Mourmouris John, Poufinas Thomas
Economics, Democritus University of Thrace, University Campus, Komotini, Greece.
Health Syst (Basingstoke). 2022 Jun 19;12(1):52-84. doi: 10.1080/20476965.2022.2085190. eCollection 2023.
This study attempts to structure methodologically the health insurance underwriting process by applying . This is done by assigning a score to each health insurance applicant which can be used to determine whether he or she is accepted, rejected or accepted with special terms and conditions (such as exclusions, additional waiting periods and/ or surcharge). The introduction of MCDM approaches in health insurance underwriting enables the quantification of the selection criteria, the increased standardization and automation of the process and its alignment through quantitative indicators with the risk tolerance/ risk appetite of the insurer, and there lie the novelties of this research. The proposed methodology can be readily implemented by insurers with added value in the underwriting, risk management and distribution (sales & marketing) functions, as well as in the profitability of the company or the level of premium paid by the insured.
本研究试图通过应用……从方法学角度构建健康保险承保流程。具体做法是为每位健康保险申请人赋予一个分数，该分数可用于确定其是否被接受、拒绝或被有特殊条款和条件（如除外责任、额外等待期和/或附加费）地接受。在健康保险承保中引入多准则决策方法能够使选择标准量化、流程的标准化和自动化程度提高，并通过定量指标使其与保险公司的风险承受能力/风险偏好保持一致，而这正是本研究的新颖之处。所提出的方法可由保险公司在承保、风险管理和分销（销售与营销）职能以及公司盈利能力或被保险人支付的保费水平方面具有附加值的情况下轻松实施。
