Descriptive Analytics And Visualization Assignment: Insights On Claimants, Payments And Practitioners

Discussion

Discuss about the Descriptive Analytics And Visualization Assignment.

Ever since third party data being made more accessible, insurance firms have been able to devise ways to acquire more insights regarding claimants and medical practitioners to better understand the risks that come with malpractice. Analytics has been able to utilise the information made available by government and other third party sources to deliver such insights to the firms.

This report provides a set of such insights as requested by one Mr. Edmond. The areas of discussion as requested, include an overall summarization of claimant amounts, profile of a typical claimant, a comparison of the current year’s claims with respect to the industry’s standards and the relationship between the specialization of the medical practitioner, how severe the claim is, and the average claim amounts. The analysis has been carried out using Microsoft Excel using statistical tools and theory to provide evidence based results.

The available data of this year’s claimants with regard to some of the details of their claims was analysed and used to gain insights as relevant to question regarding the claims payment amount and a typical claimant’s profile. Additionally this year’s claims with respect to the standards set in the industry has also been addressed. Moreover, relationship of the speciality of the medical practitioner treating the patient to whom the claim belongs with the severity of the claims, gender, attorney and paid amount have also been analysed and highlighted.  The following sections address these various aspects shedding light upon these areas as it had been requested. Question 1

 It was found that there has been an estimated average of $73458 claim payments this year. A maximum of $228725 worth claim payment amount and a minimum of $1547 was observed among the data from this year. The maximum number of claims were found to lie within the $51547 and $101547. 91% of the claims were found to have payment amounts under $101547.The following figure shows the graphical representation of the claims payment amount.

Looking to build a profile of a typical claimant, the characteristics of the claimants as per the data for this year’s claims have been discussed hence. The typical claimant was found to be of age around 45 years. 9% of the claimants were found to have no insurance, 10% have Medicare or Medicaid insurance, 47.5% applied through private insurance firms, 3.5% availed through worker’s compensation and remaining 3% were unknown. 23% of the claimants were found to be associated with severe risk of loss, 64% had medium risk and 13% had mild risk associated with the claimants. 42% of the claims were found to be involving anaesthesiologists, 24% were found to involve orthopaedic surgeons, 22.5% were found to involve dermatologists and the remaining 11.5 % were found to involve others.

Question 1

An industry report said that the average amount of claim payments had dropped at a level lower than $77,500. The validity of this statement by the study report, was scrutinized and tested using the available information on average of the claim payment amount. Thereby, it was found that there is sufficient evidence against the conjecture that average claim payment amount is greater than or equal to the value $77,500 and hence it was concluded that the statement by the report regarding average claims payment amount is indeed so. However there is a 5% that the statement that the average amount of claim payments had dropped at a level lower than $77,500 might be untrue.

Referring to another study, it was found to be saying that it had found 3 out of 4 or 75% of the claims to be of either medium or mild level of severity conditions. The statement having been tested for validity, based upon data for this year, as provided for the purpose of analysis and found no significant evidence refuting the conjecture. There was therefore not enough evidence against the conjecture that a proportion of three out of four of all claims made were of mild or medium severity for this year. The statement is thus inferred upon to be a valid one for all the patients. However there is a 5% chance that the conjecture that a proportion of three out of four of all claims made were of mild or medium severity for this year might be untrue.

The data provided for the purpose of analysis, failed to provide enough evidence to refute the validity of the tentative statement that there is no difference in the proportion of males with claims which are either mild or medium degree of severity with the proportion of females with claims of mild or medium severity. There is therefore not enough evidence based on the given data that men and women have differing proportions when it comes to having mildly severe or medium severe claims. However there is a 5% chance that the conjecture that there is no difference in the proportion of males with claims which are either mild or medium degree of severity with the proportion of females with claims of mild or medium severity is untrue.

Depending on whether a private attorney had represented the claimant or not, it is accepted in the industry that payment amounts may differ. The industry standard is stated to be so that a private attorney would cost claimant a greater average amount than one who does not have a private attorney. The data, provided for the purpose of analysis, reveals that there is enough evidence to refute that there is no difference between average payment amounts when attorney is private to when attorney is not private. The evidence supports that for claimants with private attorneys, the average amount is greater than those with otherwise. The difference in the average amounts for those whose attorney is private and those whose are not, was found to lie between the amounts $31539 and $13182 with a chance of 95%. However there is a 5% chance that the conjecture that for claimants with private attorneys, the average amount is greater than those with non-private ones.

Assessing the validity of the conjecture, as believed by stakeholders in the industry, that use of private attorneys for representation is greater for severe claims cases than those which have severity level of medium, it was ascertained that there exists enough evidence to support it. This is due to the fact that enough evidence was found to refute the statement that proportion of claimants with severe claims who have private attorneys are less or equal to proportion of claimants with severe claims who do not have private attorneys. There is 5% chance that the conjecture is however false and that private attorneys are not involved more in severe condition cases than in medium condition ones.

Investigating the data to evaluate whether cases involving orthopaedic surgeons have a lower chance of being of severe severity level, enough evidence was found to refute the conjecture of proportion of severe cases to be equal to ones that are not when orthopaedic surgeons are found to be involved. Thus it could be said that there is enough evidence to support the statement that cases involving orthopaedic surgeons have lesser proportion of severe claims. The proportion with severe condition cases when orthopaedic surgeons were involved was found to be less than proportion with severe claims when it was not an orthopaedic surgeon involved, where the value of difference lied with ninety five percent chance, between 85.65% and 44.78%. However, there is 5% chance that the conjecture is false and there is no difference.

There is not sufficient evidence, refuting the conjecture that the claim payment amount for severe claim cases involving orthopaedic surgeons is no different to the average amount for severe claim cases where specialization of the medical practitioner associated with the patient is not an orthopaedic surgeon. The claim that the average of claims payment amount is lower for severe cases associated with orthopaedic surgeons is thus not supported by the evidence. However, there is 5% chance that the conjecture is false and there is difference.

Conclusion

The analysis therefore concludes with the insights that the average amount of claim is around $51574 and $101547. Furthermore a typical claimant was found to be of age 45 with a 9% chance that he or she has no insurance and 23% of severe severity. 47.5% of the claimants had private attorneys. Significant evidence to prove that three out of four or 75% of total cases were mild and medium severity cases was found, However, no significant differences between the proportion of mild and medium cases of men and women could be found. Again, private attorneys were found to be associated with higher payment amounts. Sufficient evidence was found to support this however not enough evidence to show proportion of severe cases involving private attorneys was equal to proportion medium severity cases with private attorneys. Finally, it was found that there are lesser severe cases with orthopaedic surgeons being involved than others, however the average amount of claim payment was not found to be significantly different for orthopaedic surgeons with those of other specialities when it came to cases of severe severity claims.