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

The legal regulation of healthcare insurance is currently a major challenge for Ukraine in times of war, as the ongoing hostilities have created a pause in the full financing of the healthcare system, including healthcare insurance and ensuring access to healthcare for all citizens. That is why one of the most important issues on Ukraine's agenda is its desire to improve and modernise the existing healthcare system in line with the latest trends in healthcare insurance during the profound transformation of the country in the face of the challenges of war. The purpose of the study is to identify the specific features of legal regulation of medical expense insurance, to make a comparative analysis of international experience, and to provide recommendations on the prospects for the development of medical expense insurance in Ukraine. To achieve this goal, we used the following methods of scientific knowledge: general philosophical method, method of systemic analysis and synthesis, comparative legal method, dialectical method, methods of deduction, and induction. The practically significant conclusions and proposals obtained in the course of the thorough research are aimed at bridging the gap between the best practices implemented in other countries and the current realities of Ukraine. Taken together, this approach will help ensure the sustainability and smoothness of healthcare provision and compliance with the specifics of healthcare insurance.

The study examines the importance of legal regulation of access to health services and insurance programs for persons with mental disorders in Ukraine, taking into account modern challenges, in particular the impact of war on the mental health of the population. In conditions of extraordinary psycho-emotional burden and imperfect regulatory framework, analysis can help to improve legislation using the experience of highly developed countries. This study uses methods of analysis, synthesis, induction, deduction, dialectical, analytical, analogy and generalization. The goal is to develop recommendations for integrating international standards that will provide comprehensive protection of patients' rights and access to effective medical care even in crisis conditions. The conflict in Ukraine has further exacerbated mental health problems, with a growing demand for psychological and psychiatric care due to trauma related to war, displacement, and constant stress. Current legislation does not meet modern psycho-emotional needs. Legislative inconsistencies, funding gaps, and terminological uncertainty impede access to basic medical services and insurance programs. Establishing a unified legal framework aligned with international standards is crucial to ensuring comprehensive health care and protecting patients' rights.

In the past, the chest X-ray (CXR) was a traditional age and amount requirement used to assess potential mortality risk in life insurance applicants. It fell out of favor due to inconvenience to the applicant, cost, and lack of protective value. With the advent of deep learning techniques, can the results of the CXR, as a requirement, now add additional value to underwriting risk analysis?

Background.—: In principle, it is generally accepted that DNA methylation measures can be used to predict mortality. However, as of yet, no epigenetic metric has been successfully incorporated into underwriting procedures. In part, this failure results from the relative incompatibility of many DNA methylation measures with conventional underwriting practices.

Objective.—: To test the ability of previously established epigenetic markers of smoking, drinking and diabetes to standard lipid-based approaches for predicting mortality.

Method.—: We constructed a series of Cox proportional hazards models for mortality using clinical data and DNA methylation data from 4 previously described loci from the Framingham Heart Study.

Results.—: The incorporation of vital signs, standard lipid and diabetes laboratory assessments to a base model consisting of age and sex only modestly increased prediction of mortality from 0.732 to 0.741 area under the curve (AUC). However, the addition of epigenetic marker information for smoking and drinking to the base model markedly increased prediction (AUC=0.787) while the addition of epigenetic marker for diabetes increased prediction even further (AUC=0.792).

Conclusion.—: These results demonstrate the potential of simple interpretable, epigenetic models to predict mortality in a manner compatible with standard underwriting procedures. Potentially, this epigenetic approach using rapid methylation sensitive digital PCR procedures that can utilize saliva or whole blood DNA would increase prediction power even further while facilitating more accurate accelerated underwriting assessments of mortality.

Objective.—: To demonstrate a method which is being used to apportion between risk factors for occupationally related disease and compensate individuals with multiple risk factors. The application to individuals will be demonstrated for varicose veins.

Background.—: The National Insurance Institute (NII) is tasked with compensating work related injuries and illness in Israel. Population attributable fraction (PAF) has been utilized in order to estimate the amount of disease that can potentially be eliminated in a population through the elimination of individual risk factors. PAF is based on relative risks and the prevalence of these risks.

Methods.—: A review of the medical literature consisting of epidemiological studies of varicose veins and its multiple risk factors was conducted, with special attention to prolonged occupational standing. Summary, weighted, relative risks were calculated for eight different risk factors. The proposed formula then allowed for apportioning among those risk factors in the individual.

Results.—: The findings of the current study indicate that prolonged standing may be associated with the presence of varicose veins, however in light of the multiple other risk factors associated, its overall contribution is generally minor.

Conclusion.—: Apportionment among multiple risk factors for varicose veins can be accomplished mathematically in individuals. This application is being applied successfully for other diseases as well.

Moral hazard is well known to life insurance underwriters and medical directors to increase the risk of adverse consequences to insured individuals. The underwriting investigation of proposed insureds at time of policy issue is done to ensure no likely moral hazard exists. However, not all situations involving moral hazard may be identified at time of underwriting and policy issue, and may only be identified at time of claim. Three cases that were underwritten for life expectancies in legal matters are described here as examples of moral hazard identified at time of severe injury and/or death. All three of these cases involved a woman who manipulated her male partner into situations that increased the man's risk of severe injury and/or death to the woman's financial benefit. Such "black widows" made a great deal of effort over an extensive period of time to ensure that the moral hazard set up for their male partners resulted in a substantial financial windfall through litigation. The moral hazard set up by a black widow thus can be considered by the life insurance industry as sufficiently anti-selective and speculative to deny a claim at any time after policy issue.