Search results for: Health insurance

Authors: Mohd Zuhair, Ram Babu Roy

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This paper presents an overview of the accessibility, design, and functioning of health insurance plans launched by state governments in India. In recent years, the governments of several states in India have come forward to provide health insurance coverage for the low-income group and rural population to reduce the out of pocket expenditure (OPE) on healthcare. Different health insurance schemes have different structures and offerings which differ in the different demographic factors. This study will portray a comparative analysis of the various health insurance schemes by analyzing different offerings and finance generation of the schemes. The comparative analysis will explain the lesson to be learned from these schemes and extend the existing knowledge of the health insurance in India. This would help in recognizing tension between various drivers and identifying issues pertaining to the sustainability of health insurance schemes in India.

Keywords: Health insurance, out of pocket expenditure, universal healthcare, sustainability.

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Authors: D. Jakovčević, M. Mihelja Žaja

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This paper provides an analysis of the insurance cycle in the Republic of Croatia and whether they are affected by catastrophic losses on a global level. In general, it is considered that insurance cycles are particularly pronounced in periods of financial crisis, but are also affected by the growing number of catastrophic losses. They cause the change of insurance cycle and premium growth and intensification and narrowing of the coverage conditions, so these variables move in the same direction and these phenomena point to a new cycle. The main goal of this paper is to determine the existence of insurance cycle in the Republic of Croatia and investigate whether catastrophic losses have an influence on insurance cycles.

Keywords: Catastrophic loss, insurance cycle, premium, Republic of Croatia.

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Authors: D. Jakovčević, M. Mihelja Žaja

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The purpose of this paper is to analyze the influence and relative share of underwriting risks in explaining the variation in insurance cycles in subsequent periods. Through the insurance contracts they underwrite, insurance companies assume risks. Underwriting risks include pricing risk, reserve risk, reinsurance risk and occurrence risk. These risks pose major risks for property and liability insurers, and therefore their impact on the insurance cycle is important. The main goal of this paper is to determine the relative proportion of underwriting risks in explaining the variation of insurance cycle. In order to fulfill the main goal of the paper vector autoregressive model, VAR, will be applied.

Keywords: Insurance cycle, insurance risks, combined ratio, Republic of Croatia.

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Authors: Pavel Pešout, Miroslav Andrle

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Frauds in insurance industry are one of the major sources of operational risk of insurance companies and constitute a significant portion of their losses. Every reasonable company on the market aims for improving their processes of uncovering frauds and invests their resources to reduce them. This article is addressing fraud management area from the view of extension of existing Business Intelligence solution. We describe the frame of such solution and would like to share with readers all benefits brought to insurance companies by adopting this approach in their fight against insurance frauds.

Keywords: business intelligence, insurance fraud, fraudmanagement

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Authors: Yuthapoom Thanakijborisut

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This paper studies consumption insurance against the chronic illness in Thailand. The study estimates the impact of household consumption in the chronic illness on consumption growth. Chronic illness is the health care costs of a person or a household’s decision in treatment for the long term; the causes and effects of the household’s ability for smooth consumption. The chronic illnesses are measured in health status when at least one member within the household faces the chronic illness. The data used is from the Household Social Economic Panel Survey conducted during 2007 and 2012. The survey collected data from approximately 6,000 households from every province, both inside and outside municipal areas in Thailand. The study estimates the change in household consumption by using an ordinary least squares (OLS) regression model. The result shows that the members within the household facing the chronic illness would reduce the consumption by around 4%. This case indicates that consumption insurance in Thailand is quite sufficient against chronic illness.

Keywords: Consumption insurance, chronic illness, health care, Thailand.

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Authors: Guanqun Shi, Xueqing Zhang

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The frequent occurrence of failures in PPP projects which caused great loss has raised attention from the government as well as the concessionaire. PPPs are complex arrangements for its long operation period and multiple players. Many types of risks in PPP projects may cause the project fail. The insurance is an important tool to transfer the risks. Through a comparison and analysis of international government PPP guidelines and contracts as well as the case studies worldwide, we have identified eight main insurance principles, discussed thirteen insurance types in different stages. An overall procedure would be established to improve the practices in PPP projects.

Keywords: Public-private partnerships, insurance, contract, risk.

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Authors: Chimaobi V. Okolo, Afamefuna J. Ani, Ebere U. Okolo

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This paper seeks to assess the implications of insurance to foreign direct investment inflow in Nigeria. Multiple linear regression technique and correlation matrix test were employed to measure the extent to which foreign direct investment was influenced. The result showed that insurance premium (IP), asset size of insurance industry (AS), and total investment of the industry (TI) impacted significantly and positively on foreign direct investment inflow in Nigeria. There should be effective risk transfer mechanism and financial intermediation, which gives the investor confidence in the risk management strength of the host country.

Keywords: Foreign direct investment, insurance.

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Authors: Namrata Mishra

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Health of a person plays a vital role in the collective health of his community and hence the well-being of the society as a whole. But, in today’s fast paced technology driven world, health issues are increasingly being associated with human behaviors – their lifestyle. Social networks have tremendous impact on the health behavior of individuals. Many researchers have used social network analysis to understand human behavior that implicates their social and economic environments. It would be interesting to use a similar analysis to understand human behaviors that have health implications. This paper focuses on concepts of those behavioural analyses that have health implications using social networks analysis and provides possible algorithmic approaches. The results of these approaches can be used by the governing authorities for rolling out health plans, benefits and take preventive measures, while the pharmaceutical companies can target specific markets, helping health insurance companies to better model their insurance plans.

Keywords: Health behaviors, social network analysis, directed graph, breadth first search.

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Authors: Francesco Venuti, Simona Alfiero

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The aim of this paper is to develop an empirical research on the nature and consequences of corporate governance on Eurozone Insurance Industry risk taking attitude. More particularly, we analyzed the effect of public ownership on risk taking with respect to privately held Insurance Companies. We also analyzed the effects on risk taking attitude of different degrees of ownership concentration, directors compensation, and the dimension/diversity of the Board of Directors. Our results provide quite strong evidence that, coherently with the Agency Theory, publicly traded insurance companies with more concentrated ownership are less risky than the corresponding privately held.

Keywords: Agency theory, corporate governance, insurance companies, risk taking.

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Authors: Shu-Lin Lin, Ching-Chien Yang

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This study examines the influence of information transparency and corporate governance on purchase directors and officers liability (D&O) insurance decisions. The results show that companies with greater information transparency have significant demand for D&O insurance. Greater transparency in voluntary disclosures is significantly and positively associated with demand for insurance, indicating that increasing the degree of information disclosure reduces information asymmetry for insurers, which stimulates their willingness to provide greater protection. Analysis of insured and uninsured subsamples indicates that uninsured companies have superior corporate governance compared to insured companies. Although insured companies tend to have weaker corporate governance structures, they appoint Big 4 firms or industry experts to compensate for the weakness of their corporate governance. Empirical results indicate that purchasing D&O insurance can strengthen external corporate governance and increase companies’ willingness to voluntarily provide more transparent information.

Keywords: Directors and officers liability (D&O) insurance, information transparency, corporate governance, Big 4.

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Authors: T. Pavic Kramaric, M. Kitic

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The purpose of this article is to analyze the market structure as well as the degree of concentration in insurance markets in new EU member states. The analysis was conducted using several most commonly used concentration indicators such as concentration ratio, Herfindahl-Hirschman index and entropy index. These indicators were calculated for the 2000-2010 period on the basis of total gross written premium as the most relevant indicator of market power in insurance markets. The results of the analysis showed that in all observed countries the level of concentration decreased, though with significantly different intensity. Yet, in some countries, the level of concentration remains very high.

Keywords: insurance market, concentration, new EU member states

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Authors: Vesna Bosilj Vukšić, Darija Ivandić Vidović, Ljubica Milanović Glavan

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Information technology plays an irreplaceable role in introducing and improving business process orientation in a company. It enables implementation of the theoretical concept, measurement of results achieved and undertaking corrective measures aimed at improvements. Information technology is a key concept in the development and implementation of the business process management systems as it establishes a connection to business operations. Both in the literature and practice, insurance companies are often seen as highly process oriented due to the nature of their business and focus on customers. They are also considered leaders in using information technology for business process management. The research conducted aimed to investigate whether the perceived leadership status of insurance companies is well deserved, i.e. to establish the level of process orientation and explore the practice of information technology use in insurance companies in the region. The main instrument for primary data collection within this research was an electronic survey questionnaire sent to the management of insurance companies in the Republic of Croatia, Bosnia and Herzegovina, Slovenia, Serbia and Macedonia. The conducted research has shown that insurance companies have a satisfactory level of process orientation, but that there is also a huge potential for improvement, especially in the segment of information technology and its connection to business processes.

Keywords: Business processes management, process orientation, information technology, insurance companies.

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Authors: W. T. Hsu, H. L. Tsai

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The rapid aging of the population is a common trend in the world. However, the progress of modern medical technology has increased the average life expectancy. The global population structure has changed dramatically, and the elderly population has risen rapidly. In the face of rapid population growth, it must be noted issues of the aging population must face up to, which are the physiological, psychological, and social problems associated with aging. This study aims to investigate how insurance agents are actively dealing with an aging society, their own aging anxiety, and their exercise habits. Purposive sampling was the sampling method of this study, a total of 204 respondents were surveyed and 204 valid surveys were returned. The returned valid ratio was 100%. Statistical method included descriptive statistics, t-test, and one-way ANOVA. The results of the study found that the insurance agent’s age, seniority, exercise habits to aging anxiety are significantly different.

Keywords: Insurance agent, aging anxiety, exercise habits, elderly.

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Authors: Tahseen A. Jilani, S. M. Aqil Burney, C. Ardil

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In this paper, we have presented a new multivariate fuzzy time series forecasting method. This method assumes mfactors with one main factor of interest. History of past three years is used for making new forecasts. This new method is applied in forecasting total number of car accidents in Belgium using four secondary factors. We also make comparison of our proposed method with existing methods of fuzzy time series forecasting. Experimentally, it is shown that our proposed method perform better than existing fuzzy time series forecasting methods. Practically, actuaries are interested in analysis of the patterns of causalities in road accidents. Thus using fuzzy time series, actuaries can define fuzzy premium and fuzzy underwriting of car insurance and life insurance for car insurance. National Institute of Statistics, Belgium provides region of risk classification for each road. Thus using this risk classification, we can predict premium rate and underwriting of insurance policy holders.

Keywords: Average forecasting error rate (AFER), Fuzziness offuzzy sets Fuzzy, If-Then rules, Multivariate fuzzy time series.

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Authors: Zina Benouaret, Djamil Aissani

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In this work, we introduce the qualitative and quantitative concept of the strong stability method in the risk process modeling two lines of business of the same insurance company or an insurance and re-insurance companies that divide between them both claims and premiums with a certain proportion. The approach proposed is based on the identification of the ruin probability associate to the model considered, with a stationary distribution of a Markov random process called a reversed process. Our objective, after clarifying the condition and the perturbation domain of parameters, is to obtain the stability inequality of the ruin probability which is applied to estimate the approximation error of a model with disturbance parameters by the considered model. In the stability bound obtained, all constants are explicitly written.

Keywords: Markov chain, risk models, ruin probabilities, strong stability analysis.

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Authors: F. Havas Beigi, E. Mohammadi, M.Vafaee Yeganeh

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Curriculum is one of the most important inputs in higher education system and for knowing the strong and weak spots of it we need evaluation. The main purpose of this study was to survey of the curriculum quality of Insurance Management field. Case: University of Allameh Taba Tabaee(according to view point of students,alumni,employer and faculty members).Descriptive statistics (mean, tables, percentages, frequency distribution) and inferential statistics (CHI SQUARE) were used to analyze the data. Six criterions considered for the Quality of curriculum: objectives, content, teaching and learning methods, space and facilities, Time, assessment of learning. objectives, teaching and learning methods criterions was desirable level, content criteria was undesirable level, space and facilities, time and assessment of learning were rather desirable level. The quality of curriculum of insurance management field was relatively desirable level.

Keywords: Quality, curriculum, insurance management, higher education.

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Authors: Adrian O’Hagan, Robert McLoughlin

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Considerable focus in the world of insurance risk quantification is placed on modeling loss values from lines of business (LOBs) that possess upper tail dependence. Copulas such as the Joe, Gumbel and Student-t copula may be used for this purpose. The copula structure imparts a desired level of tail dependence on the joint distribution of claims from the different LOBs. Alternatively, practitioners may possess historical or simulated data that already exhibit upper tail dependence, through the impact of catastrophe events such as hurricanes or earthquakes. In these circumstances, it is not desirable to induce additional upper tail dependence when modeling the joint distribution of the loss values from the individual LOBs. Instead, it is of interest to accurately assess the degree of tail dependence already present in the data. The empirical copula and its associated upper tail dependence coefficient are presented in this paper as robust, efficient means of achieving this goal.

Keywords: Empirical copula, extreme events, insurance loss reserving, upper tail dependence coefficient.

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Authors: Dalia Suša Vugec, Ana-Marija Stjepić, Darija Ivandić Vidović

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Digital transformation is one of the latest trends on the global market. In order to maintain the competitive advantage and sustainability, increasing number of organizations are conducting digital transformation processes. Those organizations are changing their business processes and creating new business models with the help of digital technologies. In that sense, one should also observe the role of business process management (BPM) and its maturity in driving digital transformation. Therefore, the goal of this paper is to investigate the role of BPM in digital transformation process within one organization. Since experiences from practice show that organizations from financial sector could be observed as leaders in digital transformation, an insurance company has been selected to participate in the study. That company has been selected due to the high level of its BPM maturity and the fact that it has previously been through a digital transformation process. In order to fulfill the goals of the paper, several interviews, as well as questionnaires, have been conducted within the selected company. The results are presented in a form of a case study. Results indicate that digital transformation process within the observed company has been successful, with special focus on the development of digital strategy, BPM and change management. The role of BPM in the digital transformation of the observed company is further discussed in the paper.

Keywords: Business process management, case study, Croatia, digital transformation, insurance company.

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Authors: R. Tandlich, S. Hoossein, K. A. Tagwira, M. M. Marais, T. A. Ludwig, R. P. Chidziva, M. N. Munodawafa, W. M. Wrench

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Response to the public health-related emergencies is analysed here for a rural university in South Africa. The structure of the designated emergency plan covers all the phases of the disaster management cycle. The plan contains elements of the vulnerability model and the technocratic model of emergency management. The response structures are vertically and horizontally integrated, while the planning contains elements of scenario-based and functional planning. The available number of medical professionals at the Rhodes University, along with the medical insurance rates, makes the staff and students potentially more medically vulnerable than the South African population. The main improvements of the emergency management are required in the tornado response and the information dissemination during health emergencies. The latter should involve the increased use of social media and e-mails, following the Taylor model of communication. Infrastructure must be improved in the telecommunication sector in the face of unpredictable electricity outages.

Keywords: Public health, Rural university, Taylor model of communication.

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Authors: Rute Abreu, Fátima David, Liliane Cristina Segura

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The Deposit Guarantee Fund (DGF) and its communication with the Society, in general, and with the deposit client of Financial Institutions, in particular, is discussed through the challenges of the accounting and financial report. The Bank of Portugal promotes the Portuguese Deposit Guarantee Fund (PDGF) as a financial institution that enhanced the market confidence and stability on the deposit-insurance system. Due to the nature of their functions, it must be subject to regulation and supervision that provides a first line of defense against adversely affect confidence on the Portuguese financial market. First, this research provides evidence of the effectiveness of the protection mechanisms on the deposit insurance system, which provides high and equal protection to all stakeholders. Second, it emphasizes the need of requirements of rigorous accounting process and effective financial report to reduce the moral hazard implications. Third, this research focuses on the need of total disclosure of the financial information which gives higher transparency and protection to deposit client of financial institutions.

Keywords: Deposit Guarantee Fund, Portugal, Accounting, Financial Report.

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Authors: M. Pervan, T. Pavic Kramaric

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The aim of this paper is to investigate the influence of market share and diversification on the nonlife insurers- performance. The underlying relationships have been investigated in different industries and different disciplines (economics, management...), still, no consistency exists either in the magnitude or statistical significance of the relationship between market share (and diversification as well) on one side and companies- performance on the other side. Moreover, the direction of the relationship is also somewhat questionable. While some authors find this relationship to be positive, the others reveal its negative association. In order to test the influence of market share and diversification on companies- performance in Croatian nonlife insurance industry for the period from 1999 to 2009, we designed an empirical model in which we included the following independent variables: firms- profitability from previous years, market share, diversification and control variables (i.e. ownership, industrial concentration, GDP per capita, inflation). Using the two-step generalized method of moments (GMM) estimator we found evidence of a positive and statistically significant influence of both, market share and diversification, on insurers- profitability.

Keywords: Diversification, market share, nonlife insurance

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Authors: Haluk Eren, Ümit Çelik

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Recent developments in unmanned aerial vehicles (UAVs) have begun to attract intense interest. UAVs started to use for many different applications from military to civilian use. Some online retailer and logistics companies are testing the UAV delivery. UAVs have great potentials to reduce cost and time of deliveries and responding to emergencies in a short time. Despite these great positive sides, just a few works have been done for routing of UAVs for package deliveries. As known, transportation of goods from one place to another may have many hazards on delivery route due to falling hazards that can be exemplified as ground objects or air obstacles. This situation refers to wide-range insurance concept. For this reason, deliveries that are made with drones get into the scope of shipping insurance. On the other hand, air traffic was taken into account in the absence of unmanned aerial vehicle. But now, it has been a reality for aerial fields. In this study, the main goal is to conduct risk analysis of package delivery services using drone, based on delivery routes.

Keywords: Drone risk assessment, drone package delivery.

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Authors: Sotirios Raptis

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Bayesian reasoning (BR) or Linear (Auto) Regression (AR/LR) can predict different sources of data using priors or other data, and can link social service demands in cohorts, while their consideration in isolation (self-prediction) may lead to service misuse ignoring the context. The paper advocates that BR with Binomial (BD), or Normal (ND) models or raw data (.D) as probabilistic updates can be compared to AR/LR to link services in Scotland and reduce cost by sharing healthcare (HC) resources. Clustering, cross-correlation, along with BR, LR, AR can better predict demand. Insurance companies and policymakers can link such services, and examples include those offered to the elderly, and low-income people, smoking-related services linked to mental health services, or epidemiological weight in children. 22 service packs are used that are published by Public Health Services (PHS) Scotland and Scottish Government (SG) from 1981 to 2019, broken into 110 year series (factors), joined using LR, AR, BR. The Primary component analysis found 11 significant factors, while C-Means (CM) clustering gave five major clusters.

Keywords: Bayesian probability, cohorts, data frames, regression, services, prediction.

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Authors: Shahadat Uddin, Md Ekramul Hossain, Arif Khan

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The collaboration among physicians during episodes of care for a hospitalised patient has a significant contribution towards effective health outcome. This research aims at improving this health outcome by analysing the attributes of patient-sharing physician collaboration network (PCN) on hospital data. To accomplish this goal, we present a research framework that explores the impact of several types of attributes (such as clique and clan) of PCN on hospitalisation cost and hospital length of stay. We use electronic health insurance claim dataset to construct and explore PCNs. Each PCN is categorised as ‘low’ and ‘high’ in terms of hospitalisation cost and length of stay. The results from the proposed model show that the clique and clan of PCNs affect the hospitalisation cost and length of stay. The clique and clan of PCNs show the difference between ‘low’ and ‘high’ PCNs in terms of hospitalisation cost and length of stay. The findings and insights from this research can potentially help the healthcare stakeholders to better formulate the policy in order to improve quality of care while reducing cost.

Keywords: Clique, clan, electronic health records, physician collaboration.

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Authors: Monika Nuffer, Wesley Nuffer

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The problem of obesity is one that continues to be faced in the United States health care system and across the developing world. Prescription medications are available, but are often very expensive with minimal insurance coverage. The over-the-counter diet aid industry is a robust one, selling billions of dollars in products every year. It is important for clinicians to understand the myriad of different nutritional supplements marketed for obesity, and to weigh the evidence behind these products. This manuscript outlines the most commonly used nutritional supplements currently marketed for weight loss, reviewing the evidence with a focus on the efficacy and safety of these products.

Keywords: Obesity, weight loss, herbal products, nutritional supplements

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Authors: Y. N. Phang, E. F. Loh

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The zero inflated models are usually used in modeling count data with excess zeros where the existence of the excess zeros could be structural zeros or zeros which occur by chance. These type of data are commonly found in various disciplines such as finance, insurance, biomedical, econometrical, ecology, and health sciences which involve sex and health dental epidemiology. The most popular zero inflated models used by many researchers are zero inflated Poisson and zero inflated negative binomial models. In addition, zero inflated generalized Poisson and zero inflated double Poisson models are also discussed and found in some literature. Recently zero inflated inverse trinomial model and zero inflated strict arcsine models are advocated and proven to serve as alternative models in modeling overdispersed count data caused by excessive zeros and unobserved heterogeneity. The purpose of this paper is to review some related literature and provide a variety of examples from different disciplines in the application of zero inflated models. Different model selection methods used in model comparison are discussed.

Keywords: Overdispersed count data, model selection methods, likelihood ratio, AIC, BIC.

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Authors: Rajinder Singh, Ram Valluru

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Chain Ladder (CL) method, Expected Loss Ratio (ELR) method and Bornhuetter-Ferguson (BF) method, in addition to more complex transition-rate modeling, are commonly used actuarial reserving methods in general insurance. There is limited published research about their relative performance in the context of Mortgage Insurance (MI). In our experience, these traditional techniques pose unique challenges and do not provide stable claim estimates for medium to longer term liabilities. The relative strengths and weaknesses among various alternative approaches revolve around: stability in the recent loss development pattern, sufficiency and reliability of loss development data, and agreement/disagreement between reported losses to date and ultimate loss estimate. CL method results in volatile reserve estimates, especially for accident periods with little development experience. The ELR method breaks down especially when ultimate loss ratios are not stable and predictable. While the BF method provides a good tradeoff between the loss development approach (CL) and ELR, the approach generates claim development and ultimate reserves that are disconnected from the ever-to-date (ETD) development experience for some accident years that have more development experience. Further, BF is based on subjective a priori assumption. The fundamental shortcoming of these methods is their inability to model exogenous factors, like the economy, which impact various cohorts at the same chronological time but at staggered points along their life-time development. This paper proposes an alternative approach of parametrizing the loss development curve and using logistic regression to generate the ultimate loss estimate for each homogeneous group (accident year or delinquency period). The methodology was tested on an actual MI claim development dataset where various cohorts followed a sigmoidal trend, but levels varied substantially depending upon the economic and operational conditions during the development period spanning over many years. The proposed approach provides the ability to indirectly incorporate such exogenous factors and produce more stable loss forecasts for reserving purposes as compared to the traditional CL and BF methods.

Keywords: Actuarial loss reserving techniques, logistic regression, parametric function, volatility.

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Authors: Sotirios Raptis

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Linking social needs to social classes using different criteria may lead to social services misuse. The paper discusses using ML and Neural Networks (NNs) in linking public services in Scotland in the long term and advocates, this can result in a reduction of the services cost connecting resources needed in groups for similar services. The paper combines typical regression models with clustering and cross-correlation as complementary constituents to predict the demand. Insurance companies and public policymakers can pack linked services such as those offered to the elderly or to low-income people in the longer term. The work is based on public data from 22 services offered by Public Health Services (PHS) Scotland and from the Scottish Government (SG) from 1981 to 2019 that are broken into 110 years series called factors and uses Linear Regression (LR), Autoregression (ARMA) and 3 types of back-propagation (BP) Neural Networks (BPNN) to link them under specific conditions. Relationships found were between smoking related healthcare provision, mental health-related health services, and epidemiological weight in Primary 1(Education) Body Mass Index (BMI) in children. Primary component analysis (PCA) found 11 significant factors while C-Means (CM) clustering gave 5 major factors clusters.

Keywords: Probability, cohorts, data frames, services, prediction.

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Authors: Andrea Bellucci, Martina Tofi

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The aim of paper is to analyze business models of bancassurance in Italy for life business. The life insurance business is very developed in the Italian market and banks branches have 80% of the market share. Given its maturity, the life insurance market needs to consolidate its organizational form to allow for the development of non-life business, which nowadays collects few premiums but represents a great opportunity to enlarge the market share of bancassurance using its strength in the distribution channel while the market share of independent agents is decreasing. Starting with the main business model of bancassurance for life business, this paper will analyze the performances of life companies in the Italian market by balance sheet indicators and by main discriminant variables of business models. The study will observe trends from 2013 to 2015 for the Italian market by exploiting a database managed by Associazione Nazionale delle Imprese di Assicurazione (ANIA). The applied approach is based on a bottom-up analysis starting with variables and indicators to define business models’ classification. The statistical classification algorithm proposed by Ward is employed to design business models’ profiles. Results from the analysis will be a representation of the main business models built by their profile related to indicators. In that way, an unsupervised analysis is developed that has the limit of its judgmental dimension based on research opinion, but it is possible to obtain a design of effective business models.

Keywords: Balance sheet indicators, Bancassurance, business models, ward algorithm.

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Authors: Farhan Ismaeel Dakheel, Raoof Smko, K. Negrat, Abdelsalam Almarimi

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In this paper we used data mining techniques to identify outlier patients who are using large amount of drugs over a long period of time. Any healthcare or health insurance system should deal with the quantities of drugs utilized by chronic diseases patients. In Kingdom of Bahrain, about 20% of health budget is spent on medications. For the managers of healthcare systems, there is no enough information about the ways of drug utilization by chronic diseases patients, is there any misuse or is there outliers patients. In this work, which has been done in cooperation with information department in the Bahrain Defence Force hospital; we select the data for Cardiac patients in the period starting from 1/1/2008 to December 31/12/2008 to be the data for the model in this paper. We used three techniques for finding the drug utilization for cardiac patients. First we applied a clustering technique, followed by measuring of clustering validity, and finally we applied a decision tree as classification algorithm. The clustering results is divided into three clusters according to the drug utilization, for 1603 patients, who received 15,806 prescriptions during this period can be partitioned into three groups, where 23 patients (2.59%) who received 1316 prescriptions (8.32%) are classified to be outliers. The classification algorithm shows that the use of average drug utilization and the age, and the gender of the patient can be considered to be the main predictive factors in the induced model.

Keywords: Data Mining, Clustering, Classification, Drug Utilization..

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