Artificial intelligence applications in health insurances: a scoping review.

IF 2.5 4区医学 Q3 HEALTH POLICY & SERVICES

Cost Effectiveness and Resource Allocation Pub Date : 2025-10-06 DOI:10.1186/s12962-025-00640-w

Maryam Ramezani-A, Ahad Bakhtiari, Mohammadreza Mobinizadeh, Rajabali Daroudi, Hamid R Rabiee, Alireza Olyaeemanesh, Ali Akbar Fazaeli, Hakimeh Mostafavi, Maryam Ramezani-B, Saharnaz Sazgarnejad, Sanaz Bordbar, Amirhossein Takian

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引用次数: 0

Abstract

Introduction: The rapid evolution of technology has reshaped the insurance industry, with artificial intelligence (AI) taking center stage as a key driver of innovation. This paper examines the transformative impact of AI in health insurance, focusing on its applications and potential to revolutionize the sector.

Method: This scoping review examines literature published between 2000 and 2024, focusing on the application of AI in health insurance. We used relevant keywords related to artificial intelligence and health insurance to search the PubMed, Scopus, and Web of Science databases.

Findings: AI presents numerous opportunities in health insurance, including contributions to shaping international and national agendas, such as aligning goals, establishing indicators, and achieving objectives, financial management, fraud detection, monitoring capabilities, diagnostics and medical innovations, private insurance applications, risk management, technical analysis, and value creation. However, there are ethical challenges that must be addressed if AI is to be effectively implemented.

Conclusion: Policies for AI applications in health insurance should prioritize the protection of personal health and medical data, address ethical concerns, and ensure robust data privacy and security. Additionally, these policies should promote the use of AI to enhance customer experiences, optimize risk selection, and generate revenue for both insurers and policyholders.

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人工智能在健康保险中的应用：范围审查。

导读：技术的快速发展重塑了保险业，人工智能（AI）作为创新的关键驱动力占据了中心舞台。本文探讨了人工智能在医疗保险领域的变革性影响，重点关注其应用和彻底改变该行业的潜力。方法：本文对2000年至2024年间发表的文献进行了范围综述，重点关注人工智能在健康保险中的应用。我们使用与人工智能和健康保险相关的关键词搜索PubMed、Scopus和Web of Science数据库。研究结果：人工智能在健康保险领域提供了许多机会，包括对制定国际和国家议程的贡献，例如调整目标、建立指标和实现目标、财务管理、欺诈检测、监测能力、诊断和医疗创新、私人保险应用、风险管理、技术分析和价值创造。然而，如果要有效地实施人工智能，就必须解决一些道德挑战。结论：人工智能在医疗保险中的应用政策应优先考虑个人健康和医疗数据的保护，解决伦理问题，并确保强大的数据隐私和安全。此外，这些政策应促进人工智能的使用，以增强客户体验，优化风险选择，并为保险公司和保单持有人创造收入。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cost Effectiveness and Resource Allocation HEALTH POLICY & SERVICES-

CiteScore

3.40

自引率

4.30%

发文量

审稿时长

34 weeks

期刊介绍： Cost Effectiveness and Resource Allocation is an Open Access, peer-reviewed, online journal that considers manuscripts on all aspects of cost-effectiveness analysis, including conceptual or methodological work, economic evaluations, and policy analysis related to resource allocation at a national or international level. Cost Effectiveness and Resource Allocation is aimed at health economists, health services researchers, and policy-makers with an interest in enhancing the flow and transfer of knowledge relating to efficiency in the health sector. Manuscripts are encouraged from researchers based in low- and middle-income countries, with a view to increasing the international economic evidence base for health.