中美保险反欺诈机制比较及对策

  本文关键词：中美保险反欺诈机制比较及对策，由笔耕文化传播整理发布。

        自保险产生以来,保险欺诈就如影随形,近年来随着人们对保险认识的提高,保险业有了巨大的发展,保险欺诈也日渐增多,且保险欺诈的方式、途径也越来越多,隐蔽性越来越强,已经成为阻碍保险业健康发展的主要障碍之一,甚至使保险人在计算保费时不得不把因欺诈产生的费用考虑在内,因此保险欺诈也被喻为保险界无声的巨灾。自80年代恢复保险业以来,我国的保险公司数量和保费收入不断增长,至2011年保费收入已经达到了1.4万亿元,成为国民经济不可忽视的重要组成部分,而与保险相生相伴的保险欺诈也随着保险业的发展不断增多,根据我国保险监管部门估测,我国保险理赔中约有20%是由欺诈造成的,每年造成的损失可达上百亿元。但是我国目前还没有充分认识到保险欺诈危害的严重性,尚未建立起保险反欺诈体系,对保险反欺诈的研究还处于起步阶段,存在很多不足。而且保险欺诈并不是我国独有的现象,是一个世界性的难题,美国作为保险业最发达的国家,同时也是保险欺诈的“重灾区”,美国在保险反欺诈方面的各项机制比较健全,本文将中国和美国的保险反欺诈机制进行比较,从中发现我国在保险反欺诈过程中存在的不足,针对不足提出建议。本文以比较分析为基础,首先对保险欺诈的概念进行了界定,然后从信息不对称的角度出发,利用博弈论分析保险欺诈的成因,得到影响保险欺诈概率的三个因素：检查概率,对保险欺诈的惩罚和保险人投入的检查成本,接着从这三个因素的角度出发分析我国保险欺诈的现状及原因,然后对我国的保险反欺诈机制和美国的保险反欺诈机制进行概述及对比,从中发现我国保险反欺诈机制中的不足,最后对我国的保险反欺诈工作提出建议。根据以上思路,本文的结构分为以下五个部分：第一部分对保险欺诈的内容进行概述,共分为两节,第一节对保险欺诈的概念进行了界定,将保险欺诈与保险诈骗分别进行解释,说明保险欺诈与保险诈骗定义的不同及所适用法律的不同,以及东西方学者从不同角度对保险欺诈进行的定义；第二节从信息不对称的角度出发,利用博弈论分析了保险欺诈的成因,并得到影响保险欺诈概率的三个因素,即检查概率,对保险欺诈的惩罚和保险人投入的检查成本。第二部分对我国保险欺诈的现状进行了描述,并利用近十年来保费收入和保险赔款的数据对保险欺诈的数额进行了估测,分析出保险欺诈一直在增加的趋势,将财产险和人身险各个险种的赔付数据分别列出并进行比较,提出对于那些赔付发生额低但是赔付发生率高的险种(如农业险)要预防其保险欺诈的发生。第三部分主要对我国保险反欺诈机制进行叙述,找到了四个参考系：保险反欺诈的相关立法、保险反欺诈机构、保险反欺诈技术应用及反欺诈信息平台建设、保险反欺诈知识的宣传和专业人才的培养,从这四个方面出发,对我国的保险反欺诈的相关立法,信息平台建设等相关内容进行了详细的介绍。第四部分主要是对美国的保险反欺诈机制进行详细的描述,首先叙述了美国保险欺诈的现状,然后通过对美国关于保险反欺诈的立法,保险反欺诈机构,保险反欺诈技术及反欺诈信息平台建设,保险反欺诈知识的宣传和专业人才的培养四个方面进行介绍,如对《保险反欺诈法》等法律的介绍,对保险反欺诈局,保险反欺诈联盟等保险反欺诈机构的介绍,对美国学者使用的保险欺诈识别模型,RIDIT模型,快速分类模型等的介绍。从而对美国的保险反欺诈机制有了一个全面而详细的了解。并利用设定的参考系对中美的保险反欺诈机制进行了对比,发现我国在保险反欺诈专门立法,保险反欺诈机构设置,保险反欺诈技术使用及数据库建设以及保险反欺诈宣传上存在的不足,如我国没有关于保险反欺诈的专门立法,没有反欺诈的专门机构,尚未建立起统一的保险欺诈数据库等不足,为以后进行保险反欺诈工作提供了方向。第五部分主要是对我国保险反欺诈机制提出建议,通过同美国保险反欺诈机制的对比,对国家立法部门,保险监管部门以及保险人都提出了建议,如加快关于保险反欺诈的专门立法,建立全国统一的保险反欺诈数据库,加强保险反欺诈知识的宣传,加快保险反欺诈人才的培养,推广独立调查人制度,学习西方学者的保险欺诈识别技术,建立保险公司自己的欺诈识别模型等。总之本文通过对中美保险反欺诈机制的对比,力图寻找我国保险反欺诈机制中的不足,借鉴美国先进的保险反欺诈经验,特别是保险欺诈识别模型,从而使我们在认识到自己不足的基础之上,建立起完善的保险反欺诈机制。

    Since the insurance generated, insurance fraud has always been its constant companion, with people’s insurance awareness improve in recent years, the insurance industry has undergone tremendous development, but insurance fraud is also increasing, and invisibility increasing, the way of insurance fraud become more and more, insurance fraud has become one of the main obstacles to hinder the healthy development of the insurance industry, Even the insurers have to consider the costs due to fraud when calculate the premium, hence, Insurance fraud has been hailed as the silent catastrophe of insurance industry.With the development of china’s economic in recent years, the insurance industry has been also developed rapidly, Since restore the insurance industry in the1980s, The number of insurance companies and premium income keep growing, Premium income in2011has reached1.4trillion Yuan, has become an important part of the national economy that cannot be ignored, but insurance fraud keep growing accompany with the development of insurance, According to China’s insurance regulatory authorities estimate about20percent of China’s insurance claims caused by the fraud, can cause hundreds of billions loss. However, China is still not realized the seriousness of the hazard of insurance fraud, has not established the anti-fraud system yet, and has just beginning the study of insurance anti-fraud; there are many deficiencies in many places. Insurance fraud is a worldwide problem not just unique to our country, The United States as one of the most developed insurance industry countries; there is also a serious insurance fraud, The United States insurance industry has developed many years, so does its study of insurance anti-fraud, Therefore, in order to detect the problems in the insurance anti-fraud, This article specifically compare the insurance anti-fraud mechanism of China and the U.S. with each other, Then found the shortcomings of China’s insurance anti-fraud process, and make recommendations.This paper based on comparative analysis, defined the concept of insurance fraud first, then analyze the causes of insurance fraud with game theory from the perspective of information asymmetry, found three factors that have impact on the probability of insurance fraud:check probability, punishment, cost, then analyze the current situation of China’s insurance fraud from the view of these three factors, make an overview of the insurance anti-fraud mechanism of china and the U.S. and compare with each other, found deficiencies in China’s insurance anti-fraud mechanism, make recommendations in the end.Based on the above ideas, the structure of this paper is divided into five parts:The first part, make an overview of the contents of the insurance fraud, can be divided into two sections, the first section defines the concept of insurance fraud, the second section analyzes the causes of insurance fraud with game theory from the perspective of information asymmetry, and found three factors that have impact on the probability of insurance fraud:check probability, punishment, cost.The second part describes the status of China’s insurance fraud, and estimate the amount of insurance fraud use premiums and insurance claims data of the past decade, found the trend of insurance fraud has been increasing in recently years,The third part describes China’s insurance anti-fraud mechanism. Found four reference systems:the relevant legislation of the insurance anti-fraud, insurance anti-fraud agency, Insurance anti-fraud technology and anti-fraud information platform, publicize the insurance anti-fraud knowledge and training of professionals, introduce China’s insurance anti-fraud legislation, information platform construction and other related content from these four parts.The fourth part mainly describe the insurance anti-fraud mechanism, First described the status of insurance fraud in America, then introduce the relevant legislation of the insurance anti-fraud, insurance anti-fraud agency, Insurance anti-fraud technology and anti-fraud information platform, publicize the insurance anti-fraud knowledge and training of professionals of America. Then compare the insurance anti-fraud mechanism of China and America with reference systems, find the defects of China, Such as in China there is no specific legislation on insurance fraud prevention and specific agencies for anti-fraud, provide the direction for the future conduct of the insurance anti-fraud work.The fifth part mainly makes recommendations on China’s insurance anti-fraud mechanism, compare with insurance anti-fraud mechanism of America, make recommendations to national legislation departments, insurance regulators and insurers. Such as accelerate the special legislation on the insurance anti-fraud, establish a unified national insurance anti-fraud database, study insurance fraud recognition technology of Western scholars, promote independent investigation system etc.In short, this paper intend to find the defects of China’s insurance anti-fraud mechanism through the comparison of China and America, introduce the advanced experience of America, especially the insurance fraud recognition model, So that we recognize the insufficient, then establish a sound insurance anti-fraud mechanism.

中美保险反欺诈机制比较及对策

摘要4-7Abstract7-90.导论12-21    0.1 选题目的与意义12-13    0.2 国内外研究综述13-18    0.3 研究思路和研究方法18-19    0.4 结构安排及可能创新之处与不足19-211.保险欺诈的基本内容21-28    1.1 保险欺诈概念的界定21-22    1.2 保险欺诈成因的博弈分析22-28        1.2.1 相关假设和参数选择23        1.2.2 博弈模型的建立与分析23-282.我国保险欺诈的现状28-323.我国的保险反欺诈机制32-36    3.1 我国关于保险欺诈的相关法律32-33    3.2 我国保险反欺诈相关组织机构33    3.3 我国对保险欺诈危害性的宣传和专业人才培养33-34    3.4 我国保险反欺诈技术应用及信息平台建设34-364.美国的保险反欺诈机制及启示36-53    4.1 完善的立法36-39    4.2 建立专门的保险反欺诈机构39-41        4.2.1 建立保险反欺诈局39-40        4.2.2 拥有众多的反欺诈组织40-41    4.3 重视保险反欺诈宣传和专业人才培养41-43    4.4 注重应用先进的反欺诈技术和方法43-50        4.4.1 快速分类模型43-44        4.4.2 AAG模型44-46        4.4.3 参照单位分析法46-49        4.4.4 专家系统法49        4.4.5 神经元网络法49-50    4.5 中美保险反欺诈机制比较及对我国的启示50-535.我国保险反欺诈的对策53-59    5.1 加快保险反欺诈的专门立法,加大惩罚力度53-54    5.2 成立专门的保险反欺诈机构54    5.3 建立全国统一的反欺诈信息平台54-55    5.4 加强保险欺诈知识的宣传55-56    5.5 推广独立调查人制度56-57    5.6 加强内部管理,提高员工素养57-58    5.7 建立适合我国情况的反欺诈分析模型58-59参考文献59-62后记62-63致谢63-64在读期间科研成果目录64

  本文关键词：中美保险反欺诈机制比较及对策，，由笔耕文化传播整理发布。