Evaluation of the Effectiveness and Accuracy of Predictive Modeling Techniques on Healthcare Claims in Nigeria

Lukman Abolaji AJIJOLA; Oluwaleke Ebenezer AKINDIPE; Abdulrasheed Olajide LAWAL; Omolade Moses AFUWAPE; Priscilla Oluwaseyitan OLALEYE

Lukman Abolaji AJIJOLA Department of Actuarial Science & Insurance, University of Lagos, Akoka Lagos, Nigeria
Oluwaleke Ebenezer AKINDIPE Department of Actuarial Science & Insurance, University of Lagos, Akoka Lagos, Nigeria
Abdulrasheed Olajide LAWAL Department of Actuarial Science & Insurance, University of Lagos, Akoka Lagos, Nigeria
Omolade Moses AFUWAPE Department of Actuarial Science & Insurance, University of Lagos, Akoka Lagos, Nigeria
Priscilla Oluwaseyitan OLALEYE Department of Actuarial Science & Insurance, University of Lagos, Akoka Lagos, Nigeria

Keywords: Claim, Expenditure, Healthcare, Modelling, Prediction

Abstract

Predictive modeling in healthcare is essential for effective financial planning and strategic decision-making in the ever-revolving landscape of healthcare. This study, evaluate the effectiveness and accuracy of predictive modelling techniques on healthcare claims in Nigeria. Exploratory research design was used to carry out this study. The data were sourced from a reputable Health Maintenance Organization (HMO) in Nigeria with Datasets titled health datasets which have four (4) numerical features (claims paid, claim service type, categories of policyholder, gender). Descriptive statistics, testing for the performance of the model and model prediction were done on the data by using regression analysis. The paper emphasizes how predictive modeling methods might improve healthcare cost forecasts and decision-making. Results highlighted the necessity of better claims processing technologies, data analytics, and policy frameworks to increase Nigerian healthcare availability and affordability. The significant relationships between claim service types, categories of policyholder, Gender, and claims paid provide valuable information about the dynamics of healthcare claims in Nigeria.