Medical Insurance Problem-Solving and Analytical Questions

1. A medical insurance company has two policies: Policy A costs $200 per month and covers 80% of the medical expenses after a $500 deductible. Policy B costs $300 per month and covers 90% of the medical expenses after a $300 deductible. If a patient has $2,000 in medical expenses, which policy would be more cost-effective for them?

2. You have access to two years of claims data for patients diagnosed with diabetes. The demographic data shows an increasing trend among younger patients. How would you approach analyzing this data to propose a strategy for future insurance products that cater to this demographic?

3. A hospital recently implemented a new treatment protocol that increased patient recovery rates by 15%. After analyzing the data, the insurance company found that the treatment led to an increase in claims by 25%. How would you interpret this data and recommend actions to the insurance company?

4. In a given month, an insurance company received 1,000 claims. 60% of these were for outpatient services, and the rest were for inpatient services. Determine the ratio of outpatient to inpatient claims, and what implications could this have for the insurance company’s policy coverage?

5. You have two groups of patients: Group X has an average hospital stay of 5 days with a standard deviation of 2 days, while Group Y has an average stay of 7 days with a standard deviation of 1.5 days. How would you analyze the data to evaluate which group is more likely to require longer hospital coverage by the insurance company?

6. A new genetic test is being offered that could potentially reduce future medical claims for hereditary diseases. If the test costs $1,500 and the average future claims for individuals who have the genes is $50,000, how would you develop a model to determine the cost-effectiveness of offering coverage for this test?

7. You are presented with two different datasets: one shows the number of patients per month utilizing preventive services over the past year, and the other displays the total costs incurred for those patients over the same period. How would you analyze the correlation between the utilization of preventive services and the cost incurred by the insurance company?

8. An insurance company is considering adding a new wellness program. Last year, they found that insured individuals participating in a similar program reduced their medical costs by 30%. If the average medical expenditure per person is $10,000, what would be the potential savings for the insurance company if they enroll 1,000 individuals in the new program?

9. If a certain medication costs $200 per month and a patient is required to take it for life, while the insurance company's estimated annual surgery cost for the same condition is $30,000, how would you evaluate the long-term financial implications of covering the medication versus the surgery for the insurance provider?

10. An insurance firm decides to adjust its premium rates based on data analysis from the last 5 years. If they noted that claims rose by 15% while premiums increased by only 10%, what analytical methods would you suggest they apply to ensure their premium rates align with the actual claim trends?