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    題名: 重大疾病和住院醫療保險的評價
    其他題名: On the Valuation of Critical Illness and Hospitilization Medical Insurance
    作者: 黃泓智
    貢獻者: 國立政治大學風險管理與保險學系
    行政院國家科學委員會
    關鍵詞: 重大疾病;住院醫療保險
    日期: 2012
    上傳時間: 2012-10-22 15:45:45 (UTC+8)
    摘要: 本研究探討目前保險公司對住院醫療和重大傷病等計價方式是否正確。基於風險控管 的因素，主管機關規定長年期健康保險必須訂定給付限額，然而，目前保險公司對於 這類有給付上限之醫療險商品的保費計算方式，與之前無給付上限之醫療險商品的保 費計算方式相同，都是採用傳統精算之期望值的計算方式，此期望值的計算方式無法 反應因為考慮給付上限時，所應相對降低的保費。換句話說，目前保險公司對於這類 有給付上限之醫療險商品的保費是高估的，這對保戶相當不公平。本研究主要的目的 就是精確的計算出這類長期健康保險的公平保費，解決對保戶不公平的問題。解決此 問題最理想的方式就是採用理論推導的方式，直接求出保費的封閉解，但這有一定的 難度，由於此類有給付上限之終身醫療險商品是我國特有的商品，其他國家的健康險 多屬於短年期無給付上限的商品，因此，在國內外的期刊中也尚無發現相關文獻。長 年期健康保險包含兩種主要類型的商品：住院醫療保險和癌症等重大傷病保險，對於 癌症等重大傷病保險在考慮給付上限之保費的理論推導會比一般住院醫療保險複雜許 多，因為癌症等重大傷病保險必須同時考慮初次罹患重大傷病的機率以及罹患重大傷 病後之存活率及復原機率。本計劃預計在第一年先整理全民健康保險資料庫，取得終 身住院醫療保險以及癌症等重大傷病保險之所需要的資料，探討保險公司在實務上以 終身住院醫療的定價方法來定價癌症等重大傷病商品是否正確?在計劃的第二年將進 一步針對長期住院醫療保險推導出保費的理論封閉解以提高研究成果在學術上的貢獻 度。在計劃的第三年將針對癌症等重大傷病保險，分別以隨機模擬和理論封閉解的方 法，計算其考慮給付上限的情況下之高估保費的情形。本計劃的執行結果不論是在實 務上或是學術上都有其重要性。
    This research aims to investigate the accuracy of valuation formula for the products of hospitalization and critical illness insurance in practice. Recently, long-term health insurance products were required to set a limited coverage in order to reduce risk. Traditional actuarial pricing method is not able to apply to these types of health insurance products with a limited coverage. In other words, most insurance companies overestimate premiums for these kinds of products. It is not fair to policyholders. The purpose of this research is to calculate the fair price of the long-term health insurance with limited coverage. We aim to obtain a close form solution of the premium for these products. However, it is not easy due to its complexity. These kinds of products are not popular in other countries because of their high risks. Thus, rare literatures related to this topic are discussed. The first year of this project will first deal with the huge data set of national health insurance and find incidence rates for the use of the the products of hospitalization and critical illness insurance. We then will investigate if it is appropriate to use the pricing formula of hospitalization insurance to price the product of critical illness. In the second year, we will construct the theoretical model to obtain a close form solution of the premium for these products. So, we can double check the results obtained by stochastic simulation method. In the third year, we will investigate the same problem for the product of long-term critical illness. To construct the pricing model for this long-term critical illness product is much more complicate and difficult than those of the previous products. With the experience of the first two years, we will use both methods of stochastic simulation and close form solution to solve the problem of long-term critical illness product. We believe that the results obtained in this project will be important and useful for both practices and academics.
    關聯: 基礎研究
    學術補助
    研究期間:10108~ 10207
    研究經費:650仟元
    資料類型: report
    顯示於類別:[風險管理與保險學系] 國科會研究計畫

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