Risk segmentation in social health insurance in Chile

Hidalgo, Hector, Chipulu, Maxwell and Ojiako, Udechukwu (2013) Risk segmentation in social health insurance in Chile. International Journal of Health Care Quality Assurance, 26 (7). (In Press)

Abstract

The objective of the study is to identify how risk and social variables are likely to be impacted by an increase in the participation of the private sector in the provision of health insurance in Chile; an industry that has traditionally remained in the sole domain of the public sector. Predictive risk modelling is conducted using a database containing over two hundred and fifty thousand health insurance policy records provided by the Superintendence of Health of Chile (SHC). We find that although perceived with suspicion in some circles, risk segmentation serves as a rational approach to risk management from a resource perspective. We also find that the variables which impacted most on the potential for a high number of insurance claims include the number of dependants, gender, wages and length of time a claimant has been a customer. As it is clear that a ‘‘community-rated’’ provision of health insurance provision philosophy impacts on the ability of insurance firms to charge ‘market’ prices for insurance provision, the authors explore whether risk segmentation is a feasible means of predicting insurance claim behaviour in Chile’s private health insurance industry.

This record has no associated files available for download.

Contributors

Author: Maxwell Chipulu

Download statistics