Quality-based benefit design in health insurance : the impact of a product benefit design change on the utilisation of oral health services by members of a private health insurance fund in regional and rural New South Wales, Australia

Objective: To examine the impact on dental utilisation following the introduction of a participating provider scheme (Regional and Rural Oral Health Program {RROHP)). In this model dentists receive higher third party payments from a private health insurance fund for delivering an agreed range of preventive and diagnostic benefits at no out-ofpocket cost to insured patients. Data source/Study setting: Hospitals Contribution Fund of Australia (HCF) dental claims for all members resident in New South Wales over the six financial years from l99811999 to 200312004. Study design: This cohort study involves before and after analyses of dental claims experience over a six year period for approximately 81,000 individuals in the intervention group (HCF members resident in regional and rural New South Wales, Australia) and 267,000 in the control group (HCF members resident in the Sydney area). Only claims for individuals who were members of HCF at 31 December 1997 were included. The analysis groups claims into the three years prior to the establishment of the RROHP and the three years subsequent to implementation. Data collection/Extraction methods: The analysis is based on all claims submitted by users of services for visits between 1 July 1988 and 30 June 2004. In these data approximately 1,000,000 services were provided to the intervention group and approximately 4,900,000 in the control group. Principal findings: Using Statistical Process Control (SPC) charts, special cause variation was identified in total utilisation rate of private dental services in the intervention group post implementation. No such variation was present in the control group. On average in the three years after implementation of the program the utilisation rate of dental services by regional and rural residents of New South Wales who where members of HCF grew by 12.6%, over eight times the growth rate of 1.5% observed in the control group (HCF members who were Sydney residents). The differences were even more pronounced in the areas of service that were the focus of the program: diagnostic and preventive services. Conclusion: The implementation of a benefit design change, a participating provider scheme, that involved the removal of CO-payments on a defined range of preventive and diagnostic dental services combined with the establishment and promotion of a network of dentists, appears to have had a marked impact on HCF members' utilisation of dental services in regional and rural New South Wales, Australia.

Assessment by interview and portfolio in a Graduate School Program

Assessment plays an integral role in teaching and learning in Higher Education and teachers have a strong interest in debates and commentaries on assessment as and for learning. In a one-year graduate entry teacher preparation program, the temptation is to emphasize assessment in an attempt to ensure students “cover” everything as part of a robust preparation for the profession. The risk is that, for students, assessment drives curriculum, and time spent in the completion of assignments is no guarantee of either effective learning or authentic preparation for teaching. Interviews as assessment provide an opportunity for a learning experience as well as an authentic task, since students will shortly be interviewing for employment in a “real world” situation. This paper reports on a project experimenting with interview panels as authentic assessment with pre-service early childhood teachers. At the end of their first semester of study, students enrolled in the Graduate Diploma of Education program at the Queensland University of Technology in Australia were required to participate in a panel interview where they were graded by a panel made up of three faculty staff and one undergraduate student enrolled in the four-year Bachelor of Education program. Students and panel members completed a questionnaire on their experience after the interview. Results indicated that both students and staff valued the experience and felt it was authentic. Results are discussed in terms of how the assessment interview and portfolio presentation supports graduating students in their preparation for employment interviews, and how this authentic assessment task has benefits for both students and teaching staff.

Towards a service portfolio management framework

Services in the form of business services or IT-enabled (Web) Services have become a corporate asset of high interest in striving towards the agile organisation. However, while the design and management of a single service is widely studied and well understood, little is known about how a set of services can be managed. This gap motivated this paper, in which we explore the concept of Service Portfolio Management. In particular, we propose a Service Portfolio Management Framework that explicates service portfolio goals, tasks, governance issues, methods and enablers. The Service Portfolio Management Framework is based upon a thorough analysis and consolidation of existing, well-established portfolio management approaches. From an academic point of view, the Service Portfolio Management Framework can be positioned as an extension of portfolio management conceptualisations in the area of service management. Based on the framework, possible directions for future research are provided. From a practical point of view, the Service Portfolio Management Framework provides an organisation with a novel approach to managing its emerging service portfolios.

Insurance : The Laws of Australia

Insurance - the laws of Australia provides insurance practitioners, insurance companies and students with a principles-based, practical guide to insurance law in Australia. It provides comprehensive coverage and analysis of common law principles relating to, and the statutory regulation of, insurance contracts and the operation of an insurance business. The common law and statutory provisions are dealt within the context of marine, life and general insurance.

Developing authentic achievement for disengaged young people using an electronic portfolio system

Credentials are a salient form of cultural capital and if a student’s learning and productions are not assessed, they are invisible in current social systems of education and employment. In this field, invisible equals non-existent. This paper arises from the context of an alternative education institution where conventional educational assessment techniques currently fail to recognise the creativity and skills of a cohort of marginalised young people. In order to facilitate a new assessment model an electronic portfolio system (EPS) is being developed and trialled to capture evidence of students’ learning and their productions. In so doing a dynamic system of arranging, exhibiting, exploiting and disseminating assessment data in the form of coherent, meaningful and valuable reports will be maintained. The paper investigates the notion of assessing development of creative thinking and skills through the means of a computerised system that operates in an area described as the efield. A model of the efield is delineated and is explained as a zone existing within the internet where free users exploit the cloud and cultivate social and cultural capital. Drawing largely on sociocultural theory and Bourdieu’s concepts of field, habitus and capitals, the article positions the efield as a potentially productive instrument in assessment for learning practices. An important aspect of the dynamics of this instrument is the recognition of teachers as learners. This is seen as an integral factor in the sociocultural approach to assessment for learning practices that will be deployed with the EPS. What actually takes place is argued to be assessment for learning as a field of exchange. The model produced in this research is aimed at delivering visibility and recognition through an engaging instrument that will enhance the prospects of marginalised young people and shift the paradigm for assessment in a creative world.

Some critical legal issues affecting insurance transaction globally

Increasingly, major insurers and reinsurers are operating on a global basis. For example, General Re Corporation and Cologne Re operate in almost 150 countries : see "General Re Corporation 1999 Annual Report". This is also true for the world's major brokers, and the emergence of large broking conglomerates such as Aon and Marsh are good examples of global service providers. Against the background of this increasingly global insurance market with global participants, there are a range of common legal issues in this article but a selection of certain critical matters are canvassed in the secitons below. First there are a range of regulatory issues that must be addressed. Secondly globalisation of the industry does create added incentive for a common legal regime to cover the formation of insurance transactions and the resolution of disputes about claims, coverage and termination. In this contect codifcation of insurance laws is a critical issue. Thirdly, major advances in genetic research and biotechnology over recent years have resulted in a dramatic increase in the availability of genetic testing. These developments have given rise to concerns worldwide about the potential for misuse of genetic information by third parties such as insurers and employers. Fourthly, the essence of an insurance transaction is the transference of risk from one person to anther. It is generally accepted that this transference should occur in informed circumstances and without undue advantage being bestowed upon either party. Finally this article will consider some legal matter in relation to transacting insurance on the internet

Fraudulent insurance claims : recent legal developments

Insurance fraud continues to be a major problem worldwide. This article will canvass recent legal developments in relation to selected issues and matters of particular concern to the insurance industry. This article is confined to fraudulent claims. Fraud may arise at various points in the insurance relationship, including initial fraud on placement and fraudulent breach of contract by the assured. Fraud at the outset by the assured is treated differently from innocent or negligent conduct. "Fraud" in the context of this paper embraces all claims where an insured intednds to deceive an insurer by getting out i money to which the insured knew he had no right. This article will examine fraudulent insurance claims.

Respecting contractual intentions : balancing consumer expectations with the sanctity of contract in the context of standard form insurance contracts

It is the purpose of this article to examine the means curently available to judges to achieve a workable balance between providing appropriate consumer protection to signatories of standard form contractors while still retaining adequate respect for the sanctity of contract, and, based on this analysis, to determine whether a significantly greater scope of contract (re)construction is likely to become the norm in most common law jurisdictions in the coming decades.

Disclosure in insurance law : contemporary and historical economic considerations

This article examines the importance of accurate classification and identification of risk with particular reference to the problem of adverse selection. It is argued that, historically, this concern was the paramount consideration influencing standard form contract formation and disclosure laws. The scope of its relevance today however is less apparent in that contemporary insurance contracting is conducted in a vastly different environment from that which prevailed at the time Lloyd's was better known as a coffee house. Accordingly, the second part of this article looks at the contemporary framework of information disclosure and those dynamics within it designed to elicit information weighing on risk forecasting : specifically, (a) direct inquiry and testing requirements; (b) signaling - or incentive based structuring of insurance contractual and (c) bargaining in the shadow of the utmost good faith doctrine. Finally, certain conclusions arising out of contemporary and historical economic considerations underpinning disclosure in insurance law are outlined.

Utmost good faith in insurance : reform overdue?

Considerable attention has been devoted to the duty or doctrine of utmost good faith in the academic literature and in the courts. This attention ranges from an analysis of the precise legal basis for the duty through a consideration of the continuing nature of that duty in the post-contract environment.It is quite clear that all contracts of insurance are subject to this duty of utmost good faith. What is less clear and certain are the incidents attendant upon such a duty and the scope of the obligations that such a duty imposes. This article examines the relative positions that have been reached in England and Australia and concludes with some recommendations for legislative reform to this area of the law.

Regulatory approaches to genetic testing in insurance

Rapid advancements in the field of genetic science have engendered considerable debate, speculation, misinformation and legislative action worldwide. While programs such as the Human Genome Project bring the prospect of seemingly miraculous medical advancements within imminent reach, they also create the potential for significant invasions of traditional areas of privacy and human dignity through laying the potential foundation for new forms of discrimination in insurance, employment and immigration regulation. The insurance industry, which has of course, traditionally been premised on discrimination as part of its underwriting process, is proving to be the frontline of this regulatory battle with extensive legislation, guidelines and debate marking its progress.

Disclosure under the prescribed insurance contracts regime : Section 35 of the Insurance Contracts Act 1984 and consumer protection revisited

Section 35 of the Insurance Contracts Act 1984 requires insurers offering insurance policies in six prescribed areas "to clearly inform" prospective insureds of any departure their policies may constitute from the standard covers established by the Act and its accompanying Regulations. This prescribed insurance contracts regime was designed to remedy comprehension problems generated by the length and complexity of insurance documents and to alleviate misunderstanding over the terms and conditions of individual policies. This article examines the rationale underpinning s 35 and the prescribed insurance contracts regime and looks at the operation of the legislation with particular reference to home contents insurance in Australia. It is argued that the means whereby disclosure of derogation from standard cover may be effected largely negates the thrust of the prescribed insurance contract reform. Recommendations to address these operational deficiencies are made.

The insured's non-disclosure in the formation of insurance contracts : a comparative perspective

The requirements that an insured disclose all facts material to a transaction as well as not misrepresent material facts in the formation of an insurance contract are universal requirements of insurance law. The nature and extent of these obligations varies from one jurisdiction to the next. Disclosure in the insurance context is distinct from the general approach in commercial contracts, and in others between persons dealing at arm's length. It is the purpose of this article therefore to examine, on a comparative basis, the approaches adopted in the Anglo-Commonwealth context of England, Australia New Zealand and Singapore to the resolution of disclose issues in the formation of insurance contracts. Particular attention is focused on the Insurance Contracts Act 1984 (Australia) as this statue effects the most significant overhaul of the common law and the National Consumer Council in the United Kingdom has advocated that similar reforms be adopted.

Disclosure and concealment in consumer insurance contracts

This book provides an in-depth examination of the theoretical,legal, social and economic foundations to disclosure and concealment of information in relation to the formation of consumer insurance contracts. A comparative treatment of this issue is undertaken with particular attention given to the judicial and legislative approaches adopted in the United Kingdom, the United States of America, Australia and New Zealand.