Journal of Shandong University (Health Sciences) ›› 2019, Vol. 57 ›› Issue (8): 20-38.doi: 10.6040/j.issn.1671-7554.0.2018.1016

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Theory and methodology on health insurance actuarial science research

XIE Yuantao, LI Zhengxiao   

  1. School of Insurance, University of International Business and Economics, Beijing 100029, China
  • Published:2022-09-27

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Abstract: 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 山 东 大 学 学 报 (医 学 版)57卷8期 -谢远涛,等.健康保险精算理论与方法体系 \=-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.

Key words: Health insurance, Actuarial science, Rate-making, Credibility premium, Reserve evaluation, Run-off triangle, Premium fund allocation

CLC Number: 

  • O212/F222.3
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