本文關鍵詞： 重大疾病保險 產品運營 完善建議　出處：《貴州財經大學》2015年碩士論文　論文類型：學位論文

【摘要】：重大疾病保險(簡稱重疾險)一直是深受人們歡迎的人身險產品之一,自從1995年引入我國以來一直是保險公司的銷售熱點。隨著現(xiàn)代社會發(fā)病率的日漸提高,以及醫(yī)療費用的不斷攀高,很多人看不起病,尤其是在一些城市低收入階層和廣大農民群眾中,“因病致貧、一病返貧”的現(xiàn)象還很突出,重大疾病保險作為一個轉嫁風險的有效途徑,其健康發(fā)展就具有非常重大的社會意義。重疾險產品現(xiàn)已成為我國人身保險市場重要的保障型產品,2012年保費收入406億元,占我國健康保險保費的54.7%。我國也成為全世界最大的重大疾病保險市場。2006年,《重大疾病保險的疾病定義使用規(guī)范》的出臺,使得重大疾病的定義有了全行業(yè)統(tǒng)一的標準,減少了人們選購產品時的麻煩,減少了理賠糾紛。2013年11月,“中國人身保險業(yè)重大疾病經驗發(fā)生率表(2006—2010)”的發(fā)布,為各壽險公司重疾險產品科學合理的精算定價提供了基礎數據。然而,目前重大疾病保險在產品設計、產品定價、產品銷售和售后服務等方面仍然存在許多問題,本文以中國平安壽險貴州分公司為例,通過調查問卷和訪談等方法,對重大疾病保險產品運營各環(huán)節(jié)進行調查研究從而發(fā)現(xiàn)問題及問題出現(xiàn)的原因,并提出有針對性的建議,以期為重大疾病保險業(yè)務的健康發(fā)展提供有益的參考。文章以一家保險公司(中國平安人壽貴州分公司)為例,從公司和客戶兩個角度來審視重大疾病保險存在的問題,分別采用訪談法(公司內部員工)和問卷調查法(公司的客戶)來了解重疾險的現(xiàn)狀、存在問題及原因,最終這些問題通過產品設計、產品定價、產品銷售、理賠服務四個環(huán)節(jié)來貫穿和分類,然后分別從產品設計、產品定價、產品銷售、理賠及后續(xù)服務四個方面提出完善建議。但是問題研究和完善建議沒有嚴格的一一對應,而是互有交叉。本文主要內容有五部分：第一部分為緒論,包括選題背景與研究意義、文獻綜述、研究思路與研究方法、創(chuàng)新和不足。第二部分是重大疾病保險的相關概述與理論基礎,對重疾險內涵、產品形態(tài)、保險責任作了簡單介紹,而后對本文的理論基礎作了闡述：信息不對稱理論和整體營銷理念。第三部分重大疾病保險的產品簡介與產品運營問題研究,以中國平安人壽貴州分公司為例,首先,介紹了重大疾病保險的發(fā)展現(xiàn)狀、舉例介紹了重疾產品；其次,通過訪談法和問卷調查法找出重疾險存在的問題；最后在此基礎上,從產品設計、產品定價、產品銷售和理賠服務四個方面對重疾險運營存在的問題作了分析研究。第四部分重大疾病保險產品運營完善建議,從產品設計、產品定價、產品銷售、理賠及后續(xù)服務四個方面提出了建議。第五部分為總結與展望。本文的創(chuàng)新之處主要有以下幾點：資料方面,本文以中國平安人壽貴州分公司為例,運用最新的重疾險產品(如“平安福健康保障計劃2014")對其存在問題加以具體分析。結構布局方面,對重大疾病保險運營存在的問題,從產品設計、產品定價、產品銷售和理賠服務四個環(huán)節(jié)加以貫穿和闡述,從產品設計、產品定價、產品銷售、理賠及后續(xù)服務四個方面給出建議。觀點方面,筆者通過與公司內部人士訪談得知,理賠環(huán)節(jié)的主要問題是賠付率較高與理賠糾紛較多。理賠率較高的原因與發(fā)病率、逆選擇和道德風險、銷售和核保都有關系,理賠糾紛的主要原因是不實告知、客戶對合同的誤解、合同本身的不合理、 銷售誤導等。針對現(xiàn)代社會發(fā)病率日益提高的狀況,筆者建議對重疾險客戶進行健康管理,例如健康檔案管理服務、針對高端客戶的服務等——以降低發(fā)病率,提高生命質量,最終降低賠付率。本文的不足之處在于調查問卷的數量有些不足,對問卷缺乏更深入的量化分析,再就是部分對策建議稍顯籠統(tǒng),不夠具體。
[Abstract]:Serious illness insurance (referred to as critical illness insurance) has been one of the popular personal insurance products, since 1995, China has been the introduction of hot sales of insurance companies. With the development of modern society, the incidence is rising, and rising medical costs, many people can not afford, especially in some low-income City and the broad masses of peasants, "poverty caused by a disease, poverty" phenomenon is also very prominent, serious illness insurance as an effective way of shifting risk, its healthy development is of great social significance. Critical illness insurance product has become China's important security products insurance market, 2012 premium income 40 billion 600 million yuan, accounting for health insurance premiums in China 54.7%. China has become the world's largest major disease insurance market.2006, "disease definition of major disease insurance use specification issued to Definition of major diseases have the whole industry standard, reduce the purchase of products of trouble, reduce claims disputes.2013 in November, "the major disease insurance industry Chinese incidence table (2006 - 2010)" issued, provided the basic data for the life insurance actuarial pricing of critical illness insurance products scientific and reasonable. However, the current major disease insurance in product design, product pricing, there are still many problems of product sales and customer service service, based on the Chinese Guizhou branch of Ping An insurance company as an example, through the questionnaire and interview method, investigation and Research on various aspects of major disease insurance products in order to find the causes of operation problems and problems, and put forward some suggestions, in order to offer reference for the healthy development of major disease insurance business. According to an insurance company (China Ping An Life Guizhou branch) as an example, to examine the existence of serious illness insurance from the two aspects of company and customer, respectively, using interviews (employees) and questionnaires (clients) to understand the status of critical illness insurance, problems and causes of these problems, finally through product design, product pricing. Product sales, claims service four links to penetration and classification, and then from the product design, product pricing, product sales, the four aspects of Follow-Up Services claim and puts forward some improvement suggestions. But research suggests and improve the problem there is not a strict one-to-one correspondence, but cross each other. The main content of this paper has five parts: the first part is the introduction, including research background and significance, literature review, research ideas and research methods, innovations and shortcomings. The second part is the overview of major disease insurance and critical illness insurance on the theoretical foundation, connotation, products Form of liability insurance are introduced, then the theoretical basis of this paper expounds: the theory of asymmetric information and the overall marketing concept. Product introduction and product third major health insurance operations research problems, China in Guizhou Ping An Life Insurance Company for example, first, introduces the development status of major disease insurance, for example the critical illness products; secondly, through interviews and questionnaires to identify critical illness insurance problems; finally, from product design, product pricing, the four aspects of product sales and service claims were analyzed for critical illness insurance operational problems. The fourth part major disease insurance products operation suggestions from product design, product pricing, product sales, and puts forward some suggestions in four aspects of claims and Follow-Up Services. The fifth part is the conclusion and prospect. The main innovations of this article are to Some data, this paper takes Guizhou China Ping An Life Insurance Company as an example, using the latest critical illness insurance product (such as "Fu Ping An health insurance plan 2014") on the existing problems in detail. The layout of the structure, the existence of serious illness insurance operations, from product design, product pricing. Product sales and service claims four aspects and through the elaboration, from product design, product pricing, product sales, the four aspects of claims and give advice. Follow-Up Services point of view, the author of the interview with the company insiders that the main problem is the high rate of payment of claims and claims disputes claims a higher rate of reason more. And the incidence of adverse selection and moral hazard, are related to sales and underwriting, mainly due to claims disputes is not informed of the contract, the contract itself misunderstood customers, unreasonable, misleading sales. In modern society, the incidence rate increased, the author suggests to carry out health management for critical illness insurance customers, such as health management services for high-end customers service such as: to reduce morbidity, improve the quality of life, and ultimately reduce the loss rate. The shortcoming of this paper lies in the fact that the number of the questionnaire on some deficiencies, more quantitative analysis the lack of in-depth questionnaire, then some advice somewhat vague, not specific enough.

【學位授予單位】：貴州財經大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：F842.3

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本文編號：1468143