The main aim of this research is to present an innovative method known as fuzzy network data envelopment analysis (FNDEA) in order to assess the performance of network decision-making units (DMUs) that possess a two-stage structure while taking into account the uncertainty of data. To attain this goal, we utilize various methodologies including the non-cooperative game (leader-follower) NDEA method, the concept of Z-number, credibility theory, and chance-constrained programming (CCP) to develop a model for the fuzzy NDEA approach. The FNDEA approach offers several advantages, such as the linearity of the presented FNDEA models, the ability to rank two-stage DMUs in situations of ambiguity, the provision of a unique efficiency decomposition method in an uncertain environment, and the capability to handle Z-information. To demonstrate the applicability and effectiveness of the proposed approach, we implement the Z-number network data envelopment analysis (ZNDEA) approach in assessing the performance of Iranian private insurance companies. The results of this implementation reveal that the proposed ZNDEA method is suitable and effective for measuring and ranking insurance companies in situations where data ambiguity is present.

暂无摘要。

In order to progress towards more equitable social welfare systems we need an improved understanding of regulation in social sectors such as health and education. However, research to date has tended to focus on roles for governments and professions, overlooking the broader range of regulatory systems that emerge in contexts of market-based provisioning and partial state regulation. In this article we examine the regulation of private healthcare in India using an analytical approach informed by \'decentred\' and \'regulatory capitalism\' perspectives. We apply these ideas to qualitative data on private healthcare and its regulation in Maharashtra (review of press media, semi-structured interviews with 43 respondents, and three witness seminars), in order to describe the range of state and non-state actors involved in setting rules and norms in this context, whose interests are represented by these activities, and what problems arise. We show an eclectic set of regulatory systems in operation. Government and statutory councils do perform limited and sporadic regulatory roles, typically organised around legislation, licensing and inspections, and often prompted by the judicial arm of the state. But a range of industry-level actors, private organisations and public insurers are involved too, promoting their own interests in the sector via the offices of regulatory capitalism: accreditation companies, insurers, platform operators and consumer courts. Rules and norms are extensive but diffuse. These are produced not just through laws, licensing and professional codes of conduct, but also through industry influence over standards, practices and market organisation, and through individualised attempts to negotiate exceptions and redressal. Our findings demonstrate regulation in a marketised social sector to be partial, disjointed and decentred to multiple loci, actively representing differing interests. Greater understanding of the different actors and processes at play in such contexts can inform future progress towards universal systems for social welfare.

OBJECTIVE: The quality of socio-medical expert opinions, which are prepared for the German Pension Insurance (GPI) in the context of applications for reduced earning capacity pension due to mental disorder, has hardly been investigated so far. The aim of the present study was to investigate to what extent expert medical reports on post-traumatic stress disorder (PTSD) comply with the guideline of the GPI on socio-medical reports for mental and behavioral disorders.
METHODS: To examine the quality of expert opinions, 52 socio-medical expert opinions in which a diagnosis of post-traumatic stress disorder (PTSD) was assigned and a performance capacity of less than three hours was determined were analyzed. The quality of the expert opinions was assessed both quantitatively by calculating quality points and qualitatively by analyzing the content. Percent agreement and Cohen\'s kappa were calculated for two raters to examine rater agreement based on a subsample (n=11).
RESULTS: The analyzed appraisals scored an average of 36.1 (SD=7.4) out of a possible 92 quality points (range 22/56). In most of the expert opinions, the descriptions of participation limitations, epicrisis, and sociomedical conclusion were unsatisfactory.
CONCLUSIONS: The inadequate presentation of the functional and participation limitations in the expert opinions may not do justice to the actual facts of the case, so that the evidence of a health disorder with the corresponding participation limitations cannot be provided beyond doubt. Accordingly, measures to improve the quality of expert opinions such as training and regular quality reviews are necessary.
ZIEL: Die Qualität von sozialmedizinischen Gutachten, die im Rahmen von Anträgen auf Erwerbsminderungsrente wegen psychischer Störung für die Deutsche Rentenversicherung (DRV) angefertigt werden, ist bislang kaum untersucht worden. In der vorliegenden Studie sollte untersucht werden, inwieweit fachärztliche Gutachten zur Posttraumatischen Belastungsstörung (PTBS) der Leitlinie der DRV zu sozialmedizinischen Gutachten bei psychischen und Verhaltensstörungen entsprechen.
METHODS: Zur Überprüfung der Gutachtenqualität wurden 52 sozialmedizinische Gutachten, in denen die Diagnose einer Posttraumatischen Belastungsstörung (PTBS) vergeben und ein Leistungsvermögen von unter drei Stunden festgestellt wurde, analysiert. Die Gutachtenqualität wurde sowohl quantitativ mit der Berechnung von Qualitätspunkten, als auch qualitativ durch inhaltliche Analysen erfasst. Zur Überprüfung der Beurteiler_innenübereinstimmung wurde die prozentuale Übereinstimmung und Cohens Kappa für zwei Rater_innen anhand einer Teilstichprobe (n=11) berechnet.
UNASSIGNED: Die analysierten Gutachten erreichten durchschnittlich 36,1 (SD=7,4) von 92 möglichen Qualitätspunkten (Range 22/56). In den meisten Gutachten waren die Beschreibungen der Teilhabeeinschränkungen, der Epikrise und der sozialmedizinischen Schlussbildung unbefriedigend.
UNASSIGNED:  Die unzureichende Darstellung der Funktions- und Teilhabeeinschränkungen in den Gutachten wird möglicherweise dem tatsächlichen Sachverhalt nicht gerecht, so dass der Beweis einer Gesundheitsstörung mit den entsprechenden Leistungseinschränkungen nicht zweifelsfrei erbracht werden kann. Dementsprechend sind Maßnahmen zur Verbesserung der Gutachtenqualität wie Schulungen und regelmäßige Qualitätsüberprüfungen notwendig.

Based on the theories of welfare economics, this paper analyzed the mechanism of agricultural insurance (AI) affecting agricultural economic growth (AEG), theoretically, and carried out an empirical analysis by using the random effects model and thirteen years of panel data, which included the annual data of 11 cities in Zhejiang Province, China, from 2007 to 2019. The gross output value of agriculture, forestry, animal husbandry, and fishery (GOVA) of 11 cities in Zhejiang Province is selected as the explained variable, agricultural insurance premium income (AIPI) as an explanatory variable. We selected area of waterlogging removal (AWR), rural electricity consumption (REC), total power of agricultural machinery (TPAM), and crop-sown area (CSA) as control variables. The study shows that: (1) the AIPI has a significant positive impact on the growth of GOVA. When other conditions remain unchanged, a 1% increase in AIPI increases the GOVA by 0.166%, accordingly; (2) The control variables of REC, TPAM, and CSA are statistically significant for the growth of the GOVA. The elasticity coefficient of REC is 0.325, the elastic coefficient of the TPAM is 0.287, and the elasticity coefficient of CSA is -0.281.

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The European Union (EU) has a strong reputation and track record for the development of guidelines for the ethical use of artificial intelligence (AI) generally. In this paper, we discuss the development of an AI and ethical framework by the European Insurance and Occupational Pensions Authority (EIOPA), for the European insurance market. EIOPA\'s earlier report on big data analytics (EIOPA, 2019) provided a foundation to analyze the complex range of issues associated with AI being deployed in insurance, such as behavioral insurance, parametric products, novel pricing and risk assessment algorithms, e-service, and claims management. The paper presents an overview of AI in insurance applications throughout the insurance value chain. A general discussion of ethics, AI, and insurance is provided, and a new hierarchical model is presented that describes insurance as a complex system that can be analyzed by taking a layered, multi-level approach that maps ethical issues directly to specific level(s).

Civil liability represents one of the main responsibilities for healthcare facilities; it is the legal responsibility of paying money for damage to a person\'s health. Even though this responsibility plays a key role in the economic sustainability of healthcare facilities, the literature does not enough investigate this responsibility in regional health services. The paper aims to define the evolution of compensation models for health civil liability adopted by regional health services. Through a longitudinal case study, the paper investigates the compensation model by a leading regional health service. The finding highlights the evolution of the compensation model for health civil liability adopted by a leading Regional Health Service from 1990 to 2021. It describes a transition from an insurance model to a mixed model based on self-coverage up to a set economic level, an insurance policy with self-insurance retention and deductible for all claims. The research contributes to the literature and practice throughout the definition of a compensation model for damages based on self-insurance of regional health service and insurance policies. The research promotes a compensation model used by a leading regional health service.

OBJECTIVE: As of 2019, suicide is serious problem in Korea, with the highest suicide rate among OECD countries. To reduce suicide rates Emergency Department Based Post-Suicide Attempt Case Management carried out with government funding in South Korea, but it is insufficient to address the issue. Aim of this study is to prevent suicide attempts through continuous provision of mental health services even after discharge from acute care.
METHODS: We selected 15 mental health specialists who are multidisciplinary experts in Suicide Prevention. Two-round Delphi survey was conducted on them to reach an agreement for hospital-based case management.
RESULTS: The first Delphi survey consisted of 8 areas and 39 questions. Among them, 30 questions draw agreement above the reference value. The second Delphi survey, consisted of 37 questions, resulted in 32 above-standard questions.
CONCLUSIONS: Consensus was reached in most category of the Hospital Based Case Management for Suicide High-Risk Group. Core of the developed plan was to provide services to patients who visited the hospital, pursue the stability and universalization of services through a medical insurance fee system. In the future, hospital-based case management service will be implemented as a new model contributing to the reduction of suicide rates in Korea.

This paper describes the level of knowledge on and membership in PhilHealth (Philippine Health Insurance Corporation) among Overseas Filipino Workers (OFWs). It analytically examines the sociodemographic predictors of knowledge on and membership in PhilHealth. Results reveal that 76% of the respondents involved in the study are PhilHealth members. Generally, respondents\' level of knowledge about the insurance is moderate. Results of regression analysis reveal that sex/gender (BETA = -.319) and income (BETA = .352) predict membership in PhilHealth. Meanwhile, income (BETA = .295) and marital status (BETA = -.164) predict the level of knowledge on PhilHealth. The results indicate that those with income above PhP40,000 (approximately USD785) are the ones knowledgeable about PhilHealth. Moreover, OFWs with partners are more knowledgeable about the insurance compared to those who are not married or without partners. The results offer several insights regarding PhilHealth membership among OFWs. First, OFWs with higher income tend to become members of PhilHealth. Second, women are less likely to become members, as many of them are working in the service sectors and are generally earning lower income than their male counterparts. This result indicates that women OFWs should be encouraged to become PhilHealth members, especially if their left-behind partners or husbands are not members. This is to ensure that left-behind family members will be able to access health services.