Major Medical Expense Insurance: An Evaluation

Detection of Health Insurance Fraud with Discrete Choice Model: Evidence from Medical Expense Insurance in China

Health insurance fraud increases the inefficiency and inequality in our society. To address the widespread problem, cost effect techniques are in need to detect fraudulent claims. With a dataset from medical expense insurance in China, we propose a discrete choice model to identify predicting factors of fraudulent claims, and we address the major limitations of discrete choice model by consider...

The preoperative evaluation: medical necessity or unnecessary expense?

Medical Informatics in Insurance Medicine An Introduction to Computers for Insurance Medical Directors

Although these words were spoken by a fictional hero, the master detective Sherlock Holmes, they express a sentiment which is frequently felt by many physicians today. This issue was examined by Covell et al. in the Annals of Internal Medicine. They looked at the information needs of medical practitioners in their office practice and whether those needs were being met on a day-to-day basis. Wha...

an application of fuzzy logic for car insurance underwriting

در ایران بیمه خودرو سهم بزرگی در صنعت بیمه دارد. تعیین حق بیمه مناسب و عادلانه نیازمند طبقه بندی خریداران بیمه نامه براساس خطرات احتمالی آنها است. عوامل ریسکی فراوانی می تواند بر این قیمت گذاری تاثیر بگذارد. طبقه بندی و تعیین میزان تاثیر گذاری هر عامل ریسکی بر قیمت گذاری بیمه خودرو پیچیدگی خاصی دارد. در این پایان نامه سعی در ارائه راهی جدید برای طبقه بندی عوامل ریسکی با استفاده از اصول و روش ها...

Voluntary Health Insurance in Vietnam: an Evaluation

This paper summarises the findings of a series of articles which evaluate the impact of State-implemented voluntary health insurance (VHI) on the Vietnamese health system. The results are generally positive with clear equity gains in terms of utilisation and expenditures, and no evidence of consumer moral hazard. However VHI appears to negatively affect the quality of care, which patients trade...