清华大学经管学院中国保险与风险管理研究中心

双周学术讨论会

报告主题： 小额健康险的可持续发展与逆向选择问题研究——以巴基斯坦为例

报 告 人： 姚奕，风险管理与保险学博士，北京大学助理教授。现任北京大学中国保险与社会保障研究中心（CCISSR）研究员。2005年和2007年相继获得北京大学经济学院经济学学士、硕士学位，并于2012年获得美国威斯康星大学商学院精算、风险管理与保险学系授予的博士学位。主要研究领域包括：健康保险、小额保险和可持续发展问题、风险管理等。

报告时间：2013年12月11日星期三 14：30-16：00

报告地点：清华大学经济管理学院伟伦楼453会议室

报告语言：中文

主办单位：清华经管学院中国保险与风险管理研究中心；清华经管学院金融系

摘    要：

近年来，人们越来越关注如何让保险能够普惠低收入人群。但是，由于这类新兴的小额保险项目通常由政府或者非盈利组织资助，而普遍赔付率较高，因此其可持续性也引发广泛疑虑。本文针对一项处于发展初期的小额健康保险计划，分析探讨其财务可持续性，旨在为新兴小额保险市场的产品提供启示。同时，本文也对小额健康保险项目中的逆向选择问题进行了实证检验。

为了研究项目的财务可持续性，我们使用巴基斯坦一个小额健康保险项目的数据并分析索赔率随家庭续保年限的变化趋势。研究发现，在首个保单年度发生过多次、大额索赔的家庭更倾向于续保。尽管这种趋势可以由逆向选择来解释，但经过进一步分析后发现，与新保户相比，续保保户的索赔次数和索赔总额都显著地低于新保户。

另外，为了检验是否存在逆向选择，我们针对该小额保险项目的索赔数据进行了进一步分类。与只发生过急性疾病索赔的家庭相比，那些发生过慢性疾病索

赔的家庭更倾向于续保。而在与生育相关的医疗索赔中，逆向选择的现象非常普

遍。综上所述，尽管这一小额健康保险项目中存在着逆向选择问题，并且前期发生过索赔的家庭更有可能续保，然而那些续保家庭在续保年限中，其索赔次数和索赔总额都有了很大改善。有两类原因可以解释这一现象：第一，由于该项目是当地人首次可以享有健康保险服务，因而许多新投保的保户可能普遍存在既存疾病，因而导致首年投保的索赔率高。而这些人在续保年限中的健康状况可以得到改善，因而在此后年份的索赔次数和额度都发生了显著下降。第二，逆向选择，尤其是生育医疗服务方面的逆向选择也可能加重这一趋势。例如，怀孕的妇女选择投保，而很少续保。这些原因共同解释了续保家庭的赔付率会在投保首年后显著降低。

清华大学经济管理学院中国保险与风险管理研究中心双周学术讨论会简介：

清华大学经济管理学院中国保险与风险管理研究中心从2011年3月4日开始，在每个学期隔周举办“双周学术讨论会”。每次讨论会主要围绕风险管理与保险领域的理论与实践问题，进行学术交流和研讨。欢迎在京高校老师和研究生届时参加！也欢迎大家参与报告和现场讨论！

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联系人：

阎学煌

清华大学经济管理学院中国保险与风险管理研究中心

清华大学经济管理学院伟伦楼376室, 100084

电话：010-62773414；传真：010-62796801；电邮：yanxh2@sem.tsinghua.edu.cn

CHINA CENTER FOR INSURANCE AND RISK MANAGEMENT (CCIRM), TSINGHUA SEM

DUAL-WEEK SEMINAR

TOPIC: Sustainability and Adverse Selection in Emerging Health Insurance Markets: Evidence from Microinsurance in Pakistan

SPEAKER: Dr. YAO Yi is an assistant professor of Risk Management and Insurance at Peking University's School of Economics. She is also a Research Fellow of the China Center for Insurance and Social Security Research (CCISSR). She received her Ph.D. in the field of Risk Management and Insurance from University of Wisconsin-Madison in 2012. She earned her M.A. and B.S. in Economics from Peking University. Her research interests include Microinsurance, health insurance, sustainability, information asymmetry.

DATE/TIME: Wednesday, December 11, 2013, 2:30pm-4:00pm

VENUE: Meeting Room 453, WeiLun Building, Tsinghua SEM

LANGUAGE: Chinese

ORGANIZERS:

China Center for Insurance and Risk Management (CCIRM), Tsinghua SEM;

Department of Finance, Tsinghua SEM

ABSTRACT:

Despite widespread interest in expanding insurance at the bottom of the economic pyramid, the viability of emerging microinsurance programs has been questioned because of high loss ratios and dubious sustainability.  The purpose of this research is to derive implications for the provision of viable products for emerging microinsurers by investigating the degree of sustainability of a micro health insurance program in its early years of development and determining whether adverse selection exists within such programs. 

To investigate sustainability, I used data from a micro health insurance program in Pakistan to analyze how claim rates evolve as households renew their policies. I found that households with larger claims during the initial policy year are more likely to renew their policies. Although that pattern appears consistent with decreasing

sustainability, I found in delving deeper that when compared with households buying insurance for the first time, renewed households have significantly lower frequency of claims and also lower total claim amounts.

In addition, to determine if adverse selection existed, I further categorized the claim data from the same microinsurance program.  Compared to households that filed only claims for acute diseases, those that filed claims for chronic diseases are more likely to renew their policy.  A prevalence of adverse selection is observed within maternity-related claims.

The combination of these results shows that despite the existence of adverse selection and the fact that households with claims are more likely to renew their policies, renewed households have a much improved claim frequency and total claim amount after their first year of coverage.  This could be explained by the prevalence of pre-existing conditions among newly enrolled households that are encountering affordable healthcare for the first time.  In addition, some selection issues, such as pregnant women selecting to enroll in the program also contribute to the high first-year claim frequency among newly enrolled households.  These factors taken together explain why the loss ratio for the renewed households actually decreases dramatically after the first year of coverage.   

A Brief Introduction to the Dual-week Seminar of CCIRM, Tsinghua SEM:

China Center for Insurance and Risk Management (CCIRM), a research center of the School of Economics and Management, Tsinghua University (Tsinghua SEM), has held dual-week seminars during each semester since March 4, 2011. Covering theoretical and practical issues related to risk management and insurance, these seminars facilitate academic exchanges among faculty members and research students, both internally as well as externally.

Detailed information is available at the website: http://www/ccirm.org/academic

Contact Us:  

Yan Xuehuang

Room 376 Weilun Building,

School of Economics and Management, Tsinghua University,

Beijing, P.R.C., 100084

Tel: (8601)62773414; Fax :( 8601)62796801;Email:yanxh2@sem.tsinghua.edu.cn