This thesis investigates whether variations in wait times for different medical specialties have a significant impact on the proportion of people who choose to opt out of the public insurance system in their country. Canada presents an interesting case study because it is one of the few nations with a single-payer system for all procedures covered by the public health system. As a result, leaving Canada is the equivalent of opting into the private system in other countries where socialized medicine is available side by side to a private market provider. The results provide some evidence of a positive relationship, but are somewhat sensitive to the chosen sample period.

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.

University of Macau / Institute of Chinese Medical Sciences

A modern democratic nation is responsible to taking care its people¡¦s basic needs. This is not only the essential reason for the existence of a nation, but also its responsibility and obligation. The right to life is an important issue in international treaties and constitutions of variable nations. People are entitled to claim care from their countries to maintain a reasonable living standard. Countries are obliged to safeguard its people¡¦s right to life through legislation, to provide basic living needs which meet human nature dignity. A nation has many obligations include the maintaining of individual health, ensuring sound environment, social relief and social insurance. Financial operation is a key issue in managing a nation. Therefore, in fulfilling the obligations, a nation must consider its financial affordability seriously so as not to deteriorate its finance for overly taking care of its people. Due to rapid aging of population and low fertility, Japan implemented Long Term Care Insurance in 2000; however, many a relative legal issue was encountered while conducting such system. For instance, for the purposes of convenience and efficiency in collecting premiums, a special levy is applied to 90% of No. 1 insurees whose age were over 65, the premiums were pre-deducted from their perpetual pensions, which may cause the qualms about trenching on the capability of people to maintain a lowest living standards and the abuse of the power of administrative decision. Eyed on financial consideration, Japanese government carried out the Law for Long Term Care Insurance, refuses its service to those whose premiums were over due, and suppresses the accessibility for the poor. The group that was supposed to be taken care of by the government is totally neglected while the middle class taking advantages from the system and waste more public fund. This is completely opposite to the objectives of the long term care system legislation. This also caused the disputes that the right to life regulated in the article 25 of Japanese Constitution is violated by administrative power. Our nation is confronted with population aging and low fertility as well lately. The total fertility rate has declined to 0.895, which is the lowest in the world. In the aging society, the long term care need of the elders and the disabled, and related heavy financial burdens are already far beyond the capacities of individuals or families and become a ¡§Social Risk.¡¨ Such a risk will need a coercive risk managing technique enforced by the nation, to organize a social insurance structure so as to share the risk and reduce individuals¡¦ burdens. Our government is engaging in planning a long term care system. The flaws of Japan¡¦s Law for Long Term Care Insurance, both in legislation and enforcement, can be valuable lessons for us. This essay discussed the legalization of the long term care system of our nation, reviewed its jurisprudence and raised integrated long term care concept. Some suggestions concerned with operation subject, insurance objects and financial plans were provided in hope with a comprehensive guideline on policy making, legislation and enforcement and system construction can be established.

To set ¡§Electronic Government¡¨ into action becomes common practice all over the world. The aims of ¡§Electronic Government¡¨ are to link all government agencies, citizens and information through networking and to establish real time and interaction system services. It improves government operational procedures, promotes service efficiency and quality. There are ¡§Government to Government¡¨, ¡§Government to Business¡¨ & ¡§Government to Citizens¡¨ according to the applications of electronic business. To implement the Government to Government program, The government has deployed a¡§Electronic Gateway Information System¡¨and an E-government Common Platform Guideline to integrate interdepartmental information and simplify related operating processes. There are many important influences to lessen the need for redundant copies of official documents and to improve the efficiency of administrative procedures. The study takes Bureau of National Health Insurance Kao-ping Branch, which practice National Health Insurance in Taiwan as an example to research interdepartmental information sharing and services. That includes its performance, benefits, influential factors, and difficulties of implementation to try to seek the key problems and propose some suggestions for implementation of ¡§Electronic Gateway Information System¡¨. For examples establishing the interdepartmental integrated association, improving the system quality, protection personal detail security, etc.

On coping with the¡§hospital-based self-management＂ project implemented by the National Health Insurance in Taiwan-----A case study of an Armed Forces Hospital The global budget payment system has been implemented in Taiwan＇s National Health Insurance (NHI) for dental care, Chinese medicine and basic western medicine since 1998, and for Western medicine hospital since 2002. The purpose of this payment system is to control the toal medical expenditure by a fixed annual budget. However, it used in Westewrn medical hospital is so complicated that the fulfillment of this new system will create a new competetion era for the hospitals if without associated set of measures, its complexity is far beyond our detection. The Bureau of NHI therefore carry out variable kinds of mamagement protocols such as ¡§global budgeting system by different area＂,¡§hospital-based self-management＂, and ¡§hospital in pursuit of excellence＂, so that each branch of NHI Bureau will own a fixed amount of budget and negotiate the separate amount with the hospitals. The military hospitals are facing a critical environment; the public budget and personnels of the hospital sponsored by the National Defense Department is decreasing; and the NHI has implemented the global budgeting system which will condense the growth rate of each hospital. The thesis is focusing on the study hospital＇s model of strategic management, establishing a criteria-monitoring system in the hospital in order to analyze the details of the operating performance , when negotiating the growth rate with the Burear of NHI, which is the most important part of the plan for hospital in persuit of excellence, will find out the abnormalities and the solutions for that iii problem. The result of this study showing the management information system in a hospital will provide immediate data, analyze it and help the superintendent make decisions. It is quite critical in such a competitive environment, the information system was proved to be effective and the hospital can achieve the vision of sustainable operationOn coping with the¡§hospital-based self-management＂ project implemented by the National Health Insurance in Taiwan-----A case study of an Armed Forces Hospital The global budget payment system has been implemented in Taiwan＇s National Health Insurance (NHI) for dental care, Chinese medicine and basic western medicine since 1998, and for Western medicine hospital since 2002. The purpose of this payment system is to control the toal medical expenditure by a fixed annual budget. However, it used in Westewrn medical hospital is so complicated that the fulfillment of this new system will create a new competetion era for the hospitals if without associated set of measures, its complexity is far beyond our detection. The Bureau of NHI therefore carry out variable kinds of mamagement protocols such as ¡§global budgeting system by different area＂,¡§hospital-based self-management＂, and ¡§hospital in pursuit of excellence＂, so that each branch of NHI Bureau will own a fixed amount of budget and negotiate the separate amount with the hospitals. The military hospitals are facing a critical environment; the public budget and personnels of the hospital sponsored by the National Defense Department is decreasing; and the NHI has implemented the global budgeting system which will condense the growth rate of each hospital. The thesis is focusing on the study hospital＇s model of strategic management, establishing a criteria-monitoring system in the hospital in order to analyze the details of the operating performance , when negotiating the growth rate with the Burear of NHI, which is the most important part of the plan for hospital in persuit of excellence, will find out the abnormalities and the solutions for that iii problem. The result of this study showing the management information system in a hospital will provide immediate data, analyze it and help the superintendent make decisions. It is quite critical in such a competitive environment, the information system was proved to be effective and the hospital can achieve the vision of sustainable operation

From the implementation of National Health Insurance on March 1, 1995 in Taiwan, the public has obtained it¡¦s benefit, and it¡¦s really a blessing for Taiwanese. Following the implementation of National Health Insurance Policy, the public began having demands for National Pension due to the aging of society from 1993. As a result the authorities including the Ministry of the Interior which is in charge of National Pension, the Council of Agriculture which plans Farmer Pension, and the Council of Labor Affairs which proposes reforming Labor Pension Payment all show their attitude to take charge then positively frame each kind of pension systems. In fact, the coming of National Pension which is a blessing for the public could be the shackles to future generations. Blessing or shackles, it all depends on whether the formation of National Pension is for the public¡¦s benefit or only for the political intention. Is it for the people¡¦s lifetime protection and peaceful old age or only to make good the commitment made during the campaign? Is it a long-term, integral and foresighted consideration about people¡¦s demand or merely a short-term, sectional and realistic payback? With the basis of economic development to measure the long-term burdens and take improving financial affairs as an important condition, or, there is only one-year budget thus the local government have to raise funds and rely on central government subsidies? National Pension and National Health Insurance are both the nation¡¦s social security business, in order to benefit the public and not to recommit the same error of the current insurance systems, the authorities and other related groups should find out people¡¦s true demands and consider whether the people could afford the insurance premium but also take advantage of other countries¡¦ experience as consultation. This article is to probe into the achievement of National Pension implementation in Japan¡Xan orient country which has similar cultural background and family social formations with Taiwan.¡Xand to understand the background, current status, and the achievement of the implementation then take their strong points as an example to us. The Taiwan government planned to carry out National Pension in 2000, which is a significant social welfare policy after the implementation of National Health Insurance; unfortunately it doesn¡¦t come into effect even to this day due to the political rivalries and the substitution of political party. National Pension is a kind of compulsory savings scheme; it¡¦s a kind of insurance program and also a project of wealth redistribution. Furthermore, National Pension can be taken as the rearrangement of economic resources to regulate individual¡¦s wealth and income in the society, the arrangement of pension system would influence the management of whole economic system. The performance of pension has its dual purpose, the positive is to undertake the horizontal integration to have a healthy aged pension system; the passive is to grasp the opportunity to keep political power and electoral factors from causing the allowance or welfare systems become disordered. Lastly, to compare the main difference of pension implementation and the feasibility analysis after performance between Taiwan and Japan. Whether the pension can be put into practice or not depends on if we can achieve the most effective resources allocation of social resources, then we can see the economic benefits of pension system.

From 2002, Bureau of National Health Insurance attempted to solve the problem that the average time that a doctor uses to diagnose a sickness is to short by Global Budget System. However, in 2007, Micheal Porter argued that the average time that a doctor uses to diagnose a sickness is only three minutes. Therefore, Bureau of National Health Insurance is failed to solve this problem. In this research, we find that the time that a doctor uses to diagnose a sickness is not decided by doctors but sickness. However, the target that Bureau of National Health Insurance wants to influence is doctors. Besides, although Bureau of National Health Insurance wants to influence doctors, the people who are real influenced are operators. As the result, the average time that a doctor uses to diagnose a sickness is still short and Global Budget System lets operators not only fire inferior doctors hardly but also less invite better doctors to help. Thus, it causes sickness rights and interests damage. Besides, we try to find the high leverage solution to solve this problem. We consider three ways, including limiting doctors` patient, increasing price and helping doctors to improve their skill. After studying, we find that only helping doctors to improve their skill would not cause any side effect.

Thesis (doctoral)--Uppsala universitet, 2002. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Product risk is important to firms’ enterprise risk management. This dissertation focuses on product risk in the U.S. life insurance and health insurance industries. In particular, we add new dimensions to the measurement of product risk for these industries, and we explore how these industries manage product risk in a context of other enterprise risks. In this dissertation, we identify new product risks, propose new measures, and study the management of these risks. In the life insurance industry, we identify a new type of product risk, the guarantee risk, caused by variable annuities with guaranteed living benefits (VAGLB). We propose a value-at-risk type measure inspired by the risk-based capital C3 Phase II to quantify the guarantee risk. In the health insurance industry, where the degree of uncertainty varies for different types of health insurance policies, we develop four exposure-based risk measures to capture health insurers’ product risks. Then we study how life and health insurers manage product risks (and asset risks) by using capital in the context of other risks and appropriate controls. We add to the literature in the life insurance industry by examining the relationship between capital and risks when the guarantee risk is accounted for. In the health insurance industry, to our knowledge, no similar research on the relationship between capital and risks has been conducted. In view of the current topicality of health insurance, our research therefore adds a timely contribution to the understanding of health insurer risk management in an era of health care reform. Capital structure theories, transaction cost economics, and insurers’ risk-taking behaviors provide the theoretical foundation for our research. As to methodology, we implement standard capital structure models for the life and health insurance industries using data from the National Association of Insurance Commissioners (NAIC) annual filings of life/health insurers and health insurers. Simultaneous equations modeling is used to model life and health insurers’ enterprise risk management. And the estimation is conducted by the generalized estimation equations (GEE). We find that both U.S. life/health insurers and health insurers prudently build up capital as they experience more product risk and asset risk controlling for the other enterprise risks. We also find that life/health insurers may be using derivatives as a partial substitute for capital when managing new product risk caused by VAGLB, the guarantee risk. / text