Within all large consumer facing organizations, most decisions about how to deal with people are made automatically by computerized decision making systems. Information about people, their lifestyle and past behavior are used to predict how they are expected to behave in the future. It can be determined if someone applying for a bank loan will make their repayments, who will respond to a marketing communication and the likelihood that someone will claim on their insurance policy. This book provides a step-by-step guide to how Predictive Analytics is used by some of the world's most influential organizations. This includes international banks, leading insurance providers, credit reference agencies and national governments. It covers all stages of the Predictive Analytics process. This includes project management, data collection, sampling, data transformation and pre-processing, model construction, validation, implementation and post-implementation monitoring of the model's performance.
Statistics published by the U. S. Department of Commerce (1980) indicate that in 1977 we spent 8. 1% of our gross national product (GNP) on life, health, property-casualty, and other forms of insurance. An additional 5. 7% was used to pay the Social Security tax, which is another form of insurance premium, for a total of 14. 8% of the GNP. Although insurance had its historical origin in marine insurance, it has now developed into one of the major industries of the American economy and extends into many areas of economic activity. One area where growth has been particularly strong is the medical sector. Health insurance is a major institution in all industrialized countries. It became a government responsibility in 1883 when Bismarck intro- duced a compulsory program of health insurance for industrial workers in Germany. Programs for workers in various industrial and income categories soon followed in other European countries-Austria (1888), Hungary (1891), Norway (1909), Servia (1910), Great Britain (1911), and Russia and Romania (1912) (Rubinow, 1913:250). Programs in these countries were extended in subsequent years, and other countries in Europe followed with their own programs. Consequently, today most industrial countries have universal or near-universal health insurance coverage. In the United States the issue of national health insurance has been seriously debated since just prior to World War I, and polling data since the 1930s show that a substantial majority of the public has been supportive of such a program (Erskine, 1975).
The social security systems that, perhaps more than any other governmental programs, have characterized the development of industrial societies are under siege. On the threshold of the twenty-first century, the future of social insurance is uncertain; it may even be seriously threatened.
In this important book, nine leading scholars probe deeply into the nature of social rights, trying to read the near future and locate the most meaningful and effective role that social insurance can play as today's new socioeconomic patterns develop.
In-depth chapters analyse existing systems and recent and ongoing reforms in seven countries--Germany, the United Kingdom, Sweden, the United States, Japan, Taiwan, and China. There is also a chapter on the European Union's work toward a harmonised scheme to match other programs of integration, and a chapter on the all-important interpenetration of social insurance and human rights. The authors clearly demonstrate that the unprecedented challenges faced by social insurance today arise not only from changes in the patterns of society, but also from lack of confidence and ideological prejudice on the part of both academia and public policy.
As a major analysis of why and how a great milestone in human progress is faltering under contemporary pressures, this book is of enormous value. It deserves to be read and absorbed by all professionals in the field who want to use their knowledge and skill to ensure a future in which every man, woman, and child is provided with opportunity to live as full a life as possible.
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Understanding Health Insurance: A Guide to Billing and Reimbursement, 8th Edition is a comprehensive source for teaching the subject of health insurance and reimbursement. The book contains chapters on introductory information on the health insurance field, managed health care, legal and regulatory issues, coding systems, reimbursement methodologies, coding for medical necessity, and common health insurance plans. Each chapter contains exercises to illustrate content and reinforce learning. Numerous opportunities are provided throughout the book for manual completion of CMS-1500 claims. A CD-ROM at the back of the book allows for electronic data entry of CMS-1500 claim form information. End of chapter review questions in objective format (e.g., multiple choice) test learners on their understanding of book content. Appendices I and II provide case studies that are also included on the Student Practice CD-ROM. Additional appendices provide instruction in dental claims processing and completion of the UB-92 (claim used for inpatient and outpatient hospital claims). The accompanying workbook provides application based assignments for each chapter, additional content review (multiple choice questions), and additional case studies for practice in completing CMS-1500 claims. This edition of the book contains the most up to date information regarding health insurance claims processing and coding and reimbursement issues.