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The inclusion of the policy guarantee program in the Omnibus Law, specifically Law Number 4 of 2023 concerning the Development and Strengthening of the Financial Sector, represents a significant advancement for the Indonesian public, particularly for policyholders, including those holding mutual insurance policies. The Deposit Corporation is designated as the institution responsible for implementing this program. Considering the ongoing challenges faced by mutual insurance companies in Indonesia, such as Bumiputera 1912, the immediate realization of this program is crucial. This research aims to analyze the urgency of implementing a mutual insurance policy guarantee program in Indonesia. The study employs a normative juridical research method supported by a comprehensive literature review. In conclusion, this study highlights the urgency of implementing a mutual insurance policy guarantee program in Indonesia, which serves to: (1) rebuild public trust in the insurance industry; (2) restore stability in the financial sector; (3) create opportunities for the growth of the insurance industry; (4) provide support to struggling insurance companies to prevent their collapse; (5) uphold the constitutional mandate as outlined in the 1945 Constitution; and (6) safeguard the interests of policyholders while adhering to the mandate of the International Association of Insurance Supervisors (IAIS).

Background The impact of general population lockdown implemented in the face of the COVID-19 epidemic needs to be evaluated. We describe here a longitudinal study on the mental health of adults in France. Methods We did a secondary analysis of a web-based cohort, initially set up to study home and leisure injuries, in order to measure the consequences of the national lockdown implemented in France from 17 March 2020 to 11 May 2020, and to assess potential vulnerability and resilience factors. Eligible participants were invited to answer an online questionnaire designed to assess their living conditions and health during lockdown. Comparisons were done with answers provided 4.8 years earlier on average. Results On 15th April 2020, we sent email invitations to 9598 participants recruited between November 2014 and December 2019 and 1237 volunteers took part in the study by completing the online questionnaire. The proportion of those with anxiety symptoms markedly increased from 17.3 to 20.1%. The average self-rated level of mental health decreased from 7.77 to 7.58. Women, the elderly and the youngest appeared to be more vulnerable. A small living space (less than 30 m 2 ) was associated with an increase in depression symptoms (PHQ-9 score), and poorer self-rated physical health at recruitment was associated with an increase in anxiety symptoms (GAD-7 score). On the contrary, the average self-rated level of physical health markedly increased from 7.44 to 7.94 between recruitment and lockdown, and the proportion of those who reported a level of 9 or 10 jumped from 25.7% at recruitment to 43.1% during lockdown. Conclusions Mental health deteriorated during lockdown in France during the 2020 COVID-19 crisis. Overall, self-rated physical health improved but those who experienced a worse physical health were more likely to report anxiety symptoms.

ObjectiveTo estimate the magnitude of under-reporting of non-fatal occupational injuries (OIs) by different organisational factors in Sweden for the year 2013.MethodsCapture–recapture methods were applied using two data sources: (1) the national OI register and (2) records from a labour market insurance company. To assure comparability of data sources, the analysis was restricted to the public sector and private companies with at least 50 employees. OIs were matched using personal identification number and reported injury dates (±7 days). Organisational factors were obtained from the national labour market register and injury severity (no healthcare/only outpatient/hospitalised) from the National Patient Register. Total number of OIs and ascertainment by data sources were estimated assuming data source independence.ResultsThere were an estimated 98 493 OIs in 2013. Completeness of reporting OIs to the national register and to the insurance company was estimated at 73% and 43%, respectively. No report to either source was estimated at 15 000 OIs (~15%). Under-reporting to the national register differed by selected organisational factors, being higher among organisations in the public sector, those with more females, with a younger workforce and with a higher proportion of immigrants. Overall under-reporting was more common in agriculture (19.7%), other services (19.3%), commerce and hospitality (19.1%), health (18.4%) and education (18.4%). Under-reporting decreased as injury severity increased, with little variations across sectors of economic activity.ConclusionsResults suggest considerable under-reporting of OIs in Sweden and differential under-reporting by organisational factors. Results are relevant for official estimates of burden and for setting priorities for workplace safety and prevention.

BackgroundUnder-reporting of occupational injuries (OIs) among precariously employed workers in Sweden challenges effective surveillance of OIs and targeted preventive measures.ObjectiveTo estimate the magnitude of under-reporting of OIs among precarious and non-precarious workers in Sweden in 2013.MethodsCapture–recapture methods were applied using the national OIs register and records from a labour market insurance company. Employed workers 18–65 resident in Sweden in 2013 were included in the study (n=82 949 OIs). Precarious employment was operationalised using the national labour market register, while injury severity was constructed from the National Patient Register. Under-reporting estimates were computed stratifying by OIs severity and by sociodemographic characteristics, occupations and precarious employment.ResultsUnder-reporting of OIs followed a dose–response pattern according to the levels of precariousness (the higher the precarious level, the higher the under-reporting) being for the precarious group (22.6%, 95% CI 21.3% to 23.8%), followed by the borderline precarious (17.6%, 95% CI 17.1% to 18.2%) and lastly the non-precarious (15.0%, 95% CI 14.7% to 15.3%). Under-reporting of OIs, decreased as the injury severity increased and was higher with highest level of precariousness in all groups of severity. We also observed higher under-reporting estimates among all occupations in the precarious and borderline precarious groups as compared with the non-precarious ones.ConclusionsThis is the first register-based study to empirically demonstrate in Sweden that under-reporting of OIs is 50% higher among precariously employed workers. OIs under-reporting may represent unrecognised injuries that especially burden precariously employed workers as financial, health and social consequences shift from the employer to the employee.

IntroductionThe Resilience Analysis Grid (RAG) is a Safety-II instrument to evaluate a systems potential for resilient performance based on the four resilience potentials Responding, Monitoring, Learning and Anticipating. Since its development, only a few studies worldwide tried to bring the RAG theory into healthcare practice. In the Netherlands, the Safety-II approach has become central to patient safety in hospitals. However, there are still few instruments available to support reflection on the resilient performance of hospital systems. Given that hospital work is predominantly team-based, hospital teams and their wards provide a valuable starting point for fostering reflection on resilience in healthcare settings. This study aims to identify key factors that facilitate the use of the Resilience Analysis Grid for evaluating resilient performance in hospitals while also introducing Safety-II principles into hospital wards.MethodWe applied action research methodologies to iteratively experiment with the RAG. In collaboration with healthcare professionals from the SAZ, an association of general hospitals, and Medirisk, a Dutch mutual insurance company, we explored how to apply RAG theory in practice. The study consisted of three phases. Phases 1 and 3 included online workshops with participation from all SAZ-associated hospitals. In Phase 2, we conducted RAG reflection workshops at the emergency wards of five SAZ hospitals, involving medical, nursing, and management staff. Throughout each phase, we observed the workshops and interviewed participants about their experiences with the RAG to identify key elements for its effective use.ResultsWe identified several key elements that support the use of the RAG in hospital wards, ultimately leading to the development of the Safety-II reflection cards. These elements include the presence of a multidisciplinary group of healthcare professionals in the RAG reflection workshop, a facilitator with expertise in Safety-II principles, and a collaborative selection of a complex procedure for reflection. Additionally, fostering a shared language, cultivating an open culture, ensuring a willingness to dedicate time and space, and recognizing resilient performance as an ongoing work-in-progress are essential for effective implementation.ConclusionsRAG theory, implemented through the Safety-II reflection cards, offers specific reflection principles that make the Safety-II perspective more practical for healthcare professionals when assessing their work procedures. These principles are particularly useful for complex processes in settings like emergency rooms and intensive care units, where they help strengthen patient safety.

We analyze whether an insurance firm’s organizational form affects the degree of earnings quality in the German property-liability insurance industry. Using a dataset of 1,856 firm-year observations for the years 2001–2021 and regression analyses, we examine the “demand” hypothesis versus the “opportunistic behavior” hypothesis to identify differences in the earnings quality of mutual and stock insurance firms. Our results indicate that, consistent with the opportunistic behavior hypothesis, mutual insurance firms show higher levels of earnings quality. The results hold for various measures of earnings quality and are not affected by macroeconomic conditions. Our findings are important for various stakeholders of insurance firms as they provide knowledge on the determinants of earnings quality, which supports improved consumer product decisions.

Background Proton pump inhibitors (PPIs) are one of the most commonly prescribed pharmacological groups. Their high prevalence and duration of use are of important health concern due to the risk they can cause to patients. Despite these risks, their use remains particularly high, especially in the elderly population. We determined the trend in the prevalence of PPI consumption in the population of the Lleida Health Region between 2002 and 2015 to explore patterns of use and associated characteristics. Methods An analysis of secular trends between 2002 and 2015 was performed. The database included all individuals who used PPIs in the Lleida Health Region, which had 358.070 inhabitants in 2015. PPI use was evaluated using prescription dispensing data from the public health system. All types of PPIs approved by the pharmaceutical agency were included. Trends were investigated by age and sex. Results For the whole study period, a total of 215,417 individuals accounted for 292,122 dispensations. Overall, 48% were women, and the mean age was 62 years. The dispensing prevalence of PPI use in 2015 was 18.0% overall—20.4% for women and 15.7% for men—and was 54.6% for those over 65 years. In terms of the subtypes of PPIs, 16.8% of prescriptions were for omeprazole, 0.66% were for pantoprazole, and 0.48% were for lansoprazole. The evolution of the annual PPIs dispensation prevalence showed a progressive increase from 11.3% in 2002 to 18.0% in 2015, which was attributable to an increase in the use of omeprazole (9.0% vs. 16.8%) and, to a lesser extent, esomeprazole (0.02% vs. 0.4%). Conclusion An increase in the prevalence of PPI dispensation was observed over 14 years of follow-up. The prevalence of dispensation was especially high for the population older than 65 years, despite the risk of cognitive decline and falls. Comprehensive actions are required to to increase rational prescribing of PPIs, especially in high-risk populations.

No-fault vaccine injury compensation schemes provide financial redress for adverse effects from vaccines without establishing fault. Due to the rapid vaccine development and distribution, these programs are crucial for vaccinees during the COVID-19 pandemic. Investigating the performance differences of these schemes worldwide and finding a more balanced approach is essential to responses to future pandemics. This study examines the structure and effectiveness of 14 no-fault vaccine injury compensation schemes, analyzing data on approval rates for COVID-19 vaccine injury claims. Data sources include government reports and academic studies to compare diverse operational models and funding sources. This study included 167,532 COVID-19 vaccine injury compensation applications, with up to 137,076 claims reviewed and up to 38,658 approved, incorporating both exact and approximate official numbers. Approval rates for the reviewed claims vary widely across jurisdictions, with Japan (74.29 %) having the highest rates, and the United States (3 %) and the United Kingdom (2.64 %) the lowest. The median approval rate across all 14 jurisdictions is 26.76 %, between South Korea's 26.09 % and France's 27.42 %. These variations reflect diverse standards and policies. No clear correlation exists between funding sources and approval rates. For example, government-funded schemes in France and Japan show higher approval rates, while similar models in the United States and the United Kingdom have low rates. In New Zealand and other countries with broader medical compensation schemes, approval rates are higher than the international median. Governments may adopt more flexible standards to redress vaccine injuries by referring to international practices and the latest medical evidence. High-approval-rate countries offer insights into inclusive criteria, while low-approval-rate countries may need to reassess stringent criteria. Middle-ground countries could incorporate new medical findings to refine standards, ensuring equitable outcomes for those affected by vaccine injuries.

The readability of insurance policies has been a longstanding concern for regulators, insurers, and consumers. This study extends previous research by examining the readability of personal auto and homeowners’ insurance policies in Indiana. Using the Flesch and Flesch-Kincaid formulas, we analyzed 14 homeowners and 12 personal auto policies from major insurers. Our findings indicate that both types of policies are generally difficult to understand, with average Flesch scores below 45. While some sections, such as conditions and property coverage sections, of both policies were found to be more readable, others, like liability coverages, more specifically uninsured and underinsured motorists coverage sections, were significantly more challenging. These results highlight the need for ongoing efforts to improve policy readability and ensure that consumers can make informed decisions about their insurance coverage.

Issue/problem Since 2016, French doctors are allowed to prescribe adapted physical activity (APA) to patients with long-term illness (ALD) through the ‘sport sur ordonnance' program. Despite the goal of promoting physical activity in ALD patients, health authority recent reports unanimously highlight organisational and funding difficulties. Whereas most of the funding effort is based on national or mutual insurance companies, our intervention proposes to fix the organisational difficulties. We provided an optimized care pathway coordinated by an APA professional and an innovative online platform to ease medical prescription, patients access and follow-up to APA. Problem description Three main problems have been identified: Diagnostic heterogeneity, APA accessibility and Program evaluation. To fix these issues, the proposed intervention firstly included an initial evaluation based on a standardized diagnostic. Secondly, we evaluated APA structures following functional specifications and referenced those succeeding the criteria to ensure an optimized patients' orientation toward an adapted care service. Finally, pre- and post-care bio-psycho-social tests were mandatory. Interviews and evaluation data were stored via questionnaires on our securized platform for further analyses. Results 2200 patients benefited from our program, and 116 yet finished the whole 2-years program. Patients description: 64 yo, 66% women, 35% cancer, 14% diabetes, 11% heart failure and 9% mental illnesses. 96% declared being motivated to maintain their physical activity after the program and reported a 4.8/5 in rating their APA care. Significant pre-post enhancements suggest that our program succeed in promoting and facilitating regular APA practice in ALD patients. Lessons The ecosystem built around insurance companies (APA professionals, doctors and patients) provides an appropriate response to the health policy dedicating to promote a regular APA practice for ALD patients. However, the expected efficiency depends on a structured, organized and innovative system. Firstly, evaluating the medicoeconomic impact is necessary to ensure the sustainability of this national policy. Systematically measuring the pre- and post-care intervention should allow reaching this objective. Secondly, we learned that the necessary next steps will rely on time saving and quality increase. We propose automatized detailed and patient specific APA prescription following HAS guidelines and automatized orientation toward the most adapted APA professional.