| 中文摘要 |
本文主要探討影響台灣產險重大疾病險保單理賠的相關風險因子,樣本為台灣全國產險重大疾病險保單，分析保單年度為2012至2015年。本文主要的研究發現，相對於保險業務員通路，全體樣本的保險經紀人與直接業務通路的理賠機率與平均理賠成本均顯著較高。然而在分群樣本的結果卻不同，規模較大（前三大）的公司，保險經紀人通路的理賠機率與平均理賠成本顯著較高，然而規模較小（非前三大）的公司,直接業務通路的理賠機率與平均理賠成本均顯著相對較高。
理賠資料顯示，相對於保險業務員通路，保險經紀人的理賠幅度較高。男性比女性之理賠幅度顯著較低。年齡結構顯示，相對於30–39歲的年齡層，小於20歲與40–59歲的年齡層的理賠幅度顯著較高。癌症佔重大疾病理賠的比例約71.1%，女性比男性理賠癌症的機率顯著較高。年齡愈大，癌症出險的機率較高，年齡的平方項係數為負值，可見呈現為倒U的非線性關係。年齡結構顯示40–49歲比30–39歲年齡層發生癌症理賠的機率相對較高。我們進一步驗證台灣產險重大疾病保單是否存在訊息不對稱？實證結果顯示所有模型均未呈現保額高低與理賠發生率有關聯，換言之，並無訊息不對稱的現象存在。此外，我們也從觀察理賠保單的月份發現，相對於等待期過後第一個月，最後一個月出險的重大疾病為癌症的機率較高，而其他月份均不顯著。此到期效果的現象可能是隱含一年期的保單快到期時，被保險人比較積極去做癌症相關的篩檢，因而產生癌症的理賠率比率相較於其他疾病顯著較高。本文的實證結果可提供保險公司與政府醫療機構在重大疾病的相關資訊與醫療政策的參考依據。 |
| 英文摘要 |
We examine the risk factors of dread disease insurance for non-life insurance companies using a national database of policies from all non-life insurers in Taiwan from 2012 to 2015. We find that both insurance brokers and direct business channels have higher claim probabilities and average claim losses for total policies than traditional insurance salesperson channels. In sub-sample analysis, compared with traditional insurance salesperson channels, large insurers (the top three) and small insurers (non-top three) have significantly higher claim probabilities and average claim losses through insurance brokerage channels and direct business channels, respectively. Regarding claimants, we find that female insureds are more likely to incur cancer than males, and age has an inverted U shaped relationship with the probability of incurring cancer for all insureds. In addition, we find that cancer claims are significantly higher only for the last policy month compared with the first policy month. This result suggests that the cancer might be detected more easily by cancer screen tests that other types of dread disease. Our empirical evidence provides implications for designing premium policy of dread disease for the non-life insurance companies and the considerations of health and welfare in government sectors. |
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