THE IMPORTANCE OF BIG DATA AND ARTIFICIAL INTELLIGENCE FOR EFFECTIVE HEALTHCARE INSURANCE PLANS

2021 ◽  
Author(s):  
Mihajlo RABRENOVIC ◽  
◽  
Usman IQBAL ◽  
Keyword(s):  
Health Care ◽  
Big Data ◽  
Multidisciplinary Approach ◽  
Business Activity ◽  
Health Care Insurance ◽  
Quality Of Information ◽  
Healthcare Insurance ◽  
Managing Risk ◽  
Organizational Science

Big data is a complex noun that marks sets of data in various formats. Th ere are a lot of challenges in dealing with them, including how to store, search, analyze and share them. In this paper, co-authors deal with relation of big data and artifi cial intelligence and eff ective healthcare insurance plans. In the analysis is taken into account that insurance as a business activity is critically connected to managing risk. In the paper is tested hypothesis: the quality of understanding risks in health care insurance is directly connected to the quality of information. Th is subject requires multidisciplinary approach that includes: informatics, legal and organizational science as well as insurance in health care.

ADHD Diagnosis and Drug Use Estimates in France: A Case for Using Health Care Insurance Data

2020 ◽  
pp. 108705472090566
Author(s):  
Sébastien Ponnou ◽  
Héloïse Haliday
Keyword(s):  
Health Care ◽  
Prevalence Rate ◽  
Health Care Insurance ◽  
National Agency ◽  
Adhd Diagnosis ◽  
Prevalence Studies ◽  
National Health Care ◽  
Health Products ◽  
Prescription Rates ◽  
Healthcare Insurance

Objective: Prevalence estimates for ADHD have been debated for decades. In France, the only available study states the prevalence rate in France ranges from 3.5% to 5.6% of children aged 6 to 12. It also evaluates that 3.48% of children aged 6 to 12 are treated with psychostimulants. The article uses a different method to determine whether these estimates hold true. Method: Estimating ADHD diagnosis and methylphenidate prescription rates can be done by analyzing national health care insurance system’s data. We used data from the French Healthcare Insurance as reported by the National Agency for Medicines and Health Products Safety. Results: We claim that an adequate estimate of the ADHD prevalence rate in France fluctuates around 0.3% of children aged 6 to 11. Discussion: Methodological biases in ADHD prevalence studies and factors contributing to the low level of prescription in France need to be assessed. Conclusion: We call for supplementary investigations in health care insurance databases to conduct contradictory studies.

A Regional Health Care Network: eHealth.Braunschweig

2012 ◽  
Vol 51 (03) ◽  
pp. 199-209 ◽  
Author(s):  
T. Bartkiewicz ◽  
W. Bautsch ◽  
A. Gerlach ◽  
M. Goldapp ◽  
R. Haux ◽  
...  
Keyword(s):  
Health Care ◽  
Information Processing ◽  
Regional Health ◽  
Quality Of Information ◽  
Care Network ◽  
Healthcare Network ◽  
Regional Health Care ◽  
Quality Of Patient Care ◽  
Health Care Network

SummaryBackground: Health care network eHealth.Braunschweig has been started in the South-East region of Lower Saxony in Germany in 2009. It composes major health care players, participants from research institutions and important local industry partners.Objectives: The objective of this paper is firstly to describe the relevant regional characteristics and distinctions of the eHealth.Braunschweig health care network and to inform about the goals and structure of eHealth.Braunschweig; secondly to picture and discuss the main concepts and domain fields which are addressed in the health care network; and finally to discuss the architectural challenges of eHealth.Braunschweig regarding the addressed domain fields and defined requirements.Methods: Based on respective literature and former conducted projects we discuss the project structure and goals of eHealth.Braunschweig, depict major domain fields and requirements gained in workshops with participants and discuss the architectural challenges as well as the architectural approach of eHealth.Braunschweig network.Results: The regional healthcare network eHealth.Braunschweig has been established in April 2009. Since then the network has grown constantly and a sufficient progress in network activities has been achieved. The main domain fields have been specified in different workshops with network participants and an architectural realization approach for the transinstitutional information system architecture in the healthcare network has been developed. However, the effects on quality of information processing and quality of patient care have not been proved yet. Systematic evaluation studies have to be done in future in order to investigate the impact of information and communication technology on the quality of information processing and the quality of patient care.Conclusions: In general, the aspects described in this paper are expected to contribute to a systematic approach for the establishment of regional health care networks with lasting and sustainable effects on patient-centered health care in a regional context.

Tonsillectomy: assessment of quality by consultation rate after discharge

1999 ◽  
Vol 113 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Jeanne A. Rungby ◽  
Frans Rømeling ◽  
Peter Borum
Keyword(s):  
Health Care ◽  
Prospective Study ◽  
Health Care Professionals ◽  
Short Term ◽  
Consultation Rate ◽  
Quality Of Information ◽  
Quality Of Treatment ◽  
Pain Scores ◽  
Maximum Pain

AbstractThe aim of this prospective study was to establish a measure of short-term quality of treatment after tonsillectomy/adenotonsillectomy. One hundred and thirty-four questionnaires, returned after 14 days, from 41 children and 93 adults were analysed. Forty-seven per cent had one or more consultations with health-care professionals. Eighty-three consultations by telephone and 33 consultations in person were made. Two recent studies reported higher consultation rates in person to doctors compared to this study. The predominant reason for consulting health-care professionals was pain. Maximum pain scores were significantly higher among those with consultations vs. no consultations (p = 0.0001). Additionally, the intensity as well as the duration of maximal pain increased with the number of contacts per patient (p = 0.0001, p = 0.0045). Sixty-four per cent felt relieved after consultation by telephone and 83 per cent felt relieved after consultation in person. The present study suggests consultation rate as a parameter of quality of treatment and quality of information.

scholarly journals Nutritional interventions among old people receiving support at home

2018 ◽  
Vol 77 (3) ◽  
pp. 265-269 ◽  
Author(s):  
Anne Marie Beck
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Multidisciplinary Approach ◽  
Screening Tools ◽  
Nutritional Risk ◽  
Old People ◽  
Nutritional Interventions ◽  
Care Costs ◽  
At Home

With the focus of care shifting from the hospital to the community, supportive nutritional care to old people is to become an important issue to address in the community, since undernutrition has serious consequences, both for the quality of life and for the health care costs. Several modifiable nutritional risk factors relate to undernutrition. Unfortunately, the problem with (risk of) undernutrition is aggravated due to a lack of alertness among e.g. health care staff, leading to insufficient attention for systemic screening and nutritional care. Only a few of the existing screening tools have been validated among old people receiving support at home. Few studies have assessed the beneficial effect of nutritional support among old people in their own home, and recently, it was concluded that such have shown limited effects. One reason may be that the nutritional interventions performed have not taken the multiple nutritional risk factors afore-mentioned into consideration when formulating the action/treatment plan and hence not used a multidisciplinary approach. Another reason may be that the intervention studies have not used validated screening tools to identify those old people most likely to benefit from the nutritional support. However, three recent studies have used a multidisciplinary approach and two have proven a beneficial effect on the quality of life of the old people and the health care costs. These findings suggest that when planning nutritional intervention studies for old people receiving support at home, modifiable nutritional risk factors should be taken into consideration, and a multidisciplinary approach considered.

STUDY OF DERMATOLOGICAL EMERGENCIES AT A TERTIARY HEALTH CARE INSTITUTION

2021 ◽  
pp. 12-14
Author(s):  
V. Lakshmi Sarojini ◽  
T. Sahitya ◽  
Ch. Sowjanya
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Intensive Care ◽  
Multidisciplinary Approach ◽  
Morbidity Rate ◽  
Drug Reactions ◽  
Institutional Level ◽  
Study Centre ◽  
Set Up

Introduction:- Dermatological emergencies represent 8-20% of the emergencies presenting to emergency department. There are varying etiologies for these emergencies from neonatal age to adults . Aims and objectives:- To improve awareness of the need for intensive medical care with a multidisciplinary approach by a team of specialist doctors (physicians , intensivists, paediatricians etc., ) along with dermatologists thus to decline the fatality & morbidity rate in dermatological emergencies . Methodology:- All cases presenting to DVL OP , Casuality , intensive care units of the study centre requiring emergency dermatological consultation were included . The results are analysed for age , sex wise distribution and total number of cases as per etiology and outcome of the disease. Results:- Out of the 158 cases studied over a period of 9 months , 88 were males and 70 were females, among which 35 were children. True dermatological emergencies were 46 , other 112 required dermatological consultation on emergency basis . The main etiological factors are infections(34) , drug reactions (27) , vesiculobullous dermatoses(17) etc. Mortality seen in 4 cases . Conclusion:- During the study we learnt that multidisciplinary approach improves the quality of management and nal outcome. Gaining prociency at an institutional level which has a DICU set up with multidisciplinary approach will enable upcoming dermatologists to establish a hospital set up which can manage dermatological emergencies condently instead of limiting to clinical setup.

scholarly journals AN EFFECTIVE HEALTH CARE INSURANCE FRAUD AND ABUSE DETECTION SYSTEM

2017 ◽  
Vol 15 (2) ◽  
pp. 1-12
Author(s):  
A J IKUOMOLA ◽  
O E Ojo
Keyword(s):  
Health Care ◽  
Service Providers ◽  
Detection System ◽  
Health Care Expenditure ◽  
Claim Database ◽  
Insurance Fraud ◽  
Health Care Insurance ◽  
Health Care Fraud ◽  
Effective System ◽  
Healthcare Insurance

Due to the complexity of the processes within healthcare insurance systems and the large number of participants involved, it is very difficult to supervise the systems for fraud. The healthcare service providers’ fraud and abuse has become a serious problem. The practices such as billing for services that were never rendered, performing unnecessary medical services and misrepresenting non-covered treatment as covered treatments etc. not only contribute to the problem of rising health care expenditure but also affect the health of the patients. Traditional methods of detecting health care fraud and abuse are time-consuming and inefficient. In this paper, the health care insurance fraud and abuse detection system (HECIFADES) was proposed. The HECIFADES consist of six modules namely: claim, augment claim, claim database, profile database, profile updater and updated profiles. The system was implemented using Visual Studio 2010 and SQL. After testing, it was observed that HECIFADES was indeed an effective system for detecting fraudulent activities and yet very secured way for generating medical claims. It also improves the quality and mitigates potential payment risks and program vulnerabilities. 

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