Average Claim Research Articles

Keterlambatan Proyek yang Disebabkan oleh Owner: Evaluasi Faktor-Faktor Penyebab dan Klaim Kontraktor

Delays in construction projects are generally understood to be the sole responsibility of the contractor. In fact, these delays can also be caused by factors that actually are the responsibility of the owner, resulting in project completion exceeding the contract target date. As a result, the contractors can be affected and suffer losses due to delays that are not actually their responsibility. This study intends to evaluate project delays caused by the owner and the delay claims submitted by the contractor. This research is exploratory and uses a mixed method of quantitative and qualitative approach. Data was collected through interviews and questionnaires with 80 respondents of the construction industry. The study found five main factors causing delays caused by the owner, including: land acquisition problems, changes in design and work instructions, payment problems, and unclear drawings in the contract documents. Of these delays, the majority (93%) were claimed by contractors, with an average claim success rate of 53%, and the compensation generally in the form of extension of project completion time (63%). The most frequently chosen claim dispute settlement method (93%) is non-litigation settlement through negotiation. This research has provided a comprehensive overview of delays due to owners and the contractor claims, and gives valuable lessons for the construction industry stakeholders to cope with delays in the future.

Dependence modeling of frequency-severity of insurance claims using waiting time

Mixed copula approach has been used to jointly model discrete variable of claim counts and continuous variable of claim amounts. We propose to use a copula to link two continuous variables of the waiting time for the second claim and the average claim size. The frequency-severity dependence can be derived using the relationship between the waiting time and the counts of a Poisson process. Assuming a Gaussian copula and a log-normal distributed average claim size, we can investigate the effect of claim counts on the conditional claim severity analytically, which would be difficult in the mixed copula approach. We propose a Monte Carlo algorithm to simulate from the predictive distribution of the aggregated claims amount. In an empirical example, we illustrate the proposed method and compare with other competing methods. It shows that our proposed method provides quite competitive results.

The cost of injury in Ladies Gaelic football: A nine-year analysis (2012–2020) of the LGFA's Injury Fund

<h2>Abstract</h2><h3>Objectives</h3> Ladies Gaelic football is a popular women's sport in Ireland and internationally. An injury fund is available to Ladies Gaelic football players for claims to cover excess medical bills/lost wages, facilitating a longitudinal analysis of claim data over time. This study aimed to report Ladies Gaelic football injury claim numbers, rates, and associated costs, and consider claim trends over time. <h3>Design</h3> Descriptive epidemiology study. <h3>Methods</h3> All approved injury claims from Ladies Gaelic football players between 2012 and 2020 were analysed. The frequency of injury claims, cost of the injury fund, and specific treatment expenses were calculated for the overall sample, and for adults and youths. Claim rates per 1000 players, per 1000 adults and per 1000 youths were calculated and Poisson regression was used to examine trends over time. <h3>Results</h3> A total of €6,200,557.68 was allocated to 9348 claims, averaging €663.30 ± 1387.15 per claim. There were 12.98 (95 % confidence interval 12.72–13.25) claims per 1000 players and 1.15 (95 % confidence interval 1.12–1.17) per club. No significant injury trends over time were observed whilst the average inflation-adjusted claim cost increased by 71.9 %. Lower extremity injuries accounted for most claims (63.8 %) and most costs (83.4 %). The knee, ankle and hamstring were most frequently injured and knee injuries accounted for 70 % of injury costs. <h3>Conclusions</h3> Claim rates remained prevalent between 2012 and 2020 though average claim costs increased substantially during this time. Investment towards injury prevention strategies targeting lower extremity injuries, particularly knee injuries, is strongly supported by these data.

Analysis of game damage on the basis of judiciary documents in Nógrád County between 2015 and 2019

The common use of habitats by people and game species has been causing conflicts for a long time. With the intensification of agriculture, the level of agricultural damage has also increased. In many cases farmers and game managers try to solve their related disagreements in court, often unsuccessfully. The aim of our research was to find out the reasons for these difficulties and to show possible solutions. We studied 55 judiciary documents in three courts in Nógrád County. Red deer was involved in 42 cases of damages (76%), wild boar 33 (60%), roe deer 21 (38%) and mouflon 3 (5%), caused mainly in maize (23,64%), forest, sunflower (12,73% for both) and grassland (5,45%). Proceedings lasted for 13,65 months on average; their median was 8 months. The average claim of farmers was 1 514 610 HUF, its median was 783 000 HUF. At the end of the suits, farmers received the whole compensation in 8 cases (14,55%) and they got part of the relief on ten occasions (18,18%). Suits were ceased 14 times (25,45%) and no compensation was paid in 23 cases (41,82%). Ignorance of law and unprofessional expertise of farmers negatively influenced the judicial proceedings. Both farmers and game managers should be informed about the exact steps of the procedure for solving these long-lasting conflicts.

The evolution of private medical expenses for civil servants in Germany

In this study we analyse private medical insurance data with respect to civil servants in Germany. This data is applied to pricing purposes in the market and may therefore be deemed as useful. In particular, we discuss average health care expenditure per capita by age over time. Thereby, we analyse inpatient and outpatient benefits as well as hospital cash and dental insurance. In essence, we observe an effect that we call the rectangularisation of the cumulative health care expenditure curve. In line with this finding, we note that the modal age (at which total medical expenses for in force business are highest) has increased by 10 years of age over the last decade with respect to inpatient benefits. Moreover, we apply a linear regression model based on mortality rates as regressor. We use the Siegel test for comparing different expenditure profiles and judging goodness of fit. As a result, we find that steepening of private medical expenses by age over time is prevalent for three out of four benefit types in certain age bands. As for outpatient claims provided to male civil servants, medicalisation dominates the evolution of the average claim amount by attained age over time. On the other hand, compression is of relatively high importance for inpatient claims.

Price Variability of Standard Radiotherapy Procedure Codes in a Large Metropolitan Area from 2015-2021

<h3>Purpose/Objective(s)</h3> Compliance amongst cancer centers has been poor despite price transparency rules by the US Centers for Medicare & Medicaid Services in 2021. We investigated variability in the charged and reimbursed payments in Medicare claims for standard intensity modulated radiation therapy (IMRT) for breast and prostate cancer within a large metropolitan area. <h3>Materials/Methods</h3> Medicare claims data for radiation therapy CPT codes 77336, 77385, and 77412 from 2015 to 2021 were selected from the Definitive Healthcare claims database for providers in New York within 25 miles of the zip code 10065. Providers with unknown number of claims were excluded. Average charges, reimbursements, and total claims were obtained. Annual percentage changes (APC) were calculated. The 10 highest volume centers by total number of claims for code 77336 over the study period were analyzed. Inflation adjustment (2021 US dollars) was done. Analyses were performed in spreadsheet software. <h3>Results</h3> Of 10 cancer centers, 5 were NCI-centers including 1 that was Prospective Payment System (PPS) exempt; these 10 high-volume centers represented 82% of claims. There was variability in charges for Medicare claims for each code; for example, in 2021, the average charges ranged widely for CPT 77336 ($644-1994), 77385 ($2797-7324), and 77412 ($1775-4527). The average reimbursement per procedure was similar across centers: CPT 77336 ($110-114), 77385 ($511-526), and 77412 ($225-234) in 2021. While average charges increased yearly, the percentage reimbursed remained stable or decreased (Table). The highest average charge for each code in 2021 were from non-NCI centers; the lowest charge per code varied from PPS-exempt (77336), NCI-center (77385), and non-NCI (77412). Reimbursement per code did not appear to vary greatly by center status. <h3>Conclusion</h3> We note significant price variability for commonly used IMRT codes within one large metropolitan area with multiple high-volume cancer centers. These prices outpaced annual rate of inflation. Service charges higher than what a hospital reasonably expects to be reimbursed may both prevent competitive price shopping by the consumer and result in catastrophic financial toxicity for small payors and under/uninsured individuals. This study supports the continued efforts to prioritize price transparency and associated policy reform.

Price variability of pembrolizumab across U.S. National Cancer Institute–designated Cancer Centers (NCICCs) from 2016-2021.

48 Background: NCICCs are poorly compliant to price transparency rules set forth by the CMS. Competitive price shopping is prevented due to a lack of uniform rate setting, and service charges are often higher than what a hospital reasonably expects to be reimbursed. We investigated variability in the charged and reimbursed payments for pembrolizumab utilizing Medicare claims across all NCICCs. Methods: Medicare claims data from 2016-2021 for pembrolizumab (HCPCS J9271) infusions in a hospital outpatient department were selected from the Definitive Healthcare claims database for all hematology-oncology and medical oncology providers at NCICCs. Average charges, reimbursements, and total claims were obtained. Annual percentage changes (APC) were calculated to evaluate trends during study period. Prices are presented as inflation adjusted numbers (charged and reimbursed; 2021 dollars). Analyses were performed in Excel (Microsoft Corp). Results: Our analysis included 53 NCICCs of which 47 were part of the 340B Drug Pricing Program (NCI-340B), 11 were Prospective Payment System-exempt (NCI-PPS), and 6 NCICCs were both (PPS/340B). From 2016 to 2021, total Medicare claims increased from 9461 to 46291 across NCICCs, with NCI-PPS centers comprising 30% of claims. Total payments to NCICCs increased from $55.9M to $388.1M annually. Average charge for pembrolizumab in 2021 were: $45,227 (NCI-PPS), $46,000 (all NCICCs), $49,057 (NCI-340B), $59,392 (dual-eligible PPS/340B). During study period, APC were: 9.2% (NCICCs), 9.6% (NCI-340B), 12.8% (NCI-PPS), and 17.5% (dual-eligible PPS/340B). Despite high charged prices, reimbursement was much lower, about 18.4% (or $7364) of charged price at NCICCs over study period. Highest reimbursement was noted at NCI-PPS (22%, or $8551), and lowest at NCI-340B (16.4% or $7086) over study period. When considering a smaller cohort of PPS-only or 340B-only, PPS-only status was associated with lowest charged price but highest reimbursement (33.5%, or $8568). Conclusions: NCICCs charged &gt; 4 times the average reimbursed price for pembrolizumab, with charges increasing faster than inflation. While lower charges were noted at NCI-PPS, they received higher reimbursement. Dual PPS/340B status commanded the highest charged prices and quickest price increases. Our study informs greater price transparency regulation at NCICCs and raises questions regarding utility of special status benefits from the federal government.[Table: see text]

Generalized Linear Models for Loss Calculation in General Insurance

In most cases, loss in non-life insurance is calculated based on claim severity and frequency and an assumption of independence. However, in some cases, claim severity depends upon the claim frequency. This paper presents the derivation of aggregate loss calculation by modeling claim severity and frequency as the assumption of independence is eliminated. The authors modeled average claim severity using claim frequency as the covariate to induce the dependence among them. For that purpose, we use the generalized linear model. After doing parameters estimation, we will obtain the calculated loss.

Predicting the cost of COVID-19 treatment and its drivers in Indonesia: analysis of claims data of COVID-19 in 2020-2021

BackgroundRecent Coronavirus Disease-19 (COVID-19) pandemic shows that health system, particularly hospital care, takes the highest toll on COVID-19. As hospital gets to manage the surge of COVID-19 cases, it is important to standardize treatment standard and package for COVID-19. Until recently, in Indonesia, COVID-19 curative package in hospital is paid using a retrospective payment system (claims system) using a per-diem rate. Quantifying standard cost using an established retrospective claims dataset is important as a basis for standard formulation for COVID-19 package treatment, should COVID-19 be accommodated into the benefit package for Universal Health Coverage (UHC) under the National Health Insurance.MethodsWe estimated a standard cost for COVID-19 treatment using provider’s perspective. The analysis was conducted retrospectively using established national COVID-19 claims dataset during January 2020 until 2021. Utilizing individual-or-patient level analysis, claims profile were broken down per-patient, yielding descriptive clinical and care-related profile. Estimate of price and charge were measured in average. Moreover, indicators were regressed to the total charged price (in logarithmic scale) so as to find the predictors of cost.ResultsBased on the analysis of 102,065 total claims data received by MOH in 2020-2021, there is an average claim payment for COVID-19 in the amount of IDR 74,52 million (USD$ 5175). Significant difference exists in hospital tariffs or price to the existing claims data, indicating profit for hospital within its role in managing COVID-19 cases. Claim amount predictors were found to be associated with change of claim amount, including high level of severity, hospital class, intensive care room occupancy and ventilator usage, as well as mortality.ConclusionAs COVID-19 pandemic shifts towards an endemic, countries including Indonesia need to reflect on the existing payment system and move towards a more sustainable payment mechanism for COVID-19. The COVID-19 payment system needs to be integrated into the existing national health insurance allowing bundled payment to become more sustainable, which can be achieved by comprehensively formulating the bundled payment package for COVID-19.

Cost of a lymphedema treatment mandate - 16 years of experience in the Commonwealth of Virginia

BackgroundTreatment of chronic illness accounts for over 90% of Medicare spending. Chronic lymphedema places 3–10 million Americans at risk for recurrent cellulitis. Without convincing predictions of the costs and benefits of lymphedema treatment, insurers are reluctant to fully cover treatment of this common condition. Earlier papers discussed the costs and benefits of the first 5, 7, and 10 years of a lymphedema treatment mandate in Virginia. This paper updates these costs and benefits to 16 years of experience, and includes the impacts of the Patient Protection and Affordable Care Act of 2010 and the transition to ICD-10-CM diagnostic codes in 2015. It provides added confidence that costs of a lymphedema treatment mandate are reasonable, and can result in health insurance contract savings for reduced medical visits and hospitalizations for lymphedema patients.MethodsVirginia requires annual reporting of the segregated costs of each of its 30 medical mandates. Data on Virginia’s lymphedema treatment mandate for the years 2004 to 2019 have been collected from the series of annual reports. These data include actual lymphedema treatment claims data, utilization data, and claims-based estimates of the premium impact.ResultsThe average actual lymphedema claim cost was $2.03 per individual contract and $3.54 per group contract for the years reported, representing 0.05 and 0.08% of average total claims. The estimated premium impact was 0.16–0.32% of total average premium for all mandated coverage contracts. While lymphedema claim costs increased 3–6% per year over the study period, generally following the rise of health care costs, claim costs as a percent of average contract claims fell at a rate of 1.26–1.52% per year over that period. Medical office visits for lymphedema-related services fell from 0.10 to 0.02 visits per year per contract from the beginning to the end of the study period, and hospitalizations for lymphedema or lymphedema-related cellulitis fell to almost zero.ConclusionsThe Virginia data confirmed previous conclusions that the costs of treatment of lymphedema are a small part of a typical health insurance contract, and that treatment of lymphedema by managing swelling results in lower overall medical costs and fewer hospitalizations. This is a potent model for reduction in healthcare costs while improving the quality of care for cancer survivors and others suffering with this chronic progressive condition.

Price variability of pembrolizumab in New York City from 2016-2021.

6601 Background: There is poor compliance among cancer centers with price transparency rules set forth by the CMS in 2021. Service charges higher than what a hospital reasonably expects to be reimbursed may both prevent competitive price shopping by the consumer and result in catastrophic financial toxicity for small payors and under/uninsured individuals. We investigated variability in the charged and reimbursed payments for pembrolizumab infusion within one metro area utilizing Medicare claims. Methods: Medicare claims data from 2016 through 2021 for all pembrolizumab (HCPCS J9271) infusions in a hospital outpatient department were selected from the Definitive Healthcare claims database for medical oncology providers in New York City (NYC). Average charges, reimbursements, and total claims were obtained for the 6 largest prescribers by volume. Annual percentage changes (APC) were calculated to evaluate trends during study period. Prices are presented as inflation adjusted numbers (charged and reimbursed; 2021 dollars). Analyses were performed in Excel (Microsoft Corp). Results: Our analysis included 5 NCI-designated cancer centers (NCI-A, NCI-B, NCI-C, NCI-D) of which 1 was PPS (Prospective Payment System)-exempt (NCI-PPS). One hospital was non-NCI and 4 hospitals were part of the discounted 340B Drug Pricing Program (NCI-A, NCI-B, NCI-D, Non-NCI). From 2016 to 2021, total Medicare claims increased 793 to 1537, and total payments to all centers increased from $5.4M to $16.3M. NCI-PPS comprised 61% of claims, and 65% of total payments in 2021. Average charge for pembrolizumab in 2021 ranged from $20,130 (NCI-PPS) to $155,825 (NCI-D/340B). During study period, APC ranged from +1.7% (NCI-A/340B) to +25.4% (NCI-D/340B). Despite wide variability in charged amounts for Medicare claims, re-imbursed amounts were similar across centers (range: $6227-9623, 2021). Conclusions: There is significant variability in charges for pembrolizumab in Medicare claims with price increases outpacing the annual rate of inflation. Within NYC, the highest charges were from a 340B hospital; NCI-PPS had higher volume and total payments but consistently lower charged prices each year. Our study highlights extreme price variability, and has policy implications for price transparency requirements and uniform rate setting to establish payment levels and control rate of annual growth. [Table: see text]

Relationship Analysis of Injured Workers' Average Weekly Wages and Workers' Compensation Indemnity Claims in Maine, US: 1998 to 2017.

Explore the relationship between injured workers' average weekly wages (AWW) and their workers' compensation (WC) claims outcomes in Maine, US. A total of 29,668 indemnity (lost-time) claims categorized into three wage-based percentile groups from a 20-year period (5-year intervals) were analyzed. WC outcomes included medical costs, number of indemnity checks, claim's duration, and claim settlements. Generally, claims within the lower percentile group were less likely to have high medical costs, but were more likely to have an elevated number of indemnity checks when compared to those in the middle percentile group. An inverse relationship was observed for those claims within the higher percentile group. Generalizations about low wage earners' claims being longer-lasting and more expensive or early return to work always reducing the medical cost of claims should be avoided.

Regional trends in the cost of transurethral bladder tumor resection in the outpatient and physician office setting.

465 Background: TURBT is the standard surgical procedure for diagnosis, staging, and initial treatment of non-muscle invasive bladder cancer. This study aimed to identify current geographic trends associated with the use and cost of TURBT in Medicare beneficiaries. Methods: The Medicare Limited Data Set 100% sample of outpatient and 5% sample of carrier claims data from Q1 2019 to Q3 2020 was used for analysis. Patients who underwent TURBT were identified using CPT codes (55234, 52235, 52240). An analysis of variance (ANOVA) test was run comparing the difference in average claim payment amount, average beneficiary payment to physician, and average allowed charge amount between each region (West, Midwest, Northeast, and South). If the ANOVA test found a significant difference between regions, a t-test was run for all combinations of regions. Results: In the outpatient setting, we identified a total of 92,938 TURBT procedures between 2019 and Q3 2020, including 23,039 (Midwest), 19,890 (Northeast), 33,379 (South), and 16,630 (West). The average Medicare claim payment amount was $2,755 overall, $2,566 (Midwest), $2,866 (Northeast), $2,497 (South), and $3,092 (West). Beneficiaries paid an average of $605 in the Midwest, $673 in the Northeast, $572 in the South, and $697 in the West. The average total charge was $7,343, $7,189, $8,510, and $10,028 in the Midwest, Northeast, South, and West respectively. In the outpatient setting, there were no statistical differences for any cost related variables between the four regions. In the physician office setting, we identified 8,035 TURBT between 2019 and Q3 2020. There were 1,776, 1,577, 3,153, and 1,529 TURBT procedures in the Midwest, Northeast, South, and West, respectively. The average Medicare claim cost was $383 (Midwest), $372 (Northeast), $423 (South), and $417 (West). The average total allowed charges on the claim was $415 overall, and $392, $404, $430, and $432 in the Midwest, Northeast, South, and West, respectively. There was a significant statistical difference (p = 0.0154) for the average claim payment amount between the South and the Northeast. The two regions differed in average claim payment amount by $51 (95% CI: $15, $87). There was a significant difference in the average allowed charge amount between the South and Midwest (p = 0.019) and the West and Midwest (p = 0.016). Compared to the South, the Midwest had a lower average charge amount by $37 (95% CI: $9, $66). The West had a higher average charge amount than the Midwest by $40 (95% CI: $12, $68). Conclusions: This analysis demonstrated a significant difference in the cost of TURBT between regions in the physician office setting. The South had a significant higher claim payment amount than the Northeast. The allowed charge amount in the physician office setting for the South and the West were significantly higher than the Midwest.

Cyber risk and cybersecurity: a systematic review of data availability

Cybercrime is estimated to have cost the global economy just under USD 1 trillion in 2020, indicating an increase of more than 50% since 2018. With the average cyber insurance claim rising from USD 145,000 in 2019 to USD 359,000 in 2020, there is a growing necessity for better cyber information sources, standardised databases, mandatory reporting and public awareness. This research analyses the extant academic and industry literature on cybersecurity and cyber risk management with a particular focus on data availability. From a preliminary search resulting in 5219 cyber peer-reviewed studies, the application of the systematic methodology resulted in 79 unique datasets. We posit that the lack of available data on cyber risk poses a serious problem for stakeholders seeking to tackle this issue. In particular, we identify a lacuna in open databases that undermine collective endeavours to better manage this set of risks. The resulting data evaluation and categorisation will support cybersecurity researchers and the insurance industry in their efforts to comprehend, metricise and manage cyber risks.

PENERAPAN METODE BAYES DALAM MENGESTIMASI PREMI KREDIBILITAS PADA ASURANSI UMUM

Determination of insurance premiums is very important the calculation must be done carefully so that there is experience losses. The purpose of this research is to find out the application of empirical Bayes credibility theory Model 1 and estimate of the credibility premium on general insurance. A method that can help in overcoming these problems, that is empirical Bayes credibility theory Model 1, results of the estimated credibility premium credibility (in Euros) for insurance companies Alianz, Csob, Generali, Koop, Unisqa, and Wusten respectively as follows: 46.774811, 7.801307, 10.368991, 58.812250, 6.703035, and 5.091605. These results, the average claim is greater than the credibility premium, so that insurance companies can reserve premiums for the future.

Court decisions in criminal proceedings for dental malpractice in Taiwan

Malpractice claims place heavy economic and emotional burdens on both dentists and patients. Recently, medical malpractice lawsuits are decreasing in prevalence but increasing in severity. The percentage of dental malpractice payments is also growing among the health profession. The present study aimed to explore criminal convictions in dental malpractice litigation and to analyze the factors affecting the judgment in dental disputes in Taiwan. The keywords "dentist," "professional negligence," "medical malpractice," and "professional liability" were used to search Taiwan's Law and Regulations Retrieving System for criminal dental malpractice cases in all district courts from January 1, 2000 to June 30, 2021. The eligible judgments were summarized and analyzed. Overall, 425 cases were identified, with 28 dental disputes included in the final analysis. The dentists lost in 10 cases (35.7%). The average claim time was 36.75±16.34 months. Taipei and Taichung dealt with more lawsuit cases (n=8). Local clinics were the most common institution of the defendants (75%) and had the highest number of convictions (n=9). Implant dentistry was the most common specialty involved. Expert testimony of the Medical Review Committee (MRC) had a high K coefficient of agreement with court judgments regarding professional negligence (p<0.001). The overall criminal conviction rate was 35.7%. Implant therapy and local clinics had the highest rate of lawsuits and a considerably higher conviction rate. All guilty dentists were fined or given probation. The court judgments were highly consistent with the expert testimony of the MRC.

Gender Inequity in Utilisation of Publicly Funded Health Insurance Schemes- Findings based on insurance data from a Southern Indian State

While Publicly Funded Health Insurance Schemes (PFHIS) can be an effective strategy to achieve Universal Health Coverage by offering financial protection, the extent to which they facilitate gender equity has been less explored. Women constitute one of the main vulnerable groups owing to a combination of health and economic vulnerabilities to access inpatient care services. Gender health equity requires that healthcare resources, such as PFHIS effectively reach women. This study investigates the gender differences in utilisation of Chief Ministers’ Comprehensive Health Insurance Scheme (CMCHIS) by looking at a large volume of claims data covering 2012 to 2014 in the southern Indian state, Tamil Nadu. Previous studies indicate that women in the state had a higher hospitalisation rate than men and are entitled equally to CMCHIS. By disaggregating the data on number of beneficiaries, claim status, average and total claim value, type of procedures based on gender on a random selection of 230265 cases, the paper points out that women’s utilization of CMCHIS is significantly lesser than men. Women constitute only 36% of all beneficiaries and received only half of the total claim value disbursed through the scheme. This pro-male bias was found to be statistically significant and consistent across the scheme years, age group and type of procedures. The study concludes that the gender inequity in utilization of CMCHIS is conspicuous and needs immediate attention from policy makers and administrators. With recent inclusion of COVID19 testing and treatment under PFHIS, the paper urges for further research lest more women are left behind.

Opioid prescription patterns among urologists as compiled from within Medicare.

We aimed to evaluate opioid prescribing patterns of urologists across the United States (U.S.) and the District of Columbia (D.C.) using publicly available data from Medicare Part D. Our secondary analysis was to identify any loco-regional trends that may exist within the U.S. We queried publicly reported information from the Part D prescriber database, which is compiled from beneficiaries enrolled within the Medicare Part D prescription drug program. Only providers with the specialty description of urologist were included in this study. Between 2013 and 2017, a five-year average of 452 901 opioid claims by 9640 urologists - amounting to $5 357 114 USD and comprising 3.78% of all claims made - were identified. The state of Maine featured the highest percentage of opioid claims in relation to all claims (5.81%). West Virginia had the greatest average total opioid claims per provider (90), while Michigan featured the highest average proportion of opioid claims per provider (10.63%). The fewest opioid claims were processed within the Mid-Atlantic and New England regions. A multitude of factors likely contributes to variability between states. Urologists should be increasingly aware of their individual prescription tendencies and use available drug monitoring programs to reduce unnecessary prescriptions, all while providing more targeted and appropriate pain management.

A Study on Days of hospitalization of insured with the claims data

: The health insurance sector has grown at a double digit growth rate in India in the past decade. The Government schemes for the individuals' insurance coverage from the low-income group have resulted in higher penetration. Raise in the disposable income of the middle income and awareness of health insurance has led to self-subscription by private individuals. An increase in insurance penetration has also led to an increment in the claims for the insurer. However, the insurance coverage has been actively subscribed by the population in the age group of 19-64 years. The average claim amount processed is higher in infants and aged people. Days of hospitalization for the insured treatment help the insurers derive the claims' amounts and hence can budget the reserves accordingly. Days of hospitalization is found to have a strong positive relationship with age. Logistic regression of Half-yearly bins data has the predictability of Days of hospitalization of claimants at 69%.

Examining unit costs for COVID-19 case management in Kenya

IntroductionWe estimated unit costs for COVID-19 case management for patients with asymptomatic, mild-to-moderate, severe and critical COVID-19 disease in Kenya.MethodsWe estimated per-day unit costs of COVID-19 case management for patients....