摘要
目的 :提出不同参保对象条件下 ,糖尿病保险费精算模型的确定方法。方法 :采用疾病经济负担模型、效用理论模型和限制性Pareto分布模型分别对居民、糖尿病患者和糖尿病住院病人全面参保条件下的糖尿病医疗保险费进行厘定。结果 :女性居民平均静态保费 38.6元 ,平均动态保费 5 6 .3元 ;男性居民平均静态保费5 3.7元 ,平均动态保费 78.3元 ;糖尿病患者纯保费 1174元 ,附加保费 2 0 4元 ,总保费 1378元 ;糖尿病住院病人纯保费 10 5 2 7元 ,附加保费 2 10 5元 ,总保费 12 6 32元。结论 :在一次性交付保险费后 ,投保者在医疗保险累计年度的最高报销限额分别为女性居民 12 199.9元 ,男性居民 16 96 6 .0元 ,糖尿病患者 2 916 5元 ,糖尿病住院病人 5 0 0 0 0元。保险费厘定的风险概率需要结合参保对象参保频率、糖尿病患病率、糖尿病医疗费用变化情况等因素构建风险预测模型进行推算。
Objective:To study on an actuarial model of premium for diabetics. Methods:The premium was calculated using model of economic burden of disease,utility theoretical model and limited Pareto distribution model,premising that all the local residents,diabetics and inpatients with diabetes were insured. Results:The mean fixed premium and dynamic premium was $38.6 and $56.3 RMB respectively for a female resident; $53.7 and $78.3 RMB for a male resident. The pure,additional and gross premiums were $1174,$204 and $1378 RMB for a diabetic,respetively; $10 527,$2 105 and $12 632 for an inpatient with diabetes. Conclusion:after a lump-sum payment of insurance, the maximal compensation for an insured based on cumulative years was $12 199.9 RMB in female residents, $16 966.0 RMB in male residents,$29 165 RMB in diabetics and $50 000 in inpatients with diabetes. The risk possibility in premium calculation should be estimated based on the insurance frequency,prevalence of diabetes and the changing cost for treatment of diabetes.
出处
《广州医学院学报》
2004年第3期7-10,共4页
Academic Journal of Guangzhou Medical College
基金
广东省医学科学研究基金项目 (No.A2 0 0 2 2 5 5 )
