title: Risk segmentation in Chilean social health insurance.
abstract: OBJECTIVE
  The objective of this study is to identify how risk and social variables are likely to be impacted by an increase in private sector participation in health insurance provision. The study focuses on the Chilean health insurance industry, traditionally dominated by the public sector.
  
  
  METHODS
  Predictive risk modelling is conducted using a database containing over 250,000 health insurance policy records provided by the Superintendence of Health of Chile.
  
  
  RESULTS
  Although perceived with suspicion in some circles, risk segmentation serves as a rational approach to risk management from a resource perspective. The variables that have considerable impact on insurance claims include the number of dependents, gender, wages and the duration a claimant has been a customer.
  
  
  CONCLUSIONS
  As shown in the case study, to ensure that social benefits are realised, increased private sector participation in health insurance must be augmented by regulatory oversight and vigilance.
  
  
  CONCLUSIONS
  As it is clear that a "community-rated" health insurance provision philosophy impacts on insurance firm's ability to charge "market" prices for insurance provision, the authors explore whether risk segmentation is a feasible means of predicting insurance claim behaviour in Chile's private health insurance industry.
authors.affiliation: School of Management, University of Southampton, Southampton, UK.
authors.forename: Hector
authors.initials: H
authors.lastname: Hidalgo
authors.forename: Maxwell
authors.initials: M
authors.lastname: Chipulu
authors.forename: Udechukwu
authors.initials: U
authors.lastname: Ojiako
mesh_terms: D002677:Chile; D018166:Health Care Reform / Q000191:economics* / Q000639:trends; D006291:Health Policy / Q000191:economics* / Q000639:trends; D006801:Humans; D007348:Insurance, Health / Q000191:economics* / Q000639:trends; D017149:Private Sector / Q000191:economics / Q000639:trends; D017150:Public Sector / Q000191:economics / Q000639:trends; D012308:Risk Management / Q000379:methods* / Q000458:organization & administration; D012943:Social Security / Q000191:economics* / Q000639:trends