Risk segmentation in Chilean social health insurance

Area of Science:

• Health economics
• Insurance risk management
• Social policy analysis

Background:

• Chile's health insurance sector has historically been public-dominated.
• Growing private sector participation necessitates understanding its impact on risk and social variables.

Purpose of the Study:

• To analyze the effects of increased private sector participation in health insurance.
• To identify key risk and social variables influenced by this shift in Chile.

Main Methods:

• Utilized predictive risk modeling.
• Analyzed a large dataset of over 250,000 health insurance policy records from Chile's Superintendence of Health.

Main Results:

• Risk segmentation is a viable risk management strategy.
• Key claim-influencing variables include number of dependents, gender, wages, and customer duration.

Conclusions:

• Private sector expansion in health insurance needs regulatory oversight to maintain social benefits.
• Risk segmentation shows potential for predicting insurance claim behavior in Chile's evolving market.