Hasil untuk "Insurance"

Marije E. Hagendijk, Nina Zipfel, Jan L. Hoving et al.

Abstract Background This study explored the usability and added value of the Value@WORK-Q23 (V@W-Q23) in real-life consultations with working-age patients diagnosed with cardiovascular diseases (CVD), examining the experiences with the usability and added value by both patients and healthcare professionals and identifying potential barriers and facilitators to its use. Methods An exploratory mixed-methods design was employed, evaluating the usability and added value when testing the V@W-Q23 in real-life consultations. The V@W-Q23 was tested in three steps: (1) the patient completing the V@W-Q23 independently before the consultation, (2) the healthcare professional reviewing the results, and (3) using the insights during the consultation. These user tests took place in consultations across four healthcare settings: occupational medicine, social insurance medicine, general practice, and cardiology. Nationwide purposive sampling was used. Data collection included observation of consultations and semi-structured interviews with both the participating patients and healthcare professionals. Quantitative data were analysed using frequencies and percentages; qualitative data underwent content analysis. Results The usability of the V@W-Q23 was tested in 16 consultations involving 12 healthcare professionals and 15 patients. The V@W-Q23 was primarily used to discuss items of interest to the patient or those deviating from the professional’s expectations. Both patients and professionals found the items relevant, easy to understand, and manageable within limited time. The tool enhanced understanding of personal circumstances, increased attention to work-related topics, and improved interpersonal communication. Its added value was particularly notable for patients on temporary sick leave or those facing work-related challenges. Barriers included limited time, competing priorities, and unclear roles in work-focused healthcare. Facilitators included repeat measurements, a more appealing layout, clearer responsibilities for sending, receiving, and processing the V@W-Q23, and integration into electronic health records. The tool was also suggested for use in other chronic conditions. Conclusions The V@W-Q23 was well-received by both patients and healthcare professionals, promoting in-depth discussions about work-related issues during consultations. Its use improved understanding and attention to work-related factors, highlighting the potential for broader application in healthcare settings.

Botao 'Amber' Hu, Bangdao Chen

The emerging "agentic web" envisions large populations of autonomous agents coordinating, transacting, and delegating across open networks. Yet many agent communication and commerce protocols treat agents as low-cost identities, despite the empirical reality that LLM agents remain unreliable, hallucinated, manipulable, and vulnerable to prompt-injection and tool-abuse. A natural response is "agents-at-stake": binding economically meaningful, slashable collateral to persistent identities and adjudicating misbehavior with verifiable evidence. However, heterogeneous tasks make universal verification brittle and centralization-prone, while traditional reputation struggles under rapid model drift and opaque internal states. We propose a protocol-native alternative: insured agents. Specialized insurer agents post stake on behalf of operational agents in exchange for premiums, and receive privileged, privacy-preserving audit access via TEEs to assess claims. A hierarchical insurer market calibrates stake through pricing, decentralizes verification via competitive underwriting, and yields incentive-compatible dispute resolution.

Roger Antabe, Florence W Anfaara, Yujiro Sano et al.

<h4>Background</h4>Since its inception in 2003, Ghana's Health Insurance Scheme (NHIS) has received considerable scholarly attention on the determinants of enrollment. While most of these studies highlight the role of some socioeconomic and geographical factors, no study has explored the intersection of educational attainment and residence on NHIS enrollment. We aim to contribute to the literature and health policy in Ghana by examining the intersection of educational attainment and rural-urban residence on NHIS enrollment among women and men.<h4>Methods</h4>We used nationally representative data from the 2022 Ghana Demographic and Health Survey (GDHS). Using STATA 17, we applied multivariable logistic regression to our analytical sample comprising women (n = 14997) and men (n = 7040).<h4>Results</h4>Overall, we found that more women (90%) than men (73%) enrolled on the NHIS. Adjusting for a range of control variables, we found that women and men with secondary (OR: 1.61, 95% CI: 1.28-2.02; OR: 1.45, 95% CI: 1.16-1.82) and higher education (OR: 1.81, 95% CI: 1.24-2.64; OR: 2.85, 95% CI: 2.03-3.99) were more likely to have enrolled into the NHIS compared to those with no formal education. This difference was particularly heightened among women and men with no education. Rural women (96%) and men (90%) with higher education had higher enrollment rates compared to their urban counterparts.<h4>Conclusion</h4>We recommend revising the NHIS equity and pro-poor policy to include vulnerability at the intersection of low educational attainment and rural residence.

Guohui Guan, Zongxia Liang, Yi Xia

This paper studies the robust reinsurance and investment games for competitive insurers. Model uncertainty is characterized by a class of equivalent probability measures. Each insurer is concerned with relative performance under the worst-case scenario. Insurers' surplus processes are approximated by drifted Brownian motion with common and idiosyncratic insurance risks. The insurers can purchase proportional reinsurance to divide the insurance risk with the reinsurance premium calculated by the variance principle. We consider an incomplete market driven by the 4/2 stochastic volatility mode. This paper formulates the robust mean-field game for a non-linear system originating from the variance principle and the 4/2 model. For the case of an exponential utility function, we derive closed-form solutions for the $n$-insurer game and the corresponding mean-field game. We show that relative concerns lead to new hedging terms in the investment and reinsurance strategies. Model uncertainty can significantly change the insurers' hedging demands. The hedging demands in the investment-reinsurance strategies exhibit highly non-linear dependence with the insurers' competitive coefficients, risk aversion and ambiguity aversion coefficients. Finally, numerical results demonstrate the herd effect of competition.

Md Al Amin, Rushabh Shah, Hemanth Tummala et al.

Healthcare insurance provides financial support to access medical services for patients while ensuring timely and guaranteed payment for providers. Insurance fraud poses a significant challenge to insurance companies and policyholders, leading to increased costs and compromised healthcare treatment and service delivery. Most frauds, like phantom billing, upcoding, and unbundling, happen due to the lack of required entity participation. Also, claim activities are not transparent and accountable. Fraud can be prevented and minimized by involving every entity and making actions transparent and accountable. This paper proposes a blockchain-powered smart contract-based insurance claim processing mechanism to prevent and minimize fraud in response to this prevailing issue. All entities patients, providers, and insurance companies actively participate in the claim submission, approval, and acknowledgment process through a multi-signature technique. Also, every activity is captured and recorded in the blockchain using smart contracts to make every action transparent and accountable so that no entity can deny its actions and responsibilities. Blockchains' immutable storage property and strong integrity guarantee that recorded activities are not modified. As healthcare systems and insurance companies continue to deal with fraud challenges, this proposed approach holds the potential to significantly reduce fraudulent activities, ultimately benefiting both insurers and policyholders.

Lorand Lakatos, Ildiko Illyes, Andras Budai et al.

Accurate lymph node (LN) retrieval during colorectal carcinoma resection is pivotal for precise N-staging and the determination of adjuvant therapy. Current guidelines recommend the examination of at least 12 mesocolic or mesorectal lymph nodes for accurate staging. Traditional histological processing techniques, reliant on visual inspection and palpation, are time-consuming and heavily dependent on the examiner’s expertise and availability. Various methods have been documented to enhance LN retrieval from colorectal specimens, including intra-arterial ex vivo methylene blue injection. Recent studies have explored the utility of indocyanine green (ICG) fluorescence imaging for visualizing pericolic lymph nodes and identifying sentinel lymph nodes in colorectal malignancies. This study included 10 patients who underwent colon resection for malignant tumors. During surgery, intravenous ICG dye and an endoscopic camera were employed to assess intestinal perfusion. Post-resection, ex vivo intra-arterial administration of ICG dye was performed on the specimens, followed by routine histological processing and an ICG-assisted lymph node dissection. The objective was to evaluate whether ICG imaging could identify additional lymph nodes compared to routine manual dissection and to assess the clinical relevance of these findings. For each patient, a minimum of 12 lymph nodes (median = 25.5, interquartile range = 12.25, maximum = 33) were examined. ICG imaging facilitated the detection of a median of three additional lymph nodes not identified during routine processing. Metastatic lymph nodes were found in four patients however no additional metastatic nodes were detected with ICG assistance. Our findings suggest that ex vivo intra-arterial administration of indocyanine green dye can augment lymph node dissection, particularly in cases where the number of lymph nodes retrieved is below the recommended threshold of 12.

Tumaini Nyamhanga, Rosemary W Eustace, Janeth Philip Makoye et al.

<h4>Background</h4>Breast cancer is the second most common cause of cancer mortality among women in Tanzania and thus, early detection and treatment methods are central to improving breast cancer outcomes. However, in low- and middle-income countries in Sub-Saharan Africa, the survival rates remains low due to late presentation. Hence, a significant number of deaths could be prevented if barriers and facilitators to early detection are known.<h4>Purpose</h4>This qualitative case descriptive study explored the possible barriers to awareness and early breast cancer diagnostic services among midlife women in rural Tanzania.<h4>Methods</h4>Ten key informant interviews with health systems managers and community health workers and eight focus group discussions with women aged 40-65 years and their spouses were conducted to elicit the study data conducted from July to August 2021.<h4>Results</h4>The data revealed nine themes describing the barriers to early detection methods across five Socio-Ecological levels of influence, namely: 1) limited knowledge and 2) witchcraft beliefs (individual level); 3) limited male support (interpersonal level); 4) age and gender factors and 5) procrastination (community level) 6) limited availability of services 7) emphasis of curative over preventive care (institutional level); 8) poverty/inability to pay and 9) limitations of health insurance (societal/policy level).<h4>Conclusions</h4>The study findings suggest a need to further the design, implementation and evaluation of evidence-based community breast health awareness and education interventions to promote early detection of breast cancer in Tanzania. Specifically, the study highlights the need to address multiple level determinants of influence in breast cancer control as part of the country's Community Health Strategy.

An Chen, Giorgio Ferrari, Shihao Zhu

This paper investigates the consumption and investment decisions of an individual facing uncertain lifespan and stochastic labor income within a Black-Scholes market framework. A key aspect of our study involves the agent's option to choose when to acquire life insurance for bequest purposes. We examine two scenarios: one with a fixed bequest amount and another with a controlled bequest amount. Applying duality theory and addressing free-boundary problems, we analytically solve both cases, and provide explicit expressions for value functions and optimal strategies in both cases. In the first scenario, where the bequest amount is fixed, distinct outcomes emerge based on different levels of risk aversion parameter $γ$: (i) the optimal time for life insurance purchase occurs when the agent's wealth surpasses a critical threshold if $γ\in (0,1)$, or (ii) life insurance should be acquired immediately if $γ>1$. In contrast, in the second scenario with a controlled bequest amount, regardless of $γ$ values, immediate life insurance purchase proves to be optimal. Finally, we extend the analysis to consider a scenario in which the individual earmarks part of her initial wealth for inheritance, where a critical wealth threshold consistently emerges.

Tim J. Boonen, Xia Han

This paper studies an optimal insurance contracting problem in which the preferences of the decision maker given by the sum of the expected loss and a convex, increasing function of a deviation measure. As for the deviation measure, our focus is on convex signed Choquet integrals (such as the Gini coefficient and a convex distortion risk measure minus the expected value) and on the standard deviation. We find that if the expected value premium principle is used, then stop-loss indemnities are optimal, and we provide a precise characterization of the corresponding deductible. Moreover, if the premium principle is based on Value-at-Risk or Expected Shortfall, then a particular layer-type indemnity is optimal, in which there is coverage for small losses up to a limit, and additionally for losses beyond another deductible. The structure of these optimal indemnities remains unchanged if there is a limit on the insurance premium budget. If the unconstrained solution is not feasible, then the deductible is increased to make the budget constraint binding. We provide several examples of these results based on the Gini coefficient and the standard deviation.

Brittney M. Snyder, Tebeb Gebretsadik, Nina B. Rohrig et al.

We aimed first to assess associations between maternal health characteristics and newborn metabolite concentrations and second to assess associations between metabolites associated with maternal health characteristics and child body mass index (BMI). This study included 3492 infants enrolled in three birth cohorts with linked newborn screening metabolic data. Maternal health characteristics were ascertained from questionnaires, birth certificates, and medical records. Child BMI was ascertained from medical records and study visits. We used multivariate analysis of variance, followed by multivariable linear/proportional odds regression, to determine maternal health characteristic-newborn metabolite associations. Significant associations were found in discovery and replication cohorts of higher pre-pregnancy BMI with increased C0 and higher maternal age at delivery with increased C2 (C0: discovery: aβ 0.05 [95% CI 0.03, 0.07]; replication: aβ 0.04 [95% CI 0.006, 0.06]; C2: discovery: aβ 0.04 [95% CI 0.003, 0.08]; replication: aβ 0.04 [95% CI 0.02, 0.07]). Social Vulnerability Index, insurance, and residence were also associated with metabolite concentrations in a discovery cohort. Associations between metabolites associated with maternal health characteristics and child BMI were modified from 1–3 years (interaction: <i>p</i> < 0.05). These findings may provide insights on potential biologic pathways through which maternal health characteristics may impact fetal metabolic programming and child growth patterns.

Syed M. Hussain, Rahimah Mahat, Nek Muhammad Katbar et al.

As a result of its use in the manufacturing and construction industries, research on the flow of nanofluid is rather well-known among academics and professionals in related fields. It is helpful for electrical equipment to utilize it for cooling reasons, which has shown promising results in terms of reducing energy use. As a result, the primary objective of this research is to inspect the impacts that radiation has on the mixed convection of Walters'-B hybridity nanofluid flow of stagnant point in a horizontal circular cylinder under the circumstances of a constant heat flux. It is considered a conventional fluid despite the presence of copper (Cu) and alumina (Al2O3) nanoparticles in the water (H2O) hybridity nanofluid. To make the solution to the resulting controlling system of equations more straightforward, the numerical approach of a neural network with a back-propagation algorithm (NN-BPA) is used. It follows by clarifying how various physical characteristics, such as blended convection, thermal radiation, and stagnant movement, affect temperature, skin friction, thermal transfer, velocity, and graphical profiles of those variables. The LMNN-BPA has the quickest processing algorithm and performs well in general, corresponding to the thorough analysis. Additionally, the mixed convective and viscoelastic properties exhibit both rising and dropping developments regarding skin friction and heat transmission.

Chao Yu, Yuhan Cheng, Yilun Song

In this paper, we study the robust optimal investment and risk control problem for an insurer who owns the insider information about the financial market and the insurance market under model uncertainty. Both financial risky asset process and insurance risk process are assumed to be very general jump diffusion processes. The insider information is of the most general form rather than the initial enlargement type. We use the theory of forward integrals to give the first half characterization of the robust optimal strategy and transform the anticipating stochastic differential game problem into the nonanticipative stochastic differential game problem. Then we adopt the stochastic maximum principle to obtain the total characterization of the robust strategy. We discuss the two typical situations when the insurer is `small' and `large' by Malliavin calculus. For the `small' insurer, we obtain the closed-form solution in the continuous case and the half closed-form solution in the case with jumps. For the `large' insurer, we reduce the problem to the quadratic backward stochastic differential equation (BSDE) and obtain the closed-form solution in the continuous case without model uncertainty. We discuss some impacts of the model uncertainty, insider information and the `large' insurer on the optimal strategy.

Laurence Barry, Arthur Charpentier

Since the beginning of their history, insurers have been known to use data to classify and price risks. As such, they were confronted early on with the problem of fairness and discrimination associated with data. This issue is becoming increasingly important with access to more granular and behavioural data, and is evolving to reflect current technologies and societal concerns. By looking into earlier debates on discrimination, we show that some algorithmic biases are a renewed version of older ones, while others show a reversal of the previous order. Paradoxically, while the insurance practice has not deeply changed nor are most of these biases new, the machine learning era still deeply shakes the conception of insurance fairness.

Viviana G. R. Lobo, Thais C. O. Fonseca, Mariane B. Alves

This paper focuses on modelling surrender time for policyholders in the context of life insurance. In this setup, a large lapse rate at the first months of a contract is often observed, with a decrease in this rate after some months. The modelling of the time to cancellation must account for this specific behaviour. Another stylised fact is that policies which are not cancelled in the study period are considered censored. To account for both censuring and heterogeneous lapse rates, this work assumes a Bayesian survival model with a mixture of regressions. The inference is based on data augmentation allowing for fast computations even for data sets of over a million clients. Moreover, scalable point estimation based on EM algorithm is also presented. An illustrative example emulates a typical behaviour for life insurance contracts and a simulated study investigates the properties of the proposed model. In particular, the observed censuring in the insurance context might be up to 50% of the data, which is very unusual for survival models in other fields such as epidemiology. This aspect is exploited in our simulated study.

Wang-Chuan Juang, Sonia Ming-Jiu Chiou, Hui-Ling Yang et al.

<h4>Background</h4>In 2012, the American Board of Internal Medicine Foundation launched the Choosing Wisely campaign to reduce unnecessary care. However, it is unclear how much emergency physicians in Taiwan understand about Choosing Wisely. The purpose of this study was to explore the knowledge, attitude, and behaviour of emergency physicians in Taiwan regarding Choosing Wisely and its related factors; the intention was to identify the baseline knowledge on the basis of which to promote Choosing Wisely in Taiwan.<h4>Methods</h4>This was a cross-sectional study including emergency physicians in Taiwan as research subjects who answered online questionnaires. A 42-item questionnaire was designed according to the Knowledge, Attitude, and Behaviour model (KAB). The questionnaire linkages were delivered to emergency physicians through social media (eg., Line, Facebook) and received assistance from different hospital directors. A total of 162 valid questionnaires were collected. Data analyses include t-test, analysis of variance, chi-square test, Pearson's correlation, and multivariate linear regression model.<h4>Results</h4>The study determined that although only 38.9% of emergency physicians had heard of Choosing Wisely, the mean correct rate of knowledge score among emergency physicians was 70.1%. Attitude and the behaviour related to Choosing Wisely were positively associated, which means that the more positive the attitude towards Choosing Wisely is, the more positive the behaviour towards Choosing Wisely is. In multiple linear regression analyses, having served as a supervisor, belonging to divisions of health insurance service, and having heard of Choosing Wisely (P < 0.05) positively affect the knowledge of Choosing Wisely, but age presented a negative association.<h4>Conclusion</h4>This study found that physicians' knowledge does not influence their attitudes and behaviours, which may be related to barriers of practicing Choosing Wisely activities. To effectively promote Choosing Wisely campaign, it is recommended to focus on the significant factors associated with emergency physicians' perceptions regarding knowledge, attitude, and behavior of Choosing Wisely. Based on these factors, appropriate practice guidelines for Choosing Wisely can be formulated and promoted.

Elizabeth Mayfield Arnold, S. Kate Bridges, Cameron Goldbeck et al.

Background: Human papillomavirus (HPV) is epidemic among young people, especially those at highest risk of acquiring HPV-related cancers. Methods: Youth aged 14–24 years old (<i>N</i> = 1628) were recruited from 13 clinics, community agencies, and social media sites in Los Angeles, California, and New Orleans, Louisiana, that specialized in serving sexual and gender minority youths (SGMY), especially males at risk for HIV. A cross-sectional comparison of sociodemographic and risk histories of HPV vaccinated/unvaccinated youths was conducted using both univariate and multivariate regressions. Results: About half (51.9%) of youth were vaccinated, with similar percentages across states and across genders. Sexual and gender minority youths (SGMY, i.e., gay, bisexual, transgender, and non-heterosexual; 68.8%) and their heterosexual peers (15%) were equally likely to be vaccinated (54%), even though their risk for HPV-related cancers is very different. Vaccinations were higher among younger youth, those not using condoms, youth with greater education, that possessed a primary health care provider, and youth diagnosed with HIV. Vaccinations were lower among youth that were out-of-home due to mental health inpatient hospitalization, drug treatment, homelessness, or incarceration. Conclusions: Special programs are required to target youth experiencing multiple life stressors, especially out-of-home experiences, those with less education, and without the safety net of health insurance or a provider.

O. T. Kim, O. M. Drapkina

Currently, obesity has become one of the most serious public health problems. It takes millions of lives worldwide every year due to its association with numerous diseases and leads to significant social and economic losses. It is generally accepted that obesity is the result of the interaction of genes and environment, and the predisposition to it lies in our evolutionary past. This review discusses the role of adipose tissue in human evolution, the factors specifying a person’s predisposition to obesity, the main hypotheses for obesity origin, and potential prevention and treatment strategies arising from them. The evolutionary significance of visceral adipose tissue and some ethnic and sex characteristics associated with its distribution are also considered.

Min Su, Wei Xie, Ling Mao et al.

Objectives To better understand the characteristics of migrant workers with pneumoconiosis in China, and the factors that contribute to their morbidity.Design A cross-sectional study.Setting This study was conducted in Shanghai, Nanning and Shenzhen, China, between December 2020 and December 2021.Participants There were 601 questionnaires that were analysed involving 198 migrant workers with pneumoconiosis, 205 workers with pneumoconiosis in state-owned enterprises (SOEs) and 198 other migrant workers with non-pulmonary occupational diseases.Outcome measures Epidemiological characteristics of pneumoconiosis among migrant workers were determined. Using logistic regression, we examined the factors related to the morbidity of pneumoconiosis in migrant workers.Results The response rate was 93.27%. In comparison with pneumoconiosis among SOE workers, the number of migrant workers with pneumoconiosis who first encountered dust exposure between the ages of 30 and 44 years and had an accumulated dust exposure of 1–10 years was proportionately greater. Migrant workers who developed pneumoconiosis between 18 and 32 years and those who had stage III pneumoconiosis were proportionately greater (p&lt;0.05). Compared with migrant workers with non-pulmonary occupational diseases, six factors were associated with the morbidity of pneumoconiosis in migrant workers. Risk factors were dust exposure (OR=499.25, 95% CI: 68.33 to 3647.59) and someone smoking in the workplace (OR=5.67, 95% CI: 2.18 to 14.78). Protective factors were regular sleeping hours per night, (OR=0.23, 95% CI: 0.09 to 0.60), excellent ventilation (OR=0.09, 95% CI: 0.01 to 0.65), rules and regulations (OR=0.22, 95% CI: 0.07 to 0.66) and post-departure medical examinations (OR=0.24, 95% CI: 0.09 to 0.63).Conclusions Compared with SOE workers with pneumoconiosis, migrant workers are exposed to dust at an earlier age, but for shorter duration, display morbidity at an earlier age and have a higher proportion of tertiary pneumoconiosis. They are predominantly male and have inadequate employment stability and medical insurance. Occupational health check-ups and management systems are inadequate.

Farhad Billimoria, Filiberto Fele, Iacopo Savelli et al.

Securing an adequate supply of dispatchable resources is critical for keeping a power system reliable under high penetrations of variable generation. Traditional resource adequacy mechanisms are poorly suited to exploiting the growing flexibility and heterogeneity of load enabled by advancements in distributed resource and control technology. To address these challenges this paper develops a resource adequacy mechanism for the electricity sector utilising insurance risk management frameworks that is adapted to a future with variable generation and flexible demand. The proposed design introduces a central insurance scheme with prudential requirements that align diverse consumer reliability preferences with the financial objectives of an insurer-of-last-resort. We illustrate the benefits of the scheme in (i) differentiating load by usage to enable better management of the system during times of extreme scarcity, (ii) incentivising incremental investment in generation infrastructure that is aligned with consumer reliability preferences and (iii) improving overall reliability outcomes for consumers.

Zuo Quan Xu

This paper investigates a Pareto optimal insurance problem, where the insured maximizes her rank-dependent utility preference and the insurer is risk neutral and employs the mean-variance premium principle. To eliminate potential moral hazard issues, we only consider the so-called moral-hazard-free insurance contracts that obey the incentive compatibility constraint. The insurance problem is first formulated as a non-concave maximization problem involving Choquet expectation, then turned into a concave quantile optimization problem and finally solved by the calculus of variations method. The optimal contract is expressed by a second-order ordinary integro-differential equation with nonlocal operator. An effective numerical method is proposed to compute the optimal contract assuming the probability weighting function has a density. Also, we provide an example which is analytically solved.