Mysteries of insurances in Nepal

Mysteries of insurances in Nepal
What insurance is Nepal?
Why we have to so insurance?
Insurance companies in Nepal
Should we really have to do insurance?
What are the insurance terms and conditions and is insurance possible to the poor people

National Life & General Insurance Co. Ltd.
GPO Box 4332
Lazimpat, Kathmandu
Tel: 412625

Structural View of insurances in some of nepali life insurance company
• Home
आवरण पृष्ठ
• About Us
हाम्रो बारे
o Background
पृष्ठभूमी
o Constitution of Board
समितिको गठन
o Function, Duties & Power
काम, कर्त्यब्य र अधिकार
o Mission, Goal and Objectives
मिसन, लक्ष्य र उद्देश्य
• Human Resources
मानव साधन
o Chairman & Board Members
समितिका अध्यक्ष तथा सदस्यहरु
o Officials
अधिकृतहरु
o Ex Chairmen
पूर्व अध्यक्षहरु
o Organizational Structure
संगठनात्मक संरचना
• Sectoral Institution
क्षेत्रगत संस्थाहरु
o Pooling Agency
पुलिङ संस्था
o Life Insurance Company
जीबन बीमा कम्पनी
o Non Life Insurance Company
निर्जीवन बीमा कम्पनी
o Institutional Surveyor
संस्थागत सर्भेयर
o Personal Surveyor
ब्यक्तिगत सर्भेयर
o Institutional Agent
संस्थागत अभिकर्ता
o Personal Agent
ब्यक्तिगत अभिकर्ता
o Professional Organization
पेशागत संगठन
• Laws
कानून
o Insurance Act-1992
बीमा ऐन २०४९
o Insurance Regulation-1993
बीमा नियमाबली २०४९
o Policies
नीति
o Directives
निर्देशन
• Training
तालिम
o Insurance Agents
बीमा अभिकर्ता
o Insurance Surveyors
बीमा सर्भेयर
o Miscellaneous
बिविध
• Libraries
पुस्तकालय
o Annual Report of BS
बीमा समितिको बार्षिक प्रतिबेदन
o Annual Programme
बार्षिक कार्यक्रम
o Insurance in Plan
योजनामा बीमा
o History of Beema Samiti
बीमा समितिको इतिहास
o Glossary
प्राबिधिक शब्दावली
o Booklets
बीमा पुस्तिका
o Miscellaneous
बिबिध
• FAQ
प्राय: सोधिने प्रश्नहरु

Notice of Training of Agent (अभिकर्ताको तालिमको सूचना) बीमा सर्भेयरको तालिमको सूचना (Notice of Insurance Surveyors Training)

• Initial Draft of the Prop.Ins. Act, 2009
प्रस्तावित बीमा ऐनको प्रारम्भिक मस्यौदा, २०६६
• Contact
संपर्क
• Notice
सूचना
• Statistics
तथ्यान्क
• Citizen Charter
नागरिक बडापत्र
• Site Map
साइट म्याप
• Location of Beema Samiti
बीमा समितिको नक्सा
• Roster of Approved Chartered Accountants
स्वीकृत चार्टर्ड एकाउण्टेण्टको सूची
• Insurance News and Views
बीमा समाचार र बिचार
• Downloads
डाउन्लोड
• Related Links
सम्बन्धित लिक
• Gallery
ग्यालरी
• Feedback
तपाईँको प्रतिक्रिया

Beema Samiti (Insurance Board) an autonomous body, established to develop, systemize, regularize and regulate the insurance business of Nepal under Insurance Act, 1992.

Beema Samiti (Insurance Board) Chabahil, Kathmandu
Phone: 977-1-4810818, 977-1-4810989
Fax: 977-1-4810490
Toll Free No. 1660-01-56789

बीमा समिति नेपालको बीमा ब्यवसायलाई ब्यवस्थित, बिकसित, नियमित र नियन्त्रित गर्नको लागि बीमा ऐन, २०४९ अनुसार स्थापना गरिएको एक श्वशासित संस्था हो ।




बीमा समिति, चाबहिल, काठमाण्डौं
फोन नं : ९७७-१-४८१०८१८, ९७७-१-४८१०९८९
फ्याक्स : ९७७-१-४८१०४९०
निशुल्क फोन नं : १६६०-०१-५६७८९



1. Insurance - Wikipedia, the free encyclopedia
In law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined ...
en.wikipedia.org/wiki/Insurance - Cached - Similar
2. Health insurance - Wikipedia, the free encyclopedia
Health insurance, like other forms of insurance, is a form of collectivism by means of which people collectively pool their risk, in this case the risk of ...
en.wikipedia.org/wiki/Health_insurance - Cached - Similar
Show more results from en.wikipedia.org
3. Beema Samiti (Insurance Board)
Beema Samiti (Insurance Board) an autonomous body, established to develop, systemize, regularize and regulate the insurance business of Nepal under ...
www.bsib.org.np
4. Insurance Articles,Calculators,Tools,& Advice - Insurance on Yahoo ...
Insurance - Articles, Calculators, Tools, and Advice at Yahoo! Personal Finance.
finance.yahoo.com/insurance -
5. Insurance companies in Nepal
Premier Insurance Company (Nepal) Limited has emerged as a renowned general insurance company of the second generation. The company has earned a reputation ...
www.suryasun.com/insurance-nepal.html
United Insurance Co. (Nepal) Ltd.
United Insurance Co. (Nepal) Limited is an ISO 9001:2000 certified insurance company. The company has started its operation from December 1, 1993 (Mangsir ...
www.unitedinsurance.com.np/
6. Siddhartha Insurance Ltd.
Siddhartha Insurance limited is a newly established General Insurance duly registered with Govt of Nepal & Beema Samati (Controller of Insurance) has issued ...
www.siddharthainsurance.com
7. Industry:Insurance
The insurance company assumes all financial responsibility associated with ... Life insurance deals with policies that are written to hedge against the risk ...
www.wikinvest.com/industry/Insurance
Get free insurance quotes and rates for auto, health, home and ...
I'm expecting a baby. What insurance issues should my spouse and I look at? Can I deduct the cost of my auto insurance premiums from my income taxes? ...
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8. American International Group, Inc. - Corporate Information
... previously announced agreement with Prudential plc for Prudential to acquire AIG's wholly owned pan-Asian life insurance subsidiary AIA Group Limited. ...
9. Images for insurance
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1. Study Insurance in the UK
Study where the world does business
Cass Business School
www.cass.city.ac.uk/undergrad



Insurance
From Wikipedia, the free encyclopedia
In law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer is a company selling the insurance; an insured or policyholder is the person or entity buying the insurance policy. The insurance rate is a factor used to determine the amount to be charged for a certain amount of insurance coverage, called the premium. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.
The transaction involves the insured assuming a guaranteed and known relatively small loss in the form of payment to the insurer in exchange for the insurer's promise to compensate (indemnify) the insured in the case of a large, possibly devastating loss. The insured receives a contract called the insurance policy which details the conditions and circumstances under which the insured will be compensated.
Contents
[hide]
• 1 Principles
o 1.1 Insurability
o 1.2 Legal
o 1.3 Indemnification
• 2 Effects
• 3 Insurers' business model
o 3.1 Underwriting and investing
o 3.2 Claims
• 4 History of insurance
• 5 Types of insurance
o 5.1 Auto insurance
o 5.2 Home insurance
o 5.3 Health
o 5.4 Accident, Sickness and Unemployment Insurance
o 5.5 Casualty
o 5.6 Life
o 5.7 Property
o 5.8 Liability
o 5.9 Credit
o 5.10 Other types
o 5.11 Insurance financing vehicles
o 5.12 Closed community self-insurance
• 6 Insurance companies
• 7 Global insurance industry
• 8 Controversies
o 8.1 Religious concerns
o 8.2 Insurance insulates too much
o 8.3 Complexity of insurance policy contracts
o 8.4 Redlining
o 8.5 Insurance patents
o 8.6 The insurance industry and rent seeking
• 9 See also
• 10 Notes
• 11 Bibliography
• 12 External links



Financial market

Participants

Corporate finance

Personal finance

Public finance

Banks and banking

Financial regulation

Insurance involves pooling funds from many insured entities (known as exposures) in order to pay for relatively uncommon but severely devastating losses which can occur to these entities. The insured entities are therefore protected from risk for a fee, with the fee being dependent upon the frequency and severity of the event occurring. In order to be insurable, the risk insured against must meet certain characteristics in order to be an insurable risk. Insurance is a commercial enterprise and a major part of the financial services industry, but individual entities can also self-insure through saving money for possible future losses.
Insurability
Main article: Insurability
Risk which can be insured by private companies typically share seven common characteristics
1. Large number of similar exposure units. Since insurance operates through pooling resources, the majority of insurance policies are provided for individual members of large classes, allowing insurers to benefit from the law of large numbers in which predicted losses are similar to the actual losses. Exceptions include Lloyd's of London, which is famous for insuring the life or health of actors, actresses and sports figures. However, all exposures will have particular differences, which may lead to different rates.
2. Definite Loss. The loss takes place at a known time, in a known place, and from a known cause. The classic example is death of an insured person on a life insurance policy. Fire, automobile accidents, and worker injuries may all easily meet this criterion. Other types of losses may only be definite in theory. Occupational disease, for instance, may involve prolonged exposure to injurious conditions where no specific time, place or cause is identifiable. Ideally, the time, place and cause of a loss should be clear enough that a reasonable person, with sufficient information, could objectively verify all three elements.
3. Accidental Loss. The event that constitutes the trigger of a claim should be fortuitous, or at least outside the control of the beneficiary of the insurance. The loss should be ‘pure,’ in the sense that it results from an event for which there is only the opportunity for cost. Events that contain speculative elements, such as ordinary business risks, are generally not considered insurable.
4. Large Loss. The size of the loss must be meaningful from the perspective of the insured. Insurance premiums need to cover both the expected cost of losses, plus the cost of issuing and administering the policy, adjusting losses, and supplying the capital needed to reasonably assure that the insurer will be able to pay claims. For small losses these latter costs may be several times the size of the expected cost of losses. There is little point in paying such costs unless the protection offered has real value to a buyer.
5. Affordable Premium. If the likelihood of an insured event is so high, or the cost of the event so large, that the resulting premium is large relative to the amount of protection offered, it is not likely that anyone will buy insurance, even if on offer. Further, as the accounting profession formally recognizes in financial accounting standards, the premium cannot be so large that there is not a reasonable chance of a significant loss to the insurer. If there is no such chance of loss, the transaction may have the form of insurance, but not the substance. (See the U.S. Financial Accounting Standards Board standard number 113)
6. Calculable Loss. There are two elements that must be at least estimable, if not formally calculable: the probability of loss, and the attendant cost. Probability of loss is generally an empirical exercise, while cost has more to do with the ability of a reasonable person in possession of a copy of the insurance policy and a proof of loss associated with a claim presented under that policy to make a reasonably definite and objective evaluation of the amount of the loss recoverable as a result of the claim.
7. Limited risk of catastrophically large losses. Insurable losses are ideally independent and non-catastrophic, meaning that the one losses do not happen all at once and individual losses are not severe enough to bankrupt the insurer; insurers may prefer to limit their exposure to a loss from a single event to some small portion of their capital base, on the order of 5 percent. Capital constrains insurers' ability to sell earthquake insurance as well as wind insurance in hurricane zones. In the U.S., flood risk is insured by the federal government. In commercial fire insurance it is possible to find single properties whose total exposed value is well in excess of any individual insurer’s capital constraint. Such properties are generally shared among several insurers, or are insured by a single insurer who syndicates the risk into the reinsurance market.
Legal
When a company insures an individual entity, there are basic legal requirements. Several commonly cited legal principles of insurance include
1. Indemnity – the insurance company indemnifies, or compensates the insured in the case of certain losses only up to the insured's interest
2. Insurable interest – the insured typically must directly suffer from the loss. Insurable interest must exist whether property insurance or insurance on a person is involved. The concept requires that the insured have a "stake" in the loss or damage to the life or property insured. What that "stake" is will be determined by the kind of insurance involved and the nature of the property ownership or relationship between the persons.
3. Utmost good faith – the insured and the insurer are bound by a good faith bond of honesty and fairness
4. Contribution – insurers which have similar obligations to the insured contribute in the indemnification, according to some method
5. Subrogation – the insurance company acquires legal rights to pursue recoveries on behalf of the insured; for example, the insurer may sue those liable for insured's loss
6. Causa Proxima or Proximate Cause – the cause of loss (the "peril") must be covered under the insuring agreement of the policy, and dominant cause must not be excluded
Indemnification
Main article: Indemnity
To "indemnify" means to make whole again, or to be put in the position that one was in, to the extent possible, prior to the happening of a specified event or peril. Accordingly, life insurance is generally not considered to be indemnity insurance, but rather "contingent" insurance (i.e., a claim arises on the occurrence of a specified event). There are generally two types of insurance contracts that seek to indemnify an insured:
1. an "indemnity" policy and
2. a "pay on behalf" or "on behalf of"[4] policy.
The difference is significant on paper, but rarely material in practice.
An "indemnity" policy will never pay claims until the insured has paid out of pocket to some third party; for example, a visitor to the home slips on a floor that you left wet and sues you for $10,000 and wins. Under an "indemnity" policy the homeowner would have to come up with the $10,000 to pay for the visitor's fall and then would be "indemnified" by the insurance carrier for the out of pocket costs (the $10,000)
Under the same situation, a "pay on behalf" policy, the insurance carrier would pay the claim and the insured (the homeowner) would not be out of pocket for anything. Most modern liability insurance is written on the basis of "pay on behalf" language.
An entity seeking to transfer risk (an individual, corporation, or association of any type, etc.) becomes the 'insured' party once risk is assumed by an 'insurer', the insuring party, by means of a contract, called an insurance 'policy'. Generally, an insurance contract includes, at a minimum, the following elements: the parties (the insurer, the insured, the beneficiaries), the premium, the period of coverage, the particular loss event covered, the amount of coverage (i.e., the amount to be paid to the insured or beneficiary in the event of a loss), and exclusions (events not covered). An insured is thus said to be "indemnified" against the loss covered in the policy.
When insured parties experience a loss for a specified peril, the coverage entitles the policyholder to make a 'claim' against the insurer for the covered amount of loss as specified by the policy. The fee paid by the insured to the insurer for assuming the risk is called the 'premium'. Insurance premiums from many insureds are used to fund accounts reserved for later payment of claims—in theory for a relatively few claimants—and for overhead costs. So long as an insurer maintains adequate funds set aside for anticipated losses (i.e., reserves), the remaining margin is an insurer's profit.
Effects
Insurance can have various effects on society through the way that it changes who bears the cost of losses and damage. It can increase fraud. On the other hand, it can help societies and individuals prepare for catastrophes and mitigate the effects of catastrophes on both households and societies.
Insurance can influence the probability of losses through moral hazard, insurance fraud, and preventive steps by the insurance company. Insurance scholars have typically used morale hazard to refer to the increased loss due to unintentional carelessness and moral hazard to refer to increased risk due to intentional carelessness or indifference.[6] Insurers attempt to address carelessness through inspections, policy provisions requiring certain types of maintenance, and possible discounts for loss mitigation efforts. While in theory insurers could encourage investment in loss reduction, some commentators have argued that in practice insurers had historically not aggressively pursued loss control measures - particularly to prevent disaster losses such as hurricanes - because of concerns over rate reductions and legal battles. However, beginning around 1996 insurers began to take a more active role in loss mitigation through building codes
Insurers' business model
Underwriting and investing
The business model can be reduced to a simple equation: Profit = earned premium + investment income - incurred loss - underwriting expenses
Insurers make money in two ways:
1. Through underwriting, the process by which insurers select the risks to insure and decide how much in premiums to charge for accepting those risks;
2. By investing the premiums they collect from insured parties.
The most complicated aspect of the insurance business is the underwriting of policies. Using a wide assortment of data, insurers predict the likelihood that a claim will be made against their policies and price products accordingly. To this end, insurers use actuarial science to quantify the risks they are willing to assume and the premium they will charge to assume them. Data is analyzed to fairly accurately project the rate of future claims based on a given risk. Actuarial science uses statistics and probability to analyze the risks associated with the range of perils covered, and these scientific principles are used to determine an insurer's overall exposure. Upon termination of a given policy, the amount of premium collected and the investment gains thereon minus the amount paid out in claims is the insurer's underwriting profit on that policy. Of course, from the insurer's perspective, some policies are "winners" (i.e., the insurer pays out less in claims and expenses than it receives in premiums and investment income) and some are "losers" (i.e., the insurer pays out more in claims and expenses than it receives in premiums and investment income); insurance companies essentially use actuarial science to attempt to underwrite enough "winning" policies to pay out on the "losers" while still maintaining profitability.
An insurer's underwriting performance is measured in its combined ratio[8] which is the ratio of losses and expenses to earned premiums. A combined ratio of less than 100 percent indicates underwriting profitability, while anything over 100 indicates an underwriting loss. A company with a combined ratio over 100% may nevertheless remain profitable due to investment earnings.
Insurance companies earn investment profits on “float”. “Float” or available reserve is the amount of money, at hand at any given moment, that an insurer has collected in insurance premiums but has not paid out in claims. Insurers start investing insurance premiums as soon as they are collected and continue to earn interest or other income on them until claims are paid out. The Association of British Insurers (gathering 400 insurance companies and 94% of UK insurance services) has almost 20% of the investments in the London Stock Exchange.[9]
In the United States, the underwriting loss of property and casualty insurance companies was $142.3 billion in the five years ending 2003. But overall profit for the same period was $68.4 billion, as the result of float. Some insurance industry insiders, most notably Hank Greenberg, do not believe that it is forever possible to sustain a profit from float without an underwriting profit as well, but this opinion is not universally held.
Naturally, the “float” method is difficult to carry out in an economically depressed period. Bear markets do cause insurers to shift away from investments and to toughen up their underwriting standards. So a poor economy generally means high insurance premiums. This tendency to swing between profitable and unprofitable periods over time is commonly known as the "underwriting" or insurance cycle.[10]
Property and casualty insurers currently make the most money from their auto insurance line of business. Generally better statistics are available on auto losses and underwriting on this line of business has benefited greatly from advances in computing. Additionally, property losses in the United States, due to unpredictable natural catastrophes, have exacerbated this trend.
Claims
Claims and loss handling is the materialized utility of insurance; it is the actual "product" paid for, though one hopes it will never need to be used. Claims may be filed by insureds directly with the insurer or through brokers or agents. The insurer may require that the claim be filed on its own proprietary forms, or may accept claims on a standard industry form such as those produced by ACORD.
Insurance company claims departments employ a large number of claims adjusters supported by a staff of records management and data entry clerks. Incoming claims are classified based on severity and are assigned to adjusters whose settlement authority varies with their knowledge and experience. The adjuster undertakes a thorough investigation of each claim, usually in close cooperation with the insured, determines if coverage is available under the terms of the insurance contract, and if so, the reasonable monetary value of the claim, and authorizes payment. Adjusting liability insurance claims is particularly difficult because there is a third party involved, the plaintiff, who is under no contractual obligation to cooperate with the insurer and may in fact regard the insurer as a deep pocket. The adjuster must obtain legal counsel for the insured (either inside "house" counsel or outside "panel" counsel), monitor litigation that may take years to complete, and appear in person or over the telephone with settlement authority at a mandatory settlement conference when requested by the judge.
If a claims adjuster suspects underinsurance, the condition of average may come into play to limit the insurance company's exposure.
In managing the claims handling function, insurers seek to balance the elements of customer satisfaction, administrative handling expenses, and claims overpayment leakages. As part of this balancing act, fraudulent insurance practices are a major business risk that must be managed and overcome. Disputes between insurers and insureds over the validity of claims or claims handling practices occasionally escalate into litigation; see insurance bad faith.
History of insurance
Main article: History of insurance
In some sense we can say that insurance appears simultaneously with the appearance of human society. We know of two types of economies in human societies: money economies (with markets, money, financial instruments and so on) and non-money or natural economies (without money, markets, financial instruments and so on). The second type is a more ancient form than the first. In such an economy and community, we can see insurance in the form of people helping each other. For example, if a house burns down, the members of the community help build a new one. Should the same thing happen to one's neighbour, the other neighbours must help. Otherwise, neighbours will not receive help in the future. This type of insurance has survived to the present day in some countries where modern money economy with its financial instruments is not widespread.
Turning to insurance in the modern sense (i.e., insurance in a modern money economy, in which insurance is part of the financial sphere), early methods of transferring or distributing risk were practised by Chinese and Babylonian traders as long ago as the 3rd and 2nd millennia BC, respectively.[11] Chinese merchants travelling treacherous river rapids would redistribute their wares across many vessels to limit the loss due to any single vessel's capsizing. The Babylonians developed a system which was recorded in the famous Code of Hammurabi, c. 1750 BC, and practised by early Mediterranean sailing merchants. If a merchant received a loan to fund his shipment, he would pay the lender an additional sum in exchange for the lender's guarantee to cancel the loan should the shipment be stolen or lost at sea.
Achaemenian monarchs of Ancient Persia were the first to insure their people and made it official by registering the insuring process in governmental notary offices. The insurance tradition was performed each year in Norouz (beginning of the Iranian New Year); the heads of different ethnic groups as well as others willing to take part, presented gifts to the monarch. The most important gift was presented during a special ceremony. When a gift was worth more than 10,000 Derrik (Achaemenian gold coin) the issue was registered in a special office. This was advantageous to those who presented such special gifts. For others, the presents were fairly assessed by the confidants of the court. Then the assessment was registered in special offices.
The purpose of registering was that whenever the person who presented the gift registered by the court was in trouble, the monarch and the court would help him. Jahez, a historian and writer, writes in one of his books on ancient Iran: "[W]henever the owner of the present is in trouble or wants to construct a building, set up a feast, have his children married, etc. the one in charge of this in the court would check the registration. If the registered amount exceeded 10,000 Derrik, he or she would receive an amount of twice as much."[12]
A thousand years later, the inhabitants of Rhodes invented the concept of the 'general average'. Merchants whose goods were being shipped together would pay a proportionally divided premium which would be used to reimburse any merchant whose goods were jettisoned during storm or sinkage.
The Greeks and Romans introduced the origins of health and life insurance c. 600 AD when they organized guilds called "benevolent societies" which cared for the families and paid funeral expenses of members upon death. Guilds in the Middle Ages served a similar purpose. The Talmud deals with several aspects of insuring goods. Before insurance was established in the late 17th century, "friendly societies" existed in England, in which people donated amounts of money to a general sum that could be used for emergencies.
Separate insurance contracts (i.e., insurance policies not bundled with loans or other kinds of contracts) were invented in Genoa in the 14th century, as were insurance pools backed by pledges of landed estates. These new insurance contracts allowed insurance to be separated from investment, a separation of roles that first proved useful in marine insurance. Insurance became far more sophisticated in post-Renaissance Europe, and specialized varieties developed.
Some forms of insurance had developed in London by the early decades of the seventeenth century. For example, the will of the English colonist Robert Hayman mentions two "policies of insurance" taken out with the diocesan Chancellor of London, Arthur Duck. Of the value of £100 each, one relates to the safe arrival of Hayman's ship in Guyana and the other is in regard to "one hundred pounds assured by the said Doctor Arthur Ducke on my life". Hayman's will was signed and sealed on 17 November 1628 but not proved until 1633.[13] Toward the end of the seventeenth century, London's growing importance as a centre for trade increased demand for marine insurance. In the late 1680s, Edward Lloyd opened a coffee house that became a popular haunt of ship owners, merchants, and ships’ captains, and thereby a reliable source of the latest shipping news. It became the meeting place for parties wishing to insure cargoes and ships, and those willing to underwrite such ventures. Today, Lloyd's of London remains the leading market (note that it is not an insurance company) for marine and other specialist types of insurance, but it works rather differently than the more familiar kinds of insurance.
Insurance as we know it today can be traced to the Great Fire of London, which in 1666 devoured more than 13,000 houses. The devastating effects of the fire converted the development of insurance "from a matter of convenience into one of urgency, a change of opinion reflected in Sir Christopher Wren's inclusion of a site for 'the Insurance Office' in his new plan for London in 1667."[14] A number of attempted fire insurance schemes came to nothing, but in 1681 Nicholas Barbon, and eleven associates, established England's first fire insurance company, the 'Insurance Office for Houses', at the back of the Royal Exchange. Initially, 5,000 homes were insured by Barbon's Insurance Office.[15]
The first insurance company in the United States underwrote fire insurance and was formed in Charles Town (modern-day Charleston), South Carolina, in 1732. Benjamin Franklin helped to popularize and make standard the practice of insurance, particularly against fire in the form of perpetual insurance. In 1752, he founded the Philadelphia Contributionship for the Insurance of Houses from Loss by Fire. Franklin's company was the first to make contributions toward fire prevention. Not only did his company warn against certain fire hazards, it refused to insure certain buildings where the risk of fire was too great, such as all wooden houses. In the United States, regulation of the insurance industry is highly Balkanized, with primary responsibility assumed by individual state insurance departments. Whereas insurance markets have become centralized nationally and internationally, state insurance commissioners operate individually, though at times in concert through a national insurance commissioners' organization. In recent years, some have called for a dual state and federal regulatory system (commonly referred to as the Optional federal charter (OFC)) for insurance similar to that which oversees state banks and national banks.
Types of insurance
Any risk that can be quantified can potentially be insured. Specific kinds of risk that may give rise to claims are known as "perils". An insurance policy will set out in detail which perils are covered by the policy and which are not. Below are (non-exhaustive) lists of the many different types of insurance that exist. A single policy may cover risks in one or more of the categories set out below. For example, auto insurance would typically cover both property risk (covering the risk of theft or damage to the car) and liability risk (covering legal claims from causing an accident). A homeowner's insurance policy in the U.S. typically includes property insurance covering damage to the home and the owner's belongings, liability insurance covering certain legal claims against the owner, and even a small amount of coverage for medical expenses of guests who are injured on the owner's property.
Business insurance can be any kind of insurance that protects businesses against risks. Some principal subtypes of business insurance are (a) the various kinds of professional liability insurance, also called professional indemnity insurance, which are discussed below under that name; and (b) the business owner's policy (BOP), which bundles into one policy many of the kinds of coverage that a business owner needs, in a way analogous to how homeowners insurance bundles the coverages that a homeowner needs.[16]
Auto insurance
Main article: Vehicle insurance


A wrecked vehicle
Auto insurance protects you against financial loss if you have an accident. It is a contract between the insured and the insurance company. You agree to pay the premium and the insurance company agrees to pay losses as defined in the policy. Auto insurance provides property, liability and medical coverage:
1. Property coverage pays for damage to or theft of the car.
2. Liability coverage pays for the legal responsibility to others for bodily injury or property damage.
3. Medical coverage pays for the cost of treating injuries, rehabilitation and sometimes lost wages and funeral expenses.
An auto insurance policy comprises six kinds of coverage. Most countries require you to buy some, but not all, of these coverages. If you're financing a car, the lender may also have requirements. Most auto policies are for six months to a year.
In the United States, the insurance company should notify you by mail when it’s time to renew the policy and to pay the premium.[17]
Home insurance
Main article: Home insurance
Home insurance provides compensation for damage or destruction of a home from disasters. In some geographical areas, the standard insurances exclude certain types of disasters, such as flood and earthquakes, that require additional coverage. Maintenance-related problems are the homeowners' responsibility. The policy may include inventory, or this can be bought as a separate policy, especially for people who rent housing. In some countries, insurers offer a package which may include liability and legal responsibility for injuries and property damage caused by members of the household, including pets.[18]
Health
Main articles: Health insurance and Dental insurance


NHS Facility
Health insurance policies by the National Health Service in the United Kingdom (NHS) or other publicly-funded health programs will cover the cost of medical treatments. Dental insurance, like medical insurance, is coverage for individuals to protect them against dental costs. In the U.S. and Canada, dental insurance is often part of an employer's benefits package, along with health insurance.
Accident, Sickness and Unemployment Insurance
• Disability insurance policies provide financial support in the event the policyholder is unable to work because of disabling illness or injury. It provides monthly support to help pay such obligations as mortgage loans and credit cards.
• Disability overhead insurance allows business owners to cover the overhead expenses of their business while they are unable to work.
• Total permanent disability insurance provides benefits when a person is permanently disabled and can no longer work in their profession, often taken as an adjunct to life insurance.
• Workers' compensation insurance replaces all or part of a worker's wages lost and accompanying medical expenses incurred because of a job-related injury.
Casualty
Casualty insurance insures against accidents, not necessarily tied to any specific property.
Main article: Casualty insurance
• Crime insurance is a form of casualty insurance that covers the policyholder against losses arising from the criminal acts of third parties. For example, a company can obtain crime insurance to cover losses arising from theft or embezzlement.
• Political risk insurance is a form of casualty insurance that can be taken out by businesses with operations in countries in which there is a risk that revolution or other political conditions will result in a loss.
Life
Main article: Life insurance
Life insurance provides a monetary benefit to a decedent's family or other designated beneficiary, and may specifically provide for income to an insured person's family, burial, funeral and other final expenses. Life insurance policies often allow the option of having the proceeds paid to the beneficiary either in a lump sum cash payment or an annuity.
Annuities provide a stream of payments and are generally classified as insurance because they are issued by insurance companies and regulated as insurance and require the same kinds of actuarial and investment management expertise that life insurance requires. Annuities and pensions that pay a benefit for life are sometimes regarded as insurance against the possibility that a retiree will outlive his or her financial resources. In that sense, they are the complement of life insurance and, from an underwriting perspective, are the mirror image of life insurance.
Certain life insurance contracts accumulate cash values, which may be taken by the insured if the policy is surrendered or which may be borrowed against. Some policies, such as annuities and endowment policies, are financial instruments to accumulate or liquidate wealth when it is needed.
In many countries, such as the U.S. and the UK, the tax law provides that the interest on this cash value is not taxable under certain circumstances. This leads to widespread use of life insurance as a tax-efficient method of saving as well as protection in the event of early death.
In U.S., the tax on interest income on life insurance policies and annuities is generally deferred. However, in some cases the benefit derived from tax deferral may be offset by a low return. This depends upon the insuring company, the type of policy and other variables (mortality, market return, etc.). Moreover, other income tax saving vehicles (e.g., IRAs, 401(k) plans, Roth IRAs) may be better alternatives for value accumulation.
Property
Main article: Property insurance


This tornado damage to an Illinois home would be considered an "Act of God" for insurance purposes
Property insurance provides protection against risks to property, such as fire, theft or weather damage. This includes specialized forms of insurance such as fire insurance, flood insurance, earthquake insurance, home insurance, inland marine insurance or boiler insurance.
• Automobile insurance, known in the UK as motor insurance, is probably the most common form of insurance and may cover both legal liability claims against the driver and loss of or damage to the insured's vehicle itself. Throughout the United States an auto insurance policy is required to legally operate a motor vehicle on public roads. In some jurisdictions, bodily injury compensation for automobile accident victims has been changed to a no-fault system, which reduces or eliminates the ability to sue for compensation but provides automatic eligibility for benefits. Credit card companies insure against damage on rented cars.
o Driving School Insurance provides cover for any authorized driver whilst undergoing tuition, cover also unlike other motor policies provides cover for instructor liability where both the pupil and driving instructor are equally liable in the event of a claim.
• Aviation insurance insures against hull, spares, deductibles, hull wear and liability risks.
• Boiler insurance (also known as boiler and machinery insurance or equipment breakdown insurance) insures against accidental physical damage to equipment or machinery.
• Builder's risk insurance insures against the risk of physical loss or damage to property during construction. Builder's risk insurance is typically written on an "all risk" basis covering damage due to any cause (including the negligence of the insured) not otherwise expressly excluded. Builder's risk insurance is coverage that protects a person's or organization's insurable interest in materials, fixtures and/or equipment being used in the construction or renovation of a building or structure should those items sustain physical loss or damage from a covered cause.[19]
• Crop insurance "Farmers use crop insurance to reduce or manage various risks associated with growing crops. Such risks include crop loss or damage caused by weather, hail, drought, frost damage, insects, or disease, for instance."[20]
• Earthquake insurance is a form of property insurance that pays the policyholder in the event of an earthquake that causes damage to the property. Most ordinary homeowners insurance policies do not cover earthquake damage. Most earthquake insurance policies feature a high deductible. Rates depend on location and the probability of an earthquake, as well as the construction of the home.
• A fidelity bond is a form of casualty insurance that covers policyholders for losses that they incur as a result of fraudulent acts by specified individuals. It usually insures a business for losses caused by the dishonest acts of its employees.
• Flood insurance protects against property loss due to flooding. Many insurers in the U.S. do not provide flood insurance in some portions of the country. In response to this, the federal government created the National Flood Insurance Program which serves as the insurer of last resort.
• Home insurance, also commonly called hazard insurance or homeowners insurance (often abbreviated in the real estate industry as HOI), is the type of property insurance that covers private homes.
• Landlord insurance covers residential and commercial properties which are rented to others. Most homeowner's insurance covers only owner-occupied homes.
• Marine insurance and marine cargo insurance cover the loss or damage of ships at sea or on inland waterways, and of cargo in transit, regardless of the method of transit. When the owner of the cargo and the carrier are separate corporations, marine cargo insurance typically compensates the owner of cargo for losses sustained from fire, shipwreck, etc., but excludes losses that can be recovered from the carrier or the carrier's insurance. Many marine insurance underwriters will include "time element" coverage in such policies, which extends the indemnity to cover loss of profit and other business expenses attributable to the delay caused by a covered loss.
• Surety bond insurance is a three party insurance guaranteeing the performance of the principal.
• Terrorism insurance provides protection against any loss or damage caused by terrorist activities.
• Volcano insurance is an insurance that covers volcano damage in Hawaii.
• Windstorm insurance is an insurance covering the damage that can be caused by hurricanes and tropical cyclones.
Liability
Main article: Liability insurance
Liability insurance is a very broad superset that covers legal claims against the insured. Many types of insurance include an aspect of liability coverage. For example, a homeowner's insurance policy will normally include liability coverage which protects the insured in the event of a claim brought by someone who slips and falls on the property; automobile insurance also includes an aspect of liability insurance that indemnifies against the harm that a crashing car can cause to others' lives, health, or property. The protection offered by a liability insurance policy is twofold: a legal defense in the event of a lawsuit commenced against the policyholder and indemnification (payment on behalf of the insured) with respect to a settlement or court verdict. Liability policies typically cover only the negligence of the insured, and will not apply to results of wilful or intentional acts by the insured.
• Public liability insurance covers a business against claims should its operations injure a member of the public or damage their property in some way.
• Directors and officers liability insurance protects an organization (usually a corporation) from costs associated with litigation resulting from mistakes made by directors and officers for which they are liable. In the industry, it is usually called "D&O" for short.
• Environmental liability insurance protects the insured from bodily injury, property damage and cleanup costs as a result of the dispersal, release or escape of pollutants.
• Errors and omissions insurance: See "Professional liability insurance" under "Liability insurance".
• Prize indemnity insurance protects the insured from giving away a large prize at a specific event. Examples would include offering prizes to contestants who can make a half-court shot at a basketball game, or a hole-in-one at a golf tournament.
• Professional liability insurance, also called professional indemnity insurance, protects insured professionals such as architectural corporation and medical practice against potential negligence claims made by their patients/clients. Professional liability insurance may take on different names depending on the profession. For example, professional liability insurance in reference to the medical profession may be called malpractice insurance. Notaries public may take out errors and omissions insurance (E&O). Other potential E&O policyholders include, for example, real estate brokers, Insurance agents, home inspectors, appraisers, and website developers.
Credit
Main article: Credit insurance
Credit insurance repays some or all of a loan when certain things happen to the borrower such as unemployment, disability, or death.
• Mortgage insurance insures the lender against default by the borrower. Mortgage insurance is a form of credit insurance, although the name credit insurance more often is used to refer to policies that cover other kinds of debt.
• Many credit cards offer payment protection plans which are a form of credit insurance.
Other types
• All-risk insurance is an insurance that covers a wide-range of incidents and perils, except those noted in the policy. All-risk insurance is different from peril-specific insurance that cover losses from only those perils listed in the policy.[21] In car insurance, all-risk policy includes also the damages caused by the own driver.
• Collateral protection insurance or CPI, insures property (primarily vehicles) held as collateral for loans made by lending institutions.
• Defense Base Act Workers' compensation or DBA Insurance provides coverage for civilian workers hired by the government to perform contracts outside the U.S. and Canada. DBA is required for all U.S. citizens, U.S. residents, U.S. Green Card holders, and all employees or subcontractors hired on overseas government contracts. Depending on the country, Foreign Nationals must also be covered under DBA. This coverage typically includes expenses related to medical treatment and loss of wages, as well as disability and death benefits.
• Expatriate insurance provides individuals and organizations operating outside of their home country with protection for automobiles, property, health, liability and business pursuits.
• Financial loss insurance or Business Interruption Insurance protects individuals and companies against various financial risks. For example, a business might purchase coverage to protect it from loss of sales if a fire in a factory prevented it from carrying out its business for a time. Insurance might also cover the failure of a creditor to pay money it owes to the insured. This type of insurance is frequently referred to as "business interruption insurance." Fidelity bonds and surety bonds are included in this category, although these products provide a benefit to a third party (the "obligee") in the event the insured party (usually referred to as the "obligor") fails to perform its obligations under a contract with the obligee.
• Kidnap and ransom insurance
• Legal Expenses Insurance covers policyholders against the potential costs of legal action against an institution or an individual.
• Locked funds insurance is a little-known hybrid insurance policy jointly issued by governments and banks. It is used to protect public funds from tamper by unauthorized parties. In special cases, a government may authorize its use in protecting semi-private funds which are liable to tamper. The terms of this type of insurance are usually very strict. Therefore it is used only in extreme cases where maximum security of funds is required.
• Media Insurance is designed to cover professionals that engage in film, video and TV production.
• Nuclear incident insurance covers damages resulting from an incident involving radioactive materials and is generally arranged at the national level. See the Nuclear exclusion clause and for the United States the Price-Anderson Nuclear Industries Indemnity Act)
• Pet insurance insures pets against accidents and illnesses - some companies cover routine/wellness care and burial, as well.
• Pollution Insurance which consists of first-party coverage for contamination of insured property either by external or on-site sources. Coverage for liability to third parties arising from contamination of air, water, or land due to the sudden and accidental release of hazardous materials from the insured site. The policy usually covers the costs of cleanup and may include coverage for releases from underground storage tanks. Intentional acts are specifically excluded.
• Purchase insurance is aimed at providing protection on the products people purchase. Purchase insurance can cover individual purchase protection, warranties, guarantees, care plans and even mobile phone insurance. Such insurance is normally very limited in the scope of problems that are covered by the policy.
• Title insurance provides a guarantee that title to real property is vested in the purchaser and/or mortgagee, free and clear of liens or encumbrances. It is usually issued in conjunction with a search of the public records performed at the time of a real estate transaction.
• Travel insurance is an insurance cover taken by those who travel abroad, which covers certain losses such as medical expenses, loss of personal belongings, travel delay, personal liabilities, etc.
Insurance financing vehicles
• Fraternal insurance is provided on a cooperative basis by fraternal benefit societies or other social organizations.[22]
• No-fault insurance is a type of insurance policy (typically automobile insurance) where insureds are indemnified by their own insurer regardless of fault in the incident.
• Protected Self-Insurance is an alternative risk financing mechanism in which an organization retains the mathematically calculated cost of risk within the organization and transfers the catastrophic risk with specific and aggregate limits to an insurer so the maximum total cost of the program is known. A properly designed and underwritten Protected Self-Insurance Program reduces and stabilizes the cost of insurance and provides valuable risk management information.
• Retrospectively Rated Insurance is a method of establishing a premium on large commercial accounts. The final premium is based on the insured's actual loss experience during the policy term, sometimes subject to a minimum and maximum premium, with the final premium determined by a formula. Under this plan, the current year's premium is based partially (or wholly) on the current year's losses, although the premium adjustments may take months or years beyond the current year's expiration date. The rating formula is guaranteed in the insurance contract. Formula: retrospective premium = converted loss + basic premium × tax multiplier. Numerous variations of this formula have been developed and are in use.
• Formal self insurance is the deliberate decision to pay for otherwise insurable losses out of one's own money. This can be done on a formal basis by establishing a separate fund into which funds are deposited on a periodic basis, or by simply forgoing the purchase of available insurance and paying out-of-pocket. Self insurance is usually used to pay for high-frequency, low-severity losses. Such losses, if covered by conventional insurance, mean having to pay a premium that includes loadings for the company's general expenses, cost of putting the policy on the books, acquisition expenses, premium taxes, and contingencies. While this is true for all insurance, for small, frequent losses the transaction costs may exceed the benefit of volatility reduction that insurance otherwise affords.
• Reinsurance is a type of insurance purchased by insurance companies or self-insured employers to protect against unexpected losses. Financial reinsurance is a form of reinsurance that is primarily used for capital management rather than to transfer insurance risk.
• Social insurance can be many things to many people in many countries. But a summary of its essence is that it is a collection of insurance coverages (including components of life insurance, disability income insurance, unemployment insurance, health insurance, and others), plus retirement savings, that requires participation by all citizens. By forcing everyone in society to be a policyholder and pay premiums, it ensures that everyone can become a claimant when or if he/she needs to. Along the way this inevitably becomes related to other concepts such as the justice system and the welfare state. This is a large, complicated topic that engenders tremendous debate, which can be further studied in the following articles (and others):
o National Insurance
o Social safety net
o Social security
o Social Security debate (United States)
o Social Security (United States)
o Social welfare provision
• Stop-loss insurance provides protection against catastrophic or unpredictable losses. It is purchased by organizations who do not want to assume 100% of the liability for losses arising from the plans. Under a stop-loss policy, the insurance company becomes liable for losses that exceed certain limits called deductibles.
Closed community self-insurance
Some communities prefer to create virtual insurance amongst themselves by other means than contractual risk transfer, which assigns explicit numerical values to risk. A number of religious groups, including the Amish and some Muslim groups, depend on support provided by their communities when disasters strike. The risk presented by any given person is assumed collectively by the community who all bear the cost of rebuilding lost property and supporting people whose needs are suddenly greater after a loss of some kind. In supportive communities where others can be trusted to follow community leaders, this tacit form of insurance can work. In this manner the community can even out the extreme differences in insurability that exist among its members. Some further justification is also provided by invoking the moral hazard of explicit insurance contracts.
In the United Kingdom, The Crown (which, for practical purposes, meant the Civil service) did not insure property such as government buildings. If a government building was damaged, the cost of repair would be met from public funds because, in the long run, this was cheaper than paying insurance premiums. Since many UK government buildings have been sold to property companies, and rented back, this arrangement is now less common and may have disappeared altogether.
Insurance companies
Insurance companies may be classified into two groups:
• Life insurance companies, which sell life insurance, annuities and pensions products.
• Non-life, General, or Property/Casualty insurance companies, which sell other types of insurance.
General insurance companies can be further divided into these sub categories.
• Standard Lines
• Excess Lines
In most countries, life and non-life insurers are subject to different regulatory regimes and different tax and accounting rules. The main reason for the distinction between the two types of company is that life, annuity, and pension business is very long-term in nature — coverage for life assurance or a pension can cover risks over many decades. By contrast, non-life insurance cover usually covers a shorter period, such as one year.
In the United States, standard line insurance companies are "mainstream" insurers. These are the companies that typically insure autos, homes or businesses. They use pattern or "cookie-cutter" policies without variation from one person to the next. They usually have lower premiums than excess lines and can sell directly to individuals. They are regulated by state laws that can restrict the amount they can charge for insurance policies.
Excess line insurance companies (also known as Excess and Surplus) typically insure risks not covered by the standard lines market. They are broadly referred as being all insurance placed with non-admitted insurers. Non-admitted insurers are not licensed in the states where the risks are located. These companies have more flexibility and can react faster than standard insurance companies because they are not required to file rates and forms as the "admitted" carriers do. However, they still have substantial regulatory requirements placed upon them. State laws generally require insurance placed with surplus line agents and brokers not to be available through standard licensed insurers.
Insurance companies are generally classified as either mutual or stock companies. Mutual companies are owned by the policyholders, while stockholders (who may or may not own policies) own stock insurance companies. Demutualization of mutual insurers to form stock companies, as well as the formation of a hybrid known as a mutual holding company, became common in some countries, such as the United States, in the late 20th century.
Other possible forms for an insurance company include reciprocals, in which policyholders 'reciprocate' in sharing risks, and Lloyd's organizations.
Insurance companies are rated by various agencies such as A. M. Best. The ratings include the company's financial strength, which measures its ability to pay claims. It also rates financial instruments issued by the insurance company, such as bonds, notes, and securitization products.
Reinsurance companies are insurance companies that sell policies to other insurance companies, allowing them to reduce their risks and protect themselves from very large losses. The reinsurance market is dominated by a few very large companies, with huge reserves. A reinsurer may also be a direct writer of insurance risks as well.
Captive insurance companies may be defined as limited-purpose insurance companies established with the specific objective of financing risks emanating from their parent group or groups. This definition can sometimes be extended to include some of the risks of the parent company's customers. In short, it is an in-house self-insurance vehicle. Captives may take the form of a "pure" entity (which is a 100% subsidiary of the self-insured parent company); of a "mutual" captive (which insures the collective risks of members of an industry); and of an "association" captive (which self-insures individual risks of the members of a professional, commercial or industrial association). Captives represent commercial, economic and tax advantages to their sponsors because of the reductions in costs they help create and for the ease of insurance risk management and the flexibility for cash flows they generate. Additionally, they may provide coverage of risks which is neither available nor offered in the traditional insurance market at reasonable prices.
The types of risk that a captive can underwrite for their parents include property damage, public and product liability, professional indemnity, employee benefits, employers' liability, motor and medical aid expenses. The captive's exposure to such risks may be limited by the use of reinsurance.
Captives are becoming an increasingly important component of the risk management and risk financing strategy of their parent. This can be understood against the following background:
• heavy and increasing premium costs in almost every line of coverage;
• difficulties in insuring certain types of fortuitous risk;
• differential coverage standards in various parts of the world;
• rating structures which reflect market trends rather than individual loss experience;
• insufficient credit for deductibles and/or loss control efforts.
There are also companies known as 'insurance consultants'. Like a mortgage broker, these companies are paid a fee by the customer to shop around for the best insurance policy amongst many companies. Similar to an insurance consultant, an 'insurance broker' also shops around for the best insurance policy amongst many companies. However, with insurance brokers, the fee is usually paid in the form of commission from the insurer that is selected rather than directly from the client.
Neither insurance consultants nor insurance brokers are insurance companies and no risks are transferred to them in insurance transactions. Third party administrators are companies that perform underwriting and sometimes claim handling services for insurance companies. These companies often have special expertise that the insurance companies do not have.
The financial stability and strength of an insurance company should be a major consideration when buying an insurance contract. An insurance premium paid currently provides coverage for losses that might arise many years in the future. For that reason, the viability of the insurance carrier is very important. In recent years, a number of insurance companies have become insolvent, leaving their policyholders with no coverage (or coverage only from a government-backed insurance pool or other arrangement with less attractive payouts for losses). A number of independent rating agencies provide information and rate the financial viability of insurance companies.
Global insurance industry


Life insurance premia written in 2005


Non-life insurance premia written in 2005
Global insurance premiums grew by 3.4% in 2008 to reach $4.3 trillion. For the first time in the past three decades, premium income declined in inflation-adjusted terms, with non-life premiums falling by 0.8% and life premiums falling by 3.5%. The insurance industry is exposed to the global economic downturn on the assets side by the decline in returns on investments and on the liabilities side by a rise in claims. So far the extent of losses on both sides has been limited although investment returns fell sharply following the bankruptcy of Lehman Brothers and bailout of AIG in September 2008. The financial crisis has shown that the insurance sector is sufficiently capitalised. The vast majority of insurance companies had enough capital to absorb losses and only a small number turned to government for support.
Advanced economies account for the bulk of global insurance. With premium income of $1,753bn, Europe was the most important region in 2008, followed by North America $1,346bn and Asia $933bn. The top four countries generated more than a half of premiums. The US and Japan alone accounted for 40% of world insurance, much higher than their 7% share of the global population. Emerging markets accounted for over 85% of the world’s population but generated only around 10% of premiums. Their markets are however growing at a quicker pace.[23]
Controversies
Religious concerns
Muslim scholars have varying opinions about insurance. Insurance policies that earn interest are generally considered to be a form of riba[24] (usury) and some consider even policies that do not earn interest to be a form of gharar (speculation). Some argue that gharar is not present due to the actuarial science behind the underwriting.[25]
Jewish rabbinical scholars also have expressed reservations regarding insurance as an avoidance of God's will but most find it acceptable in moderation.[26]
Some Christians believe insurance represents a lack of faith[27] and there is a long history of resistance to commercial insurance in Anabaptist communities (Mennonites, Amish, Hutterites, Brethren in Christ) but many participate in community-based self-insurance programs that spread risk within their communities.[28][29][30]
Insurance insulates too much
By creating a "security blanket" for its insureds, an insurance company may inadvertently find that its insureds may not be as risk-averse as they might otherwise be (since, by definition, the insured has transferred the risk to the insurer), a concept known as moral hazard. To reduce their own financial exposure, insurance companies have contractual clauses that mitigate their obligation to provide coverage if the insured engages in behavior that grossly magnifies their risk of loss or liability.[citation needed]
For example, life insurance companies may require higher premiums or deny coverage altogether to people who work in hazardous occupations or engage in dangerous sports. Liability insurance providers do not provide coverage for liability arising from intentional torts committed by or at the direction of the insured. Even if a provider were so irrational as to want to provide such coverage, it is against the public policy of most countries to allow such insurance to exist, and thus it is usually illegal.[citation needed]
Complexity of insurance policy contracts
Insurance policies can be complex and some policyholders may not understand all the fees and coverages included in a policy. As a result, people may buy policies on unfavorable terms. In response to these issues, many countries have enacted detailed statutory and regulatory regimes governing every aspect of the insurance business, including minimum standards for policies and the ways in which they may be advertised and sold.
For example, most insurance policies in the English language today have been carefully drafted in plain English; the industry learned the hard way that many courts will not enforce policies against insureds when the judges themselves cannot understand what the policies are saying. Typically, courts construe ambiguities in insurance policies against the insurance company and in favor of coverage under the policy.
Many institutional insurance purchasers buy insurance through an insurance broker. While on the surface it appears the broker represents the buyer (not the insurance company), and typically counsels the buyer on appropriate coverage and policy limitations, it should be noted that in the vast majority of cases a broker's compensation comes in the form of a commission as a percentage of the insurance premium, creating a conflict of interest in that the broker's financial interest is tilted towards encouraging an insured to purchase more insurance than might be necessary at a higher price. A broker generally holds contracts with many insurers, thereby allowing the broker to "shop" the market for the best rates and coverage possible.
Insurance may also be purchased through an agent. Unlike a broker, who represents the policyholder, an agent represents the insurance company from whom the policyholder buys. An agent can represent more than one company.
An independent insurance consultant advises insureds on a fee-for-service retainer, similar to an attorney, and thus offers completely independent advice, free of the financial conflict of interest of brokers and/or agents. However, such a consultant must still work through brokers and/or
Redlining
Redlining is the practice of denying insurance coverage in specific geographic areas, supposedly because of a high likelihood of loss, while the alleged motivation is unlawful discrimination. Racial profiling or redlining has a long history in the property insurance industry in the United States. From a review of industry underwriting and marketing materials, court documents, and research by government agencies, industry and community groups, and academics, it is clear that race has long affected and continues to affect the policies and practices of the insurance industry.[31]
In July, 2007, The Federal Trade Commission released a report presenting the results of a study concerning credit-based insurance scores and automobile insurance. The study found that these scores are effective predictors of the claims that consumers will file. [32]
All states have provisions in their rate regulation laws or in their fair trade practice acts that prohibit unfair discrimination, often called redlining, in setting rates and making insurance available.[33]
In determining premiums and premium rate structures, insurers consider quantifiable factors, including location, credit scores, gender, occupation, marital status, and education level. However, the use of such factors is often considered to be unfair or unlawfully discriminatory, and the reaction against this practice has in some instances led to political disputes about the ways in which insurers determine premiums and regulatory intervention to limit the factors used.
An insurance underwriter's job is to evaluate a given risk as to the likelihood that a loss will occur. Any factor that causes a greater likelihood of loss should theoretically be charged a higher rate. This basic principle of insurance must be followed if insurance companies are to remain solvent.[citation needed] Thus, "discrimination" against (i.e., negative differential treatment of) potential insureds in the risk evaluation and premium-setting process is a necessary by-product of the fundamentals of insurance underwriting. For instance, insurers charge older people significantly higher premiums than they charge younger people for term life insurance. Older people are thus treated differently than younger people (i.e., a distinction is made, discrimination occurs). The rationale for the differential treatment goes to the heart of the risk a life insurer takes: Old people are likely to die sooner than young people, so the risk of loss (the insured's death) is greater in any given period of time and therefore the risk premium must be higher to cover the greater risk. However, treating insureds differently when there is no actuarially sound reason for doing so is unlawful discrimination.
What is often missing from the debate is that prohibiting the use of legitimate, actuarially sound factors means that an insufficient amount is being charged for a given risk, and there is thus a deficit in the system.[citation needed] The failure to address the deficit may mean insolvency and hardship for all of a company's insureds.[citation needed] The options for addressing the deficit seem to be the following: Charge the deficit to the other policyholders or charge it to the government (i.e., externalize outside of the company to society at large).[citation needed]
Insurance patents
Further information: Insurance patent
New assurance products can now be protected from copying with a business method patent in the United States.
A recent example of a new insurance product that is patented is Usage Based auto insurance. Early versions were independently invented and patented by a major U.S. auto insurance company, Progressive Auto Insurance (U.S. Patent 5,797,134) and a Spanish independent inventor, Salvador Minguijon Perez ( EP patent 0700009).
Many independent inventors are in favor of patenting new insurance products since it gives them protection from big companies when they bring their new insurance products to market. Independent inventors account for 70% of the new U.S. patent applications in this area.
Many insurance executives are opposed to patenting insurance products because it creates a new risk for them. The Hartford insurance company, for example, recently had to pay $80 million to an independent inventor, Bancorp Services, in order to settle a patent infringement and theft of trade secret lawsuit for a type of corporate owned life insurance product invented and patented by Bancorp.
There are currently about 150 new patent applications on insurance inventions filed per year in the United States. The rate at which patents have issued has steadily risen from 15 in 2002 to 44 in 2006.[34]
Inventors can now have their insurance U.S. patent applications reviewed by the public in the Peer to Patent program.[35] The first insurance patent application to be posted was US2009005522 “Risk assessment company”. It was posted on March 6, 2009. This patent application describes a method for increasing the ease of changing insurance companies.[36]
The insurance industry and rent seeking
Certain insurance products and practices have been described as rent seeking by critics.[citation needed] That is, some insurance products or practices are useful primarily because of legal benefits, such as reducing taxes, as opposed to providing protection against risks of adverse events. Under United States tax law, for example, most owners of variable annuities and variable life insurance can invest their premium payments in the stock market and defer or eliminate paying any taxes on their investments until withdrawals are made. Sometimes this tax deferral is the only reason people use these products.[citation needed] Another example is the legal infrastructure which allows life insurance to be held in an irrevocable trust which is used to pay an estate tax while the proceeds themselves are immune from the estate tax.

"BOUNCING B**BS ON SCOOTIES"

I am thankful to government of Nepal roads, otherwise I would have missed the beautiful view of...

"BOUNCING B**BS ON SCOOTIES"

Neonatal Bacterial Meningitis

Neonatal Bacterial Meningitis

Neonatal bacterial meningitis is inflammation of the meninges due to bacterial invasion. Signs are those of sepsis, CNS irritation (eg, lethargy, seizures, vomiting, irritability [particularly paradoxical irritability], nuchal rigidity, a bulging or full fontanelle), and cranial nerve abnormalities. Diagnosis is by lumbar puncture. Treatment is with antibiotics.

Neonatal bacterial meningitis occurs in 2/10,000 full-term and 2/1,000 low-birth-weight (LBW) neonates, with a male predominance. It occurs in about 15% of neonates with sepsis and occasionally occurs in isolation.

Etiology
The predominant pathogens are

Group B streptococcus (GBS—predominantly type III)
Escherichia coli (particularly those strains containing the K1 polysaccharide)
Listeria monocytogenes

Enterococci, nonenterococcal group D streptococci, α-hemolytic streptococci, and other gram-negative enteric organisms (eg, Klebsiella sp, Enterobacter sp, Citrobacter diversus) also are common pathogens. Haemophilus influenzae type b, Neisseria meningitidis, and Streptococcus pneumoniae have been reported as causes.

Neonatal bacterial meningitis most frequently results from the bacteremia that occurs with neonatal sepsis; the higher the colony count in the blood culture, the higher the risk of meningitis. Neonatal bacterial meningitis may also result from scalp lesions, particularly when developmental defects lead to communication between the skin surface and the subarachnoid space, which predisposes to thrombophlebitis of the diploic veins. Rarely, there is direct extension to the CNS from a contiguous otic focus (eg, otitis media).

Symptoms and Signs

Frequently, only those findings typical of neonatal sepsis (eg, temperature instability, respiratory distress, jaundice, apnea) are manifest. CNS signs (eg, lethargy, seizures [particularly focal], vomiting, irritability) more specifically suggest neonatal bacterial meningitis. So-called paradoxical irritability, in which cuddling and consoling by a parent irritates rather than comforts the neonate, is more specific for the diagnosis. A bulging or full fontanelle occurs in about 25% and nuchal rigidity in only 15%. The younger the patient, the less common are these findings. Cranial nerve abnormalities (particularly those involving the 3rd, 6th, and 7th nerves) may also be present.

Meningitis due to GBS may occur in the first week of life, accompanying early-onset neonatal sepsis and frequently manifesting initially as a systemic illness with prominent respiratory signs. Usually, however, GBS meningitis occurs after this period (most commonly in the first 3 mo of life) as an isolated illness characterized by absence of antecedent obstetric or perinatal complications and the presence of more specific signs of meningitis (eg, fever, lethargy, seizures).

Ventriculitis frequently accompanies neonatal bacterial meningitis, particularly when caused by gram-negative enteric bacilli. Organisms that cause meningitis together with severe vasculitis, particularly C. diversus and Enterobacter sakazakii, are likely to cause cysts and abscesses. Pseudomonas aeruginosa, E. coli K1, and Serratia sp also may cause brain abscesses. An early clinical sign of brain abscess is increased intracranial pressure (ICP), commonly manifested by vomiting, a bulging fontanelle, and sometimes enlarging head size. Deterioration in an otherwise stable neonate with meningitis suggests progressive increased ICP caused by abscess or hydrocephalus, or rupture of an abscess into the ventricular system.

Diagnosis


CSF glucose and protein levels, Gram stain, and culture
Sometimes brain CT or MRI

Definitive diagnosis is made by CSF examination via lumbar puncture (LP), which should be done in any neonate suspected of having sepsis or meningitis. However, LP can be difficult to do in a neonate, and there is some risk of hypoxia. Poor clinical condition (eg, respiratory distress, shock, thrombocytopenia) makes LP risky. If LP is delayed, the neonate should be treated as though meningitis is present. Even when the clinical condition improves, the presence of inflammatory cells and abnormal chemistries in CSF days after illness onset can still suggest the diagnosis. A needle with a trocar should be used for LP to avoid introducing epithelial rests and subsequent development of epitheliomas. The CSF, even if bloody or acellular, should be cultured. About 15 to 30% of neonates with negative blood cultures have positive CSF cultures depending on the population studied. LP should be repeated at 24 to 48 h if clinical response is questionable and at 72 h when gram-negative organisms are involved (to ensure sterilization). Repeating the CSF analysis helps guide duration of therapy and predict prognosis. Some experts believe that a repeat LP at 24 h in neonates with GBS meningitis has prognostic value. LP should not be repeated at the end of therapy if the neonate is doing well.

Normal CSF values are controversial and in part age-related. In general, both term infants and preterm infants without meningitis have ≤ 20 WBCs/μL (one fifth of which may be PMNs) in their CSF. CSF protein levels in the absence of meningitis are more variable; term infants have levels of < 100 mg/dL, whereas preterm infants have levels up to 150 mg/dL. CSF glucose levels in the absence of meningitis are > 75% of the serum value measured at the same time. These levels may be as low as 20 to 30 mg/dL (1.1 to 1.7 mmol/L).

Ventriculitis is suspected in a neonate not responding appropriately to antimicrobial therapy. The diagnosis is made when a ventricular puncture yields a WBC count greater than that from the LP, by a positive Gram stain or culture, or by increased ventricular pressure. When ventriculitis or brain abscess is suspected, an MRI or CT with contrast may aid diagnosis; dilated ventricles also confirm ventriculitis.

Prognosis

Without treatment, the mortality rate for neonatal bacterial meningitis approaches 100%. With treatment, prognosis is determined by birth weight, organism, and clinical severity. Mortality rate for gram-negative neonatal bacterial meningitis is 15 to 20%, and for gram-positive (eg, GBS) it is 6 to 10%. For organisms that cause vasculitis or brain abscess (necrotizing meningitis), the mortality rate may approach 75%. Neurologic sequelae (eg, hydrocephalus, hearing loss, intellectual disability) develop in 20 to 50% of infants who survive, with a poorer prognosis when gram-negative enteric bacilli are the cause.

Prognosis also depends partly on the number of organisms present in CSF at diagnosis. The duration of positive CSF cultures correlates directly with the incidence of complications. In general, CSF cultures from neonates with GBS are usually sterilized within the first 24 h of antimicrobial therapy. Those from gram-negative bacillary meningitis remain positive longer, with a median of 2 days.

GBS meningitis has a mortality rate significantly lower than that of early-onset GBS sepsis.

Treatment


Empiric ampicillin Some Trade Names
OMNIPEN
PRINCIPEN
Click for Drug Monograph
plus gentamicin Some Trade Names
GARAMYCIN
Click for Drug Monograph
, cefotaxime Some Trade Names
CLAFORAN
Click for Drug Monograph
, or both, followed by culture-specific drugs

Empiric antibiotic therapy: Initial empiric treatment depends on patient age and is still debated. Most experts recommend ampicillin Some Trade Names
OMNIPEN
PRINCIPEN
Click for Drug Monograph
plus an aminoglycoside, a 3rd-generation cephalosporin (eg, cefotaxime Some Trade Names
CLAFORAN
Click for Drug Monograph
), or both. Ampicillin Some Trade Names
OMNIPEN
PRINCIPEN
Click for Drug Monograph
is active against organisms such as GBS, enterococci, and Listeria. Gentamicin Some Trade Names
GARAMYCIN
Click for Drug Monograph
provides synergy and added efficacy against these organisms and adequate gram-negative coverage. Cephalosporins provide adequate gram-negative coverage but do not provide synergy with ampicillin Some Trade Names
OMNIPEN
PRINCIPEN
Click for Drug Monograph
for gram-positive organisms and may allow for some resistant organisms. Hospitalized neonates who previously received antibiotics (eg, for early-onset sepsis) may have resistant organisms; fungal disease may also be considered in a septic-appearing neonate after prolonged hospitalization. Ill neonates with hospital-acquired infection should initially receive vancomycin Some Trade Names
VANCOCIN
Click for Drug Monograph
plus an aminoglycoside with or without a 3rd-generation cephalosporin. Antibiotics are adjusted when results of CSF culture and sensitivities are known. The results of the Gram stain should not change antibiotic therapy.

Organism-specific antibiotic therapy: The recommended initial treatment for GBS meningitis in neonates < 1 wk of age is penicillin G Some Trade Names BICILLINWYCILLINClick for Drug Monograph 100,000 to 150,000 units/kg IV q 8 h or ampicillin Some Trade Names OMNIPENPRINCIPENClick for Drug Monograph 100 mg/kg IV q 8 h, plus gentamicin Some Trade Names GARAMYCINClick for Drug Monograph 4 mg/kg IV once/day if the infant is 32 to 35 wk gestational age or 5 mg/kg IV once/day if the infant is > 35 wk gestational age. If clinical improvement occurs or sterilization of CSF is documented, gentamicin Some Trade Names
GARAMYCIN
Click for Drug Monograph
can be stopped.

For enterococci or L. monocytogenes, treatment is generally ampicillin Some Trade Names
OMNIPEN
PRINCIPEN
Click for Drug Monograph
plus gentamicin Some Trade Names
GARAMYCIN
Click for Drug Monograph
.

In gram-negative bacillary meningitis, treatment is difficult. The traditional regimen of ampicillin Some Trade Names
OMNIPEN
PRINCIPEN
Click for Drug Monograph
plus an aminoglycoside results in a 15 to 20% mortality rate, with a high rate of sequelae in survivors. A 3rd-generation cephalosporin (eg, cefotaxime Some Trade Names
CLAFORAN
Click for Drug Monograph
) should be strongly considered in neonates with proven gram-negative meningitis (or sepsis) or those convincingly septic. If antibiotic resistance is a concern, both an aminoglycoside and a 3rd-generation cephalosporin may be used until sensitivities are known. However, except for initial empiric therapy, 3rd-generation cephalosporins are generally not used routinely, because certain gram-negative organisms are induced to produce β-lactamase, resulting in rapid development of resistance.

Parenteral therapy for gram-positive meningitis is given for a minimum of 14 days, and for complicated gram-positive or gram-negative meningitis, a minimum of 21 days.

Adjunctive measures: Because meningitis may be considered part of the continuum of neonatal sepsis, the adjunctive measures used in treating neonatal sepsis (see Infections in Neonates: Other treatment) should also be used to treat neonatal meningitis. Corticosteroids are not used in treatment of neonatal meningitis. Patients should be closely monitored for neurologic complications during the first 2 yr of life.

Application of Advanced Network Infrastructure Technology in Health and Disaster Management

TECHNICAL PROPOSAL


Table of Contents

1. TECHNICAL DISCUSSIONS 3
A. Statement of Work 3
A.1. Abstract 3
A.2. Objectives 4
A.3. Approach 4
A.4. Methods 5
A.4.1 Base Technologies 5
A.4.2 Components 10
A.4.3 Integrating the Components 11
A.4.4 Expanding the Scope 14
A.4.5 Energy Management 15
Related Work 15
References 16
A.5. Schedule 18
B. Personnel 18
B.1. Principal Investigator 18
B.2. Additional Investigators 18
B.3. Faculty 19
B.4. Research Staff 19
B.5. Research Assistants 19
B.6. Resumes 19
2. OTHER CONSIDERATIONS 25
3. INFORMATION TECHNOLOGY SYSTEMS SECURITY 27

1. TECHNICAL DISCUSSIONS
A. Statement of Work

A.1. Abstract
In response to the National Library of Medicine’s Broad Area Announcement titled “Application of Advanced Network Infrastructure Technology in Health and Disaster Management,” the Decision Systems Group (DSG) at Brigham and Women’s Hospital has proposed the development of SMART, acronym for Scalable Medical Alert and Response Technology, as a model for both local area and wide area patient monitoring. It will also serve as a model for patient monitoring in a disaster situation. To test this model, the DSG has proposed building a test bed patient monitoring system in the Emergency Department at the Brigham and Women’s Hospital.

In support of the Brigham and Women’s Hospital SMART proposal, as a subcontractor, MIT’s Laboratory for Computer Science (LCS) will design a scalable location-aware patient monitoring system. The three main components of this system are (1) a patient-based sensor system; (2) an indoor location infrastructure for tracking equipment and people; and (3) a location database. This patient monitoring system will be designed in a way that ensures it will work seamlessly across indoor and outdoor contexts.

This system will be based on several research initiatives of the Networks and Mobile Systems Group within LCS. The patient-based sensor system will be based on the ongoing Patient Centric Network project [Harfst 02]. The Cricket system [Priyantha 00] will be the base for the indoor location and tracking system. It will be extended with commercially available RFID technology for equipment tracking. INS [Adjie-Winoto 99] will be used for the location database. The effort will be integrated with SLAM, a new initiative examining scalability issues in sensor networks and resource location and tracking.

The Patient Centric Network is an ongoing research project: its architectural concepts and software are ready for testing outside the laboratory. The Cricket and INS systems are established research projects ready for initial deployment in production contexts. RFID is a commercially available tracking technology. The SLAM project will provide scalable data management and query processing techniques as it matures.

LCS will work closely with researchers and practitioners at BWH and CIMIT to integrate the location-aware patient monitoring system with a decision support system that will be developed by BWH researchers to recommend proper allocation of personnel and material resources for patients with cardiovascular and respiratory complaints.


A.2. Objectives

Today there are many challenges in delivering health care including
• Scarcity of trained personnel,
• Overworked providers,
• Unpredictable numbers of patients,
• Pressures to contain costs, and
• Demographic shifts: an aging population and their healthcare issues

These challenges lead to the desire to develop computer and networking systems to augment capabilities of the available healthcare workforce to serve the increasing number of patients. To alleviate some of these pressures, we are proposing to develop a system that will help to provide a higher standard of care, by
• Continuously monitoring the physiological status of at risk patients,
• Providing a ubiquitous communications link between the patient monitors and health care professionals,
• Tracking the location of patients and health care resources,
• Automatically alerting the appropriate nearby health care professionals when a patient needs care, and
• Providing logistical assistance in responding to medical emergencies.
All of this must be done without incurring undue cost. It is also crucial to not disrupt the life of the patient. The sensors and communication hardware must be lightweight, unobtrusive, and energy efficient. Furthermore, the system must be able to quickly locate the patient in the event of an emergency, without sacrificing the patient’s privacy.
A key issue is the design of the alerting system. If it “cries wolf” too often, the response time of medical personnel is bound to decline and the patient will be inclined to stop using it. On the other hand, failure to raise and alert when appropriate could have catastrophic consequences.


A.3. Approach

The approach we propose is to further develop and deploy the Patient Centric Network, Cricket (an indoors location system), INS (a system for finding devices in an environment based on location and other attributes), and an interface to existing BWH systems.

The Patient Centric Network will be expanded to incorporate pulse oximetry and one and two-lead EKG sensors. Algorithms will be developed for analyzing these signals and alerting providers to critical events.

Cricket will be deployed to provide indoor location information. It will be integrated with INS to provide a location database of providers and patients. RFID will be deployed for equipment tracking and integrated with INS.

Software will be provided to interface with provider PDAs and desktop computers to the location database, so that location queries can be resolved.

The monitoring of patients’ vital signs is not a new problem: we seek to make it available in a cost-effective, patient-and-provider friendly way in non-traditional environments, especially where there are many mobile patients. The number of false alarms will be reduced by correlating the data from multiple sensors (sensor fusion) to get information about the state of the patient that is both accurate and robust with respect to errors generated by sensors.

Within a medical system, patient data needs to be protected. To this end, we will deploy encrypted network links, use encryption to protect stored data, and restrict access to the data. Further, caregivers, patients, medical devices, and software will need to be authenticated to the system. We plan to use SDSI (Simple Distributed Security Infrastructure [sdsi]) developed at LCS by Prof. Rivest’s group, to provide authentication.

As the project develops in scope, more technologies will need to be developed and deployed and strategies for managing larger scale enterprises will become more central. When solving logistics problems, it often is important to search local information first, and then look for less local solutions. In doing this it is often necessary to respect administrative domains. For example, while most ER equipment can be available to any provider within the ER, most ER equipment is not normally available to other departments, except under unusual conditions. We will look to SLAM and Twine [Balazinska], new research initiatives, for approaches to these problems.

A.4. Methods
The following sections outline the base technologies we will use in building the SMART test bed network. Next the basic components are described. We then discuss integrating these components to produce a basic system. Finally we look briefly at expanding the scope of the system beyond the initial deployment and propose strategies for energy management.
A.4.1 Base Technologies
The following subsections describe the base technologies used in building the SMART system. They include the Patient Centric Network, the Cricket System, RFID, and INS. The Patient Centric Network focuses on collecting sensor data from each patient and processing it. The Cricket System provides location information for both patients and healthcare providers. The RFID system provides location information for equipment. INS provides a location database for patient location information, provider location information, and equipment information. These systems are all inherently scalable. We will look to the SLAM and Twine projects to provide further insights into scalability issues.
A.4.1.1 Patient Centric Network
The Patient Centric Network (PCN) is an ongoing research project at MIT. Our goal is to build a flexible, cost-effective patient monitoring system prototype based on commodity hardware, wireless communications and lightweight sensors and actuators.
This project evolved from our SpectrumWare software radio project [Bose 99]. In SpectrumWare we pushed the boundary between software and hardware in the communications domain. We captured a wideband signal, digitized it close to the antenna, moved the samples into memory, and then did all signal processing on a commodity PC. This allowed multiplexing of the same hardware for a variety of applications (ranging from a multi-mode cell phone, to a wireless patch panel, to a television), while simultaneously allowing us to experiment with novel algorithms for transmission and reception.
Here we are using a similar technique in a different domain. A medical device consists of a sensor or actuator connected to an A/D converter and a network interface. Our architecture, Figure 1, is multi-tiered. It employs a collection of gateways and software proxies, running on general-purpose hardware, to bring sensors and actuators onto the network.
Figure 1: The multi-tiered architecture of our Patient-Centric Network.

Gateways serve as relays to the main network, providing a bridge between the various communication technologies and protocols supported by sensors and the standardized technology used in the rest of the system. Supporting a new connection technology or protocol requires updating only the gateway, not the other network components.
Compared to radios, most medical sensors generate data at a relatively low rate (on the order of Hz or kHz). Furthermore, the sensors communicate with a gateway that is guaranteed to be within close proximity (approximately one meter). Together, these two facts often make it possible to use inexpensive, low power, wireless interfaces between the devices and the gateways. Furthermore, since loss of an occasional sample will not impact the overall functionality or utility of the system, devices need not attempt to retransmit lost packets.
To facilitate our goal of fusing data streams, gateways also time stamp each message before relaying it. This is a critical step. Sensor fusion requires the temporal synchronization of data from multiple sensors. Many sensors will not have a clock, and those clocks that do exist are not likely to be synchronized with each other. In contrast, each gateway has a clock, and these clocks are kept synchronized using a standard algorithm [Mills 92].
Each proxy is an application instance executing on a shared, general-purpose machine. All information processing occurs in the proxies, which can be chained together to perform sophisticated analysis, data fusion, and to create new virtual devices. The proxies perform a full spectrum of information flow operations, from communicating with devices via the gateways, to providing information to user interface applications including sophisticated alerting systems. In general, a proxy receives data from, or sends commands to, one or more upstream components; and serves data to, or accepts commands from, one or more downstream applications.
For every physical device, there is a single proxy that communicates directly with that device via a gateway. These are called device proxies. The device proxy must understand the device's (often proprietary) operating semantics so that it can provide an accessible interface to the device's functions. Our expectation is that device manufacturers will ship a default proxy with the device. Note that all components downstream from a device proxy make no distinction between it and other types of proxies.
A key advantage of using computation proxy chains to process information is the modularity of the construction. New data are readily obtained by replacing individual proxies, rather than larger, monolithic programs. Some of the most interesting proxies combine data from multiple sensors to provide synthetic devices.
User interfaces are completely separated from both devices and proxies. The separation facilitates remote monitoring on devices ranging from large format high-resolution displays to cellular telephones.
Unlike most other networks of devices, e.g., [Gribble 2001] [Heinzelman 2002], our network relies upon a centralized network manager. This software is responsible for managing the network, including detecting the arrival and departure of devices, connecting proxies to devices and to each other, supplying data to remote monitors, and providing security. The network manager is part of the trusted computing base (TCB), and therefore resides in a different administrative domain than other parts of the system. It is responsible for authenticating proxies as well as users.
We rely on a centralized network manager for several reasons. The primary reason is that a central authority most readily detects errors involving collections of components in conflicting states. Since the number of sensors connected to an individual patient will not be huge (probably less than 100), centralized management does not introduce a scaling problem.
A second reason for centralized management is that it conforms to standard hospital operating procedures. The network manager can reside in a separate administrative domain, subject to whatever controls are appropriate.
The network manager's foundation is a static database that describes known device and proxy types. The records include numerous attributes detailing the components' functionality and requirements. These attributes are particularly important when components join the network.
The network manager also tracks dynamic state about device, gateway, and proxy instances currently on the network. The information includes their operating status, along with the connections and dependencies between components.
As the number of patients to be monitored increases, more network managers can be added.

A.4.1.2 Indoor Location System: Cricket
Cricket is an indoor location system for pervasive computing environments. These environments take advantage of emergent network-enabled devices and the promise of ubiquitous network connectivity. A compelling set of applications in pervasive environments is context-aware, being able to discover the external context in which they run and adapt accordingly. An important example of context is location, such as the position (in some coordinate system) of a device or user, the geographic space in which a device or user is (e.g., the room or portion of a room), and the orientation of a device within some coordinate system. Knowledge of location in the form of coordinate position, spatial resolution, and orientation (a.k.a. "directionality" or "heading") enables a wide variety of pervasive computing applications such as resource discovery, "point-and-use" interfaces and navigation. In the proposed system, the patient monitoring devices and the healthcare providers’ devices will update the location database with their Cricket location information. This will enable healthcare providers to find patients and other healthcare providers when a patient is in distress.

While location information in outdoor environments may be obtained via the Global Positioning System or using the cellular infrastructure (with the emerging E-911 services), such capabilities are unavailable in indoor environments or around tall buildings where line-of-sight to GPS [Getting 93] satellites is usually unavailable. However, location-aware applications inside buildings, such as offices (and campuses), shopping malls, airports, homes, hospitals, etc. have the potential to fundamentally change the way they interact with their immediate environment. Obtaining location information for applications in an indoor environment in an unobstrusive and private manner is a challenging task. Indoor environments are harsher than outdoor ones in their treatment of radio signals because of multipath effects and dead spots inside buildings. User-privacy concerns are an important consideration in the successful deployment of these applications. The administration of the hardware and software infrastructure used for this must be minimal because of the large number of devices and networked services that need this information.

Technology
Cricket uses a combination of Radio Frequency (RF) and ultrasound technologies to provide a location-support service to users and applications. Wall- or ceiling-mounted beacons, deployed within a building, publish information on an RF signal in the 418 MHz AM band. With each RF advertisement, a beacon transmits a concurrent ultrasonic pulse. Compact listeners attached to mobile or static devices listen for RF signals and, upon receipt of the first few bits, listen for the corresponding ultrasonic pulse. When this pulse arrives, the listeners compute a distance estimate for the corresponding beacon. The listeners run an inference algorithm to correlate the RF and ultrasound signals (the latter are simple pulses with no data encoded on them) emitted from the same beacon. Even in the presence of several competing beacons, our goal is to accurately estimate the linear distances between a listener and all in-range beacons within a small number of seconds.

Cricket uses active beacons and passive listeners, which has three significant benefits. First, it scales well as the number of devices increases; a system with active transmitters attached to devices wouldn't scale particularly well with the density of instrumented devices. Second, its decentralized architecture makes it easy to deploy. This does not mean it is hard to manage; a centralized front-end allows easy management and control. Third, since the listener is passive, the listener controls dissemination of information about its location, thus maintaining privacy
A.4.1.3 RFID

RFID, Radio Frequency Identification [Finkenzeller 99][Sarma 00], is a commercially available system being developed to replace bar codes. As in the bar code system, each item is tagged with a unique identifier. In the bar code system, each identifier is a number. A bar code scanner is used to transfer the number from the item to an application. The application then uses the number to find information about the item from a database. A common example of the use of bar codes is in retail operations, e.g., grocery stores or department stores.

In an RFID system, there is also a tag. This time it is electronically based. An RFID reader is used to transfer the information encoded in the tag to an application. Usually the tag is passive and has no power source (i.e., no battery). The electronics on the tag are activated when the RFID tag is scanned. The scanning process has the reader generating an electromagnetic field and inducing a current in the RFID tag electronics. The current gives power to the RFID tag and allows it to emit its signal. This signal contains the identifying information. As in a bar code system, the application uses this information to select relevant information from a database.

Both systems can be used for inventory control. The chief advantage of an RFID system is that the scanning process is more tolerant of spatial ambiguity, i.e., the reader need not be very close to the tag. RFID scanning can be similar to walking through a metal detector at an airport. This hands-off scanning approach of RFID is useful in a hospital environment, where healthcare providers’ attention is focussed on patients and not on inventory.
A.4.1.4 Location Database: INS
The Intentional Naming System, INS is designed for naming and discovering a variety of resources in networks of devices and services. INS names are intentional; they describe application intent in the form of properties and attributes of resources and data, rather than simply network locations of objects (which is the way most traditional network naming systems work today). Names express and satisfy queries about information and their providers. Queries often encode the node doing the query and the results can be exact matches or range matches.

INS resolvers are called Intentional Name Resolvers, or INRs. In any domain, INRs configure themselves into an application-level overlay network based on performance metrics and exchange meta-data about names and the corresponding network locations. The configuration protocols will enable the system to work with no manual intervention, incorporating machinery to bootstrap INRs, spawn and terminate INRs, maintain neighbor relationships, and perform load management across both the local and wide-area Internet.

In addition to achieving the above properties, an important challenge in INS is scaling to a large number ("millions") of names and services. While this kind of scaling will not be relevant to our demonstration systems in the ER, it will be necessary when SMART is transferred to wide area applications. Internet routing relies almost solely on hierarchy to achieve scaling. INS cannot do this, because intentional names aren't necessarily hierarchical. To combat this, INS uses peer-to-peer techniques to scale [Balazinska].

A.4.2 Components
A.4.2.1 Tracking Equipment: RFID
We are planning to use RFID technology to track equipment. Initially each piece of equipment will be tagged with an RFID tag and added to the database of equipment. RFID readers will be added to the ER area. Each reader will have a virtual tag. This allows the reader and its location to be entered into the location database. As a piece of equipment passes an RFID reader, the reader will transmit its identity and the equipment’s RFID tag to an RFID reader manager. This reader manager will update the location information associated with that piece of equipment in the location database.
A.4.2.2 Tracking Patients: PDAs
It is important for healthcare providers to be able to find patients. This is especially true if the patient’s monitoring information shows that the patient is in need of assistance. While some people prefer not to be tracked, it is hoped that these patients will tolerate tracking in exchange for better care.

The method of choice in this environment is to provide the patient with a PDA. This PDA will be used to interface to vital signs monitoring sensors and to a Cricket listener.
The Cricket listener will listen for messages from Cricket beacons and pass these to the PDA. At the patient’s discretion, the PDA will then update the patient’s location in the location database. Alternatively, the PDA can be configured to inform the system of the patient’s location only when some event, e.g., a medical emergency, arises.
A.4.2.3 Provider PDAs
In emergencies it can be critical for healthcare providers to be able to locate other healthcare providers. We hope that healthcare providers will be comfortable being tracked.

The method will be similar to tracking patients: each healthcare provider will be provided with a PDA. This PDA will provide the healthcare provider access to patient alerts, patient records, and the location of equipment and other healthcare providers. This PDA will interface to a Cricket listener. The Cricket listener will listen to Cricket beacon messages and pass them to the PDA. The PDA will then update the location information associated with the healthcare provider in the location database.
A.4.2.4 Sensors
In support of the SMART system, we will interface PDAs with oximetry sensors and EKG sensors with small numbers of leads. These sensors will provide the ER healthcare providers with improved monitoring of patients who are between consultations or waiting for test results.

For oximetry sensors, we are considering Nonin Xpods. These are lightweight self-contained units with a serial port for transmitting data to the patient’s PDA.

We are currently engaged in adding a 2-lead EKG sensor to the Patient Centric Network.

A.4.3 Integrating the Components
Here we review how the previously presented components can be integrated to meet the goals of the SMART system.
A.4.3.1 Patient Monitoring
One of the key goals of this project is to improve monitoring of patients’ vital signs while they are in the ER: patients spend a significant amount of time in the ER, not in the presence of a healthcare provider. During this time, critical events can occur and drastic changes can take place in the patient’s health status without being visible to ER healthcare providers. SMART will provide cost-effective, patient-acceptable monitoring to prevent these undesirable outcomes.

The process here will be to provide the patient with a PDA. The PDA will interface to various sensors that are monitoring vital signs. The PDA will also interface to the Cricket location system. This will provide the PDA with location information for the patient. The patient’s PDA will update the location database with the patient’s location.
The patient’s PDA will timestamp all sensor data and pass it to the sensor proxies on the department computer that will be tracking patient status.

The department computer will have algorithms to determine whether alerts should be forwarded to healthcare providers.
A.4.3.2 Interfacing with the Decision Support System
The decision support system will be critical to making this system work well. Its chief goals are to alert healthcare provider(s) when there is a problem with a patient and to provide healthcare providers with access to information concerning patient status, patient location, equipment location, the location of other healthcare providers and a recommendation about how to proceed.
A.4.3.3 Alerts
Alerting systems play an important role in many clinical settings. They are used to alert medical personnel to conditions that arise in unattended patients. In situations where attending personnel may be subject to “information overload” they are used to direct the attention of medical personnel. We used the prototype PCN discussed above to experiment with a cardiac annunciator panel running over a wireless connection on a handheld device.

Figure 2: Annunciator panel used to raise alerts for cardiac conditions. When a condition arises, appropriate part of panel turns red. If the panel is not muted, a verbal alarm is raised as well.

The graphical display, Figure 2, provides alerts for a variety of dangerous cardiac states, and is driven by a collection of proxies that provide signal processing and sensor fusion. This virtual device uses raw data from three physical devices: central venous pressure (CVP), systolic blood pressure (SBP), and EKG.
To detect backward blood flow, the cannon wave proxy receives the CVP stream. A SBP heart rate proxy connects to the SBP device proxy and performs a heart rate calculation [Akay 94]. Similarly, the EKG rate proxy produces another heart rate calculation from the EKG device proxy. Both rate proxies compute the values using time stamps generated at the gateway. Finally, a robust heart rate proxy fuses the two primary rate values by performing a weighted average on their values. The fused heart rate is robust in that it is derived from multiple physiological signals.
This simple alerting system was built in an ad hoc fashion by getting physicians to critique several versions. It is clear to us, however, that this approach will not extend to more complex situations. What is needed is a principled and systematic way to build alerting systems.
We would like to develop a flexible software architecture that links sensors and actuators with patients and caretakers and provides sophisticated mechanisms for detecting problems and raising alerts. A generic, ideal alerting system would detect every problem, issue no false alarms, provide sufficient advanced notification to allow for preventative interventions, and warn medical personnel when an intervention has the potential to preclude potentially useful future treatments.
Of course, a perfect system is not possible. There is always uncertainty about the quality of data, the interpretation of the data, and future events. The detrimental effects of this uncertainty clearly manifest themselves in existing medical alert systems. Most noticeably, false alarms are rampant, as any visit to an ICU makes clear. Missed detections also occur, sometimes with catastrophic results.
Given this uncertainty, it seems prudent to design an architecture that carefully separates policy from mechanism. Medical personnel should be able to easily specify whatever alerting policy they desire, and the system should have mechanisms that automatically implement it. Additionally, the system should provide continuous feedback about how well (or poorly) various policies perform, and incorporate technology that allows the system to adapt to changing circumstances. Recently, we have started looking into the design of the cockpit alerting systems deployed in the Traffic Alert and Collision Avoidance System (TCAS) used by commercial aircraft. This environment has a number of things in common with medical environments, and a number of very important differences.
We plan to start our work by designing a formal model of the alerting system for a number of medical environments. It will be based on an approach devised by Jim Kuchar of MIT’s Department of Aeronautics and Astronautics [Kuchar 96][Kuchar 01][Song 01]. He converts the problem to the domain of signal-detection theory, where one must determine if a known signal is present in background noise. He models uncertainties using probability density functions, from which the probabilities of false detections and missed detections can be calculated. This mechanism enables informed decisions on how to set appropriate policies.
Sensors for patient and airplane monitoring have comparable errors that are amenable to probabilistic modeling. Using those readings to generate an estimate of the current state is quite different. With airplanes, one generates a single state estimate, along with an area around that point that accommodates for errors in the sensor data. In contrast, there are often multiple interpretations of a given physiological reading. Predicting future states is also much more difficult in the medical domain. Knowledge of airplane physics is far more precise than that of human physiology. Therefore, a far greater number of next states exist for patient monitoring. The number of possible interventions is also larger in the medical domain. Whereas a pilot can change an airplane's acceleration, altitude and direction, a doctor can apply a multitude of therapies. Moreover, medical interventions can interact in complex ways. For example, administering one drug might preclude the administration of other relevant drugs. Providing alerts about precluded treatment options is both important and challenging.
A.4.4 Expanding the Scope

The following subsections examine expanding the SMART system within a hospital, to outdoors locations, and its applicability to large scale disaster management.
A.4.4.1 Expanding within the Hospital
Twine [Balazinska] is a resource discovery system that builds on INS, using Chord [Stoica 01] as a distributed hash lookup. It uses the same naming syntax as INS. It offers both discovery and early binding functionality to client applications. Twine implements a new form of intentional name resolution that achieves scalability using a hash-based partitioning of resource descriptions among the Intentional Name Resolvers.

Twine does not require pre-configured hierarchies or special naming syntax. It works with arbitrary attribute sets and achieves balanced resource distribution among participating resolvers. It also handles queries based on orthogonal and hierarchical attributes, with no content or location constraints.

Twine uses a set of resolvers, Twine nodes, that organize themselves into an overlay network [overlaynetdefn] to route resource descriptions to each other for storage, and to collaboratively resolve client queries. Each resolver dynamically specializes in learning about a subset of other Twine nodes, as well as a subset of available resources.

The high-level motivation for Twine's design comes from peer-to-peer document distribution architectures like Freenet[Freenet]. These systems offer interesting scaling possibilities by avoiding central bottlenecks, and by having nodes specialize in subsets of the entire document space. Twine treats resource descriptions the way a system like Freenet might treat an entire document, although the details of how distribution is done are very different. Twine also focuses on resource information distribution for an efficient resolution of queries with incomplete resource descriptions. The Twine architecture is layered, building on top of Chord. Chord's simplicity makes it an attractive substrate.

A.4.4.2 Expanding Outdoors
Expanding this system to work outdoors involves interfacing with GPS to get location information and with the cellular network for wide-area communications.
A.4.4.3 Large Scale Disaster Management
When a large-scale disaster occurs, wired communications is often lost. Therefore easily deployable wireless communications systems are quite important. Adding an easily deployed location information system will help rescue workers communicate useful information to each other. Easily deployed patient monitoring systems will help rescue workers in a challenging environment deploy their efforts to best effect. Networks that are self-organizing, sometimes called ad hoc networks, are essential in dealing with a chaotic environment.

A.4.5 Energy Management

Currently mobile devices are highly dependent on battery power. Wireless communication is a particularly large consumer of power. Bluetooth [blue99] is more energy efficient than 802.11b. Bluetooth may be deployed between the vital signs monitoring sensors and the gateway. Other technologies may evolve in this area. The component technologies we plan to use have been developed with energy efficicient in mind. PCN has been designed to facilitate the use of low power communication at the edges of the network, where battery powered devices are prevalent. Though the current generation of Cricket beacons and listeners consume to much energy, we are in the process of redesigning them in a way that will significantly reduce energy consumption.
Related Work

The Patient Centric Network, a pervasive network of medical sensors, crosses many problem domains and hence shares context with much related work. We divide the work into three broad categories: point solutions for medical sensors, industrial medical or information networks, and other architectures for pervasive sensor networks.

There are an ever increasing number of well publicized point solutions to medical problems that leverage pervasive technology. Articles frequently appear in the technology sections of publications such as The New York Times and The Wall Street Journal that discuss the use of wireless links and palmtop machines to monitor
physiological signals [Gaither 01],[ortivus]. A common application is to monitor EKG on a Palm Pilot or Compaq iPaq [ipaqEKG],[pdaMD]. While each new solution is exciting, they all continue along the traditional path of point solutions in medical technology.

Closer to PCN's goals are information distribution solutions, such as those offered by Tibco [tibco]. Tibco provides an enterprise-level systems integration solution that can meet real-time process demands. While some of their techniques might be applicable
to PCN's data distribution, Tibco's architecture is not suitable for sensor networks. In particular, it does not address issues of interfacing with a large variety of individual devices, nor does it provide for fusing streams of data from sensors.

A system with similar goals to PCN is Frontiers by eko systems, Inc. [ekosystems]. Their vision is an electronic medical record system that eliminates the “enormously labor intensive and potentially error-prone paper process used today in charting surgical
patients.” The Frontiers system uses devices similar to PCN's gateway to connect devices or other information sources to centralized charting and storage servers. They focus on accessing and retrieving a broad range of data, and do not consider dynamic fusion or processing of data streams.

Another related system is the Ninja architecture, developed at Berkeley [Gribble 01],[ninjawww]. That project aims to “develop a software infrastructure to support the next generation of Internet-based applications.” Like PCN, Ninja is designed to incorporate simple devices, or units, into large, highly available Internet applications. It also has the concept of software proxies that allow composition and customization of applications. It does not deal with the fusion of streams of sensor data. Rather, its goal is to fuse services such as email clients and cell phones in a modular way. In addition, the Ninja system does not have a time-critical mechanism for monitoring the network and responding to changes or errors.

There are other location and tracking systems available: the Bat system [Harter 87], the Active Badge system [Want 92], and RADAR [Bahl 00]. These systems are based on the tracked item sending a signal to sensors that have been deployed on ceilings or walls of the building. The sensor then reports the item’s location to a central system. These systems are more difficult to deploy because the sensors need to be wired to a central computer. This also makes them less scalable. This is in contrast to the Cricket location system where the sensors are on the tracked item and the beacons are on the walls or ceilings of the building and are not connected to any network.
References
[Adjie-Winoto 99] Adjie-Winoto, W., Schwartz, E., Balakrishnan, H. and Lilley, J. “The design and implementation of an intentional naming system,” In Proc. ACM Symposium on Operating Systems Principles (Kiawah Island, SC, Dec. 1999), pp. 186–201.
[Akay 94] Akay, Metin, Biomedical Signal Processing, Academic Press, 1994.
[Bahl 00] Bahl, P., Padmanabhan, B. RADAR: An In-Building RF-based User Location and Tracking System. Proc. IEEE INFOCOM (Tel-Aviv, Israel, Mar. 2000)
[Balazinska] Balazinska, M., and Balakrishnan, H. Twine: Scalable intentional resource discovery for pervasive computing environments. http:// nms.lcs.mit.edu/projects/twine.
[Bose 99] V. Bose and M. Ismert and M. Welborn and J. Guttag, “Virtual Radios,” IEEE Journal on Selected Areas in Communications, vol. 17, no. 9, April 1999
[blue99] Specification of Bluetooth System, http://www.bluetooth.com, December, 1999.
[ekosystems] eko systems, Inc. Frontier, electronic information management. http://www.ekosystems.com
[Finkenzeller 99] Finkenzeller, K. RFID Handbook—radio-frequency identification fundamentals and applications. John Wiley & Sons,1999.
[Gaither 01] Gaither, Chris. “Bluetooth defies obituaries.” In The New York Times, December, 2001.
[Gribble 01] Gribble, Steven, “The Ninja Architecture for Robust {Internet}-scale Systems and Services,” Computer Networks, April 2001.
[Harter 97] Harter, A., Hopper, A., “A New Location Technique for the Active Office.” IEEE Personal Communications 4, 5 (October 1997), 43-47.
[Harfst 02] Harfst, Gregory and Guttag, John, “A Patient-Centric Network: An Architecture for Pervasive Medical Devices,” submitted for publication.
[Heinzelman 02] W. Heinzelman and A. Chandrakasan and H. Balakrishnan, “An Application-Specific Protocol Architecture for Wireless Microsensor Network,” IEEE Transactions on Wireless Communications, to appear 2002.
[ipaqEKG] MicroMedical. MicroMedical PocketView ECG. http://www.micromed.com.au/08_products/20_pocketview/
[Kuchar 96] Kuchar, James K., “Methodology for Alerting-System Performance Evaluation,” Journal of Guidance, Controls, and Dynamics, Volume 19, Number 2, Mar-Apr 1996.
[Kuchar 01] Kuchar, James K., “Managing Uncertainty in Decision-Aiding and Alerting System Design,” 6th CNS/ATM Conference, March 2001.
[Mills 92] Mill, David, “Network Time Protocol (Version 3) Specification, Implementation and Analysis,” IETF RFC 1305, March 1992.
[ninjawww] Ninja group at Berkeley. Nija homepage. http://ninja.cs.berkeley.edu.
[overlaynetdefn] A network is a collection of interconnected nodes. An overlay network is based on a network and uses a subset of the base network’s nodes and a subset of the base network’s connections. The method of choosing which nodes and which connections are in the overlay network depends on the purpose of the overlay network.
[Oxygen] Project Oxygen, a Consortium at MIT http://oxygen.lcs.mit.edu
[pdaMD] pdaMD.com http://www.pdamd.com/vertical/home.xml
[Priyantha 00] Priyantha, N., Chakraborty, A., and Balakrishnan, H. “The Cricket Location-Support System.” In Proc. 6th ACM MOBICOM Conf. (Boston, MA, Aug. 2000), pp. 32–43.
[ortivus] Ortivus, MobiMed 200. http://www.ortivus.com/
[Sarma 00] Sarma, S., Brock, D., and Ashton, K. “The networked physical world: Proposals for engineering the next generation of computing, commerce and automatic identification.” Tech. Rep. MIT AUTO-ID-WH-001, MIT Auto-ID Center, Dec., 2000.
[sdsi] http://theory.lcs.mit.edu/~cis/sdsi.html.
[Song 01] Song, Lixia and Kuchar, James K, “Describing, Predicting, and Mitigating Dissonance Between Alerting Systems,” International Workshop on Human Error, Safety, and System Development, June 2001.
[Stoica 01] Stoica, I., Morris, R., Karger, D., Kaashoek, M. F., and Balakrishnan, H. “Chord: A scalable peer-to-peer lookup service for internet applications.” In Proc. ACM SIGCOMM (San Diego, Aug. 2001).
[tibco] Tibco. http://www.tibco.com
[Want 92] Want, R., Hopper, A., Falcao, V., and Biggons, J. “The Active Badge Location System. ACM Transactions on Information Systems 10, 1(January 1992), 91-102.

technical proposal, budgeting proposal in health sector, proposal in nepal

Project Proposal Service Management Best Practice

Project Proposal Service Management Best Practice


Contents

1 PROJECT DETAILS 3
1.1 Summary 3
1.2 Business Objectives 3
1.3 Deliverables and Limits 3
1.4 Timing and Multi Year Projects 4
1.4.1 Timing 4
1.4.2 Multi-Year 4
1.5 Risks 4
2 PROJECT CATEGORY AND JUSTIFICATION 4
2.1 Category 4
2.2 Justification 4
3 PROJECT BENEFITS AND COSTS 5
3.1 Five Year Benefits 5
3.2 Other Funding and Staff Resources to be secured 6
3.3 Detailed Benefits and Costs Worksheet 7

1 Project Details
1.1 Summary

The IT Infrastructure Library (ITIL) was developed to help organisations meet their the corporate aims and business needs through best use of IT . In particular ITIL provides guidance on how to provide quality IT services focusing on the resources and facilities needed to support successful deployment of IT.

ITIL is now widely recognised as the world standard for IT service management best practice. Organisations can draw from ITIL taking aspects appropriate to their individual needs and building upon them. ITIL provides a flexible basis for the development of hiqh quality service provision. The coverage of ITIL includes:

• Incident Management
• Change Control
• Configuration and Release Management
• Service Level Agreements (SLA)
• Financial and Budgetary Control
• Capacity Planning and Management
• IT Service Continuity
• Running Helpdesks
• Security Management
• Disaster Recovery Planning

With the increasing adoption of IT across all aspects of University activity and in particular within the corporate applications area it is appropriate that MIS consider adopting ITIL. This project is intended to lay the foundations for the formal adoption of ITIL based service management best practices by MIS and our service partners.

Further background on ITIL is available on the UK Office of Government Commerce website www.itil.co.uk . ITIL has been adopted by a number of leading HE institutions worldwide including: Southampton and Hull in the UK and Melbourne Autstralia.
1.2 Business Objectives

Objective Number Objective Description
1 To create an awareness of ITIL within MIS and service partner areas.
2 To provide basic introductory training for key staff involved in IT service management, delivery and support.
3 To identify and recognise current examples of best practice.
4 To identify gaps in service management provision and agree a timetable for prioritising and addressing these deficiencies.
5 To agree a framework and plan for the roll out of ITIL based service management for all corporate applications related services.
1.3 Deliverables and Limits

Deliverable Number Deliverable Description
1. ITIL awareness sessions for MIS and service partner staff. We would envisage up to 16 staff being involved in these initial sessions with perhaps 8 from MIS and the same number from business partner areas.
2 Introductory ITIL training for key staff. Perhaps all 16 of the initial group but will be dependent on funding from each area so up to 8 staff in total is a more realistic target.
3 Reports on best practice and gaps for each business area represented in project. The target would be to include at least Corporate Infrastructure, Estates, Finance, Human Resources and Student in this initial group.
4 Framework and roll out plan for ITIL based service management across all corporate IT services.

1.4 Timing and Multi Year Projects
1.4.1 Timing

There are no hard milestones for this project which is the start of a long term commitment to ITIL based high quality IT service management. We would anticipate that the initial work covered by this project will be completed by July 2007 in accordance with the following outline schedule:

1. ITIL Awareness - Completed by December 2006
2. ITIL Introductory Training – Completed by March 2007
3. Business Area Service Reports – Completed by May 2007
4. Framework and Roll-out Plan – Completed by July 2007
1.4.2 Multi-Year

n/a

1.5 Risks

Risk Description
1 Key MIS service management staff are diverted to short tem and apparently higher priority support activities.
2 Service partners unable to commit resources to project due to staff shortages in service areas.


2 PROJECT CATEGORY and JUSTIFICATION
2.1 Category

Very Important This project is “Very Important”. There is an argument in favour of an “Essential” classification give the increasing and critical importance of IT service deliveryto the success of the University.

2.2 Justification

University Goals And Operational Priorities Details of these goals and operation priorities can be found in the UoE strategic plan.

Excellence in Education IT services such as DACS, WISARD and MyEd are key components in delivering educational support to undergraduate and postgraduate students.
Excellence in Research IT services such as eFinancials, Research Grants, ERI Financials and InfoEd are key components in supporting the University research programme.
Excellence in knowledge transfer and commercialisation N/A
Quality infrastructure High quality IT services are now part and parcel the overall working and learning environment for staff, students and visitors to the University.
Quality services High quality IT services are now part and parcel the overall working and learning environment for staff, students and visitors to the University.
Quality knowledge management High quality IT services are now part and parcel the overall working and learning environment for staff, students and visitors to the University.
Promoting opportunity and diversity N/A
Developing leadership and management ITIL promotes high quality management within all areas actively engaged in the delivery, support and management of IT services – this is an increasingly large group of staff within the University.
Advancing Internationalisation N/A
Engaging with the wider community It may be considered that IT services, e.g. MyEd and/or the University web site may be one of the key initial contacts people in the wider community will have with the University.
Building effective partnerships and collaborations It may be considered that IT services, e.g. MyEd and/or the University web site may be one of the key means by which partnerships and collaborations are maintained and advanced.
Effective governance and ensuring sustainability This an explicit objective of ITIL with respect to IT service management.
KMS Milestone N/A
OTHER N/A


3 PROJECT BENEFITS and COSTS

3.1 Five Year Benefits

Tangible Benefits
Benefit Assumptions
Within the 5 areas explicitly covered by this proposal (INF, EST, FIN, HR, STU) the support (KSR) budget is approximately 1250 days

If adoption of ITIL based best practice provided efficiency gains of 5%, which is a realistic target, then this translates to a saving of at least 60 days per annum.


Intangible Benefits
Benefit Assumptions
This project explicitly recognises the importance of high quality IT service delivery support and management. This can be overlooked in a period of change where ther is, rightly, a focus on delivering IT projects.
Staff engaged in IT service delivery will welcome the adoption of industry recognised best practice both as a confirmation of the quality of existing service delivery and recognition of those gaps which exist.
Customers will welcome the security provided by the adoption of industry recognised best practices for the IT services that are an increasingly vital part of their business activities.
3.2 Other Funding and Staff Resources to be secured

Additional Funding / Resources Requirements
Secured?
YES /NO
N/A – all costs includen in detailed worksheet.

Letter to Mahabir Pun of NEPAL

Dear and Respected Sir,
Thanking you a lot sir, as we have got a great Nepalese like you for developing wireless in remote mountain village of Nangi into the computer era.
Sir, we the students of Nobel College with program of BCIS (Bachelor in Computer Information System) are very interested to know about the wireless implementation in those rural areas thus we have decided to visit the Nangi area and study about the wireless technology with you and your creation. Thus, we have written this e-mail to you for requesting you to let us learn the wireless technology in your village.
We have also known that you are running a campaign “Donate $1 per month” and we are sure that we can also help in this campaign.
Likewise, we can help you to broaden the wireless technologies also. But what we need from the educational tour is that you will help us learn the technologies what you are using as well as we will share our views and known technologies and knowledge that can be used or anything that we have knowledge.
Our Package Style
Team Member 6 students
Days that we will spend with you 4 days (total)
Lectures by you 1 day
Socialization with the equipment and society 1 day
Tools and techniques that are implemented 1 day
Our sharing with you 1 day
Back to our study

We can also make you that what we have found in the field and can provide suggestion and help if and only if you wish.
At last what we are sure that you will provide good response to it.
Hope that you will help us to learn technologies and help us to broaden our mind.
Name of student:
Name Face Book id or e-mail id we use
Jayman Tamang
Preetam Balla
Ram KC
Rameshwor Shrestha
Ritesh Shrestha
Rupak Nepali (Class Representative) rupaknpl@gmail.com

Project Proposal On E-shopping with affiliation

http://rupaknepali.com.np/final-year-project-proposal-on-e-shopping-with-affiliation/1716.php

Project proposal presentation of hotel reservatin system

http://rupaknepali.com.np/project-proposal-presentation-of-hotel-reservation-system-ecommerce/1728.php

Ajax as asynchronous javascript and xml

• If we are able to make web page section to be refreshed without the use of flash and java then probably we are using Ajax. Ajax brings web interfaces using XHTML and CSS up to desktop application interface standards.

• The closest JavaScript had to offer came in the form of the setTimeout and setInterval library functions, which required delayed, seemingly parallel execution rather than the actual spawning of processes.
• Asynchronous Javascript And XML make the acronym Ajax which is the full form of it.

Ajax as asynchronous
• Ajax does exist as an incredibly useful method of communicating with the server directly from JavaScript.

• Many Ajax-based web applications use the asynchronous flag of the XMLHttpRequest object solely to handle network errors

• The direct JavaScript-to-server communication provided by the XMLHttpRequest forms the core of the technology

Ajax as javascript
• Ajax is one of the technologies which provide an interface by which JavaScript can send and receive data to and from the server without requiring a full page load.

Ajax as XML
• In Ajax, XML refers to data transportation. The XMLHttpRequest object provides another useful bit of functionality along with its HTTP methods: When the server returns XML, the XMLHttpRequest object provides the responseXML attribute, which is a read-only XML document of the response.

Ajax-driven web applications use other formats of transporting data to and from the server, including:
• URL-encoded
• Raw text
• JavaScript Object Notation (JSON

Ajax usage has exploded, much like the web technologies, which include the blink and marquee HTML tags,1 animated GIFs, applets, the table HTML tag, and Flash.