Search Results (792)

Although organizational resilience is well established, refining the systematic quantitative evaluation of health systems resilience (HSR) remains an ongoing opportunity for advancement. Research either focuses on individual HSR indicators, such as social welfare policy, public expenditure, health insurance, healthcare quality, and technology, or broadly examines socio-economic factors, highlighting the need for a more comprehensive methodological approach. This study employed the Slacks-Based Measure (SBM) within Data Envelopment Analysis (DEA) to analyze efficiency by maximizing outputs. It systematically examined key HSR factors across countries, providing insights for improved policymaking and resource allocation. Taking a five-year (2016–2020) dataset that covered 55 to 56 countries and evaluating 17 indicators across governance, health systems, and economic aspects, the paper presents that all sixteen top-ranked countries with a perfect efficiency score of 1 belonged to the high-income group, with ten in Europe, highlighting regional HSR differences. This paper concludes that adequate economic resources form the foundation of HSR and ensure stability and sustained progress. A properly supported healthcare workforce is essential for significantly enhancing health systems and delivering quality care. Last, effective governance and the equitable allocation of resources are crucial for fostering sustainable development and strengthening HSR. Full article

Against the backdrop of increasingly frequent extreme weather events and heightened market price volatility, investigating the relationship between agricultural insurance and farmers’ livelihood resilience is crucial for ensuring rural socioeconomic stability. This study utilizes field survey data from 1196 households across twelve county-level divisions (three cities and nine counties) from China’s Hainan and Yunnan provinces, specifically in natural rubber-producing regions. Using propensity score matching (PSM), we empirically examine agricultural insurance’s impact on household livelihood resilience. The results demonstrate that agricultural insurance increased the effect on farmers’ livelihood resilience by 1%. This effect is particularly pronounced among recently poverty-alleviated households and large-scale farming operations. Furthermore, the analysis highlights the mediating roles of credit availability, adoption of agricultural production technologies, and production initiative in strengthening insurance’s positive impact. Therefore, policies should be refined and expanded, combining agricultural insurance with credit support and agricultural technology extension to leverage their value and ensure the sustainable development of farm households. Full article

In 1961, Los Angeles experienced the disastrous Bel Air fire, which swept through an affluent neighborhood situated in a hilly, WUI (wildland–urban interface) location. In January 2025, the city was devastated again by a nearly-simultaneous series of wildfires, the most severe of which took place close to the 1961 fire location. Disastrous WUI fires are, unfortunately, an anticipatable occurrence in many U.S. cities. A number of issues identified earlier remained the same. Some were largely solved, while other new ones have emerged. The paper examines the Palisades Fire of January, 2025 in this context. In the intervening decades, the population of the city grew substantially. But firefighting resources did not keep pace. Very likely, the single-most-important factor in causing the 2025 disasters is that the Los Angeles Fire Department operational vehicle count shrank to 1/5 of what it was in 1961 (per capita). This is likely why critical delays were experienced in the initial attack on the Palisades Fire, leading to a runaway conflagration. Two other crucial issues were the management of vegetation and the adequacy of water supplies. On both these issues, the Palisades Fire revealed serious problems. A problem which arose after 1961 involves the unintended consequences of environmental legislation. Communities will continue to be devastated by wildfires unless adequate vegetation management is accomplished. Yet, environmental regulations are focused on maintaining the status quo, often making vegetation management difficult or ineffective. House survival during a wildfire is strongly affected by whether good vegetation management practices and good building practices (“ignition-resistant” construction features) have been implemented. The latter have not been mandatory for housing built prior to 2008, and the vast majority of houses in the area predated such building code requirements. California has also suffered from a highly counterproductive stance on insurance regulation. This has resulted in some residents not having property insurance, due to the inhospitable operating conditions for insurance firms in the state. Because of the historical precedent, the details in this paper focus on the Palisades Fire; however, many of the lessons learned apply to managing fires in all WUI areas. Policy recommendations are offered, which could help to reduce the potential for future conflagrations. Full article

Introduction: Low medication adherence and low hypertension control are a public health challenge, particularly in low- and middle-income countries (LMICs). Healthcare system- and patient-related barriers hinder the successful management of hypertension. This study aimed to identify the perceptions of barriers and facilitators to hypertension management among health system stakeholders in Santander, Colombia. Materials and Methods: We conducted a qualitative, phenomenological, and interpretative study, comprising five focus groups, to explore the barriers and facilitators to managing people with hypertension. Each focus group was formed by stakeholders from territorial entities, healthcare insurers, or healthcare providers. Meetings were held between December 2022 and February 2023. The sessions were recorded and transcribed using NVivo Transcription and analyzed using NVivo version 1.6.1. Results: Seven categories of barriers and facilitators were identified: strategies, resources, access, risk assessment, cross-sector collaboration, articulation, and stewardship. Of these categories, articulation and stewardship emerged as the main barriers, as revealed through axial coding and cluster analysis, which highlighted deficiencies in stewardship practices, a lack of clear objectives, and misalignment with public policy frameworks. Conclusions: Multisectoral actions extending beyond healthcare providers and aimed at improving coordination and intersectoral collaboration are essential for enhancing hypertension control in LMICs, such as Colombia. Addressing social determinants and strengthening primary healthcare through community-based strategies are critical, making stewardship and improved access key priorities. Full article

As sustainability becomes a strategic priority across global financial services, its implementation in emerging insurance markets remains insufficiently understood. This study explores the integration of environmental, social, and governance (ESG) principles within Saudi Arabia’s insurance sector, combining content analysis of corporate disclosures with qualitative insights from industry stakeholders. The research investigates how insurers embed ESG principles into their operations, the development of sustainable insurance products, and their perceived financial and regulatory implications. The findings reveal gradual progress in ESG integration, primarily driven by governance reforms aligned with national development agendas, while social and environmental dimensions remain comparatively underdeveloped. Stakeholders identify regulatory ambiguity, data limitations, and technical capacity as persistent barriers, but also point to increasing investor and consumer interest in sustainability-aligned offerings. This study offers policy and managerial recommendations to advance ESG principle adoption, emphasizing standardized disclosures, capacity-building, and product innovation. It contributes to the limited empirical literature on ESG principles in Middle Eastern insurance markets and highlights the sector’s potential role in promoting inclusive and sustainable finance. Full article

The recent losses and damages due to climate change have destabilized the insurance industry. As global warming is one of the most critical aspects of climate change, it is essential to investigate to what extent greenhouse gas emissions affect the financial stability of insurers. Insurers typically do not emit substantial greenhouse gases directly, while their underwriting and investment activities play a substantial role in enabling companies that do. This article uses panel data regressions to analyze companies in all insurance segments and in all geographic regions of the world from 2004 to 2023. The main finding is that insurers that increase their greenhouse gas emissions become financially unstable. This result is consistent in all three scopes (scope 1, scope 2, and scope 3) of emissions. Furthermore, the findings reveal that this impact is related to reserves and reinsurance. Specifically, reserves increase with greenhouse gas emissions, while premiums ceded to reinsurers decline. Thus, high-emissions insurers retain a significant share of carbon risk and eventually become financially weak. The results encourage several policy recommendations, highlighting the need for instruments that improve the assessment and disclosure of insurers’ carbon footprints. This is crucial to achieving environmental targets and improving the stability of both the insurance market and the economic system. Full article

The livestock sector is a significant contributor to the economy and rural livelihoods, but it is exposed to high risk across the supply chain, which is detrimental and needs to be addressed for sustainable development. Therefore, this study aimed to identify the major risk mitigation strategies (RMSs) and associated factors that affect their adoption. This study conducted a comprehensive literature review to identify the eight major RMSs and prioritized them through an analytical hierarchical process (AHP). Thereafter, a multivariate probit (MVP) model was developed to identify the factors affecting the adoption of major RMSs. The primary RMSs are livestock insurance, vaccination of livestock, and advisory/extension services. Further, the multivariate probit regression analysis shows that ‘age’, ‘social category’, ‘economic status’, ‘educational level’, ‘income level’, ‘the total number of animals’, and ‘perceived risk of foot and mouth disease’ are significant factors that influence the adoption of RMSs. This study’s findings will be useful for livestock supply chain partners to mitigate the risks along the livestock supply chain. This research will also help policymakers to develop policies/plans for incorporating these RMSs by considering the influencing associated factors. Full article

Background: The objective of this study is to investigate the prevalence and epidemiological changes of major sexually transmitted infections (STIs) in Korea over the past decade. Methods: From 2010 to 2021, patients diagnosed with STIs based on ICD-10 codes were analyzed using Korean Health insurance data. The analysis included the number of patients, prevalence, and age-specific prevalence (in 5-year intervals) over this period. We examined changes in disease patterns over time by analyzing the annual trends and age-specific prevalence of bacterial STIs such as chlamydia, mycoplasma, gonorrhea, and syphilis; viral STIs such as genital herpes, human papillomavirus (HPV), and human immunodeficiency virus (HIV); and other infections including scabies, pubic lice, and trichomoniasis. Results: In 2010, the STI with the highest prevalence due to an infectious pathogen was trichomoniasis (256.65/100,000), while latent syphilis had the lowest prevalence (5.29/100,000). In 2021, the STI with the highest prevalence was genital herpes (254.54 per 100,000 persons), and latent syphilis continued to have the lowest prevalence. Bacterial STIs showed a decreasing trend. Viral STIs showed a continuous increase throughout the study period, with anogenital warts (AGW) having the highest rate of increase. Other infections showed a decreasing trend. HIV and AGW in men showed a rapid increase. Gender differences varied depending on the disease. Conclusions: While bacterial STIs have gradually declined, viral STIs have continued to increase during last decade. The characteristics of each pathogen vary according to age and gender, necessitating the establishment of risk groups for each pathogen and the development of prevention policies accordingly. Full article

Driven by climate change and stringent ecological conservation policies, arid and semi-arid pastoral areas face acute grassland degradation and forage–livestock imbalances. In Sunan County (Gansu Province, China), herders have increasingly turned to off-site grazing—leasing crop fields in adjacent oases during autumn and winter—to alleviate local grassland pressure and adapt their livelihoods. However, the interplay between the evolving land use system (L) and this emergent borrowed pasture system (B) remains under-explored. This study introduces a coupled analytical framework linking L and B. We employ multi-temporal remote sensing imagery (2018–2023) and official statistical data to derive land use dynamic degree (LUDD) metrics and 14 indicators for the borrowed pasture system. Through entropy weighting and a coupling coordination degree model (CCDM), we quantify subsystem performance, interaction intensity, and coordination over time. The results show that 2017 was a turning point in grassland–bare land dynamics: grassland trends shifted from positive to negative, whereas bare land trends turned from negative to positive; strong coupling but low early coordination (C > 0.95; D < 0.54) were present due to institutional lags, infrastructural gaps, and rising rental costs; resilient grassroots networks bolstered coordination during COVID-19 (D ≈ 0.78 in 2023); and institutional voids limited scalability, highlighting the need for integrated subsidy, insurance, and management frameworks. In addition, among those interviewed, 75% (15/20) observed significant grassland degradation before adopting off-site grazing, and 40% (8/20) perceived improvements afterward, indicating its potential role in ecological regulation under climate stress. By fusing remote sensing quantification with local stakeholder insights, this study advances social–ecological coupling theory and offers actionable guidance for optimizing cross-regional forage allocation and adaptive governance in arid pastoral zones. Full article

Against the backdrop of evolving global climate patterns, the frequency and intensity of extreme weather events have increased significantly, posing unprecedented threats to agricultural production. This change has particularly profound impacts on agricultural systems in developing countries, making the enhancement of farmers’ capacity to withstand extreme weather events a crucial component for achieving sustainable agricultural development. As an essential safeguard for agricultural production, agricultural insurance plays an indispensable role in risk management. However, a pronounced gap persists between policy aspirations and actual adoption rates among farmers in developing economies. This study employs the integrated theory of planned behavior (TPB) and protection motivation theory (PMT) to construct an analytical framework incorporating psychological, socio-cultural, and risk-perception factors. Using Jiangsu Province—a representative high-risk agricultural region in China—as a case study, we administered 608 structured questionnaires to farmers. Structural equation modeling was applied to identify determinants influencing insurance adoption decisions. The findings reveal that farmers’ agricultural insurance purchase decisions are influenced by multiple factors. At the individual level, risk perception promotes purchase intention by activating protection motivation, while cost–benefit assessment enables farmers to make rational evaluations. At the social level, subjective norms can significantly enhance farmers’ purchase intention. Further analysis indicates that perceived severity indirectly enhances purchase intention by positively influencing attitude, while response costs negatively affect purchase intention by weakening perceived behavior control. Although challenges such as cognitive gaps and product mismatch exist in the intention-behavior transition, institutional trust can effectively mitigate these issues. It not only strengthens the positive impact of psychological factors on purchase intention, but also significantly facilitates the transformation of purchase intention into actual behavior. To promote targeted policy interventions for agricultural insurance, we propose corresponding policy recommendations from the perspective of public intervention based on the research findings. Full article

Healthcare cost acceleration and resource allocation issues have worsened across European health systems, where a small group of patients drives excessive healthcare spending. The prediction of high-cost utilization patterns is important for the sustainable management of healthcare and focused intervention measures. The aim of our study was to derive and validate machine learning algorithms for high-cost healthcare utilization prediction based on detailed administrative data and by comparing three algorithmic methods for the best risk stratification performance. The research analyzed extensive insurance beneficiary records which compile data from health group collective funds operated by non-life insurers across EU countries, across multiple service classes. The definition of high utilization was equivalent to the upper quintile of overall health expenditure using a moderate cost threshold. The research applied three machine learning algorithms, namely logistic regression using elastic net regularization, the random forest, and support vector machines. The models used a comprehensive set of predictor variables including demographics, policy profiles, and patterns of service utilization across multiple domains of healthcare. The performance of the models was evaluated using the standard train–test methodology and rigorous cross-validation procedures. All three models demonstrated outstanding discriminative ability by achieving area under the curve values at near-perfect levels. The random forest achieved the best test performance with exceptional metrics, closely followed by logistic regression with comparable exceptional performance. Service diversity proved to be the strongest predictor across all models, while dentistry services produced an extraordinarily high odds ratio with robust confidence intervals. The group of high utilizers comprised approximately one-fifth of the sample but demonstrated significantly higher utilization across all service classes. Machine learning algorithms are capable of classifying patients eligible for the high utilization of healthcare services with nearly perfect discriminative ability. The findings justify the application of predictive analytics for proactive case management, resource planning, and focused intervention measures across private group health insurance providers in EU countries. Full article

The Kingdom of Saudi Arabia (KSA) Personal Data Protection Law (PDPL) was enacted in 2021. In its brief three-year existence, the PDPL has attracted significant academic and legal practitioner attention. This critical analysis focuses on three key questions: (1) What are the key PDPL objectives? (2) How does this legislation compare with privacy–data protection approaches adopted in other jurisdictions (notably the European Union General Data Protection Regulation 2016 (GDPR))? and (3) Does the PDPL achieve a reasonable, workable balance between personal data protection (‘data subjects’ interests) and risks associated with personal data being shared with KSA insurers? The analysis confirms that these PDPL measures appear sound, but a definitive assessment of the ‘balance’ objectives highlighted here requires ongoing attention—three years of PDPL use is an insufficient basis to reach final conclusions regarding PDPL fitness for purpose. However, a tentative ‘soundness’ conclusion has reasonable support when the relevant authorities are collectively assessed, particularly regarding the treatment of personal data by KSA insurers in the context of personal insurance policies. Full article

Medicaid is a vital public health program, serving over 70 million Americans from many backgrounds. Understanding how Medicaid spending varies by political leadership and demographic factors can inform policy discussions and advocacy efforts. We conducted a cross-sectional descriptive analysis of state Medicaid spending using publicly available data. Our findings show that individuals identifying as White comprise the largest single racial group of Medicaid beneficiaries both nationally and in most states. While the 2020 Census Diversity Index correlated strongly with total Medicaid spending, no significant association was found with per enrollee spending or the federal share of Medicaid funding. States led by Democrats had higher total Medicaid spending when compared to Republican-led states. However, Republican-led states received a larger proportion of federal Medicaid funding. Among political leadership levels, Senate representation showed the strongest relationship with Medicaid spending trends compared to gubernatorial leadership and presidential voting history. In conclusion, we demonstrate that Medicaid spending impacts all racial groups and both major political parties. However, funding structures and political representation reflect distinct spending patterns. Given the evolving demographic and political landscape, ongoing policy discussions should ensure that Medicaid remains a public health program that remains effective at safeguarding human health. Full article

This study evaluates the current Spanish insurance framework for catastrophic flood risk, administered by the Consorcio de Compensación de Seguros (CCS), based on nationwide loss data reported by the CCS for the period 1996–2020. The analysis of historical claims data enables a clear differentiation between frequent, low-cost events and infrequent, high-impact catastrophes. While the CCS has fulfilled a critical role in post-disaster compensation, the findings highlight the parallel need for ex ante risk mitigation strategies. The study proposes a more efficient, two-tier risk coverage model. Events whose impacts can be managed through standard insurance mechanisms should be underwritten by private insurers using actuarially fair premiums. In contrast, events with catastrophic implications—due to their scale or financial impact—should be addressed through general solidarity mechanisms, centrally managed by the CCS. Such a risk segmentation would improve the financial sustainability of the system and create fiscal space for prevention-oriented incentives. The current design of the CCS scheme may generate moral hazard, as flood exposure is not explicitly priced into the premium structure. Empirical findings support a shift towards a more transparent, incentive-aligned model that combines collective risk sharing with individual risk responsibility—an essential balance for effective climate adaptation and long-term resilience. Full article