Research On The Behavior That Employers Control The Loss Ratio Of The Supplementary Commercial Insurance

Loss ratio is the important data of insurance company to measure the overall health condition,and how to control the overall loss ratio is the method to control the total cost of welfare.Due to the occasionality and uncertainty of life insurance,so the direct measure is to control the medical loss ratio.There are many aspects which can impact the medical loss ratio.The indirect aspects include external aspects,such as social health awareness,continuous rising of medical and pharmaceutical prices,quality and accessibility of medical service,and social medical insurance policy;internal aspects,such as type of insurance plan,category of the insured,age distribution,gender distribution,etc.The claim amount per insured,utilization rate,doctor visits per claimant,claim amount per visit are the direct aspects to control the medical loss ratio.At present,there are two ways to control the loss ratio of supplementary commercial insurance: health management and medical abuse audit.In this paper,after describing the influence factors of medical loss ratio,the pros and cons of health management and medical abuse audit are compared.Then analyze claim data of group L in recent 3 years,what's more,combining the market practice,the commercial insurance status and current loss ratio control methods of group L,come to the conclusion that group L still needs to apply both control methods of health management and medical abuse audit,to better control the medical claim ratio at current stage.Finally,suggestions regarding how other companies control the loss ratio of supplementary commercial insurance are proposed.