Risk Of Claim For Major Disease Insurance In China

With the deterioration in environmental pollution,working pressure in China,the incidence of malignant diseases continues to increase.The major disease insurance has become an important insurance product in the life insurance market,and enter into a new market Outbreak period in the next 3-4 years.However,as each insurance company enters into a rapid expansion period at the same time,the management of claims risk is ignored,resulting in a large number of claims risk concentrated in this product.Therefore,we chose the risk of claims for major diseases insurance as the object of study,carry a deep analysis and discussion on the risk of claims and management,which has a strong practical significance.First of all,based on the literature review at home and abroad,The results show that major disease insurance market lacks market education;general consumers lacks the understanding of major disease insurance,and are not satisfied with the insurance company claims service,such as the inconsistent of claims and agreement.in addition,the insurance company has internal risks,entrusted agency risk,external theoretical risk and other external risks.The internal management system,and insurance agent system and the salary system are imperfect,and the third party factors such as the external environment pressure lead to the high risk of claims for major diseases.Secondly,this article analyzes the behavior characteristics of the main interests,inclluding the insurance companies,insurance agents and policyholders,and finds out the main behavior characteristics of the three parties.As for the insurance company,they pay too much attention on premium income,while contempt for claims;besides,the staff are lacking of the ability and the quality to keep up with the business development speed;and internal insurance system is not clear;As for the insurance agents,the market is in the blind development of market development;and the regulatory responsibility between insurance companies and insurance agents are blurry;incentive system is imperfect;As for the insured person,they may choose to conceal the disease,and are lack of the understanding of the major disease insurance market;the claimant's ability to claim is weak,lacking of self-protection.Thirdly,this paper analyzes the main driving factors of the tripartite participant from the perspective of game behavior analysis.Through the analysis of the two groups of interest groups,we find that for the insured,the insurance company can adopt the following game strategies:through the product design,distinguish the policy type of the insured;through the review of reconciliation strategy,distinguish the risk type of the insured person,for agent,the insurance company can use fines to increase the cost of non-integrity agency.Through the analysis of the results of the tripartite game,the insurance company can reduce the risk of claim through setting the pre-reward and punishment constraints,while increasing the supervision of insurance after the accident.Finally,the paper summarizes the main conclusions of this paper.We put forward the following suggestion:establish a sense of competition in the insurance market through the insurance company internal management,insurance agent system norms;improve the ability to determine the major disease premium and so on.