臺灣博碩士論文加值系統

本文針對現行職業 傷害保險費率計算模式， 害保險費率計算模式， 提出將個人健康危害因素納入費率精算之可行性。健康危害因素為致使員工罹患疾病或受傷之主因，若投保單位的健康危害因素高，其導致職業傷害理賠的機會也較大，由於現行職業傷害保險費率是以過去的理賠經驗來計算，若能在職業傷害發生前先針對有較高健康危害因素的投保單位，據以收取較高的保費，以期達致費率精算公平的原則。
目前 職業傷害保險費率，分為行業別災害費率及上下班災害費率二種，每三年調整一次，由中央主管機關擬訂，報請行政院核定，送請立法院查照，因此，職業傷害保險費率係採經驗費率制，俾使各事業單位能按行業別之危險事故發生率及最近三年間職業傷害給付之實績等因素定期重新加以精算。
本文先觀察OECD (Organisation for Economic Co-operation and Development)國家有無將健康危害因素納入費率計算，方法為透過OECD國家職災保險網站、文獻及與當地職災保險官方單位聯繫的方式來獲取各國費率制度資訊。接著分析各國職災費率計算制度並檢視各國是否將健康危害因素納入職業傷害費率計算，進一步探究各國在職災費率計算上所採行的風險管理措施，最後就現有的資料評估將健康危害因素納入費率計算其可行性。檢驗結果顯示目前先進國家仍未就「健康危害因素」納入保險費率之精算，且因「健康危害因素」種類繁多，且有諸多實施上的困難，而目前較為先進的國家大致以經驗費率制度為原則，經驗費率制度是以個別雇主為實施對象，雖於依照事後實際經驗調整保險費率，但許多文獻對於經驗費率制度的損失控制或保險理賠功效持有正面之看法，且亦具有風險管理之功能，因此大部分先進國家目前皆以此原則釐訂職業傷害保險費率，並輔以「預防性觀念」的具體措施，加以調整保險費率來獎勵或懲罰投保單位，以達社會保險與風險管理之功效。若要將健康風險因素納入費率計算，本文建議可以整合職災風險因子模型與現行費率計算模型，來達到精算公平的原則。

This study aims to analyze the possibility of considering the health hazard factors whilst setting workers’ compensation rate. As for now, the workers compensation rates in Taiwan are set on the basis of historical data. This study is aim to probe the possibility of calculating the rate before the claim incurred by considering the current circumstances of each insured.
Firstly, the study observed the OECD (Organisation for Economic Co-operation and Development) countries by the accurate information from these countries official websites, researches, and contacting their rating bureau.
Secondly, analyzing all the information which calculate in the first phase. Referring OECD countries rating system, probing if any of them considering health hazard factors whilst pricing. Furthermore, the study observed other practical hazard management methods which can be the reference for Taiwan’s rating system.
Last but not the least, this study managed to build a model which integrate health hazard factors into workers’ compensation rating system.

目錄
第一章 緒論 ....................................................................................................................... 3
第一節 研究動機與目的 ............................................................................................... 2
第二節 研究架構 ............................................................................................................ 3
第二章 文獻回顧 ............................................................................................................. 4
第三章 研究方法與步驟 .............................................................................................. 6
第一節 OECD各國是否將「健康危害因素」納入職災費率的計算 ................... 6
第二節 OECD各國是否將「預防性觀念」納入保險費率的計算 ..................... 28
第三節 風險管理的方法與制度 .................................................................................. 36
一、 我國現行職災保險費率計算制度 ............................................................................. 36
二、 長期慢性病之精算評估 ........................................................................................... 40
第四節 將健康危害因素納入職業傷害保險費率之精算模型 .............................. 44
第四章 結論與建議 ...................................................................................................... 49
第一節 研究結論 ............................................................................................................ 49
第二節 研究建議 ............................................................................................................ 51
參考文獻................................................................................................................................ 52
附錄一 、OECD三十四國之職業傷害制度與依據 ........................................................ 58
附錄二 、NCCI經驗費率制度理論公式 ......................................................................... 68
附錄三 、27類特別危害健康作業類別 ........................................................................... 75
附錄四 、職業健康危害因子之量化與職業健康危害程度之公式 .............................. 100

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