Development of a Decision Support System for Handling Health Insurance Deduction

Effective hospital management involves such activities as monitoring the flow of medication, controlling treatment, and billing for the patient’s treatment. A major challenge between insurance companies and hospitals lies in the way medical treatment expenses for insured patients are reimbursed. In some cases, the insurance deduction leads to the loss of revenues by hospitals. This paper proposes a framework for the handling insurance deduction that integrates three major methodologies: Decision Support Systems, Data Mining, and Multiple Criteria Decision Making. To exemplify the practical utility of the framework, it is used to study hospital services and insurance deductions are extracted from 200,000 documents in 150 hospitals in Iran. To classify the kinds of services, decision trees are developed to mine hidden rules in the data which are then modified on the basis of some performance measures. The rules are then extracted and ranked using the TOPSIS method. The results show that the proposed framework is capable of effectively providing objective and comprehensive assessments of insurance deductions.

@article{Khademolqorani2015,
  title     = {Development of a Decision Support System for Handling Health Insurance Deduction},
  journal   = {International Journal of Advanced Computer Science and Applications},
  volume    = {6},
  number    = {2},
  year      = {2015},
  publisher = {The Science and Information Organization},
  author    = {Shakiba Khademolqorani and Ali Zeinal Hamadani},
  doi       = {10.14569/IJACSA.2015.060207},
  url       = {https://doi.org/10.14569/IJACSA.2015.060207}
}