WorldWideScience

Sample records for insurance claim review

  1. Reducing medical claims cost to Ghana?s National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews

    OpenAIRE

    Nsiah-Boateng, Eric; Asenso-Boadi, Francis; Dsane-Selby, Lydia; Andoh-Adjei, Francis-Xavier; Otoo, Nathaniel; Akweongo, Patricia; Aikins, Moses

    2017-01-01

    Background A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana. Methods The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested fr...

  2. Development of a claim review and payment model utilizing diagnosis related groups under the Korean health insurance.

    Science.gov (United States)

    Shin, Y S; Yeom, Y K; Hwang, H

    1993-02-01

    This paper describes the development of a claim review and payment model utilizing the diagnosis related groups (DRGs) for the fee for service-based payment system of the Korean health insurance. The present review process, which examines all claims manually on a case-by-case basis, has been considered to be inefficient, costly, and time-consuming. Differences in case mix among hospitals are controlled in the proposed model using the Korean DRGs. They were developed by modifying the US-DRG system. An empirical test of the model indicated that it can enhance the efficiency as well as the credibility and objectivity of the claim review. Furthermore, it is expected that it can contribute effectively to medical cost containments and to optimal practice pattern of hospitals by establishing a useful mechanism in monitoring the performance of hospitals. However, the performance of this model needs to be upgraded by refining the Korean DRGs which play a key role in the model.

  3. Organized investigation expedites insurance claims following a blowout

    International Nuclear Information System (INIS)

    Armstreet, R.

    1996-01-01

    Various types of insurance policies cover blowouts to different degrees, and a proper understanding of the incident and the coverage can expedite the adjustment process. Every well control incident, and the claim arising therefrom, has a unique set of circumstances which must be analyzed thoroughly. A blowout incident, no matter what size or how severe, can have an emotional impact on all who become involved. Bodily injuries or death of friends and coworkers can result in additional stress following a blowout. Thus, it is important that all parties involved remain mindful of sensitive matters when investigating a blowout. This paper reviews the definition of a blowout based on insurance procedures and claims. It reviews blowout expenses and contractor cost and accepted well control policies. Finally, it reviews the investigation procedures normally followed by an agent and the types of information requested from the operator

  4. The claims handling process of liability insurance in South Africa

    Directory of Open Access Journals (Sweden)

    Jacoline van Jaarsveld

    2015-04-01

    Full Text Available Liabilities play a very important financial role in business operations, professional service providers as well as in the personal lives of people. It is possible that a single claim may even lead to the bankruptcy of the defendant. The claims handling process of liability insurance by short-term insurers is therefore very important to these parties as it should be clear that liability claims may have enormous and far-reaching financial implications for them. The objective of this research paper embodies the improvement of financial decision-making by short-term insurers with regard to the claims handling process of liability insurance. Secondary data was initially studied which provided the basis to compile a questionnaire for the empirical survey. The leaders of liability insurance in the South African short-term insurance market that represented 69.5% of the annual gross written premiums received for liability insurance in South Africa were the respondents of the empirical study. The perceptions of these short-term insurers provided the primary data for the vital conclusions of this research. This paper pays special attention to the importance of the claims handling factors of liability insurance, how often the stipulations of liability insurance policies are adjusted by the short-term insurers to take the claims handling factors into consideration, as well as the problem areas which short-term insurers may experience during the claims handling process. Feasible solutions to address the problem areas are also discussed.

  5. Primary care closed claims experience of Massachusetts malpractice insurers.

    Science.gov (United States)

    Schiff, Gordon D; Puopolo, Ann Louise; Huben-Kearney, Anne; Yu, Winnie; Keohane, Carol; McDonough, Peggy; Ellis, Bonnie R; Bates, David W; Biondolillo, Madeleine

    Despite prior focus on high-impact inpatient cases, there are increasing data and awareness that malpractice in the outpatient setting, particularly in primary care, is a leading contributor to malpractice risk and claims. To study patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project. Retrospective review of pooled closed claims data of 2 malpractice carriers covering most Massachusetts physicians during a 5-year period (January 1, 2005, through December 31, 2009). Data were harmonized between the 2 insurers using a standardized taxonomy. Primary care practices in Massachusetts. All malpractice claims that involved primary care practices insured by the 2 largest insurers in the state were screened. A total of 551 claims from primary care practices were identified for the analysis. Numbers and types of claims, including whether claims involved primary care physicians or practices; classification of alleged malpractice (eg, misdiagnosis or medication error); patient diagnosis; breakdown in care process; and claim outcome (dismissed, settled, verdict for plaintiff, or verdict for defendant). During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. Allegations were related to diagnosis in 397 (72.1%), medications in 68 (12.3%), other medical treatment in 41 (7.4%), communication in 15 (2.7%), patient rights in 11 (2.0%), and patient safety or security in 8 (1.5%). Leading diagnoses were cancer (n = 190), heart diseases (n = 43), blood vessel diseases (n = 27), infections (n = 22), and stroke (n = 16). Primary care cases were significantly more likely to be settled (35.2% vs 20.5%) or result in a verdict for the plaintiff (1.6% vs 0.9%) compared with non-general medical malpractice claims (P < .001). In Massachusetts, most primary care claims filed are related to alleged misdiagnosis. Compared with malpractice

  6. 76 FR 44491 - Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals...

    Science.gov (United States)

    2011-07-26

    ... 37208) entitled, ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims..., ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and... external review processes for group health plans and health insurance issuers offering coverage in the...

  7. Do Insurers Have to Pay for Bad Behaviour in Settling Claims? Legal Aspects of Insurers' Wrongful Claims Handling

    NARCIS (Netherlands)

    W.H. van Boom (Willem)

    2011-01-01

    textabstractAbstract: This article presents a comparative legal analysis of wrongful claims handling by insurance companies in indemnity and liability insurance. From the outset, it is clear that it may be difficult to draw the line between legitimate claims denial and refusal to pay, on the one

  8. Do Insurers Have to Pay for Bad Behaviour in Settling Claims? Legal Aspects of Insurers' Wrongful Claims Handling

    OpenAIRE

    Boom, Willem

    2011-01-01

    textabstractAbstract: This article presents a comparative legal analysis of wrongful claims handling by insurance companies in indemnity and liability insurance. From the outset, it is clear that it may be difficult to draw the line between legitimate claims denial and refusal to pay, on the one hand, and malicious protraction, procrastination and rejection of valid claims, on the other hand. Therefore, it is interesting to find that European legal systems diverge considerably in their stance...

  9. The claims handling process of engineering insurance in South Africa

    Directory of Open Access Journals (Sweden)

    I.C. de Beer

    2015-05-01

    Full Text Available Due to technological developments, the complicated world of engineering and its associated products are continuously becoming more specialized. Short-term insurers provide engineering insurance to enable the owners and operators of engineering assets to combat the negative impact of the associated risks. It is, however, a huge challenge to the insurers of engineering insurance to manage the particular risks against the background of technological enhancement. The skills gap in the short-term insurance market and the engineering environment may be the main factor which inhibits the growth of the engineering insurance market. The objective of this research embodies the improvement of financial decision-making concerning the claims handling process of engineering insurance. Secondary as well as primary data were necessary to achieve the stated objective. The secondary data provided the background of the research and enabled the researchers to compile a questionnaire for the empirical survey. The questionnaire and a cover letter were sent to the top 10 short-term insurers in South Africa that are providing engineering insurance. Their perceptions should provide guidelines to other short-term insurers who are engaged in engineering insurance, as they are regarded as the market leaders of engineering insurance in South Africa. The empirical results of this research focus on the importance of various claims handling factors when assessing the claims handling process of engineering insurance, the problem areas in the claims handling process concerned, as well as how often the stipulations of engineering insurance policies are adjusted to take the claims handling factors into account.

  10. 24 CFR 207.258 - Insurance claim requirements.

    Science.gov (United States)

    2010-04-01

    ... in 24 CFR part 200, subpart B, of its intention to file an insurance claim and of its election either..., ledger cards, documents, books, papers, and accounts relating to the mortgage transaction. (iv) All...

  11. Simulation Of Premi Calculation Claims Insurance Base On Web; Case Study PT. Sinarmas Insurance Padang

    OpenAIRE

    Rohendi, Keukeu; Putra, Ilham Eka

    2016-01-01

    Sinarmas currently has several insurance services featured. To perform its function as a good insurance company is need for reform in terms of services in the process of calculating insurance premiums of insurance carried by marketing to use a calculator which interferes with the activities of marketing activities, slow printing insurance policies, automobile claims process that requires the customer to come to the office ASM, slow printing of Work Order (SPK) and the difficulty recap custome...

  12. A logistic regression model for Ghana National Health Insurance claims

    Directory of Open Access Journals (Sweden)

    Samuel Antwi

    2013-07-01

    Full Text Available In August 2003, the Ghanaian Government made history by implementing the first National Health Insurance System (NHIS in Sub-Saharan Africa. Within three years, over half of the country’s population had voluntarily enrolled into the National Health Insurance Scheme. This study had three objectives: 1 To estimate the risk factors that influences the Ghana national health insurance claims. 2 To estimate the magnitude of each of the risk factors in relation to the Ghana national health insurance claims. In this work, data was collected from the policyholders of the Ghana National Health Insurance Scheme with the help of the National Health Insurance database and the patients’ attendance register of the Koforidua Regional Hospital, from 1st January to 31st December 2011. Quantitative analysis was done using the generalized linear regression (GLR models. The results indicate that risk factors such as sex, age, marital status, distance and length of stay at the hospital were important predictors of health insurance claims. However, it was found that the risk factors; health status, billed charges and income level are not good predictors of national health insurance claim. The outcome of the study shows that sex, age, marital status, distance and length of stay at the hospital are statistically significant in the determination of the Ghana National health insurance premiums since they considerably influence claims. We recommended, among other things that, the National Health Insurance Authority should facilitate the institutionalization of the collection of appropriate data on a continuous basis to help in the determination of future premiums.

  13. Joint Asymptotic Distributions of Smallest and Largest Insurance Claims

    Directory of Open Access Journals (Sweden)

    Hansjörg Albrecher

    2014-07-01

    Full Text Available Assume that claims in a portfolio of insurance contracts are described by independent and identically distributed random variables with regularly varying tails and occur according to a near mixed Poisson process. We provide a collection of results pertaining to the joint asymptotic Laplace transforms of the normalised sums of the smallest and largest claims, when the length of the considered time interval tends to infinity. The results crucially depend on the value of the tail index of the claim distribution, as well as on the number of largest claims under consideration.

  14. Medical insurance claims associated with international business travel.

    Science.gov (United States)

    Liese, B; Mundt, K A; Dell, L D; Nagy, L; Demure, B

    1997-07-01

    Preliminary investigations of whether 10,884 staff and consultants of the World Bank experience disease due to work related travel. Medical insurance claims filed by 4738 travellers during 1993 were compared with claims of non-travellers. Specific diagnoses obtained from claims were analysed overall (one or more v no missions) and by frequency of international mission (1, 2-3, or > or = 4). Standardised rate of claims ratios (SSRs) for each diagnostic category were obtained by dividing the age adjusted rate of claims for travellers by the age adjusted rate of claims for non-travellers, and were calculated for men and women travellers separately. Overall, rates of insurance claims were 80% higher for men and 18% higher for women travellers than their non-travelling counterparts. Several associations with frequency of travel were found. SRRs for infectious disease were 1.28, 1.54, and 1.97 among men who had completed one, two or three, and four or more missions, and 1.16, 1.28, and 1.61, respectively, among women. The greatest excess related to travel was found for psychological disorders. For men SRRs were 2.11, 3.13, and 3.06 and for women, SRRs were 1.47, 1.96, and 2.59. International business travel may pose health risks beyond exposure to infectious diseases. Because travellers file medical claims at a greater rate than non-travellers, and for many categories of disease, the rate of claims increases with frequency of travel. The reasons for higher rates of claims among travellers are not well understood. Additional research on psychosocial factors, health practices, time zones crossed, and temporal relation between travel and onset of disease is planned.

  15. Compensation culture reviewed: incentives to claim and damages levels

    OpenAIRE

    Lewis, Richard Kurt

    2014-01-01

    This article reviews some recent developments which have affected the debate concerning ‘compensation culture.’ It focuses upon the number of claims and the cost of claims, looking especially at the level of damages. The role of insurers and the changing nature of personal injury practice are also discussed. The conclusion is that issues arising from the debate will continue for some time to come.

  16. Registry and health insurance claims data in vascular research and quality improvement.

    Science.gov (United States)

    Behrendt, Christian-Alexander; Heidemann, Franziska; Rieß, Henrik Christian; Stoberock, Konstanze; Debus, Sebastian Eike

    2017-01-01

    The expansion of procedures in multidisciplinary vascular medicine has sparked a controversy regarding measures of quality improvement. In addition to primary registries, the use of health insurance claims data is becoming of increasing importance. However, due to the fact that health insurance claims data are not collected for scientific evaluation but rather for reimbursement purposes, meticulous validation is necessary before and during usage in research and quality improvement matters. This review highlights the advantages and disadvantages of such data sources. A recent comprehensive expert opinion panel examined the use of health insurance claims data and other administrative data sources in medicine. Results from several studies concerning the validity of administrative data varied significantly. Validity of these data sources depends on the clinical relevance of the diagnoses considered. The rate of implausible information was 0.04 %, while the validity of the considered diagnoses varied between 80 and 97 % across multiple validation studies. A matching study between health insurance claims data of the third-largest German health insurance provider, DAK-Gesundheit, and a prospective primary registry of the German Society for Vascular Surgery demonstrated a good level of validity regarding the mortality of endovascular and open surgical treatment of abdominal aortic aneurysm in German hospitals. In addition, a large-scale international comparison of administrative data for the same disorder presented important results in treatment reality, which differed from those from earlier randomized controlled trials. The importance of administrative data for research and quality improvement will continue to increase in the future. When discussing the internal and external validity of this data source, one has to distinguish not only between its intended usage (research vs. quality improvement), but also between the included diseases and/or treatment procedures

  17. National Flood Insurance Program (NFIP) Residential Historical Claims

    Data.gov (United States)

    Department of Homeland Security — The National Flood Insurance Program (NFIP) aims to reduce the impact of flooding—a burden not covered by homeowner’s insurance—by providing insurance to homeowners,...

  18. Data analytics for insurance loss modelling, telematics pricing and claims reserving.:Data analytics for insurance loss modelling, telematics pricing and claims reserving.

    OpenAIRE

    Verbelen, Roel

    2017-01-01

    Today's society generates data more rapidly than ever before, creating many opportunities as well as challenges for statisticians. Many industries become increasingly dependent on high-quality data, and the demand for sound statistical analysis of these data is rising accordingly. In the insurance sector, data have always played a major role. When selling a contract to a client, the insurance company is liable for the claims arising from this contract and will hold capital aside to meet th...

  19. Model estimation of claim risk and premium for motor vehicle insurance by using Bayesian method

    Science.gov (United States)

    Sukono; Riaman; Lesmana, E.; Wulandari, R.; Napitupulu, H.; Supian, S.

    2018-01-01

    Risk models need to be estimated by the insurance company in order to predict the magnitude of the claim and determine the premiums charged to the insured. This is intended to prevent losses in the future. In this paper, we discuss the estimation of risk model claims and motor vehicle insurance premiums using Bayesian methods approach. It is assumed that the frequency of claims follow a Poisson distribution, while a number of claims assumed to follow a Gamma distribution. The estimation of parameters of the distribution of the frequency and amount of claims are made by using Bayesian methods. Furthermore, the estimator distribution of frequency and amount of claims are used to estimate the aggregate risk models as well as the value of the mean and variance. The mean and variance estimator that aggregate risk, was used to predict the premium eligible to be charged to the insured. Based on the analysis results, it is shown that the frequency of claims follow a Poisson distribution with parameter values λ is 5.827. While a number of claims follow the Gamma distribution with parameter values p is 7.922 and θ is 1.414. Therefore, the obtained values of the mean and variance of the aggregate claims respectively are IDR 32,667,489.88 and IDR 38,453,900,000,000.00. In this paper the prediction of the pure premium eligible charged to the insured is obtained, which amounting to IDR 2,722,290.82. The prediction of the claims and premiums aggregate can be used as a reference for the insurance company’s decision-making in management of reserves and premiums of motor vehicle insurance.

  20. Index for Predicting Insurance Claims from Wind Storms with an Application in France.

    Science.gov (United States)

    Mornet, Alexandre; Opitz, Thomas; Luzi, Michel; Loisel, Stéphane

    2015-11-01

    For insurance companies, wind storms represent a main source of volatility, leading to potentially huge aggregated claim amounts. In this article, we compare different constructions of a storm index allowing us to assess the economic impact of storms on an insurance portfolio by exploiting information from historical wind speed data. Contrary to historical insurance portfolio data, meteorological variables show fewer nonstationarities between years and are easily available with long observation records; hence, they represent a valuable source of additional information for insurers if the relation between observations of claims and wind speeds can be revealed. Since standard correlation measures between raw wind speeds and insurance claims are weak, a storm index focusing on high wind speeds can afford better information. A storm index approach has been applied to yearly aggregated claim amounts in Germany with promising results. Using historical meteorological and insurance data, we assess the consistency of the proposed index constructions with respect to various parameters and weights. Moreover, we are able to place the major insurance events since 1998 on a broader horizon beyond 40 years. Our approach provides a meteorological justification for calculating the return periods of extreme-storm-related insurance events whose magnitude has rarely been reached. © 2015 Society for Risk Analysis.

  1. Double generalized linear compound poisson models to insurance claims data

    DEFF Research Database (Denmark)

    Andersen, Daniel Arnfeldt; Bonat, Wagner Hugo

    2017-01-01

    This paper describes the specification, estimation and comparison of double generalized linear compound Poisson models based on the likelihood paradigm. The models are motivated by insurance applications, where the distribution of the response variable is composed by a degenerate distribution...... implementation and illustrate the application of double generalized linear compound Poisson models using a data set about car insurances....

  2. Dental insurance: A systematic review.

    Science.gov (United States)

    Garla, Bharath Kumar; Satish, G; Divya, K T

    2014-12-01

    To review uses of finance in dentistry. A search of 25 electronic databases and World Wide Web was conducted. Relevant journals were hand searched and further information was requested from authors. Inclusion criteria were a predefined hierarchy of evidence and objectives. Study validity was assessed with checklists. Two reviewers independently screened sources, extracted data, and assessed validity. Insurance has come of ages and has become the mainstay of payment in many developed countries. So much so that all the alternative forms of payment which originated as an alternative to fee for service now depend on insurance at one point or the other. Fee for service is still the major form of payment in many developing countries including India. It is preferred in many instances since the payment is made immediately.

  3. Pricing the property claim service (PCS) catastrophe insurance options using gamma distribution

    Science.gov (United States)

    Noviyanti, Lienda; Soleh, Achmad Zanbar; Setyanto, Gatot R.

    2017-03-01

    The catastrophic events like earthquakes, hurricanes or flooding are characteristics for some areas, a properly calculated annual premium would be closely as high as the loss insured. From an actuarial perspective, such events constitute the risk that are not insurable. On the other hand people living in such areas need protection. In order to securitize the catastrophe risk, futures or options based on a loss index could be considered. Chicago Board of Trade launched a new class of catastrophe insurance options based on new indices provided by Property Claim Services (PCS). The PCS-option is based on the Property Claim Service Index (PCS-Index). The index are used to determine and payout in writing index-based insurance derivatives. The objective of this paper is to price PCS Catastrophe Insurance Option based on PCS Catastrophe index. Gamma Distribution is used to estimate PCS Catastrophe index distribution.

  4. Analysis of the Romanian Insurance Market Based on Ensuring and Exercising Consumers` Right to Claim

    Directory of Open Access Journals (Sweden)

    Dan Armeanu

    2014-05-01

    Full Text Available In the financial market of insurance, consumer protection represents an important component contributing to the stability, discipline and efficiency of the market. In this respect, the activity of educating and informing insurance consumers on ensuring and exercising their right to claim plays a leading role in the mechanism of consumer protection. This study aims to improve the decision-making capacity of the financial services consumers from the Romanian insurance market through better information on ensuring and exercising their right to claim under the legislation. Thus, by applying three data analysis techniques – principal components analysis, cluster analysis and discriminant analysis – to the data regarding the petitions that were registered by the 41 insurance companies which operated in the Romanian market in 2012, a classification that assesses the insurance market transparency is achieved, resulting in a better information for consumers and, hence, the improvement of their protection through reducing the level of transactions that are harmful to consumers

  5. Nuclear liability insurance: the Price-Anderson reparations system and the claims experience of the nuclear industry

    International Nuclear Information System (INIS)

    Marrone, J.

    1983-01-01

    The manner in which the Price-Anderson Law operates to provide reparations is reviewed, and the changes made in the law by Congress in 1975 are outlined. Nuclear liability insurers' response to the Three Mile Island accident is described, including emergency assistance funds advanced to qualified evacuees and the claims and litigations that followed. Other nuclear liability claims that have been asserted are described as being brought chiefly by onsite workers. Good health physics protection of workers is acknowledged, but the need to improve record keeping for transient workers is stressed. The nuclear industry is urged to implement a more effective record-keeping program for such workers

  6. The Potential and Uptake of Remote Sensing in Insurance: A Review

    Directory of Open Access Journals (Sweden)

    Jan de Leeuw

    2014-11-01

    Full Text Available Global insurance markets are vast and diverse, and may offer many opportunities for remote sensing. To date, however, few operational applications of remote sensing for insurance exist. Papers claiming potential application of remote sensing typically stress the technical possibilities, without considering its contribution to customer value for the insured or to the profitability of the insurance industry. Based on a systematic search of available literature, this review investigates the potential and actual support of remote sensing to the insurance industry. The review reveals that research on remote sensing in classical claim-based insurance described in the literature revolve around crop damage and flood and fire risk assessment. Surprisingly, the use of remote sensing in claim-based insurance appears to be instigated by government rather than the insurance industry. In contrast, insurance companies are offering various index insurance products that are based on remote sensing. For example, remotely sensed index insurance for rangelands and livestock are operational, while various applications in crop index insurance are being considered or under development. The paper discusses these differences and concludes that there is particular scope for application of remote sensing by the insurance industry in index insurance because (1 indices can be constructed that correlate well with what is insured; (2 these indices can be delivered at low cost; and (3 it opens up new markets that are not served by claim-based insurance. The paper finally suggests that limited adoption of remote sensing in insurance results from a lack of mutual understanding and calls for greater cooperation between the insurance industry and the remote sensing community.

  7. Claims expenses and limits of liability in third party liability insurances

    International Nuclear Information System (INIS)

    Rehmann, J.

    1992-01-01

    After the Chernobyl accident, more than 300,000 individual claims totalling DM 440 million were settled in Germany, even though the level of radiation was relatively low. This has alerted insurers to the potential level of expenses connected with the handling and settlement of claims following a major nuclear accident which, it is estimated, could amount to DM 50 million per 100,000 claims. The Paris Convention (PC) states the principle of congruence between liability and coverage for nuclear installations. The minimum amounts of liability and coverage must be exclusively reserved for the compensation of accident victims. This paper will show that in PC countries, the majority of claims expenses - both internal and external -are borne by the insurers in addition to the sums insured for the compensation of third parties, with limited extensions of coverage in some cases. The situation is different in non-PC countries, and particularly in the United States of America, where expenses are included in the total sum insured together with compensation payments to third parties. This situation would not pose a problem if the minimum amounts of liability and coverage as stated in the PC were still applicable. In practice, most countries have since increased these amounts substantially, thus reducing the insurers' ability to make the maximum possible capacity available for indemnities to victims. Thus, before further increasing the statutory limits of liability, governments should, when conducting the Nuclear Energy Agency revision of the PC, consider allowing insurers to include claims handling expenses in their total sums insured; with a finite amount of risk, insurers would then be able to commit their full capacity instead of withholding a safety buffer for an open-ended commitment. (author)

  8. 76 FR 37037 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

    Science.gov (United States)

    2011-06-24

    ... Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and... interim final regulations published July 23, 2010 with respect to group health plans and health insurance..., group health plans, and health insurance issuers providing group health insurance coverage. The text of...

  9. The Impact of Changes to the Unemployment Rate on Australian Disability Income Insurance Claim Incidence

    Directory of Open Access Journals (Sweden)

    Gaurav Khemka

    2017-03-01

    Full Text Available We explore the extent to which claim incidence in Disability Income Insurance (DII is affected by changes in the unemployment rate in Australia. Using data from 1986 to 2001, we fit a hurdle model to explore the presence and magnitude of the effect of changes in unemployment rate on the incidence of DII claims, controlling for policy holder characteristics and seasonality. We find a clear positive association between unemployment and claim incidence, and we explore this further by gender, age, deferment period, and occupation. A multinomial logistic regression model is fitted to cause of claim data in order to explore the relationship further, and it is shown that the proportion of claims due to accident increases markedly with rising unemployment. The results suggest that during periods of rising unemployment, insurers may face increased claims from policy holders with shorter deferment periods for white-collar workers and for medium and heavy manual workers. Our findings indicate that moral hazard may have a material impact on DII claim incidence and insurer business in periods of declining economic conditions.

  10. Recursive estimation of the claim rates and sizes in an insurance model

    Directory of Open Access Journals (Sweden)

    Lakhdar Aggoun

    2004-01-01

    Full Text Available It is a common fact that for most classes of general insurance, many possible sources of heterogeneity of risk exist. Premium rates based on information from a heterogeneous portfolio might be quite inadequate. One way of reducing this danger is by grouping policies according to the different levels of the various risk factors involved. Using measure change techniques, we derive recursive filters and predictors for the claim rates and claim sizes for the different groups.

  11. 24 CFR 266.626 - Notice of default and filing an insurance claim.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Notice of default and filing an... AND OTHER AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Contract Rights and Obligations Claim Procedures § 266.626 Notice of default and filing an...

  12. 75 FR 43109 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

    Science.gov (United States)

    2010-07-23

    ... Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and... the Office of Consumer Information and Insurance Oversight of the U.S. Department of Health and Human... health insurance coverage offered in connection with a group health plan under the Employee Retirement...

  13. Health insurance and the demand for medical care: Instrumental variable estimates using health insurer claims data.

    Science.gov (United States)

    Dunn, Abe

    2016-07-01

    This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates. Published by Elsevier B.V.

  14. Premium analysis for copula model: A case study for Malaysian motor insurance claims

    Science.gov (United States)

    Resti, Yulia; Ismail, Noriszura; Jaaman, Saiful Hafizah

    2014-06-01

    This study performs premium analysis for copula models with regression marginals. For illustration purpose, the copula models are fitted to the Malaysian motor insurance claims data. In this study, we consider copula models from Archimedean and Elliptical families, and marginal distributions of Gamma and Inverse Gaussian regression models. The simulated results from independent model, which is obtained from fitting regression models separately to each claim category, and dependent model, which is obtained from fitting copula models to all claim categories, are compared. The results show that the dependent model using Frank copula is the best model since the risk premiums estimated under this model are closely approximate to the actual claims experience relative to the other copula models.

  15. Claims settlement in insurance contracts from a consumer protection perspective in Cameroon

    Directory of Open Access Journals (Sweden)

    Comfort Fuah Kwanga

    2017-10-01

    Full Text Available Everyone in the society is faced with the possibility of one or more hazards that are part of life will sooner or later befall him and may occasion some loss. This misfortune is uncertain as to the time and period when it will occur and this amongst others include: fire outbreak, accident, and even death. This necessitates the need for people to go for insurance policies which suit their various needs in order to permit compensation in case of loss. Most consumers of insurance products are “short changed” in the process because very few take the trouble to read through their insurance policies in order to ascertain and understand the terms and conditions. The result is that most often when a claim arises and it is discovered that the loss is not covered by the terms of the insurance contract, there is the tendency of blaming the insurance companies. This paper posits that: there are of course some “bad eggs” in the industry who manipulate consumers. However, the paper holds that this unpleasant quagmire is often due to lack of understanding of the terms of insurance contracts in general and consumer apathy in particular. The essence of this study is to re-iterate the need to communicate the rules of the insurance game, thereby minimizing some of the misunderstanding and problems faced by consumers.

  16. Nonparametric Fine Tuning of Mixtures: Application to Non-Life Insurance Claims Distribution Estimation

    Science.gov (United States)

    Sardet, Laure; Patilea, Valentin

    When pricing a specific insurance premium, actuary needs to evaluate the claims cost distribution for the warranty. Traditional actuarial methods use parametric specifications to model claims distribution, like lognormal, Weibull and Pareto laws. Mixtures of such distributions allow to improve the flexibility of the parametric approach and seem to be quite well-adapted to capture the skewness, the long tails as well as the unobserved heterogeneity among the claims. In this paper, instead of looking for a finely tuned mixture with many components, we choose a parsimonious mixture modeling, typically a two or three-component mixture. Next, we use the mixture cumulative distribution function (CDF) to transform data into the unit interval where we apply a beta-kernel smoothing procedure. A bandwidth rule adapted to our methodology is proposed. Finally, the beta-kernel density estimate is back-transformed to recover an estimate of the original claims density. The beta-kernel smoothing provides an automatic fine-tuning of the parsimonious mixture and thus avoids inference in more complex mixture models with many parameters. We investigate the empirical performance of the new method in the estimation of the quantiles with simulated nonnegative data and the quantiles of the individual claims distribution in a non-life insurance application.

  17. The contribution of bone scintigraphy in occupational health or medical insurance claims: a retrospective study

    Energy Technology Data Exchange (ETDEWEB)

    Versijpt, J.; Dierckx, R.A.; Bondt, P. de [Division of Nuclear Medicine, University Hospital Gent (Belgium); Dierckx, I. [Department of Radiology, St. Elisabeth Hospital Antwerpen (Belgium); Lambrecht, L. [Outpatient Internal Medicine Clinic, Gent (Belgium); Sadeleer, C. de [Division of Nuclear Medicine, University Hospital Gent (Belgium)]|[Department of Nuclear Medicine, O.L.V. Hospital Geraardsbergen (Belgium)

    1999-08-01

    Patients with a suspicion of bone damage following an industrial or traffic accident are often referred for bone scintigraphy as part of an occupational health or medical insurance investigation. The aim of this study was to assess the contribution and the potential role of bone scintigraphy compared with X-ray investigations in the aforementioned situation. To this end we evaluated 70 consecutive patients referred for bone scintigraphy during 1996 and 1997 by occupational health or medical insurance physicians. The most common reasons for referral were the exclusion of occult fractures of hands and feet, whiplash injuries, reflex sympathetic dystrophy or avascular necrosis, or the differentiation between an old and a recent vertebral fracture. X-rays were only available for comparative review of 53 patients, so only those were analysed. The results of bone scintigraphy were compared with X-rays, and their contribution and potential role in occupational health or medical insurance investigations assessed. In 31 out of the 53 patients investigated, bone scintigraphy findings concurred with X-rays as to the number and location of abnormalities. For 19 of the 53 patients, bone scintigraphy showed clinically relevant additional foci when compared with X-rays, predominantly involving lesions to hands/wrists and feet/ankles. Among these 19 patients, scintigraphic diagnoses were subsequently confirmed in ten cases by means of X-ray or computed tomography. In four patients, supplementary radiological investigations revealed no abnormalities, and in five patients no further investigations were undertaken. Finally, in three of the 53 patients, X-rays revealed bone damage (burst fractures) whilst the corresponding bone scintigraphy was negative, thus excluding recent injury. In conclusion, in 22 patients, representing 42% of the cases analysed, bone scintigraphy was conclusive compared with X-ray imaging in the final diagnosis and in this way in detecting occult or excluding

  18. The contribution of bone scintigraphy in occupational health or medical insurance claims: a retrospective study

    International Nuclear Information System (INIS)

    Versijpt, J.; Dierckx, R.A.; Bondt, P. de; Dierckx, I.; Lambrecht, L.; Sadeleer, C. de

    1999-01-01

    Patients with a suspicion of bone damage following an industrial or traffic accident are often referred for bone scintigraphy as part of an occupational health or medical insurance investigation. The aim of this study was to assess the contribution and the potential role of bone scintigraphy compared with X-ray investigations in the aforementioned situation. To this end we evaluated 70 consecutive patients referred for bone scintigraphy during 1996 and 1997 by occupational health or medical insurance physicians. The most common reasons for referral were the exclusion of occult fractures of hands and feet, whiplash injuries, reflex sympathetic dystrophy or avascular necrosis, or the differentiation between an old and a recent vertebral fracture. X-rays were only available for comparative review of 53 patients, so only those were analysed. The results of bone scintigraphy were compared with X-rays, and their contribution and potential role in occupational health or medical insurance investigations assessed. In 31 out of the 53 patients investigated, bone scintigraphy findings concurred with X-rays as to the number and location of abnormalities. For 19 of the 53 patients, bone scintigraphy showed clinically relevant additional foci when compared with X-rays, predominantly involving lesions to hands/wrists and feet/ankles. Among these 19 patients, scintigraphic diagnoses were subsequently confirmed in ten cases by means of X-ray or computed tomography. In four patients, supplementary radiological investigations revealed no abnormalities, and in five patients no further investigations were undertaken. Finally, in three of the 53 patients, X-rays revealed bone damage (burst fractures) whilst the corresponding bone scintigraphy was negative, thus excluding recent injury. In conclusion, in 22 patients, representing 42% of the cases analysed, bone scintigraphy was conclusive compared with X-ray imaging in the final diagnosis and in this way in detecting occult or excluding

  19. Gender Disparities in Ghana National Health Insurance Claims: An Econometric Analysis

    Directory of Open Access Journals (Sweden)

    Samuel Antwi

    2014-01-01

    Full Text Available The objective of this study was to find out the gender disparities in Ghana national health insurance claims. In this work, data was collected from the policyholders of the Ghana National Health Insurance Scheme with the help of the National Health Insurance database and the patients’ attendance register of the Koforidua Regional Hospital, from 1st January to 31st December 2011. The generalized linear regression (GLR models and the SPSS version 17.0 were used for the analysis. Among men, the younger people prefer attending hospital for treatment as compared to their adult counterparts. In contrast to women, younger women favor attending hospital for treatment as compared to their adult counterparts. Among men, various levels of income impact greatly on their propensity to make an insurance claim, whereas among women only the highest income level did as compared to lowest income level.Men, who completed senior high school education, were less likely to make an insurance claim as compared to their counterparts with basic or no education. However it was women who had basic education that preferred using the hospital as compared to their more educated counterparts. It is suggested that the government should consider building more health centers, clinics and cheap-compounds in at least every community, to help reduce the travel time in accessing health care.  The ministry of health and the Ghana health service should engage older citizens by encouraging them to use hospitals when they are sick instead of other alternative care providers.

  20. Risk of new acute myocardial infarction hospitalization associated with use of oral and parenteral non-steroidal anti-inflammation drugs (NSAIDs: a case-crossover study of Taiwan's National Health Insurance claims database and review of current evidence

    Directory of Open Access Journals (Sweden)

    Shau Wen-Yi

    2012-02-01

    Full Text Available Abstract Background Previous studies have documented the increased cardiovascular risk associated with the use of some nonsteroidal anti-inflammatory drugs (NSAIDs. Despite this, many old NSAIDs are still prescribed worldwide. Most of the studies to date have been focused on specific oral drugs or limited by the number of cases examined. We studied the risk of new acute myocardial infarction (AMI hospitalization with current use of a variety of oral and parenteral NSAIDs in a nationwide population, and compared our results with existing evidence. Methods We conducted a case-crossover study using the Taiwan's National Health Insurance claim database, identifying patients with new AMI hospitalized in 2006. The 1-30 days and 91-120 days prior to the admission were defined as case and matched control period for each patient, respectively. Uses of NSAIDs during the respective periods were compared using conditional logistic regression and adjusted for use of co-medications. Results 8354 new AMI hospitalization patients fulfilled the study criteria. 14 oral and 3 parenteral NSAIDs were selected based on drug utilization profile among 13.7 million NSAID users. The adjusted odds ratio, aOR (95% confidence interval, for risk of AMI and use of oral and parenteral non-selective NSAIDs were 1.42 (1.29, 1.56 and 3.35 (2.50, 4.47, respectively, and significantly greater for parenteral than oral drugs (p for interaction Conclusions The collective evidence revealed the tendency of increased AMI risk with current use of some NSAIDs. A higher AMI risk associated with use of parenteral NSAIDs was observed in the present study. Ketorolac had the highest associated risk in both oral and parenteral NSAIDs studied. Though further investigation to confirm the association is warranted, prescribing physicians and the general public should be cautious about the potential risk of AMI when using NSAIDs.

  1. The use of breast conserving surgery: linking insurance claims with tumor registry data

    International Nuclear Information System (INIS)

    Maskarinec, Gertraud; Dhakal, Sanjaya; Yamashiro, Gladys; Issell, Brian F

    2002-01-01

    The purpose of this study was to use insurance claims and tumor registry data to examine determinants of breast conserving surgery (BCS) in women with early stage breast cancer. Breast cancer cases registered in the Hawaii Tumor Registry (HTR) from 1995 to 1998 were linked with insurance claims from a local health plan. We identified 722 breast cancer cases with stage I and II disease. Surgical treatment patterns and comorbidities were identified using diagnostic and procedural codes in the claims data. The HTR database provided information on demographics and disease characteristics. We used logistic regression to assess determinants of BCS vs. mastectomy. The linked data set represented 32.8% of all early stage breast cancer cases recorded in the HTR during the study period. Due to the nature of the health plan, 79% of the cases were younger than 65 years. Women with early stage breast cancer living on Oahu were 70% more likely to receive BCS than women living on the outer islands. In the univariate analysis, older age at diagnosis, lower tumor stage, smaller tumor size, and well-differentiated tumor grade were related to receiving BCS. Ethnicity, comorbidity count, menopausal and marital status were not associated with treatment type. In addition to developing solutions that facilitate access to radiation facilities for breast cancer patients residing in remote locations, future qualitative research may help to elucidate how women and oncologists choose between BCS and mastectomy

  2. Predicting number of hospitalization days based on health insurance claims data using bagged regression trees.

    Science.gov (United States)

    Xie, Yang; Schreier, Günter; Chang, David C W; Neubauer, Sandra; Redmond, Stephen J; Lovell, Nigel H

    2014-01-01

    Healthcare administrators worldwide are striving to both lower the cost of care whilst improving the quality of care given. Therefore, better clinical and administrative decision making is needed to improve these issues. Anticipating outcomes such as number of hospitalization days could contribute to addressing this problem. In this paper, a method was developed, using large-scale health insurance claims data, to predict the number of hospitalization days in a population. We utilized a regression decision tree algorithm, along with insurance claim data from 300,000 individuals over three years, to provide predictions of number of days in hospital in the third year, based on medical admissions and claims data from the first two years. Our method performs well in the general population. For the population aged 65 years and over, the predictive model significantly improves predictions over a baseline method (predicting a constant number of days for each patient), and achieved a specificity of 70.20% and sensitivity of 75.69% in classifying these subjects into two categories of 'no hospitalization' and 'at least one day in hospital'.

  3. Pluvial, urban flood mechanisms and characteristics - Assessment based on insurance claims

    Science.gov (United States)

    Sörensen, Johanna; Mobini, Shifteh

    2017-12-01

    Pluvial flooding is a problem in many cities and for city planning purpose the mechanisms behind pluvial flooding are of interest. Previous studies seldom use insurance claim data to analyse city scale characteristics that lead to flooding. In the present study, two long time series (∼20 years) of flood claims from property owners have been collected and analysed in detail to investigate the mechanisms and characteristics leading to urban flooding. The flood claim data come from the municipal water utility company and property owners with insurance that covers property loss from overland flooding, groundwater intrusion through basement walls and flooding from the drainage system. These data are used as a proxy for flood severity for several events in the Swedish city of Malmö. It is discussed which rainfall characteristics give most flooding and why some rainfall events do not lead to severe flooding, how city scale topography and sewerage system type influence spatial distribution of flood claims, and which impact high sea level has on flooding in Malmö. Three severe flood events are described in detail and compared with a number of smaller flood events. It was found that the main mechanisms and characteristics of flood extent and its spatial distribution in Malmö are intensity and spatial distribution of rainfall, distance to the main sewer system as well as overland flow paths, and type of drainage system, while high sea level has little impact on the flood extent. Finally, measures that could be taken to lower the flood risk in Malmö, and other cities with similar characteristics, are discussed.

  4. Modeling the Malaysian motor insurance claim using artificial neural network and adaptive NeuroFuzzy inference system

    Science.gov (United States)

    Mohd Yunos, Zuriahati; Shamsuddin, Siti Mariyam; Ismail, Noriszura; Sallehuddin, Roselina

    2013-04-01

    Artificial neural network (ANN) with back propagation algorithm (BP) and ANFIS was chosen as an alternative technique in modeling motor insurance claims. In particular, an ANN and ANFIS technique is applied to model and forecast the Malaysian motor insurance data which is categorized into four claim types; third party property damage (TPPD), third party bodily injury (TPBI), own damage (OD) and theft. This study is to determine whether an ANN and ANFIS model is capable of accurately predicting motor insurance claim. There were changes made to the network structure as the number of input nodes, number of hidden nodes and pre-processing techniques are also examined and a cross-validation technique is used to improve the generalization ability of ANN and ANFIS models. Based on the empirical studies, the prediction performance of the ANN and ANFIS model is improved by using different number of input nodes and hidden nodes; and also various sizes of data. The experimental results reveal that the ANFIS model has outperformed the ANN model. Both models are capable of producing a reliable prediction for the Malaysian motor insurance claims and hence, the proposed method can be applied as an alternative to predict claim frequency and claim severity.

  5. Estimating Total Claim Size in the Auto Insurance Industry: a Comparison between Tweedie and Zero-Adjusted Inverse Gaussian Distribution

    Directory of Open Access Journals (Sweden)

    Adriana Bruscato Bortoluzzo

    2011-01-01

    Full Text Available The objective of this article is to estimate insurance claims from an auto dataset using the Tweedie and zero-adjusted inverse Gaussian (ZAIG methods. We identify factors that influence claim size and probability, and compare the results of these methods which both forecast outcomes accurately. Vehicle characteristics like territory, age, origin and type distinctly influence claim size and probability. This distinct impact is not always present in the Tweedie estimated model. Auto insurers should consider estimating total claim size using both the Tweedie and ZAIG methods. This allows for an estimation of confidence interval based on empirical quantiles using bootstrap simulation. Furthermore, the fitted models may be useful in developing a strategy to obtain premium pricing.

  6. The relationship between insurance claim closure and recovery after traffic injuries for individuals with whiplash associated disorders

    DEFF Research Database (Denmark)

    Boyle, Eleanor; Cassidy, J David; Côté, Pierre

    2017-01-01

    PURPOSE: The purpose of this study was to determine if time to claim closure was similar to time to self-reported recovery in a no fault motor vehicle collision insurance system. METHOD: A prospective cohort of traffic injured adults with a whiplash-associated disorder (WAD) was assembled. We...... Time to claim closure as an outcome measure for whiplash-associated disorders has been criticized in the literature because it is thought that closure is not reflective of the health status of the individual. We found that claim closure was associated with lower levels of disability, but the time...

  7. 20 CFR 405.410 - Selecting claims for Decision Review Board review.

    Science.gov (United States)

    2010-04-01

    ... will not review claims based on the identity of the administrative law judge who decided the claim. (b... Decision Review Board review. (a)(1) The Board may review your claim if the administrative law judge made a decision under §§ 405.340 or 405.370 of this part, regardless of whether the administrative law judge's...

  8. Resolving Malpractice Claims after Tort Reform: Experience in a Self-Insured Texas Public Academic Health System.

    Science.gov (United States)

    Sage, William M; Harding, Molly Colvard; Thomas, Eric J

    2016-12-01

    To describe the litigation experience in a state with strict tort reform of a large public university health system that has committed to transparency with patients and families in resolving medical errors. Secondary data collected from The University of Texas System, which self-insures approximately 6,000 physicians at six health campuses across the state. We obtained internal case management data for all medical malpractice claims closed during 1 year before and 6 recent years following the enactment of state tort reform legislation. We retrospectively reviewed information about malpractice claimants, malpractice claims, and the process and outcome of dispute resolution. We accessed an internal case management database, supplemented by both electronic and paper records compiled by the university's Office of General Counsel. Closed claims dropped from 244 in 2001-2002 to an annual mean of 96 in 2009-2015, closures following lawsuits from 136 in 2001-2002 to an annual mean of 28 in 2009-2015, and paid claims from 60 in 2001 to an annual mean of 20 in 2009-2015. Patterns of resolution suggest efforts by the university to provide some compensation to injured patients in cases that were no longer economically viable for plaintiffs' lawyers to litigate. The percentage of payments relating to cases in which lawsuits had been filed decreased from 82 percent in 2001-2002 to 47 percent in 2009-2012 and again to 29 percent in 2012-2015, although most paid claimants were represented by attorneys. Unrepresented patients received payment in 13 cases closed in 2009-2012 (22 percent of payments; mean amount $60,566) and in 24 cases closed in 2012-2015 (41 percent of payments; mean amount $109,410). Even after tort reform, however, claims that resulted in payment remained slow to resolve, which was worsened for claimants subject to Medicare secondary payer rules. Strict confidentiality became a more common condition of settlement, although restrictions were subsequently relaxed

  9. Analysis of 127 peripartum hypoxic brain injuries from closed claims registered by the Danish Patient Insurance Association

    DEFF Research Database (Denmark)

    Bock, J.; Christoffersen, J.K.; Hedegaard, M.

    2008-01-01

    : The authors retrospectively investigated peripartum hypoxic brain injuries registered by the Danish Patient Insurance Association. RESULTS: From 1992 to 2004, 127 approved claims concerning peripartum hypoxic brain injuries were registered and subsequently analysed. Thirty-eight newborns died, and a majority...

  10. The effectiveness of insurer-supported safety and health engineering controls in reducing workers' compensation claims and costs.

    Science.gov (United States)

    Wurzelbacher, Steven J; Bertke, Stephen J; Lampl, Michael P; Bushnell, P Timothy; Meyers, Alysha R; Robins, David C; Al-Tarawneh, Ibraheem S

    2014-12-01

    This study evaluated the effectiveness of a program in which a workers' compensation (WC) insurer provided matching funds to insured employers to implement safety/health engineering controls. Pre- and post-intervention WC metrics were compiled for the employees designated as affected by the interventions within 468 employers for interventions occurring from 2003 to 2009. Poisson, two-part, and linear regression models with repeated measures were used to evaluate differences in pre- and post-data, controlling for time trends independent of the interventions. For affected employees, total WC claim frequency rates (both medical-only and lost-time claims) decreased 66%, lost-time WC claim frequency rates decreased 78%, WC paid cost per employee decreased 81%, and WC geometric mean paid claim cost decreased 30% post-intervention. Reductions varied by employer size, specific industry, and intervention type. The insurer-supported safety/health engineering control program was effective in reducing WC claims and costs for affected employees. © 2014 Wiley Periodicals, Inc.

  11. 32 CFR 199.7 - Claims submission, review, and payment.

    Science.gov (United States)

    2010-07-01

    ... review or audit, whether the review or audit is prospective, concurrent, or retroactive, OCHAMPUS or... preauthorization must be attached to the appropriate CHAMPUS claim. (4) Advance payment prohibited. No CHAMPUS... and supplies will be subject to utilization review and quality assurance standards, norms, and...

  12. Brief biopsychosocially informed education can improve insurance workers' back pain beliefs: Implications for improving claims management behaviours.

    Science.gov (United States)

    Beales, Darren; Mitchell, Tim; Pole, Naomi; Weir, James

    2016-11-22

    Biopsychosocially informed education is associated with improved back pain beliefs and positive changes in health care practitioners' practice behaviours. Assess the effect of this type of education for insurance workers who are important non-clinical stakeholders in the rehabilitation of injured workers. Insurance workers operating in the Western Australian workers' compensation system underwent two, 1.5 hour sessions of biopsychosocially informed education focusing on understanding and identifying barriers to recovery of injured workers with musculoskeletal conditions. Back pain beliefs were assessed pre-education, immediately post-education and at three-month follow-up (n = 32). Self-reported and Injury Management Advisor-reported assessment of change in claims management behaviours were collected at the three-month follow-up. There were positive changes in the Health Care Providers' Pain and Impairment Relationship Scale (p = 0.009) and Back Beliefs Questionnaire (p = 0.049) immediately following the education that were sustained at three-month follow-up. Positive changes in claims management behaviours were supported by self-reported and Injury Management Advisor-reported data. This study provides preliminary support that a brief biopsychosocially informed education program can positively influence insurance workers' beliefs regarding back pain, with concurrent positive changes in claims management behaviours. Further research is required to ascertain if these changes result in improved claims management outcomes.

  13. 76 FR 46684 - Medicaid and Children's Health Insurance Programs; Disallowance of Claims for FFP and Technical...

    Science.gov (United States)

    2011-08-03

    ..., 433, 447, and 457 [CMS-2292-P] RIN 0938-AQ32 Medicaid and Children's Health Insurance Programs... Children's Health Insurance Program (CHIP) disallowance process to allow States the option to retain... [[Page 46685

  14. The relationship between insurance claim closure and recovery after traffic injuries for individuals with whiplash associated disorders.

    Science.gov (United States)

    Boyle, Eleanor; Cassidy, J David; Côté, Pierre; Carroll, Linda J

    2017-05-01

    The purpose of this study was to determine if time to claim closure was similar to time to self-reported recovery in a no fault motor vehicle collision insurance system. A prospective cohort of traffic injured adults with a whiplash-associated disorder (WAD) was assembled. We excluded participants who applied for benefits after 42 days of the collision, who were in hospital for more than two days and participants who were not followed up at least once after their injury. Questionnaires were completed at baseline, six weeks, three-, six-, nine- and 12-months after the collision. The mean age of the cohort was 39 years and 66% were female. The mean number of days until claim closure and for self-reported recovery was 291days and 134 days, respectively. We found those who had their claim closed at each follow-up period had lower levels of disability and were more likely to report they were recovered than participants with open claims. We conclude that time to claim closure could be used as an outcome measure in traffic collision; however, this measure should be used with caution since it over-estimates the true time to recovery. Implications for Rehabilitation Time to claim closure as an outcome measure for whiplash-associated disorders has been criticized in the literature because it is thought that closure is not reflective of the health status of the individual. We found that claim closure was associated with lower levels of disability, but the time to claim closure was significantly longer than the time to self-reported recovery. Time to claim closure may be used with caution as a "proxy" measure of recovery from an injury; however, it must be noted that it over-estimates the true time of recovery.

  15. Economic Burden in Chinese Patients with Diabetes Mellitus Using Electronic Insurance Claims Data.

    Directory of Open Access Journals (Sweden)

    Yunyu Huang

    Full Text Available There is a paucity of studies that focus on the economic burden in daily care in China using electronic health data. The aim of this study is to describe the development of the economic burden of diabetic patients in a sample city in China from 2009 to 2011 using electronic data of patients' claims records.This study is a retrospective, longitudinal study in an open cohort of Chinese patients with diabetes. The patient population consisted of people living in a provincial capital city in east China, covered by the provincial urban employee basic medical insurance (UEBMI. We included any patient who had at least one explicit diabetes diagnosis or received blood glucose lowering medication in at least one registered outpatient visit or hospitalization during a calendar year in the years 2009-2011. Cross-sectional descriptions of different types of costs, prevalence of diabetic complications and related diseases, medication use were performed for each year separately and differences between three years were compared using a chi-square test or the non-parametric Kruskal-Wallis H test.Our results showed an increasing trend in total medical cost (from 2,383 to 2,780 USD, p = 0.032 and diabetes related cost (from 1,655 to 1,857 USD for those diabetic patients during the study period. The diabetes related economic burden was significantly related to the prevalence of complications and related diseases (p<0.001. The overall medication cost during diabetes related visits also increased (from 1,335 to 1,383 USD, p = 0.021. But the use pattern and cost of diabetes-related medication did not show significant changes during the study period.The economic burden of diabetes increased significantly in urban China. It is important to improve the prevention and treatment of diabetes to contribute to the sustainability of the Chinese health-care system.

  16. Assessing the impact of space weather on the electric power grid based on insurance claims for industrial electrical equipment

    Science.gov (United States)

    Schrijver, C. J.; Dobbins, R.; Murtagh, W.; Petrinec, S. M.

    2014-07-01

    Geomagnetically induced currents are known to induce disturbances in the electric power grid. Here we perform a statistical analysis of 11,242 insurance claims from 2000 through 2010 for equipment losses and related business interruptions in North American commercial organizations that are associated with damage to, or malfunction of, electrical and electronic equipment. We find that claim rates are elevated on days with elevated geomagnetic activity by approximately 20% for the top 5% and by about 10% for the top third of most active days ranked by daily maximum variability of the geomagnetic field. When focusing on the claims explicitly attributed to electrical surges (amounting to more than half the total sample), we find that the dependence of claim rates on geomagnetic activity mirrors that of major disturbances in the U.S. high-voltage electric power grid. The claim statistics thus reveal that large-scale geomagnetic variability couples into the low-voltage power distribution network and that related power-quality variations can cause malfunctions and failures in electrical and electronic devices that, in turn, lead to an estimated 500 claims per average year within North America. We discuss the possible magnitude of the full economic impact associated with quality variations in electrical power associated with space weather.

  17. 77 FR 31499 - Medicaid and Children's Health Insurance Programs; Disallowance of Claims for FFP and Technical...

    Science.gov (United States)

    2012-05-29

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 430, 433, 447, and 457 [CMS-2292-F] RIN 0938-AQ32 Medicaid and Children's Health Insurance Programs... Children's Health Insurance Program (CHIP) disallowance process to allow States the option to retain...

  18. 78 FR 41339 - Federal Housing Administration (FHA) Multifamily Mortgage Insurance; Capturing Excess Claim Proceeds

    Science.gov (United States)

    2013-07-10

    ... mortgage insurance eligibility requirements and contract rights and obligations can be found at 24 CFR part... contract rights and obligations of mortgagees participating in FHA multifamily insurance programs and using...: Proposed rule. SUMMARY: This proposed rule would amend HUD's regulations covering the contract rights and...

  19. Data scan. With access to a newly available trove of private insurers' claims data, new institute aims to study what's driving spiraling healthcare costs.

    Science.gov (United States)

    Evans, Melanie

    2011-09-26

    A new research initiative aims to delve into private-insurer claims data to study utilization and what's driving healthcare costs. The Health Care Cost Institute will help researchers, who have been limited to Medicare data or limited private claims. "We're optimistic. We have nothing to hide here," says Michael Richards, left, of Gundersen Lutheran Medical Center.

  20. Health Insurance Rate Review Fact Sheet

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act is bringing an unprecedented level of scrutiny and transparency to health insurance rate increases. The Act ensures that, in any State, any...

  1. When can insurers offer products that dominate delayed old-age pension benefit claiming?

    NARCIS (Netherlands)

    Sanders, L.; De Waegenaere, A.M.B.; Nijman, T.E.

    2013-01-01

    It is common practice for public pension schemes to offer individuals the option to delay benefit claiming until after the normal retirement age, and increase the annual benefit level as a result. Existing literature shows that for non-liquidity constrained individuals, delaying benefit claiming for

  2. Barefoot running claims and controversies: a review of the literature.

    Science.gov (United States)

    Jenkins, David W; Cauthon, David J

    2011-01-01

    Barefoot running is slowly gaining a dedicated following. Proponents of barefoot running claim many benefits, such as improved performance and reduced injuries, whereas detractors warn of the imminent risks involved. Multiple publications were reviewed using key words. A review of the literature uncovered many studies that have looked at the barefoot condition and found notable differences in gait and other parameters. These findings, along with much anecdotal information, can lead one to extrapolate that barefoot runners should have fewer injuries, better performance, or both. Several athletic shoe companies have designed running shoes that attempt to mimic the barefoot condition and, thus, garner the purported benefits of barefoot running. Although there is no evidence that either confirms or refutes improved performance and reduced injuries in barefoot runners, many of the claimed disadvantages to barefoot running are not supported by the literature. Nonetheless, it seems that barefoot running may be an acceptable training method for athletes and coaches who understand and can minimize the risks.

  3. The insurance of bulk oil cargoes and adjustment of shortage claims

    International Nuclear Information System (INIS)

    Tavendale, R.

    1993-01-01

    Shortage claims discussed in this article include those due to a definite disaster such as a fire, those due to cargo contamination and storage, and those identified in documentation as occurring between loading and unloading. The principal types of cover are examined, and the distinction between gross and net quantities, claim documentation, the petroleum measurement tables, and guaranteed out turn cover are described in detail. (UK)

  4. Evaluation of the crash mitigation effect of low-speed automated emergency braking systems based on insurance claims data.

    Science.gov (United States)

    Isaksson-Hellman, Irene; Lindman, Magdalena

    2016-09-01

    The aim of the present study was to evaluate the crash mitigation performance of low-speed automated emergency braking collision avoidance technologies by examining crash rates, car damage, and personal injuries. Insurance claims data were used to identify rear-end frontal collisions, the specific situations where the low-speed automated emergency braking system intervenes. We compared cars of the same model (Volvo V70) with and without the low-speed automated emergency braking system (AEB and no AEB, respectively). Distributions of spare parts required for car repair were analyzed to identify car damage, and crash severity was estimated by comparing the results with laboratory crash tests. Repair costs and occupant injuries were investigated for both the striking and the struck vehicle. Rear-end frontal collisions were reduced by 27% for cars with low-speed AEB compared to cars without the system. Those of low severity were reduced by 37%, though more severe crashes were not reduced. Accordingly, the number of injured occupants in vehicles struck by low-speed AEB cars was reduced in low-severity crashes. In offset crash configurations, the system was found to be less effective. This study adds important information about the safety performance of collision avoidance technologies, beyond the number of crashes avoided. By combining insurance claims data and information from spare parts used, the study demonstrates a mitigating effect of low-speed AEB in real-world traffic.

  5. Major surgery in south India: a retrospective audit of hospital claim data from a large community health insurance programme.

    Science.gov (United States)

    Shaikh, Maaz; Woodward, Mark; Rahimi, Kazem; Patel, Anushka; Rath, Santosh; MacMahon, Stephen; Jha, Vivekanand

    2015-04-27

    Information about use of major surgery in India is scarce. This study aims to bridge this gap by auditing hospital claims from the Rajiv Aarogyasri Community Health Insurance Scheme (RACHIS) that provides access to free tertiary care for major surgery through state-funded insurance to 68 million beneficiaries with limited household incomes-81% of population in states of Telangana and Andhra Pradesh (combined Human Development Index 0·485). Beneficiary households receive an annual coverage of INR 200 000 (US$3333) for admissions to any empanelled public or private hospital. Publicly available deidentified hospital claim data for all surgical procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh. 677 332 surgical admissions (80% at private hospitals) were recorded at a mean annual rate of 259 per 100 000 beneficiaries (95% CI 235-283), excluding cataract and caesarean sections as these were not covered under the insurance programme. Men accounted for 56% of admissions. Injury was the most common cause for surgical admission (185 733; 27%) with surgical correction of long bone fractures being the most common procedure (144 997; 20%) identified in the audit. Diseases of digestive (110 922; 16%), genitourinary (82 505; 12%), and musculoskeletal system (70 053; 10%) were other leading causes for surgical admissions. Most hospital bed-days were used for injuries (584 days per 100 000 person years; 31%), digestive diseases (314 days; 17%), and musculoskeletal system (207 days; 11%), costing 19% (INR 4·4 billion), 13% (3·03 billion), and 11% (2·5 billion) of claims, respectively. Cardiovascular surgeries (53 023; 8%) alone accounted for 21% (INR 4·9 billion) of cost. Annual per capita cost of surgical claims was US$1·49 (95% CI 1·32-1·65). Our findings are limited to a population socioeconomically representative of India and other countries with low-income and middle

  6. 48 CFR 952.231-71 - Insurance-litigation and claims.

    Science.gov (United States)

    2010-10-01

    ... agencies, in connection with this contract. The Contractor shall proceed with such litigation in good faith... litigation in good faith and as directed from time to time by the Contracting Officer. (c)(1) Except as... insurance as required by law or approved in writing by the Contracting Officer. (2) The Contractor may, with...

  7. 48 CFR 970.5228-1 - Insurance-litigation and claims.

    Science.gov (United States)

    2010-10-01

    ... agencies, in connection with this contract. The Contractor shall proceed with such litigation in good faith... litigation in good faith and as directed from time to time by the Contracting Officer. (c)(1) Except as... insurance as required by law or approved in writing by the Contracting Officer. (2) The Contractor may, with...

  8. Effects of health insurance on labour supply: A systematic review

    NARCIS (Netherlands)

    Quynh, Nga Le Thi; Groot, Wim; Tomini, Sonila M.; Tomini, Florian

    2017-01-01

    This study provides a systematic review of empirical evidence on the labour supply effects of health insurance. The outcomes in the 63 studies reviewed include labour supply in terms of hours worked and the probability of employment, self-employment and the level of economic formalisation. One of

  9. Claims Handling Co-operation between Nuclear Insurance Pools in a Case of Transboundary Damage - Multilateral and Bilateral Agreements in Progress

    International Nuclear Information System (INIS)

    Zaruba, P.

    2008-01-01

    The paper is a short progress report on matters concerning the core reason for insurance of nuclear third party liability - registration, handling, organizing and settling of claims in case of a major nuclear incident, underlining claims handling co-operation between national nuclear insurance pools when damage to health or property becomes international. The contents of this paper is in close relation to information provided on this subject during the 6th International Conference in 2006. Commercial insurance companies have gained extensive experience with handling large scale claims (e.g. after floods and other natural disasters) and are capable in gathering and organizing a high number of professional loss surveyors and adjusters in a very short period of time. In case of nuclear insurance pools co-operation between members (commercial insurance companies) is an added value and can be used practically all over the country bringing into action the network of branches and offices of all the pool members. This advantage is also used in case of cross border claims when it is necessary to gather information and claims advises from a large number of subjects and from many countries, sometimes very far apart. The international network of nuclear insurance pools is an ideal tool for this task and can be mobilized practically at once. Operators of nuclear installations, especially nuclear power plants, do not have the possibility to put aside hundreds of workers to handle claims and are also usually not sufficiently equipped with the necessary know-how. The same goes for governments and government agencies which in many countries guarantee the payments of claims to victims. National nuclear insurance pools are on the other hand well equipped for this task which usually has to be in place for many years after a nuclear incident. Multilateral and bilateral agreements between national nuclear insurance pools and other institutions should be prepared and signed before any

  10. An EM Algorithm for Double-Pareto-Lognormal Generalized Linear Model Applied to Heavy-Tailed Insurance Claims

    Directory of Open Access Journals (Sweden)

    Enrique Calderín-Ojeda

    2017-11-01

    Full Text Available Generalized linear models might not be appropriate when the probability of extreme events is higher than that implied by the normal distribution. Extending the method for estimating the parameters of a double Pareto lognormal distribution (DPLN in Reed and Jorgensen (2004, we develop an EM algorithm for the heavy-tailed Double-Pareto-lognormal generalized linear model. The DPLN distribution is obtained as a mixture of a lognormal distribution with a double Pareto distribution. In this paper the associated generalized linear model has the location parameter equal to a linear predictor which is used to model insurance claim amounts for various data sets. The performance is compared with those of the generalized beta (of the second kind and lognorma distributions.

  11. Predicting the Texas Windstorm Insurance Association claim payout of commercial buildings from Hurricane Ike

    Science.gov (United States)

    Kim, J. M.; Woods, P. K.; Park, Y. J.; Son, K.

    2013-08-01

    Following growing public awareness of the danger from hurricanes and tremendous demands for analysis of loss, many researchers have conducted studies to develop hurricane damage analysis methods. Although researchers have identified the significant indicators, there currently is no comprehensive research for identifying the relationship among the vulnerabilities, natural disasters, and economic losses associated with individual buildings. To address this lack of research, this study will identify vulnerabilities and hurricane indicators, develop metrics to measure the influence of economic losses from hurricanes, and visualize the spatial distribution of vulnerability to evaluate overall hurricane damage. This paper has utilized the Geographic Information System to facilitate collecting and managing data, and has combined vulnerability factors to assess the financial losses suffered by Texas coastal counties. A multiple linear regression method has been applied to develop hurricane economic damage predicting models. To reflect the pecuniary loss, insured loss payment was used as the dependent variable to predict the actual financial damage. Geographical vulnerability indicators, built environment vulnerability indicators, and hurricane indicators were all used as independent variables. Accordingly, the models and findings may possibly provide vital references for government agencies, emergency planners, and insurance companies hoping to predict hurricane damage.

  12. 41 CFR 301-71.200 - Who must review and sign travel claims?

    Science.gov (United States)

    2010-07-01

    ... travel claims? 301-71.200 Section 301-71.200 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Claims for Reimbursement § 301-71.200 Who must review and sign travel claims...

  13. 75 FR 71564 - Defense Federal Acquisition Regulation Supplement; Contractor Insurance/Pension Review (DFARS...

    Science.gov (United States)

    2010-11-24

    ... Federal Acquisition Regulation Supplement; Contractor Insurance/Pension Review (DFARS Case 2009-D025... conducting a Contractor Insurance/Pension Review from Procedures, Guidance, and Information (PGI) to the... This final rule relocates requirements for Contractor Insurance/ Pension Review to DFARS 242.7302 from...

  14. 48 CFR 1652.204-72 - Filing health benefit claims/court review of disputed claims.

    Science.gov (United States)

    2010-10-01

    ... beyond his or her control from making the request within the time limit. (2) The Carrier has 30 days... information is required to make a decision on the claim; (iii) Specify the time limit (60 days after the date... that time and give a written notice of its decision to the covered individual and to the Carrier. (f...

  15. Tuberculosis Prevention in the Private Sector: Using Claims-Based Methods to Identify and Evaluate Latent Tuberculosis Infection Treatment With Isoniazid Among the Commercially Insured.

    Science.gov (United States)

    Stockbridge, Erica L; Miller, Thaddeus L; Carlson, Erin K; Ho, Christine

    Targeted identification and treatment of people with latent tuberculosis infection (LTBI) are key components of the US tuberculosis elimination strategy. Because of recent policy changes, some LTBI treatment may shift from public health departments to the private sector. To (1) develop methodology to estimate initiation and completion of treatment with isoniazid for LTBI using claims data, and (2) estimate treatment completion rates for isoniazid regimens from commercial insurance claims. Medical and pharmacy claims data representing insurance-paid services rendered and prescriptions filled between January 2011 and March 2015 were analyzed. Four million commercially insured individuals 0 to 64 years of age. Six-month and 9-month treatment completion rates for isoniazid LTBI regimens. There was an annual isoniazid LTBI treatment initiation rate of 12.5/100 000 insured persons. Of 1074 unique courses of treatment with isoniazid for which treatment completion could be assessed, almost half (46.3%; confidence interval, 43.3-49.3) completed 6 or more months of therapy. Of those, approximately half (48.9%; confidence interval, 44.5-53.3) completed 9 months or more. Claims data can be used to identify and evaluate LTBI treatment with isoniazid occurring in the commercial sector. Completion rates were in the range of those found in public health settings. These findings suggest that the commercial sector may be a valuable adjunct to more traditional venues for tuberculosis prevention. In addition, these newly developed claims-based methods offer a means to gain important insights and open new avenues to monitor, evaluate, and coordinate tuberculosis prevention.

  16. 78 FR 53758 - Agency Information Collection Activities: Submission for OMB Review; Comment Request: Insurance...

    Science.gov (United States)

    2013-08-30

    ... Review; Comment Request: Insurance Sales Consumer Protections AGENCY: Federal Deposit Insurance... comment for 60 days on renewal of its Insurance Sales Consumer Protections information collection, which... Sales Consumer Protections. OMB Number: 3064-0140. Frequency of Response: Once--reviewing/updating...

  17. 76 FR 37207 - Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals...

    Science.gov (United States)

    2011-06-24

    ... Department of Health and Human Services 45 CFR Part 147 Group Health Plans and Health Insurance Issuers... SERVICES [CMS-9993-IFC2] 45 CFR Part 147 RIN 0938-AQ66 Group Health Plans and Health Insurance Issuers... for group health plans and health insurance coverage in the group and individual markets under...

  18. A Critical Review of the Marketing Claims of Infant Formula Products in the United States.

    Science.gov (United States)

    Belamarich, Peter F; Bochner, Risa E; Racine, Andrew D

    2016-05-01

    A highly competitive infant formula market has resulted in direct-to-consumer marketing intended to promote the sale of modified formulas that claim to ameliorate common infant feeding problems. The claims associated with these marketing campaigns are not evaluated with reference to clinical evidence by the Food and Drug Administration. We aimed to describe the language of claims made on formula labels and compare it with the evidence in systematic reviews. Of the 22 product labels we identified, 13 product labels included claims about colic and gastrointestinal symptoms. There is insufficient evidence to support the claims that removing or reducing lactose, using hydrolyzed or soy protein or adding pre-/probiotics to formula benefits infants with fussiness, gas, or colic yet claims like "soy for fussiness and gas" encourage parents who perceive their infants to be fussy to purchase modified formula. Increased regulation of infant formula claims is warranted. © The Author(s) 2015.

  19. Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices.

    Science.gov (United States)

    Arbogast, James W; Moore-Schiltz, Laura; Jarvis, William R; Harpster-Hagen, Amanda; Hughes, Jillian; Parker, Albert

    2016-06-01

    The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.

  20. Empirical Musicology Review: Serialist Claims versus Sonic Reality

    Directory of Open Access Journals (Sweden)

    William Thomson

    2010-08-01

    Full Text Available This study examines the descriptive mores of Serialism, as found in writings of leading American academics of the past half-century. A serious gap is revealed, especially between claims made for structural conditions rooted in dodecaphonic procedures and the actual kinetics of music as heard. Curious (and debilitating ambiguities and dead ends are noted in terms used to define critical perceptual conditions in such music; some claims of significance for features of 12- tone rows in certain works are revealed as wholly irrelevant to music as sonic event. Most prominent of the writings discussed are those of Milton Babbitt, Allen Forte and David Lewin.

  1. 78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

    Science.gov (United States)

    2013-02-27

    ... Parts 144, 147, 150, et al. Patient Protection and Affordable Care Act; Health Insurance Market Rules... Insurance Market Rules; Rate Review AGENCY: Department of Health and Human Services. ACTION: Final rule. SUMMARY: This final rule implements provisions related to fair health insurance premiums, guaranteed...

  2. The Educational Benefits Claimed for Physical Education and School Sport: An Academic Review

    Science.gov (United States)

    Bailey, Richard; Armour, Kathleen; Kirk, David; Jess, Mike; Pickup, Ian; Sandford, Rachel

    2009-01-01

    This academic review critically examines the theoretical and empirical bases of claims made for the educational benefits of physical education and school sport (PESS). An historical overview of the development of PESS points to the origins of claims made in four broad domains: physical, social, affective and cognitive. Analysis of the evidence…

  3. Adherence to tobramycin inhaled powder vs inhaled solution in patients with cystic fibrosis: analysis of US insurance claims data

    Directory of Open Access Journals (Sweden)

    Hamed K

    2017-04-01

    Full Text Available Kamal Hamed,1 Valentino Conti,2 Hengfeng Tian,1 Emil Loefroth3 1Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 2Novartis Global Service Center, Dublin, Ireland; 3Novartis Sverige AB, Täby, Sweden Purpose: Tobramycin inhalation powder (TIP, the first dry-powder inhaled antibiotic for pulmonary Pseudomonas aeruginosa infection, is associated with reduced treatment burden, increased patient satisfaction, and higher self-reported adherence for cystic fibrosis (CF patients. We compared adherence in CF patients newly treated with TIP with those newly treated with the traditional tobramycin inhalation solution (TIS, using US insurance claims data.Patients and methods: From the Truven MarketScan® database, we identified CF patients chronically infected with P. aeruginosa who had been prescribed TIP between May 1, 2013 to December 31, 2014, or TIS between September 1, 2010 to April 30, 2012 with at least 12 months of continuous medical and pharmacy benefits prior to and following prescription. TIP and TIS adherence levels were assessed.Results: A total of 145 eligible patients were identified for the TIP cohort and 306 for the TIS cohort. Significant differences in age distribution (25.0 vs 21.9 years for TIP vs TIS, respectively, P=0.017, type of health plan (P=0.014, employment status (72.4% vs 63.4% of TIP vs TIS patients in full-time employment, P=0.008, and some comorbidities were observed between the two cohorts. Although a univariate analysis found no significant differences between TIP and TIS (odds ratio [OR] 1.411, 95% confidence interval [CI] 0.949–2.098, TIP was moderately associated with higher adherence levels compared with TIS in a multivariable analysis, once various demographic and clinical characteristics were adjusted for. These included geographic location (OR: 1.566, CI: 1.016–2.413 and certain comorbidities.Conclusion: This study of US patient data supports previous findings that TIP is associated with better

  4. 75 FR 33237 - Defense Federal Acquisition Regulation Supplement; Contractor Insurance/Pension Review (DFARS...

    Science.gov (United States)

    2010-06-11

    ... Acquisition Regulation Supplement; Contractor Insurance/Pension Review (DFARS Case 2009-D025) AGENCY: Defense.../Pension Review from Procedures, Guidance, and Information to the Defense Acquisition Regulation Supplement..., February 23, 2006, moved requirements for Contractor Insurance/Pension Review (CIPR) from DFARS 242.7302 to...

  5. 76 FR 71993 - Extension of Agency Information Collection Activity Under OMB Review: TSA Claims Management Program

    Science.gov (United States)

    2011-11-21

    ... Information Collection Activity Under OMB Review: TSA Claims Management Program AGENCY: Transportation... Security Administration (TSA) has forwarded the Information Collection Request (ICR), Office of Management... the nature of the information collection and its expected burden. TSA published a Federal Register...

  6. The Great Recession of 2007-2009 and Public Insurance Coverage for Children in Alabama: Enrollment and Claims Data from 1999-2011.

    Science.gov (United States)

    Morrisey, Michael A; Blackburn, Justin; Becker, David J; Sen, Bisakha; Kilgore, Meredith L; Caldwell, Cathy; Menachemi, Nir

    2016-01-01

    This study examined the impact of the Great Recession of 2007-2009 on public health insurance enrollment and expenditures in Alabama. Our analysis was designed to provide a framework for other states to conduct similar analyses to better understand the relationship between macroeconomic conditions and public health insurance costs. We analyzed enrollment and claims data from Medicaid and the Children's Health Insurance Program (CHIP) in Alabama from 1999 through 2011. We examined the relationship between county-level unemployment rates and enrollment in Medicaid and CHIP, as well as total county-level expenditures in the two programs. We used linear regressions with county fixed effects to estimate the impact of unemployment changes on enrollment and expenditures after controlling for population and programmatic changes in eligibility and cost sharing. A one-percentage-point increase in a county's unemployment rate was associated with a 4.3% increase in Medicaid enrollment, a 0.9% increase in CHIP enrollment, and an overall increase in public health insurance enrollment of 3.7%. Each percentage-point increase in unemployment was associated with a 6.2% increase in total public health insurance expenditures on children, with Medicaid spending rising by 7.5% and CHIP spending rising by 1.8%. In response to the 6.4 percentage-point increase in the state's unemployment rate during the Great Recession, combined enrollment of children in Alabama's public health insurance programs increased by 24% and total expenditures rose by 40%. Recessions have a substantial impact on the number of children enrolled in CHIP and Medicaid, and a disproportionate impact on program spending. Programs should be aware of the likely magnitudes of the effects in their budget planning.

  7. States with stronger health insurance rate review authority experienced lower premiums in the individual market in 2010-13.

    Science.gov (United States)

    Karaca-Mandic, Pinar; Fulton, Brent D; Hollingshead, Ann; Scheffler, Richard M

    2015-08-01

    States have varying degrees of review authority over health insurance carriers' rates, including prior approval authority over proposed rates and requirements for loss ratios, the proportion of premium revenues spent on medical claims. The Affordable Care Act (ACA) requires carriers in certain categories of health insurance to provide public justification for rate increases of 10 percent or more. We collected data on how states changed their rate review authority and requirements during 2010-13, the years immediately after enactment of the ACA, and we combined these data with carrier filings. We found that adjusted premiums in the individual market in states that had prior-approval authority combined with loss ratio requirements were lower in 2010-13 ($3,489) than premiums in states with no rate review authority or that had only file-and-use regulations, which gave the states no authority to block rate increases ($3,617). Adjusted premiums declined modestly in prior-approval states with loss ratio requirements, from $3,526 in 2010 to $3,452 in 2013, while premiums increased from $3,422 to $3,683 in states with no rate review authority or file-and-use regulations only. Our findings suggest that states with prior approval authority and loss ratio requirements constrained health insurance premium increases. Project HOPE—The People-to-People Health Foundation, Inc.

  8. Use of major surgery in south India: A retrospective audit of hospital claim data from a large, community health insurance program.

    Science.gov (United States)

    Shaikh, Maaz; Woodward, Mark; Rahimi, Kazem; Patel, Anushka; Rath, Santosh; MacMahon, Stephen; Jha, Vivekanand

    2015-05-01

    Information on the use of major surgery in India is scarce. In this study we aimed to bridge this gap by auditing hospital claims from Rajiv Aarogyasri Community Health Insurance Scheme, which provides access to free hospital care through state-funded insurance to 68 million beneficiaries, an estimated 81% of population in the states of Telangana and Andhra Pradesh. Publicly available deidentified hospital claim data for all surgery procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh. A total of 677,332 operative admissions (80% at private hospitals) were recorded at an annual rate of 259 per 100,000 beneficiaries, with male subjects accounting for 56% of admissions. Injury was the most common cause for operative admission (27%) with operative correction of long bone fractures being the most common procedure (20%) identified in the audit. Diseases of the digestive (16%), genitourinary (12%), and musculoskeletal (10%) systems were other leading causes for operative admissions. Most hospital bed-days were used by admissions for injuries (31%) and diseases of the digestive (17%) and musculoskeletal system (11%) costing 19%, 13%, and 11% of reimbursement. Operations on the circulatory system (8%) accounted for 21% of reimbursements. Annual per capita cost of operative claims was US$1.48. The use of surgery by an insured population in India continued to be low despite access to financing comparable with greater spending countries, highlighting need for strategies, beyond traditional health financing, that prioritize improvement in access, delivery, and use of operative care. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Brief biopsychosocially informed education can improve insurance workers? back pain beliefs: Implications for improving claims management behaviours

    OpenAIRE

    Beales, Darren; Mitchell, Tim; Pole, Naomi; Weir, James

    2016-01-01

    BACKGROUND: Biopsychosocially informed education is associated with improved back pain beliefs and positive changes in health care practitioners? practice behaviours. OBJECTIVE: Assess the effect of this type of education for insurance workers who are important non-clinical stakeholders in the rehabilitation of injured workers. METHODS: Insurance workers operating in the Western Australian workers? compensation system underwent two, 1.5 hour sessions of biopsychosocially informed education fo...

  10. Who is where at risk for Chronic Obstructive Pulmonary Disease? A spatial epidemiological analysis of health insurance claims for COPD in Northeastern Germany.

    Science.gov (United States)

    Kauhl, Boris; Maier, Werner; Schweikart, Jürgen; Keste, Andrea; Moskwyn, Marita

    2018-01-01

    Chronic obstructive pulmonary disease (COPD) has a high prevalence rate in Germany and a further increase is expected within the next years. Although risk factors on an individual level are widely understood, only little is known about the spatial heterogeneity and population-based risk factors of COPD. Background knowledge about broader, population-based processes could help to plan the future provision of healthcare and prevention strategies more aligned to the expected demand. The aim of this study is to analyze how the prevalence of COPD varies across northeastern Germany on the smallest spatial-scale possible and to identify the location-specific population-based risk factors using health insurance claims of the AOK Nordost. To visualize the spatial distribution of COPD prevalence at the level of municipalities and urban districts, we used the conditional autoregressive Besag-York-Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific ecological risk factors for COPD. The sex- and age-adjusted prevalence of COPD was 6.5% in 2012 and varied widely across northeastern Germany. Population-based risk factors consist of the proportions of insurants aged 65 and older, insurants with migration background, household size and area deprivation. The results of the GWR model revealed that the population at risk for COPD varies considerably across northeastern Germany. Area deprivation has a direct and an indirect influence on the prevalence of COPD. Persons ageing in socially disadvantaged areas have a higher chance of developing COPD, even when they are not necessarily directly affected by deprivation on an individual level. This underlines the importance of considering the impact of area deprivation on health for planning of healthcare. Additionally, our results reveal that in some parts of the study area, insurants with migration background and persons living in multi-persons households are at elevated risk

  11. 45 CFR 147.136 - Internal claims and appeals and external review processes.

    Science.gov (United States)

    2010-10-01

    ..., appropriateness, health care setting, level of care, or effectiveness of a covered benefit. (ii) The State process... pay the cost of the IRO for conducting the external review. Notwithstanding this requirement, the... not impose, for example, a $500 minimum claims threshold. (vi) The State process must allow at least...

  12. Contending Claims to Causality: A Critical Review of Mediation Research in HRD

    Science.gov (United States)

    Ghosh, Rajashi; Jacobson, Seth

    2016-01-01

    Purpose: The purpose of this paper is to conduct a critical review of the mediation studies published in the field of Human Resource Development (HRD) to discern if the study designs, the nature of data collection and the choice of statistical methods justify the causal claims made in those studies. Design/methodology/approach: This paper conducts…

  13. 76 FR 40451 - Agency Information Collection (Application for Ordinary Life Insurance) Activity Under OMB Review

    Science.gov (United States)

    2011-07-08

    ... reduced automatically by one-half from its present face value on the day before a policyholder's 65th and... (Application for Ordinary Life Insurance) Activity Under OMB Review AGENCY: Veterans Benefits Administration...) of 1995 [[Page 40452

  14. Can purchasing information be used to predict adherence to cardiovascular medications? An analysis of linked retail pharmacy and insurance claims data.

    Science.gov (United States)

    Krumme, Alexis A; Sanfélix-Gimeno, Gabriel; Franklin, Jessica M; Isaman, Danielle L; Mahesri, Mufaddal; Matlin, Olga S; Shrank, William H; Brennan, Troyen A; Brill, Gregory; Choudhry, Niteesh K

    2016-11-09

    The use of retail purchasing data may improve adherence prediction over approaches using healthcare insurance claims alone. Retrospective. A cohort of patients who received prescription medication benefits through CVS Caremark, used a CVS Pharmacy ExtraCare Health Care (ECHC) loyalty card, and initiated a statin medication in 2011. We evaluated associations between retail purchasing patterns and optimal adherence to statins in the 12 subsequent months. Among 11 010 statin initiators, 43% were optimally adherent at 12 months of follow-up. Greater numbers of store visits per month and dollar amount per visit were positively associated with optimal adherence, as was making a purchase on the same day as filling a prescription (ppurchase variables had low discriminative ability (C-statistic: 0.563), while models with both clinical and retail purchase variables achieved a C-statistic of 0.617. While the use of retail purchases may improve the discriminative ability of claims-based approaches, these data alone appear inadequate for adherence prediction, even with the addition of more complex analytical approaches. Nevertheless, associations between retail purchasing behaviours and adherence could inform the development of quality improvement interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Secondary Use of Claims Data from the Austrian Health Insurance System with i2b2: A Pilot Study.

    Science.gov (United States)

    Endel, Florian; Duftschmid, Georg

    2016-01-01

    In conformity with increasing international efforts to reuse routine health data for scientific purposes, the Main Association of Austrian Social Security Organisations provides pseudonymized claims data of the Austrian health care system for clinical research. We aimed to examine, whether an integration of the corresponding database into i2b2 would be possible and provide benefits. We applied docker-based software containers and data transformations to set up the system. To assess the benefits of i2b2 we plan to reenact the task of cohort formation of an earlier research project. The claims database was successfully integrated into i2b2. The docker-based installation approach will be published as git repository. The assessment of i2b2's benefits is currently work in progress and will be presented at the conference. Docker enables a flexible, reproducible, and resource-efficient installation of i2b2 within the restricted environment implied by our highly secured target system. First preliminary tests indicated several potential benefits of i2b2 compared to the methods applied during the earlier research project.

  16. The role of radiology in diagnostic error: a medical malpractice claims review.

    Science.gov (United States)

    Siegal, Dana; Stratchko, Lindsay M; DeRoo, Courtney

    2017-09-26

    Just as radiologic studies allow us to see past the surface to the vulnerable and broken parts of the human body, medical malpractice claims help us see past the surface of medical errors to the deeper vulnerabilities and potentially broken aspects of our healthcare delivery system. And just as the insights we gain through radiologic studies provide focus for a treatment plan for healing, so too can the analysis of malpractice claims provide insights to improve the delivery of safe patient care. We review 1325 coded claims where Radiology was the primary service provider to better understand the problems leading to patient harm, and the opportunities most likely to improve diagnostic care in the future.

  17. Impact of statins on risk of new onset diabetes mellitus: a population-based cohort study using the Korean National Health Insurance claims database

    Directory of Open Access Journals (Sweden)

    Lee J

    2016-10-01

    Full Text Available Jimin Lee,1 Yoojin Noh,1 Sooyoung Shin,1 Hong-Seok Lim,2 Rae Woong Park,3 Soo Kyung Bae,4 Euichaul Oh,4 Grace Juyun Kim,5 Ju Han Kim,5 Sukhyang Lee1 1Division of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, South Korea; 2Department of Cardiology, School of Medicine, Ajou University, Suwon, South Korea; 3Department of Biomedical Informatics, School of Medicine, Ajou University, Suwon, South Korea; 4Division of Pharmaceutical Sciences, College of Pharmacy, The Catholic University of Korea, Bucheon, South Korea; 5Division of Biomedical Informatics, College of Medicine, Seoul National University, Seoul, South Korea Abstract: Statin therapy is beneficial in reducing cardiovascular events and mortalities in patients with atherosclerotic cardiovascular diseases. Yet, there have been concerns of increased risk of diabetes with statin use. This study was aimed to evaluate the association between statins and new onset diabetes mellitus (NODM in patients with ischemic heart disease (IHD utilizing the Korean Health Insurance Review and Assessment Service claims database. Among adult patients with preexisting IHD, new statin users and matched nonstatin users were identified on a 1:1 ratio using proportionate stratified random sampling by sex and age. They were subsequently propensity score matched further with age and comorbidities to reduce the selection bias. Overall incidence rates, cumulative rates and hazard ratios (HRs between statin use and occurrence of NODM were estimated. The subgroup analyses were performed according to sex, age groups, and the individual agents and intensities of statins. A total of 156,360 patients (94,370 in the statin users and 61,990 in the nonstatin users were included in the analysis. The incidence rates of NODM were 7.8% and 4.8% in the statin users and nonstatin users, respectively. The risk of NODM was higher among statin users (crude HR 2.01, 95% confidence interval [CI] 1.93–2.10; adjusted HR 1

  18. Myths and memes about single-payer health insurance in the United States: a rebuttal to conservative claims.

    Science.gov (United States)

    Geyman, John P

    2005-01-01

    Recent years have seen the rapid growth of private think tanks within the neoconservative movement that conduct "policy research" biased to their own agenda. This article provides an evidence-based rebuttal to a 2002 report by one such think tank, the Dallas-based National Center for Policy Analysis (NCPA), which was intended to discredit 20 alleged myths about single-payer national health insurance as a policy option for the United States. Eleven "myths" are rebutted under eight categories: access, cost containment, quality, efficiency, single-payer as solution, control of drug prices, ability to compete abroad (the "business case"), and public support for a single-payer system. Six memes (self-replicating ideas that are promulgated without regard to their merits) are identified in the NCPA report. Myths and memes should have no place in the national debate now underway over the future of a failing health care system, and need to be recognized as such and countered by experience and unbiased evidence.

  19. Sports-related injuries in New Zealand: National Insurance (Accident Compensation Corporation) claims for five sporting codes from 2012 to 2016.

    Science.gov (United States)

    King, Doug; Hume, Patria A; Hardaker, Natalie; Cummins, Cloe; Gissane, Conor; Clark, Trevor

    2018-03-12

    To provide epidemiological data and related costs for sport-related injuries of five sporting codes (cricket, netball, rugby league, rugby union and football) in New Zealand for moderate-to-serious and serious injury claims. A retrospective analytical review using detailed descriptive epidemiological data obtained from the Accident Compensation Corporation (ACC) for 2012-2016. Over the 5 years of study data, rugby union recorded the most moderate-to-serious injury entitlement claims (25 226) and costs (New Zealand dollars (NZD$)267 359 440 (£139 084 749)) resulting in the highest mean cost (NZD$10 484 (£5454)) per moderate-to-serious injury entitlement claim. Rugby union recorded more serious injury entitlement claims (n=454) than cricket (t (4) =-66.6; P<0.0001); netball (t (4) =-45.1; P<0.0001); rugby league (t (4) =-61.4; P<0.0001) and football (t (4) =66.6; P<0.0001) for 2012-2016. There was a twofold increase in the number of female moderate-to-serious injury entitlement claims for football (RR 2.6 (95%CI 2.2 to 2.9); P<0.0001) compared with cricket, and a threefold increase when compared with rugby union (risk ratio (RR) 3.1 (95%CI 2.9 to 3.3); P<0.0001). Moderate-to-serious concussion claims increased between 2012 and 2016 for netball (RR 3.7 (95%CI 1.9 to 7.1); P<0.0001), rugby union (RR 2.0 (95% CI 1.6 to 2.4); P<0.0001) and football (RR 2.3 (95%CI 1.6 to 3.2); P<0.0001). Nearly a quarter of moderate-to-serious entitlement claims (23%) and costs (24%) were to participants aged 35 years or older. Rugby union and rugby league have the highest total number and costs associated with injury. Accurate sport exposure data are needed to enable injury risk calculations. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Reserving by detailed conditioning on individual claim

    Science.gov (United States)

    Kartikasari, Mujiati Dwi; Effendie, Adhitya Ronnie; Wilandari, Yuciana

    2017-03-01

    The estimation of claim reserves is an important activity in insurance companies to fulfill their liabilities. Recently, reserving method of individual claim have attracted a lot of interest in the actuarial science, which overcome some deficiency of aggregated claim method. This paper explores the Reserving by Detailed Conditioning (RDC) method using all of claim information for reserving with individual claim of liability insurance from an Indonesian general insurance company. Furthermore, we compare it to Chain Ladder and Bornhuetter-Ferguson method.

  1. Towards equitable access to medicines for the rural poor: analyses of insurance claims reveal rural pharmacy initiative triggers price competition in Kyrgyzstan.

    Science.gov (United States)

    Waning, Brenda; Maddix, Jason; Tripodis, Yorghos; Laing, Richard; Leufkens, Hubert Gm; Gokhale, Manjusha

    2009-12-14

    A rural pharmacy initiative (RPI) designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI) private pharmacies located in the region. We conducted descriptive and multivariate analyses on medicine insurance claims data from Kyrgyzstan's Mandatory Health Insurance Fund for the Jumgal District of Naryn Province from October 2003 to December 2007. We compared average quarterly medicine prices in competitor pharmacies before and after the introduction of the rural pharmacy initiative in October 2004 to determine the RPI impact on price competition. Descriptive analyses suggest competitors reacted to RPI prices for 21 of 30 (70%) medicines. Competitor medicine prices from the quarter before RPI introduction to the end of the study period decreased for 17 of 30 (57%) medicines, increased for 4 of 30 (13%) medicines, and remained unchanged for 9 of 30 (30%) medicines. Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices. Multivariate analyses on 19 medicines that met sample size criteria confirm these findings. Fourteen of these 19 (74%) competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47%) decreasing in price and 5 of 19 (26%) increasing in price. The RPI served as a market driver, spurring competition in medicine prices in competitor pharmacies, even when they were located in different villages. Initiatives designed to increase equitable access to medicines in rural regions of developing and transitional countries should consider the potential to leverage medicine price competition as a means

  2. Impact of a Health Management Program on Healthcare Outcomes among Patients on Augmentation Therapy for Alpha 1-Antitrypsin Deficiency: An Insurance Claims Analysis.

    Science.gov (United States)

    Campos, Michael A; Runken, Michael C; Davis, Angela M; Johnson, Michael P; Stone, Glenda A; Buikema, Ami R

    2018-04-01

    Alpha 1-antitrypsin deficiency (AATD) is a genetic disorder which reduces serum alpha 1-antitrypsin (AAT or alpha1-proteinase inhibitor, A1PI) and increases the risk of chronic obstructive pulmonary disease (COPD). Management strategies include intravenous A1PI augmentation, and, in some cases, a health management program (Prolastin Direct ® ; PD). This study compared clinical and economic outcomes between patients with and without PD program participation. This retrospective study included commercial and Medicare Advantage health insurance plan members with ≥ 1 claim with diagnosis codes for COPD and ≥ 1 medical or pharmacy claim including A1PI (on index date). Outcomes were compared between patients receiving only Prolastin ® or Prolastin ® -C (PD cohort) and patients who received a different brand without PD (Comparator cohort). Demographic and clinical characteristics were captured during 6 months pre-index. Post-index exacerbation episodes and healthcare utilization and costs were compared between cohorts. The study sample comprised 445 patients (n = 213 in PD cohort; n = 232 in Comparator cohort), with a mean age 55.5 years, 50.8% male, and 78.9% commercially insured. The average follow-up was 822 days (2.25 years), and the average time on A1PI was 747 days (2.04 years). Few differences were observed in demographic or clinical characteristics. Adjusting for differences in patient characteristics, the rate of severe exacerbation episodes was reduced by 36.1% in the PD cohort. Adjusted total annual all-cause costs were 11.4% lower, and adjusted mean respiratory-related costs were 10.6% lower in the PD cohort than the Comparator cohort. Annual savings in all-cause total costs in the PD cohort relative to the Comparator cohort was US$25,529 per patient, largely due to significantly fewer and shorter hospitalizations. These results suggest that comprehensive health management services may improve both clinical and economic outcomes among

  3. Adoption and impact of index-insurance and credit for smallholder farmers in developing countries : A systematic review

    NARCIS (Netherlands)

    Marr, Ana; Winkel, Anne; van Asseldonk, Marcel; Lensink, Robert; Bulte, Erwin

    2016-01-01

    Purpose – The purpose of this paper is to review the most recent scientific literature on the determinants explaining the demand for index-insurance, the impact of index-insurance and the existing links between insurance and credit. In this meta-analysis, the authors identify key discoveries on the

  4. Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study.

    Directory of Open Access Journals (Sweden)

    Jung Hoon Woo

    Full Text Available The Korean National Health Insurance, which provides universal coverage for the entire Korean population, is now facing financial instability. Frequent emergency department (ED users may represent a medically vulnerable population who could benefit from interventions that both improve care and lower costs. To understand the nature of frequent ED users in Korea, we analyzed claims data from a population-based national representative sample. We performed both bivariate and multivariable analyses to investigate the association between patient characteristics and frequent ED use (4+ ED visits in a year using claims data of a 1% random sample of the Korean population, collected in 2009. Among 156,246 total ED users, 4,835 (3.1% were frequent ED users. These patients accounted for 14% of 209,326 total ED visits and 17.2% of $76,253,784 total medical expenses generated from all ED visits in the 1% data sample. Frequent ED users tended to be older, male, and of lower socio-economic status compared with occasional ED users (p < 0.001 for each. Moreover, frequent ED users had longer stays in the hospital when admitted, higher probability of undergoing an operative procedure, and increased mortality. Among 8,425 primary diagnoses, alcohol-related complaints and schizophrenia showed the strongest positive correlation with the number of ED visits. Among the frequent ED users, mortality and annual outpatient department visits were significantly lower in the alcohol-related patient subgroup compared with other frequent ED users; furthermore, the rate was even lower than that for non-frequent ED users. Our findings suggest that expanding mental health and alcohol treatment programs may be a reasonable strategy to decrease the dependence of these patients on the ED.

  5. Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study

    Science.gov (United States)

    Woo, Jung Hoon; Grinspan, Zachary; Shapiro, Jason; Rhee, Sang Youl

    2016-01-01

    The Korean National Health Insurance, which provides universal coverage for the entire Korean population, is now facing financial instability. Frequent emergency department (ED) users may represent a medically vulnerable population who could benefit from interventions that both improve care and lower costs. To understand the nature of frequent ED users in Korea, we analyzed claims data from a population-based national representative sample. We performed both bivariate and multivariable analyses to investigate the association between patient characteristics and frequent ED use (4+ ED visits in a year) using claims data of a 1% random sample of the Korean population, collected in 2009. Among 156,246 total ED users, 4,835 (3.1%) were frequent ED users. These patients accounted for 14% of 209,326 total ED visits and 17.2% of $76,253,784 total medical expenses generated from all ED visits in the 1% data sample. Frequent ED users tended to be older, male, and of lower socio-economic status compared with occasional ED users (p users had longer stays in the hospital when admitted, higher probability of undergoing an operative procedure, and increased mortality. Among 8,425 primary diagnoses, alcohol-related complaints and schizophrenia showed the strongest positive correlation with the number of ED visits. Among the frequent ED users, mortality and annual outpatient department visits were significantly lower in the alcohol-related patient subgroup compared with other frequent ED users; furthermore, the rate was even lower than that for non-frequent ED users. Our findings suggest that expanding mental health and alcohol treatment programs may be a reasonable strategy to decrease the dependence of these patients on the ED. PMID:26809051

  6. Cost-effectiveness of national health insurance programs in high-income countries: A systematic review.

    Directory of Open Access Journals (Sweden)

    Son Nghiem

    Full Text Available National health insurance is now common in most developed countries. This study reviews the evidence and synthesizes the cost-effectiveness information for national health insurance or disability insurance programs across high-income countries.A literature search using health, economics and systematic review electronic databases (PubMed, Embase, Medline, Econlit, RepEc, Cochrane library and Campbell library, was conducted from April to October 2015.Two reviewers independently selected relevant studies by applying screening criteria to the title and keywords fields, followed by a detailed examination of abstracts.Studies were selected for data extraction using a quality assessment form consisting of five questions. Only studies with positive answers to all five screening questions were selected for data extraction. Data were entered into a data extraction form by one reviewer and verified by another.Data on costs and quality of life in control and treatment groups were used to draw distributions for synthesis. We chose the log-normal distribution for both cost and quality-of-life data to reflect non-negative value and high skew. The results were synthesized using a Monte Carlo simulation, with 10,000 repetitions, to estimate the overall cost-effectiveness of national health insurance programs.Four studies from the United States that examined the cost-effectiveness of national health insurance were included in the review. One study examined the effects of medical expenditure, and the remaining studies examined the cost-effectiveness of health insurance reforms. The incremental cost-effectiveness ratio (ICER ranged from US$23,000 to US$64,000 per QALY. The combined results showed that national health insurance is associated with an average incremental cost-effectiveness ratio of US$51,300 per quality-adjusted life year (QALY. Based on the standard threshold for cost-effectiveness, national insurance programs are cost-effective interventions

  7. Increased Risk of Hospitalization for Heart Failure with Newly Prescribed Dipeptidyl Peptidase-4 Inhibitors and Pioglitazone Using the Korean Health Insurance Claims Database

    Directory of Open Access Journals (Sweden)

    Sunghwan Suh

    2015-06-01

    Full Text Available BackgroundWe assessed the association of dipeptidyl peptidase 4 inhibitors (DPP4i with hospitalization for heart failure (HF using the Korean Health Insurance claims database.MethodsWe collected data on newly prescribed sitagliptin, vildagliptin, and pioglitazone between January 1, 2009 and December 31, 2012 (mean follow-up of 336.8 days to 935,519 patients with diabetes (518,614 males and 416,905 females aged 40 to 79 years (mean age of 59.4 years.ResultsDuring the study, 998 patients were hospitalized for primary HF (115.7 per 100,000 patient-years. The incidence rate of hospitalization for HF was 117.7 per 100,000 per patient-years among patients on pioglitazone, 105.7 for sitagliptin, and 135.8 for vildagliptin. The hospitalization rate for HF was greatest in the first 30 days after starting the medication, which corresponded to a significantly higher incidence at days 0 to 30 compared with days 31 to 360 for all three drugs. The hazard ratios were 1.85 (pioglitazone, 2.00 (sitagliptin, and 1.79 (vildagliptin. The incidence of hospitalization for HF did not differ between the drugs for any time period.ConclusionThis study showed an increase in hospitalization for HF in the initial 30 days of the DPP4i and pioglitazone compared with the subsequent follow-up period. However, the differences between the drugs were not significant.

  8. The challenge of forecasting impacts of flash floods: test of a simplified hydraulic approach and validation based on insurance claim data

    Science.gov (United States)

    Le Bihan, Guillaume; Payrastre, Olivier; Gaume, Eric; Moncoulon, David; Pons, Frédéric

    2017-11-01

    Up to now, flash flood monitoring and forecasting systems, based on rainfall radar measurements and distributed rainfall-runoff models, generally aimed at estimating flood magnitudes - typically discharges or return periods - at selected river cross sections. The approach presented here goes one step further by proposing an integrated forecasting chain for the direct assessment of flash flood possible impacts on inhabited areas (number of buildings at risk in the presented case studies). The proposed approach includes, in addition to a distributed rainfall-runoff model, an automatic hydraulic method suited for the computation of flood extent maps on a dense river network and over large territories. The resulting catalogue of flood extent maps is then combined with land use data to build a flood impact curve for each considered river reach, i.e. the number of inundated buildings versus discharge. These curves are finally used to compute estimated impacts based on forecasted discharges. The approach has been extensively tested in the regions of Alès and Draguignan, located in the south of France, where well-documented major flash floods recently occurred. The article presents two types of validation results. First, the automatically computed flood extent maps and corresponding water levels are tested against rating curves at available river gauging stations as well as against local reference or observed flood extent maps. Second, a rich and comprehensive insurance claim database is used to evaluate the relevance of the estimated impacts for some recent major floods.

  9. The challenge of forecasting impacts of flash floods: test of a simplified hydraulic approach and validation based on insurance claim data

    Directory of Open Access Journals (Sweden)

    G. Le Bihan

    2017-11-01

    Full Text Available Up to now, flash flood monitoring and forecasting systems, based on rainfall radar measurements and distributed rainfall–runoff models, generally aimed at estimating flood magnitudes – typically discharges or return periods – at selected river cross sections. The approach presented here goes one step further by proposing an integrated forecasting chain for the direct assessment of flash flood possible impacts on inhabited areas (number of buildings at risk in the presented case studies. The proposed approach includes, in addition to a distributed rainfall–runoff model, an automatic hydraulic method suited for the computation of flood extent maps on a dense river network and over large territories. The resulting catalogue of flood extent maps is then combined with land use data to build a flood impact curve for each considered river reach, i.e. the number of inundated buildings versus discharge. These curves are finally used to compute estimated impacts based on forecasted discharges. The approach has been extensively tested in the regions of Alès and Draguignan, located in the south of France, where well-documented major flash floods recently occurred. The article presents two types of validation results. First, the automatically computed flood extent maps and corresponding water levels are tested against rating curves at available river gauging stations as well as against local reference or observed flood extent maps. Second, a rich and comprehensive insurance claim database is used to evaluate the relevance of the estimated impacts for some recent major floods.

  10. Epidemiology of Trichomoniasis in South Korea and Increasing Trend in Incidence, Health Insurance Review and Assessment 2009-2014.

    Science.gov (United States)

    Joo, So-Young; Goo, Youn-Kyoung; Ryu, Jae-Sook; Lee, Sang-Eun; Lee, Won Kee; Chung, Dong-Il; Hong, Yeonchul

    2016-01-01

    Trichomoniasis, which is caused by Trichomonas vaginalis, is one of the most common non-viral sexually transmitted infections; however, limited population-based data are available that describe patterns and trends of the disease. We summarized insurance claims of trichomoniasis cases reported during 2009-2014 to South Korea Health Insurance Review and Assessment Service. The average annual incidence in South Korea was 276.8 persons per 100,000 population, and a substantial sex-associated variation was observed. The incidence rate among female subjects trended upward over 6 years, that is, it increased from 501 in 2009 to 625.8 in 2014 per 100,000 female population, which indicates a 25% overall increase. This trend was sharpest in the ≥60 years group of female population. However, a 66% decrease in incidence rates was observed among male subjects (23.7 in 2009 to 15.7 in 2014 per 100,000 male population). Further, substantial decrease was observed in the ≥40 years groups of male population. The incidence of trichomoniasis varied across regions and was the highest in Jeju province of South Korea. Overall, as the incidence of trichomoniasis appears to have increased in South Korea during 2009-2014, the disease burden is increasing; hence, there is a need to better understand the disease transmission.

  11. Claim Assessment Profile: A Method for Capturing Healthcare Evidence in the Scientific Evaluation and Review of Claims in Health Care (SEaRCH).

    Science.gov (United States)

    Hilton, Lara; Jonas, Wayne B

    2017-02-01

    Grounding health claims in an evidence base is essential for determining safety and effectiveness. However, it is not appropriate to evaluate all healthcare claims with the same methods. "Gold standard" randomized controlled trials may skip over important qualitative and observational data about use, benefits, side effects, and preferences, issues especially salient in research on complementary and integrative health (CIH) practices. This gap has prompted a move toward studying treatments in their naturalistic settings. In the 1990s, a program initiated under the National Institutes of Health was designed to provide an outreach to CIH practices for assessing the feasibility of conducting retrospective or prospective evaluations. The Claim Assessment Profile further develops this approach, within the framework of Samueli Institute's Scientific Evaluation and Review of Claims in Health Care (SEaRCH) method. The goals of a Claim Assessment Profile are to clarify the elements that constitute a practice, define key outcomes, and create an explanatory model of these impacts. The main objective is to determine readiness and capacity of a practice to engage in evaluation of effectiveness. This approach is informed by a variety of rapid assessment and stakeholder-driven methods. Site visits, structured qualitative interviews, surveys, and observational data on implementation provide descriptive data about the practice. Logic modeling defines inputs, processes, and outcome variables; Path modeling defines an analytic map to explore. The Claim Assessment Profile is a rapid assessment of the evaluability of a healthcare practice. The method was developed for use on CIH practices but has also been applied in resilience research and may be applied beyond the healthcare sector. Findings are meant to provide sufficient data to improve decision-making for stakeholders. This method provides an important first step for moving existing promising yet untested practices into

  12. [Rehabilitation in geriatric patients after ischemic stroke--a comparison of 2 organisational systems in Germany using claims data of a statutory health insurance fund].

    Science.gov (United States)

    Abbas, S; Ihle, P; Hein, R; Schubert, I

    2013-12-01

    Due to historical aspects in some federal states in Germany rehabilitation of geriatric patients is organized in geriatric departments in hospitals (§ 109 SGB V). In other states rehabilitation of these patients is mainly realized in geriatric rehabilitation facilities outside hospital care after approval by the health insurance (§ 111 SGB V). Thus, it is of interest to compare both types of health care with respect to differences in population characteristics, resource utilization and outcome parameters (i.e., excess costs, rehospitalization, fracture risk and mortality) using a common geriatric indication, the ischemic stroke, as an example. Claims data of the AOK (Local Health Care Fund) from seven federal states in Germany were used. Insured persons with a documented hospital stay with discharge diagnosis cerebral infarction/stroke (ICD-10 I63, I64, below denoted by "ischemic stroke") in 2007 (N=39,887) were included and allocated to the respective form of rehabilitative health care via the OPS (German procedure classification for inpatient procedures) procedure 8-550 (§ 109, N=1,272) or via admission to a geriatric rehabilitation unit within 1 month after hospital discharge (§ 111, N=2,200). All direct costs were ascertained and presented with and without costs of long-term care. Excess costs were calculated as the difference of costs between the first year after insult and the costs in the previous year. Excess costs in the 2 types of care were compared using multivariate quantile regression analysis. Risk of hospitalization (due to ischemic stroke or fracture) and risk of death in a 1-year follow-up was analysed using multivariate cox regression. Insured members treated according to health care type § 109 were somewhat older (mean: 81 vs. 80 years of age), more frequently female (72 vs. 67%), more often receiving long-term care (27 vs. 19%) and had more often documented sequelae after insult (>=4 diseases 39 vs. 28%). No significant differences in

  13. Exploring the small-scale spatial distribution of hypertension and its association to area deprivation based on health insurance claims in Northeastern Germany.

    Science.gov (United States)

    Kauhl, B; Maier, W; Schweikart, J; Keste, A; Moskwyn, M

    2018-01-10

    Hypertension is one of the most frequently diagnosed chronic conditions in Germany. Targeted prevention strategies and allocation of general practitioners where they are needed most are necessary to prevent severe complications arising from high blood pressure. However, data on chronic diseases in Germany are mostly available through survey data, which do not only underestimate the actual prevalence but are also only available on coarse spatial scales. The discussion of including area deprivation for planning of healthcare is still relatively young in Germany, although previous studies have shown that area deprivation is associated with adverse health outcomes, irrespective of individual characteristics. The aim of this study is therefore to analyze the spatial distribution of hypertension at very fine geographic scales and to assess location-specific associations between hypertension, socio-demographic population characteristics and area deprivation based on health insurance claims of the AOK Nordost. To visualize the spatial distribution of hypertension prevalence at very fine geographic scales, we used the conditional autoregressive Besag-York-Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific association of hypertension to area deprivation and further socio-demographic population characteristics. The sex- and age-adjusted prevalence of hypertension was 33.1% in 2012 and varied widely across northeastern Germany. The main risk factors for hypertension were proportions of insurants aged 45-64, 65 and older, area deprivation and proportion of persons commuting to work outside their residential municipality. The GWR model revealed important regional variations in the strength of the examined associations. Area deprivation has only a significant and therefore direct influence in large parts of Mecklenburg-West Pomerania. However, the spatially varying strength of the association between demographic

  14. How does age affect the care dependency risk one year after stroke? A study based on claims data from a German health insurance fund.

    Science.gov (United States)

    Schnitzer, Susanne; von dem Knesebeck, Olaf; Kohler, Martin; Peschke, Dirk; Kuhlmey, Adelheid; Schenk, Liane

    2015-10-23

    The objective of this study is to investigate the effect of age on care dependency risk 1 year after stroke. Two research questions are addressed: (1) How strong is the association between age and care dependency risk 1 year after stroke and (2) can this association be explained by burden of disease? The study is based on claims data from a German statutory health insurance fund. The study population was drawn from all continuously insured members with principal diagnoses of ischaemic stroke, hemorrhagic stroke, or transient ischaemic attack in 2007 who survived for 1 year after stroke and who were not dependent on care before their first stroke (n = 2864). Data were collected over a 1-year period. People are considered to be dependent on care if they, due to a physical, mental or psychological illness or disability, require substantial assistance in carrying out activities of daily living for a period of at least 6 months. Burden of disease was assessed by stroke subtype, history of stroke, comorbidities as well as geriatric multimorbidity. Regression models were used for data analysis. 21.6 % of patients became care dependent during the observation period. Post-stroke care dependency risk was significantly associated with age. Relative to the reference group (0-65 years), the odds ratio of care dependency was 11.30 (95 % CI: 7.82-16.34) in patients aged 86+ years and 5.10 (95 % CI: 3.88-6.71) in patients aged 76-85 years. These associations were not explained by burden of disease. On the contrary, age effects became stronger when burden of disease was included in the regression model (by between 1.1 and 28 %). Our results show that age has an effect on care dependency risk that cannot be explained by burden of disease. Thus, there must be other underlying age-dependent factors that account for the remaining age effects (e.g., social conditions). Further studies are needed to explore the causes of the strong age effects observed.

  15. Towards equitable access to medicines for the rural poor: analyses of insurance claims reveal rural pharmacy initiative triggers price competition in Kyrgyzstan

    Directory of Open Access Journals (Sweden)

    Leufkens Hubert GM

    2009-12-01

    Full Text Available Abstract Background A rural pharmacy initiative (RPI designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI private pharmacies located in the region. Methods We conducted descriptive and multivariate analyses on medicine insurance claims data from Kyrgyzstan's Mandatory Health Insurance Fund for the Jumgal District of Naryn Province from October 2003 to December 2007. We compared average quarterly medicine prices in competitor pharmacies before and after the introduction of the rural pharmacy initiative in October 2004 to determine the RPI impact on price competition. Results Descriptive analyses suggest competitors reacted to RPI prices for 21 of 30 (70% medicines. Competitor medicine prices from the quarter before RPI introduction to the end of the study period decreased for 17 of 30 (57% medicines, increased for 4 of 30 (13% medicines, and remained unchanged for 9 of 30 (30% medicines. Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices. Multivariate analyses on 19 medicines that met sample size criteria confirm these findings. Fourteen of these 19 (74% competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47% decreasing in price and 5 of 19 (26% increasing in price. Conclusions The RPI served as a market driver, spurring competition in medicine prices in competitor pharmacies, even when they were located in different villages. Initiatives designed to increase equitable access to medicines in rural regions of developing and transitional countries should consider the

  16. A systematic review of validated methods to capture acute bronchospasm using administrative or claims data.

    Science.gov (United States)

    Sharifi, Mona; Krishanswami, Shanthi; McPheeters, Melissa L

    2013-12-30

    To identify and assess billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify acute bronchospasm in administrative and claims databases. We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to bronchospasm, wheeze and acute asthma. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics. Our searches identified 677 citations of which 38 met our inclusion criteria. In these 38 studies, the most commonly used ICD-9 code was 493.x. Only 3 studies reported any validation methods for the identification of bronchospasm, wheeze or acute asthma in administrative and claims databases; all were among pediatric populations and only 2 offered any validation statistics. Some of the outcome definitions utilized were heterogeneous and included other disease based diagnoses, such as bronchiolitis and pneumonia, which are typically of an infectious etiology. One study offered the validation of algorithms utilizing Emergency Department triage chief complaint codes to diagnose acute asthma exacerbations with ICD-9 786.07 (wheezing) revealing the highest sensitivity (56%), specificity (97%), PPV (93.5%) and NPV (76%). There is a paucity of studies reporting rigorous methods to validate algorithms for the identification of bronchospasm in administrative data. The scant validated data available are limited in their generalizability to broad-based populations. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Regional Variation of Cost of Care in the Last 12 Months of Life in Switzerland: Small-area Analysis Using Insurance Claims Data.

    Science.gov (United States)

    Panczak, Radoslaw; Luta, Xhyljeta; Maessen, Maud; Stuck, Andreas E; Berlin, Claudia; Schmidlin, Kurt; Reich, Oliver; von Wyl, Viktor; Goodman, David C; Egger, Matthias; Zwahlen, Marcel; Clough-Gorr, Kerri M

    2017-02-01

    Health care spending increases sharply at the end of life. Little is known about variation of cost of end of life care between regions and the drivers of such variation. We studied small-area patterns of cost of care in the last year of life in Switzerland. We used mandatory health insurance claims data of individuals who died between 2008 and 2010 to derive cost of care. We used multilevel regression models to estimate differences in costs across 564 regions of place of residence, nested within 71 hospital service areas. We examined to what extent variation was explained by characteristics of individuals and regions, including measures of health care supply. The study population consisted of 113,277 individuals. The mean cost of care during last year of life was 32.5k (thousand) Swiss Francs per person (SD=33.2k). Cost differed substantially between regions after adjustment for patient age, sex, and cause of death. Variance was reduced by 52%-95% when we added individual and regional characteristics, with a strong effect of language region. Measures of supply of care did not show associations with costs. Remaining between and within hospital service area variations were most pronounced for older females and least for younger individuals. In Switzerland, small-area analysis revealed variation of cost of care during the last year of life according to linguistic regions and unexplained regional differences for older women. Cultural factors contribute to the delivery and utilization of health care during the last months of life and should be considered by policy makers.

  18. How does sex affect the care dependency risk one year after stroke? A study based on claims data from a German health insurance fund.

    Science.gov (United States)

    Schnitzer, Susanne; Deutschbein, Johannes; Nolte, Christian H; Kohler, Martin; Kuhlmey, Adelheid; Schenk, Liane

    2017-09-01

    The study explores the association between sex and care dependency risk one year after stroke. The study uses claims data from a German statutory health insurance fund. Patients were included if they received a diagnosis of ischemic or hemorrhagic stroke between 1 January and 31 December 2007 and if they survived for one year after stroke and were not dependent on care before the event (n = 1851). Data were collected over a one-year period. Care dependency was defined as needing substantial assistance in activities of daily living for a period of at least six months. Geriatric conditions covered ICD-10 symptom complexes that characterize geriatric patients (e.g. urinary incontinence, cognitive deficits, depression). Multivariate regression analyses were performed. One year after the stroke event, women required nursing care significantly more often than men (31.2% vs. 21.3%; odds ratio for need of assistance: 1.67; 95% CI: 1.36-2.07). Adjusted for age, the odds ratio decreased by 65.7% to 1.23 (n.s.). Adjusted for geriatric conditions, the odds ratio decreased further and did not remain significant (adjusted OR: 1.18 (CI: 0.90-1.53). It may be assumed that women have a higher risk of becoming care-dependent after stroke than men because they are older and suffer more often from geriatric conditions such as urinary incontinence at onset of stroke. Preventive strategies should therefore focus on geriatric conditions in order to reduce the post-stroke care dependency risk for women.

  19. 44 CFR 63.16 - Review of State application by the Federal Insurance Administrator.

    Science.gov (United States)

    2010-10-01

    ... for eligibility and indicate in what respects the State program and/or data base fails to comply with... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Review of State application... FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION...

  20. Farmers Insures Success

    Science.gov (United States)

    Freifeld, Lorri

    2012-01-01

    Farmers Insurance claims the No. 2 spot on the Training Top 125 with a forward-thinking training strategy linked to its primary mission: FarmersFuture 2020. It's not surprising an insurance company would have an insurance policy for the future. But Farmers takes that strategy one step further, setting its sights on 2020 with a far-reaching plan to…

  1. A systematic review, and meta-analyses, of the impact of health-related claims on dietary choices.

    Science.gov (United States)

    Kaur, Asha; Scarborough, Peter; Rayner, Mike

    2017-07-11

    Health-related claims are statements regarding the nutritional content of a food (nutrition claims) and/or indicate that a relationship exists between a food and a health outcome (health claims). Their impact on food purchasing or consumption decisions is unclear. This systematic review measured the effect of health-related claims, on pre-packaged foods in retail settings, on adult purchasing decisions (real and perceived). In September 2016, we searched MEDLINE, EMBASE, PsychINFO, CAB abstracts, Business Source Complete, and Web of Science/Science Citation Index & Social Science Citation Index for articles in English published in peer-review journals. Studies were included if they were controlled experiments where the experimental group(s) included a health-related claim and the control group involved an identical product without a health-related claim. Included studies measured (at an individual or population level); actual or intended choice, purchases, and/or consumption. The primary outcome was product choices and purchases, the secondary outcome was food consumption and preference. Results were standardised through calculating odds ratios and 95% confidence intervals (CI) for the likelihood of choosing a product when a health-related claim was present. Results were combined in a random-effects meta-analysis. Thirty-one papers were identified, 17 of which were included for meta-analyses. Most studies were conducted in Europe (n = 17) and the USA (n = 7). Identified studies were choice experiments that measured the likelihood of a product being chosen when a claim was present compared to when a claim was not present, (n = 16), 15 studies were experiments that measured either; intent-rating scale outcomes (n = 8), consumption (n = 6), a combination of the two (n = 1), or purchase data (n = 1). Overall, 20 studies found that claims increase purchasing and/or consumption, eight studies had mixed results, and two studies found consumption

  2. General insurance marketing: a review and future research agenda

    OpenAIRE

    Robson, Julie

    2015-01-01

    The financial services sector is a huge and diverse industry comprising many different forms of organisations and product offerings. Yet, a review of past papers in the Journal of Financial Services Marketing (JFSM) reveals a heavy bias towards articles on banking, to the neglect of other equally important financial services categories. The purpose of this paper is to address this imbalance and to call for more research to be conducted in a wider range of financial services categories. In par...

  3. Validity of claims made in weight management research: a narrative review of dietetic articles

    Directory of Open Access Journals (Sweden)

    Aphramor Lucy

    2010-07-01

    Full Text Available Abstract Background The best available evidence demonstrates that conventional weight management has a high long-term failure rate. The ethical implications of continued reliance on an energy deficit approach to weight management are under-explored. Methods A narrative literature review of journal articles in The Journal of Human Nutrition and Dietetics from 2004 to 2008. Results Although the energy deficit approach to weight management has a high long-term failure rate it continues to dominate research in the field. In the current research agenda, controversies and complexities in the evidence base are inadequately discussed, and claims about the likely success of weight management misrepresent available evidence. Conclusions Dietetic literature on weight management fails to meet the standards of evidence based medicine. Research in the field is characterised by speculative claims that fail to accurately represent the available data. There is a corresponding lack of debate on the ethical implications of continuing to promote ineffective treatment regimes and little research into alternative non-weight centred approaches. An alternative health at every size approach is recommended.

  4. Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries.

    Science.gov (United States)

    Nosratnejad, Shirin; Rashidian, Arash; Dror, David Mark

    2016-01-01

    Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature. We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP. 16 studies (21 articles) from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP. The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources.

  5. Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries.

    Directory of Open Access Journals (Sweden)

    Shirin Nosratnejad

    Full Text Available Access to healthcare is mostly contingent on out-of-pocket spending (OOPS by health seekers, particularly in low- and middle-income countries (LMICs. This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature.We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP.16 studies (21 articles from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP.The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources.

  6. Cost of work-related injuries in insured workplaces in Lebanon.

    OpenAIRE

    Fayad, Rim; Nuwayhid, Iman; Tamim, Hala; Kassak, Kassem; Khogali, Mustafa

    2003-01-01

    OBJECTIVE: To estimate the medical and compensation costs of work-related injuries in insured workplaces in Lebanon and to examine cost distributions by worker and injury characteristics. METHODS: A total of 3748 claims for work injuries processed in 1998 by five major insurance companies in Lebanon were reviewed. Medical costs (related to emergency room fees, physician consultations, tests, and medications) and wage and indemnity compensation costs were identified from the claims. FINDINGS: ...

  7. Clinical negligence in foot and ankle surgery: A 17-year review of claims to the NHS Litigation Authority.

    Science.gov (United States)

    Ring, J; Talbot, C L; Clough, T M

    2014-11-01

    We present a review of litigation claims relating to foot and ankle surgery in the NHS in England during the 17-year period between 1995 and 2012. A freedom of information request was made to obtain data from the NHS litigation authority (NHSLA) relating to orthopaedic claims, and the foot and ankle claims were reviewed. During this period of time, a total of 10 273 orthopaedic claims were made, of which 1294 (12.6%) were related to the foot and ankle. 1036 were closed, which comprised of 1104 specific complaints. Analysis was performed using the complaints as the denominator. The cost of settling these claims was more than £36 million. There were 372 complaints (33.7%) involving the ankle, of which 273 (73.4%) were related to trauma. Conditions affecting the first ray accounted for 236 (21.4%), of which 232 (98.3%) concerned elective practice. Overall, claims due to diagnostic errors accounted for 210 (19.0%) complaints, 208 (18.8%) from alleged incompetent surgery and 149 (13.5%) from alleged mismanagement. Our findings show that the incorrect, delayed or missed diagnosis of conditions affecting the foot and ankle is a key area for improvement, especially in trauma practice. ©2014 The British Editorial Society of Bone & Joint Surgery.

  8. Planning outstanding reserves in general insurance

    Science.gov (United States)

    Raeva, E.; Pavlov, V.

    2017-10-01

    Each insurance company have to ensure its solvency through presentation of accounts for its own reserves in the start of the year. Usually the task of the actuary is to estimate the state of the company on an annual basis and the expectation of the status of the company for a future period. One of the major problem when calculating the liabilities of the incurred claims, is related to the delay of payments. Object of consideration in the present note are the outstanding claim reserves, which are set aside to cover claims, occurred before the date of the annual account, but still not paid, and related with them expenses. There may be different reasons for the delay of claims settlement. For example, continuation the process of the liquidation of the damage waiting for necessary documents or the presence of controversial cases whose permission takes time, etc. Thus the claims, which determine the outstanding reserves could be divided in the following types: claims, which are reported, but not settled (RBNS); claims, which are incurred but not reported (IBNR); claims, whose case is finished, but it is possible to be reopened. When calculating the reserves for IBNR claims, most widely used is the Chain-ladder method and its modification presented by the Bornhuetter - Ferguson method. For modeling the outstanding claims, the available data should be presented in so called run-off triangle, which underlies in the basis of such methods. The present work provides a review of the algorithm for calculating insurance outstanding claim reserves according to the Chain-ladder method. Using available data for claims related to liability of drivers, registered in Bulgaria an example is constructed to illustrate the methodology of the Chain-Ladder method. Back-testing approach is used for validating the results.

  9. A review of health, planning, insurance and property value issues related to active solar heating systems

    International Nuclear Information System (INIS)

    Sadler, R.; Spencer, L.; Digby, G.; Battye, L.

    1996-01-01

    The research reported here considers the potential health risks, local authority planning implications, insurance and property value aspects of solar water heating systems. The United Kingdom market for this technology is also discussed. Methodologies employed, including literature reviews, telephone and postal survey and re-analysis of a 1995 survey, are explained. No major problems are identified in any of the target areas although recommendations for water temperature management and coordinated local authority policies on renewable energy are given. (UK)

  10. Differences in price elasticities of demand for health insurance: a systematic review.

    Science.gov (United States)

    Pendzialek, Jonas B; Simic, Dusan; Stock, Stephanie

    2016-01-01

    Many health insurance systems apply managed competition principles to control costs and quality of health care. Besides other factors, managed competition relies on a sufficient price-elastic demand. This paper presents a systematic review of empirical studies on price elasticity of demand for health insurance. The objective was to identify the differing international ranges of price elasticity and to find socio-economic as well as setting-oriented factors that influence price elasticity. Relevant literature for the topic was identified through a two-step identification process including a systematic search in appropriate databases and further searches within the references of the results. A total of 45 studies from countries such as the USA, Germany, the Netherlands, and Switzerland were found. Clear differences in price elasticity by countries were identified. While empirical studies showed a range between -0.2 and -1.0 for optional primary health insurance in the US, higher price elasticities between -0.6 and -4.2 for Germany and around -2 for Switzerland were calculated for mandatory primary health insurance. Dutch studies found price elasticities below -0.5. In consideration of all relevant studies, age and poorer health status were identified to decrease price elasticity. Other socio-economic factors had an unclear impact or too limited evidence. Premium level, range of premiums, homogeneity of benefits/coverage and degree of forced decision were found to have a major influence on price elasticity in their settings. Further influence was found from supplementary insurance and premium-dependent employer contribution.

  11. The Association of State Rate Review Authority with Health Insurance Premiums.

    Science.gov (United States)

    Ticse, Caroline

    2015-10-01

    Key findings. (1) Adjusted premiums in the individual market in states with prior approval authority combined with loss ratio requirements were lower in 2010-2013 than premiums in states with no rate review authority or file-and-use regulations only. (2) Adjusted premiums declined modestly in prior approval states while premiums increased in states with no rate review authority or with file-and-use regulations only. (3) The findings suggest that states with prior approval authority and loss ratio requirements constrained increases in health insurance premiums.

  12. The indoor UV tanning industry: a review of skin cancer risk, health benefit claims, and regulation.

    Science.gov (United States)

    Levine, Jody A; Sorace, Michael; Spencer, James; Siegel, Daniel M

    2005-12-01

    Nearly 30 million people tan indoors in the United States annually, including 2.3 million adolescents. Despite increased evidence on the dangers of artificial UV radiation, the popularity of indoor tanning is growing. We aim to assess the following 3 entities: (1) the association of indoor tanning with skin cancer; (2) statements regarding the health benefits of indoor tanning, especially regarding the production of vitamin D; and (3) current regulation of the tanning industry in the United States. We conducted a narrative review of the literature. Indoor tanning poses great risks. Studies support the role of artificial UV radiation in cutaneous carcinogenesis. Despite claims by the tanning industry, artificial tanning is not a safe or necessary way to increase systemic vitamin D levels. The National Institutes of Health and the World Health Organization have acknowledged the risks of indoor tanning. Nonetheless, regulations limiting tanning in the United States are surprisingly sparse. Systematic review of the literature was not performed. Health care providers must increase efforts to warn and educate the public and government about the dangers of UV radiation.

  13. The vicissitudes of "cannonballs": a response to criticisms by A.M. Hillas and a brief review of our claims

    CERN Document Server

    Dar, A; Dar, Arnon

    2006-01-01

    A.M. Hillas, in a review of the origins of cosmic rays, has recently criticized the "cannonball" (CB) model of cosmic rays and gamma-ray bursts. We respond to this critique and take the occasion to discuss the crucial question of particle acceleration in the CB model and in the generally accepted models. We also summarize our claims concerning the CB model.

  14. An Individual Claims History Simulation Machine

    Directory of Open Access Journals (Sweden)

    Andrea Gabrielli

    2018-03-01

    Full Text Available The aim of this project is to develop a stochastic simulation machine that generates individual claims histories of non-life insurance claims. This simulation machine is based on neural networks to incorporate individual claims feature information. We provide a fully calibrated stochastic scenario generator that is based on real non-life insurance data. This stochastic simulation machine allows everyone to simulate their own synthetic insurance portfolio of individual claims histories and back-test thier preferred claims reserving method.

  15. Analysis of the evidence-practice gap to facilitate proper medical care for the elderly: investigation, using databases, of utilization measures for National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).

    Science.gov (United States)

    Nakayama, Takeo; Imanaka, Yuichi; Okuno, Yasushi; Kato, Genta; Kuroda, Tomohiro; Goto, Rei; Tanaka, Shiro; Tamura, Hiroshi; Fukuhara, Shunichi; Fukuma, Shingo; Muto, Manabu; Yanagita, Motoko; Yamamoto, Yosuke

    2017-06-06

    As Japan becomes a super-aging society, presentation of the best ways to provide medical care for the elderly, and the direction of that care, are important national issues. Elderly people have multi-morbidity with numerous medical conditions and use many medical resources for complex treatment patterns. This increases the likelihood of inappropriate medical practices and an evidence-practice gap. The present study aimed to: derive findings that are applicable to policy from an elucidation of the actual state of medical care for the elderly; establish a foundation for the utilization of National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), and present measures for the utilization of existing databases in parallel with NDB validation.Cross-sectional and retrospective cohort studies were conducted using the NDB built by the Ministry of Health, Labor and Welfare of Japan, private health insurance claims databases, and the Kyoto University Hospital database (including related hospitals). Medical practices (drug prescription, interventional procedures, testing) related to four issues-potential inappropriate medication, cancer therapy, chronic kidney disease treatment, and end-of-life care-will be described. The relationships between these issues and clinical outcomes (death, initiation of dialysis and other adverse events) will be evaluated, if possible.

  16. Is there a large risk of radiation? A critical review of pessimistic claims

    International Nuclear Information System (INIS)

    Shihab-Eldin, A.; Shlyakhter, A.; Wilson, R.

    1992-07-01

    A number of situations where it has been claimed that moderate radiation doses cause leukemia or other cancers are carefully reviewed. We look at cases in the United States, Great Britain, and the Soviet Union. Usually it can be demonstrated that there is an alternative, more probable, explanation for the effect seen. In several cases the authors of the papers have fallen into statistical traps. The most frequent is a posteriori selection of cohort boundaries in both space and time: a trap illustrated dramatically by Feynman. The next most common trap is to arbitrarily select one out of many ways of looking at the data, against which we were warned by Tippett. Several cohorts are compared with respect to the number of persons at risk, average dose, and the number of cancers expected. Of these, only the cohort of A-bomb survivors in Japan and the recently unclassified data on the very large occupational doses for early Soviet nuclear workers at Chelyabinsk provide evidence of clearly visible excess cancers

  17. Is there a large risk of radiation A critical review of pessimistic claims

    Energy Technology Data Exchange (ETDEWEB)

    Shihab-Eldin, A.; Shlyakhter, A.; Wilson, R. (Harvard Univ., Cambridge, MA (United States). Dept. of Physics)

    1992-07-01

    A number of situations where it has been claimed that moderate radiation doses cause leukemia or other cancers are carefully reviewed. We look at cases in the United States, Great Britain, and the Soviet Union. Usually it can be demonstrated that there is an alternative, more probable, explanation for the effect seen. In several cases the authors of the papers have fallen into statistical traps. The most frequent is a posteriori selection of cohort boundaries in both space and time: a trap illustrated dramatically by Feynman. The next most common trap is to arbitrarily select one out of many ways of looking at the data, against which we were warned by Tippett. Several cohorts are compared with respect to the number of persons at risk, average dose, and the number of cancers expected. Of these, only the cohort of A-bomb survivors in Japan and the recently unclassified data on the very large occupational doses for early Soviet nuclear workers at Chelyabinsk provide evidence of clearly visible excess cancers.

  18. Is there a large risk of radiation? A critical review of pessimistic claims

    Energy Technology Data Exchange (ETDEWEB)

    Shihab-Eldin, A.; Shlyakhter, A.; Wilson, R. [Harvard Univ., Cambridge, MA (United States). Dept. of Physics

    1992-07-01

    A number of situations where it has been claimed that moderate radiation doses cause leukemia or other cancers are carefully reviewed. We look at cases in the United States, Great Britain, and the Soviet Union. Usually it can be demonstrated that there is an alternative, more probable, explanation for the effect seen. In several cases the authors of the papers have fallen into statistical traps. The most frequent is a posteriori selection of cohort boundaries in both space and time: a trap illustrated dramatically by Feynman. The next most common trap is to arbitrarily select one out of many ways of looking at the data, against which we were warned by Tippett. Several cohorts are compared with respect to the number of persons at risk, average dose, and the number of cancers expected. Of these, only the cohort of A-bomb survivors in Japan and the recently unclassified data on the very large occupational doses for early Soviet nuclear workers at Chelyabinsk provide evidence of clearly visible excess cancers.

  19. Nonlife Insurance Pricing:

    Science.gov (United States)

    Darooneh, Amir H.

    We consider the insurance company as a physical system which is immersed in its environment (the financial market). The insurer company interacts with the market by exchanging the money through the payments for loss claims and receiving the premium. Here, in the equilibrium state, we obtain the premium by using the canonical ensemble theory, and compare it with the Esscher principle, the well-known formula in actuary for premium calculation. We simulate the case of car insurance for quantitative comparison.

  20. American nuclear insurers

    International Nuclear Information System (INIS)

    Oliveira, R.A.

    1988-01-01

    Nuclear liability insurance covers liability for damages directly caused by the nuclear energy hazard. This coverage includes offsite bodily injury and property damage sustained by members of the general public, and bodily injury to onsite third party personnel. Recent nuclear liability claims allege bodily injury and property damage resulting from releases or radioactive materials to the environmental and occupational radiation worker exposures. Routine reactor operations involving radioactive waste have the potential to result in such claims. The nuclear insurance Pools believe that one way such claims can be minimized is through the implementation of an effective radioactive waste management program

  1. Clinical outcomes in low risk coronary artery disease patients treated with different limus-based drug-eluting stents--a nationwide retrospective cohort study using insurance claims database.

    Directory of Open Access Journals (Sweden)

    Chao-Lun Lai

    Full Text Available The clinical outcomes of different limus-based drug-eluting stents (DES in a real-world setting have not been well defined. The aim of this study was to investigate the clinical outcomes of three different limus-based DES, namely sirolimus-eluting stent (SES, Endeavor zotarolimus-eluting stent (E-ZES and everolimus-eluting stent (EES, using a national insurance claims database. We identified all patients who received implantation of single SES, E-ZES or EES between January 1, 2007 and December 31, 2009 from the National Health Insurance claims database, Taiwan. Follow-up was through December 31, 2011 for all selected clinical outcomes. The primary end-point was all-cause mortality. Secondary end-points included acute coronary events, heart failure needing hospitalization, and cerebrovascular disease. Cox regression model adjusting for baseline characteristics was used to compare the relative risks of different outcomes among the three different limus-based DES. Totally, 6584 patients were evaluated (n=2142 for SES, n=3445 for E-ZES, and n=997 for EES. After adjusting for baseline characteristics, we found no statistically significant difference in the risk of all-cause mortality in three DES groups (adjusted hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 0.94-1.38, p=0.20 in E-ZES group compared with SES group; adjusted HR: 0.77, 95% CI: 0.54-1.10, p=0.15 in EES group compared with SES group. Similarly, we found no difference in the three stent groups in risks of acute coronary events, heart failure needing hospitalization, and cerebrovascular disease. In conclusion, we observed no difference in all-cause mortality, acute coronary events, heart failure needing hospitalization, and cerebrovascular disease in patients treated with SES, E-ZES, and EES in a real-world population-based setting in Taiwan.

  2. Disability Income Insurance

    OpenAIRE

    Hayhoe, Celia Ray; Smith, Mike, CPF

    2009-01-01

    The purpose of disability income insurance is to partially replace your income if you are unable to work because of sickness or an accident. This guide reviews the types of disability insurance, important terms and concepts and employer provided benefits.

  3. Premium Pricing of Liability Insurance Using Random Sum Model

    OpenAIRE

    Kartikasari, Mujiati Dwi

    2017-01-01

    Premium pricing is one of important activities in insurance. Nonlife insurance premium is calculated from expected value of historical data claims. The historical data claims are collected so that it forms a sum of independent random number which is called random sum. In premium pricing using random sum, claim frequency distribution and claim severity distribution are combined. The combination of these distributions is called compound distribution. By using liability claim insurance data, we ...

  4. Effects of School-Based Educational Interventions for Enhancing Adolescents Abilities in Critical Appraisal of Health Claims: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Lena V Nordheim

    Full Text Available Adolescents are frequent media users who access health claims from various sources. The plethora of conflicting, pseudo-scientific, and often misleading health claims in popular media makes critical appraisal of health claims an essential ability. Schools play an important role in educating youth to critically appraise health claims. The objective of this systematic review was to evaluate the effects of school-based educational interventions for enhancing adolescents' abilities in critically appraising health claims.We searched MEDLINE, Embase, PsycINFO, AMED, Cinahl, Teachers Reference Centre, LISTA, ERIC, Sociological Abstracts, Social Services Abstracts, The Cochrane Library, Science Citation Index Expanded, Social Sciences Citation Index, and sources of grey literature. Studies that evaluated school-based educational interventions to improve adolescents' critical appraisal ability for health claims through advancing the students' knowledge about science were included. Eligible study designs were randomised and non-randomised controlled trials, and interrupted time series. Two authors independently selected studies, extracted data, and assessed risk of bias in included studies. Due to heterogeneity in interventions and inadequate reporting of results, we performed a descriptive synthesis of studies. We used GRADE (Grading of Recommendations, Assessment, Development, and Evaluation to assess the certainty of the evidence.Eight studies were included: two compared different teaching modalities, while the others compared educational interventions to instruction as usual. Studies mostly reported positive short-term effects on critical appraisal-related knowledge and skills in favour of the educational interventions. However, the certainty of the evidence for all comparisons and outcomes was very low.Educational interventions in schools may have beneficial short-term effects on knowledge and skills relevant to the critical appraisal of health

  5. Effects of School-Based Educational Interventions for Enhancing Adolescents Abilities in Critical Appraisal of Health Claims: A Systematic Review.

    Science.gov (United States)

    Nordheim, Lena V; Gundersen, Malene W; Espehaug, Birgitte; Guttersrud, Øystein; Flottorp, Signe

    2016-01-01

    Adolescents are frequent media users who access health claims from various sources. The plethora of conflicting, pseudo-scientific, and often misleading health claims in popular media makes critical appraisal of health claims an essential ability. Schools play an important role in educating youth to critically appraise health claims. The objective of this systematic review was to evaluate the effects of school-based educational interventions for enhancing adolescents' abilities in critically appraising health claims. We searched MEDLINE, Embase, PsycINFO, AMED, Cinahl, Teachers Reference Centre, LISTA, ERIC, Sociological Abstracts, Social Services Abstracts, The Cochrane Library, Science Citation Index Expanded, Social Sciences Citation Index, and sources of grey literature. Studies that evaluated school-based educational interventions to improve adolescents' critical appraisal ability for health claims through advancing the students' knowledge about science were included. Eligible study designs were randomised and non-randomised controlled trials, and interrupted time series. Two authors independently selected studies, extracted data, and assessed risk of bias in included studies. Due to heterogeneity in interventions and inadequate reporting of results, we performed a descriptive synthesis of studies. We used GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) to assess the certainty of the evidence. Eight studies were included: two compared different teaching modalities, while the others compared educational interventions to instruction as usual. Studies mostly reported positive short-term effects on critical appraisal-related knowledge and skills in favour of the educational interventions. However, the certainty of the evidence for all comparisons and outcomes was very low. Educational interventions in schools may have beneficial short-term effects on knowledge and skills relevant to the critical appraisal of health claims. The small

  6. 77 FR 70583 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

    Science.gov (United States)

    2012-11-26

    ... Parts 144, 147, 150, et al. Patient Protection and Affordable Care Act; Health Insurance Market Rules... and 156 [CMS-9972-P] RIN 0938-AR40 Patient Protection and Affordable Care Act; Health Insurance Market... Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal...

  7. A Comparative Analysis of Outstanding Claim Reserves

    Directory of Open Access Journals (Sweden)

    Zlata Djuric

    2017-12-01

    Full Text Available The key processes in the business of insurance companies which define the financial viability of their business activities, as the most important element, are the adequate amount of technical reserves. A qualitative assessment of the technical reserves level is the basic support to the management of the key business processes and proper strategic and financial decision-making in order to maximize the viability, profitability, competitiveness, and further development of the company. Based on the data on the operations of an insurance company, within a single line of insurance, different, in practice, most frequently used methods were applied in order to determine the deviation amplitude of the projected amounts from the actual claims. Another direction of research focuses on actuarial practice in non-life insurance companies operating in the territory of the Republic of Serbia. The comparative analysis of the obtained projection points to the fact that the chosen methods, commonly used in actuarial practice in the Republic of Serbia, should be monitored and reviewed. The results of the multidirectional research and detection of the existing problems provide a useful framework and a stimulating mechanism, as well as the guidelines to improve the operations and better positioning of insurance in the commercial and economic environment of the Republic of Serbia.

  8. An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan

    Directory of Open Access Journals (Sweden)

    Weiner Jonathan P

    2010-01-01

    Full Text Available Abstract Background Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. Methods A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234, while those in both 2002 and 2003 were included for prospective analyses (n = 164,562. Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. Results The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster. When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Conclusions Given the

  9. An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

    Science.gov (United States)

    Chang, Hsien-Yen; Weiner, Jonathan P

    2010-01-18

    Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory

  10. Competition in hospital and health insurance markets: a review and research agenda.

    Science.gov (United States)

    Morrisey, M A

    2001-04-01

    To review the empirical literature on the effects of selective contracting and hospital competition on hospital prices, travel distance, services, and quality; to review the effects of managed care penetration and competition on health insurance premiums; and to identify areas for further research. Selective contracting has allowed managed care plans to obtain lower prices from hospitals. This finding is generalizable beyond California and is stronger when there is more competition in the hospital market. Travel distances to hospitals of admission have not increased as a result of managed care. Evidence on the diffusion of technology in hospitals and the extent to which hospitals have specialized as a result of managed care is mixed. Little research on the effects on quality has been undertaken, but preliminary evidence suggests that hospital quality has not declined and may have improved. Actual mergers in the hospital market have not affected hospital prices. Much less research has been focused on managed care markets. Greater market penetration and greater competition among managed care plans are associated with lower managed care premiums. Greater HMO penetration appears to be much more effective than PPO penetration in leading to lower premiums. While workers are willing to change plans when faced with higher out-of-pocket premiums, there is little evidence of the willingness of employers to switch plan offerings. Preliminary evidence suggests that greater managed care penetration has led to lower overall employer premiums, but the results differ substantially between employers with and without a self-insured plan. Much more research is needed to examine all aspects of managed care markets. In hospital markets, particular attention should be focused on the effects on quality and technology diffusion.

  11. Sport-related concussions in New Zealand: a review of 10 years of Accident Compensation Corporation moderate to severe claims and costs.

    Science.gov (United States)

    King, Doug; Gissane, Conor; Brughelli, Matt; Hume, Patria A; Harawira, Joseph

    2014-05-01

    This paper provides an overview of the epidemiology of sport-related concussion and associated costs in New Zealand requiring medical treatment from 2001 to 2011 in seven sports codes. A retrospective review of injury entitlement claims by seven sports from 2001 to 2011. Data were analyzed by sporting code, age, ethnicity, gender and year of competition for total and moderate-to-severe (MSC) Accident Compensation Corporation (ACC) claims and costs. A total of 20,902 claims costing $NZD 16,546,026 were recorded over the study period of which 1330 (6.4%) were MSC claims. The mean yearly number and costs of MSC claims were 133 ± 36 and $1,303,942 ± 378,949. Rugby union had the highest number of MSC claims per year (38; 95% CI 36-41 per 1000 MSC claims). New Zealand Māori recorded the highest total ($6,000,759) and mean cost ($21,120) per MSC claim. Although MSC injury claims were only 6.4% of total claims, they accounted for 79.1% of total costs indicating that although the majority of sport-related concussions may be minor in severity, the related economic costs associated with more serious sport-related concussion can be high. The finding that rugby union recorded the most MSC claims in the current study was not unexpected. Of concern is that rugby league recorded a low number of MSC claims but the highest mean cost per claim. Due to the high mean cost per concussion, and the high total and mean cost for New Zealand Māori, further investigation is warranted. Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  12. Role of American Nuclear Insurers in reducing occupational radiation exposure

    International Nuclear Information System (INIS)

    Forbes, J.L.

    1980-01-01

    Since 1957 the nuclear insurance pools have provided liability and property insurance for the nation's nuclear power generating stations as mandated by the Price-Anderson Act. Although the insurance was originally structured to give financial protection to the insured in the event of a major accident, the potential for third-party claims arising from routine occupational exposure is becoming a more realistic pathway for a loss to the pools. In order to give maximum protection to the pools' assets, the Liability Engineering Department of American Nuclear Insurers (ANI) performs periodic inspections of the power plants. By concentrating on programs and management areas, ANI inspections complement regulatory inspections so that all major areas of common interest are reviewed. This paper presents the nature, results, and findings of those periodic inspections particularly in the general area of plant radiation protection

  13. 33 CFR 136.111 - Insurance.

    Science.gov (United States)

    2010-07-01

    ... POLLUTION FINANCIAL RESPONSIBILITY AND COMPENSATION OIL SPILL LIABILITY TRUST FUND; CLAIMS PROCEDURES... which compensation is claimed: (1) The name and address of each insurer. (2) The kind and amount of...

  14. Does the scientific evidence support the advertising claims made for products containing Lactobacillus casei and Bifidobacterium lactis? A systematic review.

    Science.gov (United States)

    Meléndez-Illanes, Lorena; González-Díaz, Cristina; Chilet-Rosell, Elisa; Álvarez-Dardet, Carlos

    2016-09-01

    To analyse the scientific evidence that exists for the advertising claims made for two products containing Lactobacillus casei and Bifidobacterium lactis and to conduct a comparison between the published literature and what is presented in the corporate website. Systematic review, using Medline through Pubmed and Embase. We included human clinical trials that exclusively measured the effect of Lactobacillus casei or Bifidobacterium lactis on a healthy population, and where the objective was related to the health claims made for certain products in advertising. We assessed the levels of evidence and the strength of the recommendation according to the classification criteria established by the Oxford Centre for Evidence Based Medicine (CEBM). We also assessed the outcomes of the studies published on the website that did not appear in the search. Of the 440 articles identified, 16 met the inclusion criteria. Only four (25%) of these presented a level of evidence of 1b and a recommendation grade of A, all corresponding to studies on product containing Bifidobacterium lactis, and only 12 of the 16 studies were published on the corporate website (47). There is insufficient scientific evidence to support the health claims made for these products, especially in the case of product containing Lactobacillus casei. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review.

    Science.gov (United States)

    Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

    2017-01-01

    Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or

  16. Consumer and product-specific characteristics influencing the effect of nutrition, health and risk reduction claims on preferences and purchase behavior - A systematic review.

    Science.gov (United States)

    Steinhauser, Johann; Hamm, Ulrich

    2018-08-01

    The research on nutrition, health, and risk reduction claims (NHR claims) shows a lack of consensus as to whether these claims have a positive or negative effect on consumer's preferences and purchase behavior. This issue has been highlighted by many authors. Therefore, a comprehensive literature review was performed to find reasons for contradictory results. First, a theoretical framework was developed which divided the determinants of the effects of NHR claims on consumers' preferences and purchase behavior into consumer and product-specific characteristics. Additionally, a categorization for the different NHR claim types was constructed to make the studies comparable. Afterwards, the scientific literature from the 1980s until May 2017 was scanned and 66 articles were found to be relevant. Consumer-specific characteristics such as nutrition knowledge, health motivation, familiarity, and socio-demographic characteristics were found to influence the NHR claim effect. Important product-specific characteristics were the perceived healthiness of the food product, the interaction between the product and the nutrient in the NHR claim, and the interaction between the claimed benefit and the NHR claim type. The consumer's nutrition knowledge and the product's perceived healthiness were deemed to be the most promising determinants for further investigation. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. RISK PREMIUM IN MOTOR VEHICLE INSURANCE

    Directory of Open Access Journals (Sweden)

    BANU ÖZGÜREL

    2013-06-01

    Full Text Available The pure premium or risk premium is the premium that would exactly meet the expected cost of the risk covered ignoring management expenses, commissions, contingency loading, etc. Claim frequency rate and mean claim size are required for estimation in calculating risk premiums. In this study, we discussed to estimate claim frequency rate and mean claim size with several methods and calculated risk premiums. Data, which supported our study, is provided by insurance company involving with motor vehicle insurance.

  18. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

    Science.gov (United States)

    Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

    2016-01-01

    Background The introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana. Methods Electronic search was done for literature published between 2003–2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context. Results Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients’ trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper. Conclusions The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy

  19. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

    Science.gov (United States)

    Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

    2016-01-01

    The introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana. Electronic search was done for literature published between 2003-2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context. Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients' trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper. The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors.

  20. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

    Directory of Open Access Journals (Sweden)

    Robert Kaba Alhassan

    Full Text Available The introduction of the national health insurance scheme (NHIS in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana.Electronic search was done for literature published between 2003-2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context.Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients' trust in the scheme and consequently decreases (reenrolment rates. These sustainability challenges were reviewed and discussed in this paper.The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors.

  1. Studies in the extensively automatic construction of large odds-based inference networks from structured data. Examples from medical, bioinformatics, and health insurance claims data.

    Science.gov (United States)

    Robson, B; Boray, S

    2018-04-01

    Theoretical and methodological principles are presented for the construction of very large inference nets for odds calculations, composed of hundreds or many thousands or more of elements, in this paper generated by structured data mining. It is argued that the usual small inference nets can sometimes represent rather simple, arbitrary estimates. Examples of applications in clinical and public health data analysis, medical claims data and detection of irregular entries, and bioinformatics data, are presented. Construction of large nets benefits from application of a theory of expected information for sparse data and the Dirac notation and algebra. The extent to which these are important here is briefly discussed. Purposes of the study include (a) exploration of the properties of large inference nets and a perturbation and tacit conditionality models, (b) using these to propose simpler models including one that a physician could use routinely, analogous to a "risk score", (c) examination of the merit of describing optimal performance in a single measure that combines accuracy, specificity, and sensitivity in place of a ROC curve, and (d) relationship to methods for detecting anomalous and potentially fraudulent data. Copyright © 2018 Elsevier Ltd. All rights reserved.

  2. Insurance Salespeople's Attitudes towards Collusion: The Case of Taiwan’s Car Insurance Industry

    OpenAIRE

    Lu-Ming Tseng; Wen-Pin Su

    2014-01-01

    Insurance researchers believe that the increase in insurance fraud may be associated with the unethical decisions made by some insurance salespeople. However, to date, research that has empirically investigated the link between insurance salespeople and collusion is scant. Using the car insurance industry in Taiwan as an example, this paper explores the impact of the opportunity to obtain the fraudulent claim and that of the size of actual loss on car insurance salespeople's attitudes towards...

  3. The role of micro health insurance in providing financial risk protection in developing countries--a systematic review.

    Science.gov (United States)

    Habib, Shifa Salman; Perveen, Shagufta; Khuwaja, Hussain Maqbool Ahmed

    2016-03-22

    Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI) has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings can be applied in the Pakistani setting. We conducted a systematic search for published literature using the search terms "Community based health insurance AND developing countries", "Micro health insurance AND developing countries", "Mutual health insurance AND developing countries", "mutual OR micro OR community based health insurance" "Health insurance AND impact AND poor" "Health insurance AND financial protection" and "mutual health organizations" on three databases, Pubmed, Google Scholar and Science Direct (Elsevier). Only those records that were published in the last ten years, in English language with their full texts available free of cost, were considered for inclusion in this review. Hand searching was carried out on the reference lists of the retrieved articles and webpages of international organizations like World Bank, World Health Organization and International Labour Organization. Twenty-three articles were eligible for inclusion in this systematic review (14 from Asia and 9 from Africa). Our analysis shows that MHI, in the majority of cases, has been found to contribute to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, total health expenditure, household borrowings and poverty. MHI also had a positive safeguarding effect on

  4. Alleged B. anthracis exposure claims in a workers' compensation setting.

    Science.gov (United States)

    Jewell, Gregory; Dunning, Kari; Lockey, James E

    2006-01-01

    Workers' compensation insurance in some states may not provide coverage for medical evaluation costs of workplace exposures related to potential bioterrorism acts if there is no diagnosed illness or disease. Personal insurance also may not provide coverage for these exposures occurring at the workplace. Governmental entities, insurers, and employers need to consider how to address such situations and the associated costs. The objective of this study was to examine characteristics of workers and total costs associated with workers' compensation claims alleging potential exposure to the bioterrorism organism B. anthracis. We examined 192 claims referred for review to the Ohio Bureau of Workers' Compensation (OBWC) from October 10, 2001, through December 20, 2004. Although some cases came from out-of-state areas where B. anthracis exposure was known to exist, no Ohio claim was associated with true B. anthracis exposure or B. anthracis-related illness. Of the 155 eligible claims, 126 included medical costs averaging dollar 219 and ranging from dollar 24 to dollar 3,126. There was no difference in mean cost for government and non-government employees (p = 0.202 Wilcoxon). The number of claims and associated medical costs for evaluation and treatment of potential workplace exposure to B. anthracis were relatively small. These results can be attributed to several factors, including no documented B. anthracis exposures and disease in Ohio and prompt transmission of recommended diagnostic and prophylactic treatment protocols to physicians. How employers, insurers, and jurisdictions address payment for evaluation and treatment of potential or documented exposures resulting from a potential terrorism-related event should be addressed proactively.

  5. Premium Forecasting of an Insurance Company: Automobile Insurance

    OpenAIRE

    Fouladvand, M. Ebrahim; Darooneh, Amir H.

    2002-01-01

    We present an analytical study of an insurance company. We model the company's performance on a statistical basis and evaluate the predicted annual income of the company in terms of insurance parameters namely the premium, total number of the insured, average loss claims etc. We restrict ourselves to a single insurance class the so-called automobile insurance. We show the existence a crossover premium p_c below which the company is loss-making. Above p_c, we also give detailed statistical ana...

  6. Insurance payment process for HANDI 2000 business management system

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, D.

    1998-08-24

    The Pensions and Savings group handles three types of payment into and out of Fluor Daniel Hanford related to insurance benefits: Premium payment to insurance company; Application of employee insurance withholding against insurance costs; Remittance of insurance claims, and administrative fees. General approach in making and recording the remittance is by forwarding payment information to Accounts Payable Master.

  7. Limitation of liability for maritime claims: Chronological critical review (international instruments and Croatian solutions

    Directory of Open Access Journals (Sweden)

    Vasilj Aleksandra V.

    2016-01-01

    Full Text Available Limitation of liability of shipowner can based on property or can be personal - shipowner responds to certain part of the property (for example ship or his entire assets to a certain amount. In the first case it is a real, and in the other the personal limitation of liability. On these principles all international instruments in this legal field have been developed. One of the well-known 'universal' principle of civil law says that the injurer must pay for a damage in full, in full extent and amount. However, when we are applying provisions of maritime law (as well as transport law in general on the liability for damages and its compensation, the situation is quite opposite. Though, that the amount of suffered damages is coming closer to said universal principle of civil law has been confirmed by Amendments to the Protocol to the Convention on Limitation of Liability for Maritime Claims 1996 (LLMC 1996. These Amendments increased amount of general (global limitation of liability for maritime claims by 51% compared to the amounts in LLMC. Increased amounts are applicable from 8th June 2015. Regarding these amendments, a number of issues can be placed: justification for introducing the institute of limitation of liability in general; reasons why the injurer is privileged in maritime (and broader in transport, in the context of the amount of the obligation of compensation for damage; and whether the application of the institute undermine the principle that is enshrined in the legal system of every modern country, according to which the injured party has the right to just compensation. On the other hand, justice can be taken as well as an argument just to implement the limitation of liability system.

  8. Worst-Case-Optimal Dynamic Reinsurance for Large Claims

    DEFF Research Database (Denmark)

    Korn, Ralf; Menkens, Olaf; Steffensen, Mogens

    2012-01-01

    We control the surplus process of a non-life insurance company by dynamic proportional reinsurance. The objective is to maximize expected (utility of the) surplus under the worst-case claim development. In the large claim case with a worst-case upper limit on claim numbers and claim sizes, we fin...

  9. The role of micro health insurance in providing financial risk protection in developing countries- a systematic review

    Directory of Open Access Journals (Sweden)

    Shifa Salman Habib

    2016-03-01

    Full Text Available Abstract Background Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings can be applied in the Pakistani setting. Methods We conducted a systematic search for published literature using the search terms “Community based health insurance AND developing countries”, “Micro health insurance AND developing countries”, “Mutual health insurance AND developing countries”, “mutual OR micro OR community based health insurance” “Health insurance AND impact AND poor” “Health insurance AND financial protection” and “mutual health organizations” on three databases, Pubmed, Google Scholar and Science Direct (Elsevier. Only those records that were published in the last ten years, in English language with their full texts available free of cost, were considered for inclusion in this review. Hand searching was carried out on the reference lists of the retrieved articles and webpages of international organizations like World Bank, World Health Organization and International Labour Organization. Results Twenty-three articles were eligible for inclusion in this systematic review (14 from Asia and 9 from Africa. Our analysis shows that MHI, in the majority of cases, has been found to contribute to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, total health expenditure

  10. Development and enrolee satisfaction with basic medical insurance in China: A systematic review and stratified cluster sampling survey.

    Science.gov (United States)

    Jing, Limei; Chen, Ru; Jing, Lisa; Qiao, Yun; Lou, Jiquan; Xu, Jing; Wang, Junwei; Chen, Wen; Sun, Xiaoming

    2017-07-01

    Basic Medical Insurance (BMI) has changed remarkably over time in China because of health reforms that aim to achieve universal coverage and better health care with adequate efforts by increasing subsidies, reimbursement, and benefits. In this paper, we present the development of BMI, including financing and operation, with a systematic review. Meanwhile, Pudong New Area in Shanghai was chosen as a typical BMI sample for its coverage and management; a stratified cluster sampling survey together with an ordinary logistic regression model was used for the analysis. Enrolee satisfaction and the factors associated with enrolee satisfaction with BMI were analysed. We found that the reenrolling rate superficially improved the BMI coverage and nearly achieved universal coverage. However, BMI funds still faced dual contradictions of fund deficit and insured under compensation, and a long-term strategy is needed to realize the integration of BMI schemes with more homogeneous coverage and benefits. Moreover, Urban Resident Basic Medical Insurance participants reported a higher rate of dissatisfaction than other participants. The key predictors of the enrolees' satisfaction were awareness of the premium and compensation, affordability of out-of-pocket costs, and the proportion of reimbursement. These results highlight the importance that the Chinese government takes measures, such as strengthening BMI fund management, exploring mixed payment methods, and regulating sequential medical orders, to develop an integrated medical insurance system of universal coverage and vertical equity while simultaneously improving enrolee satisfaction. Copyright © 2017 John Wiley & Sons, Ltd.

  11. Willingness to Pay for Insurance in Denmark

    DEFF Research Database (Denmark)

    Hansen, Jan V.; Højbjerg Jacobsen, Rasmus; Lau, Morten I.

    We estimate the maximum amount that Danish households are willing to pay for three different types of insurance: auto, home and house insurance. We use a unique combination of claims data from the largest private insurance company in Denmark, measures of individual risk attitudes and discount rates...... possible states of nature, where all uncertainty is realized in the initial period and any loss incurred by an accident is subtracted from initial wealth. The estimated willingness to pay is based on annual claims and should thus be considered as an annual premium. Since there is some uncertainty about...... of the insurance claims....

  12. Patterns and Correlates of Tic Disorder Diagnoses in Privately and Publicly Insured Youth

    Science.gov (United States)

    Olfson, Mark; Crystal, Stephen; Gerhard, Tobias; Huang, Cecilia; Walkup, James T.; Scahill, Lawrence; Walkup, John T.

    2011-01-01

    Objective: This study examined the prevalence and demographic and clinical correlates of children diagnosed with Tourette disorder, chronic motor or vocal tic disorder, and other tic disorders in public and private insurance plans over the course of a 1-year period. Method: Claims were reviewed of Medicaid (n = 10,247,827) and privately (n =…

  13. 24 CFR 241.885 - Insurance benefits.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Insurance benefits. 241.885 Section... § 241.885 Insurance benefits. (a) Method of payment. Payment of claims shall be made in the following... acceptable assignment of the note and security instrument to the Commissioner, the insurance benefits shall...

  14. On a Stochastic Model in Insurance

    Indian Academy of Sciences (India)

    Insurance mathematics today is considered a part of applied probability theory. Main objectives are modelling of claims that arrive in an insurance business, and decide how premiums are to be charged to avoid ruin of the insurance company. GENERAL I ARTICLE various results and the heuristics can be appreciated.

  15. [The essentials of workplace analysis for examining occupational disability claims].

    Science.gov (United States)

    Wachholz, St

    2015-12-01

    The insurance branch that covers the risk of occupational disability ranks among the most important private entities for offering security as far as the limitation or loss of one's ability to work is concerned. The financial risk of the insurer, the existential concerns and expectations of the claimant, as well as the legal framework and the need for a careful interdisciplinary evaluation, necessitate a professional review and assessment of the facts conducted with a sense of both responsibility and sensitivity. Carefully deliberated and sustainable decisions benefit both insurers and the insured. In order to achieve this, an opinion is required in many--and especially the more complex--cases from an external medical expert, which in turn can only be plausible and conclusive when based on a comprehensive review of the claimant's working environment and its particular (and often unique) requirements. This article is intended to increase the reader's understanding of the coherencies of workplace analysis and medical assessments, as required by insurance law and legislation. In addition, the article delivers valuable clues and guidance, both for medical experts and claims managers at insurance companies. Primarily, the claimant's occupation, as conceived in the terms and conditions of the insurance companies, is explained. The reader is then introduced to the various criteria to be considered when a claimant has several jobs at the same time, is self-employed, could be transferred to another job, is simply unable to commute to the workplace, or is prevented from working due to legal restrictions related to an illness. The article goes on to address the crucial aspect of how the degree of disability is to be measured under different circumstances, namely using the quantitative and the qualitative approach. As a reliable method for obtaining the essential data regarding the claimant's specific working conditions, which are required by both the medical expert and the

  16. [Quality Assurance in Sociomedical Evaluation by Peer Review: A Pilot Project of the German Statutory Pension Insurance].

    Science.gov (United States)

    Strahl, A; Gerlich, C; Wolf, H-D; Gehrke, J; Müller-Garnn, A; Vogel, H

    2016-03-01

    The sociomedical evaluation by the German Pension Insurance serves the purpose of determining entitlement to disability pensions. A quality assurance concept for the sociomedical evaluation was developed, which is based on a peer Review process. Peer review is an established process of external quality assurance in health care. The review is based on a hierarchically constructed manual that was evaluated in this pilot project. The database consists of 260 medical reports for disability pension of 12 pension insurance agencies. 771 reviews from 19 peers were included in the evaluation of the inter-rater reliability. Kendall's coefficient of concordance W for more than 2 raters is used as primary measure of inter-rater reliability. Reliability appeared to be heterogeneous. Kendalls W varies for the particular criteria from 0.09 to 0.88 and reached for primary criterion reproducibility a value of 0.37. The reliability of the manual seemed acceptable in the context of existing research data and is in line with existing peer review research outcomes. Nevertheless, the concordance is limited and requires optimisation. Starting points for improvement can be seen in a systematic training and regular user meetings of the peers involved. © Georg Thieme Verlag KG Stuttgart · New York.

  17. The first report of Japanese antimicrobial use measured by national database based on health insurance claims data (2011-2013): comparison with sales data, and trend analysis stratified by antimicrobial category and age group.

    Science.gov (United States)

    Yamasaki, Daisuke; Tanabe, Masaki; Muraki, Yuichi; Kato, Genta; Ohmagari, Norio; Yagi, Tetsuya

    2018-04-01

    Our objective was to evaluate the utility of the national database (NDB) based on health insurance claims data for antimicrobial use (AMU) surveillance in medical institutions in Japan. The population-weighted total AMU expressed as defined daily doses (DDDs) per 1000 inhabitants per day (DID) was measured by the NDB. The data were compared with our previous study measured by the sales data. Trend analysis of DID from 2011 to 2013 and subgroup analysis stratified by antimicrobial category and age group were performed. There was a significant linear correlation between the AMUs measured by the sales data and the NDB. Total oral and parenteral AMUs (expressed in DID) were 1.04-fold from 12.654 in 2011 to 13.202 in 2013 and 1.13-fold from 0.734 to 0.829, respectively. Percentage of oral form among total AMU was high with more than 94% during the study period. AMU in the children group (0-14 years) decreased from 2011 to 2013 regardless of dosage form, although the working age group (15-64 years) and elderly group (65 and above years) increased. Oral AMU in the working age group was approximately two-thirds of those in the other age groups. In contrast, parenteral AMU in the elderly group was extremely high compared to the other age groups. The trend of AMU stratified by antimicrobial category and age group were successfully measured using the NDB, which can be a tool to monitor outcome indices for the national action plan on antimicrobial resistance.

  18. Phyto-therapeutic claims about euphorbeaceous plants belonging to pakistan; an ethnomedicinal review

    International Nuclear Information System (INIS)

    Khalil, A.T.; Shinwari, ZK.

    2014-01-01

    Ethnobotany has attracted many researchers in the modern era in order to find novel and cheaper approaches to alleviate the human sufferings. Since ancient times, plants are used traditionally for cure. In the last few years herbal practices have attained global relevance. Among the different important plant families, the spurge family (Euphorbiaceae) is well known for its therapeutic potential. Different plants are used in folk medicinal practices in different forms to treat several diseases. Plants belonging to Euphorbiaceae are common in Pakistan and used for different purposes. The present communication deals with the different ethnomedicinal uses reported in the peer reviewed articles of the various species present in Pakistan. (author)

  19. Systematic review of willingness to pay for health insurance in low and middle income countries

    NARCIS (Netherlands)

    Nosratnejad, S. (Shirin); Rashidian, A. (Arash); D.M. Dror (David)

    2016-01-01

    textabstractObjective Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or

  20. Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data.

    Science.gov (United States)

    Kim, Jee Ae; Yoon, Seokjun; Kim, Log Young; Kim, Dong Sook

    2017-05-01

    Health Insurance and Review Assessment (HIRA) in South Korea, also called National Health Insurance (NHI) data, is a repository of claims data collected in the process of reimbursing healthcare providers. Under the universal coverage system, having fee-for-services covering all citizens in South Korea, HIRA contains comprehensive and rich information pertaining to healthcare services such as treatments, pharmaceuticals, procedures, and diagnoses for almost 50 million beneficiaries. This corpus of HIRA data, which constitutes a large repository of data in the healthcare sector, has enormous potential to create value in several ways: enhancing the efficiency of the healthcare delivery system without compromising quality of care; adding supporting evidence for a given intervention; and providing the information needed to prevent (or monitor) adverse events. In order to actualize this potential, HIRA data need to actively be utilized for research. Thus understanding this data would greatly enhance this potential. We introduce HIRA data as an important source for health research and provide guidelines for researchers who are currently utilizing HIRA, or interested in doing so, to answer their research questions. We present the characteristics and structure of HIRA data. We discuss strengths and limitations that should be considered in conducting research with HIRA data and suggest strategies for optimal utilization of HIRA data by reviewing published research using HIRA data. © 2017 The Korean Academy of Medical Sciences.

  1. Effect of Health Insurance on the Use and Provision of Maternal Health Services and Maternal and Neonatal Health Outcomes: A Systematic Review

    Science.gov (United States)

    Peterson, Lauren A.; Hatt, Laurel E.

    2013-01-01

    Financial barriers can affect timely access to maternal health services. Health insurance can influence the use and quality of these services and potentially improve maternal and neonatal health outcomes. We conducted a systematic review of the evidence on health insurance and its effects on the use and provision of maternal health services and on maternal and neonatal health outcomes in middle- and low-income countries. Studies were identified through a literature search in key databases and consultation with experts in healthcare financing and maternal health. Twenty-nine articles met the review criteria of focusing on health insurance and its effect on the use or quality of maternal health services, or maternal and neonatal health outcomes. Sixteen studies assessed demand-side effects of insurance, eight focused on supply-side effects, and the remainder addressed both. Geographically, the studies provided evidence from sub-Saharan Africa (n=11), Asia (n=9), Latin America (n=8), and Turkey. The studies included examples from national or social insurance schemes (n=7), government-run public health insurance schemes (n=4), community-based health insurance schemes (n=11), and private insurance (n=3). Half of the studies used econometric analyses while the remaining provided descriptive statistics or qualitative results. There is relatively consistent evidence that health insurance is positively correlated with the use of maternal health services. Only four studies used methods that can establish this causal relationship. Six studies presented suggestive evidence of overprovision of caesarean sections in response to providers’ payment incentives through health insurance. Few studies focused on the relationship between health insurance and the quality of maternal health services or maternal and neonatal health outcomes. The available evidence on the quality and health outcomes is inconclusive, given the differences in measurement, contradictory findings, and

  2. Dentistry in Taiwan, Republic of China: National health insurance reforms, illegal dentistry and peer review quality control

    DEFF Research Database (Denmark)

    Moore, R.; Shiau, Y.Y.

    1999-01-01

    licensure. Their popularity and price advantage has maintained a political base that affects policy decisions. Health care reforms of March, 1995 with a comprehensive national health insurance, as well as ambitious plans for systematic peer review quality control of dentists' work are unique health care......The dental health care system in Taiwan, Republic of China is described in terms of demographics, structure, context of treatment and historical development of the dental health care payment system. A notable characteristic of the system is the existence of trade dentists, who operate without...... developments worthy of the attention of health care policy makers in other countries who are studying health care reform processes...

  3. Deterministic claims reserving in short-term insuarance contracts ...

    African Journals Online (AJOL)

    Claims reserving for general insurance business has developed significantly over the recent past. This has been occasioned by the growth of the insurance market, with the risk underwriting process becoming more and more complex. New insurance products have been developed that cater for the more specific needs of ...

  4. Reviewing the Nutrition and Health Claims Regulation (EC) No. 1924/2006: What do we know about its challenges and potential impact on innovation?

    Science.gov (United States)

    Bröring, Stefanie; Khedkar, Sukhada; Ciliberti, Stefano

    2017-02-01

    Health claims potentially represent an opportunity for firms to engage in product differentiation and thereby induce investment into R&D and innovation in the food sector. The Nutrition and Health Claims Regulation (EC) No. 1924/2006 (NHCR) aims at protecting and promoting innovation as one of its objectives. However, existing studies indicate that this regulation may create several challenges for innovation in the food sector. To this end, we review the challenges related to the NHCR (Article 13.1) and its impact on innovation. Extant literature suggests that companies face challenges related to changing list of ingredients, missing transparency, wording of claims, limited financial resources, limited R&D resources, switching product categories and abandoning the functional foods sector. Moreover, current studies imply that so far the NHCR (in specific Article 13.1) does not seem to encourage innovation in the EU food sector.

  5. Nuclear insurance fire risk

    International Nuclear Information System (INIS)

    Dressler, E.G.

    2001-01-01

    Nuclear facilities operate under the constant risk that radioactive materials could be accidentally released off-site and cause injuries to people or damages to the property of others. Management of this nuclear risk, therefore, is very important to nuclear operators, financial stakeholders and the general public. Operators of these facilities normally retain a portion of this risk and transfer the remainder to others through an insurance mechanism. Since the nuclear loss exposure could be very high, insurers usually assess their risk first-hand by sending insurance engineers to conduct a nuclear insurance inspection. Because a serious fire can greatly increase the probability of an off-site release of radiation, fire safety should be included in the nuclear insurance inspection. This paper reviews essential elements of a facility's fire safety program as a key factor in underwriting nuclear third-party liability insurance. (author)

  6. Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.

    Directory of Open Access Journals (Sweden)

    Bikaramjit S Mann

    Full Text Available BACKGROUND: Prescription drugs are used in people with hypertension, diabetes, and cardiovascular disease to manage their illness. Patient cost sharing strategies such as copayments and deductibles are often employed to lower expenditures for prescription drug insurance plans, but the impact on health outcomes in these patients is unclear. OBJECTIVE: To determine the association between drug insurance and patient cost sharing strategies on medication adherence, clinical and economic outcomes in those with chronic diseases (defined herein as diabetes, hypertension, hypercholesterolemia, coronary artery disease, and cerebrovascular disease. METHODS: Studies were included if they examined various cost sharing strategies including copayments, coinsurance, fixed copayments, deductibles and maximum out-of-pocket expenditures. Value-based insurance design and reference based pricing studies were excluded. Two reviewers independently identified original intervention studies (randomized controlled trials, interrupted time series, and controlled before-after designs. MEDLINE, EMBASE, Cochrane Library, CINAHL, and relevant reference lists were searched until March 2013. Two reviewers independently assessed studies for inclusion, quality, and extracted data. Eleven studies, assessing the impact of seven policy changes, were included: 2 separate reports of one randomized controlled trial, 4 interrupted time series, and 5 controlled before-after studies. FINDINGS: Outcomes included medication adherence, clinical events (myocardial infarction, stroke, death, quality of life, healthcare utilization, or cost. The heterogeneity among the studies precluded meta-analysis. Few studies reported the impact of cost sharing strategies on mortality, clinical and economic outcomes. The association between patient copayments and medication adherence varied across studies, ranging from no difference to significantly lower adherence, depending on the amount of the copayment

  7. Understanding Reporting Delay in General Insurance

    Directory of Open Access Journals (Sweden)

    Richard J. Verrall

    2016-07-01

    Full Text Available The aim of this paper is to understand and to model claims arrival and reporting delay in general insurance. We calibrate two real individual claims data sets to the statistical model of Jewell and Norberg. One data set considers property insurance and the other one casualty insurance. For our analysis we slightly relax the model assumptions of Jewell allowing for non-stationarity so that the model is able to cope with trends and with seasonal patterns. The performance of our individual claims data prediction is compared to the prediction based on aggregate data using the Poisson chain-ladder method.

  8. 32 CFR 842.46 - Who may file a claim.

    Science.gov (United States)

    2010-07-01

    ... authorized agents may file claims for personal injury. (c) Duly appointed guardians of minor children or any other persons legally entitled to do so under applicable local law may file claims for minors' personal... action surviving an individual's death. (e) Insurers with subrogation rights may file claims for losses...

  9. Premium Pricing of Liability Insurance Using Random Sum Model

    Directory of Open Access Journals (Sweden)

    Mujiati Dwi Kartikasari

    2017-03-01

    Full Text Available Premium pricing is one of important activities in insurance. Nonlife insurance premium is calculated from expected value of historical data claims. The historical data claims are collected so that it forms a sum of independent random number which is called random sum. In premium pricing using random sum, claim frequency distribution and claim severity distribution are combined. The combination of these distributions is called compound distribution. By using liability claim insurance data, we analyze premium pricing using random sum model based on compound distribution

  10. Scientific Evaluation and Review of Claims in Health Care (SEaRCH): A Streamlined, Systematic, Phased Approach for Determining “What Works” in Healthcare

    Science.gov (United States)

    Crawford, Cindy; Hilton, Lara; Elfenbaum, Pamela

    2017-01-01

    Abstract Background: Answering the question of “what works” in healthcare can be complex and requires the careful design and sequential application of systematic methodologies. Over the last decade, the Samueli Institute has, along with multiple partners, developed a streamlined, systematic, phased approach to this process called the Scientific Evaluation and Review of Claims in Health Care (SEaRCH™). The SEaRCH process provides an approach for rigorously, efficiently, and transparently making evidence-based decisions about healthcare claims in research and practice with minimal bias. Methods: SEaRCH uses three methods combined in a coordinated fashion to help determine what works in healthcare. The first, the Claims Assessment Profile (CAP), seeks to clarify the healthcare claim and question, and its ability to be evaluated in the context of its delivery. The second method, the Rapid Evidence Assessment of the Literature (REAL©), is a streamlined, systematic review process conducted to determine the quantity, quality, and strength of evidence and risk/benefit for the treatment. The third method involves the structured use of expert panels (EPs). There are several types of EPs, depending on the purpose and need. Together, these three methods—CAP, REAL, and EP—can be integrated into a strategic approach to help answer the question “what works in healthcare?” and what it means in a comprehensive way. Discussion: SEaRCH is a systematic, rigorous approach for evaluating healthcare claims of therapies, practices, programs, or products in an efficient and stepwise fashion. It provides an iterative, protocol-driven process that is customized to the intervention, consumer, and context. Multiple communities, including those involved in health service and policy, can benefit from this organized framework, assuring that evidence-based principles determine which healthcare practices with the greatest promise are used for improving the public's health and

  11. Scientific Evaluation and Review of Claims in Health Care (SEaRCH): A Streamlined, Systematic, Phased Approach for Determining "What Works" in Healthcare.

    Science.gov (United States)

    Jonas, Wayne B; Crawford, Cindy; Hilton, Lara; Elfenbaum, Pamela

    2017-01-01

    Answering the question of "what works" in healthcare can be complex and requires the careful design and sequential application of systematic methodologies. Over the last decade, the Samueli Institute has, along with multiple partners, developed a streamlined, systematic, phased approach to this process called the Scientific Evaluation and Review of Claims in Health Care (SEaRCH™). The SEaRCH process provides an approach for rigorously, efficiently, and transparently making evidence-based decisions about healthcare claims in research and practice with minimal bias. SEaRCH uses three methods combined in a coordinated fashion to help determine what works in healthcare. The first, the Claims Assessment Profile (CAP), seeks to clarify the healthcare claim and question, and its ability to be evaluated in the context of its delivery. The second method, the Rapid Evidence Assessment of the Literature (REAL © ), is a streamlined, systematic review process conducted to determine the quantity, quality, and strength of evidence and risk/benefit for the treatment. The third method involves the structured use of expert panels (EPs). There are several types of EPs, depending on the purpose and need. Together, these three methods-CAP, REAL, and EP-can be integrated into a strategic approach to help answer the question "what works in healthcare?" and what it means in a comprehensive way. SEaRCH is a systematic, rigorous approach for evaluating healthcare claims of therapies, practices, programs, or products in an efficient and stepwise fashion. It provides an iterative, protocol-driven process that is customized to the intervention, consumer, and context. Multiple communities, including those involved in health service and policy, can benefit from this organized framework, assuring that evidence-based principles determine which healthcare practices with the greatest promise are used for improving the public's health and wellness.

  12. Health Insurance

    Science.gov (United States)

    Health insurance helps protect you from high medical care costs. It is a contract between you and your ... Many people in the United States get a health insurance policy through their employers. In most cases, the ...

  13. Catastrophe Insurance Modeled by Shot-Noise Processes

    Directory of Open Access Journals (Sweden)

    Thorsten Schmidt

    2014-02-01

    Full Text Available Shot-noise processes generalize compound Poisson processes in the following way: a jump (the shot is followed by a decline (noise. This constitutes a useful model for insurance claims in many circumstances; claims due to natural disasters or self-exciting processes exhibit similar features. We give a general account of shot-noise processes with time-inhomogeneous drivers inspired by recent results in credit risk. Moreover, we derive a number of useful results for modeling and pricing with shot-noise processes. Besides this, we obtain some highly tractable examples and constitute a useful modeling tool for dynamic claims processes. The results can in particular be used for pricing Catastrophe Bonds (CAT bonds, a traded risk-linked security. Additionally, current results regarding the estimation of shot-noise processes are reviewed.

  14. Insurance crisis

    International Nuclear Information System (INIS)

    Williams, P.L.

    1996-01-01

    The article discusses the effects of financing and technology advances on the availability of insurance for independent power producers operating gas turbines. Combined cycle units which require new materials and processes make it difficult to assess risk. Insurers are denying coverage, or raising prices and deductibles. Many lenders, however, are requiring insurance prior to financing. Some solutions proposed include information sharing by industry participants and insurers and increased risk acceptance by plant owners/operators

  15. Malpractice claims in interventional radiology: frequency, characteristics and protective measures.

    Science.gov (United States)

    Magnavita, N; Fileni, A; Mirk, P; Magnavita, G; Ricci, S; Cotroneo, A R

    2013-04-01

    The use of interventional radiology procedures has considerably increased in recent years, as has the number of related medicolegal litigations. This study aimed to highlight the problems underlying malpractice claims in interventional radiology and to assess the importance of the informed consent process. The authors examined all insurance claims relating to presumed errors in interventional radiology filed by radiologists over a period of 14 years after isolating them from the insurance database of all radiologists registered with the Italian Society of Medical Radiology (SIRM) between 1 January1993 and 31 December 2006. In the period considered, 98 malpractice claims were filed against radiologists who had performed interventional radiology procedures. In 21 cases (21.4%), the event had caused the patient's death. In >80% of cases, the event occurred in a public facility. The risk of a malpractice claim for a radiologist practising interventional procedures is 47 per 1,000, which corresponds to one malpractice claim for each 231 years of activity. Interventional radiology, a discipline with a biological risk profile similar to that of surgery, exposes practitioners to a high risk of medicolegal litigation both because of problems intrinsic to the techniques used and because of the need to operate on severely ill patients with compromised clinical status. Litigation prevention largely depends on both reducing the rate of medical error and providing the patient with correct and coherent information. Adopting good radiological practices, scrupulous review of procedures and efficiency of the instruments used and audit of organisational and management processes are all factors that can help reduce the likelihood of error. Improving communication techniques while safeguarding the patient's right to autonomy also implies adopting clear and rigorous processes for obtaining the patient's informed consent to the medical procedure.

  16. Analysis of medication-related malpractice claims: causes, preventability, and costs.

    Science.gov (United States)

    Rothschild, Jeffrey M; Federico, Frank A; Gandhi, Tejal K; Kaushal, Rainu; Williams, Deborah H; Bates, David W

    2002-11-25

    Adverse drug events (ADEs) may lead to serious injury and may result in malpractice claims. While ADEs resulting in claims are not representative of all ADEs, such data provide a useful resource for studying ADEs. Therefore, we conducted a review of medication-related malpractice claims to study their frequency, nature, and costs and to assess the human factor failures associated with preventable ADEs. We also assessed the potential benefits of proved effective ADE prevention strategies on ADE claims prevention. We conducted a retrospective analysis of a New England malpractice insurance company claims records from January 1, 1990, to December 31, 1999. Cases were electronically screened for possible ADEs and followed up by independent review of abstracts by 2 physician reviewers (T.K.G. and R.K.). Additional in-depth claims file reviews identified potential human factor failures associated with ADEs. Adverse drug events represented 6.3% (129/2040) of claims. Adverse drug events were judged preventable in 73% (n = 94) of the cases and were nearly evenly divided between outpatient and inpatient settings. The most frequently involved medication classes were antibiotics, antidepressants or antipsychotics, cardiovascular drugs, and anticoagulants. Among these ADEs, 46% were life threatening or fatal. System deficiencies and performance errors were the most frequent cause of preventable ADEs. The mean costs of defending malpractice claims due to ADEs were comparable for nonpreventable inpatient and outpatient ADEs and preventable outpatient ADEs (mean, $64,700-74,200), but costs were considerably greater for preventable inpatient ADEs (mean, $376,500). Adverse drug events associated with malpractice claims were often severe, costly, and preventable, and about half occurred in outpatients. Many interventions could potentially have prevented ADEs, with error proofing and process standardization covering the greatest proportion of events.

  17. Probabilistic Insurance

    NARCIS (Netherlands)

    Wakker, P.P.; Thaler, R.H.; Tversky, A.

    1997-01-01

    Probabilistic insurance is an insurance policy involving a small probability that the consumer will not be reimbursed. Survey data suggest that people dislike probabilistic insurance and demand more than a 20% reduction in premium to compensate for a 1% default risk. These observations cannot be

  18. Probabilistic Insurance

    NARCIS (Netherlands)

    P.P. Wakker (Peter); R.H. Thaler (Richard); A. Tversky (Amos)

    1997-01-01

    textabstractProbabilistic insurance is an insurance policy involving a small probability that the consumer will not be reimbursed. Survey data suggest that people dislike probabilistic insurance and demand more than a 20% reduction in the premium to compensate for a 1% default risk. While these

  19. Administrative and clinical denials by a large dental insurance provider

    Directory of Open Access Journals (Sweden)

    Geraldo Elias MIRANDA

    2015-01-01

    Full Text Available The objective of this study was to assess the prevalence and the type of claim denials (administrative, clinical or both made by a large dental insurance plan. This was a cross-sectional, observational study, which retrospectively collected data from the claims and denial reports of a dental insurance company. The sample consisted of the payment claims submitted by network dentists, based on their procedure reports, reviewed in the third trimester of 2012. The denials were classified and grouped into ‘administrative’, ‘clinical’ or ‘both’. The data were tabulated and submitted to uni- and bivariate analyses. The confidence intervals were 95% and the level of significance was set at 5%. The overall frequency of denials was 8.2% of the total number of procedures performed. The frequency of administrative denials was 72.88%, whereas that of technical denials was 25.95% and that of both, 1.17% (p < 0.05. It was concluded that the overall prevalence of denials in the studied sample was low. Administrative denials were the most prevalent. This type of denial could be reduced if all dental insurance providers had unified clinical and administrative protocols, and if dentists submitted all of the required documentation in accordance with these protocols.

  20. Claims in civil engineering contracts

    CERN Document Server

    Speirs, N A

    1999-01-01

    This paper considers claims arising during civil engineering construction contracts. The meaning of the word 'claim' is considered and its possible implications for additional cost and time to completion. The conditions of the construction contract selected will influence the risk apportionment between contractor and client and the price offered by the contractor for the work. Competitive bidding constraints and profit margins in the construction industry, however, may also influence the price offered. This in turn can influence the likelihood of claims arising. The client from his point of view is concerned to complete the work within an agreed time and budget. The circumstances under which claims may arise are reviewed in relation to typical conditions of contract. These circumstances are then related to the CERN LHC civil works. Ways of avoiding claims, where this is possible, are considered. Finally, the means of evaluation of claims and their settlement are considered.

  1. The assessment of solvency and determination of limits for risk acceptance in insurance companies

    Directory of Open Access Journals (Sweden)

    Drljača Dejan

    2017-01-01

    Full Text Available The subject of this paper is the presentation of key requirements for Solvency II project, the methodology for testing of capital adequacy and methods for identification, definition and establishment of risk limits, as a limit for acceptance, bearing and control of exposure to certain risks in insurance companies. The aim of the paper is to show that the capital adequacy is the key factor for insurers' safety, i.e. guarantee of capability of an insurer to settle any future liabilities and leverage for strengthening of insurer's market position. Business operations of insurance companies are exposed to a significant number of risks that differ by their nature, character and influence, due to which adequacy of calculated technical reserves does not provide a satisfactory level of safety in case of more significant impairments of assets and funds of insurers, as well as in case of significant deviations between amounts of settled claims and actuarially expected amounts of liabilities based on claims. Stress testing of capital adequacy will show that losses due to impairment of risky securities, difficult collection of low liquid, i.e. securities that are difficult to market, inability to collect receivables from reinsurers, as well as losses due to inadequately calculated reserved claims, must be covered by a solvent capital. The paper is structured so as to provide a review of rules, elements and principles that are the foundation of solvency requirements in insurance companies, methodologies of calculation of guarantee reserve, technical basis for stress testing which assesses capital adequacy of insurers, as well as methods for establishment of limits of exposure to certain risks.

  2. Burns in South Korea: An analysis of nationwide data from the Health Insurance Review and Assessment Service.

    Science.gov (United States)

    Oh, Hyunjin; Boo, Sunjoo

    2016-05-01

    The purpose of the study was to identify and describe the incidence of burn injuries in patients seen and treated in South Korea. Characteristics of inpatients and outpatients with burns were analyzed according to gender, age, burn site, and burn severity. This retrospective study examined the characteristics of a stratified sample of burn patients seen and treated in South Korea during the calendar year 2011. The sample was drawn from the national patient database Health Insurance Review and Assessment (HIRA). Approximately 1.71% of the total patients in the Patient Sample of HIRA for 2011 were burn-injured patients. The numbers of patients treated for burns were 913/10(5) males (n=8009) and 1454/10(5) females (n=11,881). Nearly all of these patients (94.1%) were covered by national health insurance and the majority of these patients (80.6%) were treated as outpatients. Nearly half of the burn injuries were of the upper extremities (43.5%), and most of these injuries (71.5%) were rated as second-degree burns. A review of the national data on patients seen and treated for burns in 2011 revealed that people in South Korea may experience higher numbers and more severe cases of burns and burn-related injuries than found in other countries. General burn prevention programs as well as gender- and age-specific prevention strategies are needed to reduce the risk of burns in this population. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  3. Value and Service Quality Assessment of the National Health Insurance Scheme in Ghana: Evidence from Ashiedu Keteke District.

    Science.gov (United States)

    Nsiah-Boateng, Eric; Aikins, Moses; Asenso-Boadi, Francis; Andoh-Adjei, Francis-Xavier

    2016-09-01

    Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to provide financial access to health care for all residents. This article analyzed claims reimbursement data of the NHIS to assess the value of the benefit package to the insured and responsiveness of the service to the financial needs of health services providers. Medical claims data reported between January 1, 2010, and December 31, 2014, were retrieved from the database of Ashiedu Keteke District Office of the National Health Insurance Authority. The incurred claims ratio, promptness of claims settlements, and claims adjustment rate were analyzed over the 5-year period. In all, 644,663 medical claims with a cost of Ghana cedi (GHS) 11.8 million (US $3.1 million) were reported over the study period. The ratio of claims cost to contributions paid increased from 4.3 to 7.2 over the 2011-2013 period, and dropped to 5.0 in 2014. The proportion of claims settled beyond 90 days also increased from 26% to 100% between 2011 and 2014. Generally, the amount of claims adjusted was low; however, it increased consistently from 1% to about 4% over the 2011-2014 period. The reasons for claims adjustments included provision of services to ineligible members, overbilling of services, and misapplication of diagnosis related groups. There is increased value of the NHIS benefit package to subscribers; however, the scheme's responsiveness to the financial needs of health services providers is low. This calls for a review of the NHIS policy to improve financial viability and service quality. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  4. Evaluating the Welfare of Index Insurance

    DEFF Research Database (Denmark)

    Harrison, Glenn W.; Martínez-Correa, Jimmy; Ng, Jia Min

    affects both the demand for the product and the welfare of individuals making take-up decisions. We study the impact of basis risk on insurance take-up and on expected welfare in a laboratory experiment with an insurance frame. We measure the expected welfare of index insurance to individuals while......Index insurance was conceived to be a product that would simplify the claim settlement process and make it more objective, reducing transaction costs and moral hazard. However, index insurance also exposes the insured to basis risk, which arises because there can be a mismatch between the index...... risks that are different from preferences exhibited for their actuarially-equivalent counterparts. We study the potential link between index insurance demand and attitudes towards compound risks. We test the hypothesis that the compound risk nature of index insurance induced by basis risk negatively...

  5. The Multiplication Effect of Legal Insurance

    NARCIS (Netherlands)

    J.P.B. De Mot (Jef); B. Depoorter (Ben); M.G. Faure (Michael)

    2016-01-01

    textabstractBecause legal insurance policies cover the expenses of plaintiffs in bringing legal claims, such policies increase the risk of negligent or careless acts by tortfeasors. For this reason, potential tortfeasors would prefer to avoid injuring holders of legal insurance policies. Since

  6. 24 CFR 232.885 - Insurance benefits.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Insurance benefits. 232.885 Section 232.885 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued....885 Insurance benefits. (a) Method of payment. Payment of claim shall be made in the following manner...

  7. ClaimAssociationService

    Data.gov (United States)

    Department of Veterans Affairs — Retrieves and updates a veteranÆs claim status and claim-rating association (claim association for current rating) from the Corporate database for a claim selected...

  8. Subgroup Analysis of Trials Is Rarely Easy (SATIRE: a study protocol for a systematic review to characterize the analysis, reporting, and claim of subgroup effects in randomized trials

    Directory of Open Access Journals (Sweden)

    Malaga German

    2009-11-01

    Full Text Available Abstract Background Subgroup analyses in randomized trials examine whether effects of interventions differ between subgroups of study populations according to characteristics of patients or interventions. However, findings from subgroup analyses may be misleading, potentially resulting in suboptimal clinical and health decision making. Few studies have investigated the reporting and conduct of subgroup analyses and a number of important questions remain unanswered. The objectives of this study are: 1 to describe the reporting of subgroup analyses and claims of subgroup effects in randomized controlled trials, 2 to assess study characteristics associated with reporting of subgroup analyses and with claims of subgroup effects, and 3 to examine the analysis, and interpretation of subgroup effects for each study's primary outcome. Methods We will conduct a systematic review of 464 randomized controlled human trials published in 2007 in the 118 Core Clinical Journals defined by the National Library of Medicine. We will randomly select journal articles, stratified in a 1:1 ratio by higher impact versus lower impact journals. According to 2007 ISI total citations, we consider the New England Journal of Medicine, JAMA, Lancet, Annals of Internal Medicine, and BMJ as higher impact journals. Teams of two reviewers will independently screen full texts of reports for eligibility, and abstract data, using standardized, pilot-tested extraction forms. We will conduct univariable and multivariable logistic regression analyses to examine the association of pre-specified study characteristics with reporting of subgroup analyses and with claims of subgroup effects for the primary and any other outcomes. Discussion A clear understanding of subgroup analyses, as currently conducted and reported in published randomized controlled trials, will reveal both strengths and weaknesses of this practice. Our findings will contribute to a set of recommendations to optimize

  9. Claiming Community

    DEFF Research Database (Denmark)

    Jensen, Steffen Bo

    As its point of departure this working paper takes the multitude of different uses and meanings of the concept of community in local politics in Cape Town. Instead of attempting to define it in substantive terms, the paper takes a social constructivist approach to the study of community...... is termed community work. First, the paper explores how community has become a governmental strategy, employed by the apartheid regime as well, although in different ways, as post-apartheid local government. Secondly, the paper explores the ways in which community becomes the means in which local residents...... lay claim on the state, as well as how it enters into local power struggles between different political groups within the township. In the third part, the paper explores how the meanings of community and the struggles to realise it have changed as South Africa, nationally and locally, has become...

  10. A Logistic Regression Based Auto Insurance Rate-Making Model Designed for the Insurance Rate Reform

    Directory of Open Access Journals (Sweden)

    Zhengmin Duan

    2018-02-01

    Full Text Available Using a generalized linear model to determine the claim frequency of auto insurance is a key ingredient in non-life insurance research. Among auto insurance rate-making models, there are very few considering auto types. Therefore, in this paper we are proposing a model that takes auto types into account by making an innovative use of the auto burden index. Based on this model and data from a Chinese insurance company, we built a clustering model that classifies auto insurance rates into three risk levels. The claim frequency and the claim costs are fitted to select a better loss distribution. Then the Logistic Regression model is employed to fit the claim frequency, with the auto burden index considered. Three key findings can be concluded from our study. First, more than 80% of the autos with an auto burden index of 20 or higher belong to the highest risk level. Secondly, the claim frequency is better fitted using the Poisson distribution, however the claim cost is better fitted using the Gamma distribution. Lastly, based on the AIC criterion, the claim frequency is more adequately represented by models that consider the auto burden index than those do not. It is believed that insurance policy recommendations that are based on Generalized linear models (GLM can benefit from our findings.

  11. On a Stochastic Model in Insurance

    Indian Academy of Sciences (India)

    day is considered a part of applied probability theory, and a major portion ... claims that arrive in an insurance business, and decide ... Study of probability of ruin and obtaining ...... An important development of late is to consider claim sizes that ...

  12. Current Status of Pathologic Examinations in Korea, 2011–2015, Based on the Health Insurance Review and Assessment Service Dataset

    Directory of Open Access Journals (Sweden)

    Sun-ju Byeon

    2017-03-01

    Full Text Available Background Pathologic examinations play an important role in medical services. Until recently, the overall status of pathologic examinations in Korea has not been identified. I conducted a nationwide survey of pathologic examination status using the insurance reimbursements (IRs dataset from the Health Insurance Review and Assessment Service (HIRA. The aims of this study were to estimate current pathologic examination status in Korea and to provide information for future resource arrangement in the pathology area. Methods I asked HIRA to provide data on IR requests, including pathologic examinations from 2011 to 2015. Pathologic examination status was investigated according to the following categories: annual statistics, requesting department, type of medical institution, administrative district, and location at which pathologic examinations were performed. Results Histologic mapping, immunohistochemistry, and cervicovaginal examinations have increased in the last 5 years. Internal medicine, general surgery, obstetrics/gynecology, and urology were the most common medical departments requesting pathologic examinations. The majority of pathologic examinations were frequently performed in tertiary hospitals. About 60.3% of pathologic examinations were requested in medical institutions located in Seoul, Gyeonggi-do, and Busan. More than half of the biopsies and aspiration cytologic examinations were performed using outside services. The mean period between IR requests and 99 percentile IR request completion inspections was 6.2 months. Conclusions This survey was based on the HIRA dataset, which is one of the largest medical datasets in Korea. The trends of some pathologic examinations were reflected in the policies and needs for detailed diagnosis. The numbers and proportions of pathologic examinations were correlated with the population and medical institutions of the area, as well as patient preference. These data will be helpful for future

  13. Nuclear insurance

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    The yearbook contains among others the figures of the nuclear insurance line. According to these these the DKVG (German nuclear power plant insurance association) has 102 member insurance companies all registered in the Federal Republic of Germany. By using reinsurance capacities of the other pools at present property insurance amounts to 1.5 billion DM and liability insurance to 200 million DM. In 1991 the damage charges on account of DKV amounted to 3.1 (1990 : 4.3) million DM. From these 0.6 million DM are apportioned to payments and 2.5 million DM to reserves. One large damage would cost a maximum gross sum of 2.2 billion DM property and liability insurance; on account of DKVG 750 million DM. (orig./HSCH) [de

  14. A Review of Activity Trackers for Senior Citizens: Research Perspectives, Commercial Landscape and the Role of the Insurance Industry

    Directory of Open Access Journals (Sweden)

    Salvatore Tedesco

    2017-06-01

    Full Text Available The objective assessment of physical activity levels through wearable inertial-based motion detectors for the automatic, continuous and long-term monitoring of people in free-living environments is a well-known research area in the literature. However, their application to older adults can present particular constraints. This paper reviews the adoption of wearable devices in senior citizens by describing various researches for monitoring physical activity indicators, such as energy expenditure, posture transitions, activity classification, fall detection and prediction, gait and balance analysis, also by adopting consumer-grade fitness trackers with the associated limitations regarding acceptability. This review also describes and compares existing commercial products encompassing activity trackers tailored for older adults, thus providing a comprehensive outlook of the status of commercially available motion tracking systems. Finally, the impact of wearable devices on life and health insurance companies, with a description of the potential benefits for the industry and the wearables market, was analyzed as an example of the potential emerging market drivers for such technology in the future.

  15. A Review of Activity Trackers for Senior Citizens: Research Perspectives, Commercial Landscape and the Role of the Insurance Industry.

    Science.gov (United States)

    Tedesco, Salvatore; Barton, John; O'Flynn, Brendan

    2017-06-03

    The objective assessment of physical activity levels through wearable inertial-based motion detectors for the automatic, continuous and long-term monitoring of people in free-living environments is a well-known research area in the literature. However, their application to older adults can present particular constraints. This paper reviews the adoption of wearable devices in senior citizens by describing various researches for monitoring physical activity indicators, such as energy expenditure, posture transitions, activity classification, fall detection and prediction, gait and balance analysis, also by adopting consumer-grade fitness trackers with the associated limitations regarding acceptability. This review also describes and compares existing commercial products encompassing activity trackers tailored for older adults, thus providing a comprehensive outlook of the status of commercially available motion tracking systems. Finally, the impact of wearable devices on life and health insurance companies, with a description of the potential benefits for the industry and the wearables market, was analyzed as an example of the potential emerging market drivers for such technology in the future.

  16. A Review of Activity Trackers for Senior Citizens: Research Perspectives, Commercial Landscape and the Role of the Insurance Industry

    Science.gov (United States)

    Tedesco, Salvatore; Barton, John; O’Flynn, Brendan

    2017-01-01

    The objective assessment of physical activity levels through wearable inertial-based motion detectors for the automatic, continuous and long-term monitoring of people in free-living environments is a well-known research area in the literature. However, their application to older adults can present particular constraints. This paper reviews the adoption of wearable devices in senior citizens by describing various researches for monitoring physical activity indicators, such as energy expenditure, posture transitions, activity classification, fall detection and prediction, gait and balance analysis, also by adopting consumer-grade fitness trackers with the associated limitations regarding acceptability. This review also describes and compares existing commercial products encompassing activity trackers tailored for older adults, thus providing a comprehensive outlook of the status of commercially available motion tracking systems. Finally, the impact of wearable devices on life and health insurance companies, with a description of the potential benefits for the industry and the wearables market, was analyzed as an example of the potential emerging market drivers for such technology in the future. PMID:28587188

  17. Probabilistic insurance

    OpenAIRE

    Wakker, P.P.; Thaler, R.H.; Tversky, A.

    1997-01-01

    textabstractProbabilistic insurance is an insurance policy involving a small probability that the consumer will not be reimbursed. Survey data suggest that people dislike probabilistic insurance and demand more than a 20% reduction in the premium to compensate for a 1% default risk. While these preferences are intuitively appealing they are difficult to reconcile with expected utility theory. Under highly plausible assumptions about the utility function, willingness to pay for probabilistic i...

  18. Risk adjustment model of credit life insurance using a genetic algorithm

    Science.gov (United States)

    Saputra, A.; Sukono; Rusyaman, E.

    2018-03-01

    In managing the risk of credit life insurance, insurance company should acknowledge the character of the risks to predict future losses. Risk characteristics can be learned in a claim distribution model. There are two standard approaches in designing the distribution model of claims over the insurance period i.e, collective risk model and individual risk model. In the collective risk model, the claim arises when risk occurs is called individual claim, accumulation of individual claim during a period of insurance is called an aggregate claim. The aggregate claim model may be formed by large model and a number of individual claims. How the measurement of insurance risk with the premium model approach and whether this approach is appropriate for estimating the potential losses occur in the future. In order to solve the problem Genetic Algorithm with Roulette Wheel Selection is used.

  19. Amendment of liability and financial security under atomic energy law. Position of the insurers

    International Nuclear Information System (INIS)

    Boetius, J.

    1991-01-01

    Since Chernobyl in 1986, there have also been intensive activities in the insurance business in reviewing the legal framework conditions in terms of there consequences for a possible settlement of claims and in dealing with the question whether the old organizational rulings can still be considered sufficient in the light of the aforementioned disaster that has occured. This leads to the deliberations on a legal canalization of liability, on third party liability, financial security, indemnification by the state, damages through precautionary measures (evacuation) and organisation of the settlement of claims. (orig./HSCH) [de

  20. Active Labour Market Programme Participation for Unemployment Insurance Recipients: A Systematic Review

    DEFF Research Database (Denmark)

    Filges, Trine; Smedslund, Geir; Knudsen, Anne-Sofie Due

    2015-01-01

    designs that used a well-defined control group were eligible for inclusion in this review. Studies that utilized qualitative approaches were not included due to the absence of adequate control group conditions. DATA COLLECTION AND ANALYSIS The total number of potential relevant studies constituted 16......,422 hits. A total of 73 studies, consisting of 143 papers, met the inclusion criteria and were critically appraised by the review authors. The final selection comprised 73 studies from 15 different countries. Only 47 studies provided data that permitted the calculation of an effect size for the primary...... outcome. Of these, six studies could not be used in the data synthesis due to their high risk of bias. An additional two studies could not be used due to overlap of data samples. A total of 39 studies were therefore included in the data synthesis. Only five studies provided data that permitted...

  1. School Insurance.

    Science.gov (United States)

    1964

    The importance of insurance in the school budget is the theme of this comprehensive bulletin on the practices and policies for Texas school districts. Also considered is the development of desirable school board policies in purchasing insurance and operating the program. Areas of discussion are: risks to be covered, amount of coverage, values,…

  2. Forest insurance

    Science.gov (United States)

    Ellis T. Williams

    1949-01-01

    Standing timber is one of the few important kinds of property that are not generally covered by insurance. Studies made by the Forest Service and other agencies have indicated that the risks involved in the insurance of timber are not unduly great, provided they can be properly distributed. Such studies, however, have thus far failed to induce any notable development...

  3. Risk segmentation in Chilean social health insurance.

    Science.gov (United States)

    Hidalgo, Hector; Chipulu, Maxwell; Ojiako, Udechukwu

    2013-01-01

    The objective of this study is to identify how risk and social variables are likely to be impacted by an increase in private sector participation in health insurance provision. The study focuses on the Chilean health insurance industry, traditionally dominated by the public sector. Predictive risk modelling is conducted using a database containing over 250,000 health insurance policy records provided by the Superintendence of Health of Chile. Although perceived with suspicion in some circles, risk segmentation serves as a rational approach to risk management from a resource perspective. The variables that have considerable impact on insurance claims include the number of dependents, gender, wages and the duration a claimant has been a customer. As shown in the case study, to ensure that social benefits are realised, increased private sector participation in health insurance must be augmented by regulatory oversight and vigilance. As it is clear that a "community-rated" health insurance provision philosophy impacts on insurance firm's ability to charge "market" prices for insurance provision, the authors explore whether risk segmentation is a feasible means of predicting insurance claim behaviour in Chile's private health insurance industry.

  4. 27 CFR 70.413 - Claims.

    Science.gov (United States)

    2010-04-01

    ... file a bond in double the amount of the tax in order to insure collection of the tax if the claim is... 5620.8 for allowance of loss, credit of tax, or relief from tax liability, as applicable, on (1....413 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE...

  5. INHERENT VICE & INSUFFICIENT PACKING CLAUSES FOR ALL RISKS INSURANCE POLICIES UNDER BRITISH INSTITUTE CARGO CLAUSES : legal issues arising from claims of loss during sea transportation of large technical equipments

    OpenAIRE

    Cheng, Jia

    2010-01-01

    Analysis and presentation of this thesis is supported by studies of many relevant cases where the major arguments are set around the exclusion clauses concerning the ‘all risks cover’ policy as found in Institute Cargo Clauses. Two cases are especially emphasized, namely Mayban General Assurance BHD v. Alstom Power Plants Ltd. and Global Process Systems Inc v. Syarikat Takaful Malaysia Berhad , mainly because of the special nature of the subject matter insured in these cases. The legal i...

  6. The insurance refund request: a legal analysis.

    Science.gov (United States)

    Rollman, S O

    1998-12-01

    When an insurance payment is made erroneously to a healthcare provider and no contract between the insurer and provider addresses the issue of refunding such payments, the law relating to restitution generally applies. Restitution does not apply, however, to three exceptions that the courts have used to refuse claims by insurers for refunds of overpayments: the innocent third-party creditor exception, whereby the healthcare provider cannot be unjustly enriched by the overpayment, cannot have induced the mistaken payment, and cannot have known beforehand that the insurer was not obligated to pay; the material change in position exception, whereby the healthcare provider in good faith accepts an overpayment and so does not pursue other means of payment; and the assumption of the risk exception, which occurs when the insurer pays a claim without having complete information about it.

  7. Neonatal hypoglycaemia: learning from claims

    OpenAIRE

    Hawdon, Jane M; Beer, Jeanette; Sharp, Deborah; Upton, Michele

    2016-01-01

    Objectives Neonatal hypoglycaemia is a potential cause of neonatal morbidity, and on rare but tragic occasions causes long-term neurodevelopmental harm with consequent emotional and practical costs for the family. The organisational cost to the NHS includes the cost of successful litigation claims. The purpose of the review was to identify themes that could alert clinicians to common pitfalls and thus improve patient safety. Design The NHS Litigation Authority (NHS LA) Claims Management Syste...

  8. Artificial intelligence applied in claims management: Bet on the right customer with claims satisfaction predictive modeling

    OpenAIRE

    Lamarsaude, Benoit

    2017-01-01

    Insurance companies suffer from loss of customer consecutively to claims. Only a small portion of dissatisfied customer expresses themselves, creating difficulties in establishing a long term relationship. Increase customer loyalty is a major subject for insurers, because they have to maintain a minimum portfolio size and acquiring newclients is more expensive than retains the existing. In this work we use artificial intelligence techniques to assess and manage the customer satisfaction when ...

  9. INSURANCE INTERMEDIARIES

    Directory of Open Access Journals (Sweden)

    Andreea Stoican

    2013-11-01

    Full Text Available The actual Civil code regulates for the first time in the Romanian legislation the intermediation contract, until its entering into force existing multiple situations that lent themselves to this legal operation, but did not benefit of such particular legal rules. Yet, the case law has shown that the situations that arise in the activity of the legal or natural persons are much more complex, this leading, in time, to the reglementation of such particular rules. Such a case is that found in the matter of insurance contracts, the position of the insurance intermediaries being regulated especially by Law no. 32/2000, according to which they represent the natural or legal persons authorized in the conditions of the above mentioned legal document, that perform intermediation activities in the insurance field, in exchange of a remuneration, as well as the intermediaries from the EU member states that perform such an activity on the Romanian territory, in accordance with the freedom in performing services. Therefore, the present paper aims to analyze the conclusion of such insurance contracts and to underline the particular position of the insurance brokers, having the following structure: 1 Introduction; 2 The reglementation of the intermediation contract/brokerage agreement in the Romanian Law; 3 The importance of the intermediaries in the insurance contracts; 4 The conclusion of the insurance contracts; 5 Conclusions.

  10. Employer-provided health insurance and the incidence of job lock: a literature review and empirical test.

    Science.gov (United States)

    Rashad, Inas; Sarpong, Eric

    2008-12-01

    The incidence of 'job lock' in the health insurance context has long been viewed as a potential problem with employer-provided health insurance, a concept that was instrumental in the passage of the United States Consolidated Omnibus Budget Reconciliation Act of 1986, and later, the Health Insurance Portability and Accountability Act in 1996. Several recent developments in healthcare in the USA include declining healthcare coverage and a noticeable shift in the burden of medical care costs to employees. If these developments cause employees with employer-provided health insurance to feel locked into their jobs, optimal job matches in the labor force may not take place. A summary of the seminal papers in the current literature on the topic of job lock is given, followed by an empirical exercise using single individuals from the National Health Interview Survey (1997-2003) and the 1979 cohort of the National Longitudinal Survey of Youth (1989-2000). Econometric methods used include difference in differences, ordinary least squares and individual fixed effects models, in gauging the potential effect that employer-provided health insurance may have on job tenure and voluntary job departure. Our findings are consistent with recent assertions that there is some evidence of job lock. Individuals with employer-provided health insurance stay on the job 16% longer and are 60% less likely to voluntarily leave their jobs than those with insurance that is not provided by their employers. Productivity may not be optimal if incentives are altered owing to the existence of fringe benefits, such as health insurance. Further research in this area should determine whether legislation beyond the Consolidated Omnibus Budget Reconciliation Act and Health Insurance Portability and Accountability Act laws is needed.

  11. 20 CFR 325.4 - Claim for unemployment benefits.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Claim for unemployment benefits. 325.4 Section 325.4 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REGISTRATION FOR RAILROAD UNEMPLOYMENT BENEFITS § 325.4 Claim for unemployment benefits. (a...

  12. Extending the Scope of Services in the Insurance Industry

    OpenAIRE

    von Watzdorf, Stephan; Gebauer, Heiko; Staake, Thorsten; Fleisch, Elgar

    2011-01-01

    The study at hand explores the influence of value-added services offered in addition to a motor insurance product on the customer's preference structure. It addresses the need of insurance companies to extend their core business with different types of supplementary services. A choice-based conjoint analysis is conducted which considers the price for the insurance product, the insurance franchise, the non-claims bonus as well as post-accident services and value-added services. Based on the re...

  13. [Jurisdictions on the reimbursement of new medical technologies by public health insurance: A systematic review].

    Science.gov (United States)

    Ex, Patricia; Felgner, Susanne; Henschke, Cornelia

    2018-04-01

    In Germany reimbursement for new medical technologies is often enforced before a social court. It is likely that these judicial decisions also affect the sickness funds' decisions on requests for reimbursement and thus patient access to new technologies in general. The aim of this study was to identify the technologies that have repeatedly generated court actions and whether these actions have been successful. The focus was on differences between sectors, technology groups and indications. Based on this, we analysed in a case study whether judicial decisions on the reimbursement of the same technologies vary across the years. Based on a systematic review, we identified judicial decisions of German social courts on new technologies for the years 2011 to 2016. The analysis included social court decisions on reimbursements for technologies used in the treatment of individual patients. 284 judicial decisions on new technologies were considered in the analysis. In one third of the cases, the sickness funds were required to reimburse the costs, with a higher percentage in inpatient than in outpatient care. Technologies used in treatment of diseases of the eyes and the ears were granted most frequently. In cases involving similar circumstances the social courts sometimes came to conflicting decisions; these decisions are, in part, contradictory to subsequent assessments by the Joint Federal Committee (G-BA). Decisions as to whether reimbursement for new technologies is granted or not do not appear to follow a systematic approach. In the context of the seemingly innovation-friendly policy in inpatient care, there is uncertainty with regard to the "generally accepted state of medical knowledge." It is problematic for both patients and their treating physicians that over a number of years legal proceedings are being initiated for technologies that have not been subjected to a systematic assessment of their benefit. Copyright © 2018. Published by Elsevier GmbH.

  14. Insurance dictionary

    International Nuclear Information System (INIS)

    Mueller-Lutz, H.L.

    1984-01-01

    Special technical terms used in the world of insurance can hardly be found in general dictionaries. This is a gap which the 'Insurance dictionary' now presented is designed to fill. In view of its supplementary function, the number of terms covered is limited to 1200. To make this dictionary especially convenient for ready reference, only the most commonly used translations are given for each key word in any of the four languages. This dictionary is subdivided into four parts, each containing the translation of the selected terms in the three other languages. To further facilitate the use of the booklet, paper of different colours was used for the printing of the German, English, French and Greek sections. The present volume was developed from a Swedish insurance dictionary (Fickordbok Foersaekring), published in 1967, which - with Swedish as the key language- offers English, French and German translations of the basic insurance terms. (orig./HP) [de

  15. Trends in pension insurance

    Directory of Open Access Journals (Sweden)

    D. Shterev

    2017-12-01

    Full Text Available This article deals with a topical for our country problem which is related to the State Social Insurance. It provides a review of the factors having an adverse effect onto the financial state of the Bulgarian pension system. Discussed are the basic parameters related to the economic incentives in connection with the optimal functioning of the pension system

  16. Do the risk factors for type 2 diabetes mellitus vary by location? A spatial analysis of health insurance claims in Northeastern Germany using kernel density estimation and geographically weighted regression

    Directory of Open Access Journals (Sweden)

    Boris Kauhl

    2016-11-01

    Full Text Available Abstract Background The provision of general practitioners (GPs in Germany still relies mainly on the ratio of inhabitants to GPs at relatively large scales and barely accounts for an increased prevalence of chronic diseases among the elderly and socially underprivileged populations. Type 2 Diabetes Mellitus (T2DM is one of the major cost-intensive diseases with high rates of potentially preventable complications. Provision of healthcare and access to preventive measures is necessary to reduce the burden of T2DM. However, current studies on the spatial variation of T2DM in Germany are mostly based on survey data, which do not only underestimate the true prevalence of T2DM, but are also only available on large spatial scales. The aim of this study is therefore to analyse the spatial distribution of T2DM at fine geographic scales and to assess location-specific risk factors based on data of the AOK health insurance. Methods To display the spatial heterogeneity of T2DM, a bivariate, adaptive kernel density estimation (KDE was applied. The spatial scan statistic (SaTScan was used to detect areas of high risk. Global and local spatial regression models were then constructed to analyze socio-demographic risk factors of T2DM. Results T2DM is especially concentrated in rural areas surrounding Berlin. The risk factors for T2DM consist of proportions of 65–79 year olds, 80 + year olds, unemployment rate among the 55–65 year olds, proportion of employees covered by mandatory social security insurance, mean income tax, and proportion of non-married couples. However, the strength of the association between T2DM and the examined socio-demographic variables displayed strong regional variations. Conclusion The prevalence of T2DM varies at the very local level. Analyzing point data on T2DM of northeastern Germany’s largest health insurance provider thus allows very detailed, location-specific knowledge about increased medical needs. Risk factors

  17. The influence of motor vehicle legislation on injury claim incidence.

    Science.gov (United States)

    Lemstra, Mark; Olszynski, W P

    2005-01-01

    Although there have been numerous strategies to prevent motor vehicle collisions and their subsequent injuries, few have been effective in preventing motor vehicle injury claims. In this paper, we examine the role of legislation and compensation system in altering injury claim incidence. The population base for our natural experiment was all Saskatchewan, Manitoba, British Columbia and Quebec residents who submitted personal injury claims to their respective motor vehicle insurance provider from 1990 to 1999. The provinces of Saskatchewan and Manitoba switched from Tort to pure No-Fault insurance on January 1, 1995 and on March 1, 1994 respectively. British Columbia maintained tort insurance and Quebec maintained pure no-fault insurance throughout the entire 10-year period. The conversion from tort insurance to pure no-fault motor vehicle insurance resulted in a five-year 31% (RR = 0.69; 95% CI 0.68-0.70) reduction in total injury claims per 100,000 residents in Saskatchewan and a five-year 43% (RR = 0.57; 95% CI 0.56-0.58) reduction in Manitoba. At the same time, the province of British Columbia retained tort insurance and had a five-year 5% reduction (RR = 0.95; 95% CI 0.94-0.99). Quebec, which retained pure no-fault throughout the entire 10-year period, had less than one third of the injury claims per 100,000 residents than the tort province of British Columbia. The conversion from tort to pure no-fault legislation has a large influence in reducing motor vehicle injury claim incidence in Canada. Legislative system and injury compensation scheme have an observable impact on injury claim incidence and can therefore have significant impact on the health care system.

  18. Nuclear liability claims handling and costs - Germany and some comparative solutions

    International Nuclear Information System (INIS)

    Harbruecker, D.

    2000-01-01

    Comparison of legal status in Central Europe: coverage by insurance and State intervention, coverage of legal expenses and interests on awards technical problems of claims handing after a nuclear incident: guidelines to be prepared by insurer before and not after an incident occurred, demands on provider of financial security claims handling for part guaranteed by State to be transferred to insurer, necessary regulations of such arrangements (author)

  19. Economic Effects of Legislations and Policies to Expand Mental Health and Substance Abuse Benefits in Health Insurance Plans: A Community Guide Systematic Review

    Science.gov (United States)

    Jacob, Verughese; Qu, Shuli; Chattopadhyay, Sajal; Sipe, Theresa Ann; Knopf, John A.; Goetzel, Ron Z.; Finnie, Ramona; Thota, Anilkrishna B.

    2015-01-01

    Background Health insurance plans have historically limited the benefits for mental health and substance abuse (MH/SA) services compared to benefits for physical health services. In recent years, legislative and policy initiatives in the U.S. have been taken to expand MH/SA health insurance benefits and achieve parity with physical health benefits. The relevance of these legislations for international audiences is also explored, particularly for the European context. Aims of the Study This paper reviews the evidence of costs and economic benefits of legislative or policy interventions to expand MH/SA health insurance benefits in the U.S. The objectives are to assess the economic value of the interventions by comparing societal cost to societal benefits, and to determine impact on costs to insurance plans resulting from expansion of these benefits. Methods The search for economic evidence covered literature published from January 1950 to March 2011 and included evaluations of federal and state laws or rules that expanded MH/SA benefits as well as voluntary actions by large employers. Two economists screened and abstracted the economic evidence of MH/SA benefits legislation based on standard economic and actuarial concepts and methods. Results The economic review included 12 studies: eleven provided evidence on cost impact to health plans, and one estimated the effect on suicides. There was insufficient evidence to determine if the intervention was cost-effective or cost-saving. However, the evidence indicates that MH/SA benefits expansion did not lead to any substantial increase in costs to insurance plans, measured as a percentage of insurance premiums. Discussion and Limitations This review is unable to determine the overall economic value of policies that expand MH/SA insurance benefits due to lack of cost-effectiveness and cost-benefit studies, predominantly due to the lack of evaluations of morbidity and mortality outcomes. This may be remedied in time when

  20. Legislations and policies to expand mental health and substance abuse benefits in health insurance plans: a community guide systematic economic review.

    Science.gov (United States)

    Jacob, Verughese; Qu, Shuli; Chattopadhyay, Sajal; Sipe, Theresa Ann; Knopf, John A; Goetzel, Ron Z; Finnie, Ramona; Thota, Anilkrishna B

    2015-03-01

    Health insurance plans have historically limited the benefits for mental health and substance abuse (MH/SA) services compared to benefits for physical health services. In recent years, legislative and policy initiatives in the U.S. have been taken to expand MH/SA health insurance benefits and achieve parity with physical health benefits. The relevance of these legislations for international audiences is also explored, particularly for the European context. This paper reviews the evidence of costs and economic benefits of legislative or policy interventions to expand MH/SA health insurance benefits in the U.S. The objectives are to assess the economic value of the interventions by comparing societal cost to societal benefits, and to determine impact on costs to insurance plans resulting from expansion of these benefits. The search for economic evidence covered literature published from January 1950 to March 2011 and included evaluations of federal and state laws or rules that expanded MH/SA benefits as well as voluntary actions by large employers. Two economists screened and abstracted the economic evidence of MH/SA benefits legislation based on standard economic and actuarial concepts and methods. The economic review included 12 studies: eleven provided evidence on cost impact to health plans, and one estimated the effect on suicides. There was insufficient evidence to determine if the intervention was cost-effective or cost-saving. However, the evidence indicates that MH/SA benefits expansion did not lead to any substantial increase in costs to insurance plans, measured as a percentage of insurance premiums. This review is unable to determine the overall economic value of policies that expanded MH/SA insurance benefits due to lack of cost-effectiveness and cost-benefit studies, predominantly due to the lack of evaluations of morbidity and mortality outcomes. This may be remedied in time when long-term MH/SA patient-level data becomes available to researchers. A

  1. Workplace Injuries in Thoroughbred Racing: An Analysis of Insurance Payments and Injuries amongst Jockeys in Australia from 2002 to 2010

    Directory of Open Access Journals (Sweden)

    Beverley A. Curry

    2015-09-01

    Full Text Available Background: There is no comprehensive study of the costs of horse-related workplace injuries to Australian Thoroughbred racing jockeys. Objectives: To analyse the characteristics of insurance payments and horse-related workplace injuries to Australian jockeys during Thoroughbred racing or training. Methods: Insurance payments to Australian jockeys and apprentice jockeys as a result of claims for injury were reviewed. The cause and nature of injuries, and the breakdown of payments associated with claims were described. Results: The incidence of claims was 2.1/1000 race rides, with an average cost of AUD 9 million/year. Race-day incidents were associated with 39% of claims, but 52% of the total cost. The mean cost of race-day incidents (AUD 33,756 was higher than non-race day incidents (AUD 20,338. Weekly benefits and medical expenses made up the majority of costs of claims. Fractures were the most common injury (29.5%, but head injuries resulting from a fall from a horse had the highest mean cost/claim (AUD 127,127. Conclusions: Costs of workplace injuries to the Australian Thoroughbred racing industry have been greatly underestimated because the focus has historically been on incidents that occur on race-days. These findings add to the evidence base for developing strategies to reduce injuries and their associated costs.

  2. Radiation injury claims: an overview and update

    International Nuclear Information System (INIS)

    Schaffer, W.G.

    1984-01-01

    The author reviews the radiation injury claims problem and summarizes the legal framework in which the claims are presently brought. Two cases are reviewed in which the decisions are troubling. The implications of these decisions are discussed in the overall radiation injury claims problem. The author notes that in the largest radiation injury case tried in the United States, the court was unable to resolve the claims within the confines of the existing law. The disregard for established norms of adjudication and the resultant decline in predictability of outcome portends grave consequences, not only for the nuclear industry but for other industries involved with potentially toxic substances

  3. Response to health insurance by previously uninsured rural children.

    Science.gov (United States)

    Tilford, J M; Robbins, J M; Shema, S J; Farmer, F L

    1999-08-01

    To examine the healthcare utilization and costs of previously uninsured rural children. Four years of claims data from a school-based health insurance program located in the Mississippi Delta. All children who were not Medicaid-eligible or were uninsured, were eligible for limited benefits under the program. The 1987 National Medical Expenditure Survey (NMES) was used to compare utilization of services. The study represents a natural experiment in the provision of insurance benefits to a previously uninsured population. Premiums for the claims cost were set with little or no information on expected use of services. Claims from the insurer were used to form a panel data set. Mixed model logistic and linear regressions were estimated to determine the response to insurance for several categories of health services. The use of services increased over time and approached the level of utilization in the NMES. Conditional medical expenditures also increased over time. Actuarial estimates of claims cost greatly exceeded actual claims cost. The provision of a limited medical, dental, and optical benefit package cost approximately $20-$24 per member per month in claims paid. An important uncertainty in providing health insurance to previously uninsured populations is whether a pent-up demand exists for health services. Evidence of a pent-up demand for medical services was not supported in this study of rural school-age children. States considering partnerships with private insurers to implement the State Children's Health Insurance Program could lower premium costs by assembling basic data on previously uninsured children.

  4. Cyber Insurance - Managing Cyber Risk

    Science.gov (United States)

    2015-04-01

    disaster response plans, how employees and others access data systems, and at a minimum, the antivirus and anti- malware software used by the business, the...a policy for insuring data stored in the cloud.[5] Typically, businesses that install or ser- vice software or networks or provide IT consulting for...security, and privacy. Errors and omissions covers claims related to performance of services such as software development or consulting services

  5. Nuclear insurance

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    The German Nuclear Power Plant Insurance (DKVG) Association was able to increase its net capacity in property insurance to 637 million marks in 1993 (1992: 589 million). The reinsurance capacity of the other pools included, the total amount covered now amounts to 2 billion marks in property incurance and 200 million marks in liability incurance. As in the year before the pool can reckon with a stable gross premium yield around 175 million marks. The revival of the US dollar has played a decisive role in this development. In 1993 in the domestic market, the DKVG offered policies for 22 types of property risk and 43 types to third-party risk, operating with a gross target premium of 65 million marks and 16 million marks, respectively. The DKVG also participated in 540 foreign insurance contracts. (orig./HSCH) [de

  6. Factors affecting the insurance sector development: Evidence from Albania

    Directory of Open Access Journals (Sweden)

    Eglantina Zyka

    2014-03-01

    Full Text Available In this paper we explore factors potentially affecting the size of Albanian insurance market, over the period 1999 to 2009. The results of co- integration regression show that GDP and fraction urban population, both one lagged value, size of population and paid claims, both at contemporary value, have significant positive effect on aggregate insurance premium in Albania while the market share of the largest company in the insurance market, one lagged value, has significant negative effect on aggregate insurance premiums. Granger causality test shows statistically significance contribution of GDP growth to insurance premium growth, GDP drives insurance premium growth but not vice versa. The Albanian insurance market is under development, indicators as: insurance penetration, premium per capita, ect are still at low level and this can justify the insignificant role of the insurance in the economy

  7. Causal language and strength of inference in academic and media articles shared in social media (CLAIMS): A systematic review.

    Science.gov (United States)

    Haber, Noah; Smith, Emily R; Moscoe, Ellen; Andrews, Kathryn; Audy, Robin; Bell, Winnie; Brennan, Alana T; Breskin, Alexander; Kane, Jeremy C; Karra, Mahesh; McClure, Elizabeth S; Suarez, Elizabeth A

    2018-01-01

    The pathway from evidence generation to consumption contains many steps which can lead to overstatement or misinformation. The proliferation of internet-based health news may encourage selection of media and academic research articles that overstate strength of causal inference. We investigated the state of causal inference in health research as it appears at the end of the pathway, at the point of social media consumption. We screened the NewsWhip Insights database for the most shared media articles on Facebook and Twitter reporting about peer-reviewed academic studies associating an exposure with a health outcome in 2015, extracting the 50 most-shared academic articles and media articles covering them. We designed and utilized a review tool to systematically assess and summarize studies' strength of causal inference, including generalizability, potential confounders, and methods used. These were then compared with the strength of causal language used to describe results in both academic and media articles. Two randomly assigned independent reviewers and one arbitrating reviewer from a pool of 21 reviewers assessed each article. We accepted the most shared 64 media articles pertaining to 50 academic articles for review, representing 68% of Facebook and 45% of Twitter shares in 2015. Thirty-four percent of academic studies and 48% of media articles used language that reviewers considered too strong for their strength of causal inference. Seventy percent of academic studies were considered low or very low strength of inference, with only 6% considered high or very high strength of causal inference. The most severe issues with academic studies' causal inference were reported to be omitted confounding variables and generalizability. Fifty-eight percent of media articles were found to have inaccurately reported the question, results, intervention, or population of the academic study. We find a large disparity between the strength of language as presented to the

  8. Inflation Insurance

    OpenAIRE

    Zvi Bodie

    1989-01-01

    A contract to insure $1 against inflation is equivalent to a European call option on the consumer price index. When there is no deductible this call option is equivalent to a forward contract on the CPI. Its price is the difference between the prices of a zero coupon real bond and a zero coupon nominal bond, both free of default risk. Provided that the risk-free real rate of interest is positive, the price of such an inflation insurance policy first rises and then falls with time to maturity....

  9. Health insurance premium tax credit. Final regulations.

    Science.gov (United States)

    2013-02-01

    This document contains final regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.These final regulations provide guidance to individuals related to employees who may enroll in eligible employer-sponsored coverage and who wish to enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the premium tax credit.

  10. What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries? A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    David Mark Dror

    insurance and CBHI, (b healthcare quality, (c trust in scheme management, and (d receipt of an insurance payout the previous year. The barriers to renewal decisions were: (a stringent rules of some CBHI schemes, (b inadequate legal and policy frameworks to support CBHI and (c inappropriate benefits package.The demand-side factors positively affecting enrolment in CBHI include education, age, female household heads, and the socioeconomic status of households. Moreover, when individuals understand how their CBHI functions they are more likely to enroll and when people have a positive claims experience, they are more likely to renew. A higher prevalence of chronic conditions or the perception that healthcare is of good quality and nearby act as factors enhancing enrolment. The perception that services are distant or deficient leads to lower enrolments. The second insight is that trust in the scheme enables enrolment. Thirdly, clarity about the legal or policy framework acts as a factor influencing enrolments. This is significant, as it points to hitherto unpublished evidence that governments can effectively broaden their outreach to grassroots groups that are excluded from social protection by formulating supportive regulatory and policy provisions even if they cannot fund such schemes in full, by leveraging people's willingness to exercise voluntary and contributory enrolment in a community-based health insurance.

  11. What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries? A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Hossain, S. A. Shahed; Pérez Koehlmoos, Tracey Lynn; John, Denny

    2016-01-01

    ) knowledge and understanding of insurance and CBHI, (b) healthcare quality, (c) trust in scheme management, and (d) receipt of an insurance payout the previous year. The barriers to renewal decisions were: (a) stringent rules of some CBHI schemes, (b) inadequate legal and policy frameworks to support CBHI and (c) inappropriate benefits package. Conclusion and Policy Implications The demand-side factors positively affecting enrolment in CBHI include education, age, female household heads, and the socioeconomic status of households. Moreover, when individuals understand how their CBHI functions they are more likely to enroll and when people have a positive claims experience, they are more likely to renew. A higher prevalence of chronic conditions or the perception that healthcare is of good quality and nearby act as factors enhancing enrolment. The perception that services are distant or deficient leads to lower enrolments. The second insight is that trust in the scheme enables enrolment. Thirdly, clarity about the legal or policy framework acts as a factor influencing enrolments. This is significant, as it points to hitherto unpublished evidence that governments can effectively broaden their outreach to grassroots groups that are excluded from social protection by formulating supportive regulatory and policy provisions even if they cannot fund such schemes in full, by leveraging people’s willingness to exercise voluntary and contributory enrolment in a community-based health insurance. PMID:27579731

  12. Improving access for Medicaid-insured children: focus on front-office personnel.

    Science.gov (United States)

    Lam, M; Riedy, C A; Milgrom, P

    1999-03-01

    Access to dental services for low-income children is limited. Front-office personnel play a role regarding dentists' participation in the Medicaid program. Subjects (N = 24) represented general dental offices in Spokane County, Wash., and included participants and nonparticipants in the Access to Baby and Child Dentistry, or ABCD, program, a dental society/community program aimed at expanding dental services provided to Medicaid-insured children. The authors stratified the participants according to the number of claims their practices submitted to Medicaid for ABCD children: non-ABCD, low-ABCD and high-ABCD. Five two-hour focus group sessions were conducted to determine participants' beliefs about, attitudes toward and experiences in serving this population. The authors' data analysis consisted of a comprehensive content review of participants' responses from transcripted audiotapes. They synthesized frequently mentioned concepts and ideas into relevant themes. The major factors affecting practices' participation in Medicaid were office policy on seeing Medicaid-insured patients; staff members' personal connection to Medicaid-insured patients; staff members' attitudes about Medicaid-insured patients; and staff members' perceptions of Medicaid-insured patients' barriers to care. The data suggest that factors affecting dentists' participation in the Medicaid program are more complex than the often-stated dissatisfactions with low reimbursement fees and hassles with paperwork. Efforts to increase dentist participation in serving Medicaid-insured patients will continue to be relatively ineffective until many of the concerns raised by this study's subjects are better understood and addressed.

  13. The effect of copayments for prescriptions on adherence to prescription medicines in publicly insured populations; a systematic review and meta-analysis.

    Science.gov (United States)

    Sinnott, Sarah-Jo; Buckley, Claire; O'Riordan, David; Bradley, Colin; Whelton, Helen

    2013-01-01

    Copayments are intended to decrease third party expenditure on pharmaceuticals, particularly those regarded as less essential. However, copayments are associated with decreased use of all medicines. Publicly insured populations encompass some vulnerable patient groups such as older individuals and low income groups, who may be especially susceptible to medication non-adherence when required to pay. Non-adherence has potential consequences of increased morbidity and costs elsewhere in the system. To quantify the risk of non-adherence to prescribed medicines in publicly insured populations exposed to copayments. The population of interest consisted of cohorts who received public health insurance. The intervention was the introduction of, or an increase, in copayment. The outcome was non-adherence to medications, evaluated using objective measures. Eight electronic databases and the grey literature were systematically searched for relevant articles, along with hand searches of references in review articles and the included studies. Studies were quality appraised using modified EPOC and EHPPH checklists. A random effects model was used to generate the meta-analysis in RevMan v5.1. Statistical heterogeneity was assessed using the I(2) test; p>0.1 indicated a lack of heterogeneity. Seven out of 41 studies met the inclusion criteria. Five studies contributed more than 1 result to the meta-analysis. The meta-analysis included 199,996 people overall; 74,236 people in the copayment group and 125,760 people in the non-copayment group. Average age was 71.75 years. In the copayment group, (verses the non-copayment group), the odds ratio for non-adherence was 1.11 (95% CI 1.09-1.14; P = medicines in publicly insured populations where copayments for medicines are necessary. Policy-makers should be wary of potential negative clinical outcomes resulting from non-adherence, and also possible knock-on economic repercussions.

  14. Outcomes, costs and stakeholders' perspectives associated with the incorporation of community pharmacy services into the National Health Insurance System in Thailand: a systematic review.

    Science.gov (United States)

    Asayut, Narong; Sookaneknun, Phayom; Chaiyasong, Surasak; Saramunee, Kritsanee

    2018-02-01

    Identify costs, outcomes and stakeholders' perspectives associated with incorporation of community pharmacy services into the Thai National Health Insurance System and their values to all stakeholders. Using a combination of search terms, a comprehensive literature search was performed using the Thai Journal Citation Index Centre, Health System Research Institute database, PubMed and references from recent reviews. Identified studies were published between January 2000 and December 2014. The review included publications in English and Thai on primary research undertaken in community pharmacies associated with the National Health Insurance System. Two independent authors performed study selection, data extraction and quality assessment. The literature search yielded 251 titles, with 18 satisfying the inclusion criteria. Clinical outcomes of community pharmacy services included control and reduction in blood pressure and blood sugar, improved adherence to medications, an increase in acceptance of interventions, and an increase in healthy behaviours. Thirty-three percentage of those at risk of diabetes and hypertension achieved normal blood sugar and blood pressure levels after being followed for 2-6 months by a community pharmacist. The cost of collaborative screening by community pharmacies and primary care units was US$ 4.5. Diabetes management costs were US$ 5.1-30.7. Community pharmacists reported high satisfaction rates. Stakeholders' perspectives revealed support for the community pharmacists' roles and the inclusion of community pharmacies as partners with the National Health Insurance System. Community pharmacy services improved outcomes for diabetic and hypertensive patients. This review supports the feasibility of incorporating community pharmacies into the Thai National Health System. © 2017 Royal Pharmaceutical Society.

  15. Insurance Regulation: The NAIC Accreditation Program Can be Improved

    National Research Council Canada - National Science Library

    DIngell, John

    2001-01-01

    ... environment of the insurance industry and insurance regulation. In addition, it has revised the way accreditation reviews are performed and scored and has improved training for members of review teams.

  16. Medical reports on persons claiming compensation for personal injury.

    Science.gov (United States)

    Cornes, P; Aitken, R C

    1992-06-01

    An audit of one insurance company's files on all employer's liability and third party motor claims settled over two years for 5000 pounds or more presented an opportunity to review the medical reports on the patients involved. A stratified random sample of files on 203 patients contained 602 reports prepared by 400 consultants. Content analysis was undertaken to evaluate compliance with published guidance on reports prepared for medico-legal purposes and to ascertain how well reports met recipients' requirements. While clinical topics were well covered, generally to a high standard, other functional, psychosocial and occupational topics, reflecting the wider clinical and non-clinical frame of reference within which lawyers and insurers normally seek information and advice, were covered less frequently, extensively and comprehensively--leaving considerable scope to improve these aspects of assessment and reporting. Further review of this aspect of professional practice should include attention to the appropriateness of existing guidance, postgraduate training requirements and the involvement of other agencies or professions in some aspects of assessment for medico-legal purposes.

  17. 32 CFR 536.120 - Claims payable as maritime claims.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Claims payable as maritime claims. 536.120... ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.120 Claims payable as maritime claims. A claim is cognizable under this subpart if it arises in or on a maritime location, involves some...

  18. Using 'big data' to validate claims made in the pharmaceutical approval process.

    Science.gov (United States)

    Wasser, Thomas; Haynes, Kevin; Barron, John; Cziraky, Mark

    2015-01-01

    Big Data in the healthcare setting refers to the storage, assimilation, and analysis of large quantities of information regarding patient care. These data can be collected and stored in a wide variety of ways including electronic medical records collected at the patient bedside, or through medical records that are coded and passed to insurance companies for reimbursement. When these data are processed it is possible to validate claims as a part of the regulatory review process regarding the anticipated performance of medications and devices. In order to analyze properly claims by manufacturers and others, there is a need to express claims in terms that are testable in a timeframe that is useful and meaningful to formulary committees. Claims for the comparative benefits and costs, including budget impact, of products and devices need to be expressed in measurable terms, ideally in the context of submission or validation protocols. Claims should be either consistent with accessible Big Data or able to support observational studies where Big Data identifies target populations. Protocols should identify, in disaggregated terms, key variables that would lead to direct or proxy validation. Once these variables are identified, Big Data can be used to query massive quantities of data in the validation process. Research can be passive or active in nature. Passive, where the data are collected retrospectively; active where the researcher is prospectively looking for indicators of co-morbid conditions, side-effects or adverse events, testing these indicators to determine if claims are within desired ranges set forth by the manufacturer. Additionally, Big Data can be used to assess the effectiveness of therapy through health insurance records. This, for example, could indicate that disease or co-morbid conditions cease to be treated. Understanding the basic strengths and weaknesses of Big Data in the claim validation process provides a glimpse of the value that this research

  19. SyncClaimService

    Data.gov (United States)

    Department of Veterans Affairs — Provides various methods to sync Claim related data for NWQ processing. It includes web operations to get Claims, get Unique Contention Classifications, get Unique...

  20. IBO Claim Taking Project

    Data.gov (United States)

    Social Security Administration — IBO manually tracks all Canadian Claims and DSU claims via this report. It also provides a summary for each region and office of origin that the DSU works with. This...

  1. Workers Compensation Claim Data -

    Data.gov (United States)

    Department of Transportation — This data set contains DOT employee workers compensation claim data for current and past DOT employees. Types of data include claim data consisting of PII data (SSN,...

  2. Medicaid Drug Claims Statistics

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicaid Drug Claims Statistics CD is a useful tool that conveniently breaks up Medicaid claim counts and separates them by quarter and includes an annual count.

  3. Crop insurance: Risks and models of insurance

    Directory of Open Access Journals (Sweden)

    Čolović Vladimir

    2014-01-01

    Full Text Available The issue of crop protection is very important because of a variety of risks that could cause difficult consequences. One type of risk protection is insurance. The author in the paper states various models of insurance in some EU countries and the systems of subsidizing of insurance premiums by state. The author also gives a picture of crop insurance in the U.S., noting that in this country pays great attention to this matter. As for crop insurance in Serbia, it is not at a high level. The main problem with crop insurance is not only the risks but also the way of protection through insurance. The basic question that arises not only in the EU is the question is who will insure and protect crops. There are three possibilities: insurance companies under state control, insurance companies that are public-private partnerships or private insurance companies on a purely commercial basis.

  4. 20 CFR 410.705 - Duplicate claims.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Duplicate claims. 410.705 Section 410.705 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Rules for the Review of Denied and Pending Claims Under the Black Lung...

  5. Insurer risk control and nuclear liability

    Energy Technology Data Exchange (ETDEWEB)

    DeMerchant, C. [Nuclear Insurance Association of Canada, Toronto, ON (Canada)

    2015-07-01

    We specialize in high quality insurance risk management, underwriting and inspections for Canadian nuclear exposures. We provide true risk transfer, secure insurance capacity and collaborate with the world's nuclear experts to create innovative domestic solutions for our clients and members. The benefit of our experience works for all stake holders: insured clients, members, multi-level government agencies and all Canadians. NIAC has a 55-year history of partnering with insurers around the globe to create reliable risk management for the nuclear industry. We offer Canadian risk solutions, thought leadership and expertise that provides security and confidence to our customers and members. NIAC leads in the areas of nuclear insurance law, good governance and claims administration to create a true Centre of Excellence.

  6. Insurer risk control and nuclear liability

    International Nuclear Information System (INIS)

    DeMerchant, C.

    2015-01-01

    We specialize in high quality insurance risk management, underwriting and inspections for Canadian nuclear exposures. We provide true risk transfer, secure insurance capacity and collaborate with the world's nuclear experts to create innovative domestic solutions for our clients and members. The benefit of our experience works for all stake holders: insured clients, members, multi-level government agencies and all Canadians. NIAC has a 55-year history of partnering with insurers around the globe to create reliable risk management for the nuclear industry. We offer Canadian risk solutions, thought leadership and expertise that provides security and confidence to our customers and members. NIAC leads in the areas of nuclear insurance law, good governance and claims administration to create a true Centre of Excellence.

  7. Premium Forecasting of AN Insurance Company:

    Science.gov (United States)

    Fouladvand, M. Ebrahim; Darooneh, Amir H.

    We present an analytical study of an insurance company. We model the company's performance on a statistical basis and evaluate the predicted annual income of the company in terms of insurance parameters namely the premium, the total number of insured, average loss claims etc. We restrict ourselves to a single insurance class the so-called automobile insurance. We show the existence of a crossover premium pc below which the company is operating at a loss. Above pc, we also give a detailed statistical analysis of the company's financial status and obtain the predicted profit along with the corresponding risk as well as ruin probability in terms of premium. Furthermore we obtain the optimal premium popt which maximizes the company's profit.

  8. HEALTH INSURANCE

    CERN Multimedia

    Division HR

    2000-01-01

    Change of name for AUSTRIA As of October 1, the AUSTRIA Assurances S.A. company will change its name to: UNIQA Assurances S.A. It inherits the same name as its parent Austrian company, which adopted it towards the end of 1999. This change has no effect on the contract which binds it to CERN for the administration of our Health Insurance Scheme. New insurance cards will be sent to you by UNIQA and the printed forms and envelopes will gradually be updated with the new name. Postal and phone addresses remain unaffected by the change. You should address your postal mail to: UNIQA Assurances rue des Eaux Vives 94 case postale 6402 1211 Genève 6 You may telephone your usual contact persons at the same numbers as before and send e-mails to the UNIQA office at CERN at: UNIQA.Assurances@cern.ch

  9. Medical research using governments' health claims databases: with or without patients' consent?

    Science.gov (United States)

    Tsai, Feng-Jen; Junod, Valérie

    2018-03-01

    Taking advantage of its single-payer, universal insurance system, Taiwan has leveraged its exhaustive database of health claims data for research purposes. Researchers can apply to receive access to pseudonymized (coded) medical data about insured patients, notably their diagnoses, health status and treatments. In view of the strict safeguards implemented, the Taiwanese government considers that this research use does not require patients' consent (either in the form of an opt-in or in the form of an opt-out). A group of non-governmental organizations has challenged this view in the Taiwanese Courts, but to no avail. The present article reviews the arguments both against and in favor of patients' consent for re-use of their data in research. It concludes that offering patients an opt-out would be appropriate as it would best balance the important interests at issue.

  10. 28 CFR 543.32 - Processing the claim.

    Science.gov (United States)

    2010-07-01

    ..., Central Office for their review. (f) Will appreciation or depreciation be considered? Yes. Staff will consider appreciation or depreciation of lost or damaged property in settling a claim. (g) If my claim is...

  11. Export insurance

    International Nuclear Information System (INIS)

    1981-01-01

    These notes are intended as a general guide for the use of members of the Canadian Nuclear Association who are, or may become, involved in supplying goods or services or contracting/ erecting as part of a contract to supply a nuclear facility to an overseas country. They give information to the type of insurances needed and available, the parties normally responsible for providing the coverages, the intent and operation of the various policies, general methods of charging premiums, and main exclusions

  12. HEALTH INSURANCE

    CERN Multimedia

    2000-01-01

    The CERN-AUSTRIA Agreement, which implemented CERN's health insurance scheme, expired on 31 December 1999.In accordance with CERN's rules, a call for tenders for the management of the health insurance scheme was issued and the contract was once again awarded to AUSTRIA. In June 1999, the Finance Committee thus authorised the Management to conclude a new contract with AUSTRIA, which came into force on 1st January 2000.Continuity is thus assured on favourable conditions and the transition from one contract to the other will entail no substantial changes in the system for those insured at CERN except for a few minor and purely formal amendmentsWHAT REMAINS UNCHANGEDThe list of benefits, i.e. the 'cover' provided by the system, is not changed;Neither is the reimbursement procedure.AUSTRIA's office at CERN and its opening hours as well as its city headquarters remain the same. The envelopes containing requests for reimbursement have had to be sent (since the end of 1998) to :Rue des Eaux-Vives 94Case postale 64021...

  13. The insurability of product recall in food supply chains

    NARCIS (Netherlands)

    Meuwissen, M.P.M.; Valeeva, N.I.; Velthuis, A.G.J.; Huirne, R.B.M.

    2006-01-01

    Insurers face growing difficulties with insuring food-related risks among others due to an increasing number of product recalls and an increasing amount of claims being pushed back into the chain. This paper focuses on the risk of product recall in dairy supply chains. The paper aims at providing

  14. 26 CFR 1.801-4 - Life insurance reserves.

    Science.gov (United States)

    2010-04-01

    ... is claimed. However, reserves held by the company with respect to the net value of risks reinsured in..., life insurance reserves, as in the case of level premium life insurance, are held to supplement the... amount (if any) by which: (i) The present value of the future net premiums required for such contract...

  15. Pricing of General Insurance and the Impact of Asymmetric Information

    DEFF Research Database (Denmark)

    Englund, Martin

    To set the insurance premium correctly is of outmost importance on a competitive insurance market. Hence the overall objective of this thesis is to improve the pricing, first by using individual claims information, and second by using information about the individuals choice of coverage. Regarding...

  16. Insurance Companies Fighting the Peer Review Empire without any Validity: the Case for Addiction and Pain Modalities in the face of an American Drug Epidemic.

    Science.gov (United States)

    Blum, K; Jacobs, W; Modestino, E J; DiNubile, N; Baron, D; McLaughlin, T; Siwicki, D; Elman, I; Moran, M; Braverman, E R; Thanos, P K; Badgaiyan, R D

    2018-10-04

    The United States are amid an opioid overdose epidemic; we are challenged to provide non-addicting/non-pharmacological alternatives to assist in pain attenuation. There are proven strategies available to manage chronic pain effectively without opioids. Utilization review providers for insurance companies often ignore medicine based scientific peer-reviewed studies that warn against the chronic use of opioid medications, as well as the lack of evidence to support long-term use of opioids for pain. This paradigm must change if we are to indeed change the drug-embracing culture in American chronic pain management. A barrier to treatment is pushback on the part of insurance companies especially as it relates to fighting against pain relief alternatives compared to classical analgesic agents. Pain specialists in the U.S., are compelled to find alternative solutions to help pain victims without promoting unwanted tolerance to analgesics and subsequent biological induction of the "addictive brain." It is noteworthy that reward center of the brain plays a crucial role in the modulation of nociception, and that adaptations in dopaminergic circuitry may affect several sensory and affective components of chronic pain syndromes. Possibly knowing a patient's genetic addiction risk score (GARS™) could eliminate guessing as it relates to becoming addicted.

  17. Exploring fraud and abuse in National Health Insurance Scheme ...

    African Journals Online (AJOL)

    This study explored patterns of fraud and abuse that exist in the National Health Insurance Scheme (NHIS) claims in the Awutu-Effutu-Senya District using data mining techniques, with a specific focus on malaria-related claims. The study employed quantitative research approach with survey design as a strategy of enquiry.

  18. Insurance billing and coding.

    Science.gov (United States)

    Napier, Rebecca H; Bruelheide, Lori S; Demann, Eric T K; Haug, Richard H

    2008-07-01

    The purpose of this article is to highlight the importance of understanding various numeric and alpha-numeric codes for accurately billing dental and medically related services to private pay or third-party insurance carriers. In the United States, common dental terminology (CDT) codes are most commonly used by dentists to submit claims, whereas current procedural terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD.9.CM) codes are more commonly used by physicians to bill for their services. The CPT and ICD.9.CM coding systems complement each other in that CPT codes provide the procedure and service information and ICD.9.CM codes provide the reason or rationale for a particular procedure or service. These codes are more commonly used for "medical necessity" determinations, and general dentists and specialists who routinely perform care, including trauma-related care, biopsies, and dental treatment as a result of or in anticipation of a cancer-related treatment, are likely to use these codes. Claim submissions for care provided can be completed electronically or by means of paper forms.

  19. Clinical safety and professional liability claims in Ophthalmology.

    Science.gov (United States)

    Dolz-Güerri, F; Gómez-Durán, E L; Martínez-Palmer, A; Castilla Céspedes, M; Arimany-Manso, J

    2017-11-01

    Patient safety is an international public health priority. Ophthalmology scientific societies and organisations have intensified their efforts in this field. As a tool to learn from errors, these efforts have been linked to the management of medical professional liability insurance through the analysis of claims. A review is performed on the improvements in patient safety, as well as professional liability issues in Ophthalmology. There is a high frequency of claims and risk of economic reparation of damage in the event of a claim in Ophthalmology. Special complaints, such as wrong surgery or lack of information, have a high risk of financial compensation and need strong efforts to prevent these potentially avoidable events. Studies focused on pathologies or specific procedures provide information of special interest to sub-specialists. The specialist in Ophthalmology, like any other doctor, is subject to the current legal provisions and appropriate mandatory training in the medical-legal aspects of health care is essential. Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career, and help in increasing patient safety. The aim of this review is to contribute to this training, for the benefit of professionals and patients. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. STUDY ON THE MAIN THEORETICAL ASPECTS RELATING TO THE PREMIUM TARIFFS IN THE PROPERTY INSURANCE

    Directory of Open Access Journals (Sweden)

    Vaduva Maria

    2012-03-01

    Full Text Available In the insurance market of goods, most of the first levied by the insurer is used for payment of damages due insured. The element mainly depending on which he fixes the level of share premium pricing is likely to size claims the insurer will pay insured. Part of the quota tariff intended for the first payment of damages is called net or share of first base. Adding to the addition cover expenditure on lodging and administering the fund insurance and financing of measures to prevent the damage, formation of the reserve fund and achieve the insurer has a specific benefit, get the first tariff or first gross.

  1. Private health insurance: implications for developing countries.

    Science.gov (United States)

    Sekhri, Neelam; Savedoff, William

    2005-02-01

    Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.

  2. Avoiding the known prior acts exclusion when insuring newly acquired entities.

    Science.gov (United States)

    Gasior, J P; Passannante, W G

    1998-09-01

    Adding a new entity to an organization's existing insurance program can be problematic if the existing policy contains a known prior acts exclusion clause. By purportedly excluding claims that a policyholder "could have reasonably foreseen or discovered," the known prior acts exclusion allows the insurer to reject those claims after a lawsuit has been filed policyholders should have known prior acts exclusion clauses removed from their policies or work with their insurers on language that will clarify the policy regarding this exclusion.

  3. 25 CFR 103.6 - To what extent will BIA guarantee or insure a loan?

    Science.gov (United States)

    2010-04-01

    ... insurance percentage rate that satisfies the lender's risk management requirements. (d) Absent exceptional... lender has insured under the Program as of the date the lender makes a claim under its insurance coverage... outstanding loans from the same lender to the same borrower; or (2) One loan guaranty under the Program when...

  4. Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims

    International Nuclear Information System (INIS)

    Breen, Micheal A.; Taylor, George A.; Dwyer, Kathy; Yu-Moe, Winnie

    2017-01-01

    Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality implicated in

  5. Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims

    Energy Technology Data Exchange (ETDEWEB)

    Breen, Micheal A.; Taylor, George A. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Dwyer, Kathy; Yu-Moe, Winnie [CRICO Risk Management Foundation, Boston, MA (United States)

    2017-06-15

    Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality

  6. Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims.

    Science.gov (United States)

    Breen, Micheál A; Dwyer, Kathy; Yu-Moe, Winnie; Taylor, George A

    2017-06-01

    Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality implicated in

  7. Trade Credit Insurance and Asymmetric Information Problem

    Directory of Open Access Journals (Sweden)

    Sokolovska Olena

    2017-03-01

    Full Text Available The presence of different risk factors in international trade gives evidence of the necessity of support in gaps that may affect exporters’ activity. To maximize the trade volumes and in the same time to minimize the exporters’ risks the stakeholders use trade credit insurance. The paper provides analysis of conceptual background of the trade credit insurance in the world. We analyzed briefly the problems, arising in insurance markets due to asymmetric information, such as adverse selection and moral hazard. Also we discuss the main stages of development of trade credit insurance in countries worldwide. Using comparative and graphical analysis we provide a brief evaluation of the dynamics of claims and recoveries for different forms of trade credit insurance. We found that the claims related to the commercial risk for medium and long trade credits in recent years exceed the recoveries, while with the political risk the reverse trend holds. And we originally consider these findings in terms of information asymmetry in the trade credit insurance differentiated by type of risk.

  8. Court rejects claim of mental illness from needlestick.

    Science.gov (United States)

    1998-05-29

    The Montana Supreme Court rejected the bid of a medical technician to remain on workers' compensation, based on his claims that he suffered from psychosis, depression, and hallucinations after pricking himself with a needle used on an HIV-positive patient. [Name removed], a respiratory therapist at Community Medical Center in Missoula, tested negative for HIV, but claimed that the psychological trauma from the needlestick injury caused him to become disabled. Based on expert testimony, the Workers' Compensation Court determined that [name removed] was faking his symptoms to collect benefits from his employer's insurer, EBI/Orion Group. [Name removed] appealed, and the Supreme Court remanded the case, stating that psychologists are not included among the medical professionals able to conduct medical reviews. The Workers' Compensation Court again found that [name removed] was faking his symptoms, and [name removed] unsuccessfully appealed. The compensation panel cited conflicting evidence from psychological tests, [name removed]'s friends' testimonies, and [name removed]'s personal diary. The Supreme Court upheld the verdict.

  9. Health and Stress Management and Mental-health Disability Claims.

    Science.gov (United States)

    Marchand, Alain; Haines, Victor Y; Harvey, Steve; Dextras-Gauthier, Julie; Durand, Pierre

    2016-12-01

    This study examines the associations between health and stress management (HSM) practices and mental-health disability claims. Data from the Salveo study was collected during 2009-2012 within 60 workplaces nested in 37 companies located in Canada (Quebec) and insured by a large insurance company. In each company, 1 h interviews were conducted with human resources managers in order to obtain data on 63 HSM practices. Companies and workplaces were sorted into the low-claims and high-claims groups according to the median rate of the population of the insurer's corporate clients. Logistic regression adjusted for design effect and multidimensional scaling was used to analyse the data. After controlling for company size and economic sector, task design, demands control, gratifications, physical activity and work-family balance were associated with low mental-health disability claims rates. Further analyses revealed three company profiles that were qualified as laissez-faire, integrated and partially integrated approaches to HSM. Of the three, the integrated profile was associated with low mental-health disability claims rates. The results of this study provide evidence-based guidance for a better control of mental-health disability claims. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  10. Operating room fires: a closed claims analysis.

    Science.gov (United States)

    Mehta, Sonya P; Bhananker, Sanjay M; Posner, Karen L; Domino, Karen B

    2013-05-01

    To assess patterns of injury and liability associated with operating room (OR) fires, closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1985 were reviewed. All claims related to fires in the OR were compared with nonfire-related surgical anesthesia claims. An analysis of fire-related claims was performed to identify causative factors. There were 103 OR fire claims (1.9% of 5,297 surgical claims). Electrocautery was the ignition source in 90% of fire claims. OR fire claims more frequently involved older outpatients compared with other surgical anesthesia claims (P fire claims (P fires (n = 93) increased over time (P fires occurred during head, neck, or upper chest procedures (high-fire-risk procedures). Oxygen served as the oxidizer in 95% of electrocautery-induced OR fires (84% with open delivery system). Most electrocautery-induced fires (n = 75, 81%) occurred during monitored anesthesia care. Oxygen was administered via an open delivery system in all high-risk procedures during monitored anesthesia care. In contrast, alcohol-containing prep solutions and volatile compounds were present in only 15% of OR fires during monitored anesthesia care. Electrocautery-induced fires during monitored anesthesia care were the most common cause of OR fires claims. Recognition of the fire triad (oxidizer, fuel, and ignition source), particularly the critical role of supplemental oxygen by an open delivery system during use of the electrocautery, is crucial to prevent OR fires. Continuing education and communication among OR personnel along with fire prevention protocols in high-fire-risk procedures may reduce the occurrence of OR fires.

  11. The effect of copayments for prescriptions on adherence to prescription medicines in publicly insured populations; a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Sarah-Jo Sinnott

    Full Text Available INTRODUCTION: Copayments are intended to decrease third party expenditure on pharmaceuticals, particularly those regarded as less essential. However, copayments are associated with decreased use of all medicines. Publicly insured populations encompass some vulnerable patient groups such as older individuals and low income groups, who may be especially susceptible to medication non-adherence when required to pay. Non-adherence has potential consequences of increased morbidity and costs elsewhere in the system. OBJECTIVE: To quantify the risk of non-adherence to prescribed medicines in publicly insured populations exposed to copayments. METHODS: The population of interest consisted of cohorts who received public health insurance. The intervention was the introduction of, or an increase, in copayment. The outcome was non-adherence to medications, evaluated using objective measures. Eight electronic databases and the grey literature were systematically searched for relevant articles, along with hand searches of references in review articles and the included studies. Studies were quality appraised using modified EPOC and EHPPH checklists. A random effects model was used to generate the meta-analysis in RevMan v5.1. Statistical heterogeneity was assessed using the I(2 test; p>0.1 indicated a lack of heterogeneity. RESULTS: Seven out of 41 studies met the inclusion criteria. Five studies contributed more than 1 result to the meta-analysis. The meta-analysis included 199,996 people overall; 74,236 people in the copayment group and 125,760 people in the non-copayment group. Average age was 71.75 years. In the copayment group, (verses the non-copayment group, the odds ratio for non-adherence was 1.11 (95% CI 1.09-1.14; P = <0.00001. An acceptable level of heterogeneity at I(2 = 7%, (p = 0.37 was observed. CONCLUSION: This meta-analysis showed an 11% increased odds of non-adherence to medicines in publicly insured populations where copayments

  12. Is eating organic a healthy or safer option? Health claims for organic food consumption, food quality and safety – A systematic review

    Directory of Open Access Journals (Sweden)

    Sneha Ghai

    2017-12-01

    Full Text Available Universally, there has been an increased awareness about the harmful effects of chemical inputs used for production of food on soil composition, environment and human health. This has triggered the consumption level of organic food products. India has witnessed a tremendous growth in domestic as well as export market. The demand is mainly driven by consumer perceptions that organic farming is more sustainable, produces healthy food, pesticide-free and safeguards the environment & biodiversity. Organic food producers also manifests the quality and safety of food. These claims which are perceived and professed as beneficial can only be accepted if they are tested and validated. Therefore, the foremost objective of this review paper is to provide an update on set of studies related to scientific evidence for nutritional composition marking the quality of organic foods vis-à-vis conventional foods and its impact on human health. Secondly, the paper examines the comparison of the sensory quality of the organic food, and thirdly the food safety aspect of organically as compared with conventionally grown foods. Past few controlled studies have proved that there is no such evidence of differences in concentration of various nutrients amongst organic and conventional foods. Furthermore, there are certain issues related to the impact and assessment of these nutrients in organic food which requires some future directives. Owing to the heterogeneity in results observed related to nutritional quality and safety of organic foods, technological aspects together with sensory parameters are the best for future comparative studies. To safeguard the public health and to avoid the difference in sampling and sample results, testing laboratories should also be adhering to uniform standards. Organic food business in India lack standard guidelines for quality, policy framework for domestic and export market. Also, traceability is another factor which should be given

  13. 28 CFR 104.31 - Procedure for claims evaluation.

    Science.gov (United States)

    2010-07-01

    ... COMPENSATION FUND OF 2001 Claim Intake, Assistance, and Review Procedures § 104.31 Procedure for claims..., described herein as “Track A” and “Track B,” selected by the claimant on the Personal Injury Compensation Form or Death Compensation Form. (1) Procedure for Track A. The Claims Evaluator shall determine...

  14. Linking individual medicare health claims data with work-life claims and other administrative data.

    Science.gov (United States)

    Mokyr Horner, Elizabeth; Cullen, Mark R

    2015-09-30

    Researchers investigating health outcomes for populations over age 65 can utilize Medicare claims data, but these data include no direct information about individuals' health prior to age 65 and are not typically linkable to files containing data on exposures and behaviors during their worklives. The current paper is a proof-of-concept, of merging employers' administrative data and private, employment-based health claims with Medicare data. Characteristics of the linked data, including sensitivity and specificity, are evaluated with an eye toward potential uses of such linked data. This paper uses a sample of former manufacturing workers from an industrial cohort as a test case. The dataset created by this integration could be useful to research in areas such as social epidemiology and occupational health. Medicare and employment administrative data were linked for a large cohort of manufacturing workers (employed at some point during 1996-2008) who transitioned onto Medicare between 2001-2009. Data on work-life health, including biometric indicators, were used to predict health at age 65 and to investigate the concordance of employment-based insurance claims with subsequent Medicare insurance claims. Chronic diseases were found to have relatively high levels of concordance between employment-based private insurance and subsequent Medicare insurance. Information about patient health prior to receipt of Medicare, including biometric indicators, were found to predict health at age 65. Combining these data allows for evaluation of continuous health trajectories, as well as modeling later-life health as a function of work-life behaviors and exposures. It also provides a potential endpoint for occupational health research. This is the first harmonization of its kind, providing a proof-of-concept. The dataset created by this integration could be useful for research in areas such as social epidemiology and occupational health.

  15. Influence of awareness on the usage of motor third party insurance ...

    African Journals Online (AJOL)

    a case study of Kampala district. ... informants (insurers, insurance regulators as well as enforcers – traffic police officers); and carried out desk review of motor third party insurance ... enormous negative economic impact on individuals, fam-.

  16. The health care burden of high grade chronic obstructive pulmonary disease in Korea: analysis of the Korean Health Insurance Review and Assessment Service data.

    Science.gov (United States)

    Kim, JinHee; Rhee, Chin Kook; Yoo, Kwang Ha; Kim, Young Sam; Lee, Sei Won; Park, Yong Bum; Lee, Jin Hwa; Oh, YeonMok; Lee, Sang Do; Kim, Yuri; Kim, KyungJoo; Yoon, HyoungKyu

    2013-01-01

    Patients with high grade chronic pulmonary obstructive disease (COPD) account for much of the COPD-related mortality and incur excessive financial burdens and medical care utilization. We aimed to determine the characteristics and medical care use of such patients using nationwide data from the Korean Health Insurance Review and Assessment Service in 2009. Patients with COPD were identified by searching with the International Classification of Diseases-10th Revision for those using medication. Patients with high grade COPD were selected based on their patterns of tertiary institute visits and medication use. The numbers of patients with high grade COPD increased rapidly in Korea during the study period, and they showed a high prevalence of comorbid disease. The total medical costs were over three times higher in patients with high grade COPD compared with those without it ($3,744 versus $1,183; P system in Korea. Prevention of progression to high grade COPD is important, both clinically and economically.

  17. Federal Deposit Insurance Corporation (FDIC) Insured Banks

    Data.gov (United States)

    Department of Homeland Security — The Summary of Deposits (SOD) is the annual survey of branch office deposits for all FDIC-insured institutions including insured U.S. branches of foreign banks. Data...

  18. Unemployment Insurance Query (UIQ)

    Data.gov (United States)

    Social Security Administration — The Unemployment Insurance Query (UIQ) provides State Unemployment Insurance agencies real-time online access to SSA data. This includes SSN verification and Title...

  19. Formalizing Probabilistic Safety Claims

    Science.gov (United States)

    Herencia-Zapana, Heber; Hagen, George E.; Narkawicz, Anthony J.

    2011-01-01

    A safety claim for a system is a statement that the system, which is subject to hazardous conditions, satisfies a given set of properties. Following work by John Rushby and Bev Littlewood, this paper presents a mathematical framework that can be used to state and formally prove probabilistic safety claims. It also enables hazardous conditions, their uncertainties, and their interactions to be integrated into the safety claim. This framework provides a formal description of the probabilistic composition of an arbitrary number of hazardous conditions and their effects on system behavior. An example is given of a probabilistic safety claim for a conflict detection algorithm for aircraft in a 2D airspace. The motivation for developing this mathematical framework is that it can be used in an automated theorem prover to formally verify safety claims.

  20. 38 CFR 6.7 - Claims of creditors, taxation.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Claims of creditors, taxation. 6.7 Section 6.7 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS UNITED... creditors, taxation. (a) Effective January 1, 1958, payments of insurance to a beneficiary under a United...

  1. Captive insurance: is it the right choice for your insurance exposures?

    Science.gov (United States)

    Frese, Richard C

    2015-12-01

    Potential benefits of a captive insurance company include: Broader coverage Improved cash flow and stability. Direct access to reinsurance markets. Tax advantages. Better handling and control of risk management and claims. Potential drawbacks and challenges include: Startup capitalization. Underwriting losses. Administration and commitment.

  2. Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Fadlallah, Racha; El-Jardali, Fadi; Hemadi, Nour; Morsi, Rami Z; Abou Samra, Clara Abou; Ahmad, Ali; Arif, Khurram; Hishi, Lama; Honein-AbouHaidar, Gladys; Akl, Elie A

    2018-01-29

    Community-based health insurance (CBHI) has evolved as an alternative health financing mechanism to out of pocket payments in low- and middle-income countries (LMICs), particularly in areas where government or employer-based health insurance is minimal. This systematic review aimed to assess the barriers and facilitators to implementation, uptake and sustainability of CHBI schemes in LMICs. We searched six electronic databases and grey literature. We included both quantitative and qualitative studies written in English language and published after year 1992. Two reviewers worked in duplicate and independently to complete study selection, data abstraction, and assessment of methodological features. We synthesized the findings based on thematic analysis and categorized according to the ecological model into individual, interpersonal, community and systems levels. Of 15,510 citations, 51 met the eligibility criteria. Individual factors included awareness and understanding of the concept of CBHI, trust in scheme and scheme managers, perceived service quality, and demographic characteristics, which influenced enrollment and sustainability. Interpersonal factors such as household dynamics, other family members enrolled in the scheme, and social solidarity influenced enrollment and renewal of membership. Community-level factors such as culture and community involvement in scheme development influenced enrollment and sustainability of scheme. Systems-level factors encompassed governance, financial and delivery arrangement. Government involvement, accountability of scheme management, and strong policymaker-implementer relation facilitated implementation and sustainability of scheme. Packages that covered outpatient and inpatient care and those tailored to community needs contributed to increased enrollment. Amount and timing of premium collection was reported to negatively influence enrollment while factors reported as threats to sustainability included facility

  3. Nuclear liability act and nuclear insurance

    International Nuclear Information System (INIS)

    Clarke, Roy G.; Goyette, R.; Mathers, C.W.; Germani, T.R.

    1976-01-01

    The Nuclear Liability Act, enacted in June 1970 and proclaimed effective October 11, 1976, is a federal law governing civil liability for nuclear damage in Canada incorporating many of the basic principles of the international conventions. Exceptions to operator liability for breach of duty imposed by the Act and duty of the operator as well as right of recourse, time limit on bringing actions, special measures for compensation and extent of territory over which the operator is liable are of particular interest. An operator must maintain $75,000,000. of insurance for each nuclear installation for which he is the operator. The Nuclear Insurance Association of Canada (NIAC) administers two ΣPoolsΣ or groups of insurance companies where each member participates for the percentage of the total limit on a net basis, one pool being for Physical Damage Insurance and the other for Liability Insurance. The Atomic Energy Control Board recommends to the Treasury Board the amount of insurance (basic) for each installation. Basic insurance required depends on the exposure and can range from $4 million for a fuel fabricator to $75 million for a power reactor. Coverage under the Operator's Policy provides for bodily injury, property damage and various other claims such as damage from certain transportation incidents as well as nuclear excursions. Workmen's Compensation will continue to be handled by the usual channels. (L.L.)

  4. 24 CFR 201.55 - Calculation of insurance claim payment.

    Science.gov (United States)

    2010-04-01

    ... dealer, real estate agent or other third party for the resale of the repossessed or foreclosed... foreclosed manufactured home and lot are classified as realty, the amount of: (i) State or local real estate...

  5. Discounting medical malpractice claim reserves for self-insured hospitals.

    Science.gov (United States)

    Frese, Richard; Kitchen, Patrick

    2011-01-01

    The hospital CFO often works with the hospital's actuary and external auditor to calculate the reserves recorded in financial statements. Hospital management, usually the CFO, needs to decide the discount rate that is most appropriate. A formal policy addressing the rationale for discounting and the rationale for selecting the discount rate can be helpful to the CFO, actuary, and external auditor.

  6. Agricultural insurance under the Solvency II Directive

    Directory of Open Access Journals (Sweden)

    Njegomir Vladimir

    2014-01-01

    Full Text Available Solvency II Directive represents a new framework of unique solvency regulation of insurance and reinsurance companies in the European Union. Although it has not yet been implemented in national legislations, it can be concluded, based on the directive wording and conducted quantitative studies, that it will have implications on agricultural producers since they are the users of insurance services. The aim of the research presented in this paper is to analyse the implications of the new directive to agricultural producers since they are the insureds and the main actors of agribusiness. Firstly, the paper gives an overview of the basic features of the new regulatory framework and then it points at the issues and the needs for intensive application of Directive in order to improve the insurance business in Serbia. The process will direct the settlement of major claims, the ones that are typical of catastrophic risks in agriculture, towards the insurance, while the expectations from the government will be directed towards the regulation of the setting and economic measures (development and investment subsidies, cooperative movement. In addition, the paper points at the demands of the new regulation and analyses the implications of the new regulation regarding the settlement of claims resulting from major flood since it represents the example that proves the basic postulate.

  7. Price-Anderson Act: Congressional review begins

    International Nuclear Information System (INIS)

    Anon.

    1984-01-01

    Every 10 years Congress reviews, amends, and extends the Price-Anderson Act of 1957, which was designed to encourage the new nuclear industry by guaranteeing insurance beyond the level provided by private insurers. The Nuclear Regulatory Commission is recommending five congressional actions for the 1987 extension: reauthorization, replacement of the absolute insurance limitation with an annual limitation of liability, raising the retrospective premium per reactor per incident from $5 million to $10 million, raising the statute of limitations on claims for 20 to 30 years, and retaining current language dealing with extraordinary events. Two bills, H.R. 421 and H.R. 3277, were introduced with provisions that broaden the opportunity for victims compensation and eliminate the subsidy aspect. Hearings began in July, with reactions from the National Taxpayers Union and Nuclear insurance underwriters in conflict over the limitations on liability. DOE and DOE contractors urge continuation of the Price-Anderson limitation

  8. Women's Health Insurance Coverage

    Science.gov (United States)

    ... Women's Health Policy Women’s Health Insurance Coverage Women’s Health Insurance Coverage Published: Oct 31, 2017 Facebook Twitter LinkedIn ... that many women continue to face. Sources of Health Insurance Coverage Employer-Sponsored Insurance: Approximately 57.9 million ...

  9. Alternative health insurance schemes

    DEFF Research Database (Denmark)

    Keiding, Hans; Hansen, Bodil O.

    2002-01-01

    In this paper, we present a simple model of health insurance with asymmetric information, where we compare two alternative ways of organizing the insurance market. Either as a competitive insurance market, where some risks remain uninsured, or as a compulsory scheme, where however, the level...... competitive insurance; this situation turns out to be at least as good as either of the alternatives...

  10. Health Insurance Basics

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Health Insurance Basics KidsHealth / For Teens / Health Insurance Basics What's ... thought advanced calculus was confusing. What Exactly Is Health Insurance? Health insurance is a plan that people buy ...

  11. Willingness to Pay for Insurance in Denmark

    DEFF Research Database (Denmark)

    Hansen, Jan V.; Højbjerg Jacobsen, Rasmus; Lau, Morten

    2016-01-01

    Danish population, and information on household income and wealth from registers at Statistics Denmark. The results show that the willingness to pay is marginally higher than the actuarially fair value under expected utility theory, but significantly higher under rank-dependent utility theory, and up......We estimate how much Danish households are willing to pay for auto, home, and house insurance. We use a unique combination of claims data from a large Danish insurance company, measures of individual risk attitudes and discount rates from a field experiment with a representative sample of the adult...

  12. Price-Anderson Act and nuclear insurance

    International Nuclear Information System (INIS)

    Long, J.D.; Long, D.P.

    1979-01-01

    The nuclear incident at Three Mile Island has served to intensify debate about elimination of the federal limit on liability of utilities (and others) for operation of private nuclear reactions and about elimination of possible federal indemnification of utilities (or others) for claims paid in nuclear incidents. Not all those who debate these issues appear to be fully informed about the present nuclear liability and insurance system. This paper provides a brief description of the Price-Anderson Act, as amended, and of the operation of the nuclear insurance pools. It also includes a comment on the recent federal district court award against the Kerr-McGee Corporation

  13. SSA Disability Claim Data

    Data.gov (United States)

    Social Security Administration — The dataset includes fiscal year data for initial claims for SSA disability benefits that were referred to a state agency for a disability determination. Specific...

  14. Accuracy of claims-based algorithms for epilepsy research: Revealing the unseen performance of claims-based studies.

    Science.gov (United States)

    Moura, Lidia M V R; Price, Maggie; Cole, Andrew J; Hoch, Daniel B; Hsu, John

    2017-04-01

    To evaluate published algorithms for the identification of epilepsy cases in medical claims data using a unique linked dataset with both clinical and claims data. Using data from a large, regional health delivery system, we identified all patients contributing biologic samples to the health system's Biobank (n = 36K). We identified all subjects with at least one diagnosis potentially consistent with epilepsy, for example, epilepsy, convulsions, syncope, or collapse, between 2014 and 2015, or who were seen at the epilepsy clinic (n = 1,217), plus a random sample of subjects with neither claims nor clinic visits (n = 435); we then performed a medical chart review in a random subsample of 1,377 to assess the epilepsy diagnosis status. Using the chart review as the reference standard, we evaluated the test characteristics of six published algorithms. The best-performing algorithm used diagnostic and prescription drug data (sensitivity = 70%, 95% confidence interval [CI] 66-73%; specificity = 77%, 95% CI 73-81%; and area under the curve [AUC] = 0.73, 95%CI 0.71-0.76) when applied to patients age 18 years or older. Restricting the sample to adults aged 18-64 years resulted in a mild improvement in accuracy (AUC = 0.75,95%CI 0.73-0.78). Adding information about current antiepileptic drug use to the algorithm increased test performance (AUC = 0.78, 95%CI 0.76-0.80). Other algorithms varied in their included data types and performed worse. Current approaches for identifying patients with epilepsy in insurance claims have important limitations when applied to the general population. Approaches incorporating a range of information, for example, diagnoses, treatments, and site of care/specialty of physician, improve the performance of identification and could be useful in epilepsy studies using large datasets. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  15. Nuclear liability insurance in the United States: an insurer's perspective

    International Nuclear Information System (INIS)

    Quattrocchi, J.

    2000-01-01

    By the mid-1950's the United States recognised that it was in the interest to promote commercial development of nuclear energy. But the uncertainties of the technology and the potential for severe accidents were clear obstacles to commercial development. Exposure to potentially serious uninsured liability inhibited the private sector. These impediments led Congress to enact the Price-Anderson Act in 1957. The Act had several purposes: the first was to encourage private development of nuclear power; the second was to establish a legal framework for handling potential liability claims; and the third was to provide a ready source of funds to compensate injured victims of a nuclear accident. Insurers chose the pooling technique by creating in the US the American Nuclear Insurers. ANI acts as a managing agent for its members insurance companies. The accident of three Miles Island occurred on 28 March 1979 and with came the claims experience in US. The 1988 amendments to the Price-Anderson Act directed the President to establish a Commission for the purpose of developing a means to assure full compensation of victims of a catastrophic nuclear accident that exceeds the limitation on aggregate public liability, or currently just over US$ 9.7 billion. The Presidential Commission issued its report in August 1990, in which it reached a number of conclusions and offered a number of recommendations.The US Congress has not acted on the Commission's report, but may revisit its recommendations as debate begins this year (1999) or next on the renewal of the Price-Anderson Act. (N.C.)

  16. Paying people to lose weight: the effectiveness of financial incentives provided by health insurers for the prevention and management of overweight and obesity - a systematic review.

    Science.gov (United States)

    Ananthapavan, J; Peterson, A; Sacks, G

    2018-05-01

    Curbing the obesity epidemic is likely to require a suite of interventions targeting the obesogenic environment as well as individual behaviour. Evidence suggests that the effectiveness of behaviour modification programmes can be enhanced by financial incentives that immediately reward weight loss behaviour. This systematic review investigated the effectiveness of incentives with a focus on assessing the relative effectiveness of incentives that target different behaviours as well as factors of importance when implementing these programmes in real-world settings (health insurer settings). A narrative review of the academic and grey literature including a variety of study designs was undertaken. Twenty studies met inclusion criteria and were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results suggest that incentivizing weight loss is effective in the short term while the incentives are in place. There are various incentive designs, and although the relative effectiveness of each of these on weight loss is not clear, it appears that positive incentives increase the uptake into programmes and may reduce dropouts. As with other weight loss initiatives, there is a need to explore ways to maintain weight loss in the longer term - incentives for weight maintenance could play a role. © 2017 World Obesity Federation.

  17. Analysis of your professional liability insurance policy.

    Science.gov (United States)

    SADUSK, J F; HASSARD, H; WATERSON, R

    1958-01-01

    The most important lessons for the physician to learn in regard to his professional liability insurance coverage are the following:1. The physician should carefully read his professional liability policy and should secure the educated aid of his attorney and his insurance broker, if they are conversant with this field.2. He should particularly read the definition of coverage and carefully survey the exclusion clauses which may deny him coverage under certain circumstances.3. If the physician is in partnership or in a group, he should be certain that he has contingent partnership coverage.4. The physician should accept coverage only from an insurance carrier of sufficient size and stability that he can be sure his coverage will be guaranteed for "latent liability" claims as the years go along-certainly for his lifetime.5. The insurance carrier offering the professional liability policy should be prepared to offer coverages up to at least $100,000/$300,000.6. The physician should be assured that the insurance carrier has claims-handling personnel and legal counsel who are experienced and expert in the professional liability field and who are locally available for service.7. The physician is best protected by a local or state group program, next best by a national group program, and last, by individual coverage.8. The physician should look with suspicion on a cancellation clause in which his policy may be summarily cancelled on brief notice.9. The physician should not buy professional liability insurance on the basis of price alone; adequacy of coverage and service and a good insurance company for his protection should be the deciding factors.

  18. Health Claims Data Warehouse (HCDW)

    Data.gov (United States)

    Office of Personnel Management — The Health Claims Data Warehouse (HCDW) will receive and analyze health claims data to support management and administrative purposes. The Federal Employee Health...

  19. Questioning the claims from Kaiser.

    Science.gov (United States)

    Talbot-Smith, Alison; Gnani, Shamini; Pollock, Allyson M; Gray, Denis Pereira

    2004-06-01

    performance by at least 10%. Similar criticisms apply to their selective use of performance measures. Finally, Feachem et al claim that Kaiser is a more integrated system than the NHS. The NHS provides health care to around 60 million people free at the point of delivery, long-term and psychiatric care, and continuing care after 100 days whereas Kaiser provides care to 6 million people, mainly employed and privately insured. Important functions, such as health protection, education and training of healthcare professionals, and research and development are not included or properly costed in Feachem et al's integrated model. We have re-examined the statements made by Feachem et al and show that the claims are unsupported by the evidence. The NHS is not similar to Kaiser in coverage, costs or performance.

  20. Examining the influence of health insurance literacy and perception on the people preference to purchase private voluntary health insurance.

    Science.gov (United States)

    Mathur, Tanuj; Das, Gurudas; Gupta, Hemendra

    2018-01-01

    Most studies have associated "un-affordability" as a plausible cause for the lower take-up of private voluntary health insurance plans. However, others refuted this claim on the pretext that when people can afford "inpatient-care" from pocket then insurance premium cost is far less than those payments. Thus, economic factors remain insufficient in clearly explaining the reason for poor private voluntary health insurance take-up. An attempt is being made by shifting the focus towards non-economic factors and understanding the role of perception and health insurance literacy in transforming people preferences to invest in private voluntary health insurance plans. The study findings will conspicuously support decision-makers in developing strategy to increase the private voluntary health insurance take-up.

  1. 75 FR 43329 - Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal...

    Science.gov (United States)

    2010-07-23

    ... 45 CFR Part 147 Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to... Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and... of Labor; Office of Consumer Information and Insurance Oversight, Department of Health and Human...

  2. 78 FR 25909 - Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance...

    Science.gov (United States)

    2013-05-03

    ... Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium.... SUMMARY: This document contains proposed regulations relating to the health insurance premium tax credit... who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the...

  3. 76 FR 64174 - Public Input on the Report to Congress on How To Modernize and Improve the System of Insurance...

    Science.gov (United States)

    2011-10-17

    ... submit views on: 1. Systemic risk regulation with respect to insurance; 2. Capital standards and the... risk; 3. Consumer protection for insurance products and practices, including gaps in State regulation... general creditor claims; iii. In the case of life insurance companies, on the loss of the special status...

  4. Insurance requirements and practices of Ethiopia's construction sector

    African Journals Online (AJOL)

    The principles of insurance and types of insurance policies in construCtion industry in general is discussed. The status of consultants and contractors in Ethiopian construction sector is briefly reviewed. Questionnaires were designed to preliminary assess whether relevant insurance policies are bought by contracting and ...

  5. 32 CFR 536.129 - Claims cognizable as UCMJ claims.

    Science.gov (United States)

    2010-07-01

    ... Personnel Claims Act and chapter 11 of AR 27-20, which provides compensation only for tangible personal... 32 National Defense 3 2010-07-01 2010-07-01 true Claims cognizable as UCMJ claims. 536.129 Section 536.129 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS...

  6. Insurance of nuclear risk

    International Nuclear Information System (INIS)

    Lacroix, M.

    1976-01-01

    Insurance for large nuclear installations covers mainly four types of risk: third party liability which in accordance with the nuclear conventions, is borne by a nuclear operator following an incident occurring in his installation or during transport of nuclear substances; material damage to the installation itself, which precisely is not covered by third party liability insurance; machinery breakdown, i.e. accidental damage or interruption of operation. Only the first category must be insured. In view of the magnitude of the risk, nuclear insurance resorts to co-insurance and reinsurance techniques which results in a special organisation of the nuclear insurance market, based on national nuclear insurance pools and on the Standing Committee on Atomic Risk of the European Insurance Committee. Conferences of the chairmen of nuclear insurance pools are convened regularly at a worldwide level. (NEA) [fr

  7. Does a Claims Diagnosis of Autism Mean a True Case?

    Science.gov (United States)

    Burke, James P.; Jain, Anjali; Yang, Wenya; Kelly, Jonathan P.; Kaiser, Marygrace; Becker, Laura; Lawer, Lindsay; Newschaffer, Craig J.

    2014-01-01

    The purpose of this study was to validate autism spectrum disorder cases identified through claims-based case identification algorithms against a clinical review of medical charts. Charts were reviewed for 432 children who fell into one of the three following groups: (a) more than or equal to two claims with an autism spectrum disorder diagnosis…

  8. A Review of Activity Trackers for Senior Citizens: Research Perspectives, Commercial Landscape and the Role of the Insurance Industry

    OpenAIRE

    Tedesco, Salvatore; Barton, John; O?Flynn, Brendan

    2017-01-01

    The objective assessment of physical activity levels through wearable inertial-based motion detectors for the automatic, continuous and long-term monitoring of people in free-living environments is a well-known research area in the literature. However, their application to older adults can present particular constraints. This paper reviews the adoption of wearable devices in senior citizens by describing various researches for monitoring physical activity indicators, such as energy expenditur...

  9. Claims-based definition of death in Japanese claims database: validity and implications.

    Science.gov (United States)

    Ooba, Nobuhiro; Setoguchi, Soko; Ando, Takashi; Sato, Tsugumichi; Yamaguchi, Takuhiro; Mochizuki, Mayumi; Kubota, Kiyoshi

    2013-01-01

    For the pending National Claims Database in Japan, researchers will not have access to death information in the enrollment files. We developed and evaluated a claims-based definition of death. We used healthcare claims and enrollment data between January 2005 and August 2009 for 195,193 beneficiaries aged 20 to 74 in 3 private health insurance unions. We developed claims-based definitions of death using discharge or disease status and Charlson comorbidity index (CCI). We calculated sensitivity, specificity and positive predictive values (PPVs) using the enrollment data as a gold standard in the overall population and subgroups divided by demographic and other factors. We also assessed bias and precision in two example studies where an outcome was death. The definition based on the combination of discharge/disease status and CCI provided moderate sensitivity (around 60%) and high specificity (99.99%) and high PPVs (94.8%). In most subgroups, sensitivity of the preferred definition was also around 60% but varied from 28 to 91%. In an example study comparing death rates between two anticancer drug classes, the claims-based definition provided valid and precise hazard ratios (HRs). In another example study comparing two classes of anti-depressants, the HR with the claims-based definition was biased and had lower precision than that with the gold standard definition. The claims-based definitions of death developed in this study had high specificity and PPVs while sensitivity was around 60%. The definitions will be useful in future studies when used with attention to the possible fluctuation of sensitivity in some subpopulations.

  10. Claims-Based Definition of Death in Japanese Claims Database: Validity and Implications

    Science.gov (United States)

    Ooba, Nobuhiro; Setoguchi, Soko; Ando, Takashi; Sato, Tsugumichi; Yamaguchi, Takuhiro; Mochizuki, Mayumi; Kubota, Kiyoshi

    2013-01-01

    Background For the pending National Claims Database in Japan, researchers will not have access to death information in the enrollment files. We developed and evaluated a claims-based definition of death. Methodology/Principal Findings We used healthcare claims and enrollment data between January 2005 and August 2009 for 195,193 beneficiaries aged 20 to 74 in 3 private health insurance unions. We developed claims-based definitions of death using discharge or disease status and Charlson comorbidity index (CCI). We calculated sensitivity, specificity and positive predictive values (PPVs) using the enrollment data as a gold standard in the overall population and subgroups divided by demographic and other factors. We also assessed bias and precision in two example studies where an outcome was death. The definition based on the combination of discharge/disease status and CCI provided moderate sensitivity (around 60%) and high specificity (99.99%) and high PPVs (94.8%). In most subgroups, sensitivity of the preferred definition was also around 60% but varied from 28 to 91%. In an example study comparing death rates between two anticancer drug classes, the claims-based definition provided valid and precise hazard ratios (HRs). In another example study comparing two classes of anti-depressants, the HR with the claims-based definition was biased and had lower precision than that with the gold standard definition. Conclusions/Significance The claims-based definitions of death developed in this study had high specificity and PPVs while sensitivity was around 60%. The definitions will be useful in future studies when used with attention to the possible fluctuation of sensitivity in some subpopulations. PMID:23741526

  11. Medication errors: an analysis comparing PHICO's closed claims data and PHICO's Event Reporting Trending System (PERTS).

    Science.gov (United States)

    Benjamin, David M; Pendrak, Robert F

    2003-07-01

    Clinical pharmacologists are all dedicated to improving the use of medications and decreasing medication errors and adverse drug reactions. However, quality improvement requires that some significant parameters of quality be categorized, measured, and tracked to provide benchmarks to which future data (performance) can be compared. One of the best ways to accumulate data on medication errors and adverse drug reactions is to look at medical malpractice data compiled by the insurance industry. Using data from PHICO insurance company, PHICO's Closed Claims Data, and PHICO's Event Reporting Trending System (PERTS), this article examines the significance and trends of the claims and events reported between 1996 and 1998. Those who misread history are doomed to repeat the mistakes of the past. From a quality improvement perspective, the categorization of the claims and events is useful for reengineering integrated medication delivery, particularly in a hospital setting, and for redesigning drug administration protocols on low therapeutic index medications and "high-risk" drugs. Demonstrable evidence of quality improvement is being required by state laws and by accreditation agencies. The state of Florida requires that quality improvement data be posted quarterly on the Web sites of the health care facilities. Other states have followed suit. The insurance industry is concerned with costs, and medication errors cost money. Even excluding costs of litigation, an adverse drug reaction may cost up to $2500 in hospital resources, and a preventable medication error may cost almost $4700. To monitor costs and assess risk, insurance companies want to know what errors are made and where the system has broken down, permitting the error to occur. Recording and evaluating reliable data on adverse drug events is the first step in improving the quality of pharmacotherapy and increasing patient safety. Cost savings and quality improvement evolve on parallel paths. The PHICO data

  12. Asymmetric Information, Self-selection, and Pricing of Insurance Contracts

    DEFF Research Database (Denmark)

    Donnelly, Catherine; Englund, Martin Kristian; Nielsen, Jens Perch

    2014-01-01

    This article presents an optional bonus-malus contract based on a priori risk classification of the underlying insurance contract. By inducing self-selection, the purchase of the bonus-malus contract can be used as a screening device. This gives an even better pricing performance than both...... an experience rating scheme and a classical no-claims bonus system. An application to the Danish automobile insurance market is considered....

  13. Energy-Efficiency Options for Insurance Loss Prevention

    Energy Technology Data Exchange (ETDEWEB)

    Mills, E. [Ernest Orlando Lawrence Berkeley National Lab., CA (United States). Environmental Energy Technologies Div.; Knoepfel, I. [Swiss Reinsurance Co., Zurich (Switzerland)

    1997-06-09

    Energy-efficiency improvements offer the insurance industry two areas of opportunity: reducing ordinary claims and avoiding greenhouse gas emissions that could precipitate natural disaster losses resulting from global climate change. We present three vehicles for taking advantage of this opportunity, including research and development, in- house energy management, and provision of key information to insurance customers and risk managers. The complementary role for renewable energy systems is also introduced.

  14. The prevalence of Behçet's disease in Korea: data from Health Insurance Review and Assessment Service from 2011 to 2015.

    Science.gov (United States)

    Kim, Ji Na; Kwak, Sang Gyu; Choe, Jung-Yoon; Kim, Seong-Kyu

    2017-01-01

    The aim of this study is to identify the prevalence of Behçet's disease (BD) from data in the Healthcare Bigdata Hub of the Health Insurance Review & Assessment (HIRA) Service from 2011 to 2015 in Korea. This study collected information on primary and auxiliary diagnoses of BD (M352) by physicians according to the Korean Standard Classification of Diseases (KCD) codes. The prevalence of BD was assessed on the basis of age, sex, and geographical distribution. We used time series analysis, using the ARIMA model for the expected prevalence of BD from 2016 to 2025. The overall prevalence of BD was gradually increased, ranging from 32.8 to 35.7 per 100,000 population over the study period. The male to female ratio of BD ranged from 0.54:1 to 0.56:1, revealing a female predominance from 2011 to 2015. Among five districts in Korea, the prevalence in the Seoul Metropolitan district was the highest, with a slowly increasing trend for the study period, accounting for about 60.3% of total BD patients. The expected prevalence of BD patients was estimated to range from 36.9 (95% CI 35.0 - 39.0) to 44.7 (95% CI 40.2 - 49.6) between 2016 and 2025. This study found that the overall prevalence of BD is estimated to be approximately 35.0 per 100,000 population, with female predominance, and predicts gradually increased prevalence of BD in Korea.

  15. Chinese nuclear insurance and Chinese nuclear insurance pool

    International Nuclear Information System (INIS)

    Gong Zhiqi

    2000-01-01

    Chinese Nuclear Insurance Started with Daya Bay Nuclear Power Station, PICC issued the insurance policy. Nuclear insurance cooperation between Chinese and international pool's organizations was set up in 1989. In 1996, the Chinese Nuclear Insurance Pool was prepared. The Chinese Nuclear Insurance Pool was approved by The Chinese Insurance Regulatory Committee in May of 1999. The principal aim is to centralize maximum the insurance capacity for nuclear insurance from local individual insurers and to strengthen the reinsurance relations with international insurance pools so as to provide the high quality insurance service for Chinese nuclear industry. The Member Company of Chinese Nuclear Pool and its roles are introduced in this article

  16. A cohort study of epilepsy among 665,000 insured dogs

    DEFF Research Database (Denmark)

    Heske, L.; Nødtvedt, A.; Jäderlund, K. Hultin

    2014-01-01

    The main objective of this study was to estimate the incidence and mortality rates of epilepsy in a large population of insured dogs and to evaluate the importance of a variety of risk factors. Survival time after a diagnosis of epilepsy was also investigated. The Swedish animal insurance database...... used in this study has previously been helpful in canine epidemiological investigations. More than 2,000,000 dog-years at-risk (DYAR) were available in the insurance database. In total, 5013 dogs had at least one veterinary care claim for epilepsy, and 2327 dogs were euthanased or died because...... of epilepsy. Based on veterinary care claims the incidence rate of epilepsy (including both idiopathic and symptomatic cases) was estimated to be 18 per 10,000 DYAR. Dogs were followed up until they were 10 (for life insurance claims) or 12 years of age (veterinary care claims). Among the 35 most common...

  17. Understanding health insurance plans

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000879.htm Understanding health insurance plans To use the sharing features on this ... plan for you and your family. Types of Health Insurance Plans Depending on how you get your health ...

  18. Characteristics of claims in the management of septic arthritis in Japan: Retrospective analyses of judicial precedents and closed claims.

    Science.gov (United States)

    Otaki, Yasuhiro; DaSilva, Makiko Ishida; Saito, Yuichi; Oyama, Yasuaki; Oiso, Giichiro; Yoshida, Tomohiko; Fukuhara, Masakazu; Moriyama, Mitsuru

    2018-03-01

    Septic arthritis (SA) cases can result in claims or litigation because of poor prognosis even if it is unavoidable. Although these claims or litigation are useful for understanding causes and background factors of medical errors, the characteristics of malpractice claims associated with SA remain undetermined in Japan. This study aimed to increase our understanding of malpractice claims in the clinical management of SA. We analyzed 6 civil precedents and 16 closed claims of SA from 8530 malpractice claims processed between July 2004 and June 2014 by the Tokyo office of Sompo Japan Nipponkoa Insurance, Incorporated. We also studied 5 accident and 21 incident reports of SA based on project data compiled by the Japan Council for Quality Health Care. The rate of negligence was 83.3% in the precedents and 75.0% in closed claims. Two main malpractice claim patterns were revealed: SA in a lower extremity joint following sepsis caused by methicillin-resistant Staphylococcus aureus in newborns and SA in an injection site following joint injection. These two patterns accounted for 83.3% and 56.3% of judicial cases and closed claim cases, respectively. Breakdowns in care process of accident and incident reports were clearly differentiated from judicial cases or closed claim cases (Fisher's exact test, p < 0.001). It is important to pay particular attention to SA following sepsis in newborns and to monitor for any signs of SA after joint injection to ensure early diagnosis. Analysis of both malpractice claims and accident and incident reports is essential to ensure a full understanding of the situation in Japan. Copyright © 2017. Published by Elsevier Taiwan LLC.

  19. New CERN Health Insurance Scheme (CHIS) forms

    CERN Multimedia

    HR Department

    2015-01-01

    New versions of the following forms for claims and requests to the CERN Health Insurance Scheme (CHIS) have been released:   form for claiming reimbursement of medical expenses,   form for requesting advance reimbursement, and   dental estimate form (for treatments foreseen to exceed 800 CHF).   The new forms are available in French and English. They can either be completed electronically before being printed and signed, or completed in paper form. New detailed instructions can be found at the back of the claim form; CHIS members are invited to read them carefully. The electronic versions (PDF) of all the forms are available on the CHIS website and on the UNIQA Member Portal. CHIS Members are requested to use these new forms forthwith and to discard any previous version. Questions regarding the above should be addressed directly to UNIQA (72730 or 022.718 63 00 or uniqa.assurances@cern.ch).

  20. 24 CFR 266.602 - Mortgage insurance premium: Insured advances.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Mortgage insurance premium: Insured... Contract Rights and Obligations Mortgage Insurance Premiums § 266.602 Mortgage insurance premium: Insured.... On each anniversary of the initial closing, the HFA shall pay an interim mortgage insurance premium...

  1. The Concentration on the Motor third Party Liability Insurance Market in Romania

    Directory of Open Access Journals (Sweden)

    Florina Oana VIRLANUTA

    2018-05-01

    Full Text Available The current paper proposes an analysis of the Romanian car insurance validity market. The topic is relevant at national and European level, and our analysis will be based on indicators such as gross written premiums, motor claims paid for bodily injuries, motor claims paid for property damage, market share on Motor Insurance market. We will also determine the degree of concentration on this market using Gini Struck Concentration Index.

  2. Optimal non-linear health insurance.

    Science.gov (United States)

    Blomqvist, A

    1997-06-01

    Most theoretical and empirical work on efficient health insurance has been based on models with linear insurance schedules (a constant co-insurance parameter). In this paper, dynamic optimization techniques are used to analyse the properties of optimal non-linear insurance schedules in a model similar to one originally considered by Spence and Zeckhauser (American Economic Review, 1971, 61, 380-387) and reminiscent of those that have been used in the literature on optimal income taxation. The results of a preliminary numerical example suggest that the welfare losses from the implicit subsidy to employer-financed health insurance under US tax law may be a good deal smaller than previously estimated using linear models.

  3. Insurance and nuclear power

    International Nuclear Information System (INIS)

    Whipple, C.

    1985-01-01

    The Price-Anderson Act is discussed, which establishes procedures for insuring nuclear facilities (including nuclear power plants). The act was enacted with the dual purpose of protecting the public and encouraging the development of a private nuclear energy industry. Criticisms that can generally be grouped into four categories regarding the Act are presented, the most controversial aspect being that should an accident occur, the aggregate liability of the reactor operator, the NRC, or any others who might be at fault is limited to $560 million. Lawsuits for amounts in excess of $560 million are prohibited. The 1975 renewal of the Price-Anderson Act does provide that damages in excess of the $560 million prompt Congress to review the particular incident and take action to protect the public from the consequences of a disaster of such magnitude

  4. Implications of chronic disease patient travel to healthcare facilities on the design of national health insurance in South Africa - a preliminary review

    CSIR Research Space (South Africa)

    Mubaiwa, T

    2017-07-01

    Full Text Available programme. The paper forms part of a research project aimed at identifying public transport design requirements to support patients with chronic diseases. This paper in particular qualitatively benchmarks the proposed South African National Health Insurance...

  5. Valuation of Non-Life Liabilities from Claims Triangles

    Directory of Open Access Journals (Sweden)

    Mathias Lindholm

    2017-07-01

    Full Text Available This paper provides a complete program for the valuation of aggregate non-life insurance liability cash flows based on claims triangle data. The valuation is fully consistent with the principle of valuation by considering the costs associated with a transfer of the liability to a so-called reference undertaking subject to capital requirements throughout the runoff of the liability cash flow. The valuation program includes complete details on parameter estimation, bias correction and conservative estimation of the value of the liability under partial information. The latter is based on a new approach to the estimation of mean squared error of claims reserve prediction.

  6. Good Faith in Life Insurance Contract by Indonesian Court

    Directory of Open Access Journals (Sweden)

    Mokhamad Khoirul Huda

    2017-03-01

    Full Text Available This paper reviews both the interpretation of good faith and its implementation by the Court in terms of life insurance contracts. The principle of good faith in life insurance contracts was under the provision of the Article 251 Wet Boek van Kophandel which assigned the obligation of good faith on the insured. Based on the context of its historical and systematical interpretation, the obligation of good faith should be on both sides, the insurer and the insured. The insured had an obligation to inform any material facts and the insurer had to investigate those all facts. Until recent days, however, judges in all levels of Court did not have any shared and full understanding on the interpretation of good faith in life insurance contracts. As the result, many Courts were frequently inconsistent with each other. Hence, the sense of fairness the people perceived from the court verdict was not achieved.

  7. Risks and nuclear insurance

    International Nuclear Information System (INIS)

    Debaets, M.; Springett, G.D.; Luotonen, K.; Virole, J.

    1988-01-01

    When analysing the nuclear insurance market, three elements must be taken into account: the nuclear operator's liability is regulated by national laws and/or international Conventions, such operators pay large premiums to insure their nuclear installations against property damage and finally, the nuclear insurance market is made up of pools and is mainly a monopoly. This report describes the different types of insurance coverage, the system governing nuclear third party liability under the Paris Convention and the Brussels Supplementary Convention and several national laws in that field. The last part of the report deals with liability and insurance aspects of international transport of nuclear materials [fr

  8. Nature of Medical Malpractice Claims Against Radiation Oncologists

    Energy Technology Data Exchange (ETDEWEB)

    Marshall, Deborah; Tringale, Kathryn [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Connor, Michael [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); University of California Irvine School of Medicine, Irvine, California (United States); Punglia, Rinaa [Department of Radiation Oncology, Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Recht, Abram [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (United States); Hattangadi-Gluth, Jona, E-mail: jhattangadi@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States)

    2017-05-01

    Purpose: To examine characteristics of medical malpractice claims involving radiation oncologists closed during a 10-year period. Methods and Materials: Malpractice claims filed against radiation oncologists from 2003 to 2012 collected by a nationwide liability insurance trade association were analyzed. Outcomes included the nature of claims and indemnity payments, including associated presenting diagnoses, procedures, alleged medical errors, and injury severity. We compared the likelihood of a claim resulting in payment in relation to injury severity categories (death as referent) using binomial logistic regression. Results: There were 362 closed claims involving radiation oncology, 102 (28%) of which were paid, resulting in $38 million in indemnity payments. The most common alleged errors included “improper performance” (38% of closed claims, 18% were paid; 29% [$11 million] of total indemnity), “errors in diagnosis” (25% of closed claims, 46% were paid; 44% [$17 million] of total indemnity), and “no medical misadventure” (14% of closed claims, 8% were paid; less than 1% [$148,000] of total indemnity). Another physician was named in 32% of claims, and consent issues/breach of contract were cited in 18%. Claims for injury resulting in death represented 39% of closed claims and 25% of total indemnity. “Improper performance” was the primary alleged error associated with injury resulting in death. Compared with claims involving death, major temporary injury (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.29-5.85, P=.009), significant permanent injury (OR 3.1, 95% CI 1.48-6.46, P=.003), and major permanent injury (OR 5.5, 95% CI 1.89-16.15, P=.002) had a higher likelihood of a claim resulting in indemnity payment. Conclusions: Improper performance was the most common alleged malpractice error. Claims involving significant or major injury were more likely to be paid than those involving death. Insights into the nature of liability claims against

  9. Recent cold fusion claims: are they valid?

    International Nuclear Information System (INIS)

    Kowalski, Ludwik

    2006-01-01

    Cold fusion consists of nuclear reactions occurring in solid metals loaded with hydrogen. Considerable progress has been made in that area in the last ten years. This 2004 paper summarizes recent claims without attempting to evaluate their validity. The manuscript was submitted to seven physics journals. Unfortunately, the editors rejected it without the benefit of the usual peer-review process. (author)

  10. BenefitClaimWebServiceBean/BenefitClaimWebService

    Data.gov (United States)

    Department of Veterans Affairs — A formal or informal request for a type of monetary or non-monetary benefit. This service provides benefit claims and benefit claim special issues data, allows the...

  11. Public Insurance and Equality

    DEFF Research Database (Denmark)

    Landes, Xavier; Néron, Pierre-Yves

    2015-01-01

    Heath (among other political theorists) considers that the principle of efficiency provides a better normative explanation and justification of public insurance than the egalitarian account. According to this view, the fact that the state is involved in the provision of specific insurance (primarily......Public insurance is commonly assimilated with redistributive tools mobilized by the welfare state in the pursuit of an egalitarian ideal. This view contains some truth, since the result of insurance, at a given moment, is the redistribution of resources from the lucky to unlucky. However, Joseph...... surrounding public insurance as a redistributive tool, advancing the idea that public insurance may be a relational egalitarian tool. It then presents a number of relational arguments in favor of the involvement of the state in the provision of specific forms of insurance, arguments that have been overlooked...

  12. A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries.

    Science.gov (United States)

    Adebayo, Esther F; Uthman, Olalekan A; Wiysonge, Charles S; Stern, Erin A; Lamont, Kim T; Ataguba, John E

    2015-12-08

    Low-income and middle-income countries (LMICs) have difficulties achieving universal financial protection, which is primordial for universal health coverage. A promising avenue to provide universal financial protection for the informal sector and the rural populace is community-based health insurance (CBHI). We systematically assessed and synthesised factors associated with CBHI enrolment in LMICs. We searched PubMed, Scopus, ERIC, PsychInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL, Cochrane Library, conference proceedings, and reference lists for eligible studies available by 31 October 2013; regardless of publication status. We included both quantitative and qualitative studies in the review. Both quantitative and qualitative studies demonstrated low levels of income and lack of financial resources as major factors affecting enrolment. Also, poor healthcare quality (including stock-outs of drugs and medical supplies, poor healthcare worker attitudes, and long waiting times) was found to be associated with low CBHI coverage. Trust in both the CBHI scheme and healthcare providers were also found to affect enrolment. Educational attainment (less educated are willing to pay less than highly educated), sex (men are willing to pay more than women), age (younger are willing to pay more than older individuals), and household size (larger households are willing to pay more than households with fewer members) also influenced CBHI enrolment. In LMICs, while CBHI schemes may be helpful in the short term to address the issue of improving the rural population and informal workers' access to health services, they still face challenges. Lack of funds, poor quality of care, and lack of trust are major reasons for low CBHI coverage in LMICs. If CBHI schemes are to serve as a means to providing access to health services, at least in the short term, then attention should be paid to the issues that militate against their success.

  13. Aviation or space policy: New challenges for the insurance sector to private human access to space

    Science.gov (United States)

    van Oijhuizen Galhego Rosa, Ana Cristina

    2013-12-01

    The phenomenon of private human access to space has introduced a new set of problems in the insurance sector. Orbital and suborbital space transportation will surely be unique commercial services for this new market. Discussions are under way regarding space insurance, in order to establish whether this new market ought to be regulated by aviation or space law. Alongside new definitions, infrastructures, legal frameworks and liability insurances, the insurance sector has also been introducing a new approach. In this paper, I aim to analyse some of the possibilities of new premiums, capacities, and policies (under aviation or space insurance rules), as well as the new insurance products related to vehicles, passengers and third party liability. This paper claims that a change toward new insurance regimes is crucial, due to the current stage in development of space tourism and the urgency to adapt insurance rules to support future development in this area.

  14. Insurances in the petroleum industry; Seguros na industria do petroleo

    Energy Technology Data Exchange (ETDEWEB)

    Lima, Juliana S.F. [IRB-Brasil Resseguros, Rio de Janeiro, RJ (Brazil)

    2004-07-01

    This work shows an overview, focused mainly Brazil, of the insurance branch that deals with the upstream activities. The oil industry represents a substantial exposition for insurance international market because of the catastrophic nature of its risks, that entails a capacity dependency. The most of Insurance split into several insurers and reinsurer and are distributed into several markets and several regions of the world. The oil and gas branch of insurance covers: physical damage to equipment (platforms, vessels, drill ship etc), build, operation and liability in consequence of claims. The contract of insurance is complex because it is specific and demands much negotiation of rates and conditions. Moreover it is needed to find reliable insurers which want to accept the risk. There are alternatives to insurance market created by oil companies such as Captive and Mutual companies. The insurance international market built a complex and customized structure in order to be able to offer coverage to upstream risks and to participate in the amounts related to oil and gas production. (author)

  15. State of emergency preparedness for US health insurance plans.

    Science.gov (United States)

    Merchant, Raina M; Finne, Kristen; Lardy, Barbara; Veselovskiy, German; Korba, Caey; Margolis, Gregg S; Lurie, Nicole

    2015-01-01

    Health insurance plans serve a critical role in public health emergencies, yet little has been published about their collective emergency preparedness practices and policies. We evaluated, on a national scale, the state of health insurance plans' emergency preparedness and policies. A survey of health insurance plans. We queried members of America's Health Insurance Plans, the national trade association representing the health insurance industry, about issues related to emergency preparedness issues: infrastructure, adaptability, connectedness, and best practices. Of 137 health insurance plans queried, 63% responded, representing 190.6 million members and 81% of US plan enrollment. All respondents had emergency plans for business continuity, and most (85%) had infrastructure for emergency teams. Some health plans also have established benchmarks for preparedness (eg, response time). Regarding adaptability, 85% had protocols to extend claim filing time and 71% could temporarily suspend prior medical authorization rules. Regarding connectedness, many plans shared their contingency plans with health officials, but often cited challenges in identifying regulatory agency contacts. Some health insurance plans had specific policies for assisting individuals dependent on durable medical equipment or home healthcare. Many plans (60%) expressed interest in sharing best practices. Health insurance plans are prioritizing emergency preparedness. We identified 6 policy modifications that health insurance plans could undertake to potentially improve healthcare system preparedness: establishing metrics and benchmarks for emergency preparedness; identifying disaster-specific policy modifications, enhancing stakeholder connectedness, considering digital strategies to enhance communication, improving support and access for special-needs individuals, and developing regular forums for knowledge exchange about emergency preparedness.

  16. Legal Services: Claims

    Science.gov (United States)

    1997-12-31

    waive such exemp- tions or privileges and direct release of the protected documents, upon balancing all pertinent factors, including finding that...injury causing death until expiration of decedent’s worklife ex- pectancy. When requested, the previous five years Federal income tax forms must be...knowing at all times how much of the CEA has been obligated, its remaining balance , and assessing each month whether the balance will cover claims

  17. 20 CFR 405.510 - Claims remanded by a Federal court.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Claims remanded by a Federal court. 405.510 Section 405.510 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS Judicial Review § 405.510 Claims remanded by a Federal court. When a...

  18. 10 CFR 765.21 - Procedures for processing reimbursement claims.

    Science.gov (United States)

    2010-01-01

    ... Department shall complete a final review of all relevant information prior to making a reimbursement decision... 10 Energy 4 2010-01-01 2010-01-01 false Procedures for processing reimbursement claims. 765.21... AND THORIUM PROCESSING SITES Procedures for Submitting and Processing Reimbursement Claims § 765.21...

  19. Verification of flood damage modelling using insurance data

    DEFF Research Database (Denmark)

    Zhou, Qianqian; Petersen, Toke E. P.; Thorsen, Bo J.

    2012-01-01

    This paper presents the results of an analysis using insurance data for damage description and risk model verification, based on data from a Danish case. The results show that simple, local statistics of rainfall are not able to describe the variation in individual cost per claim, but are, howeve...

  20. Verification of flood damage modelling using insurance data

    DEFF Research Database (Denmark)

    Zhou, Qianqian; Panduro, T. E.; Thorsen, B. J.

    2013-01-01

    This paper presents the results of an analysis using insurance data for damage description and risk model verification, based on data from a Danish case. The results show that simple, local statistics of rainfall are not able to describe the variation in individual cost per claim, but are, howeve...

  1. 7 CFR 457.122 - Walnut crop insurance provisions.

    Science.gov (United States)

    2010-01-01

    ... quarantine, boycott, or refusal of any person to accept production. 10. Duties in the Event of Damage or Loss... production on insured acreage that you intend to abandon or no longer care for, if you and we agree on the... do not agree with our appraisal, we may defer the claim only if you agree to continue to care for the...

  2. Insurability of Cyber Risk: An Empirical Analysis

    OpenAIRE

    Biener, Christian; Eling, Martin; Wirfs, Jan Hendrik

    2015-01-01

    This paper discusses the adequacy of insurance for managing cyber risk. To this end, we extract 994 cases of cyber losses from an operational risk database and analyse their statistical properties. Based on the empirical results and recent literature, we investigate the insurability of cyber risk by systematically reviewing the set of criteria introduced by Berliner (1982). Our findings emphasise the distinct characteristics of cyber risks compared with other operational risks and bring to li...

  3. Multivariate Frequency-Severity Regression Models in Insurance

    Directory of Open Access Journals (Sweden)

    Edward W. Frees

    2016-02-01

    Full Text Available In insurance and related industries including healthcare, it is common to have several outcome measures that the analyst wishes to understand using explanatory variables. For example, in automobile insurance, an accident may result in payments for damage to one’s own vehicle, damage to another party’s vehicle, or personal injury. It is also common to be interested in the frequency of accidents in addition to the severity of the claim amounts. This paper synthesizes and extends the literature on multivariate frequency-severity regression modeling with a focus on insurance industry applications. Regression models for understanding the distribution of each outcome continue to be developed yet there now exists a solid body of literature for the marginal outcomes. This paper contributes to this body of literature by focusing on the use of a copula for modeling the dependence among these outcomes; a major advantage of this tool is that it preserves the body of work established for marginal models. We illustrate this approach using data from the Wisconsin Local Government Property Insurance Fund. This fund offers insurance protection for (i property; (ii motor vehicle; and (iii contractors’ equipment claims. In addition to several claim types and frequency-severity components, outcomes can be further categorized by time and space, requiring complex dependency modeling. We find significant dependencies for these data; specifically, we find that dependencies among lines are stronger than the dependencies between the frequency and average severity within each line.

  4. Generalized Linear Models in Vehicle Insurance

    Directory of Open Access Journals (Sweden)

    Silvie Kafková

    2014-01-01

    Full Text Available Actuaries in insurance companies try to find the best model for an estimation of insurance premium. It depends on many risk factors, e.g. the car characteristics and the profile of the driver. In this paper, an analysis of the portfolio of vehicle insurance data using a generalized linear model (GLM is performed. The main advantage of the approach presented in this article is that the GLMs are not limited by inflexible preconditions. Our aim is to predict the relation of annual claim frequency on given risk factors. Based on a large real-world sample of data from 57 410 vehicles, the present study proposed a classification analysis approach that addresses the selection of predictor variables. The models with different predictor variables are compared by analysis of deviance and Akaike information criterion (AIC. Based on this comparison, the model for the best estimate of annual claim frequency is chosen. All statistical calculations are computed in R environment, which contains stats package with the function for the estimation of parameters of GLM and the function for analysis of deviation.

  5. The plaintiff's two-sided mouth: defeating ADA claims based on inconsistent positions taken by the plaintiff on other claims.

    Science.gov (United States)

    Connell, D S

    1996-01-01

    In the typical ADA claim, the plaintiff will claim that he or she has a disability but is nevertheless able to perform the essential functions of his or her job. This position is often in direct conflict with other non-ADA claims that the plaintiff has made or is making, where the plaintiff is claiming total disability and/or that he or she is unable to work. This article examines these phenomena, reviews the numerous recent cases that have found for employers based on these inconsistent positions of the plaintiff, and explains how employers can be develop and present this defense.

  6. Catastrophic risks and insurance

    International Nuclear Information System (INIS)

    Deprimoz, J.

    1988-01-01

    This short communication deals with compensation for nuclear damage and compensation for environmental pollution through industrial activities and compress both systems and their insurance coverage [fr

  7. Prescriptions and Insurance Plans

    Science.gov (United States)

    ... contributed by: familydoctor.org editorial staff Categories: Healthcare Management, Insurance & Bills, Your Health ResourcesTags: brand name, co-pay, drug, formulary, generic, isurance, medicine, ...

  8. Uninsured vs. insured population

    DEFF Research Database (Denmark)

    Andersen, Z. J.; Lin, Chyongchiou J; Chang, Chung-Chou H

    2003-01-01

    analyzed. Approximately 74 percent of uninsured Americans are nonelderly Americans. Among the nonelderly Americans, about 17 percent are uninsured. Our findings show that insurance status varies significantly by region, age, race, gender, marital status, income, education, employment status, and health......This study identified the underlying demographic and socioeconomic factors associated with insurance status among nonelderly Americans (age 19-64), as well as compared health care utilization between insured and uninsured. Data from the Community Tracking Study 1996-1997 Household Survey were...... status. Also, the insured nonelderly Americans were found to have better access to health care than the uninsured nonelderly....

  9. [Evidence-based medicine and public health law: statutory health insurance].

    Science.gov (United States)

    Dreher, Wolfgang

    2004-09-01

    Beyond all differences in terminology and legal principles between the laws governing private health insurance, the governmental financial support for civil, servants and statutory health insurance the fundamental issues to be solved by the courts in case of litigation are quite similar. But only a part of these refer to the quality of medical services, which is the main concern of Evidence-based Medicine (EbM); EbM, though, is not able to contribute towards answering the equally important question of how to distinguish between "treatment" and "(health-relevant) lifestyle". The respective definitions that have been developed in the particular fields of law are only seemingly divergent from each other and basically unsuitable to aid the physician in his clinical decision-making because the common blanket clauses of public health law are regularly interpreted as rules for the exclusion of certain claims and not as a confirmatory paraphrase of what is clinically necessary. If on the other hand medical quality is what lies at the core of litigation, reference to EbM may become necessary. In fact, it is already common practice in the statutory health insurance system that decision-making processes in the Federal Committee being responsible for quality assurance (Bundesausschuss) are based on EbM principles and that in exceptional cases only the courts have to medically review the Federal Committee's decisions.

  10. The insurance of nuclear installations

    International Nuclear Information System (INIS)

    Francis, H.W.

    1977-01-01

    A brief account is given of the development of nuclear insurance. The subject is dealt with under the following headings: the need for nuclear insurance, nuclear insurance pools, international co-operation, nuclear installations which may be insured, international conventions relating to the liability of operators of nuclear installations, classes of nuclear insurance, nuclear reactor hazards and their assessment, future developments. (U.K.)

  11. Active Labour Market Programme Participation for Unemployment Insurance Recipients

    DEFF Research Database (Denmark)

    Filges, Trine; Smedslund, Geir; Jørgensen, Anne-Marie Klint

    2016-01-01

    Objective: This review evaluates the effectiveness of Active Labour Market Programme (ALMP) participation on employment status for unemployment insurance recipients. Methods and Analysis: We followed Campbell Collaboration guidelines to conduct a systematic review. Results: A total of 73 studies...

  12. The health care burden of high grade chronic obstructive pulmonary disease in Korea: analysis of the Korean Health Insurance Review and Assessment Service data

    Directory of Open Access Journals (Sweden)

    Kim JH

    2013-11-01

    Full Text Available JinHee Kim,1 Chin Kook Rhee,2 Kwang Ha Yoo,3 Young Sam Kim,4 Sei Won Lee,5 Yong Bum Park,6 Jin Hwa Lee,7 YeonMok Oh,5 Sang Do Lee,5 Yuri Kim,8 KyungJoo Kim,8 HyoungKyu Yoon9 1Office of Health Service Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea; 2Department of Internal Medicine, Seoul St Mary’s Hospital, Catholic University of Korea College of Medicine, Seoul, Korea; 3Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea; 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; 5Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; 6Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea; 7Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea; 8Department of Clinical Research Support, National Strategic Coordinating Center for Clinical Research, Seoul, Korea; 9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary’s Hospital, Catholic University of Korea College of Medicine, Seoul, Korea Background: Patients with high grade chronic pulmonary obstructive disease (COPD account for much of the COPD-related mortality and incur excessive financial burdens and medical care utilization. We aimed to determine the characteristics and medical care use of such patients using nationwide data from the Korean Health Insurance Review and Assessment Service in 2009. Materials and methods: Patients with COPD were identified by searching with the International Classification of Diseases–10th Revision for those using medication. Patients with high grade COPD were selected based on their patterns of tertiary institute visits and medication use. Results: The numbers of patients with high grade COPD increased rapidly

  13. Understanding the productive author who published papers in medicine using National Health Insurance Database: A systematic review and meta-analysis.

    Science.gov (United States)

    Chien, Tsair-Wei; Chang, Yu; Wang, Hsien-Yi

    2018-02-01

    Many researchers used National Health Insurance database to publish medical papers which are often retrospective, population-based, and cohort studies. However, the author's research domain and academic characteristics are still unclear.By searching the PubMed database (Pubmed.com), we used the keyword of [Taiwan] and [National Health Insurance Research Database], then downloaded 2913 articles published from 1995 to 2017. Social network analysis (SNA), Gini coefficient, and Google Maps were applied to gather these data for visualizing: the most productive author; the pattern of coauthor collaboration teams; and the author's research domain denoted by abstract keywords and Pubmed MESH (medical subject heading) terms.Utilizing the 2913 papers from Taiwan's National Health Insurance database, we chose the top 10 research teams shown on Google Maps and analyzed one author (Dr. Kao) who published 149 papers in the database in 2015. In the past 15 years, we found Dr. Kao had 2987 connections with other coauthors from 13 research teams. The cooccurrence abstract keywords with the highest frequency are cohort study and National Health Insurance Research Database. The most coexistent MESH terms are tomography, X-ray computed, and positron-emission tomography. The strength of the author research distinct domain is very low (Gini < 0.40).SNA incorporated with Google Maps and Gini coefficient provides insight into the relationships between entities. The results obtained in this study can be applied for a comprehensive understanding of other productive authors in the field of academics.

  14. What factors affect voluntary uptake of community-based health insurance schemes in low- and middle-income countries? A systematic review and meta-analysis

    NARCIS (Netherlands)

    D.M. Dror (David); Shahed Hossain, S.A.; M. Majumdar (Manabi); Koehlmoos, T.L.P. (Tracey Lynn Pérez); John, D. (Denny); P. Panda (Pradeep)

    2016-01-01

    textabstractIntroduction: This research article reports on factors influencing initial voluntary uptake of community-based health insurance (CBHI) schemes in low- and middle-income countries (LMIC), and renewal decisions. Methods: Following PRISMA protocol, we conducted a comprehensive search of

  15. Transparency in the Assessment of Takaful Claims for Construction Works Loss & Damage

    OpenAIRE

    Puteri Nur Farah Naadia Mohd Fauzi; Khairuddin Abdul Rashid

    2016-01-01

    In the context of the construction industry, an alternative to the conventional insurance for works contracts is the Shariah compliant insurance otherwise known as takaful. Among the most frequently used takaful for construction works contracts is the Contractor’s All Risks (CAR) Takaful. However, the future of CAR Takaful may be affected should issues such as marketing and clarification on how it works including how claims are processed, valued and compensation ...

  16. 77 FR 44155 - Administration of Mining Claims and Sites

    Science.gov (United States)

    2012-07-27

    ... hypothetical 66-acre placer claim would be $560. IV. Procedural Matters Regulatory Planning and Review... miner maintenance fee waiver program, which further reduces any potential impact on small miners. A...

  17. How Family Status and Social Security Claiming Options Shape Optimal Life Cycle Portfolios.

    Science.gov (United States)

    Hubener, Andreas; Maurer, Raimond; Mitchell, Olivia S

    2016-04-01

    We show how optimal household decisions regarding work, retirement, saving, portfolio allocations, and life insurance are shaped by the complex financial options embedded in U.S. Social Security rules and uncertain family transitions. Our life cycle model predicts sharp consumption drops on retirement, an age-62 peak in claiming rates, and earlier claiming by wives versus husbands and single women. Moreover, life insurance is mainly purchased on men's lives. Our model, which takes Social Security rules seriously, generates wealth and retirement outcomes that are more consistent with the data, in contrast to earlier and less realistic models.

  18. How Workplace Managers Can Protect Against Hostile Environment Claims From Their Female And Male Employees: A Legal Review Of Decisional Law

    OpenAIRE

    Nina Compton

    2011-01-01

    Sexual harassment can occur in a variety of circumstances within the workplace setting.  A review of case law illuminates the circumstances that have been identified as sexual harassment.  Sexual harassment is a form of sex discrimination that violates Title VII of the Civil Rights Act of l964.  This paper reviews the decisional law which has recognized various forms of prohibited sexual harassment.  The case analysis explores numerous types of “hostile environment” sexual harassment that can...

  19. Insuring against Health Shocks: Health Insurance and Household Choices

    OpenAIRE

    Liu, Kai

    2015-01-01

    This paper provides empirical evidence on the role of public health insurance in mitigating adverse outcomes associated with health shocks. Exploiting the rollout of a universal health insurance program in rural China, I find that total household income and consumption are fully insured against health shocks even without access to health insurance. Household labor supply is an important insurance mechanism against health shocks. Access to health insurance helps households to maintain investme...

  20. Transparency, Trust and Security: An Evaluation of the Insurer's Precontractual Duties

    Directory of Open Access Journals (Sweden)

    Daleen Millard

    2014-12-01

    insurance legislation. The insurer's duty to disclose is in the last instance also derived from the common law duty not to make misrepresentations by commission or omission. When negotiating an insurance contract, the insurer's duty to speak is not based on a general requirement of bona fides, but is recognised as an ex lege duty due to the involuntary reliance of the prospective insured on information supplied by insurers in the market. A lack of transparency should lead to the insurer's accountability. A failure to disclose material information or a disclosure of false information that goes to the root of the matter and that induces the prospective policyholder to buy the insurance product is recognised as an actionable misrepresentation. Statutory provisions do not diminish the common-law duty not to make misrepresentations, but provide details of the nature and extent of the information duty to provide clarity and legal certainty in the determination of the standards of transparency required in law. In addition, statutes provide for enforcement actions by regulators, orders that could affect the licence of the insurer and provide for punishable offences and penalties. In terms of common law, a misrepresentation by omission or commission renders the insurance contract wholly or in part voidable. The policyholder may decide to rescind the contract and claim restitution. He may also, in conjunction with rescission, or as an alternative when deciding to maintain the contract, claim delictual damages or even constitutional damages when judged by a court of law as appropriate relief. Statutory remedies include a monetary award by the Insurance Ombud. Even though such an award is capped at R800 000, it is submitted that it is preferred to a civil law damages claim.

  1. Nuclear energy and insurance

    International Nuclear Information System (INIS)

    Dow, J.C.

    1989-01-01

    It was the risk of contamination of ships from the Pacific atmospheric atomic bomb tests in the 1940's that seems first to have set insurers thinking that a limited amount of cover would be a practical possibility if not a commercially-attractive proposition. One Chapter of this book traces the early, hesitant steps towards the evolution of ''nuclear insurance'', as it is usually called; a term of convenience rather than exactitude because it seems to suggest an entirely new branch of insurance with a status of its own like that of Marine, Life or Motor insurance. Insurance in the field of nuclear energy is more correctly regarded as the application of the usual, well-established forms of cover to unusual kinds of industrial plant, materials and liabilities, characterised by the peculiar dangers of radioactivity which have no parallel among the common hazards of industry and commerce. It had, and still has, the feature that individual insurance underwriters are none too keen to look upon nuclear risks as a potential source of good business and profit. Only by joining together in Syndicates or Pools have the members of the national insurance markets been able to make proper provision for nuclear risks; only by close international collaboration among the national Pools have the insurers of the world been able to assemble adequate capacity - though still, even after thirty years, not sufficient to provide complete coverage for a large nuclear installation. (author)

  2. Social health insurance

    CERN Document Server

    International Labour Office. Geneva

    1997-01-01

    This manual provides an overview of social health insurance schemes and looks at the development of health care policies and feasibility issues. It also examines the design of health insurance schemes, health care benefits, financing and costs and considers the operational and strategic information requirements.

  3. Insurance industry guide

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This is an insurance industry guide for the independent power industry. The directory includes the insurance company's name, address, telephone and FAX numbers and a description of the company's area of expertise, products and services, and limitations. The directory is international in scope. Some of the companies specialize in independent power projects

  4. Marketing in life insurance

    Directory of Open Access Journals (Sweden)

    Njegomir Vladimir

    2006-01-01

    Full Text Available Insurance industry has traditionally been oriented on sale of its products i.e. at the stage which from the aspect of marketing theory can be characterized as sales phase, phase which proceeds the marketing orientation. However, faced with numerous challenges of modern business environment such as globalization, deregulation and sophisticated information technology insurance companies must change their way of doing business. Competition is becoming fierce as insurance companies are faced with competition not only from insurance industry but also from other competitors, such as banks, that are in position to offer product substitutes for life insurance products. In this new environment information about customers and their education are becoming critical factors. Insurance companies must know their customers what influences their demand for life insurance, what is the amount of their income, what is inflation rate, their expenditures on other goods i.e. opportunity costs, etc. Those are factors that force insurance companies to concentrate more on present and potential buyers and their needs and force them to give their best to satisfy those needs in a way that will produce delighted customers.

  5. Consumer preferences in social health insurance.

    Science.gov (United States)

    Kerssens, Jan J; Groenewegen, Peter P

    2005-03-01

    Allowing consumers greater choice of health plans is believed to be the key to high quality and low costs in social health insurance. This study investigates consumer preferences (361 persons, response rate 43%) for hypothetical health plans which differed in 12 characteristics (premium, deductibles, no-claim discount, extension of insurance and financial services, red tape involved, medical help-desk, choice of family physicians and hospitals, dental benefits, physical therapy benefits, benefits for prescription drugs and homeopathy). In 90% the health plan with the most attractive characteristics was preferred, indicating a predominantly rational kind of choice. The most decisive characteristics for preference were: complete dental benefits, followed by zero deductibles, and free choice of hospitals.

  6. Unemployment Insurance and Inequality

    DEFF Research Database (Denmark)

    Larsen, Birthe; Waisman, Gisela

    This paper examines the impact of higher unemployment insurance on the fraction of the work force paying into an unemployment insurance fond, wage differences and therefore inquality and education letting worker initial wealth being important for the decisions and implied values. As usually higher...... educated workers receive a lower fraction of their wages as unemployment insurance, we consider how the impact on labour market performance and wage differences and thereby inequality differ dependent on whether educated or uneducated workers receive higher benefits. The model can help shed light...... on the the puzzle why only some workers, for given educational level, pay into an unemployment insurance fond, the lower wealth mobility than income mobility as well as the relative compressed wage structure in countries with generous social assistance as well as unemployment insurance for low income workers...

  7. Health insurance for "frontaliers"

    CERN Multimedia

    2013-01-01

    The French government has decided that, with effect from 1 June 2014, persons resident in France but working in Switzerland (hereinafter referred to as “frontaliers”) will no longer be entitled to opt for private French health insurance provision as their sole and principal health insurance.   The right of choice, which was granted by the Bilateral Agreement on the Free Movement of Persons between Switzerland and the European Union and which came into force on 1 June 2002, exempts “frontaliers” from the obligation to become a member of Switzerland’s compulsory health insurance scheme (LAMal) if they can prove that they have equivalent coverage in France, provided by either the French social security system (CMU) or a private French insurance provider. As the latter option of private health insurance as an alternative to membership of LAMal will be revoked under the new French legislation that will come into force on 1 June 2014, current “...

  8. Terrorism Risk Insurance: An Overview

    National Research Council Canada - National Science Library

    Webel, Baird

    2005-01-01

    .... Addressing this problem, Congress enacted the Terrorism Risk Insurance Act of 2002 (TRIA) to create a temporary program to share future insured terrorism losses with the property-casualty insurance industry and policyholders...

  9. Disposition of Insurance Allotment Payments

    National Research Council Canada - National Science Library

    Young, Shelton

    2001-01-01

    .... The request was prompted by action taken by the Florida Department of Insurance against two life insurance companies that had received large numbers of insurance allotments from Service members...

  10. Dental treatment injuries in the Finnish Patient Insurance Centre in 2000-2011.

    Science.gov (United States)

    Karhunen, Sini; Virtanen, Jorma I

    2016-01-01

    Objective The Patient Insurance Centre in Finland reimburses patients who sustained injuries associated with medical and dental care without having to demonstrate malpractice. The aim was to analyse all dental injuries claimed through the Patient Insurance Centre over a 12-year period in order to identify factors affecting reimbursement of claims. Methods This study investigated all dental patient insurance claims in Finland during 2000-2011. The injury cases were grouped as (K00-K08) according to the International Classification of Diseases (ICD-10). Calendar year, claimant's age and gender, dental disease group and health service sector were the explanatory factors and the outcome was the decision of a claim. Multiple logistic regression modelling was used in the statistical analyses. Results The total number of decisions related to dental claims at the PIC in 2000-2011 was 7662, of which women claimed a clear majority (72%). Diseases of the pulp and periapical tissues (K04) and dental caries (K02) were the major disease groups (both 29%). Of the claims 40% were eligible for reimbursement, 27% were classified as insignificant or unavoidable injuries and 32% were rejected for other reasons. The proportion of reimbursed claims declined during the period. Patients from the private sector were more likely to be eligible for compensation than were those from the public sector (OR = 1.89, 95% CI = 1.71-2.10). Conclusions The number of dental patient insurance claims in Finland clearly rose, while the proportion of reimbursed claims declined. More claims received compensation in the private sector than in the public sector.

  11. Attitudes toward the dubious compensation claim.

    Science.gov (United States)

    LEGGO, C

    1951-07-01

    Laws providing for compensation of workmen for occupational injury are a powerful socio-economic force. In settlement of compensation claims the goal, difficult to achieve, is fairness to employee, employer and insurance carrier. Often, medical, legal, economic and social considerations conflict with one another. A "fact" in one field may not be considered so in another. Since medical data and testimony often guide the ultimate decision of a compensation claim, the physician's attitude is a large factor not only immediately and directly in determination of the case at hand but, perhaps more important, in the ultimate direction of the socio-economic forces which spring from the sum of all such determinations. To perpetuate the good in workmen's compensation laws, the next generation of physicians-and of lawyers and business administrators as well, for they, too, are involved-ought to have basic training in the social sciences in order that they may have a broad rather than a segmental view of the problems with which they deal.

  12. Contested Property Claims

    DEFF Research Database (Denmark)

    Property relations are such a common feature of social life that we can sometimes forget the immense complexity of the web of laws, practices, and ideas that allow a property regime to function smoothly. But we are quickly reminded of this complexity when social conflict over property erupts. When...... social actors confront a property regime – for example by squatting – they enact what can be called ‘contested property claims’. These confrontations raise crucial issues of social justice and show the ways in which property conflicts often reflect wider social conflicts. Through a series of case studies...... from across the globe, this multidisciplinary anthology exploring contested property claims brings together works from anthropologists, legal scholars, and geographers, who show how disagreements give us a privileged window onto how property regimes function and illustrates the many ways...

  13. Contested Property Claims

    DEFF Research Database (Denmark)

    Property relations are such a common feature of social life that the complexity of the web of laws, practices, and ideas that allow a property regime to function smoothly are often forgotten. But we are quickly reminded of this complexity when conflict over property erupts. When social actors...... confront a property regime – for example by squatting – they enact what can be called ‘contested property claims’. As this book demonstrates, these confrontations raise crucial issues of social justice and show the ways in which property conflicts often reflect wider social conflicts. Through a series...... of case studies from across the globe, this multidisciplinary anthology brings together works from anthropologists, legal scholars, and geographers, who show how exploring contested property claims offers a privileged window onto how property regimes function, as well as an illustration of the many ways...

  14. Mediation as an alternative solution to medical malpractice court claims

    Directory of Open Access Journals (Sweden)

    Neels Claassen

    2016-05-01

    Full Text Available Is there a crisis in the healthcare industry? Most certainly there is. Dr Motsoaledi, Minister of Health, publicly acknowledged the existence of such a crisis at a Medico-Legal Summit held at his initiative in Pretoria on 9 and 10 March 2015 at St Georges Hotel.[1] Currently, as recently confirmed by the MEC for Health, Ms Mahlangu, there are about 2 000 pending court cases against the Gauteng Provincial Health Department, the total quantum being claimed amounting to approximately ZAR 3.5 billion. During 2013/2014 this department spent about ZAR 256 million on legal costs payable to claimants’ attorneys. No budget for these expenses exists, resulting in payment being made from funds designated for the acquisition of medical equipment and other purposes.[1] This undermines the department’s ability to renew old equipment and upgrade to more modern equipment, resulting in even further claims. More claims are therefore to be expected. The Medical Protection Society also confirmed an increase in medical malpractice claims against their members of nearly 550% compared to 10 years ago. The quantum of claims that exceeded ZAR 5 million per claim, also increased by 900%.[2,3] The ripple effect of these increases in medico-legal claims causes insurance premiums for healthcare professionals to become exorbitantly expensive, resulting in some practitioners leaving the medical profession. Practitioners also act more defensively in applying their trade, resulting in additional and sometimes unnecessary tests that increase the costs of medical care and often cause further grounds for the institution of claims.

  15. THE ANALYSIS OF THE COMPREHENSIVE INSURANCE DEMAND FOR TURKEY USING UTILITY THEORY AND SYSTEM SIMULATION

    Directory of Open Access Journals (Sweden)

    Murat KIRKAĞAÇ

    2017-03-01

    Full Text Available In this study, the demand for comprehensive insurance is analysed using utility theory and system simulation. A simulation study is performed to assess the behaviour of individuals with different income levels for the demand of comprehensive insurance. Simulation assumptions and input-output variables are determined using the real data set from a Turkish insurance company and the report about the insurance activities in Turkey for year 2014. The effects of income level, expected claim severity and premium level on the demand for insurance are investigated. It is concluded that while an increase in income level and expected claim severity causes an increase in the demand, an increase in premium level causes a decrease in the demand.

  16. Insurance: Accounting, Regulation, Actuarial Science

    OpenAIRE

    Alain Tosetti; Thomas Behar; Michel Fromenteau; Stéphane Ménart

    2001-01-01

    We shall be examining the following topics: (i) basic frameworks for accounting and for statutory insurance rules; and (ii) actuarial principles of insurance; for both life and nonlife (i.e. casualty and property) insurance.Section 1 introduces insurance terminology, regarding what an operation must include in order to be an insurance operation (the legal, statistical, financial or economic aspects), and introduces the accounting and regulation frameworks and the two actuarial models of insur...

  17. Risk Management in Insurance Companies

    OpenAIRE

    Yang, Xufeng

    2006-01-01

    Insurance is the uncertain business in uncertain society. Today, insures face more complex and difficult risks. Efficient risk management mechanisms are essential for the insurers. The paper is set out initially to explore UK insurance companies risk management and risk disclosure by examining companies annual report after all the listed insurance companies are required to disclose risk information in their annual report, which seeks to reflect the recent development in UK insurance companies...

  18. Algorithms to identify colonic ischemia, complications of constipation and irritable bowel syndrome in medical claims data: development and validation.

    Science.gov (United States)

    Sands, Bruce E; Duh, Mei-Sheng; Cali, Clorinda; Ajene, Anuli; Bohn, Rhonda L; Miller, David; Cole, J Alexander; Cook, Suzanne F; Walker, Alexander M

    2006-01-01

    A challenge in the use of insurance claims databases for epidemiologic research is accurate identification and verification of medical conditions. This report describes the development and validation of claims-based algorithms to identify colonic ischemia, hospitalized complications of constipation, and irritable bowel syndrome (IBS). From the research claims databases of a large healthcare company, we selected at random 120 potential cases of IBS and 59 potential cases each of colonic ischemia and hospitalized complications of constipation. We sought the written medical records and were able to abstract 107, 57, and 51 records, respectively. We established a 'true' case status for each subject by applying standard clinical criteria to the available chart data. Comparing the insurance claims histories to the assigned case status, we iteratively developed, tested, and refined claims-based algorithms that would capture the diagnoses obtained from the medical records. We set goals of high specificity for colonic ischemia and hospitalized complications of constipation, and high sensitivity for IBS. The resulting algorithms substantially improved on the accuracy achievable from a naïve acceptance of the diagnostic codes attached to insurance claims. The specificities for colonic ischemia and serious complications of constipation were 87.2 and 92.7%, respectively, and the sensitivity for IBS was 98.9%. U.S. commercial insurance claims data appear to be usable for the study of colonic ischemia, IBS, and serious complications of constipation. (c) 2005 John Wiley & Sons, Ltd.

  19. Claiming health in food products

    DEFF Research Database (Denmark)

    Lähteenmäki, Liisa

    2013-01-01

    Health-related information is increasingly used on food products to convey their benefits. Health claims as a subcategory of these messages link the beneficial component, functions or health outcomes with specific products. For consumers, health claims seem to carry the message of increased...... healthiness, but not necessarily making the product more appealing. The wording of the claim seems to have little impact on claim perception, yet the health image of carrier products is important. From consumer-related factors the relevance and attitudes towards functional foods play a role, whereas socio......-demographic factors have only minor impact and the impact seems to be case-dependent. Familiarity with claims and functional foods increase perceived healthiness and acceptance of these products. Apparently consumers make rather rational interpretations of claims and their benefits when forced to assess...

  20. Are the claims made in orthopaedic print advertisements valid?

    Science.gov (United States)

    Davidson, Donald J; Rankin, Kenneth S; Jensen, Cyrus D; Moverley, Robert; Reed, Mike R; Sprowson, Andrew P

    2014-05-01

    Advertisements are commonplace in orthopaedic journals and may influence the readership with claims of clinical and scientific fact. Since the last assessment of the claims made in orthopaedic print advertisements ten years ago, there have been legislative changes and media scrutiny which have shaped this practice. The purpose of this study is to re-evaluate these claims. Fifty claims from 50 advertisements were chosen randomly from six highly respected peer-reviewed orthopaedic journals (published July-December 2011). The evidence supporting each claim was assessed and validated by three orthopaedic surgeons. The assessors, blinded to product and company, rated the evidence and answered the following questions: Does the evidence as presented support the claim made in the advertisement and what is the quality of that evidence? Is the claim supported by enough evidence to influence your own clinical practice? Twenty-eight claims cited evidence from published literature, four from public presentations, 11 from manufacturer "data held on file" and seven had no supporting evidence. Only 12 claims were considered to have high-quality evidence and only 11 were considered well supported. A strong correlation was seen between the quality of evidence and strength of support (Spearman r = 0.945, p advertisements. High-quality evidence is required by orthopaedic surgeons to influence clinical practice and this evidence should be sought by manufacturers wishing to market a successful product.

  1. Managing and operating the reserve market as one insurance system

    International Nuclear Information System (INIS)

    Liu, Youfei; Cai, Bin; Wu, F.F.; Ni, Y.X.

    2007-01-01

    In this paper, it is suggested that the preference of an individual consumer for its power supply reliability should be considered when scheduling the system reserve. The mechanism of 'provider insurance' is introduced and the reserve market is to be managed as an insurance system. In our modeling, the generator who provides the insurance of reliable power supply via its reserve, should always collect the payment (the premium), and be rewarded with the spot market price for its called reserve. The consumer who buys the insurance, pays premium and thus obtains a reliable power supply (the claim). It is argued that such a market mechanism will result in the maximum social welfare. Moreover, it is shown that there is a kind of 'moral hazard in reverse' fact that will further improve the market efficiency. Later on, discussions on implementing the proposed method are given, and an illustrative example is provided to show basic features of the proposed method. (author)

  2. Chiropractic claims in the English-speaking world.

    Science.gov (United States)

    Ernst, Edzard; Gilbey, Andrew

    2010-04-09

    Some chiropractors and their associations claim that chiropractic is effective for conditions that lack sound supporting evidence or scientific rationale. This study therefore sought to determine the frequency of World Wide Web claims of chiropractors and their associations to treat, asthma, headache/migraine, infant colic, colic, ear infection/earache/otitis media, neck pain, whiplash (not supported by sound evidence), and lower back pain (supported by some evidence). A review of 200 chiropractor websites and 9 chiropractic associations' World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States was conducted between 1 October 2008 and 26 November 2008. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment. We found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache/migraine. Unsubstantiated claims were made about asthma, ear infection/earache/otitis media, neck pain, The majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.

  3. Claim prevention at reactor facilities

    International Nuclear Information System (INIS)

    Colby, B.P.

    1987-01-01

    Why does a radiation worker bring a claim alleging bodily injury from radiation exposure? Natural cancer, fear of radiation induced cancer, financial gain, emotional distress and mental anguish are some reasons for workers' claims. In this paper the author describes what power reactor health physicists are doing to reduce the likelihood of claims by establishing programs which provide sound protection of workers, prevent radiological events, improve workers' knowledge of radiological conditions and provide guidance for radiological incident response

  4. MOTOR THIRD PARTY LIABILITY INSURANCE – POLISH MARKET IN CONNECTIONS TO EUROPEAN TRENDS

    Directory of Open Access Journals (Sweden)

    Ilona Kwiecień

    2011-07-01

    Full Text Available Motor insurance, despite continuous product development, are still in most European countries, the predominant group of products sold by non-life Insurers. In the countries of Central and Eastern Europe is about 2/3 of the insurance written premiums. In the article authors analyze the areas and factors affecting the development of this class of insurance and current market changes in Poland in comparison to the European trends. The main attention has been devoted to number of accidents and road safety, frequency and amount of claims, other macroeconomics and legal factors. Also the financial issues, such as premium and profitability, were discussed.

  5. Financial risk and derivatives a special issue of the geneva papers on risk and insurance theory

    CERN Document Server

    Subrahmanyam, Marti

    1996-01-01

    Financial Risk and Derivatives provides an excellent illustration of the links that have developed in recent years between the theory of finance on one hand and insurance economics and actuarial science on the other. Advances in contingent claims analysis and developments in the academic and practical literature dealing with the management of financial risks reflect the close relationships between insurance and innovations in finance. The book represents an overview of the present state of the art in theoretical research dealing with financial issues of significance for insurance science. It will hopefully provide an impetus to further developments in applied insurance research.

  6. 'Serial review on clinical PET tracers'. Application of health insurance of [15O]oxygen PET and [18F]FDG-PET

    International Nuclear Information System (INIS)

    Torizuka, Kanji

    2009-01-01

    As regards the application required for health insurance of PET, the Ministry of Health, Labour and Welfare indicates the following procedures: first, request a permission to the Ministry of Health, Labour and Welfare for the clinical use of the automatic synthetic instrument for PET drug, approved according to the Pharmaceutical Affairs Law. Second, put into practice the use of PET test, under the highly advanced medicine premises. Then, in case of gathered positive results, the health insurance is approved for this PET test. Thus, following the above mentioned procedures, first, the use of [ 15 O] oxygen PET was approved in April 1996. Second, the use of [ 18 F]FDG-PET was approved in 12 different diseases: epilepsy, ischemic heart disease and 10 different types of cancer, in April 2002. Third, in April 2006, a additional 3 types of cancer were approved. Now, we are in the process to get the health insurance of all kinds of malignant tumors (cancer and sarcoma) except for the early gastric cancer. (author)

  7. Health insurance basic actuarial models

    CERN Document Server

    Pitacco, Ermanno

    2014-01-01

    Health Insurance aims at filling a gap in actuarial literature, attempting to solve the frequent misunderstanding in regards to both the purpose and the contents of health insurance products (and ‘protection products’, more generally) on the one hand, and the relevant actuarial structures on the other. In order to cover the basic principles regarding health insurance techniques, the first few chapters in this book are mainly devoted to the need for health insurance and a description of insurance products in this area (sickness insurance, accident insurance, critical illness covers, income protection, long-term care insurance, health-related benefits as riders to life insurance policies). An introduction to general actuarial and risk-management issues follows. Basic actuarial models are presented for sickness insurance and income protection (i.e. disability annuities). Several numerical examples help the reader understand the main features of pricing and reserving in the health insurance area. A short int...

  8. Insurability of Terrorism Risks

    International Nuclear Information System (INIS)

    Harbruecker, D.

    2006-01-01

    Until 2001 losses caused by terrorist attacks have been covered under fire policies worldwide with two exceptions: Spain and UK where major and multiple losses caused by ETA and IRA had led to specific insurance solutions. The September 11, 2001 attacks on the World Trade Centre have changed the world in many aspects. This includes the insurance industry, which was compelled to exclude terrorism from coverage and to offer special solutions for extra premium. Nuclear power plants have been repeatedly called targets for terrorists as their destruction could cause a large catastrophe and more victims than the September 2001 attacks. How does the insurance industry respond? (author)

  9. 77 FR 74830 - Request for Comments on a Patent Small Claims Proceeding in the United States

    Science.gov (United States)

    2012-12-18

    ...; (d) Whether there should be certain required pleadings or evidence to initiate a small claims... nature of that fee should be; (f) Whether multiple parties should be able to file claims in a small... a small claims proceeding be enforced; (o) What the nature of appellate review should be including...

  10. Can Medicaid Claims Validly Ascertain Foster Care Status?

    Science.gov (United States)

    Raghavan, Ramesh; Brown, Derek S; Allaire, Benjamin T

    2017-08-01

    Medicaid claims have been used to identify populations of children in foster care in the current literature; however, the ability of such an approach to validly ascertain a foster care population is unknown. This study linked children in the National Survey of Child and Adolescent Well-Being-I to their Medicaid claims from 36 states using their Social Security numbers. Using this match, we examined discordance between caregiver report of foster care placement and the foster care eligibility code contained in the child's Medicaid claims. Only 73% of youth placed in foster care for at least a year displayed a Medicaid code for foster care eligibility. Half of all youth coming into contact with child welfare displayed discordance between caregiver report and Medicaid claims. Children with emergency department utilization, and those in primary care case management health insurance arrangements, had the highest odds of accurate ascertainment. The use of Medicaid claims to identify a cohort of children in foster care results in high rates of underascertainment. Supplementing administrative data with survey data is one way to enhance validity of ascertainment.

  11. Turkish Compulsory Earthquake Insurance and "Istanbul Earthquake

    Science.gov (United States)

    Durukal, E.; Sesetyan, K.; Erdik, M.

    2009-04-01

    The city of Istanbul will likely experience substantial direct and indirect losses as a result of a future large (M=7+) earthquake with an annual probability of occurrence of about 2%. This paper dwells on the expected building losses in terms of probable maximum and average annualized losses and discusses the results from the perspective of the compulsory earthquake insurance scheme operational in the country. The TCIP system is essentially designed to operate in Turkey with sufficient penetration to enable the accumulation of funds in the pool. Today, with only 20% national penetration, and about approximately one-half of all policies in highly earthquake prone areas (one-third in Istanbul) the system exhibits signs of adverse selection, inadequate premium structure and insufficient funding. Our findings indicate that the national compulsory earthquake insurance pool in Turkey will face difficulties in covering incurring building losses in Istanbul in the occurrence of a large earthquake. The annualized earthquake losses in Istanbul are between 140-300 million. Even if we assume that the deductible is raised to 15%, the earthquake losses that need to be paid after a large earthquake in Istanbul will be at about 2.5 Billion, somewhat above the current capacity of the TCIP. Thus, a modification to the system for the insured in Istanbul (or Marmara region) is necessary. This may mean an increase in the premia and deductible rates, purchase of larger re-insurance covers and development of a claim processing system. Also, to avoid adverse selection, the penetration rates elsewhere in Turkey need to be increased substantially. A better model would be introduction of parametric insurance for Istanbul. By such a model the losses will not be indemnified, however will be directly calculated on the basis of indexed ground motion levels and damages. The immediate improvement of a parametric insurance model over the existing one will be the elimination of the claim processing

  12. Cross-disciplinary links in environmental systems science: Current state and claimed needs identified in a meta-review of process models.

    Science.gov (United States)

    Ayllón, Daniel; Grimm, Volker; Attinger, Sabine; Hauhs, Michael; Simmer, Clemens; Vereecken, Harry; Lischeid, Gunnar

    2018-05-01

    Terrestrial environmental systems are characterised by numerous feedback links between their different compartments. However, scientific research is organized into disciplines that focus on processes within the respective compartments rather than on interdisciplinary links. Major feedback mechanisms between compartments might therefore have been systematically overlooked so far. Without identifying these gaps, initiatives on future comprehensive environmental monitoring schemes and experimental platforms might fail. We performed a comprehensive overview of feedbacks between compartments currently represented in environmental sciences and explores to what degree missing links have already been acknowledged in the literature. We focused on process models as they can be regarded as repositories of scientific knowledge that compile findings of numerous single studies. In total, 118 simulation models from 23 model types were analysed. Missing processes linking different environmental compartments were identified based on a meta-review of 346 published reviews, model intercomparison studies, and model descriptions. Eight disciplines of environmental sciences were considered and 396 linking processes were identified and ascribed to the physical, chemical or biological domain. There were significant differences between model types and scientific disciplines regarding implemented interdisciplinary links. The most wide-spread interdisciplinary links were between physical processes in meteorology, hydrology and soil science that drive or set the boundary conditions for other processes (e.g., ecological processes). In contrast, most chemical and biological processes were restricted to links within the same compartment. Integration of multiple environmental compartments and interdisciplinary knowledge was scarce in most model types. There was a strong bias of suggested future research foci and model extensions towards reinforcing existing interdisciplinary knowledge rather than

  13. Insuring against health shocks: Health insurance and household choices.

    Science.gov (United States)

    Liu, Kai

    2016-03-01

    This paper provides empirical evidence on the role of public health insurance in mitigating adverse outcomes associated with health shocks. Exploiting the rollout of a universal health insurance program in rural China, I find that total household income and consumption are fully insured against health shocks even without access to health insurance. Household labor supply is an important insurance mechanism against health shocks. Access to health insurance helps households to maintain investment in children's human capital during negative health shocks, which suggests that one benefit of health insurance could arise from reducing the use of costly smoothing mechanisms. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Optimum amount of an insurance sum in life insurance

    Directory of Open Access Journals (Sweden)

    Janez Balkovec

    2001-01-01

    Full Text Available Personal insurance represents one of the sources of personal social security as a category of personal property. How to get a proper life insurance is a frequently asked question. When insuring material objects (car, house..., the problem is usually not in the amount of the taken insurance. With life insurance (abstract goods, problems as such occur. In this paper, we wish to present a model that, according to the financial situation and the anticipated future, makes it possible to calculate the optimum insurance sum in life insurance.

  15. Group life insurance

    CERN Multimedia

    2013-01-01

    The CERN Administration wishes to inform staff members and fellows having taken out optional life insurance under the group contract signed by CERN that the following changes to the rules and regulations entered into force on 1 January 2013:   The maximum age for an active member has been extended from 65 to 67 years. The beneficiary clause now allows insured persons to designate one or more persons of their choice to be their beneficiary(-ies), either at the time of taking out the insurance or at a later date, in which case the membership/modification form must be updated accordingly. Beneficiaries must be clearly identified (name, first name, date of birth, address).   The membership/modification form is available on the FP website: http://fp.web.cern.ch/helvetia-life-insurance For further information, please contact: Valentina Clavel (Tel. 73904) Peggy Pithioud (Tel. 72736)

  16. Vaccines as Epidemic Insurance.

    Science.gov (United States)

    Pauly, Mark V

    2017-10-27

    This paper explores the relationship between the research for and development of vaccines against global pandemics and insurance. It shows that development in advance of pandemics of a portfolio of effective and government-approved vaccines does have some insurance properties: it requires incurring costs that are certain (the costs of discovering, developing, and testing vaccines) in return for protection against large losses (if a pandemic treatable with one of the vaccines occurs) but also with the possibility of no benefit (from a vaccine against a disease that never reaches the pandemic stage). It then argues that insurance against the latter event might usefully be offered to organizations developing vaccines, and explores the benefits of insurance payments to or on behalf of countries who suffer from unpredictable pandemics. These ideas are then related to recent government, industry, and philanthropic efforts to develop better policies to make vaccines against pandemics available on a timely basis.

  17. Vaccines as Epidemic Insurance

    Directory of Open Access Journals (Sweden)

    Mark V. Pauly

    2017-10-01

    Full Text Available This paper explores the relationship between the research for and development of vaccines against global pandemics and insurance. It shows that development in advance of pandemics of a portfolio of effective and government-approved vaccines does have some insurance properties: it requires incurring costs that are certain (the costs of discovering, developing, and testing vaccines in return for protection against large losses (if a pandemic treatable with one of the vaccines occurs but also with the possibility of no benefit (from a vaccine against a disease that never reaches the pandemic stage. It then argues that insurance against the latter event might usefully be offered to organizations developing vaccines, and explores the benefits of insurance payments to or on behalf of countries who suffer from unpredictable pandemics. These ideas are then related to recent government, industry, and philanthropic efforts to develop better policies to make vaccines against pandemics available on a timely basis.

  18. M. Nuclear insurance

    International Nuclear Information System (INIS)

    1976-01-01

    Nuclear insurance and some of the features associated with it, such as the International Conventions and the operation of Atomic Risk Pools, are discussed both in general and with specific reference to the USA, Canada and the United Kingdom

  19. Building and Contents Insurance.

    Science.gov (United States)

    Freese, William C.

    Insurance coverage of school buildings and contents is becoming increasingly difficult to obtain, and increases of 50 percent or more in the premium are not uncommon. Methods of reducing premium increases are outlined in this speech. (MLF)

  20. HUD Insured Hospitals

    Data.gov (United States)

    Department of Housing and Urban Development — The Office of Healthcare Programs (OHP), previously known as the Office of Insured Health Care Facilities, is located within the Office of Housing and administers...

  1. Deductibles in health insurance

    Science.gov (United States)

    Dimitriyadis, I.; Öney, Ü. N.

    2009-11-01

    This study is an extension to a simulation study that has been developed to determine ruin probabilities in health insurance. The study concentrates on inpatient and outpatient benefits for customers of varying age bands. Loss distributions are modelled through the Allianz tool pack for different classes of insureds. Premiums at different levels of deductibles are derived in the simulation and ruin probabilities are computed assuming a linear loading on the premium. The increase in the probability of ruin at high levels of the deductible clearly shows the insufficiency of proportional loading in deductible premiums. The PH-transform pricing rule developed by Wang is analyzed as an alternative pricing rule. A simple case, where an insured is assumed to be an exponential utility decision maker while the insurer's pricing rule is a PH-transform is also treated.

  2. What can we learn from patient claims? - A retrospective analysis of incidence and patterns of adverse events after orthopaedic procedures in Sweden

    Directory of Open Access Journals (Sweden)

    Öhrn Annica

    2012-01-01

    Full Text Available Abstract Background Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden. Methods In this retrospective review data from two Swedish national databases during a 4-year period were analyzed. We used the "County Councils' Mutual Insurance Company", a national no-fault insurance system for patient claims, and the "National Patient Register at the National Board of Health and Welfare". Results A total of 6,029 patient claims filed after orthopaedic surgery were assessed during the study period. Of those, 3,336 (55% were determined to be adverse events, which received financial compensation. Hospital-acquired infections and sepsis were the most common causes of adverse events (n = 741; 22%. The surgical procedure that caused the highest rate of adverse events was "decompression of spinal cord and nerve roots" (code ABC**, with 168 adverse events of 17,507 hospitals discharges (1%. One in five (36 of 168; 21.4% injured patient was seriously disabled or died. Conclusions We conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them.

  3. The insurance of industrial risks at home and abroad

    International Nuclear Information System (INIS)

    Braun, H.

    1976-01-01

    For more than 85 years now, the Allianz has followed the trend of development in industry from both the technological and economic aspects. This contribution furnishes a review - in summarised form - of the types of insurance of significance for industry, with particular reference to the insurance requirements of the German export industry. (orig.) [de

  4. Prevention in insurance markets

    OpenAIRE

    Marie-Cécile FAGART; Bidénam KAMBIA-CHOPIN

    2006-01-01

    This paper considers a competitive insurance market under moral hazard and adverse selection, in which preventive efforts and self-protection costs are unobservable by insurance companies. Under reasonable assumptions, the conclusions of Rothschild and Stiglitz (1976) are preserved in our context even if it involves moral hazard. The riskier agents in equilibrium, who would also be the riskier agents under perfect information, receive their moral hazard contract. For other agents, adverse sel...

  5. ECONOMIC NATURE OF THE FINANCIAL REGULATION OF INSURANCE MARKET

    Directory of Open Access Journals (Sweden)

    L. Shirinyan

    2013-07-01

    Full Text Available Author made critical review of researches and found out the existance of the problem of determination and differentiation in a scientific literature the concepts “financial regulation of the insurance market”, “government financial regulation of the insurance market” and “government regulation of the insurance market”. It is offered the consideration of the insurance market from positions of analysis of the complex systems as being the component part of the greater system. It is disclosured the economic nature and determined the mentioned notions.

  6. Consumer in insurance law

    Directory of Open Access Journals (Sweden)

    Čorkalo Milena

    2016-01-01

    Full Text Available The paper analyses the notion of consumer in the European Union law, and, in particular, the notion of consumer in insurance law. The author highligts the differences between the notion of consumer is in aquis communautaire and in insurance law, discussing whether the consumer can be defined in both field in the same way, concerning that insurance services differ a lot from other kind of services. Having regarded unequal position of contracting parties and information and technical disadvantages of a weaker party, author pleads for broad definition of consumer in insurance law. In Serbian law, the consumer is not defined in consistent way. That applies on Serbian insurance law as well. Therefore, the necessity of precise and broad definition of consumes is underlined, in order to delimit the circle of subject who are in need for protection. The author holds that the issue of determination of the circle of persons entitled to extended protection as consumers is of vital importance for further development of insurance market in Serbia.

  7. Type 2 diabetes detection and management among insured adults.

    Science.gov (United States)

    Dall, Timothy M; Yang, Weyna; Halder, Pragna; Franz, Jerry; Byrne, Erin; Semilla, April P; Chakrabarti, Ritashree; Stuart, Bruce

    2016-01-01

    The Centers for Disease Control and Prevention estimates that 28.9 million adults had diabetes in 2012 in the US, though many patients are undiagnosed or not managing their condition. This study provides US national and state estimates of insured adults with type 2 diabetes who are diagnosed, receiving exams and medication, managing glycemic levels, with diabetes complications, and their health expenditures. Such information can be used for benchmarking and to identify gaps in diabetes detection and management. The study combines analysis of survey data with medical claims analysis for the commercially insured, Medicare, and Medicaid populations to estimate the number of adults with diagnosed type 2 diabetes and undiagnosed diabetes by insurance type, age, and sex. Medical claims analysis used the 2012 de-identified Normative Health Information database covering a nationally representative commercially insured population, the 2011 Medicare 5% Sample, and the 2008 Medicaid Mini-Max. Among insured adults in 2012, approximately 16.9 million had diagnosed type 2 diabetes, 1.45 million had diagnosed type 1 diabetes, and 6.9 million had undiagnosed diabetes. Of those with diagnosed type 2, approximately 13.0 million (77%) received diabetes medication-ranging from 70% in New Jersey to 82% in Utah. Suboptimal percentages had claims indicating recommended exams were performed. Of those receiving diabetes medication, 43% (5.6 million) had medical claims indicating poorly controlled diabetes-ranging from 29% with poor control in Minnesota and Iowa to 53% in Texas. Poor control was correlated with higher prevalence of neurological complications (+14%), renal complications (+14%), and peripheral vascular disease (+11%). Patients with poor control averaged $4,860 higher average annual health care expenditures-ranging from $6,680 for commercially insured patients to $4,360 for Medicaid and $3,430 for Medicare patients. This study highlights the large number of insured adults with

  8. CHIP premiums, health status, and the insurance coverage of children.

    Science.gov (United States)

    Marton, James; Talbert, Jeffery C

    2010-01-01

    This study uses the introduction of premiums into Kentucky's Children's Health Insurance Program (KCHIP) to examine whether the enrollment impact of new premiums varies by child health type. We also examine the extent to which children find alternative coverage after premium nonpayment. Public insurance claims data suggest that those with chronic health conditions are less likely to leave public coverage. We find little evidence of a differential impact of premiums on enrollment among the chronically ill. Our survey of nonpayers shows that 56% of responding families found alternative private or public health coverage for their children after losing CHIP.

  9. 45 CFR 95.631 - Cost identification for purpose of FFP claims.

    Science.gov (United States)

    2010-10-01

    ... INSURANCE PROGRAMS) Automatic Data Processing Equipment and Services-Conditions for Federal Financial Participation (FFP) Federal Financial Participation in Costs of Adp Acquisitions § 95.631 Cost identification... 45 Public Welfare 1 2010-10-01 2010-10-01 false Cost identification for purpose of FFP claims. 95...

  10. Subverting Risk Attachment as Consideration for Insurance Contracts: Kansas City College of Osteopathic Medicine v. Employers' Surplus Lines Insurance Co.

    Science.gov (United States)

    Sweeney, Patricia J.

    1980-01-01

    Legal implications and court rulings are reviewed for a case in which a medical college requested a premium refund and cancellation of the bond. It is concluded that the court decision in favor of the insurance company was inappropriate and tends to undermine insurance law. (Journal availibility: Boston U. School of Law, Boston, MA 02215) (MSE)

  11. Scientific relevance of Swiss property insurance data on flood risks and losses

    Science.gov (United States)

    Röthlisberger, Veronika; Bernet, Daniel; Keiler, Margreth

    2015-04-01

    The databases of Swiss flood insurance companies build a valuable but to date rarely used source of information for flood risk research. Detailed insights into the Swiss flood insurance system are crucial to evaluate the potential of the different databases for scientific analysis. Even though the flood insurance system modalities are mainly regulated on cantonal level there are some common principles that apply throughout Switzerland. First of all coverage against floods (and other particular natural hazards) is an integral part of every fire insurance policy for buildings or contents in Switzerland. This coupling of insurance as well as the statutory obligation to insure buildings in most of the cantons and movables in some of the cantons lead to a very high penetration. Second, in case of damage, the reinstatement costs (value as new) are compensated and third there are no (or little) deductible and co-pay. Thus the different datasets of the flood insurance companies would allow a very comprehensive data analysis. Moreover, insurance companies not only store electronically data about losses (typically date, amount of claims payment, cause of damage, identity of the insured object or policyholder) but also about insured objects. For insured objects the (insured) value and the details on the policy and its holder are the main feature to record. On buildings the insurance companies usually computerize additional information such as location, volume, year of construction or purpose of use. For the 19 (of total 26) cantons with a cantonal monopoly insurer the data of these insurance establishments have the additional value to represent (almost) the entire building stock of the respective canton. However, scientists face a wide range of the opportunities and challenges when using insurance data for flood research. The origin of flood insurance data implies that they are not generated for research but for business management. The presentation will highlighted pro and

  12. An Improved Distortion Operator for Insurance Risks

    Institute of Scientific and Technical Information of China (English)

    GAO Jian-wei; QIU Wan-hua

    2002-01-01

    This paper reviews the distortion function approach developed in the actuarial literature for insurance risks. The main aim of this paper is to derive an extensive distortion operator, and to propose a new premium principle based on this extensive distortion operator. Furthermore, the non-robustness of general distortion operator is also discussed. Examples are provided using Bernoulli, Pareto, Lognormal and Gamma distribution assumptions.

  13. A COMPARATIVE ANALYSIS BETWEEN UNIT-LINKED LIFE INSURANCE AND OTHER ALTERNATIVE INVESTMENTS

    Directory of Open Access Journals (Sweden)

    CRISTINA CIUMAS

    2015-07-01

    Full Text Available The unit-linked life insurance has two important components: protection and investment. The protection component refers to the insured sum in case of the occurrence of insured risks and the investment component refers to the policyholder’s account that represents the present value of the units from the chosen investment funds.These financial products invest most of the premium paid by the insured person in the funds managed by the insurance company or an external administrator and the lower part of the premium is intended to cover the insured risk (death, disability, etc. An important component of the activity carried out by the insurance companies is the investment of the premiums paid by policyholders in various types of assets, in order to obtain higher yields than those guaranteed by the insurance contracts, while providing the necessary liquidity for the payment of insurance claims in case of occurrence of the assumed risks. This research contributes to the existing literature regarding the study of investment alternatives, with an exclusive focus on the investment in unit-linked life insurance. A special place in this study is the presentation of investments in unit-linked insurance versus other types of financial investments: deposits, treasury bills, shares (BET, currency (EURO and gold.

  14. Sensitivity of Billing Claims for Cardiovascular Disease Events among Kidney Transplant Recipients

    Science.gov (United States)

    Lentine, Krista L.; Schnitzler, Mark A.; Abbott, Kevin C.; Bramesfeld, Kosha; Buchanan, Paula M.; Brennan, Daniel C.

    2009-01-01

    Background and objectives: Billing claims are increasingly examined beyond administrative functions as outcomes measures in observational research. Few studies have described the performance of billing claims as surrogate measures of clinical events among kidney transplant recipients. Design, setting, participants, & measurements: We investigated the sensitivity of Medicare billing claims for clinically verified cardiovascular diagnoses (five categories) and procedures (four categories) in a novel database linking Medicare claims to electronic medical records of one transplant program. Cardiovascular events identified in medical records for 571 Medicare-insured transplant recipients in 1991 through 2002 served as reference measures. Results: Within a claims-ascertainment period spanning ±30 d of clinically recorded dates, aggregate sensitivity of single claims was higher for case definitions incorporating Medicare Parts A and B for diagnoses and procedures (90.9%) compared with either Part A (82.3%) or Part B (84.6%) alone. Perfect capture of the four procedures was possible within ±30 d or with short claims window expansion, but sensitivity for the diagnoses trended lower with all study algorithms (91.2% with window up to ±90 d). Requirement for additional confirmatory diagnosis claims did not appreciably reduce sensitivity. Sensitivity patterns were similar in the early compared with late periods of the study. Conclusions: Combined use of Medicare Parts A and B billing claims composes a sensitive measure of cardiovascular events after kidney transplant. Further research is needed to define algorithms that maximize specificity as well as sensitivity of claims from Medicare and other insurers as research measures in this population. PMID:19541817

  15. Using Self-reports or Claims to Assess Disease Prevalence: It's Complicated.

    Science.gov (United States)

    St Clair, Patricia; Gaudette, Étienne; Zhao, Henu; Tysinger, Bryan; Seyedin, Roxanna; Goldman, Dana P

    2017-08-01

    Two common ways of measuring disease prevalence include: (1) using self-reported disease diagnosis from survey responses; and (2) using disease-specific diagnosis codes found in administrative data. Because they do not suffer from self-report biases, claims are often assumed to be more objective. However, it is not clear that claims always produce better prevalence estimates. Conduct an assessment of discrepancies between self-report and claims-based measures for 2 diseases in the US elderly to investigate definition, selection, and measurement error issues which may help explain divergence between claims and self-report estimates of prevalence. Self-reported data from 3 sources are included: the Health and Retirement Study, the Medicare Current Beneficiary Survey, and the National Health and Nutrition Examination Survey. Claims-based disease measurements are provided from Medicare claims linked to Health and Retirement Study and Medicare Current Beneficiary Survey participants, comprehensive claims data from a 20% random sample of Medicare enrollees, and private health insurance claims from Humana Inc. Prevalence of diagnosed disease in the US elderly are computed and compared across sources. Two medical conditions are considered: diabetes and heart attack. Comparisons of diagnosed diabetes and heart attack prevalence show similar trends by source, but claims differ from self-reports with regard to levels. Selection into insurance plans, disease definitions, and the reference period used by algorithms are identified as sources contributing to differences. Claims and self-reports both have strengths and weaknesses, which researchers need to consider when interpreting estimates of prevalence from these 2 sources.

  16. The economic crisis and the insurance industry: The evidence from the ex-Yugoslavia region

    Directory of Open Access Journals (Sweden)

    Njegomir Vladimir

    2010-01-01

    Full Text Available The paper analyses the impact of the economic crisis on the insurance industries of the ex-Yugoslavia region. The analysis encompasses five countries: Slovenia, Croatia, Serbia, Bosnia and Herzegovina, and FYR Macedonia. We examine insurance industry specifics separately for each country for the period 2004-2008 and for the first six months of 2009. While the impact of the crisis varies between countries, the research results indicate that the global financial crisis has had limited overall impact on the regional insurance industry. However the current recession resulted in negative premium growth in Serbia, Croatia and FYR Macedonia while the growth in Slovenia and Bosnia and Herzegovina declined. At the same time investment returns have declined and claims have risen in all countries. The crisis had more pronounced impact on non-life insurance premium growth in less developed insurance markets. In developed markets, namely Slovenia and Croatia, the crisis had greater impact on life insurance premium growth.

  17. The German insurance industry. Yearbook 1990 of the Gesamtverband der Deutschen Versicherungswirtschaft e.V

    International Nuclear Information System (INIS)

    1990-01-01

    The DKVG (German nuclear power plant insurance association), founded in 1957, has 104 member insurance companies, all registered in the Federal Repbulic of Germany. At present property insurance amounts to 1.5 billion DM, and liability insurance to 200 million DM. The overall damage ratio was 15.4 (1988: 5.9) percent, whereby home business remained claim-free in 1989. The relatively low damage ratio of 15 percent should not deviate from the fact that nuclear insurers always have to reckon with large damage. At the moment it would cost them a maximum gross sum of 1.7 billion DM (property and liability insurance); on account of DKVG 685 million DM. (orig./HP) [de

  18. Legal liability and claims for the hotel industry

    OpenAIRE

    Dimcho Todorov

    2017-01-01

    The paper presents a review of various aspects of legal liability and claims to hotel management arising in the hotel industry in the context of the legal framework and possible legal consequences for hotels and other types of commercial accommodation establishments. The main reasons for accidents' occurrence in the hotel industry are chronologically traced. Possible claims to the hotel management are also presented in detail. The problem with workplace discrimination, which is considered as ...

  19. Promoting universal financial protection: health insurance for the poor in Georgia--a case study.

    Science.gov (United States)

    Zoidze, Akaki; Rukhazde, Natia; Chkhatarashvili, Ketevan; Gotsadze, George

    2013-11-15

    The present study focuses on the program "Medical Insurance for the Poor (MIP)" in Georgia. Under this program, the government purchased coverage from private insurance companies for vulnerable households identified through a means testing system, targeting up to 23% of the total population. The benefit package included outpatient and inpatient services with no co-payments, but had only limited outpatient drug benefits. This paper presents the results of the study on the impact of MIP on access to health services and financial protection of the MIP-targeted and general population. With a holistic case study design, the study employed a range of quantitative and qualitative methods. The methods included document review and secondary analysis of the data obtained through the nationwide household health expenditure and utilisation surveys 2007-2010 using the difference-in-differences method. The study findings showed that MIP had a positive impact in terms of reduced expenditure for inpatient services and total household health care costs, and there was a higher probability of receiving free outpatient benefits among the MIP-insured. However, MIP insurance had almost no effect on health services utilisation and the households' expenditure on outpatient drugs, including for those with MIP insurance, due to limited drug benefits in the package and a low claims ratio. In summary, the extended MIP coverage and increased financial access provided by the program, most likely due to the exclusion of outpatient drug coverage from the benefit package and possibly due to improper utilisation management by private insurance companies, were not able to reverse adverse effects of economic slow-down and escalating health expenditure. MIP has only cushioned the negative impact for the poorest by decreasing the poor/rich gradient in the rates of catastrophic health expenditure. The recent governmental decision on major expansion of MIP coverage and inclusion of additional drug

  20. Indian community health insurance schemes provide partial protection against catastrophic health expenditure

    Directory of Open Access Journals (Sweden)

    Ranson Kent

    2007-03-01

    Full Text Available Abstract Background More than 72% of health expenditure in India is financed by individual households at the time of illness through out-of-pocket payments. This is a highly regressive way of financing health care and sometimes leads to impoverishment. Health insurance is recommended as a measure to protect households from such catastrophic health expenditure (CHE. We studied two Indian community health insurance (CHI schemes, ACCORD and SEWA, to determine whether insured households are protected from CHE. Methods ACCORD provides health insurance cover for the indigenous population, living in Gudalur, Tamil Nadu. SEWA provides insurance cover for self employed women in the state of Gujarat. Both cover hospitalisation expenses, but only upto a maximum limit of US$23 and US$45, respectively. We reviewed the insurance claims registers in both schemes and identified patients who were hospitalised during the period 01/04/2003 to 31/03/2004. Details of their diagnoses, places and costs of treatment and self-reported annual incomes were obtained. There is no single definition of CHE and none of these have been validated. For this research, we used the following definition; "annual hospital expenditure greater than 10% of annual income," to identify those who experienced CHE. Results There were a total of 683 and 3152 hospital admissions at ACCORD and SEWA, respectively. In the absence of the CHI scheme, all of the patients at ACCORD and SEWA would have had to pay OOP for their hospitalisation. With the CHI scheme, 67% and 34% of patients did not have to make any out-of-pocket (OOP payment for their hospital expenses at ACCORD and SEWA, respectively. Both CHI schemes halved the number of households that would have experienced CHE by covering hospital costs. However, despite this, 4% and 23% of households with admissions still experienced CHE at ACCORD and SEWA, respectively. This was related to the following conditions: low annual income, benefit

  1. What new policies should South Africa's life insurance industry adopt?

    Science.gov (United States)

    Solomon, G

    1996-12-01

    By February 1996, the South African life insurance industry had paid out more than R75 million in AIDS-related claims. This situation requires imposition of controls that will make economic sense while reflecting the social responsibility of the insurance companies. AIDS mortality rates suggest that for each 10% of the infected insured population, the risk premium rates should increase 400%. Thus, without controls, the life insurance sector may collapse. While it has been charged that HIV testing associated with the provision of life insurance discriminates against infected individuals, failure to test compromises the rights of uninfected individuals in the individual assurance market. HIV test protocols can be used that protect applicants from false positive results, prevent fraud, and preserve confidentiality. Proposals to require five-year retesting have also been criticized but would protect the interests of uninfected individuals who want life insurance to remain affordable. In an innovative move, South Africa now includes "full-blown AIDS" among the list of "dreaded diseases" that trigger an immediate pay-out. While purchasing life insurance may fall low on the list of priorities of an infected person, demand continues, and two companies offer expensive products to those with Stage I and II disease. Medical insurance is also threatened by the increased costs associated with HIV/AIDS, and treatment protocols may be the only way to control medical expenses and assure the future of medical insurance. At this stage of the epidemic, no one seems prepared to meet their share of the costs associated with HIV/AIDS.

  2. RISK CORRIDORS AND REINSURANCE IN HEALTH INSURANCE MARKETPLACES: Insurance for Insurers

    OpenAIRE

    LAYTON, TIMOTHY J.; MCGUIRE, THOMAS G.; SINAIKO, ANNA D.

    2016-01-01

    In order to encourage entry and lower prices, most regulated markets for health insurance include policies that seek to reduce the uncertainty faced by insurers. In addition to risk adjustment of premiums paid to plans, the Health Insurance Marketplaces established by the Affordable Care Act implement reinsurance and risk corridors. Reinsurance limits insurer costs associated with specific individuals, while risk corridors protect against aggregate losses. Both tighten the insurer's distribut...

  3. A study on the effect of exclusion period on the suicidal risk among the insured.

    Science.gov (United States)

    Yip, Paul S F; Chen, Feng

    2014-06-01

    An exclusion period (usually from 12 months to 2 years) is usually found in life insurance policies as a precautionary measure to prohibit people from insuring their lives with the intent to kill themselves shortly thereafter. Several studies have been conducted to investigate the effect of exclusion periods on the risk of suicide among the insured in the US and Australia. However, while Hong Kong has experienced an increase in the number of suicides among the insured, little is known about the dynamic between the exclusion period and suicide in Asia. Here we make use of death claims data from one of the major life insurance companies in Hong Kong to ascertain the impact of a 12-month exclusion period on suicide risk. We also use utility functions derived from economic theory to better understand individual choices regarding suicide among the insured. More specifically, we sought to determine whether there is a greater risk of suicide immediately following the 12-month exclusion period. We also examined whether the risk of suicide claims was higher than that of other non-suicidal claims. The study period for this investigation was from January 1, 1997 to December 31, 2011, during which time there were 1935 claims based on 1243 deaths. Of these, 197 were suicide-related claims for 106 suicide deaths. The mean number of life policies held by suicidal claimants and non-suicidal claimants was 1.6 and 1.4, respectively. The average/median size of the claims (total payment made on all policies held by the insured life) was HK$665,800/426,600 and HK$497,700/276,200 for suicidal and non-suicidal deaths, respectively. The policy lifetime of the claims, or the number of days from policy issuance to suicide occurrence, ranged from 38 to 7561 days, with a mean of 2209 days, a median of 1941 days, and a standard deviation of 1544 days. The peak density of suicide claims occurred on day 1039 of the policy. Our results revealed that suicide claims tend to occur earlier than other

  4. Insurance of liability for the transport of nuclear materials

    International Nuclear Information System (INIS)

    Deprimoz, J.

    1975-01-01

    The legal principle governing civil liability for damage involving nuclear substances in course of carriage are summarized, and the main aspects of the French nuclear insurance market are analysed. The financial capacity of insurance and the role of the Atomic Pool as an aid in this respect as well as its use as a mechanism for reinsurance are also discussed. As regards the insured party, cases are reviewed where the principle of the sole liability of the operator is inapplicable. Arguments are put forward demonstrating that acknowledgement of a plurality of insured persons would not necessarily lead to an increase of insurance costs. Finally, a review is made of the nature and extent of the damage covered according to whether such damage is caused to persons or property [fr

  5. ENDOWMENT LIFE INSURANCE

    Directory of Open Access Journals (Sweden)

    Zeljko Sain

    2013-06-01

    Full Text Available The aim of the paper that treats the actuarial model of insurance in case of survival or early death is to show the actuarial methods and methodology for creating a model and an appropriate number of sub-models of the most popular form of life insurance in the world. The paper applies the scientific methodology of the deductive character based on scientific, theoretical knowledge and practical realities. Following the basic theoretical model’s determinants, which are at the beginning of the paper, the basic difference between models further in this paper was carried out according to the character of the premium to be paid. Finally, the financial repercussions of some models are presented at examples in insurance companies. The result of this paper is to show the spectrum of possible forms of capital endowment insurance which can be, without major problems, depending on the financial policy of the company, applied in actual practice. The conclusion of this paper shows the theoretical and the practical reality of this model, life insurance, and its quantitative and qualitative guidelines.

  6. Group Life Insurance

    CERN Multimedia

    2013-01-01

    The CERN Administration would like to remind you that staff members and fellows have the possibility to take out a life insurance contract on favourable terms through a Group Life Insurance.   This insurance is provided by the company Helvetia and is available to you on a voluntary basis. The premium, which varies depending on the age and gender of the person insured, is calculated on the basis of the amount of the death benefit chosen by the staff member/fellow and can be purchased in slices of 10,000 CHF.    The contract normally ends at the retirement age (65/67 years) or when the staff member/fellow leaves the Organization. The premium is deducted monthly from the payroll.   Upon retirement, the staff member can opt to maintain his membership under certain conditions.   More information about Group Life Insurance can be found at: Regulations (in French) Table of premiums The Pension Fund Benefit Service &...

  7. BLM Colorado Mining Claims Closed

    Data.gov (United States)

    Department of the Interior — Shapefile Format –This data set consists of closed mining claim records extracted from BLM’s LR2000 database. These records contain case attributes as well as legal...

  8. BLM Colorado Mining Claims Active

    Data.gov (United States)

    Department of the Interior — Shapefile Format –This data set consists of active mining claim records extracted from BLM’s LR2000 database. These records contain case attributes as well as legal...

  9. Medicare Part D Claims Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — This page contains information on Part D claims data for the purposes of research, analysis, reporting, and public health functions. These data will also be used to...

  10. Adoption and impact of index-insurance and credit for smallholder farmers in developing countries

    NARCIS (Netherlands)

    Marr, Ana; Winkel, Anne; Asseldonk, van Marcel; Lensink, Robert; Bulte, Erwin

    2016-01-01

    Purpose – The purpose of this paper is to review the most recent scientific literature on the determinants explaining the demand for index-insurance, the impact of index-insurance and the existing links between insurance and credit. In this meta-analysis, the authors identify key discoveries on

  11. Serbian insurance market: Select issues

    Directory of Open Access Journals (Sweden)

    Obadović Mirjana M.

    2010-01-01

    Full Text Available Every day insurance companies face a number of risks arising from the insurance industry itself, as well as risks arising from insurance company operations. In this constant fight against risks insurance companies use different models and methods that help them better understand, have a more comprehensive view of, and develop greater tolerance towards risks, in order to reduce their exposure to these risks. The model presented in this paper has been developed for implementation in insurance risk management directly related to insurance company risk, i.e. it is a model that can reliably determine the manner and intensity with which deviations in the initial insurance risk assessment affect insurance company operations, in the form of changes in operational risks and consequently in insurance companies’ business strategies. Additionally we present the implementation of the model in the Serbian market for the period 2005-2010.

  12. Dental insurance! Are we ready?

    Directory of Open Access Journals (Sweden)

    Ravi SS Toor

    2011-01-01

    Full Text Available Dental insurance is insurance designed to pay the costs associated with dental care. The Foreign Direct Investment (FDI bill which was put forward in the winter session of the Lok Sabha (2008 focused on increasing the foreign investment share from the existing 26% to 49% in the insurance companies of India. This will allow the multibillion dollar international insurance companies to enter the Indian market and subsequently cover all aspects of insurance in India. Dental insurance will be an integral a part of this system. Dental insurance is a new concept in Southeast Asia as very few countries in Southeast Asia cover this aspect of insurance. It is important that the dentists in India should be acquainted with the different types of plans these companies are going to offer and about a new relationship which is going to emerge in the coming years between dentist, patient and the insurance company.

  13. Strategy for a transparent, accessible, and sustainable national claims database.

    Science.gov (United States)

    Gelburd, Robin

    2015-03-01

    The article outlines the strategy employed by FAIR Health, Inc, an independent nonprofit, to maintain a national database of over 18 billion private health insurance claims to support consumer education, payer and provider operations, policy makers, and researchers with standard and customized data sets on an economically self-sufficient basis. It explains how FAIR Health conducts all operations in-house, including data collection, security, validation, information organization, product creation, and transmission, with a commitment to objectivity and reliability in data and data products. It also describes the data elements available to researchers and the diverse studies that FAIR Health data facilitate.

  14. CURRENT CHANGES ON INSURANCE MARKET

    Directory of Open Access Journals (Sweden)

    Madalina Giorgiana MANGRA

    2016-12-01

    Full Text Available The offer of insurance products is about the requirements and needs of the consumer who must always have information regarding: the type of insurance risk covered and the excluded risks, the sum insured, the payment of premiums and their duration. The accurate information of customer requires, from the commencement of contract and throughout its duration, that he or she is aware of the obligations throughout the contractual period. Most of the Romanians are turning their attention to one of the insurance companies found in the top 10 in 2016, supervised by F.S.A. (Financial Supervision Authority, preferring to have a policy of mandatory household and goods insurance, auto liability or life insurance, but are also interested in travel health insurance when going abroad, private health insurance or private pension insurance. Romanians' reluctance regarding the conclusion of an insurance comes from their distrust in insurance companies (see the situations of companies like Astra Insurance, Carpatica Insurance etc., their personal financial situation and the fear that they will not receive protection if the risk is covered but the insured sum is insufficient

  15. Applications of Solar Technology for Catastrophe Response, Claims Management, and Loss Prevention

    Energy Technology Data Exchange (ETDEWEB)

    Deering, A.; Thornton, J.P.

    1999-02-17

    Today's insurance industry strongly emphasizes developing cost-effective hazard mitigation programs, increasing and retaining commercial and residential customers through better service, educating customers on their exposure and vulnerabilities to natural disasters, collaborating with government agencies and emergency management organizations, and exploring the use of new technologies to reduce the financial impact of disasters. In June of 1998, the National Renewable Energy Laboratory (NREL) and the National Association of Independent Insurers (NAII) sponsored a seminar titled, ''Solar Technology and the Insurance Industry.'' Presentations were made by insurance company representatives, insurance trade groups, government and state emergency management organizations, and technology specialists. The meeting was attended by insurers, brokers, emergency managers, and consultants from more than 25 US companies. Leading insurers from the personal line and commercial carriers were shown how solar technology can be used in underwriting, claims, catastrophe response, loss control, and risk management. Attendees requested a follow-up report on solar technology, cost, and applications in disasters, including suggestions on how to collaborate with the utility industry and how to develop educational programs for business and consumers. This report will address these issues, with an emphasis on pre-disaster planning and mitigation alternatives. It will also discuss how energy efficiency and renewable technologies can contribute to reducing insurance losses.

  16. Nigeria; Publication of Financial Sector Assessment Program Documentation––Detailed Assessment of Observance of Insurance Core Principles

    OpenAIRE

    International Monetary Fund

    2013-01-01

    Nigeria undertook a Financial Sector Assessment Program (FSAP), which included a review of the structure of Nigeria’s insurance market and the supervisory framework. The assessment was benchmarked against the Insurance Core Principles (ICPs) issued by the International Association of Insurance Supervisors (IAISs). It is advised that the National Insurance Commission (NAICOM) of Nigeria can expand the objective to include the creation of a fair, safe, and stable insurance sector for the benefi...

  17. Perspectives on medical malpractice self-insurance financial reporting.

    Science.gov (United States)

    Frese, Richard C; Kitchen, Patrick J

    2012-11-01

    Financial reporting of medical malpractice self-insurance is evolving. The Financial Accounting Standards Board Accounting Standards Codification Section 954-450-25 provides guidance for accounting and financial reporting for medical malpractice. Discounting of medical malpractice liabilities has been reassessed in recent years. Malpractice litigation reform efforts continue in several states. Accountable care organizations could increase the frequency of medical malpractice claims because of patients' heightened expectations regarding quality of care.

  18. Insurance against nuclear risks

    International Nuclear Information System (INIS)

    Dow, J.C.

    1976-01-01

    Virtually any type of nuclear risk is insurable in principle, providing, of course, that the necessary standards of safety and control are met. Some of the risks are of a relatively minor character and no more hazardous than a simple conventional risk. But insurers would not consider as a minor risk anything which involves the use of nuclear fuel or other nuclear materials which are in a critical state or capable of releasing dangerous levels of radioactivity. These would include nuclear reactors or, indeed, any type of assembly which can not be regarded as subcritical. Most insurers would also regard installations involved in the manufacturing, processing and enriching of nuclear fuel, and certainly those concerned with the reprocessing of irradiated fuel and plutonium extraction, as major risks. (HP) [de

  19. Insurance of Radioisotopes and Ionizing Radiation Sources in France

    International Nuclear Information System (INIS)

    Stanislas, A.

    2008-01-01

    Since the early sixties, Assuratome has amassed quite a long experience in the insurance of radioisotopes and more generally of ionising radiation sources when they are used transported or stored outside a nuclear installation. Aware of the specific dangers of such devices, and having no experience in this domain French insurers were looking for a pragmatic solution which would permit to continue to provide cover for users or fabricants of small radioactive sources and in the meantime to keep a rigorous control on the claims and on the loss ratio which would be achieved over the years. Hence the decision was taken by the French Insurance market to entrust the French Nuclear Insurance Pool, Assuratome, as the recommended body for delivering specific 'nuclear policies' as an expert for this category of business. The next step was to make sure that the 'conventional policies' would not provide the same cover. Therefore, an appropriate exclusion clause was introduced in all the general conditions of the TPL Policies of the conventional market and consequently in the majority, if not all, the reinsurance treaties. Besides the obvious advantage resulting in the management of this category of business in a centralised body, a major benefit of this situation is based on the strict control by the insurer of the compulsory authorisation delivered by the authorities to the owner of the radioactive source. Unofficial sources having in principal no insurance possibilities in France their use would be virtually impossible.(author)

  20. Health and nutrition content claims on Australian fast-food websites.

    Science.gov (United States)

    Wellard, Lyndal; Koukoumas, Alexandra; Watson, Wendy L; Hughes, Clare

    2017-03-01

    To determine the extent that Australian fast-food websites contain nutrition content and health claims, and whether these claims are compliant with the new provisions of the Australia New Zealand Food Standards Code ('the Code'). Systematic content analysis of all web pages to identify nutrition content and health claims. Nutrition information panels were used to determine whether products with claims met Nutrient Profiling Scoring Criteria (NPSC) and qualifying criteria, and to compare them with the Code to determine compliance. Australian websites of forty-four fast-food chains including meals, bakery, ice cream, beverage and salad chains. Any products marketed on the websites using health or nutrition content claims. Of the forty-four fast-food websites, twenty (45 %) had at least one claim. A total of 2094 claims were identified on 371 products, including 1515 nutrition content (72 %) and 579 health claims (28 %). Five fast-food products with health (5 %) and 157 products with nutrition content claims (43 %) did not meet the requirements of the Code to allow them to carry such claims. New provisions in the Code came into effect in January 2016 after a 3-year transition. Food regulatory agencies should review fast-food websites to ensure compliance with the qualifying criteria for nutrition content and health claim regulations. This would prevent consumers from viewing unhealthy foods as healthier choices. Healthy choices could be facilitated by applying NPSC to nutrition content claims. Fast-food chains should be educated on the requirements of the Code regarding claims.

  1. 32 CFR 536.121 - Claims not payable as maritime claims.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Claims not payable as maritime claims. 536.121... ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.121 Claims not payable as maritime claims... (except at (e) and (k)), and 536.46; (b) Are not maritime in nature; (c) Are not in the best interests of...

  2. Nuclear insurance and indemnity

    International Nuclear Information System (INIS)

    Kovan, D.

    1976-01-01

    A brief account is given of insurance protection in the nuclear industry, and the legislation involved. Aspects discussed are: third part liability and the role of government in setting the maximum amount of compensation; the development and concept of channelling the liability exclusively to the operator; the development of nuclear insurance facilities in Europe and the USA; and the emergence in Europe of international agreements on third party liability for protection of neighbouring countries in the event of a major accident. The development of liability law in the USA from the time of the Price Anderson Act of 1957 through subsequent legislation is described. (U.K.)

  3. Lectures on insurance models

    CERN Document Server

    Ramasubramanian, S

    2009-01-01

    Insurance has become a necessary aspect of modern society. The mathematical basis of insurance modeling is best expressed in terms of continuous time stochastic processes. This introductory text on actuarial risk theory deals with the Cramer-Lundberg model and the renewal risk model. Their basic structure and properties, including the renewal theorems as well as the corresponding ruin problems, are studied. There is a detailed discussion of heavy tailed distributions, which have become increasingly relevant. The Lundberg risk process with investment in risky asset is also considered. This book will be useful to practitioners in the field and to graduate students interested in this important branch of applied probability.

  4. Deposit insurance reform; or, deregulation is the cart, not the horse

    OpenAIRE

    John H. Kareken

    1990-01-01

    This paper, originally published in the spring 1983 Quarterly Review, explains why flat-rate deposit insurance gives financial intermediaries an incentive to take on too much risk. It also discusses the purposes of deposit insurance and some ways reforms might serve those purposes. Three possible reforms are discussed: abolishing the insurance and requiring depository institutions to either hold safe assets or mark to market, reducing the deposit ceilings for insurance, and risk-adjusting the...

  5. FEATURES OF ACCOUNTING AND AUDIT OF INSURANCE ORGANIZATIONS IN UKRAINE

    Directory of Open Access Journals (Sweden)

    А. Sholoiko

    2015-04-01

    Full Text Available Features of accounting and audit of insurance organizations in Ukraine that are based on the specific characteristics of the insurance activity and legislation are considered. The main of them are the next: the proper organization of accounting is a necessary condition of the activity of the financial institution; there are three groups of requirements to accounting of insurer, including: accounting of contracts; accounting of insurance reserves, formation financial reports in the Ukrainian insurance legislation; the use of IFRS instead of national accounting standards in preparing financial reports of insurance organizations in Ukraine is obligatory and despite of this compilation of primary documents and application of National Chart of Accounts by insurance organizations of Ukraine remains mandatory; it is necessary to follow the frequency of reporting according to national legislation; insurance companies are classified as institutions that must necessarily publish annual financial statements together with the auditor’s report about its accuracy, and this category of institutions are prohibited from using such form of organization of accounting and reporting as directly by the owner or the head of organization; audit of the annual financial statements and consolidated financial statements of insurance companies is mandatory and conducted in accordance with International quality control, auditing, review, other assurance, and related services pronouncements which adopted as national auditing standards by the Audit Chamber of Ukraine. These generalizations are done to make possible the further investigations of developing and improving in this field.

  6. Counseling as an Insured Benefit: Perspectives from the Insurance Industry

    Science.gov (United States)

    Fulton, Wallace C.

    1974-01-01

    Article discusses the feasibility of marriage counseling as an insurance benefit in the future. It is suggested that the physician be used as a marriage counselor in that insurance companies will pay for medical services. (EK)

  7. Considerations for the analysis of longitudinal electronic health records linked to claims data to study the effectiveness and safety of drugs.

    Science.gov (United States)

    Lin, K J; Schneeweiss, S

    2016-08-01

    Health insurance claims and electronic health records (EHR) databases have been considered the preferred data sources with which to study drug safety and effectiveness in routine care. Linking claims data to EHR allows researchers to leverage the complementary advantages of each data source to enhance study validity. We propose a framework to evaluate the need for supplementing claims data with EHR and vice versa to optimize outcome ascertainment, exposure assessment, and confounding adjustment. © 2016 American Society for Clinical Pharmacology and Therapeutics.

  8. Leading Causes of Anesthesia-Related Liability Claims in Ambulatory Surgery Centers.

    Science.gov (United States)

    Ranum, Darrell; Beverly, Anair; Shapiro, Fred E; Urman, Richard D

    2017-11-16

    We present a contemporary analysis of patient injury, allegations, and contributing factors of anesthesia-related closed claims, which involved cases that specifically occurred in free-standing ambulatory surgery centers (ASCs). We examined ASC-closed claims data between 2007 and 2014 from The Doctors Company, a medical malpractice insurer. Findings were coded using the Comprehensive Risk Intelligence Tool developed by CRICO Strategies. We compared coded data from ASC claims with hospital operating room (HOR) claims, in terms of injury severity category, nature of injury, nature of allegation, contributing factors identified, and contributing comorbidities and claim value. Ambulatory surgery center claims were more likely to be classified as medium severity than HOR claims, more likely to involve dental damage or pain than HOR claims, but less likely to involve death or respiratory or cardiac arrest. Technical performance was the most common contributing factor: 47% of ASCs and 48% of HORs. Only 7% of allegations relating to technical performance were judged to be a direct result of poor technical performance. The most common anesthesia procedures resulting in ASC claims were injection of anesthesia into a peripheral nerve (34%) and intubation (29%). Obesity was the most common contributing comorbidity in both settings. Mean closed claim value was significantly lower for ASC than HOR claims, averaging US $87,888 versus $107,325. Analysis of ASC and HOR claims demonstrates significant differences and several common sources of liability. These include improving strategies for thorough screening, preoperative assessment and risk stratifying of patients, incorporating routine dental and airway assessment and documentation, diagnosing and treating perioperative pain adequately, and improving the efficacy of communication between patients and care providers.

  9. Health Care, Health Insurance, and the Relative Income of the Elderly and Nonelderly

    OpenAIRE

    Gary Burtless; Pavel Svaton

    2009-01-01

    Cash income offers an incomplete picture of the resources available to finance household consumption. Most American families are covered by an insurance plan that pays for some or all of the health care they consume. Only a comparatively small percentage of families pay for the full cost of this insurance out of their cash incomes. As health care has claimed a growing share of consumption, the percentage of care that is financed out of household incomes has declined. Because health care consu...

  10. Medico-legal claims against English radiologists: 1995–2006

    Science.gov (United States)

    Halpin, S F S

    2009-01-01

    A list of claims against radiologists from 1995–2006 was obtained from the NHS Litigation Authority. It shows a total of 440 claims. The largest number of claims (199) related to delayed or missed diagnoses of cancer, and 73 claims related to breast radiology. There is a trend for a mild increase in the number of claims each year. 30 claims were made after a false-positive diagnosis of cancer. Just under £8.5 million has so far been paid in damages, with a further £5 million in legal fees. A claim for multiple missed diagnoses of breast cancer led to a pay-out of £464 000 (£673 000 after legal fees); the largest sum awarded following a delay in the diagnosis of an individual cancer was £300 000. The subtle legal distinction between error and negligence is reviewed here. The reason why breast radiologists are more likely to be sued than any other type of British radiologist is also discussed, along with the implications for UK radiological practice, particularly in light of the recent Chief Medical Officer's report on revalidation. A method is proposed that may protect radiologists from allegations of clinical negligence in the future. PMID:19470570

  11. Medico-legal claims against English radiologists: 1995-2006.

    Science.gov (United States)

    Halpin, S F S

    2009-12-01

    A list of claims against radiologists from 1995-2006 was obtained from the NHS Litigation Authority. It shows a total of 440 claims. The largest number of claims (199) related to delayed or missed diagnoses of cancer, and 73 claims related to breast radiology. There is a trend for a mild increase in the number of claims each year. 30 claims were made after a false-positive diagnosis of cancer. Just under pound8.5 million has so far been paid in damages, with a further pound5 million in legal fees. A claim for multiple missed diagnoses of breast cancer led to a pay-out of pound464 000 ( pound673 000 after legal fees); the largest sum awarded following a delay in the diagnosis of an individual cancer was pound300 000. The subtle legal distinction between error and negligence is reviewed here. The reason why breast radiologists are more likely to be sued than any other type of British radiologist is also discussed, along with the implications for UK radiological practice, particularly in light of the recent Chief Medical Officer's report on revalidation. A method is proposed that may protect radiologists from allegations of clinical negligence in the future.

  12. Disability Insurance and Health Insurance Reform: Evidence from Massachusetts

    OpenAIRE

    Nicole Maestas; Kathleen J. Mullen; Alexander Strand

    2014-01-01

    As health insurance becomes available outside of the employment relationship as a result of the Affordable Care Act (ACA), the cost of applying for Social Security Disability Insurance (SSDI)–potentially going without health insurance coverage during a waiting period totaling 29 months from disability onset–will decline for many people with employer-sponsored health insurance. At the same time, the value of SSDI and Supplemental Security Income (SSI) participation will decline for individuals...

  13. BUSINESS PROCESS MANAGEMENT IN INSURANCE CASE OF JADRANSKO INSURANCE COMPANY

    OpenAIRE

    Sanja Coric; Danijel Bara

    2014-01-01

    Selling insurance products in conditions of today’s modern technological solutions is faced with numerous challenges. Business processes in insurance as well as the results of these business processes are the real interface to policyholders. Modeling and analysis of business process in insurance ensure organizations to focus on the customer and increase the efficiency and quality of work. Managing critical business processes in every single organization, likewise in insurance is a key factor ...

  14. Paranormal health claims.

    Science.gov (United States)

    Skrabanek, P

    1988-04-15

    Faith in paranormal cures has always been the last hope of many sufferers from chronic or incurable diseases. Magico-religious rituals of healing are still around, but some have been replaced by pseudo-scientific systems, thinly disguising old superstitions in new obscurantism, more appealing to the half-educated. In medical quackery, inventiveness seems to be limitless, and only the main paranormal healing systems can be reviewed here. The increasing popularity of 'alternative' healing indicates the extent of dissatisfaction with dehumanising aspects of modern, technological medicine and its preoccupation with curing the curable at the expense of caring for the incurable. This leaves the sufferers, and also healthy people labelled with non-existent diseases, bleeding prey for the sharks roving the seas of medical ignorance.

  15. On the occurrence of rainstorm damage based on home insurance and weather data

    Science.gov (United States)

    Spekkers, M. H.; Clemens, F. H. L. R.; ten Veldhuis, J. A. E.

    2015-02-01

    Rainstorm damage caused by the malfunction of urban drainage systems and water intrusion due to defects in the building envelope can be considerable. Little research on this topic focused on the collection of damage data, the understanding of damage mechanisms and the deepening of data analysis methods. In this paper, the relative contribution of different failure mechanisms to the occurrence of rainstorm damage is investigated, as well as the extent to which these mechanisms relate to weather variables. For a case study in Rotterdam, the Netherlands, a property level home insurance database of around 3100 water-related damage claims was analysed. The records include comprehensive transcripts of communication between insurer, insured and damage assessment experts, which allowed claims to be classified according to their actual damage cause. The results show that roof and wall leakage is the most frequent failure mechanism causing precipitation-related claims, followed by blocked roof gutters, melting snow and sewer flooding. Claims related to sewer flooding were less present in the data, but are associated with significantly larger claim sizes than claims in the majority class, i.e. roof and wall leakages. Rare events logistic regression analysis revealed that maximum rainfall intensity and rainfall volume are significant predictors for the occurrence probability of precipitation-related claims. Moreover, it was found that claims associated with rainfall intensities smaller than 7-8 mm in a 60-min window are mainly related to failure processes in the private domain, such as roof and wall leakages. For rainfall events that exceed the 7-8 mm h-1 threshold, the failure of systems in the public domain, such as sewer systems, start to contribute considerably to the overall occurrence probability of claims. The communication transcripts, however, lacked information to be conclusive about to which extent sewer-related claims were caused by overloading of sewer systems or

  16. On the occurrence of rainstorm damage based on home insurance and weather data

    Directory of Open Access Journals (Sweden)

    M. H. Spekkers

    2015-02-01

    Full Text Available Rainstorm damage caused by the malfunction of urban drainage systems and water intrusion due to defects in the building envelope can be considerable. Little research on this topic focused on the collection of damage data, the understanding of damage mechanisms and the deepening of data analysis methods. In this paper, the relative contribution of different failure mechanisms to the occurrence of rainstorm damage is investigated, as well as the extent to which these mechanisms relate to weather variables. For a case study in Rotterdam, the Netherlands, a property level home insurance database of around 3100 water-related damage claims was analysed. The records include comprehensive transcripts of communication between insurer, insured and damage assessment experts, which allowed claims to be classified according to their actual damage cause. The results show that roof and wall leakage is the most frequent failure mechanism causing precipitation-related claims, followed by blocked roof gutters, melting snow and sewer flooding. Claims related to sewer flooding were less present in the data, but are associated with significantly larger claim sizes than claims in the majority class, i.e. roof and wall leakages. Rare events logistic regression analysis revealed that maximum rainfall intensity and rainfall volume are significant predictors for the occurrence probability of precipitation-related claims. Moreover, it was found that claims associated with rainfall intensities smaller than 7–8 mm in a 60-min window are mainly related to failure processes in the private domain, such as roof and wall leakages. For rainfall events that exceed the 7–8 mm h−1 threshold, the failure of systems in the public domain, such as sewer systems, start to contribute considerably to the overall occurrence probability of claims. The communication transcripts, however, lacked information to be conclusive about to which extent sewer-related claims were caused by

  17. [Neurosis as a mental disease--controversies surrounding insurance certification].

    Science.gov (United States)

    Jabłoński, Christian; Kobek, Mariusz; Kowalczyk-Jabłońska, Dorota

    2011-01-01

    In the years 2008-2009, experts from the Department of Forensic Medicine in Katowice issued a dozen of expert opinions on the nature of the neurosis, addressing the question whether neurosis is a mental disease as understood under the general insurance conditions or whether neurosis is a mental disease as such. All the submitted cases involved policemen who had been diagnosed as neurotic and were refused insurance payments since the insurance company claimed payments could not have been effected due to the diagnosis of mental disease, meaning neurosis in the discussed cases. The plaintiffs invoked the fact that medical terminology describes such states as "mental disorders". In the article, the authors present the adopted model of opinionating, make an attempt at explaining the controversy and discuss the subtleties of medical terminology and the core differences between the terms "mental disorder" and "mental disease" as employed in medico-legal opinionating in such cases.

  18. Hancocked: manulife and the limits of private health insurance.

    Science.gov (United States)

    Evans, Robert G

    2011-08-01

    Long-term care (LTC) insurance is a salesman's dream. Millions of well-heeled boomers, anxious to protect their estates from the random expropriation of institutional dependency - what a market! But for Manulife, bleeding $1.5 million a day in LTC claims through subsidiary John Hancock, LTC is a nightmare. Company spokesmen blame unexpected increases in life expectancy. But management's fundamental error was insuring correlated risks. Risk pooling works only when individual risks are uncorrelated. Increases in life expectancy affect all contracts together. Manulife made the same mistake selling equity-linked annuities with guaranteed floors - essentially insuring against stock market declines. Results for shareholders have been catastrophic. Top management, meanwhile, have been honoured and richly rewarded.

  19. Small employers and self-insured health benefits: too small to succeed?

    Science.gov (United States)

    Yee, Tracy; Christianson, Jon B; Ginsburg, Paul B

    2012-07-01

    Over the past decade, large employers increasingly have bypassed traditional health insurance for their workers, opting instead to assume the financial risk of enrollees' medical care through self-insurance. Because self-insurance arrangements may offer advantages--such as lower costs, exemption from most state insurance regulation and greater flexibility in benefit design--they are especially attractive to large firms with enough employees to spread risk adequately to avoid the financial fallout from potentially catastrophic medical costs of some employees. Recently, with rising health care costs and changing market dynamics, more small firms--100 or fewer workers--are interested in self-insuring health benefits, according to a new qualitative study from the Center for Studying Health System Change (HSC). Self-insured firms typically use a third-party administrator (TPA) to process medical claims and provide access to provider networks. Firms also often purchase stop-loss insurance to cover medical costs exceeding a predefined amount. Increasingly competitive markets for TPA services and stop-loss insurance are making self-insurance attractive to more employers. The 2010 national health reform law imposes new requirements and taxes on health insurance that may spur more small firms to consider self-insurance. In turn, if more small firms opt to self-insure, certain health reform goals, such as strengthening consumer protections and making the small-group health insurance market more viable, may be undermined. Specifically, adverse selection--attracting sicker-than-average people--is a potential issue for the insurance exchanges created by reform.

  20. 78 FR 56583 - Deposit Insurance Regulations; Definition of Insured Deposit

    Science.gov (United States)

    2013-09-13

    ... as a potential global deposit insurer, preserve confidence in the FDIC deposit insurance system, and... the United States.\\2\\ The FDIC generally pays out deposit insurance on the next business day after a... since 2001 and total approximately $1 trillion today. In many cases, these branches do not engage in...

  1. Communication from UNIQA Insurance

    CERN Multimedia

    2006-01-01

    UNIQA will start working with a new computer application to process reimbursement claims from the 3 April 2006. This will require a transition period during which data will be transferred from the old to the new computer system. This switch will mean that the claims processing computer system will be temporarily unavailable from 27 to 31 March. As a consequence, our staff in our offices in Geneva and at CERN will not be able to process any reimbursement claims or access Member's personal data during that week. We apologize for any inconvenience this necessary transition to an enhanced level of service may cause. We look forward to resuming business as usual on the 3 April. Our offices will remain open and available during that time for all other usual services. We thank you in advance for your patience and understanding.

  2. Reviewing the Suitability of Affirmative Action and the Inherent Requirements of the Job as Grounds of Justification to Equal Pay Claims in Terms Of the Employment Equity Act 55 of 1998

    Directory of Open Access Journals (Sweden)

    Shamier

    2018-01-01

    Full Text Available The Employment Equity Act 55 of 1998 ("EEA" has been amended to include a specific provision dealing with equal pay claims in the form of section 6(4. Section 6(4 of the EEA prohibits unfair discrimination in terms and conditions of employment between employees performing the same or substantially the same work or work of equal value. The Minister of Labour has issued Regulations and a Code to assist with the implementation of the principle of equal pay. Both the Regulations and the Code set out the criteria for assessing work of equal value as well as the grounds of justification to a claim of equal pay for work of equal value (factors justifying differentiation in terms and conditions of employment. The EEA refers to two grounds of justification in respect of unfair discrimination claims, namely affirmative action and the inherent requirements of the job. There is support for the view that these grounds of justification are not suitable to equal pay claims. There is a contrary view that these grounds of justification can apply to equal pay claims. The Labour Courts have not had the opportunity to analyse these grounds of justification in the context of equal pay claims. It is thus necessary to analyse these grounds of justification in order to ascertain whether they provide justifications proper to equal pay claims. The purpose of this article is to analyse the grounds of justification of pay discrimination as contained in South African law, the Conventions and Materials of the International Labour Organisation and the equal pay laws of the United Kingdom. Lastly, an analysis will be undertaken to determine whether affirmative action and the inherent requirements of the job provide justifications proper to equal pay claims.

  3. Characteristics of and risk factors for compensated occupational injury and disease claims in dairy farmers: a case-control study.

    Science.gov (United States)

    Karttunen, J P; Rautiainen, R H

    2013-07-01

    Research indicates that dairy farmers have an elevated risk of work-related adverse health outcomes. This case-control study evaluated the characteristics of and risk factors for compensated occupational injury and disease claims among Finnish dairy farmers. The cases consisted of 19 farm couples in which both spouses had a history of multiple claims. There were 283 claims in total, a rate of 26.6 claims per 100 person-years. The controls consisted of 12 couples in which neither spouse had compensated or rejected claims during their work history as insured farmers. A combined mail/telephone survey charted potential risk factors for compensated claims. These claims frequently involved work tasks and causes related to animal husbandry. Cattle were the most common cause for injuries in general and for serious injuries in particular. Gender differences in farm work and claims were observed. Using logistic regression analyses, we identified personal and work-related risk factors including long work history, small-scale dairy farm operation, and conventional stanchion barn for dairy cattle. Outdated working conditions, while not statistically significant, were positively associated with claims as well. Declined current work ability and musculoskeletal or respiratory conditions were significantly associated with claims where each of these outcomes may contribute to the other. Identified factors could be used to select subgroups of dairy farmers with either elevated or reduced risk of claims. Prevention of adverse health outcomes could be most effective when targeted to farmers at highest risk of occupational injury and disease.

  4. Voluntary Public Unemployment Insurance

    DEFF Research Database (Denmark)

    O. Parsons, Donald; Tranæs, Torben; Bie Lilleør, Helene

    Denmark has drawn much attention for its active labor market policies, but is almost unique in offering a voluntary public unemployment insurance program requiring a significant premium payment. A safety net program – a less generous, means-tested social assistance plan – completes the system...

  5. Insurance: Covering the bases

    International Nuclear Information System (INIS)

    Burr, M.T.

    1992-01-01

    This article addresses steps to take to improve the economics and risk profiles for independent power projects. The topics discussed in the article include the results of competition in the power industry, custom packages and the lack of competition among insurers in the power industry, mitigating risk through providing technical information, and developing programs

  6. Consumers’ Collision Insurance Decisions

    DEFF Research Database (Denmark)

    Austin, Laurel; Fischhoff, Baruch

    Using interviews with 74 drivers, we elicit and analyse how people think about collision coverage and, more generally, about insurance decisions. We compare the judgments and behaviours of these decision makers to the predictions of a range of theoretical models: (a) A model developed by Lee (200...

  7. HOUSING INSURANCE IN ROMANIA

    Directory of Open Access Journals (Sweden)

    FLOREA IANC MARIA MIRABELA

    2014-12-01

    Full Text Available Last few years have shown that Romania is not protected from the consequences of climate change. It is clear that type flood events may cause social problems and losses is difficult financing from public resources, especially in the context of the existence of budget constraints. The only viable system to cope with such disasters is insurance system that has the ability to spread risks by reinsurance Natural disasters - earthquakes, floods, landslides - are just some of the risks that may threaten your home. And if natural disasters can seem distant danger, think as fires, floods caused by broken pipes or theft of household goods are trouble can happen anytime to anyone. To protect yourself in such unpleasant situations, whose frequency is unfortunately on the rise, it is necessary to be assured. Thus, you will be able to recover losses in the event that they occur. The house is undoubtedly one of the most important assets we own. Therefore, the Romans began to pay increasingly more attention to domestic insurance products. Since 2011, voluntary home insurance, life insurance with, were the most dynamic segments of the market.

  8. Business intelligence for insurance companies

    OpenAIRE

    IGNATIUK A.

    2016-01-01

    The current state and future trends for the world and domestic insurance markets are analyzed. The description of business intelligence methodology, tools and their practical implication for insurance companies are provided.

  9. BUSINESS INTELLIGENCE FOR INSURANCE COMPANIES

    Directory of Open Access Journals (Sweden)

    A. Ignatiuk

    2016-06-01

    Full Text Available The current state and future trends for the world and domestic insurance markets are analyzed. The description of business intelligence methodology, tools and their practical implication for insurance companies are provided.

  10. 77 FR 74279 - Agency Information Collection (VA/DOD Joint Disability Evaluation Board Claim): Activity under...

    Science.gov (United States)

    2012-12-13

    ... Joint Disability Evaluation Board Claim): Activity under OMB Review AGENCY: Veterans Benefits... . Please refer to ``OMB Control No. 2900-0704.'' SUPPLEMENTARY INFORMATION: Title: VA/DOD Joint Disability Evaluation Board Claim, VA Form 21- 0819. OMB Control Number: 2900-0704. Type of Review: Extension of a...

  11. Prescriptions of Chinese Herbal Medicine for Constipation Under the National Health Insurance in Taiwan

    OpenAIRE

    Maw-Shiou Jong; Shinn-Jang Hwang; Yu-Chun Chen; Tzeng-Ji Chen; Fun-Jou Chen; Fang-Pey Chen

    2010-01-01

    Constipation is a common gastrointestinal problem worldwide. The aim of this study was to determine the frequency of use and prescriptive patterns of Chinese herbal medicine (CHM) in treating constipation by analyzing the claims data of traditional Chinese medicine (TCM) from the National Health Insurance (NHI) in Taiwan. Methods: The computerized claims dataset of the TCM office visits and the corresponding prescription files in 2004 compiled by the NHI Research Institute in Taiwan were l...

  12. The EU health claim regulation in international comparison

    DEFF Research Database (Denmark)

    Aschemann-Witzel, Jessica

    2011-01-01

    Nutrition and health claims are voluntary claims on food indicating favourable nutritional content or health benefits of the food. Nutrition and health claims on food are increasingly regulated in the world market. This process is accompanied by intensive stakeholder discussions on the possible...... impact on consumer protection and food marketing effectiveness. This article reviews literature on regulations in the major food markets in comparison with the EU regulation. The focus is on identifying characteristics of regulations that are expected to have an impact on consumer protection and food...... marketing. The EU regulation is regarded as focusing relatively strongly on precaution and consumer understanding. The extent to which this hampers food innovations is in dispute. It is suggested that using marketing measures in favour of scientifically approved claims as well as stakeholder cooperation...

  13. How useful are Swiss flood insurance data for flood vulnerability assessments?

    Science.gov (United States)

    Röthlisberger, Veronika; Bernet, Daniel; Zischg, Andreas; Keiler, Margreth

    2015-04-01

    The databases of Swiss flood insurance companies build a valuable but to date rarely used source of information on physical flood vulnerability. Detailed insights into the Swiss flood insurance system are crucial for using the full potential of the different databases for research on flood vulnerability. Insurance against floods in Switzerland is a federal system, the modalities are manly regulated on cantonal level. However there are some common principles that apply throughout Switzerland. First of all coverage against floods (and other particular natural hazards) is an integral part of every fire insurance policy for buildings or contents. This coupling of insurance as well as the statutory obligation to insure buildings in most of the cantons and movables in some of the cantons lead to a very high penetration. Second, in case of damage, the reinstatement costs (value as new) are compensated and third there are no (or little) deductible and co-pay. High penetration and the fact that the compensations represent a large share of the direct, tangible losses of the individual policy holders make the databases of the flood insurance companies a comprehensive and therefore valuable data source for flood vulnerability research. Insurance companies not only store electronically data about losses (typically date, amount of claims payment, cause of damage, identity of the insured object or policyholder) but also about insured objects. For insured objects the (insured) value and the details on the policy and its holder are the main feature to record. On buildings the insurance companies usually computerize additional information such as location, volume, year of construction or purpose of use. For the 19 (of total 26) cantons with a cantonal monopoly insurer the data of these insurance establishments have the additional value to represent (almost) the entire building stock of the respective canton. Spatial referenced insurance data can be used for many aspects of

  14. NATO Advanced Study Institute on Insurance and Risk Theory

    CERN Document Server

    Vylder, F; Haezendonck, J

    1986-01-01

    Canadian financial institutions have been in rapid change in the past five years. In response to these changes, the Department of Finance issued a discussion paper: The Regulation of Canadian Financial Institutions, in April 1985, and the government intends to introduce legislation in the fall. This paper studi.es the combinantion of financial institutions from the viewpoint of ruin probability. In risk theory developed to describe insurance companies [1,2,3,4,5J, the ruin probability of a company with initial reserve (capital) u is 6 1 -:;-7;;f3 u 1jJ(u) = H6 e H6 (1) Here,we assume that claims arrive as a Poisson process, and the claim amount is distributed as exponential distribution with expectation liS. 6 is the loading, i.e., premium charged is (1+6) times expected claims. Financial institutions are treated as "insurance companies": the difference between interest charged and interest paid is regarded as premiums, loan defaults are treated as claims.

  15. PREMIUMS CALCULATION FOR LIFE INSURANCE

    Directory of Open Access Journals (Sweden)

    ANA PREDA

    2012-10-01

    Full Text Available The paper presents the techniques and the formulas used on international practice for establishing the premiums for a life policy. The formulas are generally based on a series of indicators named mortality indicators which mainly point out the insured survival probability, the death probability and life expectancy at certain age. I determined, using a case study, the unique net premium, the annual net premium for a survival insurance, whole life insurance and mixed life insurance.

  16. Insurance Coverage Policies for Personalized Medicine

    Directory of Open Access Journals (Sweden)

    Andrew Hresko

    2012-10-01

    Full Text Available Adoption of personalized medicine in practice has been slow, in part due to the lack of evidence of clinical benefit provided by these technologies. Coverage by insurers is a critical step in achieving widespread adoption of personalized medicine. Insurers consider a variety of factors when formulating medical coverage policies for personalized medicine, including the overall strength of evidence for a test, availability of clinical guidelines and health technology assessments by independent organizations. In this study, we reviewed coverage policies of the largest U.S. insurers for genomic (disease-related and pharmacogenetic (PGx tests to determine the extent that these tests were covered and the evidence basis for the coverage decisions. We identified 41 coverage policies for 49 unique testing: 22 tests for disease diagnosis, prognosis and risk and 27 PGx tests. Fifty percent (or less of the tests reviewed were covered by insurers. Lack of evidence of clinical utility appears to be a major factor in decisions of non-coverage. The inclusion of PGx information in drug package inserts appears to be a common theme of PGx tests that are covered. This analysis highlights the variability of coverage determinations and factors considered, suggesting that the adoption of personal medicine will affected by numerous factors, but will continue to be slowed due to lack of demonstrated clinical benefit.

  17. Insurance - Piper Alpha ''et al''

    International Nuclear Information System (INIS)

    Hales, K.

    1995-01-01

    This paper opens with some brief information about the Piper Alpha loss, how the loss was handled and its final cost. More importantly, it discusses the effect of the Piper Alpha loss on the world insurance market including the oil insurance captives such as O.I.L Limited. Finally, the insurance market current status and prognosis for the future are considered. (Author)

  18. Characteristics of construction firms at risk for future workers' compensation claims using administrative data systems, Washington State.

    Science.gov (United States)

    Marcum, Jennifer L; Foley, Michael; Adams, Darrin; Bonauto, Dave

    2018-06-01

    Construction is high-hazard industry, and continually ranks among those with the highest workers' compensation (WC) claim rates in Washington State (WA). However, not all construction firms are at equal risk. We tested the ability to identify those construction firms most at risk for future claims using only administrative WC and unemployment insurance data. We collected information on construction firms with 10-50 average full time equivalent (FTE) employees from the WA unemployment insurance and WC data systems (n=1228). Negative binomial regression was used to test the ability of firm characteristics measured during 2011-2013 to predict time-loss claim rates in the following year, 2014. Claim rates in 2014 varied by construction industry groups, ranging from 0.7 (Land Subdivision) to 4.6 (Foundation, Structure, and Building Construction) claims per 100 FTE. Construction firms with higher average WC premium rates, a history of WC claims, increasing number of quarterly FTE, and lower average wage rates during 2011-2013 were predicted to have higher WC claim rates in 2014. We demonstrate the ability to leverage administrative data to identify construction firms predicted to have future WC claims. This study should be repeated to determine if these results are applicable to other high-hazard industries. Practical Applications: This study identified characteristics that may be used to further refine targeted outreach and prevention to construction firms at risk. Published by Elsevier Ltd.

  19. 32 CFR 842.94 - Assertable claims.

    Science.gov (United States)

    2010-07-01

    ..., against a tort-feasor when: (a) Damage results from negligence and the claim is for: (1) More than $100... ADMINISTRATIVE CLAIMS Property Damage Tort Claims in Favor of the United States (31 U.S.C. 3701, 3711-3719) § 842.... (The two claims should be consolidated and processed under subpart N). (d) The Tort-feasor or his...

  20. INSTITUTIONAL SUPPORT SOSIAL INSURANCE AGAINST OCCUPATIONAL ACCIDENTS IN UKRAINE

    Directory of Open Access Journals (Sweden)

    O. Gamankova

    2015-04-01

    Full Text Available The paper deals with the peculiarities of formation of relationships in the reform of social security. Examines institutional support provided social insurance accidents with the latest trends reform of the sector. The study notes that the organization of social security is lost insurance principle, the general principles of the Social Insurance Institute, added other excess principles that form the basis for misappropriation of funds and various abuses. These problems are urgent and require research. The paper reviews the basic principles to achieve the optimal balance of economic and social needs of providing social protection of citizens of Ukraine. The results emphasize the need for heightened security procedures for consolidation of compulsory state social insurance against industrial accidents and the State Mandatory Social Insurance against disability.