Perhitungan Premi Kredibilitas Asuransi Kesehatan dengan Pendekatan Greatest Accuracy Credibility Theory

Wiyono, Amelia Rizky Avrilia Putri (2024) Perhitungan Premi Kredibilitas Asuransi Kesehatan dengan Pendekatan Greatest Accuracy Credibility Theory. Other thesis, Institut Teknologi Sepuluh Nopember.

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Abstract

Indonesia terus mengalami peningkatan inflasi biaya medis yang berdampak pada lonjakan biaya pelayanan kesehatan. Asuransi kesehatan memiliki peran penting dalam memberikan jaminan perlindungan atas kerugian finansial yang timbul selama masa pengobatan dan perawatan medis. Pemerintah turut menghadirkan BPJS Kesehatan sebagai asuransi kesehatan sosial untuk menjamin kemampuan dalam akses pelayanan kesehatan tersebar secara merata di masyarakat. Namun, loss ratio medis juga mengalami peningkatan dari waktu ke waktu hingga mencapai 107% yang menandakan tidak seimbangnya pengeluaran untuk pertanggungan dengan pendapatan premi pada perusahaan asuransi. Perhitungan premi dengan berdasarkan riwayat pembayaran klaim diperlukan untuk menjaga angka loss ratio medis berada di persentase yang wajar. Penelitian ini menghitung premi asuransi kesehatan milik BPJS Kesehatan berdasarkan level pelayanan yang tersedia dengan metode Bühlmann-Straub pada teori kredibilitas keakuratan terbesar. Pemilihan metode berdasarkan hasil fitting data klaim BPJS Kesehatan, yakni tidak terdistribusi secara identik. Severitas BPJS Kesehatan diasumsikan berdistribusi Gamma dengan seluruh variabel acak severitas bersyarat level pelayanan memenuhi uji kesesuaian distribusi Kolmogorov-Smirnov (KS) dengan distribusi Gamma. Pemetaan level pelayanan pada perhitungan premi didasari oleh pemeringkatan level pelayanan dengan total nominal pembiayaan klaim tertinggi. Frekuensi BPJS Kesehatan mengikuti distribusi Negatif Binomial dan juga telah memenuhi uji kesesuaian distribusi Kolmogorov-Smirnov. Perolehan faktor kredibilitas bernilai sangat mendekati 1, maka premi kredibilitas BPJS Kesehatan tergolong sebagai kredibilitas penuh. Hasil perhitungan premi kredibilitas BPJS Kesehatan dengan metode Bühlmann-Straub adalah Rp 5.333.476,27 per tahun atau sebesar Rp 444.456,36 per bulan
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Indonesia continues to experience increasing medical cost inflation which has an impact on increasing health service costs. Health insurance has an important role in providing guaranteed protection against financial losses that arise during the period of medical treatment and care. The government also presents BPJS Health as social health insurance to ensure that the ability to access health services is spread evenly in society. However, the medical loss ratio has also increased over time to reach 107%, which indicates an imbalance in spending on coverage with premium income at insurance companies. Calculating premiums based on claims payment history is necessary to maintain the medical loss ratio at a reasonable percentage. This research calculates BPJS Health's health insurance premiums based on the level of service available using the Bühlmann-Straub method based on the greatest accuracy credibility theory. The choice of method is based on the results of fitting the BPJS Health claims data, which is not distributed identically. BPJS Health Severity is assumed to have a Gamma distribution with all random variables conditional on the level of service meeting the Kolmogorov-Smirnov (KS) distribution suitability test with the Gamma distribution. Mapping service levels in premium calculations is based on ranking service levels with the highest total claim financing nominal. The BPJS Health frequency follows the Negative Binomial distribution and has also met the Kolmogorov-Smirnov distribution suitability test. If the credibility factor is very close to 1, the BPJS Health credibility premium is classified as full credibility. The results of calculating the BPJS Health credibility premium using the Bühlmann-Straub method are IDR 5,333,476.27 per year or IDR 444,456.36 per month

Item Type:	Thesis (Other)
Uncontrolled Keywords:	Asuransi Kesehatan, Bühlmann-Straub, Gamma, Negatif Binomial, Premi Kredibilitas
Subjects:	Q Science > QA Mathematics > QA273.5 Stochastic geometry Q Science > QA Mathematics > QA274.2 Stochastic analysis Q Science > QA Mathematics > QA275 Theory of errors. Least squares. Including statistical inference. Error analysis (Mathematics)
Divisions:	Faculty of Science and Data Analytics (SCIENTICS) > Actuaria > 94203-(S1) Undergraduate Thesis
Depositing User:	Amelia Rizky Avrilia Putri Wiyono
Date Deposited:	24 Jul 2024 03:14
Last Modified:	24 Jul 2024 03:14
URI:	http://repository.its.ac.id/id/eprint/108714

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