摘要 我國自民國91年4月實施財產保險費率自由化三階段，整個產險業界保費，有逐年下滑的趨勢，但於民國86年經由主管機關，核准由產險公司承做的傷害險，保費卻有逐漸累積的趨勢，在民國98年保費收入已達105億，約為當年度產值10.4%，讓產險業界對產險經營健康險的未來，有相當大的鼓舞，期待成為潛力的險種。 健康險開放產險經營，以一年期以下的健康險經營為主，與壽險長年期健康險不同；壽險業健康險近年來大幅度的成長，就民國98年看，有近29.7%的成長，且有不錯的平均損失率；如何增進核保與理賠技術、選擇行銷健康險的利基點，及透過壽險公司學習經營管理經驗等，成了健康險的新加入者－「產險業界」重要的課題，本論文以此為研究課題，以期可以更瞭解產險業者產值擴增的可能機會。 本論文透過產險及壽險的比較，探討產險業者經營的優點及可能面臨的相關問題，不僅積極業務發展，並了解潛在的風險，做到足夠風險防範的管理；接著再透過個案公司的健康險發展做法，在不同的金融控股公司性質及通路特性，做為其它業者在健康險發展的觀摩和可能的借鏡。最後，經本文研究後，提出個人的建議，希望在產險業者、主管機關的共同努力之下，除了讓產險業界正面的發展，更提供消費者多一個風險轉移的管道。 / Since Taiwan’s Non-life Rate Deregulation Plan has put into practice effectively from April 1, 2002 with three phases, there is a descending tendency in total premiums. In 1997, property insurance industry was approved by competent authority to provide personal accident insurance services. Instead of decreasing, the accumulated premium in Personal Accident Insurance had increased gradually. In 1998, the premium income had reached 10.5 billion, about 10.4% of total premium income in non-life insurance industry. The result quite inspired us to expect well performance in providing health insurance, the potential insurance in the future, by non-life insurance companies. The major insurance period of health insurance provided by non-life insurance companies is one year or less than one year, differing from the health insurance sold in life insurance companies. There is substantial growth of health insurance in life insurance in recent years. In 2009, there was nearly 29.7% increase with good average loss ratio. It was the important issues of non-life insurance companies to improve skills of underwriting and claiming, select niche in health insurance marketing etc, so we select it as the main research topic of this paper. The purpose of this study was to find out the advantages and possible risks in non-life insurance companies when they are running health insurance. Not only to develop business vigorously but also to understand potential risks and manage it well. Then, the paper takes the health insurance development progress of the corporation in the case to offer new perspective to ponder over some potential problems when other non-life insurance companies are developing health insurance. Last but not least, this paper proposed some personal opinions, hoping that non-life insurance companies, competent authority could make joint efforts, in addition to making non-life insurance industry progress positively, this research also providing another risk transfer method to consumers.

本研究主要在探討台灣壽險業健康保險損失率之影響因素。首先，了解健康險損失率是否因為壽險公司規模不同而有顯著差異。再者，將壽險公司依主要專注之通路類型分為三類，包括業務員通路、經代通路以及其他通路，而觀察通路對於健康險損失率的影響情形。最後，藉由個體變數與總體變數之分析，期望以其他不同的角度協助保險公司未來對於損失率的風險控制。 研究結果發現： (一)當壽險公司之資產規模不同時，對於健康險損失率有顯著差異上的影響。大型壽險公司的平均健康險損失率顯著高於小型壽險公司之健康險平均損失率。 (二)壽險公司行銷通路的注重程度不同，確實會使健康保險損失率產生顯著的差異。研究結果發現其他通路運用程度越高的壽險公司，其健康險損失率顯著比使用經代人通路和業務員通路的壽險公司之損失率低。 (三)本研究發現健康險損失率受到總體因素的影響，一般而言比壽險公司個體因素的影響微弱。個體因素確實會顯著影響壽險公司健康險損失率，而且壽險公司不同的規模型態，其主要影響健康險損失率的因素亦會有所不同。 / This study examines the factors that influence the loss ratio of health insurance policies for life insurance companies in Taiwan. First, this thesis intends to investigate whether there are significant differences in loss ratios among insurers due to firm size. Secondly, the impact of marketing channels on health insurance loss ratio is analyzed where the distribution systems mainly used by insurers are divided into three categories: employee sales, agent/broker channel, and others. Finally, this study conducts regression analyses on the health insurance loss ratio with firm-specific and macroeconomic variables to help insurers in controlling risks in the future. The empirical results are shown as follows. 1.The loss ratios of health insurance vary significantly with firm size. The loss ratio of large insurance companies is significantly higher than that of small insurances companies. 2.Distribution system has a significant impact on the loss ratio of health insurance. When the insurer relies more on other channels, instead of employee sales and agent/broker, the insurer will have lower loss ratio. 3.The impact of macroeconomic variables on the loss ratio of health insurance is less than that of firm-specific variables. Additionally, the influential variables for loss ratio may be different between insurers of large and small sizes.