Abstract

The health insurance sector has been facing many challenges recently, such as fraudulent activities in insurance claims, data breaches, and high transaction costs, particularly with existing systems built on the Ethereum network, which negatively affect its efficiency and effectiveness. These challenges undermine the trust and financials of insurance providers while compromising the privacy of the patient's health records. To address this issue, this study proposes a conceptual framework that uses zero-knowledge proof within the blockchain system and is deployed on the Polygon Network for its low transaction fees and higher throughput. The proposed model allows the verification of an insurance claim without revealing sensitive patient health records, ensuring privacy while preventing fraudulent activities. In this conceptual design, the hospital can issue verifiable proof of treatment, appointment, and bill that shows the validity of the insurance claim without revealing the underlying health record to the insurer. This study, therefore, contributes to supporting research in decentralized applications for healthcare insurance by presenting a conceptual model and comprehensively analyzing the feasibility, rather than a full-scale implementation. It also emphasizes the need to preserve privacy in sensitive domains and the potential benefits of blockchain and ZKP integration. In conclusion, the research’s findings show that, in theory, integrating ZKP with blockchain technology can enhance healthcare insurance processes in terms of reliability, efficiency, privacy, and security. However, further research and practical development are required to realize and evaluate a fully operational system.

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