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

This article summarizes the mortality associated with asthma and was created from a presentation given at the 130th AAIM Annual Meeting.

Detecting undisclosed methamphetamine and heroin abuse is a challenge for life underwriters and medical directors. A common clinical assumption is that if substance abusers experience liver damage, it will be indicated by elevated serum transaminases. The following case suggests that assumption may not be true for heavy substance abusers who consume no or minimal alcohol. This report describes a 44-year-old male with long-term use of inhaled combined methamphetamine and heroin ("speedballs") and minimal alcohol use, whose transaminases remained normal while episodes of acute liver failure and transient hepatic encephalopathy from hyperammonemia were observed. In this case, a fatal motor vehicle accident occurred following the sudden onset of hepatic encephalopathy hours after consuming a "speedball." Normal transaminases may not be proof of a normal healthy liver among methamphetamine and heroin abusers.

Critical illness insurance was introduced 40 years ago. Medical directors continue to be challenged and frustrated with the complexities that critical illness claims offer. This article provides insights into the continued issues and possible solutions.

This article summarizes the morbidity and mortality associated with COPD and was created from a presentation given at the 130th AAIM Annual Meeting. The author reviews what most medical directors already know about COPD, but with particular attention paid to the Pulmonary Function Tests dealing with spirometry. Underwriters and medical directors need to understand the three basic measurements of spirometry (FVC, FEV1, and FEF25-75), as well as the significance of the FEV1/FVC ratio, in establishing an applicant as having an obstructive or restrictive impairment.

Objectives: -Determine the relationship between liver function test (LFT) results (GGT, alkaline phosphatase, AST, ALT and albumin) and all-cause mortality in life insurance applicants.

Method: -By use of the Social Security Master Death File, mortality was examined in 15,272,955 insurance applicants for whom blood samples were submitted to the Clinical Reference Laboratory. There were 268,593 deaths observed in this study population, after an average follow-up time of 10.9 years. Results were stratified by sex and by age less/greater than 60, creating 4 groups. Liver function test values were grouped using percentiles of their distribution within these age/ sex groups - so as to update the results generated in prior publications. Additional models were fit using different exclusions and percentile groups within single year age groups. Also, LFTs were treated as continuous variables and included in Cox models with age and smoking status.

Results: -Using the risk of the middle 50% of the population by distribution as a reference, relative mortality observed for GGT and alkaline phosphatase was linear with a steep slope from very low to high values. AST showed a J-shaped association with mortality. ALT showed a low-magnitude inverse correlation with mortality. Albumin demonstrated a higher-magnitude inverse correlation with mortality, especially at values below the median. The overall risk associated with LFTs was durable over at least 10 years of follow-up.

Conclusion: -Liver function tests show a strong and durable correlation to mortality in a large group of insurance applicants. The durability over time suggests that even older values of LFTs found in medical records could be of use in mortality risk prediction.

This article summarizes the results of a retrospective population-based cohort study using the statistical database of SEER*Stat 8.3.54 (produced 3/5/2018 for diagnosis years 1973-2014) to assess, determine, compare, and summarize the occurrence, long-term survival, and mortality indices of 218,066 patients with oral cavity and pharynx cancers by age, sex, race, stage, grade, and disease duration.

This article reviews a 20-year retrospective population-based study using the statistical database of SEER*Stat 8.3.4 to compare the occurrence, long-term survival and mortality indices of 266,898 patients with cancer of the rectum and rectosigmoid junction (RSJ) juxtaposed by age, sex, race, stage, grade, disease duration, in two cohort entry time-periods, 1973-1994 & 1995-2014.

Background and objective: -The traditional role of the insurance medical director is evolving. RGA surveyed insurance medical directors to provide an overview of their roles, skill sets, future trends, and their increasing and changing contributions to the insurance industry in recent years and throughout the current pandemic.

Method: -RGA conducted a first-of-a-kind global survey of medical directors in the insurance industry. The online survey took place from April to June 2021 and had seven key sections: medical experience and qualifications, roles and responsibilities, underwriting and claims capabilities, adapting to change, disease and product trends in insurance, challenges, and future opportunities. Globally, 124 insurance medical directors from 84 companies participated in the survey.

Results: -Respondents are an experienced group of medical directors, with 88% active in the medical profession for 10 years or more. Eighty-seven respondents (70%) dedicate the majority of their time to providing technical medical expertise. Forty-eight percent of medical directors were involved in medical issue briefings prior to the pandemic, and that number increased to 63% during the pandemic. Three of every five respondents (60%) reported a shift in underwriting to an emphasis on more competitive decisions, e-underwriting, and data analytics, while for claims practices, 35% reported a shift to more decisions being challenged and increasing complexity of claims and products. In addition, 31% of insurance medical directors are involved in product development on a regular basis. Only 50% of respondents reported a high or moderate level of investment from employers for training and development with their companies. Forty-three percent of survey respondents are interested in a change of role, especially those with less than 15 years of experience in the insurance industry. Medical directors see data and analytics (50%) as the largest area of development for future growth. Eighty-eight percent of participants surveyed believe that the future role of the medical director in the life and health insurance industry is promising.

Conclusion: -The future of the medical director role will require more strategic responsibilities, greater product development expertise, and stronger data and analytics skills to support insurer needs. It will be important for insurance medical directors to engage in conversations with their employers to discuss their current and emerging roles.