A Hybrid Mining Approach to Facilitate Health Insurance Decision: Case Study of Non-Traditional Data Mining Applications in Taiwan NHI Databases

This study examines time-sensitive applications of data mining methods to facilitate claims review processing and provide policy information for insurance decision-making vis-à-vis the Taiwan National Health Insurance databases. In order to obtain the best payment management, a hybrid mining approach, which has been grounded on the extant knowledge of data mining projects and health insurance domain knowledge, is proposed. Through the integration of data warehousing, online analytical processing, data mining techniques and traditional data analysis in the healthcare field, an easy-to-use decision support platform, which will facilitate the health insurance decision-making process, is built. Drawing from lessons learned in case study, results showed that not only is hybrid mining approach a reliable, powerful, and user-friendly platform for diversified payment decision support, but that it also has great relevance for the practice and acceptance of evidence-based medicine. Researchers should develop hybrid mining approach combined with their own application systems in the future.