本文關(guān)鍵詞： 商業(yè)健康保險(xiǎn) 產(chǎn)品開(kāi)發(fā)策略 市場(chǎng)熱點(diǎn) SWOT分析　出處：《西南財(cái)經(jīng)大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：自保險(xiǎn)業(yè)在中國(guó)復(fù)蘇以來(lái),商業(yè)健康保險(xiǎn)在中國(guó)的發(fā)展只有短短的幾十年時(shí)間。最近十年來(lái),商業(yè)健康保險(xiǎn)發(fā)展勢(shì)頭迅猛,國(guó)內(nèi)經(jīng)營(yíng)商業(yè)健康保險(xiǎn)的保險(xiǎn)公司超過(guò)120家,2013年底保費(fèi)規(guī)模已經(jīng)達(dá)到940億元,在保監(jiān)局已備案的健康保險(xiǎn)產(chǎn)品超過(guò)2000余種。同時(shí),根據(jù)國(guó)內(nèi)的一些研究調(diào)查,我國(guó)商業(yè)健康保險(xiǎn)的潛在需求在2015年將達(dá)到2050億元,健康保險(xiǎn)未來(lái)發(fā)展的商業(yè)空間十分巨大。 自2009年新一輪醫(yī)療衛(wèi)生制度改革以來(lái),國(guó)家已經(jīng)頒布各種文件確定了商業(yè)健康保險(xiǎn)在醫(yī)療衛(wèi)生保障體系中的重要地位,政府通過(guò)政策不斷鼓勵(lì)商業(yè)保險(xiǎn)公司參與公眾的健康保險(xiǎn)業(yè)務(wù),“新醫(yī)改”政策的運(yùn)行給商業(yè)健康保險(xiǎn)帶來(lái)了機(jī)遇和挑戰(zhàn)。 當(dāng)然,在商業(yè)健康保險(xiǎn)的開(kāi)發(fā)道路上,我們也發(fā)現(xiàn)了其中的一些不足。不足主要體現(xiàn)為商業(yè)健康保險(xiǎn)公司的產(chǎn)品開(kāi)發(fā)和創(chuàng)新動(dòng)力不足,研發(fā)出來(lái)的產(chǎn)品雷同性高,產(chǎn)品在市場(chǎng)上的長(zhǎng)期運(yùn)營(yíng)能力較差和產(chǎn)品結(jié)構(gòu)嚴(yán)重失衡等問(wèn)題。因此,在外部有利的經(jīng)濟(jì)環(huán)境和制度環(huán)境下,商業(yè)保險(xiǎn)公司針對(duì)產(chǎn)品存在的缺陷,對(duì)健康保險(xiǎn)產(chǎn)品進(jìn)行深入的開(kāi)發(fā)研究,提出改進(jìn)措施,開(kāi)發(fā)出真正滿(mǎn)足人們需求的健康保險(xiǎn)產(chǎn)品是有著積極的現(xiàn)實(shí)意義的。 本文在對(duì)商業(yè)健康保險(xiǎn)基本概念和獨(dú)特風(fēng)險(xiǎn)進(jìn)行闡述的基礎(chǔ)上,具體分析了我國(guó)商業(yè)健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)存在的不足,并希望通過(guò)借鑒國(guó)外先進(jìn)的健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)經(jīng)驗(yàn),為我國(guó)健康保險(xiǎn)產(chǎn)品的開(kāi)發(fā)提供較為全面和深入的意見(jiàn)。. 全文共分為五部分,內(nèi)容的結(jié)構(gòu)安排如下： 全文開(kāi)篇是“緒論”。緒論部分主要介紹了本文的選題背景、研究目的、研究的內(nèi)容、研究方法及國(guó)內(nèi)外學(xué)者在健康保險(xiǎn)領(lǐng)域的文獻(xiàn)綜述。 第一章是“商業(yè)健康保險(xiǎn)概述”。本章主要對(duì)商業(yè)健康保險(xiǎn)的基本定義和特點(diǎn)進(jìn)行了詳細(xì)描述,強(qiáng)調(diào)了有關(guān)健康保險(xiǎn)中“疾病”定義需要滿(mǎn)足的三個(gè)條件,并將商業(yè)健康保險(xiǎn)與人壽保險(xiǎn)、意外保險(xiǎn)進(jìn)行對(duì)比分析,得出商業(yè)健康保險(xiǎn)比壽險(xiǎn)和意外險(xiǎn)在核保標(biāo)準(zhǔn)上更為嚴(yán)格、經(jīng)營(yíng)風(fēng)險(xiǎn)上更具有難以預(yù)測(cè)性的結(jié)論。最后筆者著重關(guān)注了商業(yè)健康保險(xiǎn)產(chǎn)品獨(dú)特的外界經(jīng)營(yíng)風(fēng)險(xiǎn)和產(chǎn)品自身保單設(shè)計(jì)及定價(jià)風(fēng)險(xiǎn)特點(diǎn)。 第二章是“我國(guó)商業(yè)健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)的SWOT分析”。本章首先分析了商業(yè)健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)的優(yōu)勢(shì)和機(jī)遇,即我國(guó)國(guó)民經(jīng)濟(jì)的不斷增長(zhǎng)和對(duì)健康保健意識(shí)的不斷提升,大大增加了國(guó)民對(duì)于保險(xiǎn)的消費(fèi)支出,同時(shí),“新醫(yī)改”政策的推出,明確了商業(yè)健康保險(xiǎn)的地位和在國(guó)民衛(wèi)生保障體系中應(yīng)發(fā)揮的作用,鼓勵(lì)了商業(yè)健康保險(xiǎn)的不斷壯大,得出我國(guó)商業(yè)健康保險(xiǎn)產(chǎn)品正處在經(jīng)濟(jì)和政策的利好環(huán)境下,有著廣闊的市場(chǎng)前景和良好的研發(fā)創(chuàng)新環(huán)境的結(jié)論。其次分析了我國(guó)商業(yè)健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)過(guò)程中存在著創(chuàng)新動(dòng)力不足、社保的擠出效應(yīng)、健康保險(xiǎn)市場(chǎng)寡頭壟斷的劣勢(shì),并對(duì)劣勢(shì)存在的原因進(jìn)行了分析。最后指出了我國(guó)商業(yè)健康保險(xiǎn)產(chǎn)品結(jié)構(gòu)失衡、各險(xiǎn)種保單設(shè)計(jì)存在缺陷的不足之處。本章主要目的是找出我國(guó)商業(yè)健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)時(shí)存在的不足和缺陷,為后文如何制定產(chǎn)品開(kāi)發(fā)策略指明方向。 第三章是“國(guó)外健康保險(xiǎn)發(fā)展及產(chǎn)品開(kāi)發(fā)的經(jīng)驗(yàn)與啟示研究”。本章簡(jiǎn)要介紹了商業(yè)健康保險(xiǎn)在國(guó)外發(fā)達(dá)國(guó)家的發(fā)展?fàn)顩r。筆者主要選取了英國(guó)、美國(guó)、德國(guó)三個(gè)不同醫(yī)療衛(wèi)生制度國(guó)家,并對(duì)在三種不同的醫(yī)療衛(wèi)生制度下商業(yè)健康保險(xiǎn)產(chǎn)品的發(fā)展情況和開(kāi)發(fā)特點(diǎn)進(jìn)行了具體分析,最終指出了發(fā)達(dá)國(guó)家的經(jīng)驗(yàn)對(duì)于我國(guó)商業(yè)健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)可供借鑒之處。筆者研究認(rèn)為,我國(guó)產(chǎn)品開(kāi)發(fā)應(yīng)該學(xué)習(xí)外國(guó)商業(yè)健康保險(xiǎn)公司的有效開(kāi)發(fā)經(jīng)驗(yàn),要注重產(chǎn)品在市場(chǎng)經(jīng)營(yíng)的長(zhǎng)期效應(yīng)和綜合效應(yīng),根據(jù)國(guó)情及時(shí)進(jìn)行開(kāi)發(fā)技術(shù)改良,不斷豐富產(chǎn)品體系,堅(jiān)持不懈地走專(zhuān)業(yè)化的產(chǎn)品研發(fā)道路。 第四章是“促進(jìn)我國(guó)商業(yè)健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)的策略建議”。本章首先對(duì)健康保險(xiǎn)市場(chǎng)進(jìn)行了市場(chǎng)熱點(diǎn)分析和政策下的發(fā)展空間定位,通過(guò)分析可以知道我國(guó)商業(yè)健康保險(xiǎn)的發(fā)展空間可以向基本醫(yī)療保險(xiǎn)之外的“五個(gè)一部分”靠攏。其次,在制定商業(yè)健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)策略時(shí),筆者提出了我國(guó)商業(yè)健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)在路徑要選擇漸變式的改革路徑,產(chǎn)品開(kāi)發(fā)要遵循先易后難,不能魯莽冒進(jìn)的原則。同時(shí),本文也根據(jù)第二章對(duì)重大疾病保險(xiǎn)、醫(yī)療保險(xiǎn)、長(zhǎng)期護(hù)理保險(xiǎn)和失能收入損失保險(xiǎn)產(chǎn)品設(shè)計(jì)存在的問(wèn)題分別有針對(duì)性的提出了商業(yè)健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)時(shí)應(yīng)該在承保人群、責(zé)任范圍、給付方式等保單設(shè)計(jì)方面進(jìn)行改進(jìn)的意見(jiàn)。最后,本文從完善健康保險(xiǎn)產(chǎn)品銷(xiāo)售渠道角度提出了進(jìn)一步的建議和意見(jiàn)。 本文的研究特色及創(chuàng)新之處在于：一是在2009年“新醫(yī)改”方案出臺(tái)后,對(duì)商業(yè)健康保險(xiǎn)的發(fā)展進(jìn)行研究的文獻(xiàn)較多,而研究商業(yè)健康保險(xiǎn)產(chǎn)品如何進(jìn)行開(kāi)發(fā)創(chuàng)新的文獻(xiàn)較少。本文對(duì)健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)存在的問(wèn)題進(jìn)行了深入的思考和探討,提出了產(chǎn)品開(kāi)發(fā)的建議。二是本文采用了管理學(xué)中的"SWOT分析法”,利用管理學(xué)理論知識(shí)全面的分析了我國(guó)商業(yè)健康保險(xiǎn)產(chǎn)品的內(nèi)外環(huán)境、機(jī)遇挑戰(zhàn)、優(yōu)勢(shì)劣勢(shì)。為后文制定產(chǎn)品策略提供了方向。三是本文對(duì)重大疾病保險(xiǎn)、醫(yī)療保險(xiǎn)、長(zhǎng)期護(hù)理保險(xiǎn)、失能收入損失保險(xiǎn)四大健康保險(xiǎn)的分析對(duì)比皆采用實(shí)際案例分析法,根據(jù)每一類(lèi)險(xiǎn)種的特點(diǎn),選取實(shí)際市場(chǎng)中的典型產(chǎn)品進(jìn)行對(duì)比分析,更貼合現(xiàn)實(shí)市場(chǎng)和家庭需要,盡可能地將理論與實(shí)際需求相結(jié)合。 本文的不足之處： 一是研究提出的健康保險(xiǎn)產(chǎn)品開(kāi)發(fā)策略主要是對(duì)全國(guó)范圍統(tǒng)一市場(chǎng)的產(chǎn)品進(jìn)行分析,沒(méi)有考慮我國(guó)區(qū)域性經(jīng)濟(jì)發(fā)展不平衡的產(chǎn)品市場(chǎng)偏差。二是本文主要是對(duì)個(gè)人型健康保險(xiǎn)產(chǎn)品進(jìn)行分析,對(duì)于團(tuán)體類(lèi)產(chǎn)品則沒(méi)有進(jìn)行討論。三是由于筆者的理論知識(shí)有限,并且缺乏實(shí)踐經(jīng)驗(yàn),在理論分析方面研究的深入程度不夠,今天筆者將會(huì)繼續(xù)學(xué)習(xí),努力提高自己的理論與實(shí)踐水平。
[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.

【學(xué)位授予單位】：西南財(cái)經(jīng)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：F842.684

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