Study On Morbidity Measurement And Health Insurance Rating In China

Health insurance is an indispensable component of national health care system, and one of the important health funding measures. Ever since1979, the health insurance (HI) in mainland China has experienced rapid development, together with the accelerating of life insurance market, especially after2002. But the premium income ratio of HI over-Life insurance, the insurance density and depth of HI are surprisingly low. Meanwhile there exists great potential market demand for HI, as the result of implementation of social medical insurance schemes, and the expanding knowledge of medical insurance and disease insurance.The HI market in mainland China is faced with two contradictions:the increasing demand for diversified and personalized insurance products versus the inability of insurers to supply such products; the limited affordability of consumers versus the highly priced insurance products. The author believes that the roots of such contradictions may be traced back to the insufficient quantitative theoretical study of Chinese commercial health insurance, and accordingly the insufficient study on the HI pricing.The insufficient theoretical study is not caused by the lack of data from insurance companies, but the lack of abilities to accumulate and analyze data. This paper studies the mobility in mainland China. It tries to establish the mobility table unique to the mainland market, and study the pricing of commercial health insurance products. Upon comparing the theoretical pricing with the market pricing, it points out problems existing in the HI market and possible solutions.The thesis is composed of several parts:Chapter one provides the general information concerning the thesis, the background, the significance, the literature, the hypothesis, the methods, etc.Chapter two is the theoretical basis of the thesis. Health risk is the basis of health insurance. Thus the management of heal insurance products must be based onquantifying health risk. That’s why risk theory is considered the most fundamental theoretical basis of this thesis. Although there has appeared no complete risk measurement theory, the thesis applies the existing theories and methods of risk measurement. The study on HI pricing in mainland china should be guided by the insurance pricing theories. To evaluate the HI pricing and to work out possible solutions, the thesis also employs health insurance economics.Chapter three discusses the measurements of mobility with examples. It first analyzes the source and features of the mobility data to be used in the thesis. Then it examines the measurement methods that may be applied in measuring the mobility, and points out that occurrence-exposure method, random process method and regression analysis are appropriate measuring methods in Chinese market. These methods must be chosen according to the data available. So the author provides a guideline for choosing the right methods, and then makes clear the practicality of the method with cases in medical insurance.Chapter four studies the mobility of dread diseases and pricing of such products. It measures the mobility of general population and of insured population respectively, and discusses the practicality of these measuring results. Then it gets the rate of dread disease insurance with proper pricing method, and compares the rate with the market rate. It points out the market rate is higher, possibly because of the guaranteed rate, the lack of diversity, and the product faults. Finally it puts forward the solutions to dread disease insurance pricing and the product strategy.Chapter five focuses on the probability of disability, and the pricing of disability income insurance products. The definition of disability is vital to its probability, and determines the eligibility for claiming the benefit. A rigid definition of dread disease helps to decrease adverse selection and moral hazard, and helps the insurers to control risks, but may block the development of the market. The author first analyzes the diverse definitions of disability, and measures accordingly the probability of disability of general population and insured population. The data used here are from national statistics bureau. Upon the measurement, the author prices disability income insurance products, and puts forward suggestions on the development of disability income insurance.Chapter six studies the probability of long-term care (LTC) and its pricing. China now, faced with the aging population and the increase of chronicle diseases, has a great potential for LTC insurance. This chapter fist analyzes the LTC risk in mainland China, and measures the LTC probability among general population and insured population. Due to the lack of data in population covered by LTC insurance, the author gets the probability table of long-term care in mainland china based on the data among the general population. Then the author gets the rate of the LTC insurance products. Finally the chapter points out the Chinese market should focus on LTC insurance products that feature low rate, low insurance liability, and secured protection.Chapter seven provides conclusions and further discussion. It summarizes the research results of the whole thesis, and discusses briefly the points that need further study.The thesis may have the following innovations:1、About the research topic and the significance. The quantitative theoretical study of HI in mainland China is under developed, and ignored by the scholars and practitioners in this field. Based upon the study of the mobility, this thesis solves the pricing of health insurance products, and thus ensures the healthy development of HI. It also enriches the fundamental theories and methods in the field of insurance.2、About the research contents. The thesis is grounded on the health insurance practice. It establishes the measuring methods and indicator of mobility, and puts forward a guideline of applying the methods. It also tests the practicability of the measuring methods, based upon the data from different sources. The thorough analysis of research results helps to get the appropriate method, and also helps to further studies on its application.3、The thesis studies the rate of dread disease insurance, disability income loss insurance and long-term care insurance in the insurance market, and thus prices the bench mark premiums. It also puts forward insights and suggestions on the premium adjustment, rate evaluation, and possible remedies, which may, with its valuable significance in application, promote the development of health insurance in mainland China.