Key Success Factors For Implementing Insurance Claims Systems To Offset Inpatient Medical Expenses In Hospitals

Implementing insurance claims systems to offset inpatient medical expenses can help hospitals reduce bad debt risks, streamline discharge and underwriting processes, and mitigate insurance fraud. This study applied the fuzzy analytic hierarchy process (FAHP) to systematically identify the key success factors for hospitals to implement insurance claims systems to offset inpatient medical expenses. The respondents comprised supervisory, managerial, and technical personnel from both hospitals and insurance companies in Taiwan. The results indicate that System Quality and Functionality is the most critical criterion, with System and Equipment Stability, Data Security and Confidentiality, and Real-Time and Accurate Data identified as the top three sub-criteria. The group comparison results reveal that hospitals emphasize internal organizational management to ensure smooth system integration, while insurance companies focus on hospital staff’s operational familiarity and system functionality to support efficient claims processing and scalability. The findings provide practical references for system implementation planning and for enhancing collaboration between hospitals and insurance companies.