The Study Of Commercial Insurance Companies Undertaking Critical Illness Insurance Losses

Since the establishment of critical illness insurance,it has achieved initial results in the construction of basic supporting facilities and the norms of diagnosis and treatment in Shandong.Meanwhile,it has effectively improved the level of medical insurance for urban and rural residents in Shandong.But in practice,a series of problems have been exposed.Business insurance company has a serious loss in its critical illness insurance.Therefore,it is necessary to analyze the problems existing in the process of critical illness insurance by Business insurance company in typical cities of Shandong Province,and draw lessons from other typical experiences at home and abroad to perfect the operation of critical illness insurance.Based on field research of critical illness insurance carried out in Zibo city of Shandong province,analysis of business insurance company to undertake all kinds of problems exposed in the process of critical illness insurance,illness insurance and reasons for the loss of the empirical analysis,this article gives suggestions for the improvement of Zibo city of Shandong province business insurance company to undertake critical illness insurance.Based on the concepts of "quasi-public goods","urban and rural residents illness insurance" and "commercial health insurance to participate in social management" and other related basic concepts on the basis of the government and market theory,government purchase of public service theory,and commercial health insurance to participate in social management theory,and further expounds the positive role of business insurance company to undertake the residents of critical illness on the whole social insurance.Combined with the actual situation of Zibo city,the basic status of the critical illness insurance of Zibo residents is analyzed from a macro perspective,including reimbursement ratio,financing level,compensation status and existing mechanism.Combined with the system causes critical illness insurance(low level of financing,risk sharing mechanism,cost control system of limited means,poor convergence),business reasons of insurance companies(the level of operating experience,the actuarial method is not scientific,service management should be improved and the city of Zibo(local)aging trend is increasing,the price of medical expenses rise,high level of health insurance benefits)reasons for Business insurance company to undertake critical illness insurance losses are analyzed comprehensively,the more macro.By using the method of empirical analysis,the collected data are sorted out and purified from the microscopic perspective,and the decision tree function module in SPSS is used to achieve the excavation of related factors that affect the expense of critical illness insurance claims.Present situation of loss,in the analysis of the main factors affecting "illness insurance payment for inpatient days","age "and "local places",proposed to the high risk population as the main monitoring objects,control of hospitalization time and strengthen the supervision of the local hospital targeted countermeasures,has certain practical feasibility.Then it analyzes the success of "Zhanjiang mode","Xiamen model" and "American model".The critical illness insurance in the three areas to carry out the situation,explain the operation system around the critical illness insurance,introduces three government and enterprises how to establish a long-term mechanism of critical illness insurance,summed up the Zibo illness insurance is conducive to improving the operation mechanism of the referential experience.Finally,aiming at the current situation of Business insurance company's critical illness insurance in Zibo,we propose that we should optimize the reserve extraction,innovate business cooperation mode,strengthen moral hazard prevention,and improve the fund management mechanism and risk sharing mechanism of critical illness insurance.