{"id":"https://openalex.org/W4391427799","doi":"https://doi.org/10.1177/14604582241230384","title":"Identification of high-risk beneficiaries in private healthcare insurance","display_name":"Identification of high-risk beneficiaries in private healthcare insurance","publication_year":2024,"publication_date":"2024-01-01","ids":{"openalex":"https://openalex.org/W4391427799","doi":"https://doi.org/10.1177/14604582241230384","pmid":"https://pubmed.ncbi.nlm.nih.gov/38301111"},"language":"en","primary_location":{"id":"doi:10.1177/14604582241230384","is_oa":true,"landing_page_url":"https://doi.org/10.1177/14604582241230384","pdf_url":"https://journals.sagepub.com/doi/pdf/10.1177/14604582241230384","source":{"id":"https://openalex.org/S201800618","display_name":"Health Informatics Journal","issn_l":"1460-4582","issn":["1460-4582","1741-2811"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Informatics Journal","raw_type":"journal-article"},"type":"article","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://journals.sagepub.com/doi/pdf/10.1177/14604582241230384","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5046913246","display_name":"Adauto Santos","orcid":"https://orcid.org/0000-0003-1965-5421"},"institutions":[{"id":"https://openalex.org/I123443094","display_name":"Universidade Estadual de Maring\u00e1","ror":"https://ror.org/04bqqa360","country_code":"BR","type":"education","lineage":["https://openalex.org/I123443094"]}],"countries":["BR"],"is_corresponding":true,"raw_author_name":"Adauto Santos","raw_affiliation_strings":["Technology Center, State University of Maring\u00e1, Maring\u00e1, Brazil"],"affiliations":[{"raw_affiliation_string":"Technology Center, State University of Maring\u00e1, Maring\u00e1, Brazil","institution_ids":["https://openalex.org/I123443094"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5006992542","display_name":"Gislaine Camila Lapasini Leal","orcid":"https://orcid.org/0000-0001-8599-0776"},"institutions":[{"id":"https://openalex.org/I123443094","display_name":"Universidade Estadual de Maring\u00e1","ror":"https://ror.org/04bqqa360","country_code":"BR","type":"education","lineage":["https://openalex.org/I123443094"]}],"countries":["BR"],"is_corresponding":false,"raw_author_name":"Gislaine Camila Lapasini Leal","raw_affiliation_strings":["Technology Center, State University of Maring\u00e1, Maring\u00e1, Brazil"],"affiliations":[{"raw_affiliation_string":"Technology Center, State University of Maring\u00e1, Maring\u00e1, Brazil","institution_ids":["https://openalex.org/I123443094"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5009637128","display_name":"Renato Balancieri","orcid":"https://orcid.org/0000-0002-8532-2011"},"institutions":[{"id":"https://openalex.org/I3020652664","display_name":"Universidade Estadual do Paran\u00e1","ror":"https://ror.org/049rrx986","country_code":"BR","type":"education","lineage":["https://openalex.org/I3020652664"]}],"countries":["BR"],"is_corresponding":false,"raw_author_name":"Renato Balancieri","raw_affiliation_strings":["Computer Science Collegiate, State University of Paran\u00e1, Apucarana, Brazil"],"affiliations":[{"raw_affiliation_string":"Computer Science Collegiate, State University of Paran\u00e1, Apucarana, Brazil","institution_ids":["https://openalex.org/I3020652664"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5046913246"],"corresponding_institution_ids":["https://openalex.org/I123443094"],"apc_list":{"value":1500,"currency":"USD","value_usd":1500},"apc_paid":{"value":1500,"currency":"USD","value_usd":1500},"fwci":1.0348,"has_fulltext":false,"cited_by_count":1,"citation_normalized_percentile":{"value":0.83589387,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":91,"max":95},"biblio":{"volume":"30","issue":"1","first_page":"14604582241230384","last_page":"14604582241230384"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.9760000109672546,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.9760000109672546,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11531","display_name":"Healthcare Systems and Reforms","score":0.9758999943733215,"subfield":{"id":"https://openalex.org/subfields/2003","display_name":"Finance"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12394","display_name":"Insurance and Financial Risk Management","score":0.9704999923706055,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/naive-bayes-classifier","display_name":"Naive Bayes classifier","score":0.6302871704101562},{"id":"https://openalex.org/keywords/categorization","display_name":"Categorization","score":0.5684277415275574},{"id":"https://openalex.org/keywords/random-forest","display_name":"Random forest","score":0.5664284229278564},{"id":"https://openalex.org/keywords/health-care","display_name":"Health care","score":0.5454677939414978},{"id":"https://openalex.org/keywords/computer-science","display_name":"Computer science","score":0.5410645604133606},{"id":"https://openalex.org/keywords/identification","display_name":"Identification (biology)","score":0.49571382999420166},{"id":"https://openalex.org/keywords/decision-tree","display_name":"Decision tree","score":0.47390973567962646},{"id":"https://openalex.org/keywords/beneficiary","display_name":"Beneficiary","score":0.4651661217212677},{"id":"https://openalex.org/keywords/k-nearest-neighbors-algorithm","display_name":"k-nearest neighbors algorithm","score":0.46109381318092346},{"id":"https://openalex.org/keywords/actuarial-science","display_name":"Actuarial science","score":0.4308347702026367},{"id":"https://openalex.org/keywords/artificial-intelligence","display_name":"Artificial intelligence","score":0.39732715487480164},{"id":"https://openalex.org/keywords/data-mining","display_name":"Data mining","score":0.3962878882884979},{"id":"https://openalex.org/keywords/machine-learning","display_name":"Machine learning","score":0.3960914611816406},{"id":"https://openalex.org/keywords/business","display_name":"Business","score":0.2551236152648926},{"id":"https://openalex.org/keywords/support-vector-machine","display_name":"Support vector machine","score":0.21736818552017212},{"id":"https://openalex.org/keywords/finance","display_name":"Finance","score":0.1195736825466156},{"id":"https://openalex.org/keywords/political-science","display_name":"Political science","score":0.10304570198059082}],"concepts":[{"id":"https://openalex.org/C52001869","wikidata":"https://www.wikidata.org/wiki/Q812530","display_name":"Naive Bayes classifier","level":3,"score":0.6302871704101562},{"id":"https://openalex.org/C94124525","wikidata":"https://www.wikidata.org/wiki/Q912550","display_name":"Categorization","level":2,"score":0.5684277415275574},{"id":"https://openalex.org/C169258074","wikidata":"https://www.wikidata.org/wiki/Q245748","display_name":"Random forest","level":2,"score":0.5664284229278564},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5454677939414978},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.5410645604133606},{"id":"https://openalex.org/C116834253","wikidata":"https://www.wikidata.org/wiki/Q2039217","display_name":"Identification (biology)","level":2,"score":0.49571382999420166},{"id":"https://openalex.org/C84525736","wikidata":"https://www.wikidata.org/wiki/Q831366","display_name":"Decision tree","level":2,"score":0.47390973567962646},{"id":"https://openalex.org/C26869875","wikidata":"https://www.wikidata.org/wiki/Q2596417","display_name":"Beneficiary","level":2,"score":0.4651661217212677},{"id":"https://openalex.org/C113238511","wikidata":"https://www.wikidata.org/wiki/Q1071612","display_name":"k-nearest neighbors algorithm","level":2,"score":0.46109381318092346},{"id":"https://openalex.org/C162118730","wikidata":"https://www.wikidata.org/wiki/Q1128453","display_name":"Actuarial science","level":1,"score":0.4308347702026367},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.39732715487480164},{"id":"https://openalex.org/C124101348","wikidata":"https://www.wikidata.org/wiki/Q172491","display_name":"Data mining","level":1,"score":0.3962878882884979},{"id":"https://openalex.org/C119857082","wikidata":"https://www.wikidata.org/wiki/Q2539","display_name":"Machine learning","level":1,"score":0.3960914611816406},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.2551236152648926},{"id":"https://openalex.org/C12267149","wikidata":"https://www.wikidata.org/wiki/Q282453","display_name":"Support vector machine","level":2,"score":0.21736818552017212},{"id":"https://openalex.org/C10138342","wikidata":"https://www.wikidata.org/wiki/Q43015","display_name":"Finance","level":1,"score":0.1195736825466156},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.10304570198059082},{"id":"https://openalex.org/C59822182","wikidata":"https://www.wikidata.org/wiki/Q441","display_name":"Botany","level":1,"score":0.0},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"score":0.0},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.0}],"mesh":[{"descriptor_ui":"D000069550","descriptor_name":"Machine Learning","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000069550","descriptor_name":"Machine Learning","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000069550","descriptor_name":"Machine Learning","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000069550","descriptor_name":"Machine Learning","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000465","descriptor_name":"Algorithms","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D000465","descriptor_name":"Algorithms","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D000465","descriptor_name":"Algorithms","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D000465","descriptor_name":"Algorithms","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D001499","descriptor_name":"Bayes Theorem","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D001499","descriptor_name":"Bayes Theorem","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D001499","descriptor_name":"Bayes Theorem","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D001499","descriptor_name":"Bayes Theorem","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007341","descriptor_name":"Insurance","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D007341","descriptor_name":"Insurance","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D007341","descriptor_name":"Insurance","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D007341","descriptor_name":"Insurance","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D016208","descriptor_name":"Databases, Factual","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016208","descriptor_name":"Databases, Factual","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016208","descriptor_name":"Databases, Factual","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016208","descriptor_name":"Databases, Factual","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":2,"locations":[{"id":"doi:10.1177/14604582241230384","is_oa":true,"landing_page_url":"https://doi.org/10.1177/14604582241230384","pdf_url":"https://journals.sagepub.com/doi/pdf/10.1177/14604582241230384","source":{"id":"https://openalex.org/S201800618","display_name":"Health Informatics Journal","issn_l":"1460-4582","issn":["1460-4582","1741-2811"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Informatics Journal","raw_type":"journal-article"},{"id":"pmid:38301111","is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/38301111","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health informatics journal","raw_type":null}],"best_oa_location":{"id":"doi:10.1177/14604582241230384","is_oa":true,"landing_page_url":"https://doi.org/10.1177/14604582241230384","pdf_url":"https://journals.sagepub.com/doi/pdf/10.1177/14604582241230384","source":{"id":"https://openalex.org/S201800618","display_name":"Health Informatics Journal","issn_l":"1460-4582","issn":["1460-4582","1741-2811"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Informatics Journal","raw_type":"journal-article"},"sustainable_development_goals":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":false},"content_urls":{"pdf":"https://content.openalex.org/works/W4391427799.pdf"},"referenced_works_count":23,"referenced_works":["https://openalex.org/W231189394","https://openalex.org/W1930201302","https://openalex.org/W1976193075","https://openalex.org/W1980988016","https://openalex.org/W2056132907","https://openalex.org/W2085922120","https://openalex.org/W2155653793","https://openalex.org/W2157825442","https://openalex.org/W2228876158","https://openalex.org/W2295598076","https://openalex.org/W2323531818","https://openalex.org/W2754545775","https://openalex.org/W2768919196","https://openalex.org/W2911964244","https://openalex.org/W2935748408","https://openalex.org/W2996259470","https://openalex.org/W3027490873","https://openalex.org/W3100369282","https://openalex.org/W3104319567","https://openalex.org/W3118743931","https://openalex.org/W3200497182","https://openalex.org/W4200190035","https://openalex.org/W4250664506"],"related_works":["https://openalex.org/W4367336074","https://openalex.org/W3154045278","https://openalex.org/W4379620016","https://openalex.org/W4393666307","https://openalex.org/W3210764983","https://openalex.org/W4393443811","https://openalex.org/W4367335949","https://openalex.org/W3089416646","https://openalex.org/W4380048833","https://openalex.org/W4393601998"],"abstract_inverted_index":{"The":[0,84,106],"objective":[1],"of":[2,19,58,92,104],"this":[3],"study":[4,107],"was":[5],"to":[6,14,29,135],"apply":[7],"the":[8,30,39,43,100,122,129],"Knowledge":[9],"Discovery":[10],"in":[11],"Databases":[12],"process":[13],"find":[15],"out":[16],"if":[17],"beneficiaries":[18],"a":[20,89,118,125],"private":[21],"healthcare":[22],"insurance":[23],"would":[24],"belong,":[25],"at":[26],"least":[27],"once,":[28],"'very":[31],"high":[32],"cost'":[33],"and":[34,81,96],"'complex":[35],"cases'":[36],"groups":[37],"throughout":[38],"12":[40],"months":[41,116],"after":[42],"month":[44],"when":[45],"algorithms":[46,70],"were":[47,50,71],"applied.":[48],"Datasets":[49],"built":[51],"containing":[52],"information":[53],"on":[54,113],"beneficiaries'":[55],"effective":[56],"use":[57],"their":[59,65],"health":[60],"plan,":[61],"as":[62,64],"well":[63],"characteristics.":[66],"Five":[67],"machine":[68],"learning":[69],"used,":[72],"namely":[73],"Random":[74],"forest,":[75],"Extra":[76],"tree,":[77],"Xgboost,":[78],"Naive":[79],"bayes":[80],"K-nearest":[82,85],"neighbor.":[83],"neighbor":[86],"algorithm":[87],"had":[88],"recall":[90],"rate":[91],"81.12%,":[93],"83.77%":[94],"precision":[95],"an":[97],"Area":[98],"Under":[99],"Curve":[101],"(AUC)":[102],"value":[103],"0.9045.":[105],"also":[108],"revealed":[109],"that":[110],"categorization":[111],"occurs,":[112],"average,":[114],"8.11":[115],"before":[117],"beneficiary":[119],"entering,":[120],"for":[121],"first":[123],"time,":[124],"high-risk":[126],"group,":[127],"considering":[128],"dataset":[130],"classification":[131],"from":[132],"January":[133],"2019":[134],"June":[136],"2020.":[137]},"counts_by_year":[{"year":2025,"cited_by_count":1}],"updated_date":"2025-11-06T06:51:31.235846","created_date":"2025-10-10T00:00:00"}