中国商业健康保险产品开发研究

发布时间：2018-02-25 15:55

本文关键词： 商业健康保险产品开发策略市场热点 SWOT分析　出处：《西南财经大学》2014年硕士论文　论文类型：学位论文

【摘要】：自保险业在中国复苏以来,商业健康保险在中国的发展只有短短的几十年时间。最近十年来,商业健康保险发展势头迅猛,国内经营商业健康保险的保险公司超过120家,2013年底保费规模已经达到940亿元,在保监局已备案的健康保险产品超过2000余种。同时,根据国内的一些研究调查,我国商业健康保险的潜在需求在2015年将达到2050亿元,健康保险未来发展的商业空间十分巨大。自2009年新一轮医疗卫生制度改革以来,国家已经颁布各种文件确定了商业健康保险在医疗卫生保障体系中的重要地位,政府通过政策不断鼓励商业保险公司参与公众的健康保险业务,“新医改”政策的运行给商业健康保险带来了机遇和挑战。当然,在商业健康保险的开发道路上,我们也发现了其中的一些不足。不足主要体现为商业健康保险公司的产品开发和创新动力不足,研发出来的产品雷同性高,产品在市场上的长期运营能力较差和产品结构严重失衡等问题。因此,在外部有利的经济环境和制度环境下,商业保险公司针对产品存在的缺陷,对健康保险产品进行深入的开发研究,提出改进措施,开发出真正满足人们需求的健康保险产品是有着积极的现实意义的。本文在对商业健康保险基本概念和独特风险进行阐述的基础上,具体分析了我国商业健康保险产品开发存在的不足,并希望通过借鉴国外先进的健康保险产品开发经验,为我国健康保险产品的开发提供较为全面和深入的意见。. 全文共分为五部分,内容的结构安排如下：全文开篇是“绪论”。绪论部分主要介绍了本文的选题背景、研究目的、研究的内容、研究方法及国内外学者在健康保险领域的文献综述。第一章是“商业健康保险概述”。本章主要对商业健康保险的基本定义和特点进行了详细描述,强调了有关健康保险中“疾病”定义需要满足的三个条件,并将商业健康保险与人寿保险、意外保险进行对比分析,得出商业健康保险比寿险和意外险在核保标准上更为严格、经营风险上更具有难以预测性的结论。最后笔者着重关注了商业健康保险产品独特的外界经营风险和产品自身保单设计及定价风险特点。第二章是“我国商业健康保险产品开发的SWOT分析”。本章首先分析了商业健康保险产品开发的优势和机遇,即我国国民经济的不断增长和对健康保健意识的不断提升,大大增加了国民对于保险的消费支出,同时,“新医改”政策的推出,明确了商业健康保险的地位和在国民卫生保障体系中应发挥的作用,鼓励了商业健康保险的不断壮大,得出我国商业健康保险产品正处在经济和政策的利好环境下,有着广阔的市场前景和良好的研发创新环境的结论。其次分析了我国商业健康保险产品开发过程中存在着创新动力不足、社保的挤出效应、健康保险市场寡头垄断的劣势,并对劣势存在的原因进行了分析。最后指出了我国商业健康保险产品结构失衡、各险种保单设计存在缺陷的不足之处。本章主要目的是找出我国商业健康保险产品开发时存在的不足和缺陷,为后文如何制定产品开发策略指明方向。第三章是“国外健康保险发展及产品开发的经验与启示研究”。本章简要介绍了商业健康保险在国外发达国家的发展状况。笔者主要选取了英国、美国、德国三个不同医疗卫生制度国家,并对在三种不同的医疗卫生制度下商业健康保险产品的发展情况和开发特点进行了具体分析,最终指出了发达国家的经验对于我国商业健康保险产品开发可供借鉴之处。笔者研究认为,我国产品开发应该学习外国商业健康保险公司的有效开发经验,要注重产品在市场经营的长期效应和综合效应,根据国情及时进行开发技术改良,不断丰富产品体系,坚持不懈地走专业化的产品研发道路。第四章是“促进我国商业健康保险产品开发的策略建议”。本章首先对健康保险市场进行了市场热点分析和政策下的发展空间定位,通过分析可以知道我国商业健康保险的发展空间可以向基本医疗保险之外的“五个一部分”靠拢。其次,在制定商业健康保险产品开发策略时,笔者提出了我国商业健康保险产品开发在路径要选择渐变式的改革路径,产品开发要遵循先易后难,不能鲁莽冒进的原则。同时,本文也根据第二章对重大疾病保险、医疗保险、长期护理保险和失能收入损失保险产品设计存在的问题分别有针对性的提出了商业健康保险产品开发时应该在承保人群、责任范围、给付方式等保单设计方面进行改进的意见。最后,本文从完善健康保险产品销售渠道角度提出了进一步的建议和意见。本文的研究特色及创新之处在于：一是在2009年“新医改”方案出台后,对商业健康保险的发展进行研究的文献较多,而研究商业健康保险产品如何进行开发创新的文献较少。本文对健康保险产品开发存在的问题进行了深入的思考和探讨,提出了产品开发的建议。二是本文采用了管理学中的"SWOT分析法”,利用管理学理论知识全面的分析了我国商业健康保险产品的内外环境、机遇挑战、优势劣势。为后文制定产品策略提供了方向。三是本文对重大疾病保险、医疗保险、长期护理保险、失能收入损失保险四大健康保险的分析对比皆采用实际案例分析法,根据每一类险种的特点,选取实际市场中的典型产品进行对比分析,更贴合现实市场和家庭需要,尽可能地将理论与实际需求相结合。本文的不足之处：一是研究提出的健康保险产品开发策略主要是对全国范围统一市场的产品进行分析,没有考虑我国区域性经济发展不平衡的产品市场偏差。二是本文主要是对个人型健康保险产品进行分析,对于团体类产品则没有进行讨论。三是由于笔者的理论知识有限,并且缺乏实践经验,在理论分析方面研究的深入程度不够,今天笔者将会继续学习,努力提高自己的理论与实践水平。
[Abstract]:Since the insurance industry in China recovery since the development of commercial health insurance in China only lasts for a few decades. In recent ten years, the rapid development momentum of health insurance business, the domestic business of the commercial health insurance insurance companies in more than 120 by the end of 2013, the size of the premium has reached 94 billion yuan, more than 2000 kinds of health insurance products in China the Bureau has been filed. At the same time, according to some domestic research, the potential demand of commercial health insurance in China in 2015 will reach 205 billion yuan, the future development of the health insurance business is a huge space.
Since 2009 a new round of health system reform, the state has promulgated various documents to determine the important position of commercial health insurance in the medical security system, the government adopted policies continue to encourage Business insurance company to participate in the public health insurance business, "brings opportunities and challenges of new medical reform policy to the operation of commercial health insurance.
Of course, in the commercial health insurance development on the road, we also found some deficiencies. The problems mainly includes product development of commercial health insurance companies and the lack of innovation power, developed similar products of high, long-term operation of the product in the market is poor and product structure imbalance. Therefore, in the economic environment and favorable external institutional environment, the Business insurance company for the defective products are developed, in-depth study of health insurance products, and puts forward the improvement measures, the development of a truly meet the needs of people's health insurance products have a positive practical significance.
Based on the basic concepts of the commercial health insurance and special risk elaborated on the specific analysis of the shortcomings of commercial health insurance products developed in China, and hopes to learn from the advanced experience of foreign countries for the development of health insurance products, health insurance products in China's development to provide a more comprehensive and in-depth views.
The full text is divided into five parts, and the structure of the content is as follows:
The introduction is the introduction. The introduction mainly introduces the background, purpose, contents, methods and literature review of health insurance in China and abroad.
The first chapter is the overview of the commercial health insurance ". This chapter focuses on the commercial health insurance, basic definition and characteristics are described in detail, emphasizing on health insurance in the" disease "definition needs to satisfy three conditions, and the commercial health insurance and life insurance, accident insurance were analyzed, the commercial health insurance than in the life insurance and accident insurance underwriting standards more stringent, operational risk is more difficult to predict the conclusion. The author focuses on the commercial health insurance products unique outside the business risk and product design and pricing policy risk characteristics.
The second chapter is the analysis of SWOT commercial health insurance products developed in China. This chapter first analyzes the commercial health insurance product development advantages and opportunities, which is the continuous growth of national economy and the continuous improvement of the awareness of health care, greatly increasing the national insurance for consumer spending, at the same time, the introduction of new medical reform "policy, the role of the commercial health insurance status and should play in the system of national health security, encourages the commercial health insurance has grown, that commercial health insurance products in China is in the economic environment and favorable policies, has broad market prospects and good innovation environment. Secondly, analysis of China's commercial health insurance product development process there is lack of innovation power, the crowding out effect of social security, health insurance market oligopoly and the disadvantages of the disadvantages. The reasons are analyzed. Finally, pointed out that China's commercial health insurance products structural imbalance, shortcomings of the various types of insurance policy defects design. The main purpose of this chapter is to find out the existing Chinese commercial health insurance product development shortcomings and defects, for the direction of how to develop the product development strategy.
The third chapter is "the experience and Enlightenment of the development of health insurance abroad and the development of the product. This chapter briefly introduces the development of commercial health insurance in developed countries. The author mainly selected the British, American, three different national health system in Germany, and in the development and characteristics of the development of commercial health insurance products three different medical health system are analyzed in detail, finally pointed out that the experience of developed countries for reference for the development of commercial health insurance products in China. The author finds that the development of effective product development experience in China should learn from foreign commercial health insurance company, should pay attention to the long-term effect of product in the market management and comprehensive effect of development technology improvement in time according to the situation, and constantly enrich the product system, road product development unremittingly go professional.
The fourth chapter is "the promotion strategy" commercial health insurance products developed in China. The first chapter of the health insurance market development space positioning hot market analysis and policy, through the analysis we can know the development space of China's commercial health insurance to basic medical insurance "five part". Secondly, in the development of commercial health insurance product development strategy, the author puts forward China's commercial health insurance product development to choose the gradual reform path in the path of product development should follow from easy to difficult, not reckless risk into principle. At the same time, according to the second chapter of medical insurance, serious illness insurance. Long term care insurance and disability income insurance products are designed respectively puts forward the commercial health insurance product development should be in the insurance liability scope, to the crowd, In the end, this paper puts forward further suggestions and suggestions from the perspective of improving the marketing channels of health insurance products.
Study on the characteristic and innovation of this paper lies in: one is the introduction of the new medical reform program in 2009 after the study of the development of commercial health insurance, there are many literatures, and research how to develop commercial health insurance product innovation literature less. And discussed deeply thinking about the existence of health insurance product development issues. Put forward product development suggestions. Two is the management of the SWOT analysis method in the theory of knowledge management ", the comprehensive analysis of the commercial health insurance products in China's internal and external environment, opportunities and challenges, advantages and disadvantages. Provides the direction for the development of product strategy. The three is the medical treatment of major diseases insurance, insurance, long-term care insurance, disability income insurance comparison of four health insurance is used in actual case analysis, according to the characteristics of each type, select the actual The typical products in the market are compared and analyzed to meet the needs of the real market and family, and combine the theory with the actual needs as much as possible.
The shortcomings of this article are as follows:
One is the development strategy of health insurance products is mainly carries on the analysis to the nationwide unified market products, without considering the market deviation of regional economic unbalanced development in our country is two. This paper is mainly about the personal health insurance products are analyzed, for group type products are not discussed. Because the author is three the theory of knowledge is limited, and the lack of practical experience, in-depth study the extent of theoretical analysis is not enough, today I will continue to learn, and strive to improve the level of theory and practice of their own.

【学位授予单位】：西南财经大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684

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