Dynamics of healthcare shared-patient complex networks

LUIS G. MOYANO; ANA PAULA APPEL; MÁRCIA ITO; VAGNER FIGUEREDO DE SANTANA; CLAUDIO PINHANEZ

Dijon

Workshop; 7th Workshop on Complex Networks; 2016

Université de Bourgogne

Health insurance companies in Brazil have their data about claims organized having the view only for providers. In this way, they loose the physician view and how they share patients. Partnership between physicians can view as a fruitful work in most of the cases but sometimes this could be a problem for health insurance companies and patients, for example a recommendation to visit another physician only because they work in same clinic.   The focus of the work is   to better understand physicians activities and how these  activities are represented in the data.  Our approach considers three  aspects: the relationships among physicians, the relationships between physicians andpatients, and  the relationships between physicians and health providers.    We present the results of an analysis of a claims database (detailing 18  months of activity) from a large health insurance company in Brazil.    The main contribution presented in  this paper is a set of models to represent: emph{mutual referral} between physicians,   emph{patient retention}, and emph{physician centrality} in the health insurance network. Our results show the proposed models,  based on the use of graph mining techniques, help extracting new types of insights about  physicians from real health insurance claims data.