Risk Analysis Using Poisson-Pareto Models to Estimate Reserve Funds for Catastrophic Diseases in National Health Insurance

Setyo Luthfi Okta Yohandoko (Master Program in Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Padjadjaran, Jalan Raya Bandung Sumedang Km 21, Hegarmanah, Jatinangor, Sumedang Regency, West Java 45361, Indonesia)
Almira Ajeng Pangestika (Badan Pusat Statistik Provinsi Sulawesi Selatan, Jalan Haji Bau No.6 Makassar 90125 Sulawesi Selatan, Indonesia)
Yasir Salih (Department of Mathematics, Faculty of Education, Red Sea University, SUDAN)

International Journal of Quantitative Research and Modeling
Vol. 5 No. 4 (2024): International Journal of Quantitative Research and Modeling

Catastrophic diseases such as heart disease, cancer, stroke, and kidney failure pose significant financial burdens on national health insurance systems due to their high treatment costs and frequency. This study utilizes the Poisson-Pareto model to analyze aggregate claims and determine premium loading for these diseases, ensuring the financial sustainability of the National Health Insurance program. Using secondary data from 2018 to 2023, we estimate the parameters for frequency and severity distributions, calculate the expected aggregate claims, and derive the required premium loading at various confidence levels. The results show that heart disease accounts for the highest reserve fund allocation, while kidney failure requires the lowest. These findings emphasize the importance of preparing sufficient reserve funds to manage financial risks associated with catastrophic diseases. The proposed approach provides a robust framework for national health insurance providers to maintain financial stability and optimize resource allocation for high-cost diseases.