本文關(guān)鍵詞：中美保險(xiǎn)反欺詐機(jī)制比較及對(duì)策，由筆耕文化傳播整理發(fā)布。

        自保險(xiǎn)產(chǎn)生以來,保險(xiǎn)欺詐就如影隨形,近年來隨著人們對(duì)保險(xiǎn)認(rèn)識(shí)的提高,保險(xiǎn)業(yè)有了巨大的發(fā)展,保險(xiǎn)欺詐也日漸增多,且保險(xiǎn)欺詐的方式、途徑也越來越多,隱蔽性越來越強(qiáng),已經(jīng)成為阻礙保險(xiǎn)業(yè)健康發(fā)展的主要障礙之一,甚至使保險(xiǎn)人在計(jì)算保費(fèi)時(shí)不得不把因欺詐產(chǎn)生的費(fèi)用考慮在內(nèi),因此保險(xiǎn)欺詐也被喻為保險(xiǎn)界無聲的巨災(zāi)。自80年代恢復(fù)保險(xiǎn)業(yè)以來,我國(guó)的保險(xiǎn)公司數(shù)量和保費(fèi)收入不斷增長(zhǎng),至2011年保費(fèi)收入已經(jīng)達(dá)到了1.4萬億元,成為國(guó)民經(jīng)濟(jì)不可忽視的重要組成部分,而與保險(xiǎn)相生相伴的保險(xiǎn)欺詐也隨著保險(xiǎn)業(yè)的發(fā)展不斷增多,根據(jù)我國(guó)保險(xiǎn)監(jiān)管部門估測(cè),我國(guó)保險(xiǎn)理賠中約有20%是由欺詐造成的,每年造成的損失可達(dá)上百億元。但是我國(guó)目前還沒有充分認(rèn)識(shí)到保險(xiǎn)欺詐危害的嚴(yán)重性,尚未建立起保險(xiǎn)反欺詐體系,對(duì)保險(xiǎn)反欺詐的研究還處于起步階段,存在很多不足。而且保險(xiǎn)欺詐并不是我國(guó)獨(dú)有的現(xiàn)象,是一個(gè)世界性的難題,美國(guó)作為保險(xiǎn)業(yè)最發(fā)達(dá)的國(guó)家,同時(shí)也是保險(xiǎn)欺詐的“重災(zāi)區(qū)”,美國(guó)在保險(xiǎn)反欺詐方面的各項(xiàng)機(jī)制比較健全,本文將中國(guó)和美國(guó)的保險(xiǎn)反欺詐機(jī)制進(jìn)行比較,從中發(fā)現(xiàn)我國(guó)在保險(xiǎn)反欺詐過程中存在的不足,針對(duì)不足提出建議。本文以比較分析為基礎(chǔ),首先對(duì)保險(xiǎn)欺詐的概念進(jìn)行了界定,然后從信息不對(duì)稱的角度出發(fā),利用博弈論分析保險(xiǎn)欺詐的成因,得到影響保險(xiǎn)欺詐概率的三個(gè)因素：檢查概率,對(duì)保險(xiǎn)欺詐的懲罰和保險(xiǎn)人投入的檢查成本,接著從這三個(gè)因素的角度出發(fā)分析我國(guó)保險(xiǎn)欺詐的現(xiàn)狀及原因,然后對(duì)我國(guó)的保險(xiǎn)反欺詐機(jī)制和美國(guó)的保險(xiǎn)反欺詐機(jī)制進(jìn)行概述及對(duì)比,從中發(fā)現(xiàn)我國(guó)保險(xiǎn)反欺詐機(jī)制中的不足,最后對(duì)我國(guó)的保險(xiǎn)反欺詐工作提出建議。根據(jù)以上思路,本文的結(jié)構(gòu)分為以下五個(gè)部分：第一部分對(duì)保險(xiǎn)欺詐的內(nèi)容進(jìn)行概述,共分為兩節(jié),第一節(jié)對(duì)保險(xiǎn)欺詐的概念進(jìn)行了界定,將保險(xiǎn)欺詐與保險(xiǎn)詐騙分別進(jìn)行解釋,說明保險(xiǎn)欺詐與保險(xiǎn)詐騙定義的不同及所適用法律的不同,以及東西方學(xué)者從不同角度對(duì)保險(xiǎn)欺詐進(jìn)行的定義；第二節(jié)從信息不對(duì)稱的角度出發(fā),利用博弈論分析了保險(xiǎn)欺詐的成因,并得到影響保險(xiǎn)欺詐概率的三個(gè)因素,即檢查概率,對(duì)保險(xiǎn)欺詐的懲罰和保險(xiǎn)人投入的檢查成本。第二部分對(duì)我國(guó)保險(xiǎn)欺詐的現(xiàn)狀進(jìn)行了描述,并利用近十年來保費(fèi)收入和保險(xiǎn)賠款的數(shù)據(jù)對(duì)保險(xiǎn)欺詐的數(shù)額進(jìn)行了估測(cè),分析出保險(xiǎn)欺詐一直在增加的趨勢(shì),將財(cái)產(chǎn)險(xiǎn)和人身險(xiǎn)各個(gè)險(xiǎn)種的賠付數(shù)據(jù)分別列出并進(jìn)行比較,提出對(duì)于那些賠付發(fā)生額低但是賠付發(fā)生率高的險(xiǎn)種(如農(nóng)業(yè)險(xiǎn))要預(yù)防其保險(xiǎn)欺詐的發(fā)生。第三部分主要對(duì)我國(guó)保險(xiǎn)反欺詐機(jī)制進(jìn)行敘述,找到了四個(gè)參考系：保險(xiǎn)反欺詐的相關(guān)立法、保險(xiǎn)反欺詐機(jī)構(gòu)、保險(xiǎn)反欺詐技術(shù)應(yīng)用及反欺詐信息平臺(tái)建設(shè)、保險(xiǎn)反欺詐知識(shí)的宣傳和專業(yè)人才的培養(yǎng),從這四個(gè)方面出發(fā),對(duì)我國(guó)的保險(xiǎn)反欺詐的相關(guān)立法,信息平臺(tái)建設(shè)等相關(guān)內(nèi)容進(jìn)行了詳細(xì)的介紹。第四部分主要是對(duì)美國(guó)的保險(xiǎn)反欺詐機(jī)制進(jìn)行詳細(xì)的描述,首先敘述了美國(guó)保險(xiǎn)欺詐的現(xiàn)狀,然后通過對(duì)美國(guó)關(guān)于保險(xiǎn)反欺詐的立法,保險(xiǎn)反欺詐機(jī)構(gòu),保險(xiǎn)反欺詐技術(shù)及反欺詐信息平臺(tái)建設(shè),保險(xiǎn)反欺詐知識(shí)的宣傳和專業(yè)人才的培養(yǎng)四個(gè)方面進(jìn)行介紹,如對(duì)《保險(xiǎn)反欺詐法》等法律的介紹,對(duì)保險(xiǎn)反欺詐局,保險(xiǎn)反欺詐聯(lián)盟等保險(xiǎn)反欺詐機(jī)構(gòu)的介紹,對(duì)美國(guó)學(xué)者使用的保險(xiǎn)欺詐識(shí)別模型,RIDIT模型,快速分類模型等的介紹。從而對(duì)美國(guó)的保險(xiǎn)反欺詐機(jī)制有了一個(gè)全面而詳細(xì)的了解。并利用設(shè)定的參考系對(duì)中美的保險(xiǎn)反欺詐機(jī)制進(jìn)行了對(duì)比,發(fā)現(xiàn)我國(guó)在保險(xiǎn)反欺詐專門立法,保險(xiǎn)反欺詐機(jī)構(gòu)設(shè)置,保險(xiǎn)反欺詐技術(shù)使用及數(shù)據(jù)庫(kù)建設(shè)以及保險(xiǎn)反欺詐宣傳上存在的不足,如我國(guó)沒有關(guān)于保險(xiǎn)反欺詐的專門立法,沒有反欺詐的專門機(jī)構(gòu),尚未建立起統(tǒng)一的保險(xiǎn)欺詐數(shù)據(jù)庫(kù)等不足,為以后進(jìn)行保險(xiǎn)反欺詐工作提供了方向。第五部分主要是對(duì)我國(guó)保險(xiǎn)反欺詐機(jī)制提出建議,通過同美國(guó)保險(xiǎn)反欺詐機(jī)制的對(duì)比,對(duì)國(guó)家立法部門,保險(xiǎn)監(jiān)管部門以及保險(xiǎn)人都提出了建議,如加快關(guān)于保險(xiǎn)反欺詐的專門立法,建立全國(guó)統(tǒng)一的保險(xiǎn)反欺詐數(shù)據(jù)庫(kù),加強(qiáng)保險(xiǎn)反欺詐知識(shí)的宣傳,加快保險(xiǎn)反欺詐人才的培養(yǎng),推廣獨(dú)立調(diào)查人制度,學(xué)習(xí)西方學(xué)者的保險(xiǎn)欺詐識(shí)別技術(shù),建立保險(xiǎn)公司自己的欺詐識(shí)別模型等�？傊疚耐ㄟ^對(duì)中美保險(xiǎn)反欺詐機(jī)制的對(duì)比,力圖尋找我國(guó)保險(xiǎn)反欺詐機(jī)制中的不足,借鑒美國(guó)先進(jìn)的保險(xiǎn)反欺詐經(jīng)驗(yàn),特別是保險(xiǎn)欺詐識(shí)別模型,從而使我們?cè)谡J(rèn)識(shí)到自己不足的基礎(chǔ)之上,建立起完善的保險(xiǎn)反欺詐機(jī)制。

    Since the insurance generated, insurance fraud has always been its constant companion, with people’s insurance awareness improve in recent years, the insurance industry has undergone tremendous development, but insurance fraud is also increasing, and invisibility increasing, the way of insurance fraud become more and more, insurance fraud has become one of the main obstacles to hinder the healthy development of the insurance industry, Even the insurers have to consider the costs due to fraud when calculate the premium, hence, Insurance fraud has been hailed as the silent catastrophe of insurance industry.With the development of china’s economic in recent years, the insurance industry has been also developed rapidly, Since restore the insurance industry in the1980s, The number of insurance companies and premium income keep growing, Premium income in2011has reached1.4trillion Yuan, has become an important part of the national economy that cannot be ignored, but insurance fraud keep growing accompany with the development of insurance, According to China’s insurance regulatory authorities estimate about20percent of China’s insurance claims caused by the fraud, can cause hundreds of billions loss. However, China is still not realized the seriousness of the hazard of insurance fraud, has not established the anti-fraud system yet, and has just beginning the study of insurance anti-fraud; there are many deficiencies in many places. Insurance fraud is a worldwide problem not just unique to our country, The United States as one of the most developed insurance industry countries; there is also a serious insurance fraud, The United States insurance industry has developed many years, so does its study of insurance anti-fraud, Therefore, in order to detect the problems in the insurance anti-fraud, This article specifically compare the insurance anti-fraud mechanism of China and the U.S. with each other, Then found the shortcomings of China’s insurance anti-fraud process, and make recommendations.This paper based on comparative analysis, defined the concept of insurance fraud first, then analyze the causes of insurance fraud with game theory from the perspective of information asymmetry, found three factors that have impact on the probability of insurance fraud:check probability, punishment, cost, then analyze the current situation of China’s insurance fraud from the view of these three factors, make an overview of the insurance anti-fraud mechanism of china and the U.S. and compare with each other, found deficiencies in China’s insurance anti-fraud mechanism, make recommendations in the end.Based on the above ideas, the structure of this paper is divided into five parts:The first part, make an overview of the contents of the insurance fraud, can be divided into two sections, the first section defines the concept of insurance fraud, the second section analyzes the causes of insurance fraud with game theory from the perspective of information asymmetry, and found three factors that have impact on the probability of insurance fraud:check probability, punishment, cost.The second part describes the status of China’s insurance fraud, and estimate the amount of insurance fraud use premiums and insurance claims data of the past decade, found the trend of insurance fraud has been increasing in recently years,The third part describes China’s insurance anti-fraud mechanism. Found four reference systems:the relevant legislation of the insurance anti-fraud, insurance anti-fraud agency, Insurance anti-fraud technology and anti-fraud information platform, publicize the insurance anti-fraud knowledge and training of professionals, introduce China’s insurance anti-fraud legislation, information platform construction and other related content from these four parts.The fourth part mainly describe the insurance anti-fraud mechanism, First described the status of insurance fraud in America, then introduce the relevant legislation of the insurance anti-fraud, insurance anti-fraud agency, Insurance anti-fraud technology and anti-fraud information platform, publicize the insurance anti-fraud knowledge and training of professionals of America. Then compare the insurance anti-fraud mechanism of China and America with reference systems, find the defects of China, Such as in China there is no specific legislation on insurance fraud prevention and specific agencies for anti-fraud, provide the direction for the future conduct of the insurance anti-fraud work.The fifth part mainly makes recommendations on China’s insurance anti-fraud mechanism, compare with insurance anti-fraud mechanism of America, make recommendations to national legislation departments, insurance regulators and insurers. Such as accelerate the special legislation on the insurance anti-fraud, establish a unified national insurance anti-fraud database, study insurance fraud recognition technology of Western scholars, promote independent investigation system etc.In short, this paper intend to find the defects of China’s insurance anti-fraud mechanism through the comparison of China and America, introduce the advanced experience of America, especially the insurance fraud recognition model, So that we recognize the insufficient, then establish a sound insurance anti-fraud mechanism.

中美保險(xiǎn)反欺詐機(jī)制比較及對(duì)策

摘要4-7Abstract7-90.導(dǎo)論12-21    0.1 選題目的與意義12-13    0.2 國(guó)內(nèi)外研究綜述13-18    0.3 研究思路和研究方法18-19    0.4 結(jié)構(gòu)安排及可能創(chuàng)新之處與不足19-211.保險(xiǎn)欺詐的基本內(nèi)容21-28    1.1 保險(xiǎn)欺詐概念的界定21-22    1.2 保險(xiǎn)欺詐成因的博弈分析22-28        1.2.1 相關(guān)假設(shè)和參數(shù)選擇23        1.2.2 博弈模型的建立與分析23-282.我國(guó)保險(xiǎn)欺詐的現(xiàn)狀28-323.我國(guó)的保險(xiǎn)反欺詐機(jī)制32-36    3.1 我國(guó)關(guān)于保險(xiǎn)欺詐的相關(guān)法律32-33    3.2 我國(guó)保險(xiǎn)反欺詐相關(guān)組織機(jī)構(gòu)33    3.3 我國(guó)對(duì)保險(xiǎn)欺詐危害性的宣傳和專業(yè)人才培養(yǎng)33-34    3.4 我國(guó)保險(xiǎn)反欺詐技術(shù)應(yīng)用及信息平臺(tái)建設(shè)34-364.美國(guó)的保險(xiǎn)反欺詐機(jī)制及啟示36-53    4.1 完善的立法36-39    4.2 建立專門的保險(xiǎn)反欺詐機(jī)構(gòu)39-41        4.2.1 建立保險(xiǎn)反欺詐局39-40        4.2.2 擁有眾多的反欺詐組織40-41    4.3 重視保險(xiǎn)反欺詐宣傳和專業(yè)人才培養(yǎng)41-43    4.4 注重應(yīng)用先進(jìn)的反欺詐技術(shù)和方法43-50        4.4.1 快速分類模型43-44        4.4.2 AAG模型44-46        4.4.3 參照單位分析法46-49        4.4.4 專家系統(tǒng)法49        4.4.5 神經(jīng)元網(wǎng)絡(luò)法49-50    4.5 中美保險(xiǎn)反欺詐機(jī)制比較及對(duì)我國(guó)的啟示50-535.我國(guó)保險(xiǎn)反欺詐的對(duì)策53-59    5.1 加快保險(xiǎn)反欺詐的專門立法,加大懲罰力度53-54    5.2 成立專門的保險(xiǎn)反欺詐機(jī)構(gòu)54    5.3 建立全國(guó)統(tǒng)一的反欺詐信息平臺(tái)54-55    5.4 加強(qiáng)保險(xiǎn)欺詐知識(shí)的宣傳55-56    5.5 推廣獨(dú)立調(diào)查人制度56-57    5.6 加強(qiáng)內(nèi)部管理,提高員工素養(yǎng)57-58    5.7 建立適合我國(guó)情況的反欺詐分析模型58-59參考文獻(xiàn)59-62后記62-63致謝63-64在讀期間科研成果目錄64

  本文關(guān)鍵詞：中美保險(xiǎn)反欺詐機(jī)制比較及對(duì)策，，由筆耕文化傳播整理發(fā)布。