Patterns of claims and determinants of claim rejections in Kuwait's National Health Insurance for Retirees (AFYA): a comprehensive analysis.

ABSTRACT:

Introduction

Health insurance claim rejections can impose significant administrative and financial burdens, yet data from emerging national programs are limited. Kuwait's AFYA program, launched in 2016 for retirees, provides a valuable opportunity to study rejection patterns and identify the demographic and service-level factors that influence denial rates in a rapidly evolving high-income context.

Methods

This retrospective study analyzed 4.44 million AFYA claims from 2016 to 2023. Key variables included beneficiary characteristics (age group, sex), provider type, service category (dental, medical, pharmaceutical), claimed amount, and claim year. Logistic regression was employed to determine predictors of claim rejection, controlling for all the above factors. Sensitivity a

SUBMITTER: Alibrahim AI 

PROVIDER: S-EPMC12321863 | biostudies-literature | 2025

REPOSITORIES: biostudies-literature