MANAGING HEART RELATED DISEASE RISKS IN BPJS KESEHATAN USING COLLECTIVE RISK MODELS

Gede Ary Prabha Yogesswara, D. Qoyyimi, Abdurakhman Abdurakhman
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Abstract

BPJS Kesehatan is a legal entity established to administer the health service program using the insurance system. Heart related diseases is a disease with the largest coverage cost in Indonesia. It can be calculated by using the collective risk model as an approximation of the aggregate loss model. This model is a compound distribution from claim frequency and claim severity, where claim frequency be the primary distributions. The Poisson distribution can be used to the distribution of the heart disease claim frequency. Whereas, the distribution of the heart disease claim severity has a lognormal distribution. The model obtained can explain the aggregate loss of heart disease claims properly.
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使用集体风险模型管理BPJS患者心脏相关疾病风险
BPJS Kesehatan是一个使用保险系统管理医疗服务项目的法律实体。心脏相关疾病是印尼医保费用最高的疾病。它可以通过使用集体风险模型作为总损失模型的近似来计算。该模型是索赔频率和索赔严重性的复合分布,其中索赔频率是主要分布。泊松分布可用于心脏病索赔频率的分布。而心脏病索赔严重程度的分布呈对数正态分布。所得到的模型可以很好地解释心脏病索赔的总损失。
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