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Background: Equestrian sports, also referred to as equestrianism, is practiced all over the world and a popular leisure activity in Sweden. Equestrianism is the country's second-largest youth sport, and previous studies indicate that accidents are common in equestrianism. However, few previous studies have examined acute equestrian injuries leading to permanent medical impairment (PMI). Methods: By using nationwide insurance data comprising all injured equestrians registered in the Swedish Equestrian Federation, the aim was to analyse characteristics of equestrian accidents and particularly injuries leading to PMI, both in general and by age, gender, incident type, injury type and injured body region. Injury incidence and injuries leading to PMI were examined. All equestrians injured during 2017–2021 were included (n = 6,876), however, only injuries occurring in 2017 and 2018 were used to analyse the risk and the injury distribution of injuries leading to PMI. Injury incidence was calculated separately for males and females, as well as for different age groups, by dividing the number of insurance claims by the number of members multiplied by 1,000. Risk Ratio (RR) was calculated between gender. Pearson's chi-squared test was used to analyse differences in distribution for categorical variables. Results: The majority of injuries affected females, correlating to approximately three times higher risk, compared to males. The age group 21–40 years were associated with the highest injury risk (14.26/1,000 registered riders). In total 12% of all injuries led to PMI. Injuries to the upper and lower extremities, along with fractures, had a higher risk of resulting in a PMI. The risk of injury leading to PMI was higher among riders over 20 years of age. Conclusions: The fact that females face nearly three times the injury risk of males, and riders aged 21–40 had the highest injury risk while younger riders (Luke KL, McAdie T, Smith BP, Warren-Smith AK. New insights into ridden horse behaviour, horse welfare and horse-related safety. Appl Anim Behav Sci. 2022;246:105539.); (Havlik HS. Equestrian sport-related injuries: a review of current literature. Curr Sports Med Rep. 2010;9(5):299–302.); (Samuels K, Bettis A, Davenport DL, Bernard AC. Occupational vs. non-occupational equestrians: Differences in demographics and injury patterns. Injury. 2022;53(1):171–5.); (Gharooni A-A, Anwar F, Ramdeep R, Mee H. Severe equestrian injuries: A seven-year review of admissions to a UK major trauma centre. Trauma. 2023;25(1):41–7.); (Hasler RM, Gyssler L, Benneker L, Martinolli L, Schotzau A, Zimmermann H, et al. Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey. J Trauma Manag Outcomes. 2011;5:4.); (Meredith L, Brolin K, Ekman R, Thomson R. Analyses of injuries to equestrians in a Swedish district over a 16-year period. Translational Sports Med. 2019;2:270–8.) had a lower risk, indicates that preventive efforts should target both older and female riders. Injuries predominantly resulting in PMI involve upper and lower extremities, however, to prevent the most serious injuries significantly affecting a rider's daily life, measures preventing head and spinal cord neck injuries, must be implemented. Head injures remain the most frequent, serious and most significant group of injuries to prevent and mitigate, within equestrian sports. [ABSTRACT FROM AUTHOR]

Our goal was to compare molecular and immune profiles of vulvovaginal melanoma (VVM) with cutaneous melanoma (CM) and explore the significance of immune checkpoint inhibitor (ICI) agents on survival. Samples from VVM and CM tumors underwent comprehensive molecular and immune profiling. Treatment and survival data were extracted from insurance claims data and OS was calculated from time of ICI treatment to last contact. Statistical significance was determined using chi-square and Wilcoxon rank sum test and adjusted for multiple comparisons. Molecular analysis was performed on 142 VVM and 3823 CM tumors. VVM demonstrated significantly (q < 0·01) less frequent BRAF and more frequent KIT, ATRX, and SF3B1 mutations. Alterations in pathways involving DNA damage and mRNA splicing were more common in VVM, while alterations in cell cycle and chromatin remodeling were less common. Immunogenicity of VVM was lower than CM, with an absence of high TMB (0% vs 46.9%) and lower PD-L1 positivity (18·0% vs 29·5%). Median immune checkpoint gene expression was lower in VVM, as were cell fractions for type I macrophages and CD8+ T-cells(q < 0·01). Myeloid dendritic cells were increased in VVM(q < 0·01). Median OS was shorter for VVM than for CM patients treated with ICIs (17·6 versus 37·9 months, HR:1·65 (95% CI 1·02–2·67) p = 0·04). VVM has a distinct molecular and immune profile compared to CM, which may contribute to the worse survival in VVM compared to CM patients treated with ICI therapy. Though ICIs have been a mainstay of treatment in recent years, our findings suggest that new therapeutic strategies are needed. • Vulvovaginal melanoma is a rare disease, with minimal available data on molecular and immunologic characteristics. • Vulvovaginal melanoma has less frequent BRAF and more frequent KIT, ATRX, and SF3B1 mutations than cutaneous melanoma. • High tumor mutation burden was absent in vulvovaginal melanoma tumors, compared with 50% TMB-H cutaneous melanomas. • Vulvovaginal melanoma patients receiving immune checkpoint inhibitor therapy had a shorter OS compared to cutaneous patients. [ABSTRACT FROM AUTHOR]

Objectives: In the United States (US), prescription drug coverage is subject to prior authorization (PA) criteria, which may vary between health plans and may exceed drug label requirements. This study aimed to characterize profiles and treatment history of patients with treatment-resistant depression (TRD) who initiated esketamine nasal spray, by stringency of their health plans' PA criteria relative to the esketamine label. Methods: Adults with evidence of TRD (≥2 antidepressant courses of adequate dose and duration) prior to initiating esketamine were identified using US insurance claims data (03/2016–02/2022). Based on health plan PA criteria for esketamine obtained from Managed Markets Insight & Technology data (05/2020–02/2022), patients were grouped into stringent (PA criteria exceeds label) and non-stringent (PA criteria less stringent or equal to label) cohorts. Patient treatment history before esketamine initiation was compared using Wilcoxon rank sum and Fisher's exact tests. Results: The stringent cohort included 168 patients (mean age: 45 years, 63% female) and the non-stringent cohort included 400 patients (mean age: 45 years, 70% female). During the ongoing major depressive episode before esketamine initiation, the stringent versus non-stringent cohort completed 3.9 versus 3.8 antidepressant treatment courses, on average (p = 0.217); 94.6% versus 96.8% used augmentation therapy (p = 0.240), including 59.3% versus 58.1% with an antipsychotic (p = 0.844), respectively. Conclusions: Regardless of health plan stringency, on average, patients exceeded US label-mandated number of antidepressant trials before esketamine initiation, which questions the need for health insurance plans PA criteria above label. [ABSTRACT FROM AUTHOR]

Introduction: Real-world evidence is receiving considerable attention as a way to evaluate the efficacy and safety of medical products for substance use disorders (SUDs). However, the feasibility of using real-world data (RWD) to emulate clinical trials evaluating treatments for SUDs is uncertain. The aim of this study is to identify the number of clinical trials evaluating treatments for SUDs with reported results that could be feasibly emulated using observational data from contemporary insurance claims and/or electronic health record (EHR) data. Methods: In this cross-sectional study, all phase 2–4 trials evaluating treatments for SUDs registered on ClinicalTrials.gov with reported results were identified. Each trial was evaluated to determine if the indications, interventions, at least 80% of eligibility criteria, comparators, and primary end points could be ascertained using contemporarily available administrative claims and/or structured EHR data. Results: There were 272 SUD trials on ClinicalTrials.gov with reported results. Of these, when examining feasibility using contemporarily available administrative claims and/or structured EHR data, 262 (96.3%) had indications that were ascertainable; 194 (71.3%) had interventions that were ascertainable; 21 (7.7%) had at least 80% of eligibility criteria that were ascertainable; 17 (6.3%) had active comparators that were ascertainable; and 61 (22.4%) had primary end points that were ascertainable. In total, there were no trials for which all 5 characteristics were ascertainable using contemporarily available administrative claims and/or structured EHR data. When considering placebo comparators as ascertainable, there were 6 (2.2%) trials that had all 5 key characteristics classified as ascertainable from contemporarily available administrative claims and/or structured EHR data. Conclusions: No trials evaluating treatments for SUDs could be feasibly emulated using contemporarily available RWD, demonstrating a need for an increase in the resolution of data capture within a public health system to facilitate trial emulation. [ABSTRACT FROM AUTHOR]

Background: Since June 2017, oral pre-exposure prophylaxis (PrEP) has been reimbursed in Belgium for people at substantial risk of HIV. To inform the national PrEP programme, we described sociodemographic characteristics of PrEP users, PrEP dispensing practices, testing for HIV and sexually transmitted infections (STIs; gonorrhoea, chlamydia and syphilis), and incidence of HIV and STIs. Methods: Analysis of routinely collected social health insurance claims data from all individuals who were dispensed at least one PrEP prescription between June 2017 and December 2019. Using logistic regression adjusted for age, we examined associations between sociodemographic characteristics and having been dispensed PrEP only once in the first six months of PrEP use. Results: Overall, 4559 individuals were dispensed PrEP. Almost all PrEP users were male (99.2%, 4522/4559), with a median age of 37 years (IQR 30–45). A minority were entitled to an increased healthcare allowance (11.4%, 514/4559). 18% (657/3636) were dispensed PrEP only once in the first six months of PrEP use. PrEP users younger than 25 years, unemployed, entitled to an increased healthcare allowance, and who initiated PrEP between January 2019 and June 2019 were more likely to have had no PrEP dispensing after initiation compared to their counterparts. The testing rates for bacterial STIs and HIV were 4.2 tests per person-year (95% CI 4.1–4.2) and 3.6 tests per person-year (95% CI 3.5–3.6), respectively. Twelve individuals were identified to have seroconverted during the study period, resulting in an HIV incidence rate of 0.21/100 person-years (95% CI 0.12–0.36). The incidence of bacterial STIs was 81.2/100 person-years (95% CI 78.7–83.8). Conclusions: The study highlights challenges in PrEP persistence and a high incidence of bacterial STIs among individuals receiving PrEP. Tailored prevention support is crucial for individuals with ongoing HIV risk to optimise PrEP effectiveness. Integrated STI testing and prevention interventions within PrEP care are necessary to mitigate STI acquisition and transmission among PrEP users. [ABSTRACT FROM AUTHOR]

Claims analysis and risk management is key to avoiding fraud and managing risk in the life insurance industry. Though visualization plays a fundamental role in supporting analysis tasks in the business domain, exploring user behaviour remains a challenging task. The prevalence of natural language interactions enhanced with data visualization has become quite the norm. With the increasing demand for visualization tools and varying levels of user expertise, the use of a natural language interface (NLI) is common. However, the design of visual analytics tools enhanced by NLIs for risk management and claim analysis requires thorough task analysis and domain expertise. In this work, we investigate an alternative approach through a natural language interaction-based interactive visualization such as a chart, pie chart, or histogram, which can be used for insurance claim analysis and risk management. We design a new visual analytics solution named InsCRMVis which is enhanced by NLIs. We present an expert evaluation of InsCRMVis based on the Task Load Index questionnaire which is currently the standard metrics measure to investigate its usability (effectiveness, efficiency, satisfaction) to support human task performance. To evaluate its performance, we performed a user study of ten experts which suggests that InsCRMVis can provide better insights and assistance to insurance managers in reducing loss and guiding changes to insurance premium policies. Furthermore, we provide a concise set of guidelines that can be used when visualizing risk to avoid dangers in the insurance domain. We discuss the challenges associated with the use of a visualization system in the insurance industry, focusing on aspects related to visualization research. [ABSTRACT FROM AUTHOR]

Background: Orthogeriatric co-management (OGCM) addresses the special needs of geriatric fracture patients. Most of the research on OGCM focused on hip fractures while results concerning other severe fractures are rare. We conducted a health-economic evaluation of OGCM for pelvic and vertebral fractures. Methods: In this retrospective cohort study, we used German health and long-term care insurance claims data and included cases of geriatric patients aged 80 years or older treated in an OGCM (OGCM group) or a non-OGCM hospital (non-OGCM group) due to pelvic or vertebral fractures in 2014–2018. We analyzed life years gained, fracture-free life years gained, healthcare costs, and cost-effectiveness within 1 year. We applied entropy balancing, weighted gamma and two-part models. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. Results: We included 21,036 cases with pelvic (71.2% in the OGCM, 28.8% in the non-OGCM group) and 33,827 with vertebral fractures (72.8% OGCM, 27.2% non-OGCM group). 4.5–5.9% of the pelvic and 31.8–33.8% of the vertebral fracture cases were treated surgically. Total healthcare costs were significantly higher after treatment in OGCM compared to non-OGCM hospitals for both fracture cohorts. For both fracture cohorts, a 95% probability of cost-effectiveness was not exceeded for a willingness-to-pay of up to €150,000 per life year or €150,000 per fracture-free life year gained. Conclusion: We did not obtain distinct benefits of treatment in an OGCM hospital. Assigning cases to OGCM or non-OGCM group on hospital level might have underestimated the effect of OGCM as not all patients in the OGCM group have received OGCM. [ABSTRACT FROM AUTHOR]

This article presents a mixed Pareto model and examines its suitability for modeling non life insurance claim severity data sets which exhibit peculiar characteristics that cannot be captured by the Pareto distribution. Furthermore, we introduce regression specifications for both the mean and the dispersion parameters of the mixed Pareto model. Our main achievement is that we develop a novel Expectation-Maximization (EM) algorithm for finding the maximum likelihood (ML) estimates of the parameters of the mixed Pareto regression model which is used for demonstration purposes. Finally, a real-data application based on motor insurance claim size data is provided. [ABSTRACT FROM AUTHOR]

We utilized national claims-based data to identify the change in odds of diagnosis of ALS following possible-ALS-symptoms-and whether the change varies in urban/rural areas. Insurance claims were obtained from the Merative MarketScan databases, 2001–2021 in the United States. Individuals with incident ALS were identified and matched on age, sex, and enrollment period to individuals without ALS. For all individuals, claims for 8 possible-ALS-symptoms in the time before any ALS diagnosis were identified. We then used conditional logistic regression to estimate the odds of being diagnosed with ALS following these symptoms and whether the association varied by urban/rural location. 19,226 individuals with ALS were matched to 96,126 controls. Patients with ALS were more likely to live in an urban area (87.0% vs 84.5%). Of those with ALS 84% had 1+ of our 8 possible-ALS-symptom compared to 51% of controls. After adjustment for confounders, having possible-ALS-symptoms increased the odds of a future ALS diagnosis by nearly 5-fold. A dose-response pattern was present with increasing odds as the number of symptoms increased. In all models, urban areas were associated with increased odds of diagnosis with ALS while the effect of having a symptom was smaller in urban places. Urban cases of ALS are diagnosed at younger ages. These results suggest symptoms may appear and be noted years before the diagnosis of ALS. Additionally, rural patients are diagnosed at later ages with a greater dependence on symptoms than urban patients. These results highlight potential improvements for screening for ALS. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is a growing concern, impacting patient safety and healthcare costs. Monitoring its prevalence and temporal trends is essential for effective healthcare management. Aim: This study aimed to determine prevalence and trends of polypharmacy and excessive polypharmacy in Belgium. Method: Utilizing a federal claims database, medication data were analyzed from 2012 to 2021. Polypharmacy (≥ 5 medications) and excessive polypharmacy (≥ 10 medications) were evaluated, with prevalence calculated per 1000 inhabitants, and reported per year, age group and region. Linear regression estimated the impact of age and year on polypharmacy prevalence. Results: In 2021, polypharmacy and excessive polypharmacy were reported in 135/1000 and 31/1000 Belgians respectively. Prevalence of both increased steadily from 2012 to 2021, with excessive polypharmacy rising more prominently. Among adults aged ≥ 65 years, prevalence rates were higher, with polypharmacy at 434/1000 and excessive polypharmacy at 106/1000. Regional variations were observed, with prevalence highest in the Walloons region. Patient age and year (2012–2021) were associated with both polypharmacy and excessive polypharmacy (p < 0.001). Conclusion: We observed increases in polypharmacy and excessive polypharmacy over a decade in Belgium, particularly among older adults. Efforts to monitor, manage, and optimize medication use are imperative to ensure safe and effective healthcare delivery. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion We determined the number of care transitions in the year before death among older adults requiring long‐term care (LTC) and those receiving public LTC insurance (LTCI) services in Japan, along with care transition pathways and factors associated with the number of care transitions.This study used data from the Japanese LTCI claims, which store national information on certification of needed LTC and LTCI claims data. Services received in the year before death were classified as in‐home, facility, mixture of in‐home and facility, and not using LTCI services. The transition count is presented, and Sankey diagrams are produced to visualize care transition pathways. We used a multivariable analysis to identify factors associated with the number of care transitions.Of the participants, 276 896 (65.2%) experienced at least one transition in LTCI care settings in the year before death. Further, 72.0% of those requiring mild LTC underwent one or more transitions. Participants who were 75–84 years old (vs. 65–74 years old), male, without medical care needs, with symptoms of dementia, and with changes in LTC needs in the year before death were more likely to require care transitions. Moreover, participants with higher baseline LTC needs were less likely to require transitions.Over half the participants requiring LTC underwent one or more care transitions in the year before death. Policy deliberations regarding enhancing care under the LTCI system at the end of life and optimizing care transitions are necessary. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Pancreatic cancer presents a critical health issue characterized by low survival rates. Identifying risk factors in specific populations, such as those with diabetes, is crucial for early detection and improved outcomes. This study aimed to identify risk factors for pancreatic cancer in diabetic patients using a longitudinal cohort from the Shizuoka Kokuho database, spanning April 2012 to September 2021. Diabetic patients were identified and monitored for the onset of pancreatic cancer. Factors analyzed included age, sex, the Elixhauser comorbidity index, and specific comorbidities. Statistical analyses involved univariate and multivariate Cox proportional hazards regression. The study identified 212,775 as diabetic patients and 1755 developed pancreatic cancer during the period. The annual incidence rate of pancreatic cancer in this group was 166.7 cases per 100,000 person-years. The study identified older age, male sex, a history of liver disease, chronic pancreatitis, and pancreatic cystic lesions as significant risk factors for pancreatic cancer in diabetic patients. The study also highlighted the absence of a significant association between diabetes type or diabetic complications and the onset of pancreatic cancer. These findings may aid in the early diagnosis of pancreatic cancer in diabetic patients and may inform revisions in screening practices in diabetic patients. [ABSTRACT FROM AUTHOR]

Orthogeriatric co-management (OGCM) describes a collaboration of orthopedic surgeons and geriatricians for the treatment of fragility fractures in geriatric patients. While its cost-effectiveness for hip fractures has been widely investigated, research focusing on fractures of the upper extremities is lacking. Thus, we conducted a health economic evaluation of treatment in OGCM hospitals for forearm and humerus fractures. In a retrospective cohort study with nationwide health insurance claims data, we selected the first inpatient stay due to a forearm or humerus fracture in 2014–2018 either treated in hospitals that were able to offer OGCM (OGCM group) or not (non-OGCM group) and applied a 1-year follow-up. We included 31,557 cases with forearm (63.1% OGCM group) and 39,093 cases with humerus fractures (63.9% OGCM group) and balanced relevant covariates using entropy balancing. We investigated costs in different health sectors, length of stay, and cost-effectiveness regarding total cost per life year or fracture-free life year gained. In both fracture cohorts, initial hospital stay, inpatient stay, and total costs were higher in OGCM than in non-OGCM hospitals. For neither cohort nor effectiveness outcome, the probability that treatment in OGCM hospitals was cost-effective exceeded 95% for a willingness-to-pay of up to €150,000. We did not find distinct benefits of treatment in OGCM hospitals. Assigning cases to study groups on hospital-level and using life years and fracture-free life years, which might not adequately reflect the manifold ways these fractures affect the patients' health, as effectiveness outcomes, might have underestimated the effectiveness of treatment in OGCM hospitals. [ABSTRACT FROM AUTHOR]

The studied semi‐continuous time series contains a nonnegligible portion of observations equal to a single value (typically zero), whereas the remaining outcomes are strictly positive. A novel class of hurdle GARCH models having dependent zero occurrences is considered and the classical maximum likelihood estimation is employed. However, a distribution of the underlying time series innovations does not belong into the exponential family, which together with the dependence of innovations makes the whole inference nonstandard. Consistency and asymptotic normality of the estimator are derived. Efficiency of the estimation is elaborated and compared with the alternative quasi‐likelihood approach. A bootstrap prediction is also discussed. An analysis of sparse nonlife insurance claims is performed. [ABSTRACT FROM AUTHOR]

Benralizumab, a monoclonal antibody targeting IL-5 receptors, reduces exacerbations and oral corticosteroid requirements for severe, uncontrolled eosinophilic asthma. In Japan, geographic disparities in asthma outcomes suggest differential prescribing and access. This study aimed to quantify regional prescribing variations for benralizumab nationwide. Using Japan's National Database (NDB) of insurance claims (2009–2019), benralizumab standardized claim ratios (SCRs) were calculated for 47 prefectures. Correlations between SCRs and other biologics' SCRs, economic variables like average income, and physician densities were evaluated through univariate analysis and multivariate regressions. Income-related barriers to optimal prescribing were examined. Wide variation emerged in benralizumab SCRs, from 40.1 to 184.2 across prefectures. SCRs strongly correlated with omalizumab (r = 0.61, p < 0.00001) and mepolizumab (r = 0.43, p = 0.0024). Average monthly income also positively correlated with benralizumab SCRs (r = 0.45, p = 0.0016), whereas lifestyle factors were insignificant. Respiratory specialist density modestly correlated with SCRs (r = 0.29, p = 0.047). In multivariate regressions, average income remained the most robust predictor (B = 0.74, p = 0.022). Benralizumab SCRs strongly associate with income metrics more than healthcare infrastructure/population factors. Many regions show low SCRs, constituting apparent prescribing gaps. Access barriers for advanced asthma therapies remain inequitable among Japan's income strata. Addressing affordability alongside specialist allocation can achieve better prescribing quality and asthma outcomes. [ABSTRACT FROM AUTHOR]

Reserve management is a crucial component in corporate risk management. Claims provision refers to funds allocated by the Company to cover claims that may arise from either Incurred But Not Reported (IBNR) or Reported But Not Settled business activities of the Company. (RBNS). There are several different methods commonly used in carrying out the calculation of company claims reserves and one of them is the method munich chain ladder which is the development of chain ladders method. The aim of the study is to apply the munich chain ladder method in calculating the reservation of motor vehicle insurance claims using the motor vehicle insurance claims data from the insurance company PT ABC during the period 2011-2023. The results of the research showed that the method of munich chain ladder can be used to generate more accurate reservation projections of motor vehicles insurance claim compared to the chain ladders method. This study has made an important contribution to the insurance industry in improving the accuracy of the calculation of reservation claims for motor vehicles. By using the munich chain ladder method, insurance companies can make more accurate projections to control risk and manage finances more effectively. [ABSTRACT FROM AUTHOR]

The article discusses updates in the statutes in Florida covering the construction industry in a bid to bolster building safety, ensure prompt payment of construction services, and reduce insurance claims. Also cited are some fatal accidents that inspired said statutes like the Fidenae ampitheater collapse in A.D. 27, and the exemptions in areas like licensing, coding, and permitting.

Despite improvements in the insurance sector's performance, there are still misconceptions among the public, fueled by negative media coverage. These misconceptions exist across all areas of insurance, including life insurance and travel insurance. Insurance companies are working to communicate the positive role insurance plays and address these misconceptions through public education campaigns and improved communication with customers. However, mainstream media outlets need to do more to spread news of positive insurance outcomes and debunk myths. The insurance industry has made significant advancements, such as faster claims response times and improved customer experience, but these achievements are often overshadowed by negative coverage. [Extracted from the article]

Background: With advent of newer treatments for psoriasis, real-world use of biologics in Japan is evolving. Methods: This retrospective study utilized data from patients with ≥1 psoriasis-related biologic claims record between January 2016 and December 2020 in Japan to evaluate treatment patterns, healthcare resource utilization (HCRU), and associated costs. Data were analyzed using descriptive statistics. Results: Of 1,614 eligible patients, 72.5% were male, 29.2% had comorbid hypertension and 26.6% had comorbid cardiovascular disease. Interleukin (IL)-17 and tumor necrosis factor alpha (TNFα) inhibitors were commonly prescribed across lines of treatment, while IL-23 inhibitors were most considered for switches (92% of switches were from IL-12/23/IL-17/TNFα inhibitors). The overall mean adherence rate for all classes was 80.1%, but adherence varied across biologics. Infliximab and IL-23 inhibitor users exhibited optimal medical possession ratios, reflecting the best adherence rates. Overall HCRU (visits/ patient-year) was 9.05 for outpatient visits, 0.09 for inpatient hospitalization, and 0.5 for psoriasis-related phototherapy. HCRU associated with hospitalization was slightly higher for bio-experienced patients and so was the overall costs per patient-year relative to bio-naïve patients. Conclusion: Variable adherence rates observed suggest the need for improvement in treatment management with different biologics. Bio-experienced patients burdened by disease progression and treatment switches may result in increased HCRU. [ABSTRACT FROM AUTHOR]

There is limited evaluation of approaches to identify patients with new onset bipolar affective disorder (BPAD) when using administrative datasets. Using the Massachusetts All-Payer Claims Database (APCD), we identified individuals with a 2016 diagnosis of bipolar disorder with mania and examined patterns of psychiatric and medical care over the preceding 48 months. Among 4806 individuals aged 15–35 years with a 2016 BPAD with mania diagnosis, 3066 had 48 months of historical APCD data, and of those, 75 % involved information from ≥2 payors. After excluding individuals with historical BPAD or mania diagnoses, there were 583 individuals whose 2016 BPAD with mania diagnosis appeared to be new (i.e., 34 new diagnoses per 100,000 individuals aged 15–35 years). Most individuals received medical care, e.g., 98 % had outpatient visits, 76 % had Emergency Department (ED) visits, and 50 % had mental health-related ED visits during the 48 months prior to their first mania diagnosis. One-third (37.2 %) had a depressive episode before their initial BPAD with mania diagnosis. Study was conducted in one state among insured individuals. We used administrative data, which permits evaluation of large populations but lacks rigorous, well-validated claims-based definitions for BPAD. There could be diagnostic uncertainty during illness course, and clinicians may differ in their diagnostic thresholds. Careful examination of multiple years of patient history spanning all payors is essential for identifying new onset BPAD diagnoses presenting with mania, which in turn is critical to estimating population rates of new disease and understanding the early course of disease. • The rate of new mania diagnoses was 34 per 100,000 individuals. • 97.6 % with new mania had ≥1 outpatient visits in the 48 months prior to diagnosis. • 76.3 % had ED visits, 50.1 % had mental health-related ED visits during that time. • 37.2 % had a depressive episode in the 48 months prior to a new mania diagnosis. [ABSTRACT FROM AUTHOR]

Cognitive impairment and decreased executing functioning represent common symptoms of both ADHD and pregnancy. This study aimed to characterize temporal trends and racial/ethnic disparities in ADHD diagnosis during the perinatal period. In this serial cross-sectional study, we used administrative claims to create a cohort of commercially insured women with a documented live birth between 2008 and 2020 and identified those with an ADHD diagnosis in the year before or after delivery. We applied logistic regression to assess the probability of ADHD diagnosis adjusting for race/ethnicity, age, and comorbid conditions. We used this model to calculate the predicted probability of ADHD diagnosis by racial/ethnic group for each year. We identified 736,325 deliveries from 2008 to 2020. Overall, 16,801 (2.28 %) of deliveries had an ADHD diagnosis in the year before or after delivery. ADHD rates increased 290 % from 101 (95%CI: 92–111) per 10,000 deliveries in 2008 to 394 (95%CI: 371–419) per 10,000 deliveries in 2020. White women experienced the highest rates followed by Black, Hispanic, and Asian, respectively. Increasing ADHD diagnosis rates during the perinatal period may reflect improved detection but racial disparities persist. Additional research is needed to develop equitable outreach strategies to better support women experiencing ADHD during the perinatal period. • Deficits in cognition and executing functioning are common complaints of pregnancy. • ADHD diagnoses among delivering women increased 290 % between 2008 and 2020. • Women of color were less likely to have a perinatal ADHD diagnosis than white women. • Increasing diagnosis may reflect improved detection but racial disparities persist. [ABSTRACT FROM AUTHOR]

Annually, urinary tract infections (UTIs) affect over a hundred million people worldwide. Early detection of high-risk individuals can help prevent hospitalization for UTIs, which imposes significant economic and social burden on patients and caregivers. We present two methods to generate risk score models for UTI hospitalization. We utilize a sample of patients from the insurance claims data provided by the Centers for Medicare and Medicaid Services to develop and validate the proposed methods. Our dataset encompasses a wide range of features, such as demographics, medical history, and healthcare utilization of the patients along with provider quality metrics and community-based metrics. The proposed methods scale and round the coefficients of an underlying logistic regression model to create scoring tables. We present computational experiments to evaluate the prediction performance of both models. We also discuss different features of these models with respect to their impact on interpretability. Our findings emphasize the effectiveness of risk score models as practical tools for identifying high-risk patients and provide a quantitative assessment of the significance of various risk factors in UTI hospitalizations such as admission to ICU in the last 3 months, cognitive disorders and low inpatient, outpatient and carrier costs in the last 6 months. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort study performed in a nationwide insurance claims database. Objective. To evaluate the duration and magnitude of post-operative opioid prescriptions after minimally invasive surgical sacroiliac joint fusion (MIS SIJF) as compared to other common spine surgeries. Summary of Background Data. MIS SIJF has been reported to significantly improve quality of life and reduce pain. However, there is a paucity of reported data on post-operative opioid use in patients undergoing MIS SIJF for sacroiliac joint dysfunction. Methods. A nationwide insurance claims database was queried to identify 4,666 patients who underwent MIS SIJF. Patients were stratified by pre-operative opioid use: Opioid naïve, sporadic use, or chronic use were respectively defined as 0,1, or ≥2 opioid prescriptions filled within 6 months prior to surgery. Duration of opioid use was defined by the time between MIS SIJF and last opioid prescription filled while magnitude of opioid use was determined by milligram morphine equivalents filled by 30 days post-operation. This opioid use data was compared to that of other common spine surgeries. Results. Patients undergoing MIS SIJF continued to fill opioid prescriptions 1-year post-operatively at significantly higher proportions than those undergoing other common spine procedures assessed by prior literature within each of the pre-operative opioid use cohorts (chronic: 73% vs. 49-62%; P<0.0001, sporadic: 39% vs. 23-28%; P<0.0001, opioid naïve: 22% vs. 15-18%; P<0.0001). Chronic users filled the highest opiate dosages during the 30-day postoperative period, filling on average 64.75 MME/d compared to 19.75 MME/d and 24.25 MME/d by the opioid naïve and sporadic users, respectively. Conclusion. After MIS SIJF, opioid naïve patients use fewer opioids and for a shorter period of time compared to patients with sporadic or chronic pre-operative opioid use. MIS SIJF may result in less effective pain reduction when compared to other common spine surgeries evaluated via identical methodology. [ABSTRACT FROM AUTHOR]

In Indonesia, where the agricultural insurance system has been in full operation since 2016, a new damage assessment estimation formula for rice diseases was created through integrating the current damage assessment method and unmanned aerial vehicle (UAV) multispectral remote sensing data to improve the efficiency and precision of damage assessment work performed for the payments of insurance claims. The new method can quickly and efficiently output objective assessment results. In this study, UAV images and bacterial leaf blight (BLB) rice damage assessment data were acquired during the rainy and dry seasons of 2021 and 2022 in West Java, Indonesia, where serious BLB damage occurs every year. The six-level BLB score (0, 1, 3, 5, 7, and 9) and damage intensity calculated from the score were used as the BLB damage assessment data. The relationship between normalized UAV data, normalized difference vegetation index (NDVI), and BLB score showed significant correlations at the 1% level. The analysis of damage intensities and UAV data for paddy plots in all cropping seasons showed high correlation coefficients with the normalized red band, normalized near-infrared band, and NDVI, similar to the results of the BLB score analysis. However, for paddy plots with damage intensities of 70% or higher, the biased numbering of the BLB score data may have affected the evaluation results. Therefore, we conducted an analysis using an average of 1090 survey points for each BLB score and confirmed a strong relationship, with correlation coefficients exceeding 0.9 for the normalized red band, normalized near-infrared band, and NDVI. Through comparing the time required by the current assessment method with that required by the assessment method integrating UAV data, it was demonstrated that the evaluation time was reduced by more than 60% on average. We are able to propose a new assessment method for the Indonesian government to achieve complete objective enumeration. [ABSTRACT FROM AUTHOR]

This paper proposes a new boosting machine based on forward stagewise additive modeling with cost-complexity pruned trees. In the Tweedie case, it deals directly with observed responses, not gradients of the loss function. Trees included in the score progressively reduce to the root-node one, in an adaptive way. The proposed Adaptive Boosting Tree (ABT) machine thus automatically stops at that time, avoiding to resort to the time-consuming cross validation approach. Case studies performed on motor third-party liability insurance claim data demonstrate the performances of the proposed ABT machine for ratemaking, in comparison with regular gradient boosting trees. [ABSTRACT FROM AUTHOR]

In property insurance claims triage, insurers often use static information to assess the severity of a claim and to identify the subsequent actions. We hypothesize that the pattern of weather conditions throughout the course of a loss event is predictive of the insured losses, and hence appropriate use of weather dynamics improves the operation of insurers' claim management. To test this hypothesis, we propose a deep learning method to incorporate dynamic weather information in the predictive modeling of the insured losses for reported claims. The proposed method features a hierarchical network architecture to address the challenges in claims triage due to the nature of weather dynamics. In the empirical analysis, we examine a portfolio of hail damage property insurance claims obtained from a major U.S. insurance carrier. When supplemented by dynamic weather information, the deep learning method exhibits substantial improvement in the hold-out predictive performance. We further design a cost-conscious decision strategy for triaging claims using the probabilistic forecasts of the insurance claim amounts. We show that leveraging weather dynamics in claims triage leads to a reduction of up to 9% and 6% in operational costs compared to when the triaging decision is based on forecasts without any weather information and with only static weather information, respectively. Supplementary materials for this article are available online. [ABSTRACT FROM AUTHOR]

This study proposes a new discrete distribution in the mixed Poisson paradigm to obtain a distribution that provides a better fit to skewed and dispersed count observation with excess zero. The cubic transmutation map is used to extend the exponential distribution, and the obtained continuous distribution is assumed for the parameter of the Poisson distribution. Various moment-based properties of the new distribution are obtained. The Nelder-Mead algorithm provides the fastest convergence iteration under the maximum likelihood estimation technique. The shapes of the proposed new discrete distribution are similar to those of the mixing distribution. Frequencies of insurance claims from different countries are used to assess the performance of the new proposition (and its zero-inflated form). Results show that the new distribution outperforms other competing ones in most cases. It is also revealed that the natural form of the new distribution outperforms its zeroinflated version in many cases despite having observations with excess zero counts. [ABSTRACT FROM AUTHOR]

Background: Early detection of Alzheimer's disease (AD) is a key component for the success of the recently approved lecanemab and aducanumab. Patients with neuroinflammation-related conditions are associated with a higher risk for developing AD. Objective: Investigate the incidence of AD among patients with neuroinflammation-related conditions including epilepsy, hemorrhage stroke, multiple sclerosis (MS), and traumatic brain injury (TBI). Methods: We used Optum's de-identified Clinformatics Data Mart Database (CDM). We derived covariate-matched cohorts including patients with neuroinflammation-related conditions and controls without the corresponding condition. The matched cohorts were: 1) patients with epilepsy and controls (N = 67,825 matched pairs); 2) patients with hemorrhage stroke and controls (N = 81,510 matched pairs); 3) patients with MS and controls (N = 9,853 matched pairs); and 4) patients TBI and controls (N = 104,637 matched pairs). We used the Cox model to investigate the associations between neuroinflammation-related conditions and AD. Results: We identified that epilepsy, hemorrhage stroke, and TBI were associated with increased risks of AD in both males and females (hazard ratios [HRs]≥1.74, p < 0.001), as well as in gender- and race-conscious subpopulations (HRs≥1.64, p < 0.001). We identified that MS was associated with increased risks of AD in both males and females (HRs≥1.47, p≤0.004), while gender- and race-conscious subgroup analysis shown mixed associations. Conclusions: Patients with epilepsy, hemorrhage stroke, MS, and/or TBI are associated with a higher risk of developing AD. More attention on cognitive status should be given to older patients with these conditions. [ABSTRACT FROM AUTHOR]

Background The US Centers for Disease Control and Prevention recommends HIV testing every 3 months in oral PrEP users. We performed a national assessment of HIV testing compliance among oral PrEP users. Methods We analyzed 408 910 PrEP prescriptions issued to 39 809 PrEP users using a national insurance claims database that contained commercial and Medicaid claims. We identified PrEP use based on pharmacy claims and outpatient diagnostic coding. We evaluated the percentage of PrEP prescription refills without HIV testing (identified by CPT codes) within the prior 3, 6, and 12 months using time to event methods. We performed subgroup and multivariate analyses by age, gender, race, insurance type, and geography. Results Of 39 809 persons, 36 197 were commercially insured, 3612 were Medicaid-insured, and 96% identified as male; the median age (interquartile range) was 34 (29–44) years, and the Medicaid-insured PrEP users were 24% Black/African American, 44% White, and 9% Hispanic/Latinx. Within the prior 3, 6, and 12 months, respectively, the percentage of PrEP prescription fills in individuals without HIV Ag/Ab testing was 34.3% (95% CI, 34.2%–34.5%), 23.8% (95% CI, 23.7%–23.9%), and 16.6% (95% CI, 16.4%–16.7%), and the percentage without any type of HIV test was 25.8% (95% CI, 25.6%–25.9%), 14.6% (95% CI, 14.5%–14.7%), and 7.8% (95% CI, 7.7%–7.9%). Conclusions Approximately 1 in 3 oral PrEP prescriptions were filled in persons who had not received an HIV Ag/Ab test within the prior 3 months, with evidence of health disparities. These findings inform clinical PrEP monitoring efforts and compliance with national HIV testing guidance to monitor PrEP users. [ABSTRACT FROM AUTHOR]

This paper is devoted to asymptotic analysis for a continuous-time risk model with the insurance surplus process and the log-price process of the investment driven by two dependent jump-diffusion processes. We take into account arbitrary dependence between the insurance claims and their corresponding investment return jumps caused by a sequence of systematic factors, whose arrival times constitute a renewal counting process. Under the framework of regular variation, we obtain a simple and unified asymptotic formula for the finite-time ruin probability as the initial wealth becomes large. It turns out that, in the weakly dependent case, the tails of the claims determine the exact decay rate of the finite-time ruin probability while the investment return jumps only contribute to the coefficient of the asymptotic formula; however, in the strongly dependent case, they both produce essential impacts on the finite-time ruin probability which is under-estimated in the weakly dependent case. [ABSTRACT FROM AUTHOR]

Objective: To assess postacute rehabilitation service use and length of stay among a national sample of patients with brain tumors after surgery. Design: A retrospective review was conducted of health care claims data of a national sample of patients via The Optum Clinformatics DataMart. Setting and Participants: This study included adult individuals (≥18 years of age) who were diagnosed with a brain tumor between 2015 and 2019 and underwent a craniotomy or craniectomy within 180 days of diagnosis. Methods: Descriptive statistics were used to characterize patients by tumor type. Multivariate models assessed factors associated with discharge setting and length of stay. Results: Of the 10,275 individuals identified, 69% had malignant tumors. Over two thirds of patients were discharged directly home (with or without home health care) and 9.3% and 9.5% were discharged to acute rehabilitation facilities (inpatient rehabilitation facilities [IRF]) and skilled nursing facilities (SNF/ICF), respectively. About 13.5% were discharged to other settings. The average length of stay during the episode of care was 8.6 (SD = 9.6) days. After adjusting for confounders, individuals with benign brain tumors were more likely to be discharged to either IRF or SNF/ICF than return home after acute care stay, as were those with greater comorbidities, older age, fee‐for‐service and health maintenance organization insurance. Wealthier patients were less likely to be discharged to a SNF/ICF than home, although income was not a factor affecting discharge to an IRF. Patients with benign tumors, the oldest old (80+), those with more comorbidities as well as Black and Hispanic patients had a longer length of stay during the acute hospitalization. Conclusions: Individuals with brain tumors have deficits amenable to rehabilitation; however, this study finds that service use differs by tumor type and demographic and socioeconomic factors. Further study is needed to identify if there are barriers to access and use of rehabilitation services in this population. [ABSTRACT FROM AUTHOR]

When shopping for gadgets online, a person often feels worried if their shopping activity ends in fraud. Lack of confidence in online shopping is experienced by some consumers which makes them no longer want to buy gadgets on online shopping sites. The risk of buying a gadget in online shopping is huge. Starting from the risk of goods being damaged during shipment, theft, goods not arriving and much more. The aim of this study is to demonstrate the influence of the price, risk and claims of shipping insurance on the decision to buy gadgets in E-commerce. This research uses quantitative methods with double linear regression analysis. Research results show that prices influence purchasing decisions, risks influence purchase decisions, and insurance claims influence buying decisions. [ABSTRACT FROM AUTHOR]

The accurate forecasting of insurance claims is a critical component for insurers’ risk management decisions. Hierarchical Bayesian parametric (BP) models can be used for health insurance claims forecasting, but they are unsatisfactory to describe the claims distribution. Therefore, Bayesian nonparametric (BNP) models can be a more suitable alternative to deal with the complex characteristics of the health insurance claims distribution, including heavy tails, skewness, and multimodality. In this study, we apply both a BP model and a BNP model to predict group health claims using simulated and real-world data for a private life insurer in Indonesia. The findings show that the BNP model outperforms the BP model in terms of claims prediction accuracy. Furthermore, our analysis highlights the flexibility and robustness of BNP models in handling diverse data structures in health insurance claims. [ABSTRACT FROM AUTHOR]

In this research, we consider cyber risk in insurance using a quantum approach, with a focus on the differences between reported cyber claims and the number of cyber attacks that caused them. Unlike the traditional probabilistic approach, quantum modeling makes it possible to deal with non-commutative event paths. We investigate the classification of cyber claims according to different cyber risk behaviors to enable more precise analysis and management of cyber risks. Additionally, we examine how historical cyber claims can be utilized through the application of copula functions for dependent insurance claims. We also discuss classification, likelihood estimation, and risk-loss calculation within the context of dependent insurance claim data. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study is to assess if daily use of hypnotics increases mortality, aspiration pneumonia and hip fracture among relatively healthy individuals aged 75 years or older who lead independent lives in the community. Method and Patients: Of the adults aged 75 years or older residing in Hokkaido prefecture of Japan (n = 705,538), those who did not meet several exclusion criteria were eligible for generating propensity score‐matched cohorts (n = 214,723). Exclusion criteria included co‐prescribed medications acting on the central nervous system, diagnoses of malignant neoplasm, dementia, depression, etc. We compared 33,095 participants who were prescribed hypnotics for daily use (hypnotic group) with a propensity score‐matched cohort without a prescription (control group). Participants were followed for more than 42 months. Results: During the 42‐month follow‐up period, the incidence of the three outcome measures in the hypnotics group was significantly higher than that in the control group (aspiration pneumonia p < 0.001, hip fracture p = 0.007, and all‐cause mortality p < 0.001). Sensitivity analyses utilizing inverse probability weighting demonstrated hazard ratios of 1.083 [1.023–1.146] for mortality, 1.117 [1.014–1.230] for aspiration pneumonia, and 1.720 [1.559–1.897] for hip fracture. Meanwhile, the attribute risk differences were 2.7, 1.5, and 1.0 per 1000 patient‐years, respectively. Conclusions: Although daily use of hypnotics increased the risk of three events, their attribute risk differences were fewer than 3.0 per 1000 patient‐years. The results will help provide guidance on whether it is reasonable to prescribe hypnotics to geriatric population aged 75 or older leading independent lives in the community. Clinical trial registration: UMIN‐CTR UMIN000048398. Key points: It is controversial if daily use of hypnotics increases mortality, aspiration pneumonia and hip fracture in individuals aged 75 years or older leading independent lives in the community.We compared 33,095 participants who were prescribed hypnotics for daily use (hypnotic group) with a propensity score‐matched cohort without a prescription (control group).The incidence of the three adverse events in the hypnotics group was significantly higher than that in the control group, although the attribute risk differences were 2.7, 1.5, and 1.0 per 1000 patient‐years, respectively.The results will help provide guidance on whether it is reasonable to prescribe hypnotics to geriatric population aged 75 or older leading independent lives in the community. [ABSTRACT FROM AUTHOR]

The American Law Institute (ALI) has approved volume 3 of the new Restatement (Third) of Torts, which includes a section on first-party bad faith. The ALI aims to clarify and simplify the law, and the restatement process involves drafts, input from advisers and members, and final approval by the ALI Council. The Third Restatement expands on the treatment of bad faith in the Restatement of the Law of Liability Insurance (RLLI), specifically in section 20 A. This section provides a comprehensive overview of first-party bad faith law, covering its history, the nature of insurance contracts, the subjective and objective nature of the tort, and the obligations of insurers. It also addresses issues such as the timing of an insurer's knowledge, the scope of liability, and the damages that an insured may recover. While the impact of section 20 A on the future of first-party bad faith law is uncertain, it serves as a useful summary of the principles and may be a valuable resource for lawyers and judges in this area. [Extracted from the article]

This paper showcases the effectiveness of the discrete generalized Burr-Hatke distribution in analyzing insurance claims data, specifically focusing on scenarios with over-dispersed and zero-inflated claims. Key contributions include presenting foundational statistical theories with mathematical proofs to enrich the paper's mathematical and statistical aspects. Through the application of this discrete distribution, the study conducted a thorough risk analysis across five diverse sets of insurance claims data, evaluating critical risk indicators at specified quantiles. These indicators provided detailed insights into potential losses across different risk levels, supporting effective risk management strategies. The research emphasizes the importance of selecting appropriate probability distributions when analyzing zero-inflated data, as commonly observed in insurance claims. The discrete distribution accommodated these unique data characteristics and facilitated a robust analysis of risk metrics, enhancing the accuracy of potential loss assessments and reducing associated uncertainties. Furthermore, the study highlights the practical relevance of the discrete distribution in addressing specific challenges inherent to insurance claims data. By leveraging this distribution, insurers and risk analysts can improve their risk modeling capabilities, leading to more informed decision-making and enhanced financial exposure management. [ABSTRACT FROM AUTHOR]

The current healthcare insurance claim requires more procedures to be claimed from an insurance company. Healthcare insurance companies are crucial for patient financial assistance, but efficient claim processing can lead to lower the levels of care. Patients have already claimed insurance in certain locations and are attempting to claim it again in another location. This work proposes to increase claim speed, avoid fraudulent claims, and provide privacy for patient data on decentralized storage through permissioned blockchain. To ensure patient data privacy and assist insurance agents and individuals in verifying eligibility and claim status, hash values are used to store data in a block. Every claim's information is stored in a block. If the patient attempts to claim again, the agent will validate the block and have the option to accept or reject the request. The integrity, speed, and security of patient health information can be achieved through this technique. [ABSTRACT FROM AUTHOR]

Extreme winds are by far the largest contributor to Norway's insurance claims related to natural hazards. The predictive skills of four different damage functions are assessed for Norway at the municipality and national levels on daily and annual temporal scales using municipality-level insurance data and the high-resolution Norwegian hindcast (NORA3) wind speed data for the period 1985–2020. Special attention is given to extreme damaging events and occurrence probabilities of wind-speed-induced damage. Because of the complex topography of Norway and the resulting high heterogeneity of the population density, the wind speed is weighted with the population. The largest per capita losses and severe damage occur most frequently in the western municipalities of Norway, which are more exposed to incoming storms from the North Atlantic, whilst there are seldom any large losses further inland. There is no single damage function that outperforms others. However, a good agreement between the observed and estimated losses at municipality and national levels for a combination of damage functions suggests their usability in estimating severe damage associated with windstorms. Furthermore, the damage functions are able to successfully reconstruct the geographical pattern of losses caused by extreme windstorms with a high degree of correlation. From event occurrence probabilities, the present study devises a damage classifier that exhibits some skill at distinguishing between daily damaging and non-damaging events at the municipality level. While large-loss events are well captured, the skewness and zero inflation of the loss data greatly reduce the quality of both the damage functions and the classifier for moderate- and weak-loss events. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Motor Vehicle Accident (MVA) Fund Botswana compensates claimants who lose their incomes due to road traffic accidents. In Botswana, road traffic accidents are becoming more frequent, and the MVA Fund is experiencing escalating claims. We describe the demographic characteristics of loss of income (LOI) claimants of the MVA Fund Botswana. We assess whether demographic characteristics are related to return to work (RTW). OBJECTIVE: We retrospectively reviewed records of MVA Fund claimants and extracted demographic information. We investigated the demographic profile and the relationship between demographic information and RTW. METHODS: We reviewed 432 LOI claims received by MVA Fund from January 1, 2015 to December 31, 2020. We descriptively analysed the demographic profiles of claimants. We used a univariate analysis and multivariate logistic regression to determine the association between independent demographic variables and the dependent variable, RTW. RESULTS: MVA Fund claimants were on average 37-years-old. Claimants were mostly from low-income socio-economic backgrounds. RTW was significantly associated with injury severity, type of injury, and having a RTW plan offer. The final predictors of RTW, using logistic regression, were time away from work and severity of injury. CONCLUSION: In Botswana, claimants who had severe injuries and who stayed away from work for longer were less likely to RTW. The MVA Fund Botswana must recognise the demographic profiles of claimants which are likely to influence RTW. [ABSTRACT FROM AUTHOR]

We assemble homeowner insurance claims from 28 independently operated country subsidiaries of a multinational insurance firm. We propose a new insurance model, in which consumers can make invalid claims and firms can deny valid claims, as is common in the data. In the model, trust and honesty shape equilibrium insurance contracts, disputes, and claim payments, especially when disputes are too small for courts. We test the model by investigating claim incidence, dispute, rejection, and payment, as well as insurance costs and pricing across countries. The evidence is consistent with the centrality of trust for insurance markets, as our model predicts. Authors have furnished data/code, which are available on the Oxford University Press Web site next to the link to the final published paper online. [ABSTRACT FROM AUTHOR]

The epidemiology of blastomycosis in Vermont, USA, is poorly understood. Using insurance claims data, we estimated the mean annual blastomycosis incidence was 1.8 patients/100,000 persons during 2011–2020. Incidence and disease severity were highest in north-central counties. Our findings highlight a need for improved clinical awareness and expanded surveillance.

Estimating loss reserves is a crucial activity for non-life insurance companies. It involves adjusting the expected evolution of claims over different periods of active policies and their fluctuations. The chain-ladder (CL) technique is recognized as one of the most effective methods for calculating claim reserves in this context. It has become a benchmark within the insurance sector for predicting loss reserves and has been adapted to estimate variability margins. This variability has been addressed through both stochastic and possibilistic analyses. This study adopts the latter approach, proposing the use of the CL framework combined with intuitionistic fuzzy numbers (IFNs). While modeling with fuzzy numbers (FNs) introduces only epistemic uncertainty, employing IFNs allows for the representation of bipolar data regarding the feasible and infeasible values of loss reserves. In short, this paper presents an extension of the chain-ladder technique that estimates the parameters governing claim development through intuitionistic fuzzy regression, such as symmetric triangular IFNs. Additionally, it compares the results obtained with this method with those derived from the stochastic chain ladder by England and Verrall. [ABSTRACT FROM AUTHOR]

Background: Potential differences in buprenorphine treatment outcomes across various treatment settings are poorly characterized in multi-state administrative data. We thus evaluated the association of opioid use disorder (OUD) treatment setting and insurance type with risk of buprenorphine discontinuation among commercial insurance and Medicaid enrollees initiated on buprenorphine. Methods: In this observational, retrospective cohort study using the Merative MarketScan databases (2006–2016), we analyzed buprenorphine retention in 58,200 US adults with OUD. Predictor variables included insurance status (Medicaid vs commercial) and treatment setting, operationalized as substance use disorder (SUD) specialty treatment facility versus outpatient primary care physicians (PCPs) versus outpatient psychiatry, ascertained by linking physician visit codes to buprenorphine prescriptions. Treatment setting was inferred based on timing of prescriber visit claims preceding prescription fills. We estimated time to buprenorphine discontinuation using multivariable cox regression. Results: Among enrollees with OUD receiving buprenorphine, 26,168 (45.0%) had prescriptions from SUD facilities without outpatient buprenorphine treatment, with the remaining treated by outpatient PCPs (n = 23,899, 41.1%) and psychiatrists (n = 8133, 13.9%). Overall, 50.6% and 73.3% discontinued treatment at 180 and 365 days respectively. Buprenorphine discontinuation was higher among enrollees receiving prescriptions from SUD facilities (aHR = 1.03[1.01–1.06]) and PCPs (aHR = 1.07[1.05–1.10]). Medicaid enrollees had lower buprenorphine retention than those with commercial insurance, particularly those receiving buprenorphine from SUD facilities and PCPs (aHR = 1.24[1.20–1.29] and aHR = 1.39[1.34–1.45] respectively, relative to comparator group of commercial insurance enrollees receiving buprenorphine from outpatient psychiatry). Conclusion: Buprenorphine discontinuation is high across outpatient PCP, psychiatry, and SUD treatment facility settings, with potentially lower treatment retention among Medicaid enrollees receiving care from SUD facilities and PCPs. [ABSTRACT FROM AUTHOR]