台灣地區健康保險之再保險實務研究

隨著醫療技術的提升及全民健保制度的實施保障國民基本的醫療及照顧，而提高國民健康照顧的意識，也引發商業健康保險的需求，其中商業健康保險之終身健康險，因終身保證費率，保險公司更是承擔較高之風險，是以業者藉由再保險安排以分散自身經營風險，惟安排再保險僅是風險規劃中的一種方式，以往保險公司基於再保安排不易或評估自行承擔能力後，大多將風險自留。為了督促保險公司正視長期健康險所產生難以預料的風險，主管機關修訂「人身保險商品審查要點」，規定壽險公司未來在送審長期健康保險時，須說明「風險控制方式，如有無保費調整機制、有無限額或自負額、如何安排再保等」，藉此使人身保險業注意長期健康保險之風險控制。根據本研究的結果我們得到以下結論: (1) 醫療費用發展趨勢持續成長。(2) 健康險保單設計應回歸補償契約之本質。(3) 主管機關之態度，轉為積極匡正市場之走向(4) 失能保險之開展需主管機關協助。(5) 國內欠缺經驗統計資料。(6) 保險費率及再保費率之充分性不足。

關鍵字

再保險；健康保險

並列摘要

As the medical technology and national health insurance policy, people pay more attention on health care and create the demand of commercial health insurance in these days. The insurance company takes more risk, because the guaranteed premium during the entire period. The insurance companies should separate their running risk by reinsurance. However, they used to take the responsibilities by themselves, because of difficulties of reinsurance support. To remind insurance companies the unpredictable risk, the Financial Supervisory Commission asked the risk control program for new insurance products. This study is by case study and has the conclusion as follow, 1.The tendency of medical cost is continued to increase. 2.Health insurance should be designed to compensate the expense of the insured. 3.The Financial Supervisory Commission takes a rectified attitude toward health insurance market. 4.The development of disable insurance depends on the superintendent organization.5. The lack of statistical materials in Taiwan market.6.The insurance premium rate and reinsurance premium rate is insufficient.