Feasibility and Risk Assessment for Participating Health Insurance

• Main Authors: DAI,XI-QI, 戴希祺
• Other Authors: CHANG,CHIH-KAI
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/946wxm

碩士 === 逢甲大學 === 風險管理與保險學系 === 107 === Due to the precedent of participating (par) health insurance in foreign markets nowadays, in order to integrate with international advanced countries and accelerate the development of innovative products in Taiwan, and to meet the needs of the current market, this paper mainly focuses on the feasibility of participating health insurance, and explore the potential of market development. Additionally, this study proposes risk assessment model for the feasibility evaluation. Under this model, some important factors or variables which may cause impact on the financial sustainability are considered: such as uncertainty in medical costs and longevity risks faced by insurance companies in designing participating health insurance. Finally, different policy design schemes and dividend mechanism are also proposed to reduce the previously mentioned risks. The feasibility of participating health insurance includes the following three parts: Firstly, reviewing the current insurance regulations which are related to participating health insurance. As stated in Article 140 of “Insurance Law in Taiwan”, there is no apparent limitation on the issue of health insurance with participating features. Most of the laws and regulations are principle-based and are not specific to participating in health insurance. Therefore, it is not necessary to propose new laws for participating health insurance but with minor extent of “life insurance” to “life and health insurance”. However, according to the Disclosure Principle, insurance companies are required to the disclose bonus declaration, with more complex formula or expression including morbidity factors for Participating Health Insurance. Secondly, Risk-Based Capital of Participating health insurance has no needs to be modified, since the current liability reserve for the risk capital system has already reflected the risk of future losses and exposure to risks, along with the future bonus declaration. Thirdly, empirical evidence in this study shows that, insurance companies have achieved well underwriting effects and are profitable in some health insurance contracts with reimbursement on outpatient or hospitalization and surgeries. Therefore, it is feasible for insurance companies to issue such participating health insurance for promotion and marketing consideration. As for the dividend mechanism, this study compares two main participating features: non-cash bonus and cash-bonus. Furthermore, the utility of the bonus reserve is also discussed in this study. All the researches as above could provide a reference for the risk of the insurance companys product design for par health insurance.