本文關鍵詞： 商業(yè)健康保險 產品開發(fā)策略 市場熱點 SWOT分析　出處：《西南財經大學》2014年碩士論文　論文類型：學位論文

【摘要】：自保險業(yè)在中國復蘇以來,商業(yè)健康保險在中國的發(fā)展只有短短的幾十年時間。最近十年來,商業(yè)健康保險發(fā)展勢頭迅猛,國內經營商業(yè)健康保險的保險公司超過120家,2013年底保費規(guī)模已經達到940億元,在保監(jiān)局已備案的健康保險產品超過2000余種。同時,根據國內的一些研究調查,我國商業(yè)健康保險的潛在需求在2015年將達到2050億元,健康保險未來發(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,國家已經頒布各種文件確定了商業(yè)健康保險在醫(yī)療衛(wèi)生保障體系中的重要地位,政府通過政策不斷鼓勵商業(yè)保險公司參與公眾的健康保險業(yè)務,“新醫(yī)改”政策的運行給商業(yè)健康保險帶來了機遇和挑戰(zhàn)。 當然,在商業(yè)健康保險的開發(fā)道路上,我們也發(fā)現了其中的一些不足。不足主要體現為商業(yè)健康保險公司的產品開發(fā)和創(chuàng)新動力不足,研發(fā)出來的產品雷同性高,產品在市場上的長期運營能力較差和產品結構嚴重失衡等問題。因此,在外部有利的經濟環(huán)境和制度環(huán)境下,商業(yè)保險公司針對產品存在的缺陷,對健康保險產品進行深入的開發(fā)研究,提出改進措施,開發(fā)出真正滿足人們需求的健康保險產品是有著積極的現實意義的。 本文在對商業(yè)健康保險基本概念和獨特風險進行闡述的基礎上,具體分析了我國商業(yè)健康保險產品開發(fā)存在的不足,并希望通過借鑒國外先進的健康保險產品開發(fā)經驗,為我國健康保險產品的開發(fā)提供較為全面和深入的意見。. 全文共分為五部分,內容的結構安排如下： 全文開篇是“緒論”。緒論部分主要介紹了本文的選題背景、研究目的、研究的內容、研究方法及國內外學者在健康保險領域的文獻綜述。 第一章是“商業(yè)健康保險概述”。本章主要對商業(yè)健康保險的基本定義和特點進行了詳細描述,強調了有關健康保險中“疾病”定義需要滿足的三個條件,并將商業(yè)健康保險與人壽保險、意外保險進行對比分析,得出商業(yè)健康保險比壽險和意外險在核保標準上更為嚴格、經營風險上更具有難以預測性的結論。最后筆者著重關注了商業(yè)健康保險產品獨特的外界經營風險和產品自身保單設計及定價風險特點。 第二章是“我國商業(yè)健康保險產品開發(fā)的SWOT分析”。本章首先分析了商業(yè)健康保險產品開發(fā)的優(yōu)勢和機遇,即我國國民經濟的不斷增長和對健康保健意識的不斷提升,大大增加了國民對于保險的消費支出,同時,“新醫(yī)改”政策的推出,明確了商業(yè)健康保險的地位和在國民衛(wèi)生保障體系中應發(fā)揮的作用,鼓勵了商業(yè)健康保險的不斷壯大,得出我國商業(yè)健康保險產品正處在經濟和政策的利好環(huán)境下,有著廣闊的市場前景和良好的研發(fā)創(chuàng)新環(huán)境的結論。其次分析了我國商業(yè)健康保險產品開發(fā)過程中存在著創(chuàng)新動力不足、社保的擠出效應、健康保險市場寡頭壟斷的劣勢,并對劣勢存在的原因進行了分析。最后指出了我國商業(yè)健康保險產品結構失衡、各險種保單設計存在缺陷的不足之處。本章主要目的是找出我國商業(yè)健康保險產品開發(fā)時存在的不足和缺陷,為后文如何制定產品開發(fā)策略指明方向。 第三章是“國外健康保險發(fā)展及產品開發(fā)的經驗與啟示研究”。本章簡要介紹了商業(yè)健康保險在國外發(fā)達國家的發(fā)展狀況。筆者主要選取了英國、美國、德國三個不同醫(yī)療衛(wèi)生制度國家,并對在三種不同的醫(yī)療衛(wèi)生制度下商業(yè)健康保險產品的發(fā)展情況和開發(fā)特點進行了具體分析,最終指出了發(fā)達國家的經驗對于我國商業(yè)健康保險產品開發(fā)可供借鑒之處。筆者研究認為,我國產品開發(fā)應該學習外國商業(yè)健康保險公司的有效開發(fā)經驗,要注重產品在市場經營的長期效應和綜合效應,根據國情及時進行開發(fā)技術改良,不斷豐富產品體系,堅持不懈地走專業(yè)化的產品研發(fā)道路。 第四章是“促進我國商業(yè)健康保險產品開發(fā)的策略建議”。本章首先對健康保險市場進行了市場熱點分析和政策下的發(fā)展空間定位,通過分析可以知道我國商業(yè)健康保險的發(fā)展空間可以向基本醫(yī)療保險之外的“五個一部分”靠攏。其次,在制定商業(yè)健康保險產品開發(fā)策略時,筆者提出了我國商業(yè)健康保險產品開發(fā)在路徑要選擇漸變式的改革路徑,產品開發(fā)要遵循先易后難,不能魯莽冒進的原則。同時,本文也根據第二章對重大疾病保險、醫(yī)療保險、長期護理保險和失能收入損失保險產品設計存在的問題分別有針對性的提出了商業(yè)健康保險產品開發(fā)時應該在承保人群、責任范圍、給付方式等保單設計方面進行改進的意見。最后,本文從完善健康保險產品銷售渠道角度提出了進一步的建議和意見。 本文的研究特色及創(chuàng)新之處在于：一是在2009年“新醫(yī)改”方案出臺后,對商業(yè)健康保險的發(fā)展進行研究的文獻較多,而研究商業(yè)健康保險產品如何進行開發(fā)創(chuàng)新的文獻較少。本文對健康保險產品開發(fā)存在的問題進行了深入的思考和探討,提出了產品開發(fā)的建議。二是本文采用了管理學中的"SWOT分析法”,利用管理學理論知識全面的分析了我國商業(yè)健康保險產品的內外環(huán)境、機遇挑戰(zhàn)、優(yōu)勢劣勢。為后文制定產品策略提供了方向。三是本文對重大疾病保險、醫(yī)療保險、長期護理保險、失能收入損失保險四大健康保險的分析對比皆采用實際案例分析法,根據每一類險種的特點,選取實際市場中的典型產品進行對比分析,更貼合現實市場和家庭需要,盡可能地將理論與實際需求相結合。 本文的不足之處： 一是研究提出的健康保險產品開發(fā)策略主要是對全國范圍統(tǒng)一市場的產品進行分析,沒有考慮我國區(qū)域性經濟發(fā)展不平衡的產品市場偏差。二是本文主要是對個人型健康保險產品進行分析,對于團體類產品則沒有進行討論。三是由于筆者的理論知識有限,并且缺乏實踐經驗,在理論分析方面研究的深入程度不夠,今天筆者將會繼續(xù)學習,努力提高自己的理論與實踐水平。
[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.

【學位授予單位】：西南財經大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：F842.684

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