Although the universal health coverage (UHC) is pursued by many countries, not all countries with UHC include dental care as their benefits. Japan, with its long-held tradition of UHC, has covered dental care as essential benefit and majority of dental care services are provided to all patients with minimal copayment. Being under the UHC, the scope of services as well as prices are regulated by the uniform fee schedule and dentists submit claims according to the uniform format and fee schedule. The author analyzes the publicly available dental health insurance claims data as well as a sampling survey on dental hygiene and illustrates how Japan’s dental care is responding to the challenges of the population ageing.

To gain insight into the real-life care of patients in the healthcare system, data from hospital information systems and insurance systems are required. Consequently, linking clinical data with claims data is necessary. To ensure their syntactic and semantic interoperability, the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) was chosen. However, there is no detailed guide that would allow researchers to follow a consistent process for data harmonization. Thus, the aim of this paper is to conceptualize a generic data harmonization process for OMOP CDM. For this purpose, we conducted a literature review focusing on publications that address the harmonization of clinical or claims data in OMOP CDM. Subsequently, the process steps used and their chronological order were extracted for each included publication. The results were then compared to derive a generic sequence of the process steps. From 23 publications included, a generic data harmonization process for OMOP CDM was conceptualized, consisting of nine process steps: dataset specification, data profiling, vocabulary identification, coverage analysis of vocabularies, semantic mapping, structural mapping, extract-transform-load-process, qualitative and quantitative data quality analysis. This process can be used as a step-by-step guide to assist other researchers in harmonizing source data in OMOP CDM.

Selenium and iodine are essential micronutrients for humans. They are often deficient in food supply due to low phytoavailable concentrations in soil. Agronomic biofortification of food crops is one approach to overcome micronutrient malnutrition. This study focused on German consumers’ willingness to purchase selenium- and/or iodine-biofortified apples. For this purpose, an online survey was carried out. In this context, consumers were asked to choose their most preferred apple product from a set card of product alternatives (Discrete Choice Experiment). The multinomial logit model results demonstrated that German consumers’ have a preference in particular for iodine-biofortified apples. Furthermore, apple choice was mainly influenced by price, health claims, and plastic-free packaging material. Viewed individually, selenium did not exert an effect on product choice whereas positive interactions between both micronutrients exist.

Management of tumor lysis syndrome (TLS) associated with cancer chemotherapy for malignant tumors is important because of its potentially fatal course. The use of rasburicase, a recombinant urate oxidase, is recommended for TLS; however, because rasburicase is an enzymatic drug, one should be cautious of anaphylaxis during administration. Using claims data in Japan, we investigated the rate of rasburicase re-administration and the occurrence of anaphylaxis during re-administration in patients with hematopoietic malignancies in a multicenter setting. Re-administration of rasburicase was defined as administration after an interval of 21 days from the first dose. Of 373 patients, 18 were re-administered with rasburicase (re-administration rate: 4.8%). No patient developed anaphylaxis. The median number of days from the first to the last dose of rasburicase was 256.5 days (interquartile range: 138.8–455.8 days). The median daily dose was 7.5 mg (4.5–11.3 mg), and the median total dose was 33.8 mg (19.1–64.1 mg). This claims database analysis revealed that the re-administration rate of rasburicase was low in Japanese patients with hematopoietic malignancies, suggesting that rasburicase was being used appropriately, and that associated anaphylaxis was not observed.

In the rapidly evolving field of insurance, accurate risk measurement is crucial for effective claims management and financial stability. Therefore, this research presented a systematic literature review (SLR) on insurance claims risk measurement using Hidden Markov Model (HMM). Bibliometric analysis was conducted using VOSviewer and ResearchRabbit software to map research trends and collaboration networks in this topic. The review explored the implementation of HMM in predicting the frequency and magnitude of insurance claims, with a focus on the statistical distribution methods used. In addition, the research emphasized the influence of the number of hidden states in HMM on claims behavior, both in terms of frequency and magnitude, and provided interpretations of these hidden dynamics. Data sources for the review comprised three databases, namely Scopus, ScienceDirect, and Dimensions. The article selection process followed PRISMA guidelines, resulting in five key articles relevant to the topic. The results offered insights into the application of HMM for forecasting the frequency and severity of insurance claims and opened avenues for further investigation on distribution models and hidden state modeling.

One of the challenges in the healthcare sector is making accurate forecasts across insurance years for claims reserve. The state-of-the-art envisages various methods for estimating the claims reserve but without being applied to systems that do not present huge variability and heterogeneity, such as the healthcare sector. The methodology is based on generalized linear models using the Overdispersed Poisson distribution as shown in the state-of-the-art. In this context, we developed a method to estimate the parameters of the quasi-likelihood function using a Gauss-Newton algorithm optimized through a genetic algorithm. The genetic algorithm plays a crucial role in glimpsing the position of the global minimum to ensure a correct convergence of the Gauss-Newton method, where the choice of the initial guess is fundamental. The proposed methodology has been entirely developed using MATLAB and has been applied to estimate the claims reserve in the healthcare system of the Tuscany Region in Italy, as case study. The results obtained were validated by comparing them with the state-of-the-art by measuring the confidence intervals of the Overdispersed Poisson distribution parameters. Therefore local healthcare authorities could use the proposed and improved methodology to allocate the resources dedicated to healthcare and global management.

Medical insurance claims are becoming increasingly common data sources to answer a variety of questions in biomedical research. Although comprehensive in terms of longitudinal characterization of disease development and progression for a potentially large number of patients, population-based studies using these datasets require thoughtful modification to sample selection and analytic strategies, relative to other types of studies. Along with complex selection bias and missing data issues, claims-based studies are purely observational, which limits effective understanding and characterization of the treatment differences between groups being compared. All these issues contribute to a crisis in reproducibility and replication of comparative findings. This paper offers some practical guidance to the full analytical process, demonstrates methods for estimating causal treatment effects on several types of outcomes common to such studies, such as binary, count, time to event and longitudinally varying repeated measures outcomes, and aims to increase transparency and reproducibility. We provide an online version of the paper with readily implementable code for the entire analysis pipeline to serve as a guided tutorial for practitioners. The online version can be accessed at https://rydaro.github.io/. The analytic pipeline is illustrated using a sub-cohort of patients with advanced prostate cancer from the large Clinformatics TM Data Mart Database (OptumInsight, Eden Prairie, Minnesota), consisting of 73 million distinct private payer insurees from 2001-2016.

In this paper we consider type II bivariate generalized power series Poisson distribution as a compound Poisson distribution with bivariate generalized power series compounding distribution. We obtain some properties, p.m.f. and conditional distributions. In addition we also give a brief discussion about the multivariate extension of this case. Then we introduce type II bivariate generalized power series Poisson process and consider a bivariate risk model with type II bivariate generalized power series Poisson model as the counting process. For this model we derive distribution of the time to ruin and bounds for the probability of ruin. We obtain partial integro-differential equation for the ruin probabilities and express its bivariate transform through two univariate boundary transforms,where one of the initial capitals is fixed at zero.

The chain ladder method is a popular technique to estimate the future reserves needed to handle claims that are not fully settled. Since the predictions of the aggregate portfolio (consisting of different subportfolios) in general differ from the sum of the predictions of the subportfolios, a general multivariate chain ladder (GMCL) method has already been proposed. However, the GMCL method is based on the seemingly unrelated regression (SUR) technique which makes it very sensitive to outliers. To address this issue a robust alternative is introduced which estimates the SUR parameters in a more outlier resistant way. With the robust methodology it is possible to detect which claims have an abnormally large influence on the reserve estimates. We introduce a simulation design to generate artificial multivariate run-off triangles based on the GMCL model and illustrate the importance of taking into account contemporaneous correlations and structural connections between the run-off triangles. By adding contamination to these artificial datasets, the sensitivity of the traditional GMCL method and the good performance of the robust GMCL method is shown. From the analysis of a portfolio from practice it is clear that the robust GMCL method can provide better insight in the structure of the data.

Infusions of Camellia sinensis leaves have been known for their health benefits. The ABC method is a method of enriching organic infusion leaves (from Camellia. sinensis) with organic dry and concentrated extracts using organic acacia gum and its application to white tea has provided Qi cha tea®. In the present study, we assessed the content of tea polyphenols and caffeine, and biochemical properties of Qi cha tea® and its botanical constituents. Antioxidant and cell viability activities were determined by the 1,1-diphenyl-2-picrylhydrazyl assay and MTT assay in Caco-2 and human HCT-116 cell lines, respectively. The caffeine, catechin, epicatechin composition of Qi cha tea® was modified with less caffeine and gallic acid and more EGCG than the original white tea. The majority of the tested botanical samples including Qi cha tea® at 50 µg/mL showed similar antioxidant activities, with the exception of Echinacea. The greatest effect was found for white tea. The antioxidant power of the Qi cha tea® (90% at 50 µg/mL for pressurized liquid extraction (PLE) was divided by approximately a factor of 2 (61% at 50 µg/mL for pressurized liquid extraction products (PLEP)) which corresponds to the 48.3 % (mass/mass) white tea original content in the Qi cha tea®. Qi cha tea® showed the lowest activity in the viability of the two cell lines. The application of the ABC (Bio Concentrate Assets®) method to Qi cha tea® using various botanicals and dry extract with the acacia gum as blinder has allowed the development a new innovative functional health beverages which comply with European health claims.

Since the 1970s, the usefulness of nailfold capillaroscopy (NFC) in the diagnosis of rheumatological disorders such as systemic sclerosis has been well known, and further studies also showed that NFC can detect non-rheumatic diseases such as diabetes, glaucoma, dermatitis, Alzheimer disease, and so on. In the past decade, the morphological changes in the nailfold capillary have been also reported in the unhealthy lifestyle habits such as smoking, inappropriate diets, sleep shortage, and even psychological stress which presents slow blood flow. Therefore, study in the relationships between the morphology of nailfold capillaries and lifestyle habits has high potential to understand the unhealthy state, or even predict the pre-disease condition. So, simple, inexpensive, and non-invasive methods such as NFC are constantly needed for routine health checkups. Thus, we undertook a systematic search in PubMed database, and summarized the studies reporting the assessment of morphological NFC in order to undertake a comprehensive review on the usefulness of NFC not only in clinical diagnosis, but also in unhealthy dietary lifestyle improvements. Here in this review paper, we finally summarized the dietary and lifestyle health promotion strategy judging from NFC- and the other relating-measurement from the viewpoint of healthy microvascular blood flow and endothelial function.

Background: All Payer Claims Databases (APCD) are a rich source of health information, however, race and ethnicity (R&E) data are largely missing. Bayesian Improved Surname Geocoding (BISG) is a common R&E imputation method, yet, validation of BISG in APCDs is lacking. We used the BISG to impute missing R&E in the Oregon APCD. Methods: BISG imputed R&E for Asian Pacific Islanders (API), Blacks, Hispanics and Whites were contrasted to the gold standard (vital statistics) and sensitivity and specificity improvements were assessed. Logistic regression examined whether missing R&E was random across patient characteristics. Results: Among 85,857 individuals in the study, 32.1% (n=27,594) had missing R&E. Missing R&E was not randomly distributed. There were higher odds of missingness among males, Whites, those age 65 and older, and commercially insured individuals. Differences in the percent missing were also found by co-morbid conditions and mortality causes. Imputing the missing R&E with BISG method improved the sensitivity to identify White, Black, API, and Hispanics. Conclusions: APCDs can benefit from enhancing missing R&E with BISG imputation to perform more robust population-health level analyses and identify inequities according to R&E without losing power or dropping non-random records with missing R&E data.

In the dynamic arena of healthcare research, where the complexities of data often rival the intricacies of biological systems, the ability to model and analyze such multifaceted datasets is crucial. This comprehensive review delves into the evolution and application of Soft Sets and their extensions, including HyperSoft Sets, SuperHyperSoft Sets, IndetermSoft Sets, IndetermHyperSoft Sets, and TreeSoft Sets, in healthcare claims data analysis. These extensions address intricate challenges in data analysis, offering versatile frameworks for managing uncertainty and indeterminacy inherent in healthcare claims data. By exploring their definitions and applications, this review elucidates how these mathematical tools have evolved and their significance in advancing healthcare research and enhancing data analysis methodologies. Real-world examples underscore the implications of these tools, emphasizing their pivotal role in facilitating informed decision-making and knowledge discovery in healthcare. The review systematically examines various case studies and research findings to illustrate the practical utility of Soft Set extensions. Detailed analyses of real-world scenarios highlight advancements in processing complex healthcare data. The conclusions drawn from this analysis indicate that the adoption of Soft Sets and their extensions can significantly improve the accuracy and efficiency of healthcare data analysis, ultimately contributing to better healthcare outcomes and more informed policy-making. Future research directions are also discussed, suggesting further potential applications and developments in this field.

In actuarial practice, the modeling of total losses tied to a certain policy is a non-trivial task. Traditional parametric models to predict total losses have limitations due to complex distributional features such as extreme skewness, zero inflation, multi-modality, etc., and the lack of explicit solutions for log-normal convolution. In the recent literature, the application of the Dirichlet process mixture for insurance loss has been proposed to eliminate the risk of model misspecification biases; however, the effect of covariates as well as missing covariates in the modeling framework is rarely studied. In this article, we propose novel connections among covariate-dependent Dirichlet process mixture, log-normal convolution, and missing covariate imputation. Assuming an individual loss is log-normally distributed, we develop a log skew-normal Dirichlet process to approximate the log-normal sum. As a generative approach, our framework models the joint of outcome and covariates, which allows to impute missing covariates under the assumption of missingness at random. The performance is assessed by applying our model to several insurance datasets, and the empirical results demonstrate the benefit of our model compared to the existing actuarial models such as the Tweedie-based generalized linear model, generalized additive model, or multivariate adaptive regression spline.

In this paper, we study a generalised CIR process with externally-exciting and self-exciting jumps, and focus on the distributional properties and applications of this process and its aggregated process. The first and second moments of this jump-diffusion process are used to calculate the insurance premium based on mean-variance principle. The Laplace transform of the aggregated process is derived, and this leads to an application for pricing default-free bonds which could capture the impacts of both exogenous and endogenous shocks. Illustrative numerical examples and comparisons with other models are also provided.

Conflicts are frequent within the complex professional environment of the construction industry. If claims cannot be overcome amicably, they result in disputes that lead to litigation. Identification of the causes of these claims and their impact on the duration, cost, and quality of the final project is expected to facilitate the prevention of unsuccessful performance of construction contracts. The novelty of this study is that after codifying the most common causes of construction contract claims derived from the extant literature, they are further investigated in terms of their probability of occurrence and the perceived impact they have on the project completion time, its total cost, and quality. Based on calculated relative importance indices from expert opinion, this paper proposes probability and severity of impact values for 39 common causes of claims in the construction industry. These can be applied to calculate their risk values for stakeholders in public construction contracts to plan mitigation measures of contractual claims. The findings show that the top five riskiest causes of contractual claims in the Greek construction industry are changes in quantities, work, or scope, design quality deficiencies or errors, payment delays, delays in work progress, and the financial failure of the contractor.

This study delves into the dynamics of 'Variations' and 'Claims' within construction projects, specifically under the FIDIC-Red Book 1999 (FIDIC 1999) framework. It aims to identify, categorize, and devise mitigation strategies for key types of Variations and Claims, aligning with the FIDIC Conditions of Contract. The research, drawing on inputs from construction industry professionals including Contract Administrators and Project Managers, focuses on the MENA re-gion. This choice is driven by the region's extensive adoption of FIDIC standards and its rapidly growing construction sector. Data collection encompassed a questionnaire distributed to 80 industry experts, predominantly through interviews, focusing on countries like Saudi Arabia, UAE, Kuwait, and Egypt. These locations were chosen to reflect diverse construction practices and the involvement of international firms. Utilizing SPSS-V.25 for statistical analysis, the study uncovers the most prevalent and impactful causes of Variations and Claims, highlighting the critical need for managerial intervention. A key feature of this study is the integration of Scientometric Analysis for a quantitative review of current literature, providing a comprehensive academic context. A significant addition to the methodology is the implementation of a k-means clustering analysis. This advanced statistical technique further classifies the data into distinct clusters, each representing unique combinations of 'Frequency' and 'Impact' of Variations and Claims. The k-means analysis elucidates intricate patterns and potential solutions, offering profound insights into effectively managing these issues. These analytical advancements are crucial in identifying significant and manageable responses to reduce the frequency and impact of Variations and Claims in construction projects.

This study delves into the dynamics of 'Variations' and 'Claims' within construction projects, specifically under the FIDIC-Red Book 1999 framework. The study aims to identify, categorize, and devise mitigation strategies for key types of variations and claims aligning with the FIDIC conditions of contract. The research is drawing on inputs from construction industry professionals including contract administrators and project managers, focusing on the MENA region. This choice is driven by the region's extensive adoption of FIDIC standards and its rapidly growing construction sector. Data collection encompassed a questionnaire distributed to 80 industry experts predominantly through interviews that focused on countries like Saudi Arabia, UAE, Kuwait, and Egypt. These locations were chosen to reflect diverse construction practices and the involvement of international firms. Utilizing SPSS-V.25 for statistical analysis, the study uncovers the most prevalent and impactful causes of variations and claims, highlighting the critical need for managerial intervention. A key feature is the integration of scientometric analysis for a quantitative finding. A significant addition to the methodology is the implementation of a k-means clustering analysis. The survey had high internal consistency with a Cronbach's alpha of 0.97, and respondents reported frequent and significant claims like delayed drawings, ambiguous documents, and client changes. The results showed that effective claims management requires clear communication and balanced contracts, while poor design and contract documentation cause variations and claims. Spearman's correlation showed strong positive relationships between certain claim types and causes, emphasizing the importance of dealing with these factors to reduce claims. Most respondents said the survey could predict and reduce claims.