健康保險無理賠獎勵機制之外溢效果

Health Insurance Spill-Over Effect on No Claims Bonus System Site No. 26

金融監督管理委員會自2017年起鼓勵保險業開發具外溢效果之健康管理保險商品，自此商品在市場快速發展。無理賠獎勵機制之健康險商品屬於此類商品，住院無理賠獎勵機制為本文的研究重點。過往對於無理賠獎勵機制的研究常見於車險，而鮮少人身保險領域有相關之研究。本文探討健康險之無理賠獎勵機制所反饋之外溢效果，且透過連續時間之馬可夫模型描述住院醫療理賠行為，進一步比較無理賠獎勵機制下之定價，以分析無理賠獎勵機制對保戶金錢上的外溢效果，以及保險公司的資金壓力。

In 2017, the Financial Supervisory Commission in Taiwan promotes and encourages the insurance industry to develop the health management products with spill-over effects. Since then, the products grew fast in the market. One type of these products is the no claim bonus health insurance products. In this paper, our attention is on the no hospital in-patient claims. In the past, most of the studies about no claims bonus system had been in the field of the property insurance, and seldom studied in the health insurance. Using the continuous-time Markov model describe the inpatient claims behavior and price the no claims bonus system embedded in the insurance product. The monetary spill-over effect to the insured can then be measured, as well as the insurer's financial pressure.