Academic literature on the topic 'Australian Associated Motor Insurers Management'

The prevalence of chronic disease comorbidity has increased worldwide. Comorbidity—i.e., the presence of multiple chronic diseases—is associated with adverse health outcomes in terms of mobility and quality of life as well as financial burden. Understanding the progression of comorbidities can provide valuable insights towards the prevention and better management of chronic diseases. Administrative data can be used in this regard as they contain semantic information on patients’ health conditions. Most studies in this field are focused on understanding the progression of one chronic disease rather than multiple diseases. This study aims to understand the progression of two chronic diseases in the Australian health context. It specifically focuses on the comorbidity progression of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM), as the prevalence of these chronic diseases in Australians is high. A research framework is proposed to understand and represent the progression of CVD in patients with T2DM using graph theory and social network analysis techniques. Two study cohorts (i.e., patients with both T2DM and CVD and patients with only T2DM) were selected from an administrative dataset obtained from an Australian health insurance company. Two baseline disease networks were constructed from these two selected cohorts. A final disease network from two baseline disease networks was then generated by weight adjustments in a normalized way. The prevalence of renal failure, fluid and electrolyte disorders, hypertension and obesity was significantly higher in patients with both CVD and T2DM than patients with only T2DM. This showed that these chronic diseases occurred frequently during the progression of CVD in patients with T2DM. The proposed network-based model may potentially help the healthcare provider to understand high-risk diseases and the progression patterns between the recurrence of T2DM and CVD. Also, the framework could be useful for stakeholders including governments and private health insurers to adopt appropriate preventive health management programs for patients at a high risk of developing multiple chronic diseases.

Purpose The life insurance industry has been exposed to high levels of longevity risk born from the mismatch between realized mortality trends and anticipated forecast. Annuity providers are exposed to extended periods of annuity payments. There are no immediate instruments in the market to counter the risk directly. This paper aims to develop appropriate instruments for hedging longevity risk and providing an insight on how existing products can be tailor-made to effectively immunize portfolios consisting of life insurance using a cointegration vector error correction model with regime-switching (RS-VECM), which enables both short-term fluctuations, through the autoregressive structure [AR(1)] and long-run equilibria using a cointegration relationship. The authors also develop synthetic products that can be used to effectively hedge longevity risk faced by life insurance and annuity providers who actively hold portfolios of life insurance products. Models are derived using South African data. The authors also derive closed-form expressions for hedge ratios associated with synthetic products written on life insurance contracts as this will provide a natural way of immunizing the associated portfolios. The authors further show how to address the current liquidity challenges in the longevity market by devising longevity swaps and develop pricing and hedging algorithms for longevity-linked securities. The use of a cointergrating relationship improves the model fitting process, as all the VECMs and RS-VECMs yield greater criteria values than their vector autoregressive model (VAR) and regime-switching vector autoregressive model (RS-VAR) counterpart’s, even though there are accruing parameters involved. Design/methodology/approach The market model adopted from Ngai and Sherris (2011) is a cointegration RS-VECM for this enables both short-term fluctuations, through the AR(1) and long-run equilibria using a cointegration relationship (Johansen, 1988, 1995a, 1995b), with a heteroskedasticity through the use of regime-switching. The RS-VECM is seen to have the best fit for Australian data under various model selection criteria by Sherris and Zhang (2009). Harris (1997) (Sajjad et al., 2008) also fits a regime-switching VAR model using Australian (UK and US) data to four key macroeconomic variables (market stock indices), showing that regime-switching is a significant improvement over autoregressive conditional heteroscedasticity (ARCH) and generalised autoregressive conditional heteroscedasticity (GARCH) processes in the account for volatility, evidence similar to that of Sherris and Zhang (2009) in the case of Exponential Regressive Conditional Heteroscedasticity (ERCH). Ngai and Sherris (2011) and Sherris and Zhang (2009) also fit a VAR model to Australian data with simultaneous regime-switching across many economic and financial series. Findings The authors develop a longevity swap using nighttime data instead of usual income measures as it yields statistically accurate results. The authors also develop longevity derivatives and annuities including variable annuities with guaranteed lifetime withdrawal benefit (GLWB) and inflation-indexed annuities. Improved market and mortality models are developed and estimated using South African data to model the underlying risks. Macroeconomic variables dependence is modeled using a cointegrating VECM as used in Ngai and Sherris (2011), which enables both short-run dependence and long-run equilibrium. Longevity swaps provide protection against longevity risk and benefit the most from hedging longevity risk. Longevity bonds are also effective as a hedging instrument in life annuities. The cost of hedging, as reflected in the price of longevity risk, has a statistically significant effect on the effectiveness of hedging options. Research limitations/implications This study relied on secondary data partly reported by independent institutions and the government, which may be biased because of smoothening, interpolation or extrapolation processes. Practical implications An examination of South Africa’s mortality based on industry experience in comparison to population mortality would demand confirmation of the analysis in this paper based on Belgian data as well as other less developed economies. This study shows that to provide inflation-indexed life annuities, there is a need for an active market for hedging inflation in South Africa. This would demand the South African Government through the help of Actuarial Society of South Africa (ASSA) to issue inflation-indexed securities which will help annuities and insurance providers immunize their portfolios from longevity risk. Social implications In South Africa, there is an infant market for inflation hedging and no market for longevity swaps. The effect of not being able to hedge inflation is guaranteed, and longevity swaps in annuity products is revealed to be useful and significant, particularly using developing or emerging economies as a laboratory. This study has shown that government issuance or allowing issuance, of longevity swaps, can enable insurers to manage longevity risk. If the South African Government, through ASSA, is to develop a projected mortality reference index for South Africa, this would allow the development of mortality-linked securities and longevity swaps which ultimately maximize the social welfare of life assurance policy holders. Originality/value The paper proposes longevity swaps and static hedging because they are simple, less costly and practical with feasible applications to the South African market, an economy of over 50 million people. As the market for MLS develops further, dynamic hedging should become possible.

BackgroundVideo review has become an important tool in professional sporting codes to help sideline identification and management of players with a potential concussion.AimTo assess current practices related to video review of concussion in professional sports internationally, and compare protocols and diagnostic criteria used to identify and manage potential concussions.MethodsCurrent concussion management guidelines from professional national and international sporting codes were reviewed. Specific criteria and definitions of video signs associated with concussion were compared between codes. Rules and regulations adopted across the codes for processes around video review were also assessed.ResultsSix sports with specific diagnostic criteria and definitions for signs of concussion identified on video review participated in this study (Australian football, American football, world rugby, cricket, rugby league and ice hockey). Video signs common to all sports include lying motionless/loss of responsiveness and motor incoordination. The video signs considered by the majority of sports as most predictive of a diagnosis of concussion include motor incoordination, impact seizure, tonic posturing and lying motionless. Regulatory requirements, sideline availability of video, medical expertise of video reviewers and use of spotters differ across sports and geographical boundaries. By and large, these differences reflect a pragmatic approach from each sport, with limited underlying research and development of the video review process in some instances.ConclusionsThe use of video analysis in assisting medical staff with the diagnosis or identification of potential concussion is well established across different sports internationally. The diagnostic criteria used and the expertise of the video review personnel are not clearly established, and research efforts would benefit from a collaborative harmonisation across sporting codes.

Social Return on Investment (SROI) is an internationally recognised methodology used to measure and value the economic impact of program outcomes. Like a traditional cost-benefit analysis, SROI examines economic outcomes, but also includes the social, environmental and cultural outcomes created by the investment. These outcomes are evaluated against their cost, using financial proxies to estimate their relative economic worth. SROI is particularly valuable in the indigenous natural resource management context, because of the strong ‘value’ or importance of non-economic (particularly cultural) costs and benefits. The Alinytjara Wilurara Natural Resources Management Board undertook a study of the economic, social, environmental and cultural impacts and benefits of the presence of large feral herbivores in the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, in the far north-west of South Australia. Camels, donkeys and horses present significant impacts for the community in terms of vehicle collisions, community health, damage to infrastructure and water pollution, as well as impacts on sites of cultural and spiritual significance to the local communities. With the annual cost impacts incurred by society caused by large feral herbivores in the APY lands valued at $4.2million and possible dollar value of those animals valued at $140000, the study found that there was a net cost impact of ~$4million from not managing the impact of these animals. The study also found significant cultural impacts of large feral herbivores, such as the fouling of natural springs and other culturally sensitive sites, and further analysis would be required to determine the economic cost of these impacts. Investment models that consider a broad range of costs and benefits are considered necessary for Australian rangelands, particularly Indigenous-owned land. This paper presents a case study of the development of a ranger program that employs local community members to manage the impacts of large feral herbivores that will provide a net benefit to society of ~$3million every year, aside from the additional benefits of employment and economic participation. The $3-million net benefit accrues from saving human lives and costs associated with vehicle accidents, and reduced management costs and increased income for pastoral areas of the APY Lands. APY community members, and the APY Pastoral business are core beneficiaries; however, there are several external beneficiaries that this SROI approach recognises including the Motor Accident Commission, Health Departments and South Australian Police. The strongly positive SROI in this case presents an excellent co-investment opportunity for agencies whose core focus is on road safety and health. Importantly, the SROI approach to creation of social value can be implemented in a way that is consistent with stated community aspirations for development.

IntroductionThe epidemiology, pathogenesis, management and outcomes of cerebral palsy (CP) in low-income and middle-income countries including Vietnam are unknown because of the lack of mechanisms for standardised collection of data. In this paper, we outline the protocol for developing a hospital-based surveillance system modelled on the Paediatric Active Enhanced Disease Surveillance (PAEDS) system in Australia. Using PAEDS-Vietnam we will define the aetiology, motor function and its severity, associated impairments, and nutritional and rehabilitation status of children with CP in Hanoi, Vietnam. These essential baseline data will inform future health service planning, health professional education and training, and family support.Methods and analysisThis is a hospital-based prospective surveillance of children with CP presenting to the rehabilitation, neurology and general paediatric services at the National Children’s Hospital and St Paul Hospital in Hanoi. We will use active, prospective daily case-finding for all children with CP aged <18 years who are hospitalised or present to outpatient departments. Following parental consent, data will be collected using a modified version of the Australian Cerebral Palsy Register questionnaire. The data collection form has been developed in consultation with local and international experts and translated into Vietnamese. Information collected will include demographics, maternal health and birth history, type and severity of CP, known risk factors for CP, and nutrition, immunisation, education and rehabilitation status.Ethics and disseminationThis study was approved by the Hanoi Medical University Institutional Review Board (decision no 1722) and The University of Sydney Human Research Ethics Committee (approval no 2016/456). Establishment of PAEDS-Vietnam will enable hospital-based surveillance of CP for the first time in Vietnam. It will identify preventable causes of CP, patient needs and service gaps, and facilitate early diagnosis and intervention. Study findings will be disseminated through local and international conferences and peer-reviewed publications.

Objective The primary objective of this study was to evaluate the effect of an online education program used to implement the Australian (New South Wales) whiplash guidelines with general practitioners (GP). The secondary aim was to identify factors associated with learning. Methods An online educational and evaluation activity was developed to reflect the key messages for GP from the Australian whiplash guidelines. The educational activity was hosted on the Royal Australian College of General Practitioners’ website (www.gplearning.com.au) for a period of 3 years. Participants were recruited through advertisement and media releases. Participants completed a baseline evaluation of their knowledge, participated in the interactive educational activity and completed a post-knowledge questionnaire. The primary outcome was change in professional knowledge, predictors of learning were computed using linear regression. Results Two hundred and fifteen GP participated. Knowledge significantly improved between baseline and post-knowledge questionnaire scores (P < 0.00001). A total of 57.2% of participants improved their knowledge by more than 20%, indicating a large effect. Low baseline knowledge predicted learning, accounting for 71% of the variance. Conclusions Online education of GP significantly improved their knowledge in relation to guidelines for whiplash. Those with low baseline knowledge improved their knowledge the most, suggesting that implementation strategies should be targeted at this group. What is known about the topic? Clinical guidelines are usually developed to improve knowledge and ultimately change clinical practice to reflect best practice management of that condition. However, developing and publishing guidelines alone rarely changes knowledge or clinical practice. With GP, effective implementation strategies to improve knowledge have included face to face education such as interactive educational meetings and educational outreach. However, these strategies are expensive and time consuming. Whiplash is a significant health problem in Australia, and although GP are commonly consulted for this condition, an individual GP may only see one whiplash case per year, meaning that face to face implementation strategies may not be pragmatic for this condition. What does this paper add? This paper shows that online education was effective in improving GP knowledge of clinical guidelines for whiplash. The effect was as large as the reported effects for face to face education in other studies. Importantly this paper shows that the less GP knew about whiplash, the more they learnt, indicating that the strategy was effective for those who most required the education. Finally, the online strategy reached GP in rural and remote places in Australia. This paper therefore shows that online education can be an effective method to improve GP knowledge about managing whiplash. It is hoped that it may provide the impetus to use this strategy for implementing clinical guidelines for other conditions. What are the implications for practitioners? Practitioners can be confident that using an online educational program will improve their knowledge of managing conditions they previously knew little about. It is hoped that this will translate into a change in clinical practice. For example, GP using this strategy improved knowledge in knowing when to X-ray, when to refer and what interventions to provide for people with whiplash. For any health practitioners managing whiplash access to this information is still available using the New South Wales Motor Accident Authority website (www.maa.nsw.gov.au)

e21577 Background: Response rates to PD1 inhibitors are high in unresectable locally advanced or metastatic cSCC. However, the management of cSCC patients with LN-PNI is challenging given that standard measures of disease burden and treatment response are poorly suited to PNI. This study aims to quantify radiological and symptomatic PD1 inhibitor response in cSCC LN-PNI. Methods: Patients with biopsy or radiologically confirmed cSCC LN-PNI treated with PD1 inhibitors between September 2017 and April 2021 were enrolled in this retrospective observational study. Radiological disease control (RDC) was defined as non-progressive radiological changes (including absence of proximal extension of PNI) ± partial or complete resolution on MRI or CT. A detailed symptomatic assessment was performed at every clinic visit. Progression free survival (PFS) was calculated from the time of initiating treatment to radiological disease progression (RDP). Survival was calculated using the Kaplan-Meier method and Cox regression was used to determine the effect of early symptomatic response (≤6 wks) and RDC at first staging scan (≤12 wks) on PFS. Results: Four Australian hospitals enrolled 31 cSCC LN-PNI patients (median age 75 years; M: F = 3:1), of which 29 (93.5%) had trigeminal and 9 (29.0%) had facial nerve involvement. Symptoms were present in 29 (93.5%) patients at baseline, including neuropathic pain in 24 (77.4%) and motor weakness (facial palsy or ophthalmoplegia) in 10 (32%). 16 (51.6%) patients had prior surgery or radiotherapy, but none received prior systemic therapy for LN-PNI. RDC on first restaging (6-12 wks) was observed in 28 (90.3%) patients and symptomatic improvement was seen in 23 (79.3%) amongst the 29 symptomatic at presentation. At a median follow-up of 18.7 months, patients with RDC on first restaging scan had a 24-month PFS of 84.2% versus 25% with RDP (p < 0.001, HR = 0.086, 95% CI = 0.018 to 0.403). Symptomatic response at 6 wks was associated with superior 12-month PFS (94.7% versus 55.6%, p < 0.01, HR = 0.068; 95% CI 0.008 to 0.584). There was high concordance (89.6%) between symptomatic and radiological control (Cohen’s Κ = 0.61, χ2 = 8.0023, p-value = 0.0047). Ocular toxicity was seen in 5 patients (16.1%), with corneal ulceration in 2 patients which was higher than expected but otherwise, toxicity profile was consistent with PD-1 inhibitors. Conclusions: These results demonstrate high response rates of PD1 inhibitors in patients with cSCC LN-PNI with acceptable toxicity and durability of response. Early symptomatic improvement within 6 wks and RDC on the first staging scan were significant markers of durable treatment response. PD1 inhibitors are active in patients with LN-PNI and should be considered for the treatment of cSCC with LN-PNI.

Objectives: Cognitive impairment impacts negatively on Parkinson's disease (PD) patient and caregiver quality of life (QoL). We examined cognitive impairment in PD patients and their caregivers to determine if caregiver cognition affected their PD relative.Methods: Validated cognition and clinical outcome measures were assessed in 103 PD patients and 81 caregivers.Results: PD patients showed more cognitive impairment than their carers, with 48.6% having possible Mild Cognitive Impairment (MCI) and 16.5% having PD dementia. Increasing age, male gender, lower education level, various non-motor symptoms and certain therapies, associated with poorer cognition in PD. Eighteen and a half percent of caregivers were found to have MCI, in association with a lower physical and mental QoL. This reflected in lower QoL and mood for the respective PD patients.Conclusion: Impaired cognition and QoL in caregivers was associated with decreased QoL and mood for respective PD patients, suggesting MCI in caregivers is an important consideration for the management of PD.