Abstract: 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.
Abstract: 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.
Abstract: This study, for its research subjects, uses patients who
had undergone total knee replacement surgery from the database of the
National Health Insurance Administration. Through the review of
literatures and the interviews with physicians, important factors are
selected after careful screening. Then using Cross Entropy Method,
Genetic Algorithm Logistic Regression, and Particle Swarm
Optimization, the weight of each factor is calculated and obtained. In
the meantime, Excel VBA and Case Based Reasoning are combined
and adopted to evaluate the system. Results show no significant
difference found through Genetic Algorithm Logistic Regression and
Particle Swarm Optimization with over 97% accuracy in both
methods. Both ROC areas are above 0.87. This study can provide
critical reference to medical personnel as clinical assessment to
effectively enhance medical care quality and efficiency, prevent
unnecessary waste, and provide practical advantages to resource
allocation to medical institutes.
Abstract: 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.