Study On Influencing Factors Of Short-term Health Insurance Payments

Under the new normal economic development, rural medical service demand increases and social health protection effect highlights the growing problem of insufficient market of huge health care security needs. Although demand and great development potential, but the current domestic health insurance loss ratio remains high, profitability has been troubled by poor insurers problems. How accumulated in a scientific manner the course of business information from a huge amount of data analysis, mining valuable information to improve operational efficiency is to improve the core competitiveness of enterprises an important tool.By extracting A company short-term health insurance claims data cleaning pretreatment, using SPSS software for statistical analysis, provided short-term health insurance payment amounted to the dependent variable, the establishment of the generalized linear model to estimate the risk of age, sex, disease, occupation and other regions factors on payment amount of influence. Found that age, gender, disease, occupation, region and Ln insured significantly affect payouts for specific types of variables were performed statistical description and detailed analysis and comparison, multi-dimensional cross-analysis variable value at risk. Customer data classification analysis by underwriting all types of customers Chuxian probability, claims risk value customer groups comprehensive assessment to determine the risk of claims distinguishing characteristics of different groups of customers; by empirical results found in the short-term health insurance management problems:Ratemaking unscientific, micro-payment intensive claims management costs and underwriting aspects of customer information is not rigorous, claims processing records Chuxian name of the disease are not standardized, and further refine the management process are summarized key risk control points, strengthening risk management and control, improve service quality and improve data quality in three areas targeted an optimization suggestions:First, the implementation of differentiated rates, flexible set the insured amount, set the proportion of payment, guide truthfully inform, increase survey efforts to improve the professional level; the second is to strengthen the health management, disease prevention, optimization and convenient services, to strengthen cross-border cooperation; third is to improve data quality and data management.Based on the short-term health insurance claims data, multi-dimensional visual analysis and data mining, attempts to apply to the claims data analysis perspective of risk assessment management, customer base classification of digital definition, the corresponding management measures, insurance risk control and for short-term health provide the basis for claims service, reduce management costs, improve management efficiency.