An Empirical Study of Adverse Selection Problem in Medical Insurance

伴隨著經濟發展、國民所得增加以及醫療技術一日千里，民眾對於健康險的需要日益增加，但由於全民健康保險所提供的基本保障有限，並不足以滿足高齡化社會的需求，因此商業健康保險的市場快速成長，但損失率也是居高不下，由此可見商業健康險市場上可能存在有保險公司無法正確估的被保險人風險特性，引發逆選擇問題。故本文針對台灣健康險保險市場之訊逆選擇問題加以研究。 本研究以某家保險公司的終身醫療健康自2010年01月至2014年12月之間共42,284筆理賠資料進行實證研究，探討因資訊不對稱而產生的逆選擇問題，研究方式以Tobit迴歸模型分析，討論已繳保費與初次理賠時間以及損失率之間的關係；模型中以投保年齡、性別、繳別、通路別及地區為控制變數。 根據實證結果顯示，該公司此一終身醫療健康保險確實存在逆選擇的問題。已繳保費、投保年齡、性別、繳別及地區，與初次理賠時間或理賠值之間亦有顯著關聯，因此，本文認為控制這些變數，應可有助於降低該公司保險契約中所隱含的逆選擇問題。Along with economic development, national income increased and advances in medical technology, people increasing need for health insurance, but the basic guarantee universal health insurance due to the limited offer and is not sufficient to meet the needs of an aging society, and therefore the commercial health insurance market rapid growth, but the loss rate is high, there may be insurance companies can not estimate correctly the risk characteristics of the insured person shows that commercial health insurance market, causing adverse selection problems. Therefore, this paper for the hearing to study the adverse selection problem of the Taiwan health insurance market. In this study, a life-long medical and health insurance companies from between January 2010 to December 2014 a total of 42,284 pen claims data empirical study on the adverse selection problem arising due to information asymmetry, research ways to Tobit regression model analyzed and discussed the relationship between premiums paid and claims the first time, and the loss rate between; the model to the insured age, sex, do not pay, do not access and area control variables. According to empirical results show that the company life-long health insurance really adverse selection problems. Paid premiums, insured age, gender, and region do not pay, the time between the initial claim or claims are also significantly associated values, therefore, this paper argues control these variables should be helpful to reduce the company's insurance contract implicit in The adverse selection problem.目錄 第一章 緒論 1 第一章 研究背景 1 第二章 研究目地 3 第三章 論文架構 6 第二章 文獻探討 8 第一章 保險逆選擇問題之理論文獻 8 第二節 保險逆選擇問題之實證文獻 12 第三章研究資料與方法 16 第一節 研究對象 16 第二節 實證方法 19 第三節 變數說明 21 第四章 實證結果 27 第一節 敘述統計 27 第二節 Tobit迴歸分析結果 33 第五章 結論與建議 38 第一節 研究結論 38 第二節 研究建議 39 參考文獻 4