Investigating a Hybrid Mining Approach to aid Health Insurance Decision Making: the Case of National Health Insurance (NHI) in Taiwan

摘要

This study investigates the characteristics of data mining methods to show how they can aid in claims review processing and provide policy information for insurance decision making vis-a-vis the Taiwan National Health Insurance database. In order to obtain the best payment management, a hybrid mining approach, which has been based on the existent 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. Based on two case studies, results showed that not only is hybrid mining approach a reliable, powerful, and user-friendly platform for strategic health insurance decision making, but that it also has great relevance for the practice and acceptance of evidence-based medicine.