support (aOR = 2.06, 95% CI: 1.01–4.15, p  < 0.05), and the presence of chronic disease (aOR = 2.92, 95% CI: 1.70–4.98, p  < 0.001) were statistically significant with health service utilization among the senior citizens. Conclusions Many senior citizens did not utilize the healthcare services. Enrollment in social health insurance, awareness of free health services, family support and presence of chronic conditions were significantly associated with higher health service utilization. This suggests that to increase health service utilization awareness about health, including social health insurance, and fostering a sense of security and well-being is crucial.