An Analytical Data Model to Improve Benefits of the Comprehensive Health Insurance System By Data Mining Techniques

Health insurance represents a crucial safeguard against the myriad risks associated with individual health conditions, covering expenses related to examinations, diagnosis and treatment, as well as providing psychological and physical support. Until mid-2019, Egypt implemented a social health insurance system, and then moved to a renewed framework known as the comprehensive health insurance system in the latter half of 2019. The research at hand focuses on exploring a new mechanism through develop a new model, it can be help the General Authority for Health Insurance to attainment of maximum benefits, whether in terms of individuals medical services or the enhancement of the nation's overall income return. The researcher depends on using the data mining technique to conduct specialized analyzes of big data for the new model, to offer the numerous advantages, including empowering decision-makers to make accurate decisions based on reliable information and proficient data analysis, Based on the new model for the health insurance system that was prepared and implemented using the Weka program, version 3.8.6, through the classifier scheme (classifiers.trees.J48 algorithm), the applied pattern was used: (Scheme:weka.classifiers.misc.InputMappedClassifier -I -trim -Wweka.classifiers.trees.J48 -- -C 0.25 -M 2), Through the Weka program, a new model was designed that contains two parts. The first part is to classify the insured into insurance categories according to their monthly salaries, and the second part is to predict the classification and distribution of employees among insurance packages according to the new health insurance model. The model was prepared using Weka.classifiers.trees.J48. software to analysis the dataset of 2781 employees. One of the significant outcomes that the researcher emphasizes from implementing the new model is the attainment of maximum benefits, whether in terms of individual medical services or the enhancement of the nation's overall income return. Under the existing health insurance law in Egypt, the monthly subscription fee is a flat 1% for all employees, without accounting for other factors. The results of applying the new model showed the effectiveness of the model through a comparison between the current subscription fees and the new health insurance model, developed using the same dataset of 2781 employees, reveals that the total monthly subscription fees under the current health insurance system amount to 153057.97 Egyptian Pounds (L.E.), whereas the total subscription fees under the new health insurance system model reach 365998.91 L.E., The financial benefits realized from the new model amount to 212940.94 L.E., representing a percentage increase of up to 139.12%. This demonstrates a considerable improvement in financial outcomes, and the potential advantages of transitioning to the new health insurance model.