| Summary: | 碩士 === 淡江大學 === 保險學系保險經營碩士在職專班 === 106 === To evaluate the risks of information asymmetry and adverse selection, this empirical study included 1,680,898 insureds’ information which were registered in the full sales period from 1999 to 2017 and the 185,835 claim which claimed actual hospitalization from 2010 to 2017.
In this study, the elements of insured population, the factors of seeing doctors, the rate of claims, the days of claims, and the payment of claims were thoroughly analyzed with the descriptive statistics, the Logistic regression and OLS models. The factors of treatment reasons which usually brought in a claim, were meanwhile, particularly discussed with the geographic information of hospitals, classification of hospitals, and the code of ICD-9-CM.
After analysis is found that the claim rate, claim days and the claim payments were empirically revealed a high relevance with the elements of insured population, such as the insuance amount, the insured gender, the insured age, the insured state of marriage, the premium type, the insured conditions, the education of insured, and the insured occupation classes. Furthermore, compared with other areas, the northern Taiwan has proposed higher claim payments in average if we look into the geographic information of insured habitation and hospitals. On the contrast, the claim rate, the claim days and the claim payments were comparatively low in the non-metropolitan areas.
When it comes to the hospital classification, it comes up with longer claim days in medical centre and much claim payments in Clinics. As far as the ICD-9-CM was concerned, there are three codes which claim longer days, and they are mental and behavioral disorders, diseases of the nervous system, and the diseases of the circulatory system. Mentioning the factors of high claim payments, the top five factors are malignant neoplasms, mental and behavioral disorders, pregnancy, childbirth and the puerperium, diseases of the musculoskeletal system and connective tissue, congenital malformations. Above all, this essay proposes the improving suggestions in underwriting and in the management of claim. It also gives words in producing new certain medical insurance. It is expected to adjust the marketing strategy upon the actual medical use patterns, and it is also expected to put an end to improper claim and moreover to achieve the insurance company balance of payments and performance.
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