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Businesses in high-risk environments have been reluctant to adopt modern machine learning approaches due to their complex and uninterpretable nature. Most current solutions provide local, instance-level explanations, but this is insufficient for understanding the model as a whole. In this work, we show that strategy clusters (i.e., groups of data instances that are treated distinctly by the model) can be used to understand the global behavior of a complex ML model. To support effective exploration and understanding of these clusters, we introduce StrategyAtlas, a system designed to analyze and explain model strategies. Furthermore, it supports multiple ways to utilize these strategies for simplifying and improving the reference model. In collaboration with a large insurance company, we present a use case in automatic insurance acceptance, and show how professional data scientists were enabled to understand a complex model and improve the production model based on these insights.

The objective of this study was to evaluate indicators of diabetes quality of care for US nonelderly, adult Medicaid enrollees with type 2 diabetes and compare federally qualified health centers (FQHCs) versus non-FQHCs.We analyzed diabetes process measures and acute health services utilization with 2012 US fee-for-service and managed care Medicaid claims in all 50 states and DC. We compared FQHC (N=121,977) to non-FQHC patients (N=700,401) using propensity scores to balance covariates and generalized estimating equation models.Overall, laboratory-based process measures occurred more frequently (range, 65.7%-76.6%) than measures requiring specialty referrals (retinal examinations, 33.3%; diabetes education, 3.4%). Compared with non-FQHC patients, FQHC patients had about 3 percentage point lower rates of each process measure, except for higher rates of diabetes education [relative risk=1.09, 95% confidence interval (CI): 1.03-1.16]. FQHC patients had fewer overall [incident rate ratio (IRR)=0.87, 95% CI: 0.86-0.88] and diabetes-related hospitalizations (IRR=0.79, 95% CI: 0.77-0.81), but more overall (IRR=1.06, 95% CI: 1.05-1.07) and diabetes-related emergency department visits (IRR=1.10, 95% CI: 1.08-1.13).This national analysis identified opportunities to improve diabetes management among Medicaid enrollees with type 2 diabetes, especially for retinal examinations or diabetes education. Overall, we found slightly lower rates of most diabetes care process measures for FQHC patients versus non-FQHC patients. Despite having higher rates of emergency department visits, FQHC patients were significantly less likely to be hospitalized than non-FQHC patients. These findings emphasize the need to identify innovative, effective approaches to improve diabetes care for Medicaid enrollees, especially in FQHC settings.

ObjectiveTo further elucidate the relationship between low socioeconomic status (SES) and larger, more complex stones requiring staged surgical interventions. Specifically, we aimed to determine if underinsurance (Medicaid, Medicare, and self-pay insurance types) is associated with multiple surgeries within 1 year.MethodsWeperformed a retrospectivelongitudinal analysis of prospectively collected datafrom the California statewide Department of Health Care Access and Information (HCAI) dataset. We includedadult patients who had their first recorded kidney stone encounter between 2009 and 2018 and underwent at least 1 urologic stone procedure. We followed these patients within the dataset for one year after their initial surgeryto assess for factors predicting multiple surgical treatments for stones.ResultsA total of 156,319 adults were included in the study. The proportions of individuals in private insurance, Medicaid, Medicare and self-pay/indigent groups differed by the presence or absence of additional surgeries (64.0%, 13.5%, 19.4%, and 0.1%, vs 70.3%, 10.1%, 16.6%, and 0.1%, respectively). Compared to private insurance, Medicaid (1.46 [1.40-1.53] P < .001) and Medicare (1.15 [1.10-1.20] P < .001) insurance types were associated with significantly greater odds of multiple surgeries, whereas no significant association was seen in the self-pay/indigent insurance type (1.35 [0.83-2.19], P=1.0).ConclusionIn a statewide, California database from 2009 to 2018, underinsured adults had higher odds of undergoing a second procedure for kidney stones within 1 year of initial surgical treatment. This study adds to the expanding body of literature linking suboptimal healthcare access and disparate outcomes for kidney stone patients.

Background/Aim. The Structured Inventory of Malingered Symptomatology (SIMS) is a self-report measure to be used with adults, which may be utilized to assess the potential malingering of psychosis, neurologic impairment, amnesia, low intelligence, or affective disorder. The aim of the study was to examine the discriminant validity of SIMS under conditions of simulating symptoms of neurological and memory disorders, in response to a hypothetical situation, after watching a recording of an actual car accident in which a motorcycle rider sustained head injuries. Methods. The study involved 94 students (35 men and 59 women) from the University of Criminal Investigation and Police Studies in Belgrade and the Faculty of Medicine – Special Education and Rehabilitation in Novi Sad, aged 20–26 [arithmetic mean = 20.69; standard deviation (SD) = 0.80], divided into two groups (n = 47), malingerer and control. The malingerer group was instructed to identify with the motorcycle rider hit by the car and malinger symptoms related to neurological difficulties and amnesia in order to obtain greater reimbursement from the insurance company. The control group had instructions to honestly assess the probability of occurrence of the symptoms. Results. The results of the multivariate one-way analysis of variance suggested that the effect of experimental manipulation was statistically significant [F (88, 5) = 91.21, p < 0.001; η2p = 0.838]. Univariate effects were also statistically significant for all five scales. Participants in the malingerer group scored higher on all five scales than participants in the control group. The magnitudes of the effects support the largest differences between the malingerer and control groups on the scales of Memory Disorders and Neurological Disorders, which was also the basic instruction for simulating symptoms given to the participants in the malingerer group. Conclusion. The obtained results support the discriminant validity of the SIMS questionnaire in the situation of simulating symptoms of neurological disorders and memory disorders. Uvod/Cilj. Strukturisani inventar simuliranih simptoma – Structured Inventory of Malingered Symptomatology (SIMS) je mera samoprocene koja se koristi kod odraslih osoba, a može biti korišćena za procenu potencijalnog razvoja psihoze, neurološkog oštećenja, amnezije, niske inteligencije ili afektivnog poremećaja. Cilj rada bio je da se ispita diskriminativna validnost SIMS-a u uslovima simuliranja simptoma neuroloških oštećenja i poremećaja pamćenja u odgovoru na hipotetičku situaciju, nakon gledanja snimka realne saobraćajne nezgode u kojoj je vozač motocikla zadobio povrede glave. Metode. U istraživanju su učestvovala 94 studenta (35 muškaraca i 59 žena) Kriminalističkopolicijskog univerziteta u Beogradu i Medicinskog fakulteta – smer Specijalna edukacija i rehabilitacija u Novom Sadu, starosti od 20–26 godina [aritmetička sredina = 20.69; standardna devijacija (SD) = 0.80)], koji su bili podeljeni u dve grupe (n = 47), kontrolnu grupu i grupu ispitanika koji su simulirali simptome. Grupa ispitanika koji su simulirali simptome imala je zadatak da se poistoveti sa motociklistom kojeg je udario automobil i da simulira neurološke simptome i amneziju, sa ciljem da dobiju više novca od osiguravajuće kompanije. Kontrolna grupa imala je zadatak da iskreno proceni koji simptomi bi mogli nastati nakon saobraćajne nesreće. Rezultati. Rezultati multivarijatne jednosmerne analize varijanse su pokazali da je efekat eksperimentalne manipulacije bio statistički značajan [F(88, 5) = 91.21, p < 0.001; η2p = 0.838]. Univarijatni efekti su takođe bili statistički značajni za svih pet skala. Ispitanici iz kontrolne grupe postizali su niže skorove na svih pet skala u odnosu na ispitanike iz grupe koja je simulirala simptome. Veličine efekata govore u prilog najvećih razlika između grupe koja je simulirala simptome i kontrolne grupe na skalama Poremećaji pamćenja i Neurološka oštećenja, što je ujedno i bila osnovna instrukcija za simuliranje simptoma kod te grupe ispitanika. Zaključak. Dobijeni rezultati idu u prilog diskriminativne validnosti upitnika SIMS u situaciji simuliranja simptoma neuroloških oštećenja i poremećaja pamćenja.

This study estimates the rural-urban differences in outpatient service utilization and expenditures for depression, anxiety disorder, and substance use disorder, and the evolving mental health provider mix for privately insured US adults aged 18-64 during 2005-2018.We used the IBM MarketScan Commercial Claims and Encounters Database for individuals covered by employer-sponsored health insurance, from 2005 to 2018, with a yearly total number of beneficiaries ranging from 17.5 to 53.1 million. Claims for nonelderly adults with mental health and substance abuse coverage are included. Outcomes include rates of outpatient service utilization for depression, anxiety disorder, and substance use disorder; counts of outpatient visits; expenditure and share of the out-of-pocket cost; and the mental health services provider mix.Rural enrollees were less likely than urban enrollees to use outpatient mental health services for depression by 1.2% (percentage points) in 2005 and 0.6% in 2018. Among those who used outpatient mental health services, rural enrollees had fewer outpatient visits than their urban counterparts (difference: 1.8-2.4 visits for depression, 1.2-1.7 visits for anxiety disorder, and 0.7-2.1 visits for substance use disorder). Rural patients paid less per year for mental health outpatient visits of the 3 conditions but incurred a higher share of out-of-pocket expenses. Rural and urban patients differ in the mix of mental health providers, with rural enrollees relying more on primary care providers than urban enrollees.Rural-urban disparities in access to mental health services persist during 2005-2018 among a population with private insurance.

UDC 330.131.7; JEL Classification: М11 Babailov V.K., Dmytriieva O.I. RISK MANAGEMENT IS THE MANAGEMENT OF LOSSES FROM RISK Currently, the problem of deepening the understanding of risks and especially improving risk management arouse an increasing interest. Quite recently, a significant step in this direction was made – a more important conclusion was drawn about the need to divide risk management into three professionally oriented parts: risk economics, risk engineering and risk administration. That is, the management of economic, engineering and administrative risks must be done separately by relevant specialists. However, the further deepening of the understanding of risks by the authors of this publication led to doubt and the emergence of the question of how legit is using the phrase "risk management" in the literature and especially in the practice of management. The answer to this question, to this component of the general problem, becomes up-to-date and relevant. The analysis of the latest research and publications shows that all authors without any doubt consider the existence of risk management itself. And therefore the question (or risk management, or risk losses) is not even asked by them at all. On the contrary, according to the authors of this publication, risk management does not exist in any form, but there is only loss management under risk conditions. The purpose of the article was to prove or disprove this hypothesis. The following important fact was taken into account during the formulation of the tasks: there are no other phrases related to actions with risks, except "risk management" and "loss management under risk conditions" in the practice of modern risk management. This important circumstance was also taken into account: risk management now includes all three of its main forms: choosing a smaller risk from several different ones; use of the risk-free portion at risk; risk insurance (in its various forms). Therefore, taking into account these notes, the following tasks were formulated: to emphasize the true meaning of the concept of "management"; prove that choosing less risk, using the risk-free share of risk and insurance against risk is not risk management; substantiate the conclusion about the absence of risk management and the existence of only management of losses from risk; determine the main results of the conducted research. Research methods: analogy, concepts, review of literary sources, 2С70, AIO. Results: the difference, non-identity of management and management (management is the sum of management and production) was determined; it was established that choosing less risk is not risk management; it was proven that using the risk-free share of risk is not risk management either; it was argued that risk insurance in all its forms is not risk management; it is reasonable that risk management does not exist in any form, but there is only management of losses from risk; the essence of risk management, as the management of losses from risks, and its content, which contains two elements: risk management and risk production, were defined. Scientific novelty: for the first time, the widespread opinion about the existence of the so-called "risk management" and the need to eliminate it from practice was refuted; the meaning of the new term and the concept of "risk-management" was determined, precisely as the management of costs from risks. Practical significance: The obtained results will lead to radical changes in the understanding of the nature of risks, which will contribute to the elimination of unnecessary costs for the erroneous and redundant process of the so-called "risk management" and will lead to a significant increase in the effectiveness of the management of losses from risks., УДК 330.131.7; JEL Classification: М11 Бабайлов В.К., Дмитрієва О.І. РИЗИК-УПРАВЛІННЯ - ЦЕ УПРАВЛІННЯ ВТРАТАМИ ВІД РИЗИКУ В даний час спостерігається значне зростання інтересу до проблеми поглиблення розуміння ризиків і особливе до удосконалення управління ризиками. Зовсім недавно здійснений значний крок у цьому напрямку – зроблений важливіший висновок про необхідність поділення ризик-менеджменту на три професійно орієнтовані частини: ризик-економіку, ризик-інженерію і ризик-адміністрацію. Тобто, управління економічними, інженерними і адміністративними ризиками зобов’язані робити окремо відповідні спеціалісти. Але подальше поглиблення розуміння ризиків авторами даної публікації привело до сумніву і виникненню питання у правомірності використання у літературі і особливе у практиці управління словосполучення «управління ризиками». Відповідь на це питання, на цю складову загальної проблеми стає сучасною і актуальною. Аналіз останніх досліджень і публікацій свідчить про те, що всі автори без усякого сумніву вважають існування саме управління ризиками. Й тому питання (або управління ризиками, або втратами від ризиків) не ставиться ними навіть взагалі. Навпаки, на думку авторів даної публікації, управління ризиками не існує ні в якої формі, але існує тільки управління втратами в умовах ризику. Метою статті й стало доказ або спростування цієї гіпотези. При формуванні задач ураховувався саме такий важливий факт: інших словосполучень, щодо дій з ризиками, крім «управління ризиками» і «управління втратами в умовах ризику» у практики сучасного ризик-менеджменту не існує. Приймалося до уваги й така важлива обставина: під управлінням ризиками зараз розуміються всі три основні його форми: вибір меншого ризику з декількох різних; використання у ризику безризикової частки; страхування від ризику (причому в самих різних його формах). Отже, з урахуванням цих приміток були сформульовані й такі задачі: акцентувати увагу на істинному сенсі поняття «управління»; довести, що вибір меншого ризику, використання безризикової частки ризику і страхування від ризику – це не є управління ризиками; обґрунтувати висновок про відсутність управління ризиками і існування тільки управління втратами від ризиків; визначити основні результати проведеного дослідження. Методики дослідження: аналогія, поняття, огляд літературних джерел, 2С70, ВЄО. Результати: визначене відмінність, нетотожність управління і менеджменту (управління є сума менеджменту і виробництва); встановлене, що вибір меншого ризику – це не є управління ризиками; доведено, що використання безризикової частки ризику – це теж не є управління ризикам; аргументоване, що страхування від ризику у всіх його формах– й це не є управління ризиками; обґрунтоване, що управління ризиками не снує ні в якої формі, а існує тільки управління втратами від ризику; визначені сутність ризик-управління, як управління втратами від ризиків, і його зміст, який містить два елементи: ризик-менеджмент і ризик-виробництво. Наукова новизна: вперше спростована розповсюджена думка про існування так званого «управління ризиками» і необхідність усунення його з практики; визначений сенс нового терміну і поняття «ризик-управління», саме як управління витратами від ризиків. Практична значимість: Отримані результати приведуть до кардинальних змін у розумінні природи ризиків, що сприятиме усуненню зайвих затрат на помилковий і зайвий процес так званого «управління ризиками» і приведе до значного підвищення ефективності управління саме втратами від ризиків.

U ovom radu posebna pozornost se posvećuje razvoju pojma osiguranja i njegovu utjecaju na društvo općenito od daleke povijesti do novijeg doba. Objasnit će se posebno utjecaj na generaciju Z i zastupljenost osiguranja u današnjem društvu. Osiguranje na radu kao jedno od najvažnijih je ujedno i sinonim za sam pojam osiguranja, pored ostalih ni malo manje važnih vrsta osiguranja. Razvojem i ostalih vrsta uvelike se povećala kvaliteta života i zadovoljstvo društva. Spriječili su se neki negativni utjecaji i smanjile stope kriminala i prevara. Poseban naglasak će biti kako društvo doživljava osiguranje. Zbog određenih skandala u prošlosti, slika osiguranja se na neki način podijelila, te danas imamo sukobljena shvaćanja osiguranja. Također, jedan od naglasaka će biti usporedba osiguranja u Republici Hrvatskoj, EU općenito s osiguranjem u Sjedinjenim Američkim Državama. Govorit će se isto tako o izrazito bitnom pojmu za ekonomski svijet, kako je to osiguranje pospješilo ekonomski razvoj u Europskoj Uniji. In this worksheet special attention would be about insurance development and its impact on society through history until today. The main focus will be about generation Z and insurance presence in todays society. Workers compensation as one of the most important types of insurance and also synonym for insurance world will be explained next to other types, but not less important ones. Development of the whole insurance market led us to better life quality as also society living pleasure. Negative influences have been stopped as criminal ratio also. Due to several scandals in the past, insurance picture was little bit ruined and splitted so today we have confronted thoughts of insurance. Also, one of the focuses would be comparassion between Croatian, EU and USA insurance market. Word is gonna be also about economic world and how did it changed due to insurance development.

The adoption of the General Data Protection Regulation (GDPR) has resulted in a significant shift in how the data of European Union citizens is handled. A variety of data sharing challenges in scenarios such as smart cities have arisen, especially when attempting to semantically represent GDPR legal bases, such as consent, contracts and the data types and specific sources related to them. Most of the existing ontologies that model GDPR focus mainly on consent. In order to represent other GDPR bases, such as contracts, multiple ontologies need to be simultaneously reused and combined, which can result in inconsistent and conflicting knowledge representation. To address this challenge, we present the smashHitCore ontology. smashHitCore provides a unified and coherent model for both consent and contracts, as well as the sensor data and data processing associated with them. The ontology was developed in response to real-world sensor data sharing use cases in the insurance and smart city domains. The ontology has been successfully utilised to enable GDPR-complaint data sharing in a connected car for insurance use cases and in a city feedback system as part of a smart city use case.

Algorithmic predictions are used in insurance to assess the risk exposure of potential customers. This article examines the impact of digital tools on the field of motor insurance, where telematics devices produce data about policyholders’ driving styles. The individual’s resulting behavioural score is combined with their actuarial score to determine the price of the policy or additional incentives. Current experimentation is moving in the direction of proactivity: instead of waiting for a claim to arise, insurance companies engage in coaching and other interventions to mitigate risk. The article explores the potential consequences of these practices on the social function of insurance, which makes risks bearable by socialising them over a pool of insured individuals. The introduction of behavioural variables and the corresponding idea of fairness could instead isolate individuals in their exposure to risk and affect their attitude towards future initiatives.

BackgroundDepression is a common neuropsychiatric consequence of stroke, but there is little empiric evidence regarding clinical diagnosis and management of poststroke depression.MethodsRetrospective cohort study among 831 471 privately insured patients with first stroke in the USA from 2003 to 2020. We identified diagnoses of poststroke depression using codes from the International Classification of Diseases. We identified treatment based on prescriptions for antidepressants. We used Cox proportional hazards regression analysis to examine rates of poststroke depression diagnosis by gender, age and race/ethnicity. Among individuals who received a diagnosis of poststroke depression, we estimated treatment rates by gender, race/ethnicity and age using negative binomial regression analysis.ResultsAnnual diagnosis and treatment rates for poststroke depression increased from 2003 to 2020 (both p for trendConclusionsIn this insured population, we identify potential inequities in clinical management of poststroke depression by gender, race/ethnicity and age that may reflect barriers other than access to healthcare.

Applying Value Added Tax (VAT) to financial services is difficult. Several more or less complex methods for handling financial services within a VAT system have been developed, none of them being fully satisfactory. In 2018, Julio López-Laborda and Guillermo Peña have published “A New Method for Applying VAT to Financial Services” in the National Tax Journal (vol. 71 (1), pp. 155–181), called “mobile-ratio method”. This paper examines whether the new method is adequate for insurance services. It reveals that the analogy between insurance services and other financial services, while amazing at first glance, does not reach far enough to make the “mobile-ratio method” practically applicable to insurance services.

Prior research suggests a link between obstructive sleep apnea (OSA) and the likelihood of developing a variety of solid tumors; however, there are no studies assessing OSA and leukemia. This study is the first to identify a potential association between OSA and leukemia using data from the Korea National Health Insurance Service database.A total of 162,646 patients (≥20 years of age and without any cancer history) newly diagnosed with OSA between 2011 and 2017 were included. A control group of 813,230 subjects was selected using propensity score matching based on age and sex. The mean follow-up time was 4.4 ± 2.0 years. The primary endpoint was newly diagnosed leukemia of any type. The leukemia hazard ratio (95% confidence interval [CI]) was calculated for patients with OSA and compared with that of patients in the control group.The incidence of leukemia among patients with OSA was significantly higher than that in the controls (1.35 [1.05-1.74]). The hazard ratio was the highest, 1.74 in those under 40 years, and gradually decreased with age, to 1.38 in those aged 40-65 years and 0.96 in those over 65. In particular, the incidence of lymphoid leukemia (2.06 [1.18-3.60]) was higher than that of myeloid (1.34 [1.00-1.81]) or unspecified leukemia (0.60 [0.20-1.58]).OSA is associated with an increased incidence of leukemia, particularly in patients younger than 40 years of age.

Insurance companies are increasingly making unilateral determinations of admission status for primary total knee arthroplasty (TKA). These determinations may differ from those based on surgeon-derived criteria for outpatient knee replacement. The goal of this study is to determine if insurance company determinations of outpatient status are as reliable as surgeon-derived criteria in predicting outpatient discharge after TKA.We retrospectively reviewed 709 patients who were preoperatively authorized for outpatient TKA. Patients were stratified into 2 groups: "outpatient per surgeon" (appropriate for outpatient surgery per institutional protocols) or "outpatient per insurance" (appropriate for inpatient surgery per institutional protocols but denied inpatient status by insurance). The primary endpoint of this study was the conversion rate of outpatient to inpatient stay. Univariate logistic regression was performed to compare the odds of conversion to inpatient stay between outpatient per surgeon and outpatient per insurance procedures and other covariates.The cohort included 434 outpatient per insurance (61.2%) and 275 outpatient per surgeon (38.8%) patients. Surgeons accurately predicted outpatients' discharge 92.0% of the time, while insurance companies did so 81.3% of time (P.001). Outpatient per insurance procedures (odds ratio [OR] 2.20, P = .003) and body mass index35 kg/mDetermining inpatient versus outpatient status is a complex decision involving both clinical and social factors. Surgeons accurately predicted outpatient discharge 92% of the time. Moreover, outpatient per insurance procedures were twice as likely to be converted to inpatient status. Therefore, insurance companies should leave deciding admission status up to both the patient and surgeon.

To quantify the total hospital costs associated with the treatment of lower extremity long-bone fracture aseptic and septic unhealed fracture, to determine if insurance adequately covers these costs, and to examine whether insurance type correlates with barriers to accessing care.Retrospective cohort study.Academic Level II trauma center.All patients undergoing operative treatment of OTA/AO classification 31, 32, 33, 41, 42, and 43 fractures between 2012 and 2020 at a single Level II trauma center with minimum of 1-year follow-up.The primary outcome was the total cost of treatment for all hospital-based episodes of care. Distance traveled from primary residence was measured as a surrogate for barriers to care.One hundred seventeen patients with uncomplicated fracture healing, 82 with aseptic unhealed fracture, and 44 with septic unhealed fracture were included in the final cohort. The median cost of treatment for treatment of septic unhealed fracture was $148,318 [interquartile range(IQR) 87,241-256,928], $45,230 (IQR 31,510-68,030) for treatment of aseptic unhealed fracture, and $33,991 (IQR 25,609-54,590) for uncomplicated fracture healing. The hospital made a profit on all patients with commercial insurance, but lost money on all patients with public insurance. Among patients with unhealed fracture, those with public insurance traveled 4 times further for their care compared with patients with commercial insurance (P = 0.004).Septic unhealed fracture of lower extremity long-bone fractures is an outsized burden on the health care system. Public insurance for both septic and aseptic unhealed fracture does not cover hospital costs. The increased distances traveled by our Medi-Cal and Medicare population may reflect the economic disincentive for local hospitals to care for publicly insured patients with unhealed fractures.Economic Level V. See Instructions for Authors for a complete description of levels of evidence.

Lumbar disc herniations (LDH) are among the most common spinal conditions. Despite increased appreciation for the importance of social determinants of health, the role that these factors play in patients with lumbar disc herniations is poorly defined.To elucidate the association between insurance status and baseline patient reported outcome measures (PROMs) in the setting of lumbar disc herniations.Retrospective cohort study PATIENT SAMPLE: Baseline patient-reported outcome measures (PROMS) were reviewed from 924 adult patients presenting for treatment of lumbar disc herniation within our institutional healthcare system (2015-2020).The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, PROMIS Global-Physical, and visual analogue scale (VAS) for back and leg pain were assessed.PROMIS scores at presentation were defined at the primary outcome and insurance status as the primary predictor. Differences in clinical and sociodemographic characteristics between our cohorts, stratified by insurance status, were evaluated using Wilcoxon rank-sum or chi-squared testing. We used multivariable negative binomial regression modeling to adjust for potential confounders including age, gender, race, language, ethnicity, comorbidity index, and median geospatial household income.We included 924 patients, with mean age of 58.4 +/- 15.2 years and 52.6% male prevalence. Patients insured through Medicaid were more likely to be Black, Hispanic, and non-English speaking patients compared with the commercially insured. The Charlson Comorbidity index was significantly higher in the Medicare group. Following adjusted analysis, patients with Medicaid insurance had significantly worse PF10a (IRR, 0.90, 95% CI 0.85-0.96), as well as PROMIS Global-Physical score (IRR 0.88, 95% CI 0.82-0.94), and VAS low back pain (IRR 1.20, 95% CI 1.04-1.40) when compared to the commercially insured.We encountered worse physical function, mental, and pain-related patient-reported outcomes for those with Medicaid insurance in a population of patients presenting for evaluation of lumbar disc herniation. These findings, including worse depression, anxiety, and higher axial back pain scores, merit further investigation into potential health system asymmetries, and should be accounted for by treating providers.

Background: Many women with endometriosis experience chronic abdominal pain. Clinical guidelines recommend treatment with analgesics, contraceptive hormones, gonadotropin-releasing hormone analogs,...

Little is known about the clinical care, use of medicines, and risk factors associated with mortality among the population with private health insurance with COVID-19 in South Africa.This was a retrospective cross-sectional study using claims data of patients with confirmed COVID-19. Sociodemographics, comorbidities, severity, concurrent/progressive comorbidity, drug treatment, and outcomes were extracted from administrative data. Univariate and multivariate logistic regression models were used to explore the risk factors associated with in-hospital death.This study included 154,519 patients with COVID-19; only 24% were categorized as severe because they received in-hospital care. Antibiotic (42.8%) and steroid (30%) use was high in this population. After adjusting for known comorbidities, concurrent/progressive diagnosis of the following conditions were associated with higher in-hospital death odds: acute respiratory distress syndrome (aOR = 1.55; 95% CI = 1.44-1.68), septic shock (aOR = 1.55; 95% CI = 2.00-4.12), pneumonia (aOR = 1.35; 95% CI = 1.24-1.47), acute renal failure (aOR = 2.30; 95% CI = 2.09-2.5), and stroke (aOR = 2.09; 95% CI = 1.75-2.49). The use of antivirals (aOR = 0.47; 95% CI= 0.40-0.54), and/or steroids (aOR = 0.46; 95% CI = 0.43-0.50) were associated with decreased death odds. The use of antibiotics in-hospital was not associated with increased survival (aOR = 0.97; 95% CI = 0.91-1.04).Comorbidities remain significant risk factors for death mediated by organ failure. The use of antibiotics did not change the odds of death, suggesting inappropriate use.

A través del presente escrito, se quiere proponer diferentes estrategias en función de los procesos operativos de la empresa específicamente en el área Multiline hogar individual, ya que se evidenciaron algunas falencias como por ejemplo bases de datos incompletas, instructivos pocos eficientes y tiempos de respuesta lentos. Todo esto se llevó a cabo gracias a una evaluación propia en los periodos de trabajo bajo los cuales se diseñaron objetivos a corto y largo plazo ligados a herramientas que permitieran optimizar la creación de informes, bases de datos y estimación de tasas. Gracias a ello se evidencio un mejor funcionamiento en los procesos internos de la empresa, y además de ello un mejor manejo de los tiempos de trabajo en relación con la generación de informes Through this paper, we want to propose different strategies based on the operational processes of the company, specifically in the Multiline individual home area, since some shortcomings were evidenced, such as incomplete databases, inefficient instructions and slow response times. All this was carried out thanks to an own evaluation during the work periods under which short and long term objectives were designed linked to tools that would allow optimizing the creation of reports, databases and estimation of rates. Thanks to this, a better performance in the internal processes of the company was evidenced, and also a better management of work times in relation to the generation of reports. Profesional en Negocios Internacionales Pregrado

The article examines the specifics of the legal regulation of insurance relations in the conditions of martial law and the functioning of the insurance services market under the conditions of force majeure. On the basis of the analysis of scientific literature, regulatory legal acts, norms of current civil legislation and court practice, the peculiarities of providing insurance services under the condition of force majeure in the conditions of martial law were investigated. The destruction of the housing stock and infrastructure, significant damage, which became the inevitable consequences of the war in Ukraine. It was established that the insurance institute is one of the effective mechanisms aimed at providing compensation and compensation for losses to citizens as a result of military operations. Insurance is aimed at protecting the property interests and safety of both individuals and business entities. It is noted that the occurrence of insurance events related to the loss of housing stock and other property by citizens of Ukraine as a result of military operations after February 24, 2022, should not be a reason for refusing to pay insurance compensation. It is proven that the introduction of the legal regime of martial law with the beginning of the war involves the possibility of limiting the constitutional rights and freedoms of a person and a citizen, the rights and legal interests of legal entities. At the same time, the fact of the introduction of martial law should not affect the validity of any transactions, including the validity of insurance contracts, and all rights and obligations of the parties remain valid. Insurance contracts are valid regardless of the introduction of martial law in Ukraine, with standard force majeure clauses that apply to other types of contracts. It is noted that the war in Ukraine belongs to force majeure circumstances (circumstances of irresistible force). It is established that insurance does not constitute any exception in the context of force majeure. It is noted that the parties to the insurance contract may refer to force majeure as a basis for releasing them from liability for non-fulfillment of the terms of the contract. In order to improve insurance activities during the period of martial law, the National Bank, as a regulator in the market of insurance services, on February 27, 2022 recommended to insurers to simplify the procedure for settling cases that have the characteristics of insurance, by making maximum use of electronic documents and copies of necessary documents in case of impossibility or complications the possibility of obtaining their originals, as well as using other means of remote settlement of insurance cases. Based on the results of the research, it is summarized that the market of insurance services in Ukraine during the period of martial law should work taking into account the emergence of new challenges., У статті досліджуються питання особливості правового регулювання страхових відносин в умовах воєнного стану та функціонування ринку страхових послуг за умови дії форс-мажорних обставин. На основі аналізу наукової літератури, нормативно-правових актів, норм чинного цивільного законодавства та судової практики досліджено особливості надання страхових послуг за умови дії форс-мажорних обставин в умовах воєнного стану. Зазначено, що війна проти України, розпочата російською федерацією, значно вплинула як на економіку держави, так і на всі сфери суспільного життя. Руйнування житлового фонду та інфраструктури, нанесені значні збитки, стали невідворотними наслідками війни в Україні. Встановлено, що інститут страхування є одним із дієвих механізмів, що спрямований на забезпечення компенсації та відшкодування збитків громадянам у результаті військових дій. Страхування спрямовано на захист майнових інтересів і безпеку як фізичних осіб, так і суб’єктів господарювання. Зазначено, що настання страхових випадків, пов’язаних із втратою громадянами України житлового фонду та іншого майна у результаті військових дій після 24 лютого 2022 р., не повинно бути підставою для відмови у виплаті страхового відшкодування. Доведено, що запровадження правового режиму воєнного стану з початком війни передбачає можливість обмеження конституційних прав і свобод людини та громадянина, прав і законних інтересів юридичних осіб. Водночас, факт запровадження воєнного стану не має впливати на чинність будь-яких правочинів, у тому числі дії договорів страхування, права та обов’язки сторін, залишаються дійсними. Договори страхування є чинними незалежно від введення в Україні воєнного стану, зі стандартними форс-мажорними застереженнями, які застосовуються і в інших видах договорів. Зазначено, що війна в Україні належить до форс-мажорних обставин (обставин непереборної сили). Встановлено, що страхування не становить жодного винятку в контексті форс-мажорних обставин. Зазначено, що сторони договору страхування можуть посилатися на дію форс-мажорних обставин, як на підставу звільнення їх від відповідальності за невиконання умов договору. З метою вдосконалення страхової діяльності у період воєнного стану, Національний банк, як регулятор на ринку страхових послуг, 27 лютого 2022 року рекомендував страховикам спростити процедуру врегулювання випадків, що мають ознаки страхових, шляхом максимального використання електронних документів і копій необхідних документів у разі неможливості або ускладнення можливості отримання їх оригіналів, а також застосовувати інші засоби дистанційного врегулювання страхових випадків. За результатами дослідження резюмовано, що ринок страхових послуг в Україні у період воєнного стану має працювати з урахуванням виникнення нових викликів.

At last, chronic pain, with its consequences and impact for patients and society, is now considered as a disease in its own in the 11th revision of the international classification of diseases (ICD). We present here in the light of two clinical cases, why the diagnosis of chronic primary pain is useful and how to utilize these new codes. We hope to rapidly see the awaited impact on the healthcare system (from the patient care to insurance issues), as on research and teaching.

This paper analyses the project of the private insurance sector to assume the role of protagonist in guaranteeing social protection and investigates its consequences for the management of inequalities. In Brazil, as in other countries, austerity policies have been implemented causing significant impacts on social insurance and benefits reduction. Based on multisite ethnographic research (2017--2019), developed with insurance market agents, this article analyses the processes of financialisation of social protection and popularisation of private insurance in contemporary Brazil., Este artigo analisa o projeto do setor segurador privado para assumir um papel de maior protagonismo na garantia de proteção social e reflete sobre as suas consequências na administração das desigualdades. No Brasil, assim como noutros países, políticas de austeridade têm sido implementadas ocasionando impactos significativos na redução de seguros e benefícios sociais. Baseado em pesquisa etnográfica multisituada (2017-2019), desenvolvida com agentes do mercado segurador, o presente artigo analisa os processos de financeirização da proteção social e de popularização dos seguros privados no Brasil contemporâneo.

The undertaken study aims to examine the reasons for the delay in implementing financial technologies in both the conventional and participatory insurance sectors in Morocco while providing recommendations to overcome these obstacles. To achieve these objectives, a qualitative research approach was adopted, involving industry professionals to obtain detailed responses using semi-structured interview methods. This method facilitated a comprehensive analysis of our research problem. The obtained results revealed the existence of several difficulties and barriers hindering the implementation of financial technologies in the insurance sector in Morocco. These obstacles include resistance to change within companies, regulatory constraints, concerns about data security, and the need to train employees in new technologies. All these factors have contributed to the delayed adoption of financial technologies in the Moroccan insurance sector. However, the study does not merely highlight the obstacles; it also proposes recommendations to overcome them. Among these recommendations are raising awareness and providing training to stakeholders about the benefits of financial technologies, establishing a regulatory framework conducive to innovation, strengthening cybersecurity measures, and fostering collaboration among sector actors to promote the adoption of financial technologies. This study holds particular significance in the current context characterized by multiple crises and a focus on digital transformation. Indeed, it represents the first attempt to explore and analyze the specific challenges of implementing financial technologies in the insurance sector in Morocco while offering tailored solutions for industry professionals. By shedding light on these challenges and providing practical recommendations, this study contributes to stimulating the development of the Moroccan insurance sector in the era of digital transformation. Keywords: Financial technology, insurance, takaful, Insurtech JEL Classification: G22 Paper type: Empirical research, L'étude entreprise vise à examiner les raisons du retard de l'implémentation des technologies financières dans le secteur assurantiel conventionnel et participatif au Maroc, tout en proposant des recommandations pour surmonter ces obstacles. Afin d'atteindre ces objectifs, une approche de recherche qualitative a été adoptée, faisant appel aux professionnels de l'industrie pour obtenir des réponses détaillées à l'aide de la méthode des entretiens semi-directifs. Cette méthode a permis de fournir une analyse approfondie de notre problématique. Les résultats obtenus ont révélé l'existence de plusieurs difficultés et barrières entravant l'implémentation des technologies financières dans le secteur assurantiel au Maroc. Parmi ces obstacles, on peut citer la résistance au changement au sein des entreprises, les contraintes réglementaires, les préoccupations en matière de sécurité des données et la nécessité de former les employés aux nouvelles technologies. Ces facteurs ont tous contribué à retarder l'adoption des technologies financières dans le secteur assurantiel marocain. Toutefois, l'étude ne se contente pas de mettre en évidence les obstacles, elle propose également des recommandations pour les surmonter. Parmi ces recommandations, on peut citer la sensibilisation et la formation des parties prenantes aux avantages des technologies financières, la mise en place d'un cadre réglementaire favorable à l'innovation, le renforcement de la cybersécurité et la collaboration entre les acteurs du secteur pour favoriser l'adoption des technologies financières. Cette étude revêt une importance particulière dans le contexte actuel marqué par une accumulation de crises et une orientation vers la transformation numérique. En effet, elle représente la première tentative de découvrir et d'analyser les difficultés spécifiques à l'implémentation des technologies financières dans le secteur assurantiel au Maroc, tout en proposant des solutions adaptées aux professionnels du secteur. En mettant en lumière ces défis et en offrant des recommandations pratiques, cette étude contribue à stimuler le développement du secteur assurantiel marocain dans l'ère de la transformation digitale. Mots clés : Technologie financière, assurance, Takaful, Assurtech Classification JEL : G22 Type de l’article: Recherche empirique

Resumo O artigo analisa as disputas entre elites para expansão de mercados ligados aos veículos rumo a setores populares. Tomamos dois casos como entrada empírica: o setor de leilões de carros usados, que opõe elite tradicional e elites financeiras globais; e as disputas entre seguradoras tradicionais e elites emergentes ligadas às associações de proteção veicular. Argumentamos que a recorrência do uso do termo confiança nesses conflitos evidencia a centralidade do crime, como fato ou ameaça, para a construção e funcionamento de mercados legais de veículos e produtos a eles ligados. O artigo é baseado em entrevistas e na observação participante em eventos; conferências e entrevistas disponíveis na internet; materiais secundários produzidos pelos atores engajados nas disputas; e projetos de lei e legislações. Abstract The article analyzes the disputes between elites for the expansion of markets linked to vehicles towards low income sectors. We take two cases as empirical input: the used car auction sector, which opposes traditional elites and global financial elites; and disputes between traditional insurers and emerging elites linked to vehicle protection associations. We argue that the centrality of trust in these conflicts highlights that crime, as a fact or threat, is central to the construction and functioning of vehicle legal markets and related products. The article is based on conferences, testimonies and interviews available on the internet, materials produced by actors engaged in disputes and draft laws and legislation.

In this paper, we analyse 1. how care and control are at stake in emerging data-driven insurance technologies and 2. how ‘digital trust’ becomes a key for insurers in solving frictions between careful control and controlling care elements. Data-driven technologies are supposed to disrupt insurance by enabling new ways to calculate, price and manage risks. The implementation of these technologies is controversial, with fears of increased surveillance, control and exclusion from coverage. However, they are not yet established as a common practice. Besides technological development, the realization of data-driven insurance depends on relational aspects, such as trust. Trust has for long been a key concern in the insurance business. Lately, insurers have paid heightened attention to it in the digital context. Algorithmic technologies based on increased monitoring of digital traces can help insurers control and trust their customers. However, they might not be useful and caring enough to engender trust among policyholders. In this paper, we show the frictions between insurers’ will to collect new data and their need to ensure trust among customers. The emergence of data-driven insurance technologies will potentially reconfigure the trust relations, with insurers employing the notion of ‘digital trust’ to solve the frictions. Hence, the developing of Insurtech serves as a lens to analyse how algorithmic technologies affect values in established institutions like insurance. The paper is based on empirical fieldwork conducted among insurance providers in Finland, Belgium and the Netherlands. Furthermore, we analyse reinsurance companies’ reports on digitalization and ‘digital trust’.

In this paper, we analyse 1. how care and control are at stake in emerging data-driven insurance technologies and 2. how ‘digital trust’ becomes a key for insurers in solving frictions between careful control and controlling care elements. Data-driven technologies are supposed to disrupt insurance by enabling new ways to calculate, price and manage risks. The implementation of these technologies is controversial, with fears of increased surveillance, control and exclusion from coverage. However, they are not yet established as a common practice. Besides technological development, the realization of data-driven insurance depends on relational aspects, such as trust. Trust has for long been a key concern in the insurance business. Lately, insurers have paid heightened attention to it in the digital context. Algorithmic technologies based on increased monitoring of digital traces can help insurers control and trust their customers. However, they might not be useful and caring enough to engender trust among policyholders. In this paper, we show the frictions between insurers’ will to collect new data and their need to ensure trust among customers. The emergence of data-driven insurance technologies will potentially reconfigure the trust relations, with insurers employing the notion of ‘digital trust’ to solve the frictions. Hence, the developing of Insurtech serves as a lens to analyse how algorithmic technologies affect values in established institutions like insurance. The paper is based on empirical fieldwork conducted among insurance providers in Finland, Belgium and the Netherlands. Furthermore, we analyse reinsurance companies’ reports on digitalization and ‘digital trust’.

In this paper, we analyse 1. how care and control are at stake in emerging data-driven insurance technologies and 2. how ‘digital trust’ becomes a key for insurers in solving frictions between careful control and controlling care elements. Data-driven technologies are supposed to disrupt insurance by enabling new ways to calculate, price and manage risks. The implementation of these technologies is controversial, with fears of increased surveillance, control and exclusion from coverage. However, they are not yet established as a common practice. Besides technological development, the realization of data-driven insurance depends on relational aspects, such as trust.Trust has for long been a key concern in the insurance business. Lately, insurers have paid heightened attention to it in the digital context. Algorithmic technologies based on increased monitoring of digital traces can help insurers control and trust their customers. However, they might not be useful and caring enough to engender trust among policyholders. In this paper, we show the frictions between insurers’ will to collect new data and their need to ensure trust among customers. The emergence of data-driven insurance technologies will potentially reconfigure the trust relations, with insurers employing the notion of ‘digital trust’ to solve the frictions. Hence, the developing of Insurtech serves as a lens to analyse how algorithmic technologies affect values in established institutions like insurance. The paper is based on empirical fieldwork conducted among insurance providers in Finland, Belgium and the Netherlands. Furthermore, we analyse reinsurance companies’ reports on digitalization and ‘digital trust’.

Climate change is a significant threat, and insurance can provide a significant impulse to provide systemic responses. While several normative frameworks for sustainable business models have been developed, it is still unclear what customers expect and how companies should actually act in their specific business environments. We investigated customer expectations in the context of Swiss retail insurance and found that less than a fifth of customers consider sustainability a very important factor in their next purchase decision, and that core customers in the 35–54 age range are comparatively less concerned about sustainability in general. Customers place most value on social rather than environmental issues. Insurers should improve their efforts in the core business, especially regarding sustainable claims handling, rather than regarding investment management or their own footprint. On the other hand, more than 40% of customers do not feel they know enough to have an opinion about their insurer’s efforts toward sustainability, and there were no significant differences in customer perceptions among the different insurers. These results should have profound implications for communication, business model development, and business transformation efforts for insurers. They also provide important missing detail about customer expectations regarding sustainability in the academic literature.

Upper respiratory tract (URT) disorders are common in dogs but neither general nor breed-related epidemiological data are widely reported. This study´s aims were to describe the epidemiology of URT disorders in a Swedish population of dogs and to investigate whether brachycephalic breeds were overrepresented among high-risk breeds. A cohort of dogs insured by Agria Djurförsäkring in Sweden (2011-2014) was used to calculate overall and breed-specific incidence rate (IR), age at first URT diagnosis and relative risk (RR) for URT disorders. For breeds with high RR for URT disorders, co-morbidities throughout the dog's insurance period and age at death were investigated. The cohort included approximately 450,000 dogs. URT disorders had an overall IR of 50.56 (95% CI; 49.14-52.01) per 10,000 dog years at risk. Among 327 breeds, the English bulldog, Japanese chin, Pomeranian, Norwich terrier and pug had highest RR of URT disorders. Eight of 13 breeds with high RR for URT disorders were brachycephalic. The median age at first URT diagnosis was 6.00 years (interquartile range 2.59-9.78). French bulldogs with URT diagnoses had a significantly shorter life span (median = 3.61 years) than other breeds with URT diagnosis (median = 7.81 years). Dogs with high risk for URT disorders had more co-morbidities than average.

— It is a significant difficulty for the insurance industry to charge each customer a premium that is reasonable for the risk that they represent. The insurer's management results and financial statements are significantly obstructed by how accurately the claim amount is projected. Estimating the cost of claims in an insurance company is a real problem that needs a more precise and automated solution. A lot of factors influence the cost of claims based on health characteristics such as age, sex, weight, BMI, hereditary disorders, the number of dependents, blood pressure, smokers, region, regular exercise, and others. The cost of health insurance is analyzed and projected by insurance companies using a variety of techniques. This study demonstrates the ability of various models to predict insurance premiums.

— It is a significant difficulty for the insurance industry to charge each customer a premium that is reasonable for the risk that they represent. The insurer's management results and financial statements are significantly obstructed by how accurately the claim amount is projected. Estimating the cost of claims in an insurance company is a real problem that needs a more precise and automated solution. A lot of factors influence the cost of claims based on health characteristics such as age, sex, weight, BMI, hereditary disorders, the number of dependents, blood pressure, smokers, region, regular exercise, and others. The cost of health insurance is analyzed and projected by insurance companies using a variety of techniques. This study demonstrates the ability of various models to predict insurance premiums.

The insurance industry is an integral part of any modern economy, providing individuals and businesses with protection against a wide range of risks. However, the success of the industry depends largely on consumer perception towards insurance schemes. Consumer perception towards insurance schemes can have a significant impact on the demand for insurance products, the competitiveness of the insurance market, and the overall profitability of insurance companies., https://vixra.org/abs/2305.0110, {"references":["Bajari, P., Hong, H., & Krainer, J. (2015). Estimating dynamic models of consumer choice using maximum likelihood and the simulation method. Journal of Business & Economic Statistics, 33(4), 545-561","Carson, R. T., Hanemann, W. M., Kopp, R. J., Krosnick, J. A., Mitchell, R. C., Presser, S., ... & Conaway, M. (2017). American statistical association statement on statistical significance and p-values. The American Statistician, 71(1), 129-133","Chen, H., & Chen, M. (2019). Factors affecting consumer attitudes towards insurance products in Taiwan. International Journal of Economics, Commerce and Management, 7(8), 46-58","Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155-159","Doherty, N. A., & Singer, M. (2018). Risk and insurance. John Wiley & Sons","Hair Jr, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2019). Multivariate data analysis (8th ed.). Cengage Learning","Kahneman, D., & Tversky, A. (1979). Prospect theory: An analysis of decision under risk. Econometrica: Journal of the Econometric Society, 47(2), 263-291","Kleijnen, J. P. C., & van der Heijden, M. C. (2018). Business analytics in the context of big data: A roadmap for research. European Journal of Operational Research, 269(2), 786-800","Lam, D. Y., Wong, T. K., & Lee, H. W. (2017). Insurance coverage in developing economies: An exploratory study in the Philippines. Journal of Asia-Pacific Business, 18(4), 340-359","Luce, M. F. (1998). Choosing to avoid: Coping with negatively emotion-laden consumer decisions. Journal of Consumer Research, 24(4), 409-433","Pandey, A. (2021). Insurance sector in India: An overview. Retrieved from https://www.ibef.org/industry/insurance-sector-india.aspx","PwC. (2019). Insurance banana skins. Retrieved from https://www.pwc.com/gx/en/insurance/publications/assets/pwc-insurance-bana na-skins-2019.pdf","Rabin, M. (2002). Inference by believers in the law of small numbers. The Quarterly Journal of Economics, 117(3), 775-816","Rogers, R. W. (1975). A protection motivation theory of fear appeals and attitude change. The Journal of Psychology, 91(1), 93-114","Verhoef, P. C., Kannan, P. K., & Inman, J. J. (2015). From multi-channel retailing to omni-channel retailing: Introduction to the special issue on multi-channel retailing. Journal of Retailing, 91(2), 174-181","Sharma, Ram. (2022). Comparative Longitudinal Analysis on Global Inflation with a special emphasis on Indian Economy. A Flourishing Digital Era: Innovations in Industry, Education, Management and Society, 1(1), 903. https://doi.org/10.5281/zenodo.7939068"]}

My technical work and my STS research are connected primarily through the idea of insulin costs and exploring the efforts made toward providing insulin at an affordable price. My technical work focuses on the design of insulin, prioritizing keeping costs as low as possible while creating a safe and effective drug. My research explores the obstacles that exist that prevent insulin prices from being affordable, specifically focusing on the Affordable Insulin Now Act and its failure to provide affordable insulin for the uninsured. While my technical work and my STS research approach insulin costs from different angles, the theme of obtainable affordable insulin is consistent across both projects. My technical work explores the design of an affordable insulin glargine product. Insulin glargine is a slow-releasing and long-acting insulin product that benefits those who have to take insulin every day by easing the application and use of the drug. Our capstone team designed an insulin manufacturing plant located in Singapore to service the developing and developed nations in the surrounding areas of Asia. The goal of our project was to design a plant that would minimize the costs of insulin while remaining profitable. Ultimately, we were able to produce insulin that sells to the consumer for $0.0075/unit. Thus, our product will cost someone who weighs 75kg $43.88/month, a much less expensive price for patients when compared to our competitors. While we were able to keep costs low for patients, our yearly revenue of about $4.8 billion with an internal return rate of 242% renders our plant economically viable. Producing 764 batches per year allows us to service 4% of the target market, or 9 million people. Through our research, we were able to prove that it is possible to create an affordable insulin product while remaining profitable. My STS research also explores insulin costs but from a different angle. My research focuses on the relationships between insulin prices, manufacturer control, and government policy. Specifically, my research paper focuses on the failures of The Affordable Insulin Now Act. The failure in the creation of this policy yields many consequences: enrollees of Medicare Part D will have a $2,000 out-of-pocket cost for prescription drugs beginning in 2025, uninsured diabetics see no change in insulin prices, and there is no limit to the price that insulin manufacturers can charge. I claim that The Affordable Insulin Now Act failed to be inclusive due to pressure from large manufacturers to retain their monopoly and the United States government’s negligence concerning rising insulin prices and high out-of-pocket costs for many diabetic Americans. My paper explores this claim and discusses how influential each of these factors is. My research aims to stimulate a conversation around insulin prices and convince readers that it is possible to obtain affordable insulin prices for all people. Working on these two projects simultaneously greatly added value to both. My technical work gave me a better understanding of the possibility of producing affordable insulin, which helped me provide context for my paper and offer insight into manufacturers’ influence over insulin prices. My research paper helped me understand that, while manufacturers have a large say in the cost of insulin, policymakers also can pass laws that make insulin prices more affordable. Working on both projects together has allowed me to explore insulin prices from multiple angles and each work contributed to improving the quality of the other. Additionally, researching insulin prices from multiple angles made me more passionate about the discrepancy in accessibility to life-saving products for those above and below the poverty line.

Purpose: The purpose of this study is to examine the differences in leadership styles prevalent in the public sector with those working in the banking and insurance industries. Cluster variables from both industries included in the analysis are as follows: Idealized influence, inspiring motivation, intellectual stimulation, and individualized consideration are all components of leadership. Theoretical Framework: Due to its apparent efficacy, transformational leadership has received a lot of attention from public sector researchers over the past decade. Successful leaders alter their teams by enlisting their followers' help in effecting change. A transformational leader is one who "transforms" their followers by inspiring them to make positive personal and professional shifts. Design / Methodology / Approach:The study is exploratory research design using Quantitative data collected from the Banking and Insurance sector employees. The study uses a well-structured questionnaire using Likert scale items. The sample was chosen on Convenience basis from 5 select public sector Insurance companies and 5 select public sector Insurance companies. 100 Questionnaires each were distributed and 97 valid responses were selected for banking industry and 90 responses from Insurance Industry were selected for the study. Paired t test using SPSS software was utilised for analysing the data in the study. Findings:The findings of the study show that there is significant difference between the leadership styles practices in Banking and Insurance industry. The banking sector employees showed a greater inclination towards transformational leadership with higher mean scores and statistically significant outcomes. Research Implications: Banking and insurance each have their own distinct cultures and management philosophies; as a result, they cannot be studied as a single entity under the umbrella of the BFSI sector. Additional research on the various leadership styles currently in use within the banking and insurance sectors is necessary. Originality/Value: There are no studies related comparative analysis between Insurance and Banking industry on the leadership styles in Public sector.

In pediatric patients with neurogenic bladder (NGB), urinary tract evaluation, early diagnosis, and individualized management are important. We aimed to clarify the current status of diagnosis and treatment of NGB in Japanese children. This descriptive, observational, retrospective cohort study using the JMDC claims database included NGB patients aged ≤17 years over a 12-month follow-up period. Of the 1065 pediatric NGB patients, 38.9% had spina bifida. Dermatological and gastrointestinal comorbidities were common in the baseline period. Renal/bladder ultrasound was a commonly performed investigation (38.3%), but urodynamics was infrequently used (3.0%). Of all the overactive bladder medications, anticholinergics were used commonly (17.9% patients), and most patients used anticholinergics alone (without combination therapy). Clean intermittent catheterization (CIC; alone or in combination with medications) was performed in 9.3% of patients, and 3.9% of patients were concomitantly treated with medications. The most common incident complication was lower urinary tract infection (18.1%), which was especially common in patients with open spina bifida (54.1%). Despite guideline recommendations, lower urinary tract dysfunction is not thoroughly evaluated. Adequate understanding of patient status is critical to optimal patient management (behavioral therapy, CIC, and medication) in clinical practice.

The risks of the logistics activity of agricultural enterprises have been identified, which are conditionally systematized into 2 groups: exogenous (political, foreign economic, institutional, market, insurance, financial, environmental) and endogenous (related to the processes of material and technical support, stock formation, economic, transport, sales, information). The expediency of applying a comprehensive approach to risk management of logistics activities of enterprises in the agrarian sector is substantiated. A set of measures for leveling the risks of logistics activities in the logistics management system of agricultural enterprises in conditions of instability and crisis phenomena is proposed.&nbsp

The growing demand for cyber insurance, which serves as a crucial vehicle for businesses' cyber risk management, is precipitated by the increasing number of incidents of cyberattacks and the corresponding legislative developments. As the cyber insurance market is hardening, risk insurers are faced with the challenge of reasonably pricing their products, particularly stand-alone policies. In this thesis, a pricing framework is established to benefit insurance carriers in the valuation of cyber insurance products and regulators in connection with reserving for cyber losses. Specifically, a hidden Markov model, driving certain factors of cyber risk dynamics, is used to calibrate the counting process for cyber incidents. Three self-contained but closely linked research undertakings in developing methodologies for cyber-risk analyses are presented in this thesis. The first research study puts forward a valuation framework in which cyber-attack occurrences are captured by a regime-switching model driven by a Markov process that transitions in a three-state cyber kill chain. The estimator for the transition matrix is calculated utilising the change of reference probability measures along with the EM algorithm. The cyber insurance premium is then computed based on the random total losses, which are assumed to be following the doubly truncated Pareto distribution. The Vasi\v{c}ek model describes the interest-are process for discounting. In our second research investigation, a modelling framework is proposed for the risk assessment of private health data breaches. Our investigation focuses on the data sets compiled by the Privacy Rights Clearinghouse and the U.S. Department of Health and Human Services. The counting process for the data-breach incidents is shown to be adequately modelled by the Markov-modulated non-homogeneous Poisson process (MMNPP) whilst the logarithm of the breach sizes is well-captured by the generalised Pareto distribution. We compute the cyber insurance premium at the institution level as well as both the Value-at-Risk (VaR) and Average VaR metrics. Our results indicate that cyber insurance policies with longer maturity are more cost-effective. This contribution advances in parameter estimation and implementation of the MMNPP in the context of cyber risk modelling. The third research work extends the MMNPP model by constructing robust filter-based and smoother-based EM algorithms. In contrast to the usual EM algorithm for the maximum likelihood estimation, the filtering and smoothing-driven algorithms are more efficient and can incorporate new information into the parameter estimates in real time. A numerical demonstration of the MMNPP is carried out using the HHS data. To compare the three EM algorithms, we conduct a comprehensive simulation-based analysis with respect to the algorithms' efficiency, partition size, data size, intensity difference, regime occurrences impacted by transition rates, and the number-of-regimes selection. The comparative-analysis results together with the various heuristics for detailed implementation provide practical guidance to the end users of MMNPP.

The article is devoted to the definition of insurance in tourism, which will ensure that the tourist solves all problems and receives qualified medical, legal or administrative assistance. It was determined what insurance is, travel insurance, insurance in tourism. It has been proven that insurance in the tourism industry is used to insure against the risk of financial losses, both large and small, that may arise from damage to the insured or his property, or from liability for damage caused to a third party. The main categories of travel insurance have been revealed, namely: insurance against trip cancellation or interruption, insurance for luggage and personal belongings, medical insurance, accident insurance, in-flight accident insurance. The main sections of the travel insurance policy were also mentioned. During the pandemic, it has become more difficult to travel, so you need to understand the requirements of different countries, as well as protect yourself from risks due to the disease. Additional insurances against no-show and additional financial risks help protect tourists from illness if they have a travel permit. It was concluded that travel insurance provides some security and confidence for tourists to travel with peace of mind. Insurance is designed to cover financial risks., Стаття присвячена визначенню страхування в туризмі, яке забезпечить туристу вирішити всі проблеми й одержати кваліфіковану медичну, юридичну чи адміністративну допомогу. Визначено було, що таке страхування, туристична страховка, страхування в туризмі. Доведено, що страхування в туристичній галузі використовуються для страхування від ризику фінансових втрат, як великих, так і малих, які можуть виникнути внаслідок нанесення шкоди страхувальника або його майна, або від відповідальності за шкоду заподіяну третій стороні. Розкрили основні категорії туристичного страхування, а саме: страхування від скасування або перерви поїздки, страхування багажу та особистих речей, медичне страхування, страхування від нещасних випадків, страхування нещасних випадків при польоті. Зазначено також було основні розділи туристичного страхового полісу. Під час пандемії стало важче подорожувати, тому потрібно розуміти вимоги різних країн, а також убезпечити себе від ризиків через хворобу. Захистити туристів від захворювання при наявності туристичної путівки, допомагають додаткові страховки від невиїзду та додаткових фінансових ризиків (таке страхування покриває всіх осіб, вказаних у заявці, або кількох заявках, якщо мова про одну родину). Було зроблено висновок про те, що страхування подорожей забезпечує певну безпеку та впевненість в тому, щоб туристи могли спокійно подорожувати. Страхування розроблено для покриття фінансових ризиків.

Funding Information: The Argentina survey − Estudio Argentino de Epidemiología en Salud Mental (EASM) − was supported by a grant from the Argentinian Ministry of Health (Ministerio de Salud de la Nación) − (Grant Number 2002–17270/13–5). The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204–3. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The Mental Health Study Medellín – Colombia was carried out and supported jointly by the Center for Excellence on Research in Mental Health (CES University) and the Secretary of Health of Medellín. The ESEMeD project is funded by the European Commission (Contracts QLG5–1999-01042; SANCO 2004123, and EAHC 20081308), the Piedmont Region (Italy)), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000–158-CE), Generalitat de Catalunya (2017 SGR 452; 2014 SGR 748), Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The Lebanese Evaluation of the Burden of Ailments and Needs of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health / Fogarty International Center (R03 TW006481–01), anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from, Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, Glaxo Smith Kline, Lundbeck, Novartis, OmniPharma, Pfizer, Phenicia, Servier, UPO. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544- H), with supplemental support from the Pan American Health Organization (PAHO). The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria), and the Federal Ministry of Health, Abuja, Nigeria. The Portuguese Mental Health Study was carried out by the Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon, with collaboration of the Portuguese Catholic University, and was funded by Champalimaud Foundation, Gulbenkian Foundation, Foundation for Science and Technology (FCT) and Ministry of Health. The Romania WMH study projects “Policies in Mental Health Area” and “National Study regarding Mental Health and Services Use” were carried out by National School of Public Health & Health Services Management (former National Institute for Research & Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics-National Centre for Training in Statistics, SC Cheyenne Services SRL, Statistics Netherlands and were funded by Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania SRL. The Psychiatric Enquiry to General Population in Southeast Spain – Murcia (PEGASUS-Murcia) Project has been financed by the Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejería de Sanidad y Política Social) and Fundación para la Formación e Investigación Sanitarias (FFIS) of Murcia. The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust. Dr. Stein is supported by the Medical Research Council of South Africa (MRC). Publisher Copyright: © 2023, The Author(s). Background: Posttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs). Methods: Seventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage. Results: 12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR =.35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage. Conclusion: There is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes. publishersversion published

While many states have legalized medical cannabis, many unintended consequences remain under-studied. We focus on one potential detriment-the effect of cannabis legalization on automobile safety. We examine this relationship through auto insurance premiums. Employing a modern difference-in-differences framework and zip code-level premium data from 2014 to 2019, we find that premiums declined, on average, by $22 per year following medical cannabis legalization. The effect is more substantial in areas near a dispensary and in areas with a higher prevalence of drunk driving before legalization. We estimate that existing legalization has reduced health expenditures related to auto accidents by almost $820 million per year with the potential for a further $350 million reduction if legalized nationally.

As a favorite means to promote the development of green agriculture, agricultural insurance can not only encourage farmers to adopt green production technology and improve production efficiency, but also achieve the purpose of reducing the input of chemicals to protect the environment. This article aims to study the dynamic relationship between agricultural insurance, air pollution, and agricultural green total factor productivity using the panel vector auto-regressive method (PVAR) and panel data of 30 provinces in China from 2005 to 2018. The empirical results show that there is a significant cross-sectional dependence and the co-integration relationship between agricultural insurance, air pollution, and agricultural green total factor productivity. The increase in agricultural insurance can improve agricultural green total factor productivity and aggravate air pollution to a certain extent. However, serious air pollution does not improve agricultural green total factor productivity. Panel Granger causality test results show that agricultural insurance has a one-way causal relationship with green total factor productivity and air pollution, and so does air pollution with agricultural green total factor productivity. In addition, impulse response results show that increasing agricultural insurance or reducing air pollution can improve agricultural green total factor productivity. These conclusions have long-term practical implications for both agricultural policymakers and environmental managers.

To ensure safe development of the financial and insurance industry and promote the continuous growth of the social economy, the theory and its role of deep learning are firstly analyzed. Secondly, the security of financial and insurance and bankruptcy probability are discussed. Finally, an analytical model of the security bankruptcy probability of financial and insurance is designed through a deep learning model, and the model is evaluated comprehensively. The research results manifest that first, the designed security evaluation of the financial and insurance industry based on the deep learning and bankruptcy probability analysis model not only has strong learning ability but also can effectively reduce its own calculation error through short-time learning. Then, by comparing with other models, it is found that the designed model has a stronger ability to control various errors than other models, and the overall error rate of the model can be reduced to about 20%. At last, the data training indicates that the model designed by the deep learning method can accurately and effectively predict the basic situation of the financial and insurance industry, the minimum error can reach 0, and the highest is only about 3. The research provides a technical reference for the development of the financial and insurance industry and contributes to the prosperity of the social economy.

To examine temporal trends in cervical cancer screening practices and associated downstream abnormalities and procedures.Women aged 18-64 years with commercial insurance or Medicaid insurance from 2008 to 2019 were identified using the IBM MarketScan databases. The annual rates of screening overall and by type of test (cytology, co-testing, or primary human papillomavirus testing) were examined. Downstream abnormal cytologic and histologic test results, colposcopies, and excisional procedures were examined, and rates were reported for the population of eligible patients with continuous insurance and for those who underwent screening. Changes over time in testing and outcomes were compared using χ2 tests and Spearman's correlation.From 2008 to 2019, the annual screening prevalence decreased from 42.6% to 29.4% in women with commercial insurance (P.001) and from 27.9% to 12.4% among women with Medicaid insurance (P.001). In the cohort of women with commercial insurance, cytology usage decreased from 79.4% to 38.9% and co-testing increased from 20.1% to 59.6% (P.001). Per 1,000 women screened, the rate of abnormal histologic and cytologic test results rose from 96 to 119 (P.001) and colposcopies rose from 33 to 42 (P.001); excisional procedures remained relatively constant. Per 1,000 eligible women, the rate of abnormal histologic and cytologic test results decreased from 41 to 35 (P.001), colposcopies declined from 14 to 12, and excisional procedures decreased from 3 to 2.Human papillomavirus testing has been rapidly incorporated into cervical cancer screening and is associated with an increasing trend of downstream abnormalities and procedures among screened women but a declining trend at the population level.

PURPOSE: Prior algorithms enabled the identification and gender categorization of transgender people in insurance claims databases in which sex and gender are not simultaneously captured. However, these methods have been unable to categorize the gender of a large proportion of their samples. We improve upon these methods to identify the gender of a larger proportion of transgender people in insurance claims data. METHODS: Using 2001–2019 Optum's Clinformatics(®) Data Mart insurance claims data, we adapted prior algorithms by combining diagnosis, procedure, and pharmacy claims to (1) identify a transgender sample; and (2) stratify the sample by gender category (trans feminine and nonbinary [TFN], trans masculine and nonbinary [TMN], unclassified). We used logistic regression to estimate the burden of 13 chronic health conditions, controlling for gender category, age, race/ethnicity, enrollment length, and census region. RESULTS: We identified 38,598 unique transgender people, comprising 50% [n = 19,252] TMN, 26% (n = 10,040) TFN, and 24% (n = 9306) unclassified individuals. In adjusted models, relative to TMN people, TFN people had significantly higher odds of most chronic health conditions, including HIV, atherosclerotic cardiovascular disorder, myocardial infarction, alcohol use disorder, and drug use disorder. Notably, TMN individuals had significantly higher odds of post-traumatic stress disorder and depression than TFN individuals. CONCLUSION: By combining complex administrative claims-based algorithms, we identified the largest U.S.-based sample of transgender individuals and inferred the gender of >75% of the sample. Adjusted models extend prior research documenting key health disparities by gender category. These methods may enable researchers to explore rare and sex-specific conditions in hard-to-reach transgender populations.