Addressing Medical Inflation with Generative AI Technology

Medical inflation refers to the phenomenon where healthcare costs increase at a faster rate than general inflation. In Indonesia, medical inflation can reach 2-3 times that of general inflation. In 2023, health insurance claims amounted to IDR 20.83 trillion, a 24.9% increase from the previous year.

In the first quarter of 2024 alone, claims have reached IDR 5.96 trillion, indicating a significant upward trend. The main factors driving this increase are medical inflation and overutilization of medical services in hospitals. This high number of claims raises concerns and demands innovative solutions to address this issue.

In this digital era, technology plays a crucial role in various sectors, including health insurance. One promising innovation is Generative AI. This technology offers great potential in reducing the burden of rising health insurance claims. The Financial Services Authority (OJK) has encouraged the use of digital technology, including Generative AI, to build more efficient systems and reduce overutilization of medical services.

  • Reducing Overutilization of Medical Services
    Generative AI can help reduce unnecessary hospital visits through effective online consultations. Using a robust database, AI can provide accurate medical recommendations without physical intervention.

    This not only reduces the burden on hospitals but also lowers medical costs borne by insurance companies. Implementing AI in medical consultations can offer faster and more accurate initial diagnoses, reducing the need for further expensive and often unnecessary examinations.

  • Building a Database to Mitigate Fraud Risk
    One of the main benefits of Generative AI is its ability to build and analyze comprehensive databases. With accurate data, insurance companies can more easily detect potential fraud and take preventive actions before problems escalate.

    This database also ensures that submitted claims are valid and comply with applicable regulations. Data analysis using AI allows for the identification of suspicious patterns that may be missed by conventional systems.

  • Medical Cost Efficiency
    The OJK has promoted medical cost efficiency through digital technology. Generative AI can play a role in optimizing administrative and operational processes in hospitals, thereby reducing unnecessary overhead costs.

    With more efficient processes, costs incurred by patients and insurance companies can be minimized, preventing insurance claims from swelling significantly. AI can automate various administrative tasks, reduce human error, and speed up service delivery.

  • Promoting a Healthy Lifestyle
    In addition to technology, the OJK also urges the public to adopt a healthy lifestyle. Generative AI can assist in providing personalized health advice based on individual data, encouraging people to be more active and maintain their health.

    With a healthier lifestyle, the potential for health insurance claims can decrease as disease rates decline. AI can provide regular reminders for physical activities, dietary tips, and real-time health monitoring.

Facing the rising surge of health insurance claims, Generative AI offers innovative solutions to address various challenges. By reducing overutilization of medical services, building a robust database, and promoting cost efficiency, this technology has the potential to transform the health insurance landscape in Indonesia.

In the future, the implementation of Generative AI will not only help insurance companies but also provide significant benefits to the entire healthcare ecosystem. Society is expected to become healthier and more productive, while the insurance industry becomes more efficient and sustainable.

ABOUT MIMIN

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The applications that can be generated include, amongst others, the ease of running chat commerce, chat campaigns, customer automation, omnichannel inbox, and Generative-AI chatbot.

With Mimin, businesses can deliver superior customer experiences, strengthen customer relationships, and build stronger customer loyalty.

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