Enhancing Privacy and Traceability of Public Health Insurance Claim System using Blockchain Technology

Andry Alamsyah ^* I Putu Sadhu Setiawan

• Telkom University, Bandung, Indonesia

The insurance industry has transformed into a global multi-billion-dollar sector, with health insurance becoming increasingly common due to the high cost of healthcare. This rapid growth presents significant risks, including increased data breaches and fraud exposure. Additionally, the complexity of managing vast amounts of sensitive data requires robust systems to ensure its privacy and security. Recognizing these challenges, blockchain technology offers a secure, transparent, and tamper-proof recordkeeping solution. Indonesia's National Health Insurance (NHI) is one of the largest national insurance companies, covering over 200 million citizens and aiming to achieve universal healthcare. This extensive coverage presents challenges in managing policyholders' data privacy and traceability during the NHI claim process as they cannot control or monitor their data activities in the NHI claim process, which can lead to unauthorized data access, misuse, and lack of transparency along the process. We propose a blockchain-based system for policyholders' private control access and data activity traceability, ensuring authorized access and data integrity during claims. Our design includes three blockchain architectures tailored to the NHI claim process: functional, logical, and physical data architecture. The functional architecture uses a use case diagram to show the actor's behavior along the process. The logical architecture depicts the new parallel process and data movement of the healthcare treatment and NHI claim process in a Business Process Model and Notation (BPMN) and layered design. The physical data architecture shows a class diagram's detailed data and actor relationships. Additionally, we developed a prototype to demonstrate key features of the new model. This research addresses stakeholders' concerns about data privacy and traceability in the NHI claim process.