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.
