Machine learning for an explainable cost prediction of medical insurance

Predictive modeling in healthcare continues to be an active actuarial research topic as more insurance companies aim to maximize the potential of Machine Learning (ML) approaches to increase their productivity and efficiency. In this paper, the authors deployed three regression-based ensemble ML models that combine variations of decision trees through Extreme Gradient Boosting (XGBoost), Gradient-boosting Machine (GBM), and Random Forest (RF) methods in predicting medical insurance costs. Explainable Artificial Intelligence (XAi) methods SHapley Additive exPlanations (SHAP) and Individual Conditional Expectation (ICE) plots were deployed to discover and explain the key determinant factors that influence medical insurance premium prices in the dataset. The dataset used comprised 986 records and is publicly available in the KAGGLE repository. The models were evaluated using four performance evaluation metrics, including R-squared (R²), Mean Absolute Error (MAE), Root Mean Squared Error (RMSE), and Mean Absolute Percentage Error (MAPE). The results show that all models produced impressive outcomes; however, the XGBoost model achieved a better overall performance although it also expanded more computational resources, while the RF model recorded a lesser prediction error and consumed far fewer computing resources than the XGBoost model. Furthermore, we compared the outcome of both XAi methods in identifying the key determinant features that influenced the PremiumPrices for each model and whereas both XAi methods produced similar outcomes, we found that the ICE plots showed in more detail the interactions between each variable than the SHAP analysis which seemed to be more high-level. It is the aim of the authors that the contributions of this study will help policymakers, insurers, and potential medical insurance buyers in their decision-making process for selecting the right policies that meet their specific needs.