Number Of Claims Research Articles

Evaluating the antimicrobial efficacy of long-lasting hand sanitizers on skin

The microbicidal efficacy of hand sanitizer formulations is usually measured through standardized quantitative suspension tests and fingerpad tests; these cannot evaluate long-lasting formulations or are impractical due to biological risks, high cost, or time required for testing. With increased numbers of long-lasting microbicidal activity claims of commercially available hand sanitizers, alternative testing strategies are required. To explore the use of a standardized ex-vivo pig skin model to reproducibly measure long-lasting efficacy of an alcohol-free hand sanitizer formulation. The microbicidal efficacy of an alcohol-free hand sanitizer was tested against Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae, and the enveloped virus SARS-CoV-2 with quantitative suspension tests (EN13727 and EN14476) with a contact time of 5min. The product was then tested over a 6h period using an ex-vivo pig skin model with a modified version of PAS 2424 to simulate the impact of skin abrasion. Quantitative suspension tests yielded a >5 log10 reduction for all organisms tested within a 5min contact time. Pig skin tests showed reduced but consistent efficacy at all time points and indicated no significant impact of abrasion on efficacy. The use of the ex-vivo pig skin model provides a potentially viable and convenient model system to test long-lasting hand sanitizer formulations, providing a path for sustainable hand sanitizer formulation claims of activity on skin.

Trends and Clinical Characteristics of Next-Generation Sequencing-Based Genetic Panel Tests: An Analysis of Korean Nationwide Claims Data.

In the modern era of precision medicine, next-generation sequencing (NGS) is employed for a variety of clinical purposes. The aim of this study was to investigate the trends and clinical characteristics of NGS testing in South Korea. This nationwide, population-based, retrospective cohort study examined National Health Insurance Service claims data from 2017 to 2021 for NGS and from 2008 to 2021 for gene-targeted anticancer drugs. Among the total 98,748 claims, there were 51,407 (52.1%) solid cancer panels, 30,173 (30.5%) hereditary disease panels, and 17,168 (17.4%) hematolymphoid cancer panels. The number of annual claims showed a persistent upward trend, exhibiting a 5.4-fold increase, from 5,436 in 2017 to 29,557 in 2021. In the solid cancer panel, colorectal cancer was the most common (19.2%), followed by lung cancer (18.8%). The annual claims for targeted cancer drugs have increased 25.7-fold, from 3,932 in 2008 to 101,211 in 2020. Drugs for the treatment of lung cancer accounted for 488,819 (71.9%) claims. The number of patients who received non-hereditary NGS testing has substantially increased, and among them, the count of patients prescribed targeted anticancer drugs consistently rose from 508 (13.9%) in 2017 to 2,245 (12.3%) in 2020. This study highlights the rising nationwide demand for comprehensive genetic testing for disease diagnosis and treatment following NGS reimbursement by the National Health Insurance in South Korea, in addition to the need for greater utilization of targeted anticancer drugs.

The Comparison of Estimated Reserve Claims with the Classical Chain Ladder and Bornhuetter-Double Chain Ladder Method

In the world of insurance, insurance companies need to back up claims to ensure that the company can cover expenses resulting from filing claims from policyholders. Claim reserves represent the estimated value of claim payments in the future, where there are differences in the estimated and actual value of claim payments. Errors in predicting claim reserves will result in inaccuracies and disrupt the insurance company's financial stability. There are several ways to estimate claim reserves, one of the most common methods is using a Chain Ladder. However, the Chain Ladder method is very susceptible to outliers, so another method is needed to estimate claims reserves that are more accurate. This study discusses the comparison between the Chain Ladder method and one of the development methods, namely Bornhuetter-Double Chain Ladder in estimating claim reserves. The Bornhuetter-Double Chain Ladder method uses data on claims that have occurred as a whole, the amount of claims that have been paid, and the number of claims that have occurred. Based on the research results, it can be concluded that the Bornhuetter-Double Chain Ladder method is capable of producing more stable and accurate claim reserves compared to the Chain Ladder method.

Trends of Surgical Service Utilization for Lumbar Spinal Stenosis in South Korea: A 10-Year (2010-2019) Cross-Sectional Analysis of the Health Insurance Review and Assessment Service-National Patient Sample Data.

Background and Objectives: This retrospective, cross-sectional, and descriptive study used claims data from the Korean Health Insurance Review and Assessment Service (HIRA) between 2010 and 2019 to analyze the trend of surgical service utilization in patients with lumbar spinal stenosis (LSS). Materials and Methods: The national patient sample data provided by the HIRA, which consisted of a 2% sample of the entire Korean population, was used to assess all patients who underwent decompression or fusion surgery at least once in Korea, with LSS as the main diagnosis from January 2010 to December 2019. An in-depth analysis was conducted to examine the utilization of surgical services, taking into account various demographic characteristics of patients, the frequency of claims for different types of surgeries, reoperation rates, the specific types of inpatient care associated with each surgery type, prescribed medications, and the overall expense of healthcare services. Results: A total of 6194 claims and 6074 patients were analyzed. The number of HIRA claims for patients increased from 393 (2010) to 417 (2019) for decompression, and from 230 (2010) to 244 (2019) for fusion. As for the medical expenses of surgery, there was an increase from United States dollar (USD) 867,549.31 (2010) to USD 1,153,078.94 (2019) for decompression and from USD 1,330,440.37 (2010) to USD 1,780,026.48 (2019) for fusion. Decompression accounted for the highest proportion (65.8%) of the first surgeries, but more patients underwent fusion (50.6%) than decompression (49.4%) in the second surgery. Across all sex and age groups, patients who underwent fusion procedures experienced longer hospital stays and incurred higher medical expenses for their inpatient care. Conclusion: The surgical service utilization of patients with LSS and the prescribing rate of opioids and non-opioid analgesics for surgical patients increased in 2019 compared to 2010. From mid-2010 onward, claims for fusion showed a gradual decrease, whereas those for decompression showed a continuously increasing trend. The findings of this study are expected to provide basic research data for clinicians, researchers, and policymakers.

A Study on the Current State of Pediatric Dentists and the Adequacy of Supply and Demand Based on Covered Services

The aim of this study was to identify the current state of pediatric dentists, evaluate the adequacy of pediatric dentist supply and demand, and find out the perception of all pediatric dentists on the current state of pediatric dentists and policy establishment. An Online survey was conducted among pediatric dentists. The questionnaire was subdivided into ‘general characteristics’, ‘number of dental treatments and working days per year’, ‘proportion of covered services’, ‘perceptions of supply and demand of pediatric dentists’. Through the Korean Academy of Pediatric Dentistry, the Health Insurance Review and Assessment Services, the National Health Insurance Service (NHIS), and the Korean Statistical Information Service, the current state of pediatric dentists, the number of claims for covered services, and the decrease in births per year were investigated. Dental clinics claiming to be pediatric dentistry reached half of all medical institutions, but only 3.78% of pediatric dentists actually worked. 61.36% of all pediatric dentists were concentrated in the metropolitan area, showing a national imbalance. Although the population of children and adolescents have continuously decreased over the past 20 years, the number of NHIS-covered services has shown a continuous increase. Over the past 10 years, the optimal supply of pediatric dentists has been maintained at around 4,000. According to the analysis, 92.15% of pediatric dentists thought that it was necessary to prepare policies and support measures at the government level. This study is expected to be used as basic data for establishing a demand estimation method for pediatric dentistry specialists in the future.

1117 The NHS in Crisis; Assessment of the Impact of Litigation Trends Over 20 Years in General Surgery

Abstract Introduction A rising proportion of the National Health Service (NHS) annual budget is being spent on medico-legal costs, with over 1.6% of total UK healthcare spending on litigation in the year 2018/19. This is a risk to both patient care and public opinion of the NHS and as per business definitions the system is in crisis. This paper aims to assess the scale of the litigation crisis to fuel further work into mitigating it to improve value for patients and staff alike. Method Data was obtained from NHS resolution for claims relating to General Surgery between January 2000 and December 2020 to include the following: number of claims, cost of settled claims with and without damages paid, age/sex of patients, and primary injuries/causes. Results Between 2000 and 2020, 17,542 claims were made against General Surgical units in England with an increase in claims per year. Successfully closed claims cost the NHS £1.3 billion. The three most common causes for claims were intra-operative problems, failure/delay of treatment and failure/delay of diagnosis. Conclusions The NHS is threatened by a litigation crisis, with case volume and cost rising out of proportion to surgical workload and inflation. The most common causes for claims are known complications discussed as part of a standard consenting process, indicating that current practice may fail to achieve adequate patient understanding of surgical risk. More research is required to improve the current consenting process and identify demographics that may increase an individual’s propensity to make a claim.

PEMODELAN DATA FREKUENSI KLAIM ASURANSI KENDARAAN BERMOTOR UNTUK CAKUPAN THIRD PARTY LIABILITY MENGGUNAKAN DISTRIBUSI POISSON-ARADHANA

The presence of insurance can provide coverage for all risks that occur for owners or motorists. Insurance will provide various forms of coverage in accordance with their respective products, so that vehicle owners or drivers will get protection, benefits or compensation for losses from various risks that occur above by buying an insurance policy of course. In Indonesia, motor vehicle insurance is included in the group of liability insurance. One of these insurance coverages is third-party legal liability. This is a protection against liability or third party legal responsibility or Third Party Liability, because the benefits provide protection against claims and losses experienced by third parties, in this case victims involved in accidents. Insurance premiums that can be provided by insurance companies to policyholders can be calculated based on the distribution model of claim frequency and claim size. Claim frequency is the number of insurance claims that occur in one period. Claim frequency data is often overdispersed. Poisson mixture distribution is often used as an alternative method for modeling claim frequency data when overdispersion occurs. This thesis will discuss the Poisson-Aradhana distribution modeling of motor vehicle insurance claim frequency data in Indonesia in 2019. The maximum likelihood estimation method is used to estimate the parameters of the Poisson-Aradhana distribution. The fit test used in this study is the Chi-Square test. The research material used is secondary data on the frequency of motor vehicle insurance claims recorded by PT. X from 8 categories and 3 regions in 2019. The results of the application of the Poisson-Aradhana mixed distribution on the frequency data of motor vehicle insurance claims for TPL coverage with comprehensive coverage at PT. X in 2019, most of the claim frequency data comes from a population with a Poison-Aradhana mixed distribution except for claim frequency data in category 1 region 3 and category 4 region 2

Analysis of the prescription trends of potentially inappropriate medications in Korean older outpatients by sex: A retrospective study using data from the health insurance review and assessment service.

This study aimed to determine the policy implications for drug management by identifying the prescription trends of potentially inappropriate medications (PIMs) in older outpatients. Considering the Drug Utilization Review and Korean version of the standards for PIMs based on the Beers Criteria, 141 ingredients were selected that spanned over 7 years of health insurance claims data analysis. During the study period, the number of patients and claims related to PIMs increased. Although the number of health insurance claims decreased in 2020 owing to coronavirus disease (COVID-19), it increased again in 2021. Tamsulosin was the most frequently prescribed drug for male patients, followed by alprazolam and zolpidem. For female patients, eperisone was the most frequently prescribed drug, followed by alprazolam, zolpidem, and etizolam. In Korea, health insurance claims for PIMs decreased in 2020 owing to the COVID-19 pandemic. However, an overall increasing trend was observed from 2015 to 2021. Moreover, during this period, the prescription trend of benzodiazepine-type drugs and zolpidem increased in both male and female patients. Therefore, management policies regarding PIMs and drug ingredients, such as benzodiazepines and zolpidem, are required.

Slice by slice: An Australian state-by-state analysis of Mohs micrographic surgery over 5 years.

In November 2018, Mohs micrographic surgery (MMS) was restricted to fellows registered with the Australasian College of Dermatologists. Three new item numbers for the provision of MMS were also introduced. We examine the national and state usage of MMS item numbers based on Medicare claim statistics and Mohs surgeons' self-reported data, noting the impact of the pandemic and the usage of individual item numbers. Medicare item number data were obtained from the Medicare Benefits Schedule website for January 2017-December 2021. Self-reported data were collected on an annual basis by the Royal College of Pathologists of Australasia (RCPA) as part of the Quality Assurance Program (QAP) from 2019 onwards. Data were analysed with the Holt-Winters smoothing method for forecasting. An increasing number of MMS claims were processed each year, with a total of 89,183 for the study period. Since November 2018, 97.7% of procedures have been conducted on the head, neck, genitalia, hand, digits, leg (below the knee) or foot. The provision of services across the country was maintained during the pandemic years of 2020-2021, with an increase in services in Queensland. There were discrepancies between the states for procedures performed in greater than six sections; these constituted more than 35% of claims in Queensland and Western Australia compared to less than 15% in other states. The pandemic impacted certain states more than others, with Victoria and the Northern Territory having significantly fewer presentations than predicted (p < 0.05). Overall, the use of MMS in Australia is in keeping with peer-developed guidelines, despite discrepancies between states. Although certain states were more severely affected by the pandemic, MMS is increasingly used in Australia.

Mental health and use of Medicare Benefits Schedule follow-up mental health services by Indigenous people in Australia during the COVID-19 pandemic.

Mental health care has declined during the COVID-19 pandemic as has attendance for preventive mental health health services. This study aimed to investigate trends in all types of mental health service claims identified in an Indigenous-specific health assessment for Indigenous people before and during COVID-19. We conducted an analysis of Medicare Benefits Scheme (MBS) mental health service items (Items 81,325 and 81,355), to investigate the trends in all types of mental health service claims specifically intended for Indigenous people of Australia. Data were analysed using descriptive statistics, including the total annual numbers of Indigenous peoples' mental health service claims cross-tabulated by age groups and gender, between the calendar years 2017-2021. Multivariable Poisson regression modelling was used to determine associations that were statistically significant. Our results indicate an overall rise in MBS claims for mental health follow-up services during 2019-2020 followed by a decline in 2020-2021. In addition, there was an overall decline in claims for follow-up psychology services across the time period 2019-2021. We found a significant decline in MBS items specific to follow-up mental health services (MBS Items 81,325 and 81,355) for Indigenous people in Australia suggesting a decline in attendance for mental health service follow-up which in turn may indicate a deficit in mental health care during the COVID-19 pandemic, an issue that may lead to poorer mental health outcomes in the future. Further research is needed to understand whether these changes were due to the impact of the COVID-19 pandemic or other factors.

Utilization of Opioid Agonist Therapies in Canada

&#x0D; Canada continues to experience an opioid crisis that has had a devastating impact on public health, highlighting the importance of management strategies for opioid use disorder (OUD). Several opioid agonist therapies (OATs) for the management of OUD are available in Canada, including recent approvals of new brand name drugs and generic versions of widely used OATs.&#x0D; Coverage criteria for OATs are comparable across public drug plans in Canada. Methadone hydrochloride (HCL) and the combination of buprenorphine HCL and naloxone HCL (buprenorphine HCL-naloxone HCL) are typically listed as regular or open benefits; generics for these 2 medications have been available since 2020 and 2013, respectively. Sublocade and Probuphine — long-acting buprenorphine preparations approved by Health Canada in 2018 — have varied coverage that is often dependent on prior therapy requirement.&#x0D; The annual number of public claims for OATs decreased by 19.5% from 2018 to 2022. The market share of claims during this period was dominated by methadone HCL and buprenorphine HCL-naloxone HCL, with an increase in claims market share for buprenorphine over time (starting in 2020) and a negligible contribution by buprenorphine HCL. Additionally, in a subanalysis on the number of OAT claimants, the results did not indicate a decrease in individual beneficiaries for these medications; therefore, the decrease in OAT claims was likely driven by increased usage of OATs that require fewer claims per patient, as opposed to decreased OAT use in the population.&#x0D; Despite the decrease in annual OAT claims during the analysis period, total OAT expenditures increased every year, with a 67.0% increase from 2018 to 2022 (5-year total of $307 million). The increase was initially driven by buprenorphine HCL-naloxone HCL, which increased from $27 million (58.9% of OAT expenditures) in 2018 to $39 million (67.2% of OAT expenditures) in 2019. Thereafter, expenditures for buprenorphine drove overall OAT cost increases from 2020 onward, accounting for $22 million (28.2% of OAT expenditures) in 2022. In contrast, methadone HCL accounted for a decreasing proportion of expenditures each year ($19 million or 41.1% of OAT expenditures in 2018 to $16 million or 21.0% of OAT expenditures in 2022), despite having the greatest proportion of claims throughout the study period.&#x0D; The availability of new OAT formulations and generic versions of existing products, as well as other notable regulatory policy changes (e.g., Health Canada’s removal of the need for an exemption to prescribe methadone HCL) and reimbursement decisions (e.g., positive reimbursement recommendations from CADTH for the newer branded OATs, Sublocade and Probuphine), impacted the observed utilization and expenditure patterns, and will likely continue to influence decision-making, particularly where coverage has recently changed or has yet to change to reflect the evolving landscape. If the utilization of injectable buprenorphine (Sublocade) continues at the rate observed in this analysis, it will likely continue to drive increases in OAT expenditures; Sublocade has several patents and the earliest patent expiry is not until 2031, so generic versions of this formulation will likely not be available for several more years. Overall, the findings of this analysis may help to inform jurisdictions in funding decisions regarding OATs for the treatment of OUD.&#x0D;

Real-World Treatment Patterns in Patients with Vitiligo in the United States.

Vitiligo is an autoimmune disorder resulting in skin depigmentation, with limited approved treatment options. This study evaluated medication utilization and treatment patterns among patients in the first year following vitiligo diagnosis. This retrospective analysis of claims data from the Merative® MarketScan Research Databases included patients aged ≥ 12years newly diagnosed with vitiligo. Patients were identified between October 1, 2016, and April 30, 2021, and had ≥ 12months of continuous enrollment pre- and post-vitiligo diagnosis. Medication use, treatment line of therapy, time to and number of medication claims, and length of therapy were reported in the 12months post-vitiligo diagnosis. Results are reported separately for treatment initiators post-vitiligo diagnosis, patients with moderate-to-severe vitiligo, and adolescents (aged 12-17years). A total of 19,335 patients were included in the analysis, with half (N = 9648, 49.9%) not receiving any treatment during the 12-month follow-up. Switching was minimal among treatment initiators (N = 5845) in the 12months post-vitiligo diagnosis, with the most frequent first-line treatments being high-potency topical corticosteroids (25.4%), oral corticosteroids (23.1%), and topical calcineurin inhibitors (TCI, 14.7%). Adolescents initiating treatment (N = 486) most frequently received TCI (30.9%) as first-line therapy. Patients with moderate-to-severe vitiligo (N = 3462) were very likely to receive treatment during follow-up, with only 1.5% not receiving treatment. Among patients with no vitiligo treatment prior to diagnosis, time to first medication claim ranged from 51.9days (standard deviation [SD], 84.0) for TCI to 178.6days (SD 116.0) for systemic immunosuppressants; mean total days supplied ranged from 14.4days (SD 27.1) for oral corticosteroids to 121.0 (SD 114.0) for immunosuppressants. In this real-world study, a high proportion of patients did not receive any treatment. Among those receiving treatment, most were unlikely to switch or use a combination of treatments within the first year of vitiligo diagnosis.

Nutrient content and cost of canned and dried legumes and plant-based meat analogues available in New Zealand supermarkets.

Plant-based eating patterns are recommended for human and planetary health. Plant-based protein sources in supermarkets include traditional options and plant-based meat analogues. This cross-sectional survey examined the nutritional content, healthiness, cost and labelling of these products. Nutrient content and claims on canned legumes (plain [N = 64] and flavoured [N = 25]), canned baked beans (N = 23), dried legumes (N = 21), tofu (plain [N = 8] and flavoured [N = 5]), falafels (N = 14), meat analogues (meat-free burgers [N = 11], meat-free sausages [N = 10] and 'other' meat-free products [N = 20]) were obtained from a database of packaged foods in New Zealand. Mean (SD) energy, protein, total fat, saturated fat, sodium and dietary fibre content (per 100 g) was calculated for each category. Healthiness was assessed using an estimated Health Star Rating (Rating ≥3.5 considered 'healthy'). Product data were linked with household purchasing data from the 2019 Nielsen IQ® consumer panel to calculate mean purchase price/100 g/category. The number and type of nutrition claims were compared across categories. The highest mean protein content was 'other' meat-free products (14.8 ± 6.9 g/100 g). Meat-free sausages had the highest sodium and saturated fat content (643 ± 148 mg/100 g, 3.7 ± 4.5 g/100 g). Overall, few meat analogues (N = 5, 12%) scored an estimated Health Star Rating ≥3.5. Dried legumes were the cheapest plant protein (mean ± SD) purchase price = NZ $0.30 ± 0.16/100 g), compared with 'other' meat-free products (purchase price = NZ $2.57 ± 0.88/100 g). The most common nutrition claims on meat analogues were about protein content. Dietary fibre claims were the most common on canned and dried legumes. Meat analogues offer convenience, however, may be less healthy and more expensive than traditional plant-based proteins. This study assists dietitians in providing accurate consumer messaging about healthy plant-based proteins.

PENENTUAN TARIF PREMI PADA ASURANSI KENDARAAN DENGAN BESAR KLAIM BERDISTRIBUSI EKSPONENSIAL DAN GAMMA

Calculation of vehicle insurance premium rates can be done using the aggregate claims model. The aggregate claims model consists of a combination of two independent random variables, namely the number of claims that occur and the amount of claims for each event. The research method is in the form of literature studies and case studies using secondary data in the form of data on the number of claims and the amount of claims collected from January 2013 to December 2019. Based on the data collected, there were 802 claims with the smallest claim being IDR 50,000 and the largest being IDR 211,715,000. Testing the hypothesis shows that the data on the number of claims has a Poisson distribution, and the amount of claims follows two types of distribution, namely the exponential and gamma distribution so that the aggregate claim distribution is a combination of Poisson-Exponential and Poisson-Gamma. Parameter estimation for each distribution is carried out by the moment method with available secondary data. This study concludes that the use of the pure premium principle provides the same premium rate for both distributions of aggregate claims, amounting to IDR 82,856.39 per month per person. While the use of the expected value principle provides a premium rate for the Poisson-Gamma aggregate claims distribution 8.76 times greater than the Poisson- Exponential aggregate claims distribution, namely IDR 1,920,019.55 per month and IDR 219,155.20 per month, respectively.

Estimation of Premium Reserves for Last Survivor Endowment Insurance Using the New Jersey Method

There are a few cases of life insurance firms going bankrupt due to mistakes when estimating premium reserves, causing companies unable to pay compensation to policyholders. This is caused when the number of claims submitted by the insured that must be paid exceeds the number of claims previously estimated. Situations like this can be anticipated if the insurance firm has a properly prepared and calculated reserve value. There are various types of life insurance, one of which is endowment life insurance. The purpose of this study is to calculate the amount of reserves adjusted for last survivor endowment life insurance using the New Jersey method. To compute reserves, first, researchers determine the benefits, then the annuity, and finally the annual premium. In the first year, the premium reserve value under the New Jersey method is zero. The New Jersey method begins premium reserves in the second year, for &lt;em&gt;t&lt;/em&gt; years, with where reflecting the duration of the insurer's contract. Based on the data analysis performed, the value of the New Jersey reserves for the two insureds is determined by the length of the insurance contract and the age of the insured at the time of insurance. The value of reserves is seen based on the initial age of a person when starting insurance, the older the initial age of the insurance participant, the greater the amount of reserves obtained by the company. This research is expected can be a reference and help insurance field to estimate premium reserves.

Simulasi Pergerakan Dana Tabarru Produk Asuransi Jiwa Unit Link Syariah

Premi or known as Contributions in sharia insurance are part of tabbaru fund which is paid by participants. Tabarru’ has puposes to provide the "benevolent funds" with the sincere intention of helping each other among fellow "takaful" participants when one of them suffers a misfortune, such as death. These funds provided by insurance participants will be used to pay claims or insurance benefits by insurance companies. A sharia insurance company is considered doing well financially when tabbaru's funds are well managed to paid the insurance claim. In addition, the company must have sufficient funds to overcome the underwriting deficit in case it happen. This study aims to simulate the adequacy of a company's tabarru’ funds in each period, assuming there is no change in the number of participants during that period. The simulation results can conclude the adequacy of tabarru funds to pay participant claims. Sum of tabarru’ funds are calculated based on the sum of each participant's tabarru’ contribution, which is affected by each sharia-linked unit life insurance product and the participant's policy period. The tabarru’ fund sufficiency simulation is predicted using the IMA(2,1) time series model. The results of this study conclude that the average tabarru funds for each product will be used up in the following year with the criteria of the number of people making claims of not less than five participants. In this study, we found that the company can survive if the number of claims paid from the tabarru' fund with participants tabarru' fund contributions is balanced.

Diagnostic rate estimation from Medicare records: Dependence on claim numbers and latent clinical features

ObjectiveInternational Classification of Disorders version 10 (ICD-10) codes contribute heavily to healthcare data. Medicare claims and other data-sources are used to constitute study populations and appraise healthcare processes. How variability in claims-per-beneficiary impacts diagnostic determinations is inadequately understood. The objective of this study is so assess distributional properties of Medicare claims, and examine claim rates impact on code utilization and rate determinations. MethodsThe study population was Medicare beneficiaries aged 75–79.99 with claim(s) in the 5% standard analytical Carrier and Outpatient files, alive and participating in Medicare part B for all 12 months of 2017. Medicare beneficiary files were processed to create records containing all ICD-10 codes specified, key demographics, Part B and vital status, and the total claims for each 2017 beneficiary. Claim number cohorts were characterized. ResultsBeneficiaries meeting inclusion criteria totaled 221,625, these having 7,617,503 claims; 96.4% had between 1 and 120 claims. Median claims were 24 for males (females 25); modal claims were 11 (13). Average distinct codes per beneficiary increased with claims number. The assignment of ICD-10 codes, i.e., ‘diagnostic rate estimates’ (DRE), increased as claim numbers increased for most codes among those most commonly utilized. For some conditions, mostly benign and age-related, DREs plateaued as claim numbers increased. For other conditions, typically associated with clinical acuity, e.g., chest pain, DREs increased steeply with claims. ConclusionsOlder adult Medicare beneficiaries aged 75–80 exhibited varying claims activity over the course of a year. Although DRE dependence on claim numbers varies across ICD-10 codes, rate estimates are higher for beneficiaries with claim numbers above the median.

Optimal reinsurance contract and investment strategy for multiple competitive-cooperative insurers and a reinsurer

Abstract Accepted by: Giorgio Consigli In this article, we consider a reinsurance contract design by taking into account the joint interests of multiple insurers and a reinsurer. The reinsurance contract consists of optimal reinsurance strategies and reinsurance prices. The former are chosen by the competitive–cooperative insurers and the latter are determined by a reinsurer. Both insurers and the reinsurer can invest in the common risk-free asset and one different risky asset. The optimal time-consistent reinsurance–investment strategies of the insurers and the optimal reinsurance prices and investment strategy of the reinsurer are derived analytically. Numerical experiments are carried out to illustrate the influences of model parameters on the optimal reinsurance contract and optimal investment strategies. We find that the establishment of the reinsurance contract is affected by the correlation between the claim sizes of insurers as well as that of claim numbers. The results reveal that competition and cooperation will lead to a decrease and increase of the reinsurance price, respectively, showing the importance of opting for cooperation among insurers. Both competition and cooperation are beneficial to insurers, especially for those with high risk aversion.

Analysis of Japanese nationwide health datasets: association between lifestyle habits and prevalence of neuropathic pain and fibromyalgia with reference to dementia-related diseases and Parkinson's disease.

Chronic pain is defined as pain that persists or recurs for more than 3months. This study focuses on neuropathic pain (NP) and fibromyalgia (FM) which are chronic pain states, and aims to identify lifestyle habits associated with their prevalence. Other neurological disorders are also analyzed as references. Association between the variable referring to disease prevalence (number of claims for reimbursement of marker drugs) and the variable for lifestyle habits/health examination results (collected from insured individuals aged 40-74 years) was determined by analyzing Japanese nationwide datasets, which were collected in 2018 and aggregated by prefecture. Pregabalin, donepezil, and levodopa were used as marker drugs for the chronic pain states, dementia-related diseases (Alzheimer's disease and Lewy body dementia) and Parkinson's disease (PD), respectively. Pearson's correlation analysis and multiple linear regression analysis were conducted. Variables showing correlation coefficient (|r|)>0.5 were put into the multiple linear regression. Exercise habits (ꞵ=-0.3182), smoking habits (0.3218), daily drinking (0.2683), and alanine aminotransferase>51 U/L (0.2309) were finally incorporated in the equation for pregabalin (R 2=0.7268). Walking speed (-0.4543) and daily drinking (0.5077) were incorporated in the equation for donepezil (R 2=0.5718). The prevalence of chronic pain states is associated with lifestyle habits, just like the dementia-related diseases. Exercise in daily life is negatively associated with the prevalence of the chronic pain states, although excessive alcohol drinking, smoking, and high serum ALT are positively associated with it. The prevalence of PD seems less associated with lifestyle habits.

Examining claims on food packages in India: Are they inadequate and deceptive?

This study examines the presence of claims on 230 food packages marketed in India and the extent of compliance with guidelines provided by the Food Safety and Standards Authority of India (FSSAI). The results reveal that word claims (natural) and nutrient content claims are most popularly used on food packages. Still, a large number of claims used on food packages cannot be classified or verified due to the absence of clear definitions from the regulator. In addition to this, unhealthy foods carry claims and foods also contain claims which have been stated as prohibited. These findings call for timely necessary actions on part of the regulator to protect the health of consumers.