Claim Expenses Research Articles

FAKTOR-FAKTOR YANG MEMPENGARUHI SURPLUS UNDERWRITING DANA TABARRU’ PADA PERUSAHAAN ASURANSI JIWA SYARIAH

This study aims to determine factors that affect surplus underwriting of tabarru‟ fund on Sharia Life Insurance in Indonesia. The factors used in this study is net contribution, claim expenses and investment return. This study used is panel data regression with Econometric Views (EViews) 8.0 as statistical analysis software. The samples are 14 Sharia Life Insurance, consists of 13 Islamic business units and 1 full sharia. During 2011 to 2015, the hypothesis test result showed the factors affecting surplus underwriting of tabarru‟ fund is net contribution, claim expenses and investment return always showed significant effect partially or simultaneously to the surplus underwriting of tabarru‟ fund on sharia life insurance.

Expanding Palliative Medicine across Care Settings: One Health System Experience.

The success of our hospital-based Palliative Care program stimulated requests to duplicate the program across the health system continuum of care. To develop a model of care focused on a high-need, high-cost population that could be implemented across all care settings, including hospitals and patients' homes. To fiscally support program expansion from hospital to home, we conducted a retrospective cost analysis for home-based Palliative Care (HBPC)-enrolled patients with continuous claims months before program enrollment through date of death. The HBPC enrollees were evaluated against a cohort group of CMS (Centers for Medicare & Medicaid Service) and Medicare Advantage patients who did not participate in the HBPC program (n = 3135). Twenty-one months of claims leading up to the date of death were evaluated for both populations. The analysis was designed to test whether Palliative Care patients demonstrated less overall claims expense and service utilization in the same periods as patients without Palliative Care. Claim months were grouped into three-month clusters for evaluation and statistical testing of per member per month utilization and cost. Overall, HBPC patients demonstrated significantly less service utilization and cost in the months leading up to death. Cost differences were primarily driven by clear cost divergence in the last three months of life [$9,843 (PC) vs. $27,530 (C)]. Our program grew from a hospital-based program to include the establishment of a home-based program. Palliative Care programs can successfully expand outside hospital walls to serve a high need/high-cost patient population.

Analisis Pengaruh Rasio Early Warning System Terhadap Financial Solvency Pada Perusahaan Asuransi Jiwa Syariah Di Indonesia

This study aims to examine the influence of the Early Warning System ratio which consist of surplus change ratio, claim load ratio, cost management ratio, liquidity ratio and premium growth ratio to financial solvency of sharia life insurance company in Indonesia period 2012 - 2016. The data used are secondary data obtained from the website of Asosiasi Asuransi Syariah Indonesia ( AASI ). Sampling technique used in this research is purposive sampling. The sample used in this research is 10 sharia life insurance companies . Hypothesis testing by using multiple linear regression analysis. The results of this study prove that financial solvency at the sharia fairyde 2012 - 2016, with an average value of 507.68% with a minimum financial solvency of 126.83 % and a maximum value of 2447.50 %. The variables that affect the financial solvency in this period of research are the ratio of claims expense and liquidity ratio which shows the negative and significant influence. Surplus change ratios, management expense ratios, the ratio of premium growth proved to be no significant effect on financial solvency . The ratio of Early Warning System in this study proved to have an effect on the financial solvency at the predictive ability level of 25.5% as shown in the adjusted R square value. Other variables not found in this research have influence to financial solvency equal to 74,5%.

ANALISIS HASIL INVESTASI, PENDAPATAN PREMI, DAN BEBAN KLAIM TERHADAP LABA PERUSAHAAN PERASURANSIAN DI INDONESIA

Insurance is a fund raising agency sourced from the receipt of insurance premiums from the public and distributed by claims. In addition to premium receipts, the company also puts its funds in the form of investments. This aims of this paper is to analyze the investment returns, premium income, and claims expense to profit using partial correlation, determination and multiple linear regression. The methods that use to collects the data for this final task are using observation and study documentation using quantitative analysis. Analytical technique is multiple linear regression using IBM SPSS 21 software. The used data in this paper is secondary data that obtained from the website of Otoritas Jasa Keuangan. From the results of the correlation coefficient test partially obtained investment returns and premium income has a significant relationship to profit, a positive value of 0.657 and 0.737 means the relationship is strong and unidirectional whereas, claims load has a significant relationship to profit, negative value of -0.786 means strong relationship And counterclockwise, simultaneously (together) shows that investment returns, premium income, claims expenses have significant relationship to profit, and a positive value of 0.881. The result of determination coefficient test shows that there is a significant influence of 77.6% and the remaining 22.4% influenced by other factors. The regression equation formed is Y = -2,682 + + – 2,369 + e.

Is Obesity Associated With Adverse Workers' Compensation Claims Outcomes?

A pilot study indicated that obesity was associated with an increased time lost from work and higher costs among workers' compensation claimants sustaining severe, but not minor injuries. The aim of this study was to further test the hypotheses by increasing sample size and controlling for additional confounding factors. Cost and lost time outcomes were assessed for 2301 lost time workers' compensation claims filed in 2011 and 2012 followed to the end of the first quarter of the third postinjury year. Adjusting for gender, age, marital status, attorney involvement, and spinal procedures, the odds ratios of incurring a claim expense at least $100,000 after a severe injury for an overweight or obese versus normal weight claimant was 2.11 [95% confidence interval (95% CI): 1.04 to 4.29] and 2.23 (95% CI:1.12-4.46), respectively. Obesity was associated with increased costs among workers' compensation claimants sustaining severe, but not minor injuries.

Analisis Pendapatan Premi Dan Beban Klaim Terhadap Laporan Keuangan Perusahaan Asuransi

The purpose of this research is to investigate and analyse th effect premium income and claims expense, on financial statements. The data were collected by observations and thn analysed using comaparative and/or trend analysis. This analysis is used to identify the changes that occurred in the financial statements of the insurance company, as indications of presence of a premium increase or decrease revenue and claims expense in the amount of IDR or percentage in a certain period. The results showed that (1) premium income and expense claims in a period of increased and decreased, (2) increase or decrease in premium income was very influential on the insurance company's financial statements, (3) increase or decrease the burden of claims is very influential on the financial statements of insurance companies.
 Keywords : premium income, claims expense, financial statements of insurance companies

Predictive Models for Diabetes Patients in Medicaid

Predictive modeling can be used to identify persons who are at increased risk for adverse health outcomes. We used demographic, medical, and pharmacy claims data to create a gender-specific model for fee-for-service Medicaid based on 2 states' data that can assist with the identification of persons with an elevated future risk of hospitalization, elevated claims expense, or death. Depending on age and the outcome of interest, the area under the receiver operating characteristic curve for this predictive modeling tool across 2 states' diabetes populations ranged from 0.608 to 0.834. We conclude that this analysis yielded a level of accuracy comparable to other predictive models that can be used to target patient enrollment in population-based care management.

Health plan auditing: 100-percent-of-claims vs. random-sample audits

The objective of this study was to examine the relative efficacy of two different methodologies for auditing self-funded medical claim expenses: 100-percent-of-claims auditing versus random-sampling auditing. Multiple data sets of claim errors or 'exceptions' from two Fortune-100 corporations were analysed and compared to 100 simulated audits of 300- and 400-claim random samples. Random-sample simulations failed to identify a significant number and amount of the errors that ranged from $200,000 to $750,000. These results suggest that health plan expenses of corporations could be significantly reduced if they audited 100% of claims and embraced a zero-defect approach.

Iodine-induced thyrotoxicosis after ingestion of kelp-containing tea

Iodine-induced thyrotoxicosis after ingestion of kelp-containing tea

Medicare spending for injured elders: are there opportunities for savings?

Claims for injury care provided to aged fee-for-service (FFS) beneficiaries cost Medicare more than $8 billion in 1999, almost 6 percent of Medicare claims spending for elders. More than one-fifth of aged FFS beneficiaries had an injury that resulted in a claim. Fractures, which were experienced by one in seventeen aged beneficiaries, were responsible far 67 percent of total injury claims expenses. Medicare could realize substantial savings if these injuries could be prevented; the program should consider underwriting effective prevention activities.

Accounting Estimation Disclosures and Firm Valuation in the Property-Casualty Insurance Industry

Accounting earnings are subject to estimation error. Under GAAP, corrections to estimates are included in current and future earnings, but characteristics of previous errors are not disclosed. An exception exists for property-casualty insurers. SEC mandated disclosures reveal errors in previous claim expense estimates as well as the correction for those errors in current earnings. An important issue is whether these detailed disclosures are value-relevant. We examine the information content of the SEC disclosures by testing their valuation implications. We investigate whether estimation errors in previous earnings influence the reflection of current earnings in price. Results suggest that investors use these disclosures in valuation decisions. Insurers with more variable estimation errors have smaller earnings response coefficients. Apparently investors assume that the precision of previous earnings is indicative of the precision in current earnings. We also find that stock returns are associated with revisions of previous estimations included in current earnings. Our research has implications for regulation, suggesting that similar disclosures should be considered for other estimates.

083071 (E40, M40) A methodology for pricing and reserving for claim expenses in workers compensation : Kellogg Rahardo K.,Casualty Actuarial Forum, 1996, pp. 151 – 184

083071 (E40, M40) A methodology for pricing and reserving for claim expenses in workers compensation : Kellogg Rahardo K.,Casualty Actuarial Forum, 1996, pp. 151 – 184

Risk Factors for Hospital Malpractice Exposure: Implications for Managers and Insurers

The professional liability system has been criticized for a wide variety of reasons, including its inefficiency and tendency to increase the costs of medical care.' The system, however, can embody socially beneficial incentives;2 that is, liability for malpractice claims may encourage providers to improve their performance to reduce future claims expense. It is not certain, however, whether our system in fact provides incentives for improved performance. If malpractice claims are perceived as essentially random, then the system serves merely to compensate the injured party but offers no incentives for medical care providers to reduce the risk of poor patient outcomes. However, if specific risk factors that predict malpractice exposure can be identified, then managers and insurers can act upon them to reduce the risk and cost of claims.

Technology and Outpatient Review: A Preliminary Evaluation

Most health care utilization and cost control programs focus on inpatient care or on high-cost, catastrophic illnesses or injuries. Recently, however, Parkside Health Management Corporation has developed a utilization review program that targets treatments and high-technology procedures performed primarily in an outpatient setting, as well as specific inpatient procedures not included in other review programs. These include chiropractic, podiatric, and physical therapy treatments; cesarean section; and endoscopy, ultrasound in pregnancy, and lithotripsy. The treatments/procedures examined in this program, called Technology and Outpatient Review (TOR), account for approximately 6% of claims expenses. Bigel Institute for Health Policy researchers are evaluating a pilot test to determine TOR's effect on health care costs and utilization, appropriateness, and patient satisfaction.