西方国家商业健康保险发展的常规历程theregularroutineof.ppt

谢 谢！ Thanks * * * * 中国商业健康保险的发展路径研究 王治军 王沁 Wang zhijun Wang qin Study on the Chinese commercial health insurance developing routine 主要内容 Contents 一、对商业健康保险特性的分析 Analysis on commercial health insurance’s characteristics 二、西方国家商业健康保险发展的常规历程 The regular routine of commercial health insurance development in west countries 三、对我国商业健康保险公司发展的建议 Suggestion on our commercial health insurance company development 一、对商业健康保险特性的分析Analysis on commercial health insurance’s characteristics 医疗风险 Health care risk 道德风险 Moral hazard 逆选择风险 Adverse selection risk 1、健康保险风险的来源 The source of health insurance risk 政府主办模式 Government dominant model 商业机构主办模式 Private insurance company model 混合模式 Mixed model 2、健康保险风险的管理模式 Management model on the health insurance risk 一、对商业健康保险特性的分析Analysis on commercial health insurance’s characteristics 1）国外 Over-sea countries 2）中国 China 基本要素 Basic elements 主办者不是政府部门，大部分主办者是以营利为目的的商业机构，也有部分非赢利组织。Most of them are sponsored by insurance company to make profit, some are NPO. 健康风险局限于疾病、意外、功能衰竭等，环境因素等系统性医疗风险几乎不在保险范围。Health care risk mainly caused by diseases, accident, functional failure, in a narrow sense. 补偿方式以财务损失为主，很少涉及医疗服务项目的提供。 Loss compensation mainly depends on financial way, medical service are less provided. 3、健康保险的定义 The definition on health insurance 一、对商业健康保险特性的分析Analysis on commercial health insurance’s characteristics 1）健康风险特征 Characteristics of health risk 2）保险合同要素 Elements of insurance contract 3）产品类别 Product classification 4）客户需求特征 Characteristics of customer demands 5）运营管理特点 Features of operation management 4、商业健康保险风险的特征 The characteristic of commercial health insurance risk 一、对商业健康保险特性的分析Analysis on commercial health insurance’s characteristics 小结 Brief sum-up 健康保险是保险中较为特殊的分类，由于保险标的是健康风险和与之相关的财务损失，跨越了保险与医学两个领域，涉及疾病、诊疗费用，医疗服务的方方面面，风险识别和防范的复杂程度高，对医疗卫生环境和政府干预的依赖性强，在精算定价、核保核赔、销售管理等环节不同于传统的财产和人寿保险，这些特性决定了健康保险在实际运营中承保利润边际偏小且不稳定，商业化运作的难度较大。 Health insurance is a special classification. It contains both insurance and medicine techn