Proceedings of The 7th International Conference on Applied Research in Management, Economics and Accounting
Innovation in Medical and Legal Education: Artificial Intelligence in lawsuits against Health Plans
Flávio H. B. de Souza, José H. C. Resende Júnior, Christiano J. Perlatto, Elisângela C. O. Gonçalves, Gregory Lauar e Souza, Juliana C. Machado, Lígia B. Patto, Luciana C. Tanure, Rafaela R. Rocha, Carolina C. de M. Barcelos, Viviane C. F. Cezar, Marina C. P. Trindade, Ricardo M. Pedrosa, Alessandra R. C. Kelle¹, Magnólia M. B. P. de Lima, Aline P. F. Bambirra, Vitor A. de Melo, Bárbara de O. Souza, Leonora de O. Rocha, Samara S. Leal¹, Marconi A. dos Reis, Luiza P. Campos, Ana T. S. R. Borges, Maria L. Brandão, Paula , Mariana G. Aguiar, Nathalia F. O. Sousa, Paula G. Ferreira, Gustavo H. dos Reis,, Daniela M. B. S. de Almeida, Rodrigo Freire
The Sistema Único de Saúde (SUS) should provide universal access to health throughout Brazil, however it has been suffering from problems of insufficient funding. Thus, many citizens seek additional assistance through private health plans. These are supervised by a regulatory agency but, when necessary, there is legal action by law firms. This research presents a descriptive exploratory cross-sectional study carried out by academics and professors from the Medicine, Law and Information Technology courses, which aims to demonstrate the inclusion of the highlighted universe, with the results of the application of Artificial Intelligence (AI), during Medical and Legal education, in the legal analysis of clients in the private health area against their respective health plans. Data were collected on 126 lawsuits against health plans. Then, standardization and data analysis for the application of AI techniques for pattern recognition, and finally, a critical evaluation of the strategies that could be carried out by the legal department, via AI, in addition to the students’ evaluation of the experience. AI techniques were applied to evaluate processes in terms of Provenance, Disapplicability and Partial Provenance. AI algorithms were used to predict the outcome of an action, reaching a maximum accuracy of 71%. There was an interdisciplinary integration of professors, with assessments from each area. Despite the low accuracy of the AI solution, due to the insufficient number of samples, the experiment brought an integration of knowledge from Medicine, Law and Technology, in addition to Scientific concepts, where the greatest contribution was in the teaching methodology.
keywords: Teaching, Artificial intelligence, Health insurance, Innovation, Law