CMS is investigating techniques that might help identify costly physician practice patterns. One method presently under evaluation is to compare resource use for certain episodes of care using commercially available episode grouping software. Although this software has been used by the private sector to classify insured individuals' medical claims into episodes of care, it has never been used w...

Australia has extensive administrative health data collected by Commonwealth and state agencies. The value of the health data is how quickly and effectively the data can be converted into useful knowledge independent of its quantity and quality. Using a unique cleaned and linked administrative health dataset we address the problem of empirically defining episodes of care. An episode of care is ...

BACKGROUND A large group of patients of Ladek Zdrój spa consists of people with disabilities confirmed by objective tests performed under the pension prevention program of the Social Insurance Institution (ZUS). The purpose of disability prevention is to improve the health conditions to the extent required to continue work. The aim of the study was to identify the differences in the assessment ...

The multi-state life insurance contract is reconsidered in a framework of securitization where insurance claims may be priced by the principle of no arbitrage. This way a generalized version of Thiele’s differential equation (TDE) is obtained for insurance contracts linked to indices, possibly marketed securities. The equation is exemplified by a traditional policy, a simple unit-linked policy ...

Health maintenance organization (HMO) administrative databases have been used as sampling frames for ascertaining nonmelanoma skin cancer (NMSC). However, because of the lack of tumor registry information on these cancers, these ascertainment methods have not been previously validated. NMSC cases arising from patients served by a staff model medical group and diagnosed between 1 January 2007 an...

The lower level of school quality available for blacks relative to whites in the segregated era is frequently cited as a primary cause for the currently observed gap in black-white average wages. The inferior education provided to black children is argued to have caused lower levels of human capital production in black schools than white schools The gap in black-white wages can be traced to thi...

we show a lot of respect for science today. to back up our claims, we tend to appeal to scientific methods. it seems that we all agree that these methods are effective for gaining the truth. we can ask why science has its special status as a supplier of knowledge about our external world and our bodies. of course, one should not always trust what scientists say. nonetheless, epistemological jus...

The Nutrition Labeling and Education Act (NLEA), which amended the Federal Food, Drug, and Cosmetic Act in 1990, authorized the use of health claims that are based on significant scientific agreement in food labeling. In 1994, the Dietary Supplement Health and Education Act (DSHEA) defined dietary supplements and created a legal framework for use of claims that is similar to the regulation of f...

BACKGROUND Women with ovarian cancer have reported abdominal/pelvic pain, bloating, difficulty eating or feeling full quickly, and urinary frequency/urgency prior to diagnosis. We explored these findings in a general population using a dataset of insured women aged 40-64 and investigated the potential effectiveness of a routine review of claims data as a prescreen to identify women at high risk...