부분적 청구경력 고지 간소화에 따른 건강보험 요율 차등화에 관한 연구

초록

The simplification of the obligation to disclose the claim history of private health insurance in Korea has been developed for the purpose of expanding the market for individuals whose coverage denied by health insurance underwriting due to a mild chronic illness or treatment history. Following policy change, the launch of simplified issue insurance has been limited to fixed benefit products and supplementary private health insurances for those with pre-existing conditions in the private sector. The simplified disclosure obligation is a major factor in determining rates aside from gender and age; however, it does not reflect subtle differences in rate over the period of the disclosed claim history. This study conducted an empirical analysis through logistic regression using the National Health Insurance Sample Cohort Database to investigate change in healthcare utilization according to the degree of simplification for disclosure of claim history in insurance contract. The results suggest that a higher degree of simplification of disclosure increases the probability of healthcare utilization at a statistically significant level, and inpatients are relatively more affected than outpatients. In addition, the annual premium rate for private health insurance and the level of bonus-malus were derived by differentiating the degree of simplification of disclosure of claim history.

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