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Costing Models

Two cost-benefit Models are commonly employed in order to analyze profitability of a new project: Cost-Benefit Analysis, and Cost-Effectiveness Analysis.

A cost-benefit analysis addresses all financial aspects of a project to determine its potential profitability, including any benefits obtained through the project and any costs that go into developing, implementing and executing the project. To reach the final estimate, the analyst subtracts the costs from the potential financial benefits.

A cost-effectiveness analysis is used when you cannot place (or it is not easy to place) a monetary value on the outcome. In health care system, for instance, the analyst can assess the cost of a given course of action such as physical therapy versus surgery; however, it is difficult to predict and value outcomes because patient success and obstacles are all unique and different. In such case, the analyst can add the factor of effectiveness

Applying these two analysis in a insurance industry might be very complex. On some occasions, costs and benefits of a fraud-preventing strategy can be easily translated in monetary values, but sometimes the cost of a preventing strategy is clear but the results is not clear as well as the costs. For instance, in case of prevention, providing a cost-benefit analysis is easier because it fits into Cost-Benefit Analysis model. The model hinges on an ability to translate outcomes into a monetary value, something most feasible with public finance–related interventions. In a prevention, there exist clear amounts of costs including overpayment, implementation costs, and benefits including recovery and prevented payments for future (usually it is calculated for six month in the U.S.). The subtraction of costs from benefits can be an estimate of net saving, and the net saving clarifies that whether the prevention has been effective.

[1] - In the US, The Bureau of Investigations calculate the saving as it follows: They calculate the average monthly benefit per person per program(s) applied for. The rate is then multiplied by the number of clients in negative action cases per program by six months. Example: they paid $1000 between 100 clients each month. Average $10 for each person. Then they detect 30 fraudulent claims for benefits. It causes to negative action that means stopping payments. In this case, the net saving is 10*30= 300 which is saving for one month, then 300*6= $1800 saving for six month.