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Currently, the health system is a treatment-oriented system focused on service providers. In this system, the main focus is on the health market, with little attention on insured. One way to get out of existing conditions is to empower the insured in order to involve them actively in maintaining and improving health. The paper aims to discuss these issues.

This qualitative study was done using the content analysis method. Based on the purposive sampling method and theoretical saturation criterion, 24 individuals including 12 health insurance experts and 12 insured participated in the study in 2018. The semi-structured interview method was used to collect data. Data were analyzed using MAXQDA10 software.

Having analyzed the interviews, 750 codes were obtained. These codes were categorized into two categories of “insurance experts” and “insured” and ten subcategories of “informing and educating, cost reduction, intersectional activities, expectations from the insured, services package, access to services, inability to pay costs, participation, and expectations from the insurance organization.”

This qualitative study was conducted to assess and determine the effective strategies for empowering the insured under health insurance. The results of this study are helpful to the health insurance organizations and health decision makers to detect the effective ways to develop the quality of insurance services, improve the status of insured, and increase access to health care goods and services.

In Denmark and several other European countries, firms are obliged to cover the first two weeks of sickness. The insurance scheme is provided by government authority and is designed to help small firms with the financial burden related to sickness absence of their workers. The purpose of this paper is to investigate the effect of firms’ participation in an insurance scheme on the long-term sickness absence of their employees, using administrative records.

To identify potential moral hazard, the authors use IV approach created by the eligibility threshold, in order to identify the true causal effect of sickness insurance on sickness absence of workers. The authors use the eligibility criterion as an instrument for the participation in the insurance scheme. The authors confirm the presence of moral hazard in insured firms.

The authors show that sickness absence in insured firms is much more prevalent than in uninsured firms. Sickness spells in insured firms are shorter and the conditional probability to return back to work from sickness is much higher in insured firms.

These results suggest that employees in insured firms are less monitored during the first two weeks and that their sickness is less serious. The authors demonstrate in the paper that the minimum cost of the present insurance scheme is similar to about 1,100 man-years. On top of that comes a substantial cost to more short time sickness.

The authors provide additional evidence on this topic using precise administrative spell data combined with socio-economic data. Compared to previous literature, the authors include duration analysis and identify the presence of moral hazard using a Cox proportional hazard model.

This article seeks to examine the reference yield calculation method used in crop insurance rating and provides recommendations that could potentially improve actuarial performance of the Federal crop insurance program.

Conceptual, numerical, and statistical analysis is utilized to evaluate the reference yield calculation method used in the US Federal crop insurance program.

The results suggest that reference yields, which at the time of this study are calculated using National Agricultural Statistics Service (NASS) data, do not accurately represent the average actual yields of the insured pool of producers in the Federal crop insurance program. In addition, it is found that not regularly updating these NASS‐based reference yields exacerbates this problem because these reference yields do not appropriately represent the current state of technological progress.

The empirical analysis leads this paper to recommend a reference yield calculation procedure that utilizes county‐average yields from the risk management agency (RMA) participation database and an approach that uses spatially aggregated average yields in cases when data for a particular county are sparse.

No previous study has investigated the reference yield calculation method in the Federal crop insurance program using both RMA and NASS data sets. Moreover, this study contributes to the small literature that examines various aspects of the actual production history (APH) rating platform and suggests refinements to improve actuarial performance.

The purpose of this paper is to provide a critical examination of the current law and the proposed changes made by the Law Commission, after consultation, in relation to non‐fraudulent pre‐contractual duties in insurance law.

The research is addressed using case law, statutes, current academic and law commission publications in the UK and Australia.

First, the paper finds that the current state of the law is unfair in relation to consumers and small businesses and much reform is needed to rebalance the nature of insurance contracts to reflect modern day practice.

This work does not address detailed issues in relation to fraudulent misrepresentations.

The law will be brought into line with current practice by the Financial Ombudsman Service.

This paper will be of interest to legal practitioners and academics and those in the insurance industry.

The purpose of this paper is to provide a critical examination of the current law and the possible changes that are under consideration by the Law Commissions, after public consultation in relation to the continuing duty of good faith and post‐contractual duties owed by the insured towards the insurer.

The research is addressed using case law, statutes, current academic and Law Commissions publications in the UK.

First, the paper finds that the current state of the law allows for the insurer to claim damages from an insured when a fraudulent claim is made to recover the cost of any investigations. Second the insurer can refuse to meet a claim that is tainted by fraud. Third the insurer can have the right to avoid the policy obligations upon the discovery of a fraud, but subject to some limitations. Fourth there is a need for the insured to be protected against an insurer's unjustified allegations of fraud.

This work does not address detailed issues in relation to pre‐contractual issues of good faith. These have been discussed in a previous edition of this journal see Swaby. G. (2010) “Insurance law: fit for purpose in the twenty‐first century?” IJLMA, 52 (1), pp. 21‐39. ISSN 1754‐243X.

The Law Commission will be undertaking further consultations before reforming this area of law.

This paper will be of interest to legal practitioners and academics and those in the insurance industry.

In recent years, the frequency and severity of cybersecurity incidents have prompted customers to seek out specialized insurance products. However, this has also presented insurers with operational challenges and increased costs. The assessment of risks for health systems and cyber–physical systems (CPS) necessitates a heightened degree of attention. The significant values of potential damages and claims request a solid insurance system, part of cyber-resilience. This research paper focuses on the emerging cyber insurance market that is currently in the process of standardizing and improving its risk analysis concerning the potential insured entity.

The authors' approach involves a quantitative analysis utilizing a Likert-style questionnaire designed to survey cyber insurance professionals. The authors' aim is to identify the current methods used in gathering information from potential clients, as well as the manner in which this information is analyzed by the insurers. Additionally, the authors gather insights on potential improvements that could be made to this process.

The study the authors elaborated it has a particularly important cyber and risk components for insurance area, because it addresses a “niche” area not yet proper addressed in specialized literature – cyber insurance. Cyber risk management approaches are not uniform at the international level, nor at the insurer level. Also, not all insurers can perform solid assessments, especially since their companies should first prove that they are fully compliant with international cyber security standards.

This research has concentrated on analyzing the current practices in terms of gathering information about the insured entity before issuing the cyber insurance policy, level of details concerning the cyber security posture of the insured entity and way such information should be analyzed in a standardized and useful manner. The novelty of this research resides in the analysis performed as detailed above and the proposals in terms of information gathered, depth of analysis and standardization of approach made. Future work on the topic can focus on the standardization process for analyzing cyber risk for insurance clients, to improve the proposal based also on historical elements and trends in the market. Thus, future research can further refine the standardization process to analyze in more depth the way this can be implemented and included in relevant legislation at the EU level.

Proposed improvements include proposals in terms of the level of detail and the usefulness of an independent centralized approach for information gathering and analysis, especially given the re-insurance and brokerage activities. The authors also propose a common practical procedural approach in risk management, with the involvement of insurance companies and certification institutions of cyber security auditors.

The study investigates the information gathered by insurers from potential clients of cyber insurance and the way this is analyzed and updated for issuance of the insurance policy.

Information systems play a significant role in the improving of health and healthcare, as well as in the planning and financing of health services. Fund’s Information System is an essential component of the information infrastructure that allows assessment of the impact of changes in health insurance and healthcare for the population. The purpose of this paper is to give a brief overview of the affection of e-services and electronic data exchange (between Fund’s information systems and other IT systems) at the quality of service for insured people and savings funds.

The authors opted for an exploratory study using the e-services implemented in Health Insurance Fund (HIF) of Macedonia and data which were complemented by documentary analysis, including brand documents and descriptions of internal processes. In this paper is presented an analysis of the financial aspects of some e-services in HIF of Macedonia by using computer-based information systems and calculating the financial implications on insured people, companies and healthcare providers.

The analysis conducted in this paper shows that the HIF’s e-services would have a positive impact for the insured people, healthcare providers and companies when fulfilling their administrative obligations and exercising their rights.

The analysis presented in this paper can serve as a valuable input for the healthcare authorities in making decisions related to introducing e-services in healthcare. These enhanced e-services will improve the quality service of the HIF.

This study aims to investigate the difference in the pattern of influence of perceived service quality on insured and uninsured patients’ satisfaction levels.

This study follows a cross-sectional primary research design. A questionnaire survey method is implemented to collect primary data from 322 respondents who have received medical care during the past 1 year. A total of 168 respondents had a subscription to health insurance and 154 of them were without health insurance coverage. Data is analysed through factor analysis and multiple regression with SPSS-26.

This study identifies a critical difference in the pattern of influence of perceived service quality on patient satisfaction in the case of insured and uninsured patients. This difference is mainly related to the number of technical and functional service quality dimensions as significant predictors of insured and uninsured patients’ satisfaction.

The present study extends the existing body of knowledge related to perceived service quality and patient satisfaction with an interesting observation. Technical dimensions of perceived service quality act as equally important drivers of patient satisfaction in the case of both uninsured and insured patients. However, more number of functional service quality dimensions act as important drivers of patient satisfaction in the case of insured patients compared to uninsured patients. This serves as an important takeaway for health-care managers/administrators to identify areas of service quality need to be strengthened.

Intellectual property owners put themselves at a competitive disadvantage if they rely only on traditional insurance policies to manage risk.

To examine associations by gender between cancer history and major health insurance transitions (gains and losses), and relationships between insurance transitions and access to care.

Longitudinal 2008–2013 Medical Expenditure Panel Survey data were pooled yielding 2,223 cancer survivors and 50,692 individuals with no cancer history ages 18–63 years upon survey entry, with gender-specific sub-analyses. Access-to-care implications of insurance loss or gain were compared by cancer history and gender.

Initially uninsured cancer survivors were significantly more likely to gain insurance coverage than individuals with no cancer history (RR: 1.25; 95% CI: 1.08–1.44). Females in particular were significantly more likely to gain insurance (unmarried RR: 1.16; 95% CI: 1.06–1.28; married RR: 1.09; 95% CI: 1.02–1.16). Significantly higher rates of difficulty accessing needed medical care and prescription medications were reported by those remaining uninsured, those who lost insurance, and women in general. Remaining uninsured, losing insurance, and male gender were associated with lack of a usual source of care.

Additional outreach to disadvantaged populations is needed to improve access to affordable insurance and medical care. Future longitudinal studies should assess whether major Affordable Care Act (ACA) provisions enacted after the 2008–2013 study period (or those of ACA’s replacement) are addressing these important issues.

Loss of health insurance coverage can reduce health care access resulting in poor health outcomes. Cancer survivors may be particularly at risk of insurance coverage gaps due to the long-term chronic disease trajectory. This study is novel in exploring associations between cancer history by gender and health insurance transitions, both gains and losses, in a national non-elderly adult sample.