健康保险精算理论与方法体系  

Theory and methodology on health insurance actuarial science research

作　　者：谢远涛[1] 李政宵 Yuantao XIE;Zhengxiao LI(School of Insurance, University of International Business and Economics, Beijing 100029, China)

机构地区：[1]对外经济贸易大学保险学院

出　　处：《山东大学学报（医学版）》2019年第8期20-38,共19页Journal of Shandong University:Health Sciences

基　　金：国家社科基金(18BJY212);对外经济贸易大学学术创新团队课题(CXTD9-04)

摘　　要：健康保险精算中,需要结合保险公司的赔付数据、医疗机构的临床数据和患者个人数据进行建模分析,从精算的思路看主要分为费率厘定和准备金评估,保费收取后,传统保险只是被动管理风险,从主动风险管理角度来看,还需要考虑后续的基金分配问题。费率厘定主要包含基于损失分布的费率厘定,传统的分类费率厘定、经验费率厘定、整合费率厘定,以及基于发病率的定价模型和基于依赖视角的调整模型;准备金评估主要包含基于流量三角形的确定型准备金评估和随机准备金评估,以及用于分析0赔案的操作时间的评估模型;基金管理本质上属于一个优化模型,是一个非常广阔的模型框架。讨论了简单的基金分配问题,并综合介绍了发病率、马氏链、发病率期权、偿付能力、风险监管等相关的研究框架和研究方法。It is necessary to combine the compensation data of insurance companies, clinical diagnostic data of medical institutions and personal data of patients for health actuarial science modeling and analysis. From the actuarial point of view, it is mainly divided into rate-making and reserve evaluation. The traditional insurance focuses on passive risk management, while premium fund allocation becomes important from the perspective of active risk management. Rate-making can be classified into rough estimation method, regression models method, loss distribution method and empirical frequency method. It can also be classified into traditional classification rate, credibility rate, integrated rate, as well as pricing model based on incidence and adjustment model based on dependency perspective, from the point of view of pricing process and rate characteristics. Reserve evaluation includes deterministic reserve evaluation and stochastic reserve evaluation. The basic tool is the run-off triangle and the improved analysis framework based on operation time that dealing with the zero-claim problem. The deterministic model has developed to Mack model and Munich model, and the stochastic model has developed from generalized linear models to hierarchy models, and the stochastic effect has been extended. Premium fund allocation is essentially an optimization model and a very broad model framework. In the current paper, we discusses a simple fund allocation problem, and give a list of related research frameworks and methods, such as morbidity, Markov chain, morbidity options, solvency, risk supervision and so on.

关 键 词：健康保险 精算 费率厘定 经验费率 准备金评估 流量三角 基金分配 

分 类 号：O212[理学—概率论与数理统计] F222.3[理学—数学]