EVALUATION OF THE PAYMENT SCHEDULE OF A HEALTH INSURER

Objective: The present study aimed to develop a model for estimating monthly claims payments that involved the collaboration of service providers of health plan operators. Rationale: Although each insurer has a specific payment schedule, it is feasible to conceive that the date of discharge is dependent upon the time the event is received by the insurer. However, it should be noted that the variation of the claims paid in each month is due to different factors, and the seasonality of the coverage offered by these companies is very relevant for insertion into a payment model. Method: Through the analysis of the seasonality of previous periods, a model of payments of monthly claims was conceived through one of an event simulation. Results: In the scope of the results it was verified that the proposed model showed a significant adhesion for 7 of the 10 months analyzed. That is, by comparing the estimated values from the model with the actual values, it was verified that for 7 months the error, in module, was less than 10%. Contributions: The model presented here has conditions to be used to estimate the flow of future payments, making it possible to increase the procedures for managing the financial resources of the health plan operators, as well as an improvement in their financial results. It should be noted that other parameters, such as the profile of insurance portfolios and the region, could be incorporated into future versions of this model in order to increase its accuracy.