Australian Health Insurance Simulation

A realistic simulation of an Australian health insurance company's operational database, designed as a source for data warehouse demonstrations and testing. This project generates time-series data with daily changes that can be tracked using SQL Server's Change Data Capture (CDC).

📋 Features

• Core Insurance Operations
  • Member management and demographics
  • Policy creation and lifecycle management
  • Coverage plan configuration
  • Claims processing and assessment
  • Premium payment tracking
  • Provider network management
• Data Generation
  • Dynamic patient data generation with realistic demographics
  • Age distributions matching population demographics
  • Life stages with address and name changes over time
  • Data variants to simulate errors and changes
• Australian-Specific Elements
  • Hospital cover tiers (Basic, Bronze, Silver, Gold)
  • Private Health Insurance (PHI) rebate tiers
  • Lifetime Health Cover (LHC) loading
  • Medicare Benefits Schedule (MBS) integration
  • Australian states and postcodes
• Technical Features
  • SQL Server Change Data Capture (CDC) for tracking changes
  • Synthea FHIR patient data integration
  • PyODBC database connectivity
  • Comprehensive test suite
  • Cross-platform support (Linux, macOS, Windows)

🚀 Getting Started

Prerequisites

• Python 3.8+
• SQL Server instance
• ODBC Driver 17+ for SQL Server
• pyodbc package
• Faker library (for dynamic data generation)

Installation

# Clone the repository
git clone https://github.com/yourusername/health-insurance-au.git
cd health-insurance-au

# Install dependencies
pip install -e .

Database Configuration

Create a configuration file with your database credentials:

cp config/db_config.env.example config/db_config.env
# Edit config/db_config.env with your database credentials

Initialize the Database

On Linux/macOS:

# Initialize the database schema
./bin/initialize_db.sh

# Add initial reference data
./bin/add_initial_data.sh

On Windows:

# Initialize the database schema
bin\initialize_db.bat

# Add initial reference data
bin\add_initial_data.bat

🏃‍♂️ Running Simulations

Quick Start

Run a realistic simulation with dynamic data generation:

On Linux/macOS:

./bin/run_realistic_simulation.sh --start-date 2023-01-01 --end-date 2023-01-31 --members-per-day 10

On Windows:

bin\run_realistic_simulation.bat --start-date 2023-01-01 --end-date 2023-01-31 --members-per-day 10

Simulation Options

Option	Description
--start-date	Start date for the simulation (YYYY-MM-DD)
--end-date	End date for the simulation (YYYY-MM-DD)
--members-per-day	Base number of new members per day
--log-level	Logging level (DEBUG, INFO, WARNING, ERROR)
--reset-members	Reset the list of used member IDs
--use-static-data	Use static data from JSON file instead of dynamic generation

Data Generation

The simulation generates data with realistic patterns:

• Fewer members join on weekends
• More claims at the beginning/end of the month
• Business hours for transactions (8 AM to 5 PM)

Dynamic vs Static Data

By default, the simulation uses dynamic data generation to create realistic patient profiles:

On Linux/macOS:

# Use dynamic data generation (default)
./bin/run_realistic_simulation.sh --start-date 2023-01-01 --end-date 2023-01-31

# Use static data from JSON file
./bin/run_realistic_simulation.sh --start-date 2023-01-01 --end-date 2023-01-31 --use-static-data

On Windows:

# Use dynamic data generation (default)
bin\run_realistic_simulation.bat --start-date 2023-01-01 --end-date 2023-01-31

# Use static data from JSON file
bin\run_realistic_simulation.bat --start-date 2023-01-01 --end-date 2023-01-31 --use-static-data

📊 Database Structure

The database is organized into the following schemas:

Insurance Schema

Core operational tables for the insurance business:

• Members - Personal information, contact details, Medicare numbers
• CoveragePlans - Plan details, benefits, premiums, waiting periods
• Policies - Policy details, status, coverage type, excess amounts
• PolicyMembers - Relationship between policies and members
• Claims - Claim details, status, payment information
• Providers - Provider information, specialties, agreement status
• PremiumPayments - Payment tracking, due dates, payment status

Regulatory Schema

Tables related to Australian health insurance regulations:

• PHIRebateTiers - Private Health Insurance rebate tiers and rates
• MBSItems - Medicare Benefits Schedule items and rebates

Integration Schema

Tables for Synthea FHIR data integration:

• SyntheaPatients - Patient data from Synthea
• SyntheaEncounters - Encounter data from Synthea
• SyntheaProcedures - Procedure data from Synthea

📈 Change Data Capture (CDC)

This project uses SQL Server's Change Data Capture (CDC) feature to track changes to the data over time.

Enable CDC

On Linux/macOS:

# Enable CDC on the database and tables
./bin/enable_cdc.sh

On Windows:

# Enable CDC on the database and tables
bin\enable_cdc.bat

Monitor CDC Changes

# Monitor changes to a specific table for the last 24 hours
./bin/monitor_cdc.sh --schema Insurance --table Members --hours 24

🧪 Testing

Run the test suite:

On Linux/macOS:

# Run all tests
./bin/run_tests.sh

# Run tests with coverage report
./bin/run_tests.sh coverage

On Windows:

# Run all tests
bin\run_tests.bat

# Run tests with coverage report
bin\run_tests.bat coverage

📚 Documentation

Detailed documentation is available in the docs/ directory:

• Database Configuration
• Change Data Capture
• Synthea Integration
• Dynamic Data Generation

📁 Project Structure

health_insurance_au/          # Main Python package
├── api/                      # API endpoints
├── cli/                      # Command-line interfaces
├── models/                   # Data models
├── simulation/               # Simulation modules
│   └── simulation.py         # Core simulation logic
├── utils/                    # Utility functions
│   ├── data_generation/      # Dynamic patient data generation
│   │   └── generate_data.py  # Core data generation script
│   ├── data_loader.py        # Load data from static files
│   └── dynamic_data_generator.py  # Dynamic data integration
├── integration/              # External system integration
└── config.py                 # Configuration settings

scripts/                      # Standalone scripts
├── db/                       # Database scripts
└── simulation/               # Simulation scripts
    └── realistic_simulation.py  # Realistic simulation script

bin/                          # Scripts for running operations
├── initialize_db.sh/.bat     # Database initialization
├── add_initial_data.sh/.bat  # Add initial data
├── run_realistic_simulation.sh/.bat  # Run realistic simulation
├── enable_cdc.sh/.bat        # Enable CDC
└── run_tests.sh/.bat         # Run tests

config/                       # Configuration files
docs/                         # Documentation
data/                         # Data files
tests/                        # Test suite

🤝 Contributing

Contributions are welcome! Please feel free to submit a Pull Request.

1. Fork the repository
2. Create your feature branch (git checkout -b feature/amazing-feature)
3. Commit your changes (git commit -m 'Add some amazing feature')
4. Push to the branch (git push origin feature/amazing-feature)
5. Open a Pull Request

📄 License

This project is licensed under the MIT License - see the LICENSE file for details.

📧 Contact

Project Maintainer - Mehdi Modarressi

Project Link: https://github.com/Mmodarre/AusHealthSim