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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…
This paper proposes a definition of system health in the context of multiple agents optimizing a joint reward function. We use this definition as a credit assignment term in a policy gradient algorithm to distinguish the contributions of…
Under the Affordable Care Act (ACA), insurers cannot engage in medical underwriting and thus face perverse incentives to engage in risk selection and discourage low-value patients from enrolling in their plans. One ACA program intended to…
Advanced classification algorithms are being increasingly used in safety-critical applications like health-care, engineering, etc. In such applications, miss-classifications made by ML algorithms can result in substantial financial or…
Uplift modeling is an emerging machine learning approach for estimating the treatment effect at an individual or subgroup level. It can be used for optimizing the performance of interventions such as marketing campaigns and product designs.…
In real-world classification settings, such as loan application evaluation or content moderation on online platforms, individuals respond to classifier predictions by strategically updating their features to increase their likelihood of…
Matching is a popular nonparametric covariate adjustment strategy in empirical health services research. Matching helps construct two groups comparable in many baseline covariates but different in some key aspects under investigation. In…
Risk adjustment has become an increasingly important tool in healthcare. It has been extensively applied to payment adjustment for health plans to reflect the expected cost of providing coverage for members. Risk adjustment models are…
We provide sufficient conditions for semi-nonparametric point identification of a mixture model of decision making under risk, when agents make choices in multiple lines of insurance coverage (contexts) by purchasing a bundle. As a first…
Risk prediction is central to both clinical medicine and public health. While many machine learning models have been developed to predict mortality, they are rarely applied in the clinical literature, where classification tasks typically…
Risk stratification is a key tool in clinical decision-making, yet current approaches often fail to translate sophisticated survival analysis into actionable clinical criteria. We present a novel method for unsupervised machine learning…
Autocalibration is known to be an important requirement for insurance premiums since it guarantees that premium income balances corresponding claims, on average, not only at portfolio level but also inside each group paying similar…
The use of machine learning systems to support decision making in healthcare raises questions as to what extent these systems may introduce or exacerbate disparities in care for historically underrepresented and mistreated groups, due to…
Covariate imbalance between treatment groups makes it difficult to compare cumulative incidence curves in competing risk analyses. In this paper we discuss different methods to estimate adjusted cumulative incidence curves including inverse…
Purpose: Health recommenders act as important decision support systems, aiding patients and medical professionals in taking actions that lead to patients' well-being. These systems extract the information which may be of particular…
Health insurance companies cover half of the United States population through commercial employer-sponsored health plans and pay 1.2 trillion US dollars every year to cover medical expenses for their members. The actuary and underwriter…
With medical tests becoming increasingly available, concerns about over-testing and over-treatment dramatically increase. Hence, it is important to understand the influence of testing on treatment selection in general practice. Most…
Dynamic, risk-based pricing can systematically exclude vulnerable consumer groups from essential resources such as health insurance and consumer credit. We show that a regulator can realign private incentives with social objectives through…
The key concepts (calibration, discrimination, and discordance) important in understanding and comparing risk models are best conveyed graphically. To illustrate this, models predicting death and acute kidney injury in a large cohort of PCI…
In countries that enabled patients to choose their own providers, a common problem is that the patients did not make rational decisions, and hence, fail to use healthcare resources efficiently. This might cause problems such as overwhelming…