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商业健康险从无到有,到如今的步履艰难,主要原因是重保、重赔、轻防,未注重健康风险的管理。本文运用NCD(无赔款折扣优待)模型实现健康险的浮动费率,降低健康体的费率,提高非健康体的费率,实现了各健康级别群体的健康风险与保费的相对合理。并通过健康教育和预防保健等措施减少风险因素、降低疾病发病率、阻止疾病的恶化,减少了理赔的次数和额度,把客户群有效地引导并维持在低风险的健康状态。这不仅能够最大程度地减轻社会医疗资源的紧张,而且降低健康保险公司的平均综合成本率,也有助于提升专业公司的整体形象和经营效益。
Commercial health insurance from scratch, to today’s difficult footing, mainly due to reinsurance, heavy pay, light defense, did not pay attention to the management of health risks. In this paper, the floating rate of health insurance, the rate of health promotion, the rate of non-health promotion and the healthy risk and premium of each health level are achieved by using the NCD model. And through health education and preventive measures to reduce risk factors such as reducing the incidence of disease, stop the deterioration of the disease, reducing the number of claims and the amount of the customer base effectively guide and maintain a low-risk health status. This not only minimizes the strain on social health care resources, but also reduces the average consolidated cost of health insurance companies, which in turn helps enhance the overall image and operating efficiency of specialized companies.