A Research On The Risk Controlling Of Commercial Health Insurance In China

Chinese health insurance system mainly contents two parts: the Social Health Insurance and the Commercial Health Insurance. As important supplement of the Social Health Insurance, Commercial Health Insurance is of great market potential. However, as a kind of economical activity, there is bound to have risks objectively. At present, the lack of risk controlling measure in the health insurance becomes the bottleneck of its development in China. Therefore, the crucial point of successfully developing the Commercial Health Insurance is the risk controlling. In China, the Commercial Health Insurance is still in the spouting stage. The study of risk and risk controlling of the Commercial Health Insurance has just been started. In order to make our Commercial Health Insurance develop rapidly and healthy, analyze the risk and take it's relevant measures to control the risk is necessary. The thesis choice of the text is based on this thought, and I hope it can be helpful to the study of risk in the Commercial Health Insurance in our country.This text takes the risk and risk controlling of the Commercial Health Insurance as core content. It synthetically used the theory and method of Insurance, Information Economic and Mathematical Statistics, etc. According to the present situations in China and practices in the health insurance, the text listed out a series of thing and method of risk controlling which are fit for the particular situation in China and the developing law of Commercial Health Insurance. It content: 1) It gives out a basic frame of the risk controlling method of Commercial HealthInsurance. That is it has to consummate the policy and legal environment in the macroscopical and promote the innovation in the medical service system forcefully, and make an excellent environment for the risk controlling of Commercial Health Insurance. 2) In microscopical, it embark on the interior management of the insurance company, especially on control of the medical treating cost, set the "share the interest, shoulder the risk" system with hospital. Strengthen the control in the product exploitation, verifying and paying process. 3) It elaborate the way and process of statistic and intendance. Include the integrated intendance of compensation risk, average compensation sum and the ruin probability. Provide some measure for using the statistical index to dynamically control the process of Commercial Health Insurance.