Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.031
Filtrar
1.
Health Aff (Millwood) ; 41(2): 212-218, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130064

RESUMO

As the use of machine learning algorithms in health care continues to expand, there are growing concerns about equity, fairness, and bias in the ways in which machine learning models are developed and used in clinical and business decisions. We present a guide to the data ecosystem used by health insurers to highlight where bias can arise along machine learning pipelines. We suggest mechanisms for identifying and dealing with bias and discuss challenges and opportunities to increase fairness through analytics in the health insurance industry.


Assuntos
Ecossistema , Seguradoras , Algoritmos , Viés , Humanos , Aprendizado de Máquina
2.
Health Aff (Millwood) ; 41(11): 1652-1660, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36343312

RESUMO

Although hospital consolidation within markets has been well documented, consolidation across markets has not, even though economic theory predicts-and evidence is emerging-that cross-market hospital systems raise prices by exerting market power across markets when negotiating with common customers (primarily insurers). This study analyzes hospital systems using the American Hospital Association Annual Survey Database and defines hospital geographic markets as commuting zones that link workers to places of employment. The share of community hospitals in the US that were part of hospital systems increased from 10 percent in 1970 to 67 percent in 2019, resulting in 3,436 hospitals within 368 systems in 2019. Of these systems, 216 (59 percent) owned hospitals in multiple commuting zones, in part because 55 percent of the 1,500 hospitals targeted for a merger or acquisition between 2010 and 2019 were located in a different commuting zone than the acquirer. Based on market-power differences among hospitals in systems, the number of systems in urban commuting zones that could potentially exert enhanced cross-market power increased from thirty-seven systems in 2009 to fifty-seven systems in 2019, an increase of 54 percent. The increase in cross-market hospital systems warrants concern and scrutiny because of the potential anticompetitive impact of hospital systems exerting market power across markets in negotiations with common customers.


Assuntos
Competição Econômica , Seguro Saúde , Estados Unidos , Humanos , Seguradoras , Hospitais , Negociação/métodos
3.
Arthroscopy ; 38(11): 3020-3022, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36344059

RESUMO

Making an accurate preoperative diagnosis is critical to optimizing outcomes after hip arthroscopy. A detailed history, thorough physical examination, imaging studies, and diagnostic injections must all be considered in the decision-making process. In today's health care climate, it is imperative to obtain essential and indicated preoperative information while being mindful of health care dollars. Magnetic resonance imaging (MRI) of the hip has been shown to be a highly sensitive modality for hip and pelvis disorders. However, it is critical to recognize that acetabular labral tears and other hip pathology are highly prevalent in an asymptomatic young adult population. There are certainly situations when an MRI should be obtained (suspected arthritic symptoms, avascular necrosis, synovial disorders, uncommon osseous tumors); however, these patients generally present with atypical symptoms. In addition, obtaining an MRI can delay surgical intervention, which has been shown to lead to inferior outcomes in prior studies. MRI is not imperative when patients present with typical intermittent, deep anterior, lateral, groin pain with prolonged sitting, twisting and pivoting, and transitioning from sitting to standing. The typical physical examination includes positive hip impingement testing (FADIR / anterior impingement test) that recreates the patients presenting complaints. Appropriate imaging includes plain radiographs revealing adequate acetabular coverage (not significantly dysplastic) or acetabular overcoverage (pincer-type femoracetabular impingement), cam-type femoracetabular impingement, and well-maintained joint space on all views, including a false profile radiograph to further evaluate the anterior joint space. Finally, a diagnostic injection can be invaluable to further confirm the hip joint proper as the source of pain. If all of the above criteria are met, I strongly believe an MRI is unlikely to alter the surgical decision-making process. In the end, the treating clinician should determine when an MRI is necessary based on the presenting symptoms and examination, rather than insurers applying a blanket requirement for preauthorization. This physician autonomy would ultimately lead to more efficient and cost-effective patient care. Medicine is an art, and unjustified handcuffing of the artist without evidence could result in inferior results.


Assuntos
Impacto Femoroacetabular , Adulto Jovem , Humanos , Impacto Femoroacetabular/cirurgia , Artroscopia/métodos , Seguradoras , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Acetábulo/patologia , Imageamento por Ressonância Magnética/métodos , Dor , Pessoal de Saúde , Atenção à Saúde , Tomada de Decisões
4.
Pharmacoeconomics ; 40(12): 1131-1142, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36348153

RESUMO

The USA pays more for brand-name prescription drugs than any other country and new legislation from August 2022 gives Medicare the authority to directly negotiate certain drug prices with manufacturers starting in 2026-something the federal insurer had been prohibited from doing for its prior history. As the USA prepares for negotiations, we therefore surveyed how comparable industrialized countries use statutory requirements and procedures to negotiate brand-name drug prices. Guidance documents, regulations, government and academic publications were reviewed to identify the process of negotiating drug prices in peer countries that have been cited as potential examples for US payment reform: Australia, Canada, France, Germany, and the UK. Processes for arriving at a final price for a drug generally fall under three approaches: statutory rebates, setting a maximum price, and arbitration between national (public) insurers and manufacturers. Each approach to price negotiation could be adopted by Medicare and reduce spending even if Medicare does not adopt an exclusionary or closed formulary. Much remains to be determined about how the new price negotiation authority in the USA will be implemented, and policymakers can learn from comparator countries' statutory and regulatory strategies for price negotiation.


Assuntos
Programas Nacionais de Saúde , Negociação , Idoso , Humanos , Seguradoras , Alemanha , Austrália
5.
BMJ Glob Health ; 7(Suppl 6)2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36379588

RESUMO

BACKGROUND: Colombia's universal health coverage programme has enrolled 98% of the population, thereby improving financial protection and health outcomes. The right to participate in the organisation of healthcare is enshrined in the 1991 Colombian Constitution. One participatory mechanism is the legal and regulatory provision that citizens can form user associations. This study examines the functionality of health insurance user associations and their influence on citizen empowerment and health insurance responsiveness. METHODS: The mixed methods study includes document review (n=72), a survey of beneficiaries (n=1311), a survey of user associations members (n=27), as well as interviews (n=19), focus group discussions (n=6) and stakeholder consultations (n=6) with user association members, government officials, and representatives from insurers, the pharmaceutical industry, and patient associations. Analysis used a content-process-context framework to understand how user associations are designed to work according to policy content, how they actually work in terms of coverage, public awareness, membership, and effectiveness, and contextual influences. FINDINGS: Colombia's user associations have a mandate to represent citizens' interests, enable participation in insurer decision-making, 'defend users' and oversee quality services. Insurers are mandated to ensure their enrollees create user associations, but are not required to provide resources to support their work. Thus, we found that user associations had been formed throughout the country, but the public was widely unaware of their existence. Many associations were weak, passive or entirely inactive. Limited market competition and toothless policies about user associations made insurers indifferent to community involvement. CONCLUSION: Currently, the initiative suffers from low awareness and low participation levels that can hardly lead to empowered enrollees and more responsive health insurance programmes. Yet, most stakeholders value the space to participate and still see potential in the initiative. This warrants a range of policy recommendations to strengthen user associations and truly enable them to effect change.


Assuntos
Seguradoras , Seguro Saúde , Humanos , Colômbia , Cobertura Universal do Seguro de Saúde , Participação da Comunidade
6.
AMA J Ethics ; 24(11): E1075-1082, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36342491

RESUMO

Prices private insurers negotiate with health care organizations and clinicians have historically been confidential. Since the early 2000s, privately insured patients have faced increasing out-of-pocket costs and demanded more information about variability in negotiated prices, some of which has slowly become available. This article argues that fragmentation in US health care delivery streams and shortcomings in formal quality measures mean that the value of making prices transparent is in its usefulness as a tool for policymakers and regulators rather than for patients.


Assuntos
Gastos em Saúde , Seguradoras , Humanos , Estados Unidos , Atenção à Saúde , Negociação
7.
BMJ Open Qual ; 11(4)2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36375859

RESUMO

BACKGROUND: Audit and feedback (A&F) is a valuable quality improvement strategy, which can contribute to de-implementation of low-value care. In the Netherlands, all health insurers collaboratively provide A&F to general practitioners (GPs), the 'Primary Care Practice Report' (PCPR). Unfortunately, the use of this report by GPs is limited. This study examined the thoughts of GPs on the usability of the PCPR and GPs recommendations for improving the PCPR. METHOD: We used an interpretative qualitative design, with think-aloud tasks to uncover thoughts of GPs on the usability of the PCPR and semistructured interview questions to ask GPs' recommendations for improvement of the PCPR. Interviews were audiorecorded and transcribed ad verbatim. Data were analysed using thematic content analysis. RESULTS: We identified two main themes: 'poor usability of the PCPR', and 'minimal motivation to change based on the PCPR'. The GPs found the usability of the PCPR poor due to the feedback not being clinically meaningful, the data not being recent, individual and reliable, the performance comparators offer insufficient guidance to assess clinical performance, the results are not discussed with peers and the definitions and visuals are unclear. The GPs recommended improving these issues. The GPs motivation to change based on the PCPR was minimal. CONCLUSIONS: The GPs evaluated the PCPR as poorly usable and were minimally motivated to change. The PCPR seems developed from the perspective of the reports' commissioners, health insurers, and does not meet known criteria for effective A&F design and user-centred design. Importantly, the GPs did state that well-designed feedback could contribute to their motivation to improve clinical performance.Furthermore, the GPs stated that they receive a multitude of A&F reports, which they hardly use. Thus, we see a need for policy makers to invest in less, but more usable A&F reports.


Assuntos
Clínicos Gerais , Humanos , Retroalimentação , Seguradoras , Atitude do Pessoal de Saúde , Pesquisa Qualitativa
9.
JAMA Netw Open ; 5(10): e2239131, 2022 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-36306129

RESUMO

Importance: Despite a widespread belief that private insurers spend large amounts on health care for enrollees receiving dialysis, data limitations over the past decade have precluded a comprehensive analysis of the topic. Objective: To examine the amount and types of increases in health care spending for privately insured patients associated with initiating dialysis care. Design, Setting, and Participants: A cohort study covering calendar years 2012 to 2019 included patients with kidney failure who had employer-sponsored insurance for 12 months following dialysis initiation. Data analysis was performed from August 27, 2021, to August 18, 2022. The data cover the entirety of the US and were obtained from the Health Care Cost Institute. The data include all medical claims for enrollees in employer-sponsored health insurance plans offered by multiple major health care insurers within the US. Participants included patients younger than 65 years who were continuously enrolled in these plans in the 12 months before and after their first claim for dialysis care. Patients also had to have nonmissing documented key characteristics, such as sex, race and ethnicity, and health characteristics. Exposures: A claim for dialysis care. Main Outcomes and Measures: Out-of-pocket, inpatient, outpatient, physician services, prescription medication, and total health care spending. The hypothesis tested was formulated before data collection. Results: The sample included 309 800 enrollee-months, which was a balanced panel of 25 months for 12 392 enrollees. At baseline, 7534 patients (61%) were male, 5415 (44%) were aged 55 to 64 years, and patients had been enrolled with their insurer for a mean of 30 months (95% CI, 29.9-30.1 months). In the 12 months before initiating dialysis care, total monthly health care spending was $5025 per patient per month (95% CI, $4945-$5106). Dialysis care initiation was associated with an increase in total monthly spending of $14 685 (95% CI, $14 413-$14 957). This increase occurred across all spending categories (dialysis, nondialysis outpatient, inpatient, physician services, and prescription drugs). Monthly patient out-of-pocket spending increased by $170 (95% CI, $162-$178). These spending increases occurred abruptly, beginning about 2 months before dialysis initiation, and remained increased for the subsequent 12 months. Conclusions and Relevance: In this cohort study, evidence that private insurers experience significant, sustained increases in spending when patients initiated dialysis was noted. The findings suggest that proposed policies aimed at limiting the amount dialysis facilities charge private insurers and the enrollees has the potential to reduce health care spending in this high-cost population.


Assuntos
Gastos em Saúde , Diálise Renal , Humanos , Masculino , Feminino , Estudos de Coortes , Seguradoras , Custos de Cuidados de Saúde
10.
Ned Tijdschr Geneeskd ; 1662022 10 20.
Artigo em Holandês | MEDLINE | ID: mdl-36300469

RESUMO

The role of clinical practice guidelines has changed dramatically the past 50 years. Both beneficial, as also having some disadvantageous effects. Considering the international developments, such as a growing body of evidence and evolving methodologies, some limits might be in reach or already been reached. The solution thereof is part nationally and part internationally. Internationally because of new methodologies and technologies, such as use of artificial intelligence, and nationally in a more coherent approach. Coherent not only in medical disciplines, but also in policies of government, regulators, and health insurers. This calls for a renewed, integral and an all-encompassing vision.


Assuntos
Inteligência Artificial , Seguradoras , Humanos
11.
Am J Manag Care ; 28(10): 539-542, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36252173

RESUMO

OBJECTIVES: To characterize the proportion of Medicare Advantage (MA) enrollees who switched insurers or disenrolled to traditional Medicare (TM) in the years immediately after first choosing to join an MA health plan. STUDY DESIGN: Retrospective analysis using 2012-2017 Medicare enrollment data. METHODS: We studied enrollees who joined MA between 2012 and 2016 and identified all enrollees who changed insurers (switched insurance or disenrolled to TM) at least once between the start of enrollment and the end of the study period. We categorized each change as switching insurers or disenrollment to TM, and by whether the previous insurer had exited the market. RESULTS: Among 6,520,169 new MA enrollees, 15.6% had changed insurance within 1 year after enrollment in MA and 49.2% had changed insurance by 5 years. More enrollees switched insurers rather than disenrolled, and most enrollees who changed insurers did not do so as a result of insurer exits. CONCLUSIONS: New MA enrollees change insurers at a substantial rate when followed across multiple years. These changes may disincentivize insurers from investing in preventive care and chronic disease management and, as shown in several non-MA populations, may lead to discontinuities in care, increased expenditures, and inferior health outcomes.


Assuntos
Medicare Part C , Idoso , Doença Crônica , Gastos em Saúde , Humanos , Seguradoras , Estudos Retrospectivos , Estados Unidos
12.
Am J Manag Care ; 28(9): e347-e350, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36121367

RESUMO

OBJECTIVES: This study investigates a sample of the pricing data released by hospitals under the price transparency law effective January 2021 to better understand the prices paid by health insurance exchange (HIX) plans relative to commercial group and Medicare Advantage plans. STUDY DESIGN: Cross-sectional analysis of hospital pricing data. METHODS: We compared allowed amounts for 25 common inpatient services and 56 common outpatient services across 22 hospital-insurer dyads, selected by the availability of plan-specific pricing data from the top 100 hospitals by bed counts and the top 100 hospitals by gross revenue based on 2017 CMS data. RESULTS: Insurers in our sample generally negotiated allowed amounts for their HIX plans that were lower than their commercial group rates and well above their Medicare Advantage contracts within the same hospital. CONCLUSIONS: Allowed amounts for HIX plans were generally lower than commercial group rates and higher than Medicare Advantage rates. Better information on HIX pricing is needed as the federal government and states consider additional ways to expand health care coverage, such as public options or expanded Medicaid or Medicare eligibility.


Assuntos
Seguradoras , Medicare Part C , Idoso , Custos e Análise de Custo , Estudos Transversais , Hospitais , Humanos , Estados Unidos
13.
J Health Econ ; 85: 102663, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35944308

RESUMO

In this paper, I study tiered cost sharing, an innovative incentive structure designed to steer patients toward low-cost providers using large out-of-pocket price differentials. Using administrative data from New Hampshire, where two large insurers utilize tiered pricing programs, I estimate the effects of tiering on choices and spending for common gastrointestinal endoscopic procedures. I first conduct a difference-in-differences analysis using the rollout of one insurer's tiered option. I then develop and estimate a demand model to explicitly compare the tiered design with other common plans. Both the reduced form and structural models imply that the tiered plans are associated with 4.5%-6.3% less in mean per-episode spending than high-deductible and coinsurance-based plans, and do not affect the likelihood of seeking care. I find evidence that the savings is in part due to a salience or "simple pricing" effect whereby patients respond to tiered out-of-pocket prices but not to traditional deductibles or coinsurance rates.


Assuntos
Custo Compartilhado de Seguro , Dedutíveis e Cosseguros , Atenção à Saúde , Gastos em Saúde , Humanos , Seguradoras , Estados Unidos
14.
JAMA Health Forum ; 3(2): e215104, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35977281

RESUMO

Importance: Use of hospice has been demonstrated to be cost saving to the Medicare program and yet the extent to which hospice saves money across all payers, including whether it shifts costs to families, is unknown. Objective: To estimate the association between hospice use and total health care costs including family out-of-pocket health care spending. Design Setting and Participants: This retrospective cohort study of health care spending in the last 6 months of life used data from the nationally representative Medicare Current Beneficiary Survey (MCBS) between the years 2002 and 2018. Participants were MCBS participants who resided in the community and died between 2002 and 2018. Exposures: Covariate balancing propensity scores were used to compare participants who used hospice (n = 2113) and those who did not (n = 3351), stratified by duration of hospice use. Main Outcomes and Measures: Total health care expenditures were measured across payers (family out-of-pocket, Medicare, Medicare Advantage, Medicaid, private insurance, private health maintenance organizations, Veteran's Administration, and other) and by expenditure type (inpatient care, outpatient care, medical visits, skilled nursing, home health, hospice, durable medical equipment, and prescription drugs). Results: The study population included 5464 decedents (mean age 78.7 years; 48% female) and 38% enrolled with hospice. Total health care expenditures were lower for those who used hospice compared with propensity score weighted non-hospice control participants for the last 3 days of life ($2813 lower; 95% CI, $2396-$3230); last week of life ($6806 lower; 95% CI, $6261-$7350); last 2 weeks of life ($8785 lower; 95% CI, $7971-$9600); last month of life ($11 747 lower; 95% CI, $10 072-$13 422); and last 3 months of life ($10 908 lower; 95% CI, $7283-$14 533). Family out-of-pocket expenditures were lower for hospice enrollees in the last 3 days of life ($71; 95% CI, $43-$100); last week of life ($216; 95% CI, $175-$256); last 2 weeks of life ($265; 95% CI, $149-$382); and last month of life ($670; 95% CI, $530-$811) compared with those who did not use hospice. Health care savings were associated with reductions in inpatient care. Conclusions and Relevance: In this population-based cohort study of community-dwelling Medicare beneficiaries, hospice enrollment was associated with lower total health care costs for the last 3 days to 3 months of life. Importantly, we found no evidence of cost shifting from Medicare to families related to hospice enrollment. The magnitude of lower out-of-pocket spending to families who enrolled with hospice is meaningful to many Americans, particularly those with lower socioeconomic status.


Assuntos
Seguradoras , Medicare , Idoso , Estudos de Coortes , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Estudos Retrospectivos , Estados Unidos
15.
Artigo em Inglês | MEDLINE | ID: mdl-35955035

RESUMO

Housing is a critical enabler of a dignified life, civic participation and the achievement of human rights. Providing appropriate housing for people who experience neurotrauma as a result of road or workplace injury, with both the assistive technology and human support required, continues however to be a policy and practice challenge. Australian and New Zealand motor accident, disability and injury insurers have high and enduring liability in this area, and their under-researched perspectives are needed to strengthen the evidence base for policy and practice development. This qualitative study utilised focus group methodology with representatives from government injury and disability insurers across Australia and New Zealand (n = 8). The study aimed to identify (a) issues and trends; (b) factors for decision making; and (c) service impacts relating to housing and support for people with disability and high daily support needs. Thematic analysis generated results across four key areas: influences on the decision to fund housing and/or support; identifying 'good' housing solutions; evaluating cost-benefit of housing and support investments; and developing future investment in housing and support. Findings such as those regarding decision-making, and investment, attest to the value of capturing the perspectives of this key group of stakeholders to assist to envision better housing and support for people with disability.


Assuntos
Pessoas com Deficiência , Habitação , Acidentes , Austrália , Humanos , Seguradoras , Nova Zelândia
16.
Urology ; 168: 110-115, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35798183

RESUMO

OBJECTIVE: To understand the growing role of advanced practice providers (APPs) in urologic care, we investigated urology procedural claims submitted to public and private health insurers. METHODS: We used Medicare summary and commercial health insurance claims from 2010 to 2020 to calculate the number and proportion of common urologic procedures performed by APPs. To characterize broader trends across urology, we categorized the urologic procedures into five groups: cancer procedures, cystoscopy procedures, imaging procedures, urgent procedures, and voiding dysfunction. RESULTS: APPs submitted an increasing proportion of Medicare and commercial urology procedural claims between 2010 and 2020 (2% and 1% more claims, respectively), including several procedure groups: voiding dysfunction (12% and 4%), urgent procedures (8% and 5%), cancer procedures (3% and 2%), and cystoscopy procedures (1% and 1%). APPs consistently submitted a larger proportion of claims to Medicare than private insurers and, as of 2019, voiding dysfunction and cancer procedures were the most common urologic procedures performed by APPs in the Medicare data (82,749 and 73,837 procedures, respectively). In 2020, procedures with the greatest proportion of Medicare and commercial claims submitted by APPs included percutaneous tibial nerve stimulation (24% and 10% of claims, respectively), bladder installations (16% and 8%), neurostimulator programming (14% and 7%), and complicated Foley catheter placement (12% and 7%). CONCLUSION: APPs account for a growing proportion of urology procedural claims submitted to public and private health insurers. Stakeholders need to be aware of these changes in the urologic workforce to maintain the standard of care across urology.


Assuntos
Neoplasias , Urologia , Idoso , Humanos , Estados Unidos , Seguradoras , Medicare , Atenção à Saúde
17.
Am J Manag Care ; 28(7): e255-e262, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35852888

RESUMO

OBJECTIVES: To examine the use of step therapy, prior authorization, and Part D formulary exclusion by 4 large Medicare Advantage (MA) insurers to manage 20 physician-administered drugs with the highest total Medicare expenditures (top 20 drugs). STUDY DESIGN: We collected data for United Healthcare, CVS/Aetna, Humana, and Kaiser plans to create a database of 2020 Part B coverage restrictions and conducted a retrospective analysis of 2018-2020 Part D formularies. METHODS: For each insurer, we calculated the number of top 20 physician-administered drugs subject to prior authorization and step therapy. For physician-administered drugs for which there were no similar or interchangeable alternatives, we examined which insurers required prior authorization or step therapy. Finally, we examined whether insurers restricted access to physician-administered drugs by reducing coverage on Part D formularies. RESULTS: Of the top 20 physician-administered drugs, 17 were subject to prior authorization and 10 were subject to step therapy by at least 1 insurer. For 5 physician-administered drugs without a similar or interchangeable alternative, none were subject to step therapy and all were subject to prior authorization by at least 1 insurer. Across the 4 insurers, 16 physician-administered drugs were covered on all or some of the Part D formularies in 2018, which decreased to 6 in 2020. CONCLUSIONS: Four large MA insurers managed access to expensive physician-administered drugs with a combination of prior authorization, step therapy, and Part D formulary design. When a low-cost alternative exists, these tools can help reduce wasteful spending, but the administrative barriers may also reduce access.


Assuntos
Medicare Part C , Medicare Part D , Médicos , Idoso , Humanos , Seguradoras , Autorização Prévia , Estudos Retrospectivos , Estados Unidos
18.
Artigo em Inglês | MEDLINE | ID: mdl-35805557

RESUMO

Artificial intelligence (AI) and machine learning (ML) in healthcare are approaches to make people's lives easier by anticipating and diagnosing diseases more swiftly than most medical experts. There is a direct link between the insurer and the policyholder when the distance between an insurance business and the consumer is reduced to zero with the use of technology, especially digital health insurance. In comparison with traditional insurance, AI and machine learning have altered the way insurers create health insurance policies and helped consumers receive services faster. Insurance businesses use ML to provide clients with accurate, quick, and efficient health insurance coverage. This research trained and evaluated an artificial intelligence network-based regression-based model to predict health insurance premiums. The authors predicted the health insurance cost incurred by individuals on the basis of their features. On the basis of various parameters, such as age, gender, body mass index, number of children, smoking habits, and geolocation, an artificial neural network model was trained and evaluated. The experimental results displayed an accuracy of 92.72%, and the authors analyzed the model's performance using key performance metrics.


Assuntos
Inteligência Artificial , Seguradoras , Criança , Humanos , Seguro Saúde , Aprendizado de Máquina , Redes Neurais de Computação
19.
Rev Med Suisse ; 18(788): 1295-1299, 2022 Jun 29.
Artigo em Francês | MEDLINE | ID: mdl-35770431

RESUMO

Return to work is at the crossroads of complex medical, legal, economic and social concepts and involves a multitude of stakeholders who are often far removed from the reality of care in the medical practice. This article presents some basic concepts on return to work and explores some good practice guidelines. It also describes the role and limits of the occupational physician in the company and mentions possible areas of collaboration with social insurers and employers. It aims to provide concrete elements for the practice of the primary care physician.


Le retour au travail est au croisement de notions médicales, juridiques, économiques et sociales complexes et implique une multitude de parties prenantes qui restent souvent éloignées de la réalité de la prise en charge au cabinet médical. Cet article présente quelques notions de base sur le retour au travail et explore certaines orientations de bonnes pratiques. Il décrit également le rôle et les limites du médecin du travail en entreprise et mentionne les champs de collaboration possible avec les assureurs sociaux et les employeurs. Il vise à fournir des éléments concrets pour la pratique du médecin de premier recours.


Assuntos
Médicos de Atenção Primária , Retorno ao Trabalho , Humanos , Seguradoras
20.
Med Care Res Rev ; 79(6): 819-833, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35677989

RESUMO

Existing risk-equalization models in individual health insurance markets with premium-rate restrictions do not completely compensate insurers for predictable profits/losses, confronting insurers with risk selection incentives. To guide further improvement of risk-equalization models, it is important to obtain insight into the drivers of remaining predictable profits/losses. This article studies a specific potential driver: end-of-life spending (defined here as spending in the last 1-5 years of life). Using administrative (N = 16.9 m) and health survey (N = 384 k) data from the Netherlands, we examine the extent to which end-of-life spending contributes to predictable profits/losses for selective groups. We do so by simulating the predictable profits/losses for these groups with and without end-of-life spending while correcting for the overall spending difference between these two situations. Our main finding is that-even under a sophisticated risk-equalization model-end-of-life spending can contribute to predictable losses for specific chronic conditions.


Assuntos
Motivação , Risco Ajustado , Humanos , Seguro Saúde , Seguradoras , Morte , Gastos em Saúde
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...