UN News and World Report has published a study which states that there have been extensive medical malpractices in the United States, the cost of which is almost 2.4 percent of the annual spending on health care. According to another study that has been published in the New England Journal of Medicine in 2011, it has been observed that 7.4 percent of the US licensed physicians has the problem of malpractice between 1991 and 2005. These malpractices have increased the cost of health care and has also resulted in the increase in the premiums for the insurance of medical malpractice.
Thus, United health group have collected some data on the health insurance and is interested in having a better understanding of the claims that are paid for the lawsuits of medical malpractice. The dataset contains information about the claim amounts and also about the type of physician the claimants are visiting, the type of problems they are facing. Thus, for the interest of the company, analysis have been conducted on the dataset provided and the following information have been obtained as a result of the analysis.
Summary of Claim Payment Amount
200 claims have been selected randomly for the purpose of the analysis. It has been seen from the analysis of 200 claims that the average claim amount is $73457.49. The claim amounts are extremely scattered. Fifty percent of the claim amounts are less than $72571.38. There are more claim amounts that are less than the average amount.
From the data, it has been observed that the average age of the claimants are 44.49 years and the proportion of claimants who do not have any insurance is 0.09. There are more female claimants that the male claimants. The proportion of female claimants are 0.605. Also, it has been seen that people with medium severity of health conditions mostly claim for the health care amount. The proportion of claimants with medium severity of health conditions is 0.64.
Comparison of claims against Industry Standards
The company United Health Group is interested in comparing the claims made this year with the industry standards. According to the reports of an industry, the average claim amount that has been paid has dropped below $77,500. Analysis have been conducted to test whether this claim can be supported or not. From the results of the analysis, it has been observed that the claim amount has reduced and have dropped below $77,500. This claim can be supported with 95 percent confidence. Enough evidence has been obtained to support this claim.
Proportion of claims with Mild or Medium Severity
According to another similar study, there has been a report that 3 out of four claims made by the claimants are of “MILD” or “MEDIUM” severity conditions. Thus, it is claimed that 75 percent of the claims are made by the claimants of MILD or MEDIUM severity conditions. The truthfulness of this statement also has to be tested. From the results of this test, it has been observed that less than 75 percent of the claims made by the claimants are of “MILD” or “MEDIUM” severity conditions. Thus, there is not enough evidence to support the result of the report that has been provided by the study. Hence, it can be said that this statement is still not valid for all patients.
Difference in Proportion of claims with Mild or Medium Severity based on Gender
Next, the company, United Healthy Group, is interested to test whether there is any difference in the proportion of MILD or MEDIUM claims based on gender of the claimants. From the results obtained to test this claim, it has been observed that there is no significant difference in the proportion of MILD or MEDIUM claims based on gender of the claimants. It can be said with 95 percent confidence that there is no difference in the claim amounts based on gender. Thus, both the male and female claimants are claiming on an average the same amount of premium for MEDIUM or MILD severity conditions.
Claims by private and non-private attorney
According to the industry standards, there is a belief that the standard of payments is related to the attorney, whether the attorney is private or not private. More specifically, it is believed that when the attorney is private, the amount claimed is higher than the amount claimed when the attorney involved is not private. To test this claim, analysis has been conducted on the data provided here. From the analysis, it can be said with 95 percent confidence that the amount claimed for health care when the attorney is private is higher than the case when the attorney is not private. Thus, enough evidence have been obtained to support the belief that has been obtained from the industry standards. Hence, it can be said that the data collected by the United Health Group supports the above mentioned proposition.
Private Attorney Representation in Severe and Medium Severity
It has also been proposed that according to the belief of the stakeholders, the severe claims represent more private attorney than the claims with medium severity. From the available data, a test has been conducted to test whether the proposition can be supported or not. From the results of the tests conducted, it can be said that, proportion of claimants with medium severity are more likely to attend private attorney than the proportion of claimants with severe condition. Thus, from the data provided, the statement made by the stakeholders cannot be supported. There has not been enough evidence to support the belief of the stakeholders.
Relationship between specialty of the physician involved, the severity of the claim, and average claim amounts
Percentage of Severe Claims for Orthopedic Surgeon and other Specialists
It is the belief of the chief data scientist of United Health Group that the percentage of Severe claims that involve orthopedic surgeons is higher than the percentage of severe claims by other specialists. To test whether this claim can be supported or not, analysis has been conducted on the dataset and it has been observed that the percentage of severe claims that involve orthopedic surgeons is less than the percentage of severe claims by other specialists. Thus, there is not enough evidence to support the assertion made by the chief data scientist of the company on this matter.
Difference in average claim amount for Orthopedic Surgeon and other Specialists
It is also the belief of the chief data scientist that the average claim amount for severe claim is higher for the involvement of orthopedic surgeons than that of other specialists. Test has been conducted to test this this claim and the results showed that the claim amount severe claim is significantly less for the involvement of orthopedic surgeons than that of other specialists. Thus, not enough evidence have been found to support the assertion of the chief data scientist.
From all the discussions conducted above, it can be concluded that the average amount paid for the claims has dropped below $77,000. 3 out of 4 cases are not of mild or medium severity conditions. Rather less than 3 claims out of 4 claims are of mild or medium severity conditions. No significant difference in the proportion of mild or medium claims have been observed by the patient’s gender. Further, it has been observed that the average claim amount is less when a private attorney is present rather than when a private attorney is not present. It has also been observed that representation of private attorney is higher for claims with medium severity than for severe claims. Moreover, percentage of severe claims with the involvement of orthopedic surgeons is less than the percentage of severe claims with the involvement of other specialists. Also, the average claim amount is less for severe claims with the involvement of orthopedic surgeons rather than the other specializations.
Some results have been obtained which does not support the previous studies or beliefs of the data scientist of United Health Group. One of the major reasons behind these results is the number of samples. 200 samples are very less to represent the whole US population. Thus, if the sample size is increased, the results obtained might be different from what has been obtained from this analysis.