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題名 臺灣發展健康管理保單之問題與分析
A Study of Usage-Based Health Insurance in Taiwan作者 辛佩霓
Hsin, Pei-Ni貢獻者 王儷玲
辛佩霓
Hsin, Pei-Ni關鍵詞 健康管理保單
UBI保單
穿戴式裝置
IoT裝置
動態定價日期 2020 上傳時間 3-Aug-2020 17:40:58 (UTC+8) 摘要 本研究探討我國健康管理保單市場之發展，希望透過文獻回顧、案例探討與深度訪談的研究方法，分析我國健康管理保單遇到的挑戰與未來發展機會。本研究將目前健康管理保單所遇到的問題分為五大部分，分別為保單設計、銷售與通路、健康資料搜集、外溢機制與回饋條件、異業合作模式，從商品設計到發單銷售、售後服務的價值鏈拆解出各環節遇到的挑戰。此外，本研究亦以深度訪談的方式獲取實務界的建議，發現保險業者認為除了市場銷售的因素之外，主管機關的法規開放及監理模式對我國創新型保單的發展甚為重要。本研究先進行文獻回顧，再整理國內8 家30餘張健康管理保單外溢保單商品，並比較國外同類型保單趨勢，如南非Vitality活力計畫的發展、中國商業健康保險與醫療服務的融合、美國商業健康保險特約醫療網絡體系的建立等；此外，並進一步透過深度訪談彙整業菁英受訪者意見。彙整以上分析發現，本研究認為我國健康管理保單之發展，「數據」掌握是兵家必爭之地，更是未來保險公司勝出的關鍵。保險業者不僅應從商品類型與定價策略創新，更應將健康保險與「健康管理」、「醫療服務」等產業鏈結合，創造「大健康產業生態圈」；台灣保險市場未來在創新保單設計上，必須做到發掘新型定價因子、增加銷售誘因並擴展銷售通路、增進保險公司資料搜集的便利性、發展多元外溢機制與回饋條件、建立大健康產業圈之異業合作模式，並強化政府單位與監理機關的支持，才能打造合適的健康管理保單的發展環境，創造保戶與保險公司的雙贏，並達到提升整體社會福利最大化的共榮願景。 參考文獻 一、中文部分王志剛、周涇與施洵（2018）。醫療+保險：如何構建跨界融合生態圈。大陸：機械工業出版社王儷玲、彭金隆、謝明華與臧正運（2018）。我國保險業金融科技(FinTech/InsurTech)發展趨勢之風險管理及監理機制研究。財團法人保險安定基金委託研究報告。李橋興與趙紅艷（2018）。大健康產業展研究綜述。經濟研究導刊，18(7)，53-55。林嬪嬙（2014）。臺灣智慧醫療推展現況。醫療品質雜誌，8(3)，22-23。許明暉（2015）。台灣智慧醫療現況與未來發展。醫療資訊雜誌，24(5)，59-63。楊淑美與謝邦昌（2018）。智慧醫療在保險業保單設計之研究-以糖尿病為例. Journal of Data Analysis, 13(6), 183-218.鍾孟鈴（2017）。2017年國際保險學會全球保險論壇及全球保險教育協會年會出國報告。財團法人保險事業發展中心。戴偉、張霄艷與孫曉偉（2015）。大健康理念下的「醫養結合」模式。中國社會保障，15(10)，82-83。二、英文部分Gore, A. (2015). How Discovery keeps innovating. McKinsey. Retrieved May 6, 2020, from https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/how-discovery-keeps-innovating.Cappiello, A. (2018). Technology and the insurance industry: Re-configuring the competitive landscape: Springer.Cather, D.A. (2018), Cream Skimming: Innovations in Insurance Risk Classification and Adverse Selection. Risk Management and Insurance Review, 21: 335-366.Discovery (2017). Get healthy. Get rewarded. Discovery Vitality.Discovery (2018). Get healthy. Get rewarded. Discovery Vitality.Stipp, E. (2016). The impact of wellness engagement on morbidity and mortality – a big data case study. Discovery Health.Financial Stability Board (2019). FinTech and market structure in financial services: Market developments and potential financial stability implications. Financial Stability Board.Financial Technology Partners (2016). Prepare for the Insurtech wave. Financial Technology Partners.Groenewald, P., Bradshaw, D., Daniels, J., Zinyakatira, N., Matzopoulos, R., Bourne, D., et al. (2010). Local-level mortality surveillance in resource-limited settings: a case study of Cape Town highlights disparities in health. Bulletin of the World Health Organization, 88, 444-451.Inoma, H. and Pfajfar, M. (2018). Adacta partnering with WeSavvy. Adacta. Retrieved June 6, 2020, from https://www.adacta-group.com/news-center/adacta-partnering- with-wesavvy.Hsu, W. C., Lau, K. H. K., Huang, R., Ghiloni, S., Le, H., Gilroy, S., et al. (2016). Utilization of a cloud-based diabetes management program for insulin initiation and titration enables collaborative decision making between healthcare providers and patients. Diabetes technology & therapeutics, 18(2), 59-67.Infoholic Research (2018). InsurTech (Insurance Technology) Market Forecast upto 2023. Infoholic Research LLP. Retrieved June 6, 2020, from https://www.infoholicresearch.com/report/insurtech-market/International Association of Insurance Supervisors (2017). FinTech developments in the insurance industry. International Association of Insurance Supervisors.International Association of Insurance Supervisors (2018a). Application paper on the use of digital technology in inclusive insurance. International Association of Insurance Supervisors.International Association of Insurance Supervisors (2018b). Issues Paper on the Increasing Use of Digital Technology in Insurance and its Potential Impact on Consumer Outcomes. International Association of Insurance Supervisors.International Association of Insurance Supervisors (2020). Application paper on the use of digital technology in inclusive insurance. International Association of Insurance Supervisors.Manral, J. (2015). IoT Enabled Insurance Ecosystem - Possibilities, Challenges and Risks.Cummins, J. (2013). Underwriting the Applicant With Diabetes: How Important Is Glycemic Control? Risk Matters , General Re, Sydney. Retrieved June 7, 2020, from: https://www.genre.com/knowledge/publications/rmoceania1311-en.htmlBreteau, J. (2017). Wearable technology -the next frontier in health insurance. The Future of Health, Retrieved June 6, 2020, from https://www.linkedin.com/pulse/wearable-technology-next-frontier-health-insurance-julien-breteau.KPMG and CB Insight (2016). The pulse of Fintech 2015 in review: Global Analysis of Fintech Venture Funding. KPMG and CB insights.KPMG (2019). The pulse of Fintech 2019: Biannual global analysis of investment in fintech. KPMG.Park, M. (2017). Digital health for insurers. Dacadoo Life Insurance.McFall, L. (2019). Personalizing solidarity? The role of self-tracking in health insurance pricing. Economy and society, 48(1), 52-76.Wyk, P. V., Msemburi, W., Laubscher, R., Dorrington, R. E., Groenewald, P., Matzopoulos, R., et al. (2013). Second national burden of disease study South Africa: national and subnational mortality trends, 1997–2009. The Lancet, 381, S113.Porter, M. E., Kramer, M. R. and Sesia, A. (2014). “Discovery Limited.” Harvard Business School Case.Silvello, A. (2017). IoT and Connected Insurance Reshaping The Health Insurance Industry. A Customer-centric “From Cure To Care” Approach. EAI Endorsed Transactions on Ambient Systems, 4(15).Silvello, A., and Procaccini, A. (2019). Connected Insurance Reshaping the Health Insurance Industry. In Smart Healthcare: IntechOpen.Spender, A., Bullen, C., Altmann-Richer, L., Cripps, J., Duffy, R., Falkous, C., .et al. (2019). Wearables and the internet of things: Considerations for the life and health insurance industry. British Actuarial Journal, 24.World Economic Forum (2015). The future of financial services: How disruptive innovations are reshaping the way financial services are structured, provisioned and consumed. World Economic Forum and Deloitte Consulting LLP.Wu, T., Wu, F., Redoute, J.-M., & Yuce, M. R. (2017). An autonomous wireless body area network implementation towards IoT connected healthcare applications. Ieee Access, 5, 11413-11422.三、 網路資源1.Clover Health https://www.cloverhealth.com/en/2.Discovery Insurance https://www.discovery.co.za3.Financial Stability Board (FSB) https://www.fsb.org4.International Association of Insurance Supervisors (IAIS) https://www.iaisweb.org/5.McKinsey & Company https://www.mckinsey.com/6.Organization for Economic Co-operation and Development (OECD) http://www.oecd.org/7.Oscar Health https://www.hioscar.com8.UnitedHealth Group https://www.unitedhealthgroup.com9.中國人壽 https://www.chinalife.com.tw/wps/portal/chinalife10.中國平安保險 https://www.pingan.com11.台灣人壽 https://www.taiwanlife.com12.台灣失智症協會 http://www.tada2002.org.tw13.金融監督管理委員會全球資訊網 https://www.fsc.gov.tw/ch/index.jsp14.保險業資訊公開觀測站https://ins-info.ib.gov.tw/customer/announceinfo.aspx15.南山人壽 https://www.nanshanlife.com.tw/NanshanWeb16.泰康保險集團 http://www.taikang.com/about/group.html17.財團法人保險事業發展中心https://www.tii.org.tw/tii/18.現代保險https://www.rmim.com.tw/news19.國泰人壽 https://www.cathaylife.com.tw/cathaylife/20.康健人壽 https://www.cigna.com.tw21.眾安保險 https://www.zhongan.com22.第一金人壽 https://www.firstlife.com.tw23.富邦人壽 https://www.fubon.com/life/24.陽光保險 https://www.sinosig.com25.新光人壽 https://www.skl.com.tw 描述 碩士
國立政治大學
風險管理與保險學系
107358005資料來源 http://thesis.lib.nccu.edu.tw/record/#G0107358005 資料類型 thesis dc.contributor.advisor 王儷玲 zh_TW dc.contributor.author (Authors) 辛佩霓 zh_TW dc.contributor.author (Authors) Hsin, Pei-Ni en_US dc.creator (作者) 辛佩霓 zh_TW dc.creator (作者) Hsin, Pei-Ni en_US dc.date (日期) 2020 en_US dc.date.accessioned 3-Aug-2020 17:40:58 (UTC+8) - dc.date.available 3-Aug-2020 17:40:58 (UTC+8) - dc.date.issued (上傳時間) 3-Aug-2020 17:40:58 (UTC+8) - dc.identifier (Other Identifiers) G0107358005 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/131004 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 風險管理與保險學系 zh_TW dc.description (描述) 107358005 zh_TW dc.description.abstract (摘要) 本研究探討我國健康管理保單市場之發展，希望透過文獻回顧、案例探討與深度訪談的研究方法，分析我國健康管理保單遇到的挑戰與未來發展機會。本研究將目前健康管理保單所遇到的問題分為五大部分，分別為保單設計、銷售與通路、健康資料搜集、外溢機制與回饋條件、異業合作模式，從商品設計到發單銷售、售後服務的價值鏈拆解出各環節遇到的挑戰。此外，本研究亦以深度訪談的方式獲取實務界的建議，發現保險業者認為除了市場銷售的因素之外，主管機關的法規開放及監理模式對我國創新型保單的發展甚為重要。本研究先進行文獻回顧，再整理國內8 家30餘張健康管理保單外溢保單商品，並比較國外同類型保單趨勢，如南非Vitality活力計畫的發展、中國商業健康保險與醫療服務的融合、美國商業健康保險特約醫療網絡體系的建立等；此外，並進一步透過深度訪談彙整業菁英受訪者意見。彙整以上分析發現，本研究認為我國健康管理保單之發展，「數據」掌握是兵家必爭之地，更是未來保險公司勝出的關鍵。保險業者不僅應從商品類型與定價策略創新，更應將健康保險與「健康管理」、「醫療服務」等產業鏈結合，創造「大健康產業生態圈」；台灣保險市場未來在創新保單設計上，必須做到發掘新型定價因子、增加銷售誘因並擴展銷售通路、增進保險公司資料搜集的便利性、發展多元外溢機制與回饋條件、建立大健康產業圈之異業合作模式，並強化政府單位與監理機關的支持，才能打造合適的健康管理保單的發展環境，創造保戶與保險公司的雙贏，並達到提升整體社會福利最大化的共榮願景。 zh_TW dc.description.tableofcontents 第一章、 緒論 1第一節、研究背景 1第二節、研究動機 5第三節、研究目的 5第四節、研究方法 7第五節、研究架構 9第二章、 文獻回顧 11第三章、 國內外健康管理保單發展狀況 19第一節、國內健康管理保單案例探討 19第二節、國外健康管理保單案例探討 43第四章、 深度訪談 64第一節、訪談題目 64第二節、訪談回答整理 68第五章、 健康管理保單未來發展機會建議 81第一節、借鏡國外健康管理保單之發展機會 81第二節、國內健康管理保單發展機會 92第六章、 結論與未來研究方向 110第一節、實證研究發現 110第二節、產業發展與政策建議 114第三節、未來研究方向與建議 120參考文獻 121 zh_TW dc.format.extent 4003763 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0107358005 en_US dc.subject (關鍵詞) 健康管理保單 zh_TW dc.subject (關鍵詞) UBI保單 zh_TW dc.subject (關鍵詞) 穿戴式裝置 zh_TW dc.subject (關鍵詞) IoT裝置 zh_TW dc.subject (關鍵詞) 動態定價 zh_TW dc.title (題名) 臺灣發展健康管理保單之問題與分析 zh_TW dc.title (題名) A Study of Usage-Based Health Insurance in Taiwan en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 一、中文部分王志剛、周涇與施洵（2018）。醫療+保險：如何構建跨界融合生態圈。大陸：機械工業出版社王儷玲、彭金隆、謝明華與臧正運（2018）。我國保險業金融科技(FinTech/InsurTech)發展趨勢之風險管理及監理機制研究。財團法人保險安定基金委託研究報告。李橋興與趙紅艷（2018）。大健康產業展研究綜述。經濟研究導刊，18(7)，53-55。林嬪嬙（2014）。臺灣智慧醫療推展現況。醫療品質雜誌，8(3)，22-23。許明暉（2015）。台灣智慧醫療現況與未來發展。醫療資訊雜誌，24(5)，59-63。楊淑美與謝邦昌（2018）。智慧醫療在保險業保單設計之研究-以糖尿病為例. Journal of Data Analysis, 13(6), 183-218.鍾孟鈴（2017）。2017年國際保險學會全球保險論壇及全球保險教育協會年會出國報告。財團法人保險事業發展中心。戴偉、張霄艷與孫曉偉（2015）。大健康理念下的「醫養結合」模式。中國社會保障，15(10)，82-83。二、英文部分Gore, A. (2015). How Discovery keeps innovating. McKinsey. Retrieved May 6, 2020, from https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/how-discovery-keeps-innovating.Cappiello, A. (2018). Technology and the insurance industry: Re-configuring the competitive landscape: Springer.Cather, D.A. (2018), Cream Skimming: Innovations in Insurance Risk Classification and Adverse Selection. Risk Management and Insurance Review, 21: 335-366.Discovery (2017). Get healthy. Get rewarded. Discovery Vitality.Discovery (2018). Get healthy. Get rewarded. Discovery Vitality.Stipp, E. (2016). The impact of wellness engagement on morbidity and mortality – a big data case study. Discovery Health.Financial Stability Board (2019). FinTech and market structure in financial services: Market developments and potential financial stability implications. Financial Stability Board.Financial Technology Partners (2016). Prepare for the Insurtech wave. Financial Technology Partners.Groenewald, P., Bradshaw, D., Daniels, J., Zinyakatira, N., Matzopoulos, R., Bourne, D., et al. (2010). Local-level mortality surveillance in resource-limited settings: a case study of Cape Town highlights disparities in health. Bulletin of the World Health Organization, 88, 444-451.Inoma, H. and Pfajfar, M. (2018). Adacta partnering with WeSavvy. Adacta. Retrieved June 6, 2020, from https://www.adacta-group.com/news-center/adacta-partnering- with-wesavvy.Hsu, W. C., Lau, K. H. K., Huang, R., Ghiloni, S., Le, H., Gilroy, S., et al. (2016). Utilization of a cloud-based diabetes management program for insulin initiation and titration enables collaborative decision making between healthcare providers and patients. Diabetes technology & therapeutics, 18(2), 59-67.Infoholic Research (2018). InsurTech (Insurance Technology) Market Forecast upto 2023. Infoholic Research LLP. Retrieved June 6, 2020, from https://www.infoholicresearch.com/report/insurtech-market/International Association of Insurance Supervisors (2017). FinTech developments in the insurance industry. International Association of Insurance Supervisors.International Association of Insurance Supervisors (2018a). Application paper on the use of digital technology in inclusive insurance. International Association of Insurance Supervisors.International Association of Insurance Supervisors (2018b). Issues Paper on the Increasing Use of Digital Technology in Insurance and its Potential Impact on Consumer Outcomes. International Association of Insurance Supervisors.International Association of Insurance Supervisors (2020). Application paper on the use of digital technology in inclusive insurance. International Association of Insurance Supervisors.Manral, J. (2015). IoT Enabled Insurance Ecosystem - Possibilities, Challenges and Risks.Cummins, J. (2013). Underwriting the Applicant With Diabetes: How Important Is Glycemic Control? Risk Matters , General Re, Sydney. Retrieved June 7, 2020, from: https://www.genre.com/knowledge/publications/rmoceania1311-en.htmlBreteau, J. (2017). Wearable technology -the next frontier in health insurance. The Future of Health, Retrieved June 6, 2020, from https://www.linkedin.com/pulse/wearable-technology-next-frontier-health-insurance-julien-breteau.KPMG and CB Insight (2016). The pulse of Fintech 2015 in review: Global Analysis of Fintech Venture Funding. KPMG and CB insights.KPMG (2019). The pulse of Fintech 2019: Biannual global analysis of investment in fintech. KPMG.Park, M. (2017). Digital health for insurers. Dacadoo Life Insurance.McFall, L. (2019). Personalizing solidarity? The role of self-tracking in health insurance pricing. Economy and society, 48(1), 52-76.Wyk, P. V., Msemburi, W., Laubscher, R., Dorrington, R. E., Groenewald, P., Matzopoulos, R., et al. (2013). Second national burden of disease study South Africa: national and subnational mortality trends, 1997–2009. The Lancet, 381, S113.Porter, M. E., Kramer, M. R. and Sesia, A. (2014). “Discovery Limited.” Harvard Business School Case.Silvello, A. (2017). IoT and Connected Insurance Reshaping The Health Insurance Industry. A Customer-centric “From Cure To Care” Approach. EAI Endorsed Transactions on Ambient Systems, 4(15).Silvello, A., and Procaccini, A. (2019). Connected Insurance Reshaping the Health Insurance Industry. In Smart Healthcare: IntechOpen.Spender, A., Bullen, C., Altmann-Richer, L., Cripps, J., Duffy, R., Falkous, C., .et al. (2019). Wearables and the internet of things: Considerations for the life and health insurance industry. British Actuarial Journal, 24.World Economic Forum (2015). The future of financial services: How disruptive innovations are reshaping the way financial services are structured, provisioned and consumed. World Economic Forum and Deloitte Consulting LLP.Wu, T., Wu, F., Redoute, J.-M., & Yuce, M. R. (2017). An autonomous wireless body area network implementation towards IoT connected healthcare applications. Ieee Access, 5, 11413-11422.三、 網路資源1.Clover Health https://www.cloverhealth.com/en/2.Discovery Insurance https://www.discovery.co.za3.Financial Stability Board (FSB) https://www.fsb.org4.International Association of Insurance Supervisors (IAIS) https://www.iaisweb.org/5.McKinsey & Company https://www.mckinsey.com/6.Organization for Economic Co-operation and Development (OECD) http://www.oecd.org/7.Oscar Health https://www.hioscar.com8.UnitedHealth Group https://www.unitedhealthgroup.com9.中國人壽 https://www.chinalife.com.tw/wps/portal/chinalife10.中國平安保險 https://www.pingan.com11.台灣人壽 https://www.taiwanlife.com12.台灣失智症協會 http://www.tada2002.org.tw13.金融監督管理委員會全球資訊網 https://www.fsc.gov.tw/ch/index.jsp14.保險業資訊公開觀測站https://ins-info.ib.gov.tw/customer/announceinfo.aspx15.南山人壽 https://www.nanshanlife.com.tw/NanshanWeb16.泰康保險集團 http://www.taikang.com/about/group.html17.財團法人保險事業發展中心https://www.tii.org.tw/tii/18.現代保險https://www.rmim.com.tw/news19.國泰人壽 https://www.cathaylife.com.tw/cathaylife/20.康健人壽 https://www.cigna.com.tw21.眾安保險 https://www.zhongan.com22.第一金人壽 https://www.firstlife.com.tw23.富邦人壽 https://www.fubon.com/life/24.陽光保險 https://www.sinosig.com25.新光人壽 https://www.skl.com.tw zh_TW dc.identifier.doi (DOI) 10.6814/NCCU202000772 en_US
