WHO世界卫生组织：2024年利用机器学习在菲律宾的索偿管理过程中发现欺诈行为-国家健康保险计划的意见报告（英文版）

Artificial intelligence, and machine learning (ML) in particular, have the potential to support health financing functions and thus may contribute to progress towards the UHC objectives, including enhanced efficiency as well as transparency and accountability. When applied within claims management and fraud detection processes, ML could contribute to improved accuracy of classification of insurance claims, earlier detection of problematic claims, a higher fraud detection rate, and a decrease