Cost and Compensation of Injuries in Medical Malpractice

Compensation determinations for victims of medical malpractice were studied. Results showed that for birth-related and emergency room cases of permanent injury in Florida, a claimant receiving much more than economic loss in compensation more nearly appears to be the exception than the norm

Out-of-Pocket Costs and the Flexible Benefits Decision: Do Employees Make Effective Health Care Choices?

This study analyzes employees\u27 ability to select health insurance benefits that fit their needs.The study analyzes both the actual choices and the implications of those choices for employees, measured as out-of-pocket costs (OPC). By introducing OPC as a measure of decision quality, this study demonstrates its advantages over measuring only employee choice. Results from a sample of manufacturing employees suggest that most employees made cost-optimizing decisions, out-performing recommendations from a linear model. Employees also were financially better off overall with choice than they would have been had they all been placed into either medical plan option available to them. This study supports the value of choice, but does not support the assertion that employees always make benefits decisions that best fit their needs

Relationship of national institutes of health stroke scale to 30-day mortality in medicare beneficiaries with acute ischemic stroke.

BackgroundThe National Institutes of Health Stroke Scale (NIHSS), a well-validated tool for assessing initial stroke severity, has previously been shown to be associated with mortality in acute ischemic stroke. However, the relationship, optimal categorization, and risk discrimination with the NIHSS for predicting 30-day mortality among Medicare beneficiaries with acute ischemic stroke has not been well studied.Methods and resultsWe analyzed data from 33102 fee-for-service Medicare beneficiaries treated at 404 Get With The Guidelines-Stroke hospitals between April 2003 and December 2006 with NIHSS documented. The 30-day mortality rate by NIHSS as a continuous variable and by risk-tree determined or prespecified categories were analyzed, with discrimination of risk quantified by the c-statistic. In this cohort, mean age was 79.0 years and 58% were female. The median NIHSS score was 5 (25th to 75th percentile 2 to 12). There were 4496 deaths in the first 30 days (13.6%). There was a strong graded relation between increasing NIHSS score and higher 30-day mortality. The 30-day mortality rates for acute ischemic stroke by NIHSS categories were as follows: 0 to 7, 4.2%; 8 to 13, 13.9%; 14 to 21, 31.6%; 22 to 42, 53.5%. A model with NIHSS alone provided excellent discrimination whether included as a continuous variable (c-statistic 0.82 [0.81 to 0.83]), 4 categories (c-statistic 0.80 [0.79 to 0.80]), or 3 categories (c-statistic 0.79 [0.78 to 0.79]).ConclusionsThe NIHSS provides substantial prognostic information regarding 30-day mortality risk in Medicare beneficiaries with acute ischemic stroke. This index of stroke severity is a very strong discriminator of mortality risk, even in the absence of other clinical information, whether used as a continuous or categorical risk determinant. (J Am Heart Assoc. 2012;1:42-50.)

Modelling the disability severity score in motor insurance claims: an application to the Spanish case

Bodily injury claims have the greatest impact on the claim costs of motor insurance companies. The disability severity of motor claims is assessed in numerous European countries by means of score systems. In this paper a zero inflated generalized Poisson regression model is implemented to estimate the disability severity score of victims in-volved in motor accidents on Spanish roads. We show that the injury severity estimates may beautomatically converted into financial terms by insurers at any point of the claim handling process. As such, the methodology described may be used by motor insurers operating in the Spanish market to monitor the size of bodily injury claims. By using insurance data, various applications are presented in which the score estimate of disability severity is of value to insurers, either for computing the claim compensation or for claim reserve purposes.Motor accident, disability severity, zero-inflated generalized Poisson model, disability scoring scale.

Maternity Care and Consumer-Driven Health Plans

Compares out-of-pocket costs of maternity care under consumer-driven health plans (CDHP) to a traditional health insurance plan. Explores related factors including prenatal care coverage and unpredictability of costs for delivery and hospital stays

Price Sensitivity in Employee Health Care Choices: The Utility of Out-Of-Pocket Costs and Risk Aversion

Using data from both company records and an insurance provider, the authors develop a direct measure of out-of-pocket costs incurred by employees choosing a health care plan. Previous studies have used characteristics of medical plans and demographic variables as proxies for OPC. By better specifying the consequences of the health care choice, the authors show how the demand for health plans is kinked in a manner consistent with risk aversion. The results suggest that using the proposed OPC measure can help practitioners and researchers better understand and predict the pattern of employee health care benefit choices