糖尿病保險平台模式之研究

本研究首先探討糖尿病的醫療需求，與現有糖尿病保險的比較，而後針對傳統保險價值活動上各個階段，讓保戶感到不滿意，或是待改良的部分做深入的探討。台灣目前保險業者的費率表無法真實且完整的反映醫療風險，而醫療風險評估不夠準確的情況，造成糖尿病保險費計價機制不夠公平，保戶和保險公司皆承受了資訊不對稱的風險，造成整體系統的不效率，影響消費者投保、保險公司承保的意願。因此研究自分析保險市場，糖尿病醫療照護方法出發，確認目前的保險需求缺口，以新興的移動醫療平台為學習對象，提出保險結合雲端照護的創新商業模式，以網路科技有效監控風險，維持保險風險分擔的本質，在物聯網、醫療科學技術、儀器的發展下，病人的健康狀況更容易被掌握，保費得以更加精準的計算，同時醫療數據也可幫助醫療團隊，依照患者的習性、病情，從投藥、飲食、運動三個面向給予更適切的醫療照護。透過雲端平台商業模式應用科技，使原本繁雜的保險投保、核保、理賠程序簡化、無紙化，平台減少相關的營運成本，增加風險控管，提供額外的醫療照護增加平台附加價值，提高病患的投保意願，讓原本被排除在保險外的人群也能夠投保保險，完善社會照護網。

關鍵字

保險平台模式；雲端居家照護；糖尿病；糖尿病風險監控；物聯網科技

並列摘要

Taiwan’s economy has grown very much in past decades. People also change their eating habits into a more refined diet. Therefore, in the eyes of a growing number of citizens who are diagnosed with diabetes or three-hypers. The age of diabetic patients also gradually become younger and more dangerous. The demand for insurance designed for diabetic patients is rising. However, the insurance for diabetic patients charges for high premium and the qualification for application is also restricted. Through analysis of traditional insurance, the research tries to build a process to make diabetic patients more willing to join the insurance platform. The business model combines both cloud healthcare and insurance risk monitor to reduce the information asymmetry problem and moral hazard that insurance companies face. The insured households will receive remote home nursing care and professional instruction about diet and drugs taking. With the IoT technology applied, the diabetic patients’ health is more easily to monitor and the risk is also precisely calculated. The cloud technology also has lower the operation cost. From the above two aspects, the insurance platform fundamentally reduces the high premium on diabetes insurance. The insurance policy is also made insured households to do self-health management so that the risk of diabetes complication is lower and save the overall social medical cost.