我國產險公司經營商業健康險之探討

The Investigation on Non-Life Insurance Companies Operating Commercial Health Insurance in Taiwan

謝慧齡(Hui-Ling Hsieh)

指導教授 ： 田峻吉

淡江大學/商學院/保險學系保險經營碩士班/碩士(2009年)

https://doi.org/10.6846/TKU.2009.00905

摘要

2007年7月18日總統公佈施行「保險法部分條文修正草案」，產險業自此開放核准經營健康保險，而成為繼傷害險之後與壽險公司相競爭之險種。然而產險公司經營健康險並非全無風險，還有許多問題值得深思及釐清，例如：產險公司於經營健康險初期削價競爭乃是攻取市佔率手段之一，但此種作法是否會步上傷害險惡性競爭殺價之後塵？極度競爭下之產品定價是否與費率釐定原則所訂定之保費有所差距？低價搶佔市場是否會影響產險公司未來清償能力？

此外，目前產險業所經營之健康險尚未開放保證續保，然保險法第138條但書之規定，為將來產險業發行保證續保健康險商品之可能性預留伏筆，則有無保證續保健康險之保費是否有所差距？因此，本研究首先藉由蒐集相關文獻進行回顧以奠定理論基礎，並以日額型定期醫療險為研究對象。進而整理各項損失發生率，例如住院發生率、住院天數等數據以建立定期醫療保險費率釐定模型，利用模型計算定期醫療險保費，與選定之產險公司醫療險商品保費進行比較分析。最後，為探討保證續保對產險業經營健康險之影響，本研究另比較保證續保下之保費差異，並且進行分析，以觀察其對產險公司清償能力之影響。

關鍵字

產險公司 ； 健康保險 ； 費率釐定 ； 保證續保

並列摘要

Non-life insurance companies are approved to operate in health insurance since Insurance Act revised on July 18, 2007. However, property-liability insurers issuing health insurance still have a lot of problems need to further investigate. For example, non-life insurers could misprice the health insurance premium because they are not familiar with morbidity table. Moreover, if non-life insurers always use low-price strategies to expand their market share, it could increase the probability of insolvency. 　　

Non-life insurance companies are temporarily approved sell one-year term health insurance policy without guaranteed renewable. However, the provision of Article 138 of the Insurance Act keeps the possibility that property-liability insurers sell the health policies with guaranteed renewable clause in the future. The purpose of this paper investigate the impact of non-life insurance industries operate guaranteed renewable health insurance policy. Then, we adopt the National Health Insurance Research Database (NHIRD) to calculate the health insurance premium and compare our results with two selected non-life insurance companies The paper concludes with a discussion of possible threats that guaranteed renewable policy for the non-life insurance industries.

並列關鍵字

Non-Life Insurance Companies ； Health Insurance ； Pricing ； Guaranteed Renewable

參考文獻

8.林國欽(2007)，產險業經營健康保險之核保與理賠問題之研究，淡江大學保險學系保險經營研究所碩士論文。

15.葉郁秀(2008)，台灣地區健康保險之再保險實務研究，淡江大學保險學系保險經營研究所碩士論文。

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一、 英文部分：