台灣產險重大疾病保險理賠之實證研究

CLAIM PATTERNS OF DREAD DISEASE INSURANCE POLICIES FOR NON-LIFE INSURERS IN TAIWAN

利菊秀(Chu-Shiu Li)；洪至仁(Chih-Jen Hung)；彭盛昌(Sheng-Chang Peng)；何雅利(Ya-Lee Ho)

重大疾病險 ； 訊息不對稱 ； 理賠機率 ； 平均理賠金額 ； 理賠幅度 ； 到期效果 ； Dread disease insurance ； Asymmetric information ； Claim probability ； Average claim loss ； Loss severity ； Expiration effect

經濟論文

51卷3期（2023 / 09 / 01）

309 - 351

繁體中文;英文

本文主要探討影響台灣產險重大疾病險保單理賠的相關風險因子，樣本為台灣全國產險重大疾病險保單，分析保單年度為2012至2015年。本文主要的研究發現，相對於保險業務員通路，全體樣本的保險經紀人與直接業務通路的理賠機率與平均理賠成本均顯著較高。然而在分群樣本的結果卻不同，規模較大（前三大）的公司，保險經紀人通路的理賠機率與平均理賠成本顯著較高，然而規模較小（非前三大）的公司，直接業務通路的理賠機率與平均理賠成本均顯著相對較高。理賠資料顯示，相對於保險業務員通路，保險經紀人的理賠幅度較高。男性比女性之理賠幅度顯著較低。年齡結構顯示，相對於30－39歲的年齡層，小於20歲與40－59歲的年齡層的理賠幅度顯著較高。癌症佔重大疾病理賠的比例約71.1%，女性比男性理賠癌症的機率顯著較高。年齡愈大，癌症出險的機率較高，年齡的平方項係數為負值，可見呈現為倒U的非線性關係。年齡結構顯示40－49歲比30－39歲年齡層發生癌症理賠的機率相對較高。我們進一步驗證台灣產險重大疾病保單是否存在訊息不對稱？實證結果顯示所有模型均未呈現保額高低與理賠發生率有關聯，換言之，並無訊息不對稱的現象存在。此外，我們也從觀察理賠保單的月份發現，相對於等待期過後第一個月，最後一個月出險的重大疾病為癌症的機率較高，而其他月份均不顯著。此到期效果的現象可能是隱含一年期的保單快到期時，被保險人比較積極去做癌症相關的篩檢，因而產生癌症的理賠率比率相較於其他疾病顯著較高。本文的實證結果可提供保險公司與政府醫療機構在重大疾病的相關資訊與醫療政策的參考依據。

We examine the risk factors of dread disease insurance for non-life insurance companies using a national database of policies from all non-life insurers in Taiwan from 2012 to 2015. We find that both insurance brokers and direct business channels have higher claim probabilities and average claim losses for total policies than traditional insurance salesperson channels. In sub-sample analysis, compared with traditional insurance salesperson channels, large insurers (the top three) and small insurers (non-top three) have significantly higher claim probabilities and average claim losses through insurance brokerage channels and direct business channels, respectively. Regarding claimants, we find that female insureds are more likely to incur cancer than males, and age has an inverted U shaped relationship with the probability of incurring cancer for all insureds. In addition, we find that cancer claims are significantly higher only for the last policy month compared with the first policy month. This result suggests that the cancer might be detected more easily by cancer screen tests that other types of dread disease. Our empirical evidence provides implications for designing premium policy of dread disease for the non-life insurance companies and the considerations of health and welfare in government sectors.

1. 王儷玲, J. L.,薛國平, G.-P.,陳麗如, L.-R.(2007)。銷售通路對汽車車體損失險損失率之影響。風險管理學報，9(3)，221-243。
   連結：
2. 汪琪玲, K. C.(2006)。台灣車體損失險上的動機效果。台大管理論叢，17(1)，31-58。
   連結：
3. 許文彥, W.-Y.,林庭宇, T.-Y.,邵淑君, S. S. C.(2014)。銷售通路與業務品質－個人健康損失情形之實證研究。經濟論文，42(2)，197-233。
   連結：
4. Barrese, J.,Doerpinghaus, H. I.,Nelson, J. M.(1995).Do Independent Agent Insurers Provide Superior Service? The Insurance Marketing Puzzle.Journal of Risk and Insurance,62,297-308.
5. Berger, A. N.,Cummins, J. D.,Weiss, M. A.(1997).The Coexistence of Multiple Distributions Systems for Financial Services: The Case of Property-Liability Insurance.Journal of Business,70,515-546.
6. Butler, R.,Worrall, J.(1991).Claims Reporting and Risk Bearing Moral Hazard in Workers’ Compensation.Journal of Risk and Insurance,58,191-204.
7. Cardon, J. H.,Hendel, I.(2001).Asymmetric Information in Health Insurance: Evidence from the National Medical Expenditure Survey.Rand Journal of Economics,32(3),408-427.
8. Cawley, J.,Philipson, T. J.(1999).An Empirical Examination of Information Barriers to Trade in Insurance.American Economic Review,89(4),827-846.
9. Chan, T. S.(1998).Consumer Complaints, Racial Discrimination, and Distribution Channels in Private Passenger Auto Insurance.Journal of Insurance Regulation,16,24-41.
10. Chiappori, P. A.,Salanie, B.(2000).Testing for Asymmetric Information in Insurance Markets.Journal of Political Economy,108(1),56-78.
11. de Meza, D.,Webb, D. C.(2001).Advantageous Selection in Insurance Markets.Rand Journal of Economics,32(2),249-262.
12. Dionne, G.,Gagné, R.(2002).Replacement Cost Endorsement and Opportunistic Fraud in Automobile Insurance.Journal of Risk and Uncertainty,24,213-230.
13. Dionne, G.,Gourieroux, C.,Vanasse, C.(2001).Testing for Evidence of Adverse Selection in the Automobile Insurance Market: A Comment.Journal of Political Economy,109(2),444-455.
14. Eppert, T.(2014).Critical Illness-Fit for the Elderly?.Risk Insights,18(3),1-5.
15. Finkelstein, A.,McGarry, K.(2006).Multiple Dimensions of Private Information: Evidence from the Long-Term Care Insurance Market.American Economic Review,96(4),938-958.
16. Finkelstein, A.,Poterba, J.(2004).Adverse Selection in Insurance Markets: Policyholder Evidence from the U.K. Annuity Market.Journal of Political Economy,112(1),183-208.
17. Führer, C.,Michel, J.(2004).An Empirical Study of Firm Size and Competitiveness in German Life Insurance.Zeitschrift für die gesamte Versicherungswissenschaft,93(2),251-267.
18. Gao, F.,Powers, M. R.,Wang, J.(2009).Adverse Selection or Advantageous Selection? Risk and Underwriting in China’s Health-Insurance Market.Insurance: Mathematics and Economics,44(3),505-510.
19. Hsieh, S. H.,Liu, C. T.,Tzeng, L. Y.(2014).Insurance Marketing Channel as a Screening Mechanism: Empirical Evidences from Taiwan Automobile Insurance Market.The Geneva Papers on Risk and Insurance-Issues and Practice,39(1),90-103.
20. Keane, M.,Stavrunova, O.(2016).Adverse Selection, Moral Hazard and the Demand for Medigap Insurance.Journal of Econometrics,190(1),62-78.
21. Kim, W. J.,Mayers, D.,Smith, C. W.(1996).On the Choice of Insurance Distribution Systems.Journal of Risk and Insurance,63,207-227.
22. Kopcke, A. W.(ed.),Randall, R. E.(ed.)(1992).The Financial Condition and Regulation of Insurance Companies.Boston, MA:Federal Reserve Bank of Boston.
23. Li, C. S.,Liu, C. C.,Peng, S. C.(2013).The Expiration Date Effects of Automobile Insurance Contracts: The Curious Case of Last Policy Month Claims in Taiwan.Geneva Risk and Insurance Review,38,23-47.
24. Li, C. S.,Liu, C. C.,Yeh, J.(2007).The Incentive Effects of Increasing Per-Claim Deductible Contracts in Automobile Insurance.Journal of Risk and Insurance,74(2),441-459.
25. Mayers, D.,Smith, C. W., Jr.(1981).Contractual Provisions, Organizational Structure, and Conflict Control in Insurance Markets.Journal of Business,54(3),407-434.
26. Mayers, D.,Smith, C. W., Jr.(1988).Ownership Structure across Lines of Property Casualty Insurance.The Journal of Law & Economics,31,351-378.
27. Peng, J. L.,Wang, K. C.(2015).Information Problems in Bancassurance: Empirical Evidence Based on a Comparison Between Over-the-Counter and Telephone Marketing Customers.The Geneva Risk and Insurance Review,40(2),102-132.
28. Peng, S. C.,Li, C. S.,Liu, C. C.(2017).Distribution Channel and Information Asymmetry: An Empirical Analysis in Taiwanese Automobile Physical Damage Insurance Market.Asia-Pacific Risk and Insurance Association 21th Annual Conference,Poznan, Poland:
29. Picard, P.,Wang, K. C.(2015).,未出版
30. Posey, L. L.,Yavas, A.(1995).A Search Model of Marketing Systems in PropertyLiability Insurance.Journal of Risk and Insurance,62(4),666-689.
31. Regan, L.,Tzeng, L. Y.(1999).Organizational Form in the Property-Liability Insurance Industry.Journal of Risk and Insurance,66(2),253-273.
32. Rothschild, M.,Stiglitz, J. E.(1976).Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information.Quarterly Journal of Economics,90(4),629-649.
33. Sass, T. R.,Gisser, M.(1989).Agency Cost, Firm Size, and Exclusive Dealing.The Journal of Law & Economics,32(2),381-400.
34. Sun, X.,Jackson, S.,Carmichael, G.,Sleigh, A. C.(2009).Catastrophic Medical Payment and Financial Protection in Rural China: Evidence from the New Cooperative Medical Scheme in Shandong Province.Health Economics,18(1),103-119.
35. Tobin, J.(1958).Estimation of Relationships for Limited Dependent Variables.Econometrica: Journal of the Econometric Society,26(1),24-36.
36. Venezia, I.,Galai, D.,Shapira, Z.(1999).Exclusive vs. Independent Agents: A Separating Equilibrium Approach.Journal of Economic Behavior & Organization,40(4),443-456.
37. Wang, J. L.,Chung, C. F.,Tzeng, L. Y.(2008).An Empirical Analysis of the Effects of Increasing Deductibles on Moral Hazard.Journal of Risk and Insurance,75(3),551-566.
38. Wang, K. C.,Peng, J. L.,Sun, Y. Y.,Chang, Y. C.(2011).The Asymmetric Information Problem in Taiwan's Cancer Insurance Market.The Geneva Risk and Insurance Review,36(2),202-219.
39. Yi, H.,Zhang, L.,Singer, K.,Rozelle, S.,Atlas, S.(2009).Health Insurance and Catastrophic Illness: A Report on the New Cooperative Medical System in Rural China.Health Economics,18(S2),S119-S127.