Incidence, Dependence Structure of Disease, and Rate Making for Health Insurance

الملخص EN

In order to analyze the two goals under the national strategy of “Healthy China”, this paper attempts to solve the problem of coverage rate and guarantee level of health insurance, as well as the rational allocation of full life cycle health insurance resources.

This paper uses pair copula to model the dependence of different disease incidence and proposes an actuarial model for rate making in health insurance based on the dependence captured by pair copula.

These are far more accurate than any other model and more proper for covering a basket of several different diseases.

The data for the paper was drawn from the experience incidence table of major diseases (malignant tumor, acute myocardial infarction, and stroke sequelae) from the ages 0-65 years in the Chinese life insurance industry.

Extending the hypothesis of independence in actuarial modeling, the authors comprehensively use a hierarchical copula theory to extract the dependence structure of risk variable in insurance.

The classification rate making technology and survival analysis method in traditional actuarial pricing were also considered.

This paper applied the generalized linear model, which is commonly used in nonlife insurance pricing for empirical study of health insurance rate making.

The authors discovered that the incidence of major diseases and the single premium rate calculated by the generalized linear model under HAC dependence structure were both significantly different from that calculated by the Manchester United method without dependency.

The authors also stated that the rate based on the generalized linear model under HAC dependence structure was a bit different from that without dependency but both were generally the same as that of Care Expert in PICC Health.

The underestimation or overestimation of systematic risks and the distortion of the rate system can be eliminated if we combine risk dependence into modeling.