Journal of insurance medicine (New York, N.Y.)最新文献

{"title":"Comorbid Illness, Injuries and Health Insurance Subscription Among Self-Reported Mentally Disabled Subjects of Tamil Nadu, India.","authors":"A M Anusa,&nbsp;C Ramasubramaniam,&nbsp;Thavarajah Rooban","doi":"10.17849/insm-47-04-1-11.1","DOIUrl":"https://doi.org/10.17849/insm-47-04-1-11.1","url":null,"abstract":"<p><strong>Background: </strong>-Mentally Disabled (MD) subjects often have multiple co-morbidities and also experience injuries, acute and chronic illness like the general population. Details of such episodes and the impact of health insurance have not been described for Tamil Nadu, an Indian state population. This manuscript intends to report on this experience.</p><p><strong>Materials and method: </strong>-Secondary Data Analysis of District Level Household and Facility survey-4 (2012-13) were employed for this study. Comparison of MD with the normal population was performed. Demographic characteristics along with injury (in preceding year), acute illness (within past 15 days) and the experience of chronic illness (requiring treatment for 1 month), treatment seeking behavior and health insurance coverage formed the variables. Descriptive statistics, chi-square and odds ratio are presented. P≤0.005 was considered as statistical significance.</p><p><strong>Result: </strong>-Of the 179381 surveyed, 565(0.3%) had some form of MD and 169938 (94.7%) had no disabilities. The two groups varied in age, gender, and marital status. MD population had nearly 4 times the incidence of injury (P = 0.000) in the past 1 year, more commonly requiring in-patient treatment. Epilepsy was more common among individuals with MD with odds ratio of 7.159 [P = 0.015]. Health insurance cover and its influence on treatment seeking behavior are presented.</p><p><strong>Discussion: </strong>-The experience of injuries, acute and chronic illness by individuals with MD, to the best of our knowledge has been described for the first time in Tamil Nadu. Individuals with MD and without health insurance often do not take treatment. The absence of health insurance with the resulting increased cost of out-of-pocket expense for chronic illness may force them to neglect their health. These factors are discussed along with recommendations for policy makers.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36979409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JIM Reading List.","authors":"","doi":"10.17849/insm-47-03-194-200.1","DOIUrl":"https://doi.org/10.17849/insm-47-03-194-200.1","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67475728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Cancer: 20-Year Comparative Mortality and Survival Analysis of Six Thyroid Cancer Histologic Subtypes by Age, Sex, Race, Stage, Cohort Entry Time-Period and Disease Duration (SEER*Stat 8.3.2) A Systematic Review of 145,457 Cases for Diagnosis Years 1993-2013.","authors":"Anthony F Milano","doi":"10.17849/insm-47-03-143-158.1","DOIUrl":"https://doi.org/10.17849/insm-47-03-143-158.1","url":null,"abstract":"<p><strong>Background: </strong>-Incidence and prognosis of cancers of the endocrine glands vary greatly by stage and histologic type, and, thyroid cancer accounts for most (92%) of the cancers of the endocrine glands. It is the 8^th most common of cancers and has been rising in incidence since 1975. It remains a formidable health threat in the United States in 2016 with estimated cases of 64,300 and 1980 deaths.</p><p><strong>Objective: </strong>-Provide 20-year comparative mortality analysis of thyroid cancer in a recent group of 145,457 staged cases (97.5%) of a total of 149,202 patients during the 1993-2013 entry time-period in six histologic subtypes by age, sex, race, stage and disease duration.</p><p><strong>Methods: </strong>-Population-based data from SEER registries, ¹ 1973-2013, (SEER*Stat 8.3.2.) were analyzed.</p><p><strong>Results: </strong>- Tables 1 - 8 provide basic SEER epidemiologic, demographic, case-statistics, and comparative mortality follow-up data of 4 principal and 2 supplementary thyroid cancer oncotypes by age, sex, race, stage and disease duration of patients in the 1993-2013 time-period. [Table: see text] [Table: see text] [Table: see text] [Table: see text] [Table: see text] [Table: see text] [Table: see text] [Table: see text] Conclusions.-Thyroid cancer when localized has a very good prognosis, with no significant excess mortality after diagnosis in papillary and papillary follicular variant cancers (PFV). Because nearly two thirds of thyroid cancers are localized, and excess death rate (EDR) is small in patients with regional cancer under age 50, overall excess mortality for all ages also virtually disappeared after 10 years in papillary and follicular cancer. Overall, the 5-year survival rate is greater than 90% for papillary and follicular carcinomas. Nevertheless, because of the marked predominance of papillary carcinoma, the continued increase in its relative frequency and annual projected deaths, thyroid carcinoma remains a significant health concern in the current era.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality Rates and Excess Death Rates for the Seriously Mentally Ill.","authors":"Robert J Reynolds,&nbsp;Steven M Day,&nbsp;Alan Shafer,&nbsp;Emilie Becker","doi":"10.17849/insm-47-04-1-8.1","DOIUrl":"https://doi.org/10.17849/insm-47-04-1-8.1","url":null,"abstract":"<p><strong>Objectives: </strong>-To compute mortality rates and excess death rates for patients with serious mental illness, specific to categories of gender, age and race/ethnicity.</p><p><strong>Background: </strong>-People with serious mental illness are known to be at greatly increased risk of mortality across the lifespan. However, the measures of mortality reported for this high-risk population are typically only summary measures, which do not provide either the mortality rates or excess death rates needed to construct life tables for individuals with serious mental illness.</p><p><strong>Methods: </strong>-Mortality rates were computed by dividing the number of deaths by the amount of life-years lived in strata specific to gender, age and race/ethnicity. Age-specific excess death rates were determined as the difference between the study population rate and the corresponding general population rate in each stratum. To compute excess death rates beyond observed ages in the cohort, a method with documented reliability and validity for chronic medical conditions was used.</p><p><strong>Results: </strong>-For the cohort with mental illness, mortality rates for Black and White females were mostly equal, and consistently greater than those for Hispanic females; excess death rates for females displayed a similar pattern. Among males, mortality rates were highest for Whites, with Hispanics and Blacks close in magnitude at all ages. Excess death rates for males showed more divergence between the categories of race/ethnicity across the age range.</p><p><strong>Conclusions: </strong>-Mortality rates specific to categories of gender, age and race/ethnicity show sufficient differences as to make them the preferred way to construct life tables. This is especially true in contrast to broader summary measures such as risk ratios, standardized incidence rates, or life expectancy.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36915417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Cell Myeloma - 20-Year Comparative Survival and Mortality of Three Plasma Cell Myeloma ICD-O-3 Oncologic Phenotypes by Age, Sex, Race, Stage, Cohort Entry Time-Period and Disease Duration: A Systematic Review of 111,041 Cases for Diagnosis Years 1973-2014: (SEER*Stat 8.3.4).","authors":"Anthony F Milano","doi":"10.17849/insm-47-04-1-9.1","DOIUrl":"https://doi.org/10.17849/insm-47-04-1-9.1","url":null,"abstract":"<p><strong>Background: </strong>-The values of SEER site recode variables are based on the primary site and histology data fields submitted to SEER by the registries. The site recode variables define the major cancer site/histology groups that are commonly used in the reporting of cancer incidence data and are added to the SEER databases as a convenience for researchers. These codes and definitions are periodically updated and changed by the National Cancer Institute as newer and more applicable information becomes available. Because this myeloma analysis includes cases diagnosed 2010+, the ICD-O-3 recode-updates with adjustment for WHO 2008 hematopoietic histologies that account for changes in the obsolete classification of hematopoietic histology codes, and the assignment of new names (ie, multiple myeloma-MM - to - plasma cell myeloma-PCM) is adhered to and used here. Plasma cell myeloma (PCM) is a bone-marrow based multifocal plasma cell malignancy (primary site C421). PCM is characterized by a single clone of plasma cells, believed to be derived from lymphoid B cells, and spans a clinical spectrum from asymptomatic to aggressive forms, plus disorders caused by the deposition of abnormal immunoglobulin chains in tissue. The current myeloma group ICD-O-3 histologic morphology types consists of: ICD-O-3 9731: Plasmacytoma, NOS, occurring in bone (osseous plasmacytoma malignancy data reportable to SEER only beginning since 1986); ICD-O-3 9732: Plasma cell myeloma - composed of three clinical variants: a) asymptomatic, b) Non-secretory myeloma, and c) Plasma cell leukemia (all coded to 9732); ICD-O-3 9734: Extramedullary plasmacytoma; anatomic sites other than bone.</p><p><strong>Objective: </strong>-Using the statistical database of SEER*Stat 8.3.4 (produced 4/14/2017 for diagnosis years 1973-2014), to assess, determine, compare, and summarize the occurrence, long-term survival and mortality indices of the three morphologic types of myeloma by age, sex, race and stage in two-cohort entry time-periods (1973-1994 and 1995-2014). All analyses are accomplished within the context of current SEER Site Recode ICD-O-3 (1/27/2003) definitions, terminologies and descriptions, and also in accordance with the rules of the consolidated Hematopoietic and Lymphoid Neoplasm Coding Manual data base (effective 1/1/2010 - release date January 2015).</p><p><strong>Methods: </strong>-Population data including 111,041 cases collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Frequency Database (18 SEER Registries Research Data + Hurricane Katrina Impacted Louisiana Cases, November 2016 Submission, 1973-2014 varying) for diagnosis years 1973-2014: Relative Survival Statistics were analyzed in two cohorts: 1973-1994 and 1995-2014. Survival statistics were derived from: SEER*Stat Database: Incidence - SEER 9 Regs Research Data, November 2016 Submission (1973-2014) <Katrina/Rita Population Adjustment> Released April 2017.</p><p","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36884250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Merit-based Claim Adjudication for Cancer Treatment Toxicities - Policy Trends that Lower Downstream Costs.","authors":"Ricky McCullough","doi":"10.17849/insm-47-4-1-13.1","DOIUrl":"https://doi.org/10.17849/insm-47-4-1-13.1","url":null,"abstract":"<p><strong>Background: </strong>-Due largely to the lack of effective therapeutic options, between 1973-2013, chemoradiation toxic mucositis (CRTM) has remained an uncapped expenditure for 40 years, with incremental costs of $17,000-$40,000 per patient per episode. Costs in patient morbidity and mortality have continued as well. A recent therapeutic option associated with complete prevention and/or rapid sustained elimination (high potency polymerized cross-linked sucralfate, HPPCLS) delivers value by eliminating downstream costs CRTM experienced in the first 12 months. While many insurers carry the therapy as a specialty pharmacy support drug, few are familiar with the associated health economic benefits and the statutory requirements driving its coverage.</p><p><strong>Purpose: </strong>-To present the rationale behind early policy trends that frame CRTM as an emergent/urgent medical condition mandated coverage as an essential health benefit. Rather than problematic for costs, this coverage trend appears to be value-based.</p><p><strong>Methods: </strong>-Discuss early adverse claim experience of HPPCLS. Present the costs, tenets and statutes driving policy trend toward obligatory coverage of CRTM. Review the ethical (fiduciary) and statutory requirements for CRTM coverage.</p><p><strong>Results: </strong>-CRTM coverage is ethically responsible since it is a direct consequence of authorized cancer treatment. The symptom/signs complex of CRTM meets the 'prudent layperson' statutory definition of emergency medical condition. All previously uncapped downstream costs of CRTM can be reduced to the cost of therapy, saving $15-$30K per patient per CRTM episode.</p><p><strong>Conclusions: </strong>-Policy trend of CRTM coverage as an emergent/urgent medical condition is a value-based approach of toxicity management, conserving resources, cutting costs and eliminating patient morbidity and mortality.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36979408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All-Cause Mortality for Life Insurance Applicants with a Family History of Coronary Artery Disease Before 60.","authors":"Stephen A Freitas,&nbsp;Ross MacKenzie,&nbsp;David N Wylde,&nbsp;Jason Von Bergen,&nbsp;J Carl Holowaty,&nbsp;Margaret Beckman,&nbsp;Steven J Rigatti,&nbsp;Stacy Gill","doi":"10.17849/insm-47-03-159-171.1","DOIUrl":"https://doi.org/10.17849/insm-47-03-159-171.1","url":null,"abstract":"<p><strong>Objective: </strong>-To determine the all-cause mortality of life insurance applicants having a family history of coronary artery disease (CAD) before age 60.</p><p><strong>Background: </strong>-Epidemiological studies have shown that a family history of premature CAD is an independent risk factor for CAD events. The strength of the association between family history and CAD is greatest with earlier age of presentation of CAD in the family member and when multiple family members are affected. Despite earlier insurance studies on this relationship, there is sparse current data on the association between family history of CAD and all-cause mortality in life insurance applicants.</p><p><strong>Methodology: </strong>-Life insurance applicants with reported family history of Coronary Artery Disease (CAD) were extracted from data covering United States residents between October 2009 and October 2016. Information about these applicants was matched to the Social Security Death Master (SSDMF) file for deaths occurring from 2009 to 2012 and to another commercially available death source file (Other Death Source, ODS) for deaths occurring from 2009 to 2016 to determine vital status. Actual to Expected (A/E) mortality ratios were calculated using the Society of Actuaries 2015 Valuation Basic Table (2015VBT), select and ultimate table (age last birthday). All expected bases were not smoker distinct. Confidence bands around these mortality ratios were calculated. The variables of interest were applicant age, gender, number of family members with CAD before age 60, and the presence of cardiac or cardiovascular conditions.</p><p><strong>Results: </strong>-Overall, the mortality of applicants with family members with a history of CAD before age 60 was slightly lower than expected mortality based on the 2015 VBT. Applicants with a cardiac or cardiovascular comorbid condition had a significantly higher mortality ratio. For applicants aged 25-54 and 65-75 with cardiac comorbid conditions, the mortality ratio was 2 times that of those without a cardiac comorbid condition. For those aged 55-64 with cardiovascular comorbid conditions, the mortality ratio was 2.9 times that of those without a cardiovascular comorbid condition. Females had a slightly higher mortality ratio for all age groups, number of family members with CAD before age 60, and cardiovascular conditions.</p><p><strong>Conclusion: </strong>-A family history of CAD before the age of 60 in an insurance applicant may be associated with increased all-cause mortality. Overall in this study, life insurance applicants had a mortality slightly lower than the expected mortality based on the 2015 VBT. However, applicants with a positive family history and a cardiac or cardiovascular comorbid condition had a significantly higher mortality ratio.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neck Mass in a Five-year-old Afghan Child.","authors":"David S Williams","doi":"10.17849/insm-47-03-191-193.1","DOIUrl":"https://doi.org/10.17849/insm-47-03-191-193.1","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Vanishing Art of Medical Underwriting.","authors":"Robert Goldstone","doi":"10.17849/insm-47-03-172-175.1","DOIUrl":"https://doi.org/10.17849/insm-47-03-172-175.1","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wide QRS Tachycardia on the Holter - What is the Diagnosis?","authors":"Emoke Posan","doi":"10.17849/insm-47-4-1-5.1","DOIUrl":"https://doi.org/10.17849/insm-47-4-1-5.1","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37025260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}