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

Little evidence based information exists in the medical literature on the mortality of abusers of anabolic androgenic steroids. These individuals range from competitive athletes and body builders to those whose who use physician prescribed mega-doses. Life insurance medical directors have little guidance on how to underwrite these individuals when presented with their applications. A recent article presented a Kaplan-Meir mortality curve accompanied with a control population demonstrating the mortality of these individuals over a 13-year period. Users of non-physiologic doses of anabolic androgenic steroids experience a mortality about two times the expected mortality of the control population. They should be underwritten with ratings commensurate with their anabolic androgenic steroid abuse and demonstrated mortality.

Universal Health Insurance does not exist in the United States for two reasons: (1) there is a general unwillingness to dismantle the historically grown framework of the world's most complex mix of public and private sector health coverage and (2) mere cost considerations. The first concern can be abated by establishing a Universal Health Insurance system which retains many or most of the historically grown infrastructure. Cost containment of such a reform is addressed herein in that the two proposed pathways comprise either (1) a leveled solution through Medicare-expansion for the uninsured only or (2) a more complex solution through a national, 2-tier healthcare system for all Americans. Both pathways are based on solid financing without major tax increases by using existing and/or yet untapped funding sources. The insurance consequences for both options are assessable. They are minor for the Medicare-expansion and more wide-ranging, yet also achievable, for a national, 2-tier healthcare system. Universal Health Insurance must no longer be an illusion that continues to haunt our society in the 21st century.

The basic definitions of obstructive sleep apnea (OSA), its epidemiology, its clinical features and complications, and the morbidity and mortality of OSA are discussed. Included in this treatise is a discussion of the various symptomatic and polysomnographic phenotypes of COPD that may enable better treatment and impact mortality in persons with OSA. The goal of this article is to serve as a reference for life and disability insurance company medical directors and underwriters when underwriting an applicant with probable or diagnosed sleep apnea. It is well-referenced (133 ref.) allowing for more in-depth investigation of any aspect of sleep apnea being queried.

As the Covid-19 pandemic continues into its 4th year, reports of long-term morbidity and mortality are now attracting attention. Recent studies suggest that Covid-19 survivors are at increased risk of common illnesses, such as myocardial infarction, diabetes mellitus and autoimmune disorders. Mortality may also be increased. This article will review the evidence that supports some of these observations and provide an opinion about their validity and their relevance to insured cohorts.

Applications of Artificial Intelligence (AI) deep-learning models to screening for clinical conditions continue to evolve. Instances provided in this treatise include using a simple one-view PA chest radiograph to screen for Type 2 Diabetes Mellitus (T2DM), congestive heart failure, valvular heart disease, and to assess mortality in asymptomatic persons with respiratory diseases. This technology incorporates hundreds of thousands of CXRs into a convoluted neural network and is generally named AI CXR. As an example, the AUROC (Area Under Receiving Operator Characteristic) of screening for T2DM was 0.84, with sensitivity and specificities that exceed those of the United States Preventative Services Task Force (USPSTF) guidelines for screening with HBA1c or blood glucose studies. The AUROC's for diagnosing ejection fractions less than 40% was 0.92, and for detecting valvular heart diseases was 0.87. The potential implications for underwriting life and disability policies may be significant. A companion article in the Journal of Insurance Medicine addresses this same technology using a simple 12-lead ECG, generally named AI ECGs.

The life insurance industry is transitioning towards precision underwriting driven by increased data availability and access to advanced analytical tools. Effectively utilizing diverse data sources in life insurance underwriting presents an opportunity for medical directors to fully leverage their skillset in this evolving environment. By navigating these changes, balancing the value of data against its limitations, and fostering collaborative approaches to enhance risk assessment and underwriting processes, medical directors can maintain a pivotal role in the life insurance companies of tomorrow.

Context.—: As the Covid-19 pandemic continues into its 4th year, reports of long-term morbidity and mortality are now attracting attention. Recent studies suggest that Covid-19 survivors are at increased risk of common illnesses, such as myocardial infarction, diabetes mellitus and autoimmune disorders. Mortality may also be increased. This article will review the evidence that supports some of these observations and provide an opinion about their validity and their relevance to insured cohorts.