Machine learning models outperform traditional actuarial methods in predicting health insurance costs.
problem Improving accuracy in health insurance pricing to identify concession opportunities.
method Developed and evaluated two machine learning models at the patient and employer-group levels.
result Machine learning models outperformed traditional actuarial models by 20% in predicting costs.
The distribution of health care payments to insurance plans has substantial consequences for social policy. Risk adjustment formulas predict spending in health insurance markets in order to provide fair benefits and health care coverage for all enrollees, regardless of their health status. Unfortunately, current risk a…
Deep neural network predicts health costs better than traditional models.
problem Accurate prediction of healthcare costs for optimal cost management.
method Developed a deep neural network to predict future health care costs from health insurance claims records.
result Deep neural network outperformed ridge regression and Morbi-RSA models in cost prediction.
Improved disability insurance model with collective health claims.
problem Enhance disability insurance model with collective health claims.
method Expand classic semi-Markov model with collective health claims, solve many-body problem using mean-field approach.
result Mean-field approach simplifies complex model into a transparent pricing method.
This note fills the gap in market-consistent valuation of lifelong health insurance products.
problem Market-consistent valuation of lifelong health insurance products is not well-addressed.
method Constructs a valuation portfolio to separate Best Estimate into policy data and financial instrument prices.
result The Best Estimate valuation is not uniquely determined by prevailing term structures and requires a stochastic model.
Two machine learning models detect anomalies in ER claims, saving up to 40% in improper payments.
problem Improper health insurance payments from fraud and upcoding.
method Two machine learning models: an upcoding model based on severity code distributions and a random forest model for claim sorting.
result Random forest model saved 12% to 40% in improper payments compared to a baseline approach.
Fraud causes substantial costs and losses for companies and clients in the finance and insurance industries. Examples are fraudulent credit card transactions or fraudulent claims. It has been estimated that roughly 10 percent of the insurance industry's incurred losses and loss adjustment expenses each year stem from…
Alternative model predicts health insurance reimbursement based on contract limitations.
problem Estimating the ratio of reimbursement to health care expenditures after deductibles and copayments.
method Proposes a Zero-One Inflated Beta regression model using GAMLSS.
result The model provides a dependency structure between reimbursement and contract limitations.
High quality risk adjustment in health insurance markets weakens insurer incentives to engage in inefficient behavior to attract lower-cost enrollees. We propose a novel methodology based on Markov Chain Monte Carlo methods to improve risk adjustment by clustering diagnostic codes into risk groups optimal for health ex…
Study decomposes racial healthcare disparities via shifts in mediator distributions.
problem Racial disparities in healthcare expenditures and their underlying drivers.
method Framework decomposing disparities into mediator distribution shifts and residual components, using MEPS data.
result Substantial disparities persist even when mediators are equalized, suggesting unmeasured or structural factors.
Study clusters Kenyan medical insurance companies based on financial performance and reporting consistency.
problem Identifying financial health and reporting consistency in Kenyan medical insurance companies.
method Advanced clustering techniques (KMeans, DTW) on financial ratios and time series data.
result Four distinct clusters identified, each representing different financial performance and reporting consistency combinations.
Model evaluates insurance risk using thermodynamic principles.
problem Risk of lapses due to adverse selection in insurance.
method Collective model with diffusion process influenced by statistical mechanics.
result Derives level premium to evaluate insurance risk.
Study on excess mortality in Germany during 2020-21.
problem Analyzing excess mortality during the pandemic in Germany.
method Empirical study using official death counts.
result Provided conclusions for insurance businesses.
Recently it's been shown that neural networks can use images of human faces to accurately predict Body Mass Index (BMI), a widely used health indicator. In this paper we demonstrate that a neural network performing BMI inference is indeed vulnerable to test-time adversarial attacks. This extends test-time adversarial a…
Study assesses health plan risk measures for Solvency Capital Requirement.
problem Assessing risk measures for health plans to meet Solvency Capital Requirement.
method Three-part regression model with three GLMs for claim counts, episode allocation, and severity.
result Reduction in regression models compared to traditional methods.
Insurance companies must manage millions of claims per year. While most of these claims are non-fraudulent, fraud detection is core for insurance companies. The ultimate goal is a predictive model to single out the fraudulent claims and pay out the non-fraudulent ones immediately. Modern machine learning methods are we…
Deep learning predicts drug prescriptions across global health records.
problem Predicting drug prescriptions in chronic disease patients.
method Adaptive cross-global attention graph kernel network with support vector machine.
result Model outperforms current methods in accuracy and interpretability.
The paper tackles robust control for insurance contracts under uncertain transition rates.
problem Maximizing utility in insurance contracts with uncertain transition rates.
method Novel robust utility maximization problem under bounded cumulative transition rate uncertainty, using worst-case scenario analysis.
result Existence and uniqueness of worst-case and best-case reserves for insurance contracts.
Unified framework for fair pricing in long-term insurance products.
problem Unclear generalization of fair pricing methods to long-term products.
method Reformulate multi-state transition models as Poisson regression problems.
result Direct application of existing fair pricing methods to long-term insurance products.
Study predicts high-cost patients using insurance claims data.
problem Accurately identifying high-cost patients to manage costs.
method Applied machine learning to health insurance claims data.
result Developed a high-performance algorithm with 91.2% AUC.
Early diagnosis is important for type 2 diabetes (T2D) to improve patient prognosis, prevent complications and reduce long-term treatment costs. We present a novel risk profiling approach based exclusively on health expenditure data that is available to Belgian mutual health insurers. We used expenditure data related t…
Enhanced Tweedie model for insurance claims using CatBoost.
problem Accurately modeling aggregate claims with zero-inflated data.
method Refined Tweedie model with boosting methods in CatBoost.
result Marked improvement in model performance for insurance analytics.
Model quantifies cyber-attacks' impact on firms and insurers.
problem Impact of cyber-attacks on firms' revenues and insurers' portfolios.
method Stochastic SIR model coupled with granular firm growth model.
result Predicts insurer needs to compensate up to two days of revenue in a 100-day incident.
The paper models SaaS products as insurance, offering new pricing tools.
problem Modeling capped-usage SaaS products with insurance principles.
method Frequency-severity decomposition, premium calculation, Monte Carlo simulations.
result SaaS pricing can be analyzed using insurance actuarial methods.
A Longitudinal Attribute-Conditioned Neural Network (LANTERN) framework for modeling health-state transition probabilities in irregular longitudinal data.
problem Estimating long-term care transition probabilities in irregular longitudinal health data.
method A neural network that learns from individual health history, incorporates time elapsed, and conditions on demographic and socioeconomic attributes.
result Improves severe disability discrimination and maintains strong calibration.
The paper develops a filtering framework for estimating hazard rates with jumps in financial and insurance applications.
problem Estimating hazard rates with unobservable change-points in financial and insurance contexts.
method Continuous-time filtering framework using progressive enlargement of filtration, stochastic differential equations, and sensitivity analysis.
result Explicit formula for survival probability conditional on partial information.
The paper develops a valuation framework for GLWB-LTC contracts with Levy dynamics and stochastic interest rates.
problem Valuation of GLWB-LTC contracts with financial guarantees, longevity protection, and health-contingent LTC payments.
method Coupling a recombining Hull-White trinomial tree with an IMEX finite difference scheme, incorporating a seven-state health model.
result Hybrid tree-IMEX method delivers stable long-maturity prices consistent with simulation benchmarks.
In this paper we explore different regression models based on Clusterwise Linear Regression (CLR). CLR aims to find the partition of the data into k clusters, such that linear regressions fitted to each of the clusters minimize overall mean squared error on the whole data. The main obstacle preventing to use found re…
Proposes GLWB-LTC for enhanced life care annuities with dynamic withdrawal strategies and stochastic interest rates.
problem Improving life care annuity features and pricing methods.
method Introduces GLWB-LTC with dynamic withdrawal strategies and stochastic interest rates. Solves the stochastic control problem using a robust tree method.
result Optimal withdrawal strategies vary over time with policyholder's health status, highlighting the advantage of flexibility.
Though there is a growing body of literature on fairness for supervised learning, the problem of incorporating fairness into unsupervised learning has been less well-studied. This paper studies fairness in the context of principal component analysis (PCA). We first present a definition of fairness for dimensionality re…
There is an increasing interest in estimating heterogeneity in causal effects in randomized and observational studies. However, little research has been conducted to understand heterogeneity in an instrumental variables study. In this work, we present a method to estimate heterogeneous causal effects using an instrumen…
With the increased availability of large databases of electronic health records (EHRs) comes the chance of enhancing health risks screening. Most post-marketing detections of adverse drug reaction (ADR) rely on physicians' spontaneous reports, leading to under reporting. To take up this challenge, we develop a scalable…
Deep Claim predicts payer responses from claims data using deep learning.
problem Predicting payer responses from claims data to improve healthcare performance.
method Learning complex dependencies in claim inputs to create a compact representation, then using deep learning to predict responses.
result Deep Claim improves claim denial prediction by 22.21%.
It is not clear how to target patients who are most likely to benefit from digital care management programs ex-ante, a shortcoming of current risk score based approaches. This study focuses on defining impactability by identifying those patients most likely to benefit from technology enabled care management, delivered …
Study insurance pricing under correlation ambiguity without increasing prices or reducing utility.
problem Understanding the dependence structure between insurance and financial risks.
method Dynamic equilibrium analysis of insurance pricing with worst-case beliefs.
result Correlation ambiguity does not necessarily increase insurance prices or reduce insurers' utility.
Paper proves Pareto efficient insurance for multiple entities.
problem Optimizing insurance for multiple policyholders and insurers.
method Sum-minimization characterization and pairwise implementability analysis.
result Characterization of Pareto efficient insurance arrangements.
New insights show Medicaid impacts on ED use vary widely, with some groups seeing significant increases.
problem Understanding the varied impacts of Medicaid on emergency department use.
method Causal machine learning methods to identify heterogeneous impacts.
result Meaningful heterogeneity in the effect of Medicaid on ED use, with a small group driving the overall effect.
Objective: Patient notes in electronic health records (EHRs) may contain critical information for medical investigations. However, the vast majority of medical investigators can only access de-identified notes, in order to protect the confidentiality of patients. In the United States, the Health Insurance Portability a…
Study on systemic risk in European insurance sector, showing insurer connections during stress.
problem Understanding systemic risk connectedness in European insurance sector.
method Common connectedness framework applied to returns, volatility, value-at-risk, and expected shortfall.
result Insurers are a significant component of systemic risk connectedness, especially during stress episodes.
The paper examines how risk reduction and insurance choices interact under convex premium principles.
problem Interaction between self-protection and insurance demand under convex premium principles.
method Investigates optimal prevention efforts and insurance shares using distortion risk measures.
result Self-protection and insurance are complementary, but ex ante moral hazard can turn this into a substitution effect.
Parametric insurance offers better risk-sharing in high-risk settings than traditional indemnity insurance.
problem High-risk environments where traditional indemnity insurance is unaffordable or ineffective.
method Comparison of excess-of-loss indemnity insurance and parametric insurance within a mean-variance framework, considering fixed costs and binding budget constraints.
result Parametric insurance yields higher welfare for risk-averse individuals, especially when indemnity insurance is impractical.
The paper examines insurance market dynamics and optimal regulation.
problem Equilibrium outcomes in dynamic insurance markets.
method Analyzes three equilibrium outcomes: positive, zero, and market failure.
result Insurers may accept underwriting losses by investing profits, especially with negative correlations.
We consider an investor who wants to select her/his optimal consumption, investment and insurance policies. Motivated by new insurance products, we allow not only the financial marke but also the insurable loss to depend on the regime of the economy. The objective of the investor is to maximize her/his expected total d…
Optimal insurance contract limits insurer's risk exposure variance.
problem Designing an optimal insurance contract limiting insurer's risk exposure variance.
method Derive optimal policy semi-analytically, focusing on actuarially fair case.
result Expected coverage is larger for wealthier insured, indicating normal good.
Paper models demand and solvency for index insurance, combining traditional and measurable index-based coverage.
problem Reducing protection gaps for emerging risks.
method Develops a model for demand and solvency conditions, combining traditional and index-based insurance.
result Deduces a product that benefits from both traditional and index-based insurance approaches.
Two pension funds mutually insure against longevity risk.
problem Mutual insurance against systematic longevity risk for pension funds.
method Mathematical demonstration and market clearing condition.
result Insurance provides little benefit when fund preferences are similar, but can be beneficial when preferences vary significantly.
Reinsurance can help life insurers maintain higher capital guarantees without losing utility.
problem Decreasing capital guarantees in life insurance products.
method Dynamic investment-reinsurance optimization problem with simultaneous Value-at-Risk and no-short-selling constraints. Introduced guarantee-equivalent utility gain for comparison.
result Optimally managed reinsurance allows insurers to offer higher capital guarantees without reducing expected utility.
The paper introduces a new model to correct bias in treatment effect estimates due to sample selection.
problem Bias in treatment effect estimates due to sample selection.
method Type 2 Tobit Bayesian Additive Regression Trees (TOBART-2) with Dirichlet Process Mixture distribution and soft trees.
result Corrects bias in treatment effect estimates by accounting for nonlinearities and model uncertainty.