Adaptive to change? Compositional modelling of Healthcare Insurances using Protocol Modelling

Abstract

This report presents the results of research on application of Protocol Modelling in the domain of healthcare insurance claims processing in the Dutch context. The conclusion of this study is that all necessary elements of flexibility for a healthcare insurance model, namely, flexibility in addition and removal of covered care procedures, flexibility in conditional coverage and flexible deductible, are supported by the protocol model by such means as Parameterization, User Exits, Composition, Derived Attributes and States. The first two options can also be achieved by other modelling techniques. The third option of CSP parallel composition leverages the composition semantics of Protocol Modelling. Composition, derived states and attributes enable the reuse of model elements.