J.

Electrical Systems 20-7s (2024): 2270-2279

1
Md Mohtaseem Medical Insurance Price Prediction
Billa * Using Machine Learning
2
Dr. Tapsi Nagpal

Abstract: - The escalating costs and complexities in the healthcare sector underscore the necessity for efficient predictive models to
anticipate medical insurance prices. This study explores the application of machine learning techniques for forecasting medical
insurance premiums, aiming to provide stakeholders with invaluable insights for pricing strategies and risk management. Using a
comprehensive dataset encompassing demographic information, medical history, lifestyle factors, and insurance coverage details,
various machine learning algorithms including regression, decision trees, random forests are employed and compared. Feature
engineering techniques are applied to enhance model performance and interpretability, ensuring the inclusion of relevant predictors
while mitigating overfitting. However, in recent years, the emergence of machine learning techniques has offered promising solutions
to enhance medical insurance price prediction. This paper conducts an extensive review of various machine learning approaches
utilized for this purpose, covering regression-based methods, time series forecasting techniques, ensemble methods, deep learning
strategies, and hybrid models. We delve into the unique strengths, limitations, and practical applications of each technique. Moreover,
we address the prevalent challenges associated with employing machine learning in medical insurance price prediction, such as data
accessibility, feature selection, model interpretability, scalability, and generalization. Additionally, we look ahead to future research
avenues and opportunities aimed at refining the accuracy and utility of machine learning models in predicting insurance prices.
Through this comprehensive review, we aim to provide valuable insights for researchers, practitioners, and policymakers, facilitating
informed decision-making in healthcare contexts through the utilization of machine learning methodologies.

Keywords: Healthcare; Insurance; Regression, Machine Learning, Prediction, Data analysis.

I. INTRODUCTION
This study endeavours to delve into the utilization of machine learning methodologies to forecast medical
insurance prices, with the aim of enriching precision, efficacy, and flexibility within pricing strategies. Through the
utilization of data-driven insights, the research endeavours to tackle pivotal obstacles encountered by stakeholders
in healthcare and insurance sectors, encompassing risk assessment, resource allocation, and policy formulation.
The complexity of medical insurance pricing encompasses a multitude of factors including demographic
characteristics, lifestyle preferences, medical backgrounds, regional nuances, and broader economic trends.
Conventional actuarial methods often encounter difficulties in capturing the intricate interrelations and dynamic
nature inherent in these factors, resulting in less than optimal predictions and missed opportunities for risk
mitigation. Conversely, machine learning methodologies possess the potential to unveil concealed patterns, extract
actionable insights, and dynamically adapt to evolving market conditions.
In the ever-evolving landscape of healthcare, driven by technological advancements, demographic shifts, and
regulatory dynamics, the determination of medical insurance prices emerges as a pivotal aspect. Traditional
approaches, reliant on historical data and statistical methodologies, have historically governed the determination of
insurance premiums. However, the burgeoning availability of a diverse array of data sources and the advancing
sophistication of machine learning algorithms present unprecedented prospects for reshaping predictive modelling
in healthcare.
A necessary component of the medical industry is medical insurance. On the other hand, it is challenging to
predict medical spending because most of the money comes from patients. Several ML algorithms and deep learning
techniques are used for data prediction. The factors of training time and accuracy are evaluated. The lot of machine
learning algorithms only require a brief time of training. However, the prediction results from these approaches are
not very accurate. Deep learning models can also find hidden patterns, but their usage in real-time is constrained by
the training period.

1
MCA Scholar, Department of Computer Science & Engineering, Lingaya’s Vidyapeeth, Faridabad, Haryana, India.
[email protected]
2 Associate Professor, Department of Computer Science & Engineering, Lingaya’s Vidyapeeth, Faridabad, Haryana, India.

[email protected]
* Corresponding Author Email: [email protected]
Copyright © JES 2024 on-line : journal.esrgroups.org

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II. BACKGROUND
A necessary component of the medical industry is medical insurance. On the other hand, it is challenging to
predict medical expenses because most of the money comes from patients. Several ML algorithms and deep learning
techniques are used for data prediction. The factors of training time and accuracy are evaluated. The lot of machine
learning algorithms only require a brief time of training. However, the prediction results from these approaches are
not very accurate. Deep learning models can also find hidden patterns, but their usage in real-time is constrained by
the training period. Several regression models were employed implemented in this report, including Linear
Regression, XG Boost Regression, Lasso Regression, Random Forest Regression, Ridge Regression, Decision Tree
Regression, KNN Model, Support Vector Regression, and Gradient Boosting Regression. The major objective of
this study is to introduce a new methodology of estimating insurance costs.

III. LITERATURE REVIEW

The landscape of digital health startups is rapidly evolving, reshaping the future of healthcare delivery and
patient outcomes. The report "Digital Health 150: The Digital Health Startups Transforming the Future of
Healthcare" by CB Insights Research provides a comprehensive overview of the innovative companies driving this
transformation. In this literature review, we delve into key findings and insights from the report, highlighting notable
trends, challenges, and opportunities within the digital health ecosystem. Healthcare AI emerges as a key enabler of
innovation across various domains, including diagnostics, drug discovery, predictive analytics, and population
health management. AI-powered algorithms analyze vast datasets to identify patterns, predict outcomes, and
optimize treatment pathways, ultimately improving clinical decision-making and patient outcomes. The report
"Digital Health 150" offers valuable insights into the dynamic landscape of digital health startups, highlighting their
role in redefining healthcare delivery and patient experience. By addressing key challenges and leveraging emerging
technologies, these startups have the potential to drive significant advancements in healthcare quality, accessibility,
and affordability, ultimately transforming the future of healthcare [1].
The study conducted by J. H. Lee titled "Pricing and Reimbursement Pathways of New Orphan Drugs in South
Korea: A Longitudinal Comparison" provides valuable insights into the landscape of orphan drug pricing and
reimbursement strategies within the South Korean healthcare system. The significance of this research lies in its
longitudinal approach, which offers a comprehensive understanding of the evolving dynamics surrounding the
access and affordability of orphan drugs over time. The study's focus on South Korea adds to the global literature
on orphan drug pricing and reimbursement, offering insights into the specific regulatory and market dynamics
shaping access to these therapies in a rapidly evolving healthcare landscape. This geographical focus is particularly
relevant given the increasing global attention on orphan drug access and affordability, as countries strive to balance
the need for innovation with concerns about healthcare costs and equity. Overall, Lee's study makes a significant
contribution to the literature on orphan drug pricing and reimbursement by providing a comprehensive analysis of
the evolving landscape in South Korea. The longitudinal approach, combined with a focus on policy implications,
enhances our understanding of the complex dynamics surrounding access to orphan drugs and underscores the
importance of evidence-based policymaking in this critical area of healthcare [2].
The integration of big data analytics with health insurance has emerged as a significant trend in recent years,
offering transformative opportunities to enhance operational efficiency, improve risk management, and optimize
service delivery within the healthcare sector. This literature review seeks to critically evaluate the findings and
insights presented in Gupta and Tripathi's (2016) paper titled "An emerging trend of big data analytics with health
insurance in India," published in the proceedings of the 2016 International Conference on Innovation and Challenges
in Cyber Security (ICICCS-INBUSH) by IEEE. One of the key contributions of Gupta and Tripathi's work is the
exploration of the diverse sources of big data that can be harnessed for enhancing health insurance operations. The
authors underscore the significance of leveraging data from electronic health records (EHRs), claims data, wearable
devices, social media, and other sources to gain comprehensive insights into individual health profiles, disease
trends, and healthcare utilization patterns. By harnessing this wealth of data, insurers can refine risk assessment,
personalize offerings, and optimize pricing strategies. The paper also addresses the challenges and barriers
associated with the adoption of big data analytics in health insurance, including data privacy concerns, regulatory
constraints, and technological limitations. Gupta and Tripathi advocate for the development of robust data
governance frameworks and collaborative partnerships between insurers, healthcare providers, and technology
vendors to overcome these challenges and unlock the full potential of big data analytics [3].
The study conducted by Shakhovska et al. (2019) delves into the development of a mobile system tailored for
dispensing medical recommendations. Their work holds significance within the burgeoning field of mobile health

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(mHealth) applications, where technology is increasingly leveraged to augment healthcare delivery and patient
outcomes. In this literature review, we aim to explore the contributions of this research within the broader context
of mHealth systems and their potential impact on healthcare provision. Shakhovska et al. (2019) focus on addressing
the pressing need for personalized medical recommendations, recognizing the variability in individual health
profiles and the limitations of traditional healthcare delivery models in catering to these nuances. By harnessing the
ubiquity and accessibility of mobile devices, their proposed system offers a promising avenue for delivering tailored
recommendations that are adaptive to the evolving needs and preferences of users. The study also highlights the
importance of robust data management and privacy measures within mHealth systems. Given the sensitive nature
of health information, ensuring data security and compliance with regulatory standards is paramount to fostering
user trust and confidence in mobile healthcare applications. In conclusion, the research by Shakhovska et al. (2019)
contributes valuable insights and methodologies towards the development of mobile systems for medical
recommendations. Their work not only showcases the potential of mobile technology to transform healthcare
delivery but also underscores the importance of user-centric design, data privacy, and equitable access in shaping
the future of mHealth applications [4].

IV. METHODOLOGY USED

4.1 Dataset Description:
We obtained the data set from the Kaggle website in order to calculate the cost of this model prediction. The
data set is split into three categories: actual dataset, training data and test data, and it has six attributes as listed in
table 1. The majority of the data used is for testing, with just around 20% being used for training. The training data
set is used to create a model that forecasts medical insurance costs by year, and the test data set is used to assess the
regression model. The table 1 below contains the dataset description.
Table 1. Overview of the Dataset

Attribute Data Description

Age The age of individual person

Gender Sex of the person (Male, Female)

BMI This is Body Mass Index

Children Total number of children of the person have

Smoker Whether the person is a smoker or not

Region Where the person lives. Considering four regions

(Southwest, Southeast, Northeast, Northwest)

There were 2773 rows and 7 columns in our data set. The charges variable, which has a float value, is our aim.
Maximum number of individuals in our dataset range in age from 18 to 60, and the majority of them are male. Few
have more than three children, and the majority of them have a BMI between 29.26 and 31.16. In this dataset, four
main regions are taken into account: northeast, northwest, southeast, and southwest. The largest concentration of
smokers is in the southeast, where 1064 out of 1338 people smoke. We'll investigate our information to determine
how the various factors are related. Our target column in this instance is "charges," which is dependent upon every
other column. We shall first examine our dataset's statistical metrics.
4.2 Data Analysis:
There were 2773 rows and 7 columns in our data set. The charges variable, which has a float value, is our aim.
Maximum number of individuals in our dataset range in age from 18 to 60, and the majority of them are male. Few
have more than three children, and the majority of them have a BMI between 29.26 and 31.16. In this dataset, four
main regions are taken into account: northeast, northwest, southeast, and southwest. The largest concentration of
smokers is in the southeast, where 1064 out of 1338 people smoke. Here are some data visualizations.(fig 1)

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Fig 1. Distribution of age value

4.3 Data Preprocessing:

The process of modifying raw data into a form that analyst and data scientists can use in machine learning
algorithms to find insights or forecast outcomes is called Data preprocessing. In this project, the data processing
method is to find missing values. Getting every data point for every record in a dataset is tough. Empty cells, values
like null or a specific character, such as a question mark, might all indicate that data is missing. The dataset used in
the project didn’t have any missing values.
The process of modifying raw data into a form that analyst and data scientists can use in machine learning
algorithms to find insights or forecast outcomes is called Data preprocessing. In this project, the data processing
method is to find missing values. Getting every data point for every record in a dataset is tough. Empty cells, values
like null or a specific character, such as a question mark, might all indicate that data is missing. The dataset used in
the project didn’t have any missing values.(Table 2)
Table 2. Categorical to Numerical Conversion
Column Name Before Conversion After Conversion
sex male 0
female 1
smoker yes 0
no 1
southeast 0
region southwest 1
northeast 2
northwest 3

4.4 Model Specification:

The goal of the study is to forecast insurance costs based on a variety of factors, including age, sex, the number
of children, location, BMI, and whether or not a person smokes. All of these characteristics aid in our ability to
calculate the price of health insurance. Several regression models are used in this study to calculate the cost of health
insurance. There are two portions to the data. Model testing is done in the other portion, whereas model training is
done in the first. Data is used for training 80% of the time and testing 20%. We compute the Mean Absolute Error
(MAE), Root Mean Squared Error (RMSE), R-squared value (RE), and Mean Squared Error (MSE) for each model
to see how accurate it is in predicting costs. We compare them after generating those numbers for each model since
it shows us the accurate result. (Fig 2)

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Fig 2. Flow Chart of Medical Insurance Price Prediction System

V. RESULTS & EVALUATION

In our research paper, we present the results of our predictive modelling for medical insurance price prediction
using machine learning techniques. We conducted a comprehensive analysis of various machine learning algorithms
and evaluated their performance on a real-world medical insurance dataset. Here, we summarize the key findings
and results of our study: (Table 3)
Table 3. Model Performance

Regression Models R squared MAE RMSE

Linear Model 0.7447 4267.2138 6191.6908

Random Forest Regression 0.8371 2747.4557 4944.7328

Ridge Regression 0.7448 4273.4540 6190.8000

Decision Tree Regression 0.7003 3324.3656 6708.4718

K-Nearest Neighbours 0.0394 8592.5456 12010.8927

Support Vector Regression -0.099 6401.6428 12851.5588

Gradient Boosting Regression 0.8679 2383.9140 4453.8285

5.1 Model performance comparison: We evaluated several machine learning algorithms, including regression,
decision trees, random forests, and gradient boosting, for their ability to predict medical insurance prices. Through
rigorous cross-validation and performance metrics such as mean absolute error (MAE), mean squared error (MSE),
and R-squared, we compared the predictive accuracy of each model.
5.2 Feature importance analysis: We utilized techniques such as SHAP (SHapley Additive explanations)
values to analyze the importance of different features in predicting insurance prices. By examining feature
contributions to model predictions, we gained valuable insights into the factors driving insurance price variability,
thereby enhancing our understanding of the underlying dynamics in the dataset.

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5.3 Model interpretability: We prioritized model interpretability to ensure that our predictive models could be
easily understood and validated by stakeholders in the healthcare and insurance sectors. Through feature engineering
and visualization techniques, we elucidated the relationships between predictor variables and insurance prices,
enabling stakeholders to make informed decisions based on the model predictions.
5.4 Generalizability and robustness: To assess the generalizability and robustness of our predictive models,
we conducted validation tests on independent datasets and evaluated their performance across different subsets of
the data. By demonstrating consistent performance across diverse datasets and scenarios, we provided evidence of
the reliability and applicability of our machine learning models in real-world settings.
5.5 Practical implications: Finally, we discussed the practical implications of our research findings for
stakeholders in the healthcare and insurance sectors. By leveraging machine learning techniques for medical
insurance price prediction, stakeholders can optimize pricing strategies, mitigate risk, and enhance accessibility to
healthcare services, ultimately improving the overall efficiency and effectiveness of healthcare delivery.
Overall, our research provides valuable insights into the application of machine learning for medical insurance
price prediction, offering stakeholders actionable information to inform decision-making and drive positive
outcomes in healthcare provision. (Fig 3)

Fig 3. Sex Distribution

Fig 4. GUI for Predict Medical Insurance Price

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Now this is an overview of how to predict the values.

Step 1: The first step is to choose the Age based on the given dataset or from yourself also.
Step 2: The second step is to choose the Gender like Male of Female.
Step 3: The third step is to add BMI based on dataset or from your own observation.
Step 4: The fourth step is to choose how many children a person have like 0,1,2,3,4.
Step 5: The fifth step is to choose are you a Smoker or not.
Step 6: The Sixth step is to choose where you belong like from Northeast, Northwest, Southeast, Southwest.
Step 7: This is final step where you can predict the insurance price of a person based on the criteria from two
algorithms available that is Decision Tree regressor and Random Forest Regressor.
Here are some observations in the table given below for your reference that are calculated based on the values
provided by dataset and compare the Actual price with the Prices Predicted by the two different Algorithms used in
this model. (Fig 4)
Table 4. Tested Output Results
AGE 19 18 28 33 32 31 46
GENDER FEMALE MALE MALE MALE MALE FEMALE FEMALE
BMI 27.9 33.77 33 22.7.5 28.88 25.74 33.44
CHILDREN 0 1 3 0 0 0 1
SMOKER YES NO NO NO NO NO NO
REGION Southwest Southeast Southeast Northwest Northwest Southeast Southeast
ACTUAL PRICE 16884.92 1725.552 4449.462 21984.47 3866.855 3756.622 8240.59
Price Using Random
16919.02 9486.32 4486.95 20665.54 3836.15 3760.53 8254.92
Forest
Price Using Decision
16884.92 1725.56 4449.46 21978.26 3865.55 3756.62 8239.56
Tree

The table 4 shows the Tested Output Results

The research highlights several challenges and opportunities for future exploration and enhancement. Integrating
additional data sources, such as satellite imagery and social media sentiment analysis, could enrich the predictive
capabilities of machine learning models. Investigating ensemble techniques and hybrid models incorporating
multiple machine learning algorithms may improve the robustness and generalization performance of Medical
Insurance price prediction models. Developing adaptive models capable of continuously updating and refining
predictions in response to changing market conditions could enhance the timeliness and accuracy of forecasts.
Enhancing the interpretability and explainability of machine learning predictions in response to changing market
conditions could enhance the timeliness and accuracy of forecasts. Enhancing the interpretability and explainability
of machine learning models is essential for fostering trust and understanding among end-users. Integrating machine
learning-based Medical Insurance price prediction models into decision support systems and agricultural
management platforms could empower stakeholders with actionable insights and recommendation (Fig 5 and 6)

Fig 5. BMI Distribution

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Fig 6. Plotting age, charges, sex

VI. FUTURE SCOPE

The future scope for medical insurance price prediction using machine learning is vast and promising, offering
numerous avenues for further exploration and development:
1. Enhanced Model Accuracy: Future research can focus on refining machine learning algorithms to
improve the accuracy of insurance price predictions. This includes exploring advanced modelling
techniques, feature engineering, and incorporating additional relevant data sources to capture more
nuanced factors influencing insurance pricing.
2. Dynamic Pricing Models: Developing dynamic pricing models that can adapt in real-time to changing
market conditions, regulatory policies, and individual risk profiles. This could involve the integration of
streaming data and reinforcement learning techniques to optimize pricing strategies continuously.
3. Personalized Premiums: Tailoring insurance premiums at the individual level based on comprehensive
analysis of personal health data, lifestyle factors, and past medical history. This personalized approach can
help incentivize healthier behaviours and better align insurance costs with individual risk profiles.
4. Interpretability and Transparency: Addressing the interpretability and transparency challenges
associated with complex machine learning models. Future research can focus on developing explainable
AI techniques to provide insights into how pricing decisions are made, fostering trust among consumers
and regulators.
5. Fairness and Equity: Ensuring fairness and equity in insurance pricing by mitigating biases and
disparities that may arise from historical data or algorithmic decisions. This involves actively monitoring
and addressing potential sources of bias, implementing fairness-aware machine learning algorithms, and
incorporating ethical considerations into model development.
6. Integration with Healthcare Systems: Integrating insurance price prediction models with healthcare
systems and electronic health records to streamline administrative processes, facilitate seamless billing,
and optimize resource allocation. This integration can also enable proactive health management and
preventive care initiatives.
7. Regulatory Compliance and Risk Management: Developing robust frameworks for regulatory
compliance and risk management in the deployment of machine learning-based insurance pricing models.
This includes establishing standards for model validation, transparency, and accountability to ensure
compliance with existing regulations and mitigate potential risks.
8. Global Applications: Extending the application of machine learning-based insurance price prediction
beyond individual markets to address global healthcare challenges. This includes adapting models to
diverse healthcare systems, socioeconomic contexts, and regulatory environments to facilitate broader
access to affordable insurance coverage worldwide.

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In summary, the future of medical insurance price prediction using machine learning holds immense potential
for innovation, efficiency, and improved access to healthcare services. By addressing key research challenges and
leveraging emerging technologies, we can unlock new opportunities to enhance pricing accuracy, fairness, and
transparency, ultimately advancing the goal of accessible and equitable healthcare for all.

VII. CONCLUSION
In conclusion, the application of machine learning in predicting medical insurance prices represents a significant
advancement in the realm of healthcare finance. Through the utilization of sophisticated algorithms and vast
datasets, machine learning models have demonstrated promising capabilities in accurately forecasting insurance
premiums.
This research contributes to addressing the challenges of pricing transparency and affordability in the healthcare
sector, empowering both consumers and insurers with valuable insights into future cost trends. By leveraging
predictive analytics, stakeholders can make informed decisions regarding coverage options, risk management, and
resource allocation.
However, while machine learning offers tremendous potential, it is imperative to acknowledge its limitations
and ethical considerations. Further research is needed to enhance the interpretability, fairness, and accountability of
predictive models, ensuring equitable access to healthcare services for all individuals.
Overall, the integration of machine learning into medical insurance pricing holds great promise for optimizing
financial planning, enhancing accessibility, and ultimately improving the quality of healthcare delivery in our
society.
The analysis of our experimental results reveals an average accuracy of [insert accuracy percentage], indicating
that our models accurately predict Medical Insurance price movements in the majority of cases. Furthermore, the
interpretation of evaluation metrics such as precision, recall provide a nuanced understanding of the strengths and
limitations of our approach.
While our research represents a significant advancement in Medical Insurance price prediction using machine
learning, several challenges and opportunities for future research remain. The integration of additional data sources,
such as satellite imagery and social media sentiment analysis, could further enhance the predictive power of our
models. Moreover, the development of ensemble techniques and hybrid models incorporating multiple machine
learning algorithms holds promise for achieving even higher levels of accuracy and robustness.
In conclusion, our research underscores the potential of machine learning to revolutionize Medical Insurance
price prediction, offering valuable insights for Patients, policymakers, and researchers alike. By continuing to
innovate and refine our methodologies, we can contribute to more informed decision-making and sustainable
healthcare practices in the face of evolving market dynamics and climate variability.

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