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Classification of the financial sustainability of health insurance beneficiaries through data mining techniques

dc.contributor.authorReboucas, Silvia Maria Dias Pedro
dc.contributor.authorOliveira, Daniele Adelaide Brandao de
dc.contributor.authorSoares, Romulo Alves
dc.contributor.authorFerreira, Eugénia Maria Dores Maia
dc.contributor.authorGouveia, Maria José
dc.date.accessioned2017-04-07T15:57:20Z
dc.date.available2017-04-07T15:57:20Z
dc.date.issued2016
dc.description.abstractAdvances in information technologies have led to the storage of large amounts of data by organizations. An analysis of this data through data mining techniques is important support for decision-making. This article aims to apply techniques for the classification of the beneficiaries of an operator of health insurance in Brazil, according to their financial sustainability, via their sociodemographic characteristics and their healthcare cost history. Beneficiaries with a loss ratio greater than 0.75 are considered unsustainable. The sample consists of 38875 beneficiaries, active between the years 2011 and 2013. The techniques used were logistic regression and classification trees. The performance of the models was compared to accuracy rates and receiver operating Characteristic curves (ROC curves), by determining the area under the curves (AUC). The results showed that most of the sample is composed of sustainable beneficiaries. The logistic regression model had a 68.43% accuracy rate with AUC of 0.7501, and the classification tree obtained 67.76% accuracy and an AUC of 0.6855. Age and the type of plan were the most important variables related to the profile of the beneficiaries in the classification. The highlights with regard to healthcare costs were annual spending on consultation and on dental insurance.
dc.identifier.issn1647-3183
dc.identifier.otherAUT: ECA01563; MJG70027;
dc.identifier.urihttp://hdl.handle.net/10400.1/9680
dc.language.isoeng
dc.peerreviewedyes
dc.publisherResearch Centre for Spatial and Organizational Dynamics (CIEO)
dc.relation.isbasedonWOS:000391035400004
dc.titleClassification of the financial sustainability of health insurance beneficiaries through data mining techniques
dc.typejournal article
dspace.entity.typePublication
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/5876/UID%2FSOC%2F04020%2F2013/PT
oaire.citation.endPage242
oaire.citation.issue3
oaire.citation.startPage229
oaire.citation.titleJournal of Spatial and Organizational Dynamics
oaire.citation.volume4
oaire.fundingStream5876
person.familyNameGouveia
person.givenNameMaria José Baltazar dos Reis de Pinto
person.identifier.ciencia-id6F1F-BE3C-26A5
person.identifier.orcid0000-0002-5056-1944
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsopenAccess
rcaap.typearticle
relation.isAuthorOfPublication48aedff2-842b-4cdd-8237-0474be2e3e42
relation.isAuthorOfPublication.latestForDiscovery48aedff2-842b-4cdd-8237-0474be2e3e42
relation.isProjectOfPublicationd929dde6-e7fa-4824-aba6-9f5e14a1e1be
relation.isProjectOfPublication.latestForDiscoveryd929dde6-e7fa-4824-aba6-9f5e14a1e1be

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