The National Health Insurance Policy Paper (NHI) that was promulgated in 2011, marks the beginning of the South African Department of Health’s journey into delivering a health system that offers universal coverage to all it’s citizens, that is free at the point of contact. (NHI, 2011) The implementation of this new health system faces many challenges such as the impact of HIV/AIDS. This research was conducted to ascertain what this impact would be according to subject matter experts in the field.Twenty interviews with experts from the different stakeholder groups were undertaken.The findings revealed that there is dire a need for a new health system to offer financial risk protection and universal coverage to all South African residents. Health Systems strengthening will form a significant part of the reformation that is needed to get the health system to work efficiently. HIV/AIDS must be monitored and managed carefully to avoid multi-drug resistant strains from emerging. An existing model has been adapted for the purposes of this study that allows focus on the various components of the health system. Each component or building block will need attention and strategic direction to ensure that the entire system can function holistically, seamlessly and efficiently. / Dissertation (MBA)--University of Pretoria, 2013. / Gordon Institute of Business Science (GIBS) / unrestricted

The subject of the thesis is to analyze the current status of insurance coverage selected municipalities, analysis and comparison of offers insurance protection of property from commercial insurance community and the proposed changes in the scope of the cover of the municipality.

Os objetivos deste trabalho foram analisar as informações contidas nas apólices de dano à pessoa em processos de sinistros de seguradoras, e propor melhorias para o atendimento de traumatizados portadores desse tipo de produto. Foram descritas as informações sobre o perfil do segurado - sexo, faixa etária e ocupação -; características do trauma - como local e etiologia do dano -; características da lesão e dos tratamentos reabilitadores; adequação dos tratamentos propostos, dos honorários e da documentação. Foram elencadas as falhas detectadas nas apólices cuja documentação apresentava-se insuficiente. O estudo abrangeu 151 processos, dos quais 132 constituiam-se em Avisos de Acidente (iniciais) e 19 em Avisos de Continuidade. Quanto aos tipos de seguros, 124 eram de Seguro Escolar, 07 de Afastamento Profissional e 01 de DPVAT. Nos processos, 84 (63,64%) segurados eram do sexo masculino e 48 (36,36%) do sexo feminino; a faixa etária predominante foi a compreendida entre 6 e 10 anos, com 42 (31,82%) casos; o local de maior ocorrência foi a área escolar (57 = 43,18%). Na etiologia do dano constatou-se que 59 (44,70%) acidentes aconteceram durante locomoções, 34 (25,76%) em atividades lúdicas, 18 (13,64%) em práticas esportivas e 16 (12,12%) em ambiente doméstico, nos três últimos dos quais as quedas ocorreram com maior freqüência. Os dados de lesões referem-se tão somente aos Avisos de Acidentes, nos quais predominaram as fraturas coronárias simples, com 94 ocorrências, e 21 acidentes geraram lesões associadas de tecidos duros e tecidos moles. Da mesma forma, os tratamentos reabilitadores só contemplam os Avisos de Acidentes, nos quais prevaleceu a dentística (112). Na análise da adequação de tratamentos propostos, dos 151 processos, 133 estavam adequados e 18 inadequados. Quanto aos honorários profissionais, 89 apresentaram valores satisfatórios e 55, valores acima dos usuais. Os 7 processos restantes eram de Afastamento Profissional, nos quais não são avaliados os custos de tratamento e sim o tempo de restabelecimento. Em relação à adequação da documentação, 74 estavam adequados e 77 não completaram a documentação requisitada. Dentre os inadequados, a principal falha foi a ausência de radiografias iniciais e/ou finais. / This dissertation aims at analyzing the data on accident claims in personal injury policies from insurance companies and at proposing improvements on the treatment of injured people who hold this kind of product. The study describes information related to the insured profile (gender, age and occupation), to the trauma (such as the place and etiology of damage), the lesion and rehabilitation treatment characteristics, as well as whether proposed treatments were adequate for the fees charged and for the documentary evidence submitted. Errors identified in policies with insufficient documentation were also listed. The study encompassed 151 claims, 132 of which were Notification of Accidents (Initial Claims) and 19 were Notification about the Eligibility for Continuity of Care. As for the kinds of insurance, 124 related to School Accident Insurances, while 07, to Professional Leave, and only 01 related to Motor Vehicle Personal Injury Insurance. In those claims, 84 (63,64%) insured were male, whereas 48 (36,36%) were female; the main age group ranged from 6 to 10 years old, totalizing 42 cases (or 31,82%). Schools were the place where the greatest number of accidents (57 = 44,53%) occurred. In the etiology of damage, it was observed that 59 accidents (44,70%) occurred during locomotion movement, 34 cases (25,76%) in playing, 18 (13,64%) during the practice of sports and 16 (12,12%) at home. In the last three types, fall accidents occurred more frequently. As for the kind of lesion, the simple fracture crown prevailed in 94 cases, whereas in 21 accidents, it were hard and soft associated lesions. In the rehabilitation treatments, dentistry prevailed in 112 proceedings. As for the suitability of proposed treatments, out of 151 claims, 133 were adequate whereas 18 were not. As far as fees for professional services were concerned, 89 were considered satisfactory, while 55 were considered overcharged. The last 7 claims were related to Professional Leave, and so what is assessed is the time to recovery and not the treatment costs. In relation to documentary evidence, 74 claims submitted proper documents, while 77 did not. The latter main error was that initial and /or final radiographic documentation was not sent to the insurance companies.

Os objetivos deste trabalho foram analisar as informações contidas nas apólices de dano à pessoa em processos de sinistros de seguradoras, e propor melhorias para o atendimento de traumatizados portadores desse tipo de produto. Foram descritas as informações sobre o perfil do segurado - sexo, faixa etária e ocupação -; características do trauma - como local e etiologia do dano -; características da lesão e dos tratamentos reabilitadores; adequação dos tratamentos propostos, dos honorários e da documentação. Foram elencadas as falhas detectadas nas apólices cuja documentação apresentava-se insuficiente. O estudo abrangeu 151 processos, dos quais 132 constituiam-se em Avisos de Acidente (iniciais) e 19 em Avisos de Continuidade. Quanto aos tipos de seguros, 124 eram de Seguro Escolar, 07 de Afastamento Profissional e 01 de DPVAT. Nos processos, 84 (63,64%) segurados eram do sexo masculino e 48 (36,36%) do sexo feminino; a faixa etária predominante foi a compreendida entre 6 e 10 anos, com 42 (31,82%) casos; o local de maior ocorrência foi a área escolar (57 = 43,18%). Na etiologia do dano constatou-se que 59 (44,70%) acidentes aconteceram durante locomoções, 34 (25,76%) em atividades lúdicas, 18 (13,64%) em práticas esportivas e 16 (12,12%) em ambiente doméstico, nos três últimos dos quais as quedas ocorreram com maior freqüência. Os dados de lesões referem-se tão somente aos Avisos de Acidentes, nos quais predominaram as fraturas coronárias simples, com 94 ocorrências, e 21 acidentes geraram lesões associadas de tecidos duros e tecidos moles. Da mesma forma, os tratamentos reabilitadores só contemplam os Avisos de Acidentes, nos quais prevaleceu a dentística (112). Na análise da adequação de tratamentos propostos, dos 151 processos, 133 estavam adequados e 18 inadequados. Quanto aos honorários profissionais, 89 apresentaram valores satisfatórios e 55, valores acima dos usuais. Os 7 processos restantes eram de Afastamento Profissional, nos quais não são avaliados os custos de tratamento e sim o tempo de restabelecimento. Em relação à adequação da documentação, 74 estavam adequados e 77 não completaram a documentação requisitada. Dentre os inadequados, a principal falha foi a ausência de radiografias iniciais e/ou finais. / This dissertation aims at analyzing the data on accident claims in personal injury policies from insurance companies and at proposing improvements on the treatment of injured people who hold this kind of product. The study describes information related to the insured profile (gender, age and occupation), to the trauma (such as the place and etiology of damage), the lesion and rehabilitation treatment characteristics, as well as whether proposed treatments were adequate for the fees charged and for the documentary evidence submitted. Errors identified in policies with insufficient documentation were also listed. The study encompassed 151 claims, 132 of which were Notification of Accidents (Initial Claims) and 19 were Notification about the Eligibility for Continuity of Care. As for the kinds of insurance, 124 related to School Accident Insurances, while 07, to Professional Leave, and only 01 related to Motor Vehicle Personal Injury Insurance. In those claims, 84 (63,64%) insured were male, whereas 48 (36,36%) were female; the main age group ranged from 6 to 10 years old, totalizing 42 cases (or 31,82%). Schools were the place where the greatest number of accidents (57 = 44,53%) occurred. In the etiology of damage, it was observed that 59 accidents (44,70%) occurred during locomotion movement, 34 cases (25,76%) in playing, 18 (13,64%) during the practice of sports and 16 (12,12%) at home. In the last three types, fall accidents occurred more frequently. As for the kind of lesion, the simple fracture crown prevailed in 94 cases, whereas in 21 accidents, it were hard and soft associated lesions. In the rehabilitation treatments, dentistry prevailed in 112 proceedings. As for the suitability of proposed treatments, out of 151 claims, 133 were adequate whereas 18 were not. As far as fees for professional services were concerned, 89 were considered satisfactory, while 55 were considered overcharged. The last 7 claims were related to Professional Leave, and so what is assessed is the time to recovery and not the treatment costs. In relation to documentary evidence, 74 claims submitted proper documents, while 77 did not. The latter main error was that initial and /or final radiographic documentation was not sent to the insurance companies.

Notion cardinale du droit des assurances car autour duquel s'organise autant l'opération que le contrat d'assurance, le risque est un terme résolument polysémique. Si ailleurs, dans d'autres domaines du Droit, cette réalité ne poserait pas véritablement de difficulté, ici, en droit des assurances il en va autrement. En effet, dans ce domaine du Droit, la polysémie exagérée du risque a fini par générer une cacophonie sémantique qui provoque des difficultés de communication et a fortiori de compréhension entre l'assureur, l'assuré, le juge, le législateur et la doctrine. Or chacun le sait : lorsque les paroles des lois n'éveillent plus chez tous les hommes les mêmes idées, l’insécurité juridique guette car le raisonnement juridique se fait alors nécessairement « à tâtons ». C'est au-devant de ce constat que l'intérêt de notre thèse point alors : en effet, au-delà des apparences, le risque assurantiel n'intègre-t-il pas à quelque échelle d'analyse la potentialité d'une conception uniformisée qui permettrait d’éveiller chez tous les hommes la même idée ? Nous allons démontrer que la réponse à cette interrogation est plus qu'affirmative. Cette donne acquise, il nous faudra alors aller au-delà du constat et en analyser au plus près les différentes répercussions au plan juridique. / Undisputably a chore notion in insurance law because of its role within the insurance mechanism and the insurance policy, the concept of « risk » is without a doubt barely polysemous. If that fact would not really matter in some other law fields, herein, in the field of insurance law, it goes differently. Indeed, in this latter field, the polysemy of the risk has tangibly generated misunderstandings between the insurance provider, the policy holder, the judge, the legislator and the doctrine. And as everyone knows, when the terms of the laws don’t really appeal to the same ideas to people, legal insecurity is wrapping as the basis of the legal reasonning is then standing on a subjective scale. Before this state of affairs, the interest of our thesis shows then up : beyond the appearances, can’t the concept of risk reveal any potentiality to a uniform conception that would appeal to the same idea to people ? We will prove that the question has definitely an affirmative answer. Hence, we should then go beyond this established fact and analyse closely the different legal impact it would drain off.

The aim of this thesis is to determine height of insurance payment caused by treefall in municipality of Zduchovice. Theoretical part consists of explanation of elementary terms used in properties and insurance industry, and of price estimation of the building – recreational cottage. Practical part consists of price estimation of the building when the insurance contract was concluded, price before the insured event occurred and total cost of repairing of damaged constructions by means of cost method. Moreover, the cost is evaluated by means of itemized budget. At the conclusion, an analysis is provided based on results found, the favourableness of the current insurance policy is assessed and the evaluation of the costs is provided based on cost method and itemized budget.

The aim of my thesis is to outline the field of the insurance-claims settlement, to determine the amount of indemnity for the damage caused by the weight of snow, and also to clarify basic concepts of real estate appraisal. In the introduction I define basic concepts associated with that topic. Then I bring the reader into the field of real estate appraisal and I define basic concepts and appraisal methods and description. In the next part of my thesis I mention the principles of the insurance company´s claim settlement activity, the products related to property insurance, the person involved in the settlement, and last but not least I outline the claim settlement process itself. However, the point is not just to provide a plain list of all steps involved in the process but to give the reader a better idea how to proceed and what the basic concepts of the field are. In the final practical part I will focus precisely on the determination of the compensation for the damage casused by the weight of snow based on reasonable costs and for bringing the insured property to its original (operational) state.

This thesis addresses the requirements and procedure for determining the amount of indemnity for a home insurance claim within the selected period of time. Introductory chapter describes general principles of insurance and types of insurance. It clarifies differences between insurance and insurance industry. Next section is devoted to the particulars of the insurance contract, one of the mandatory legislation at the conclusion of the insurance policy and, therefore, this topic received considerable attention. The work also focuses on property insurance, on the valuation methods for the liquidation of assets and, finally, discusses the basic concepts of the topic. The main chapter describes a case study of insurance claim process and indemnification process in the event of property damage. The beginning of the section describes the case study property in general. Later in the chapter it is described property appraisal throughout past decades, the event of property damage, process of determination of the amount of indemnity in accordance with the insurance contract and general insurance conditions. The final chapter focuses on the evaluation of the results and their comparison.

This thesis deals with the issues of determining the amount of insurance coverage of a house destroyed by flood. The aim of this paper is to explain the terms related to evaluation and insurance. Then to value immovable property by costs, document the damages and determine the costs for rebuilding the damaged parts in accordance with the insurance policy. It is necessary to determine the insurance value of the house. At the end of this thesis the history of floods in the particular area and flood control methods are discussed.

La subrogation est un mode privilégié de transmission des créances en assurance maritime. Elle met en présence les principaux acteurs du commerce maritime : l'assuré, l'assureur et le tiers responsable. La subrogation de l'assureur maritime a toujours bénéficié d'une faveur particulière se traduisant par la souplesse des textes juridiques aussi bien pour la subrogation légale qui s'exerce de plein droit par le seul fait de la loi, que pour la subrogation conventionnelle qui procède de la volonté des parties. Cependant, face aux exigences procédurales des juridictions, le contentieux de la subrogation tend davantage vers un durcissement. Dès lors, la question se pose de savoir s'il existe d'autres alternatives pour l'assureur maritime ? Le recours à l'arbitrage constitue une bonne solution au regard de la souplesse des sentences rendues en la matière. Aussi, la jurisprudence judiciaire fait état d'une grande évolution qui porterait les assureurs vers des moyens de droit commun, entre autres, la cession de créance, la répétition de l'indû et l'action "de in rem verso" pour pallier l'incertitude du contentieux de la subrogation. Sur le plan du droit international privé, il n'y a pas de règle spécifique à la subrogation de l'assureur maritime. Mais, les Règlements Rome I et Rome II édictent des mécanismes de conflits de lois applicables aux relations contractuelles et extra contractuelles. Ils désignent la loi qui régit la subrogation / Subrogation is a privileged mode of transmission of claims in marine insurance. It brings together key players in the maritime trade: the insured, the insurer and the third party responsible. Subrogation of the underwriter has always enjoyed a special favor resulting flexibility of legal texts both for subrogation exerted automatically by the fact of the law, for contractual subrogation which proceeds the will of the parties. However, faced with the procedural requirements of the courts, litigation of subrogation tends more toward a cure. Therefore, the question arises of whether if there are other alternatives to the underwriter? The arbitration is a good solution in terms of the flexibility of awards made in the matter. Also, judicial jurisprudence reported a great change that would insurers to ordinary means, among other things, the assignment, the repetition of the undue and action "de in rem verso" to overcome the uncertainty of litigation of subrogation. In terms of private international law, there is no specific rule of subrogation of the marine insurer. However, the Regulations Rome I and Rome II enact conflict mechanisms applicable to contractual and extra-contractual. They designate the law that governs subrogation