台灣癌後保險創新發展策略之探討：以乳癌為例

Abstract

癌後保險已在2018年上路，但是至今並不普遍，現今只有國泰人壽以及台灣人壽的兩張保單，本研究將訪談乳癌患者，並以國泰的癌後保單為分析對象，將價值主張與顧客素描進行價值適配，找出可以滿足保戶需求的部分，以及尚待解決的痛點，並了解在滿足癌友需求的同時，如何讓保戶出險率降低，使得服務提供者 (保險公司)也獲益，達到正向循環。 香港與新加坡已有提供給痊癒癌友的保單，保障其復發時的醫療，台灣可參考其條款及核保條件作為乳癌癌後保單設計，並搭配外溢保單提供保戶保費優惠，以及降低保險公司的出險賠償率。此研究將探討保險公司基於社會責任發展癌後保單的同時，如何發展健康保險生態系，發掘更多的獲利可能性。 本篇以以下三主軸作為主要癌後保單創新發展策略： 一、從大眾走向「分眾」「分群」：將乳癌以動情素(ER)、黃體素(PR)、人類表皮生長因子受體2 (HER-2)表現型分群，不同期別、接受療程、康復年數、積極健康管理意願、健檢數值等作為分群分眾的基礎，篩選出風險較小的癌友族群。 二、從事後理賠走向「事前預防」：搭配外溢保單積極的健康管理概念，使得復發機率最小化成為保單商品設計的終極目標。 三、從保障為主走向「健康保險生態系」：擴展合作產業例如：健身中心、健康食品、醫療院所、醫學美容、藥局、健檢中心等，癌友在增進健康降低復發率的過程中，將可能會需要的服務及產品串聯，更大程度的協助癌友健康管理，增進保單價值，也增加保險公司異業合作的營收來源。

Cancer rate has increased in recent year and has ranked No.1 of top ten causes of death. Patients can get a claim to pay for the medical expenses for the first time they diagnosed cancer. However, as the survival rate of cancer increased, many patients may need subsidy for medical treatment if any relapse occurred. The post-cancer insurance has launched in 2018 in Taiwan, but it has not been widespread until these days. There are only two post-cancer insurance provider in Taiwan market. One of them is Cathay Life Insurance Company, Ltd., and the other is Taiwan Life Insurance Co., Ltd.. In this study, we will interview breast cancer patients to understand their desires for an ideal post-cancer insurance. Most importantly, we then compare the needs with the value proposition of existing Cathay Pacific’s post-cancer insurance for value fit, and figure out the gap between two parties. Based on these results, we can explore more possibility to add value to the insurance service, and to create new profitable business model for the insurance providers. Hong Kong and Singapore have already developed post-cancer insurance for relapse subsidy. Taiwan can refer to their medical term as a template, and combine with Spillover-effect products to develop brand new type of post-cancer insurance. This article uses the following three main strategies to develop post-cancer policy: First, divide into different segments by tumor type and treatments received. Breast cancer can divided into categories based on the phenotypes of Estrogen Receptor (ER), Progesteron Receptor (PR), and Human Epidermal Growth Factor Receptor 2 (HER-2). The relapse rates of each categories are significantly different. Furthermore, the period of recovery, medication, surgery treatment, and follow-up action will all impacts the health condition. Certain characteristics of the patients have the lower relapses rate. By grouping and segmentation, we can target the patients with comparably lower risky. Secondly, prevention-oriented policy can be combined to decrease the risk: With the concept of active health management, spillover insurance policies can create incentive to stay health and minimize the probability of adverse body reaction. Last but not the least, sculpt 'health insurance ecosystem': Based on the results of customer interviews, they have needs from healthcare institutes such as fitness centers, dietary supplements, medical institutions, aesthetic medicine, pharmacies, health inspection centers. As a result, expanding cooperative industries can benefit both patients and the insurance companies. The value of the new insurance product will be promoted and additional profit may be achieved in the long run.