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Managed care organization (MCO) has been adopted in Malaysia to act as a mediator between business organizations and health care providers. It's given the task to reconcile claims made by the providers for the medical services provided to the organizationspsilaemployees. Controlling MCOspsila operations cost in processing claims is an ideal scenario targeted to manage the total cost which are borne by the organizations.Thus, allowing organizations to provide quality health plans to their employees. Health plan is the health benefits covered by an organization for its employees.This research has categorized health plans into two types and identified the existence of semistructured characteristics within the Type 2 health plan. A semistructured data model was constructed, focusing on outpatient care.
Date of Conference: 3-5 April 2009