Phát triển nghiệp vụ bảo hiểm sức khỏe tại tổng công ty bảo hiểm pvi

" Il TRUONG DAI HOC KINH TE QUOC DAN ■ ■ SOS0 ♦ G8G8 DAI HOC K.T.Q.D TT THONG TIN THU'VIEN PHONG LIAN AN-Tl'LiEli nguyIn bao tho PHAT TRIEN NGHIEP VU BAO HIEM SU'D KHOE TAI TONG CONG TY BAO HIEM PVI Chuyen nganh: Kinh te Bao hiem LUAN VAN THAC SY KINH TE • • NGl/OI HLONG DAN KHOA HOC: PGS.TS Nguyen Van Dinh THS HA NOI - 2014 11 If LOI CAM DOAN Ban luan van dugc hoan la ca qua trinh nghien cuu nghiem tuc cua toi cung voi su giup da tan tinh cua giao vien hudng dan PGS.TS Nguyen Van Dinh Toi cam doan cac so lieu, ket qua, trich dan luan van co nguon goc ro rang va trung thuc Ha Noi, Td thang Nguyen Bao Tha nam 2014 LOI CAM ON Dd lam dugc luan van nay, toi da nhan dugc su giup quy bau cua cac th Sy co giao, cac dong nghiep, ban be va gia dinh suot thoi gian qua Truce tien, toi xin gui lbi cam on tran trgng nhat toi PGS TS Nguyen Van Dinh, ngubi hudng dan luan van, da dinh hudng, giup toi tiep can thuc tien va tan tinh hudng dan toi hoan luan van Toi xin cam on den Quy Thay, Cd Vien Dao tao sau dai hgc - trudng Dai hgc Kinh te Quoc dan da trang bi cho toi nhieu kien thuc bo ich va gia tri suot qua trinh hoc tap Sau cung, toi xin cam on nhung ngudi ban va ngubi than da tan tinh ho trg, gop y va giup de toi co the hoan tot nhat luan van Xin chan cam on! MUC LUC • • LO1 CAM DOAN LOI CAM ON MUC LUC DANH MUC CAC CHIT VIET TAT DANH MUC BANG BIEU DANH MUC BIEU DO VA SO DO TOM TAT LU AN VAN PHAN MCI DAU CHITONG NHLTNG VAN DE CO BAN VE BAO HIEM SlTC KHOE 1.1 Khai quat ve Bao hiem sue khde 1.1.1 Khai niem Bao hiem sue khde 1.1.2 Muc dich, su can thiet khach quan cua Bao hiem sue khde 1.1.3 Vai tro cua Bao hiem sue khde 1.1.4 Cac nguyen tac cua Bao hiem sue khde 1.2 Noi dung ca ban cua nghiep vu Bao hiem sue khde 10 1.2.1 Doi tuong va pham vi bao hiem 10 1.2.2 So tien bao hiem va phi bao hiem 11 1.2.3 Giam dinh va chi tra bao hiem .12 1.2.4 Hopddng BHSK 12 1.3 Cac yeu to anh huoug den su phat trien nghiep vu Bao hiem sue khde 14 1.3.1 Cac yeu to khach quan 14 1.3.2 Cac yeu to chu quan 15 1.4 Danh gia su phat trien cua nghiep vu BHSK 16 1.4.1 Cac chi tieu danh gia ve san pham, kenh phan phoi 16 1.4.2 Cac chi tieu danh gia ket qua kinh doanh 16 1.4.3 Chi tieu danh gia hieu qua kinh doanh 17 1.5 Mot vai net ve Bao hiem sue khde tren the gioi va tinh hinh Bao hiem sue khde o’Viet Nam 18 1.5.1 Mot vai net ve Bao hiem sue khde tren the gioi 18 1.5.2 Tinh hinh BHSK d Viet Nam .25 CHlTONG THlTC TRANG PHAT TRIEN BAO HIEM SlTC KHOE TAI • • • TONG CONG TY BAO HIEM PVI 28 2.1 Gioi thieu ve Tong cong ty Bao hiem PVI 28 2.1.1 Qua trinh hinh va phat trien 28 2.1.2 Co cau to chuc cua Tong Cong ty Bao hiem PVI 30 2.1.3 Cac nghiep vu - san pham bao hiem chlnh cua Tong Cong ty bao hiem PVI 35 2.1.4 Ket quahoat dong giai doan 2009 - 2013 cua Tong Cong ty bao hiem PVI 36 2.2 Thur trang phat trien nghiep vu Bao hiem Sue khde tai Tong cong ty Bao hiem PVI (2009-2013) 40 2.2.1 Cac san pham cua nghiep vu Bao hiem sue khde 40 2.2.2 He thong kenh phan phoi san pham 50 2.2.3 Ket qua va hieu qua trien khai nghiep vu Bao hiem sue khoe tai Tong cong ty Bao hiem PVI 53 2.2.4 Danh gia su phat trien cua nghiep vu Bao hiem sue khoe tai Tong cong ty Bao hidm PVI 69 CHlTONG GIAI PHAP PHAT TRIEN BAO HIEM SUt KHOE TAI TONG CONG TY BAO HIEM PVI 79 3.1 Trien vong thi trudug Bao hiem sue khde tai Viet Nam va phuong huong phat trien nghiep vu BHSK cua Tong cong ty Bao hiem PVI thoi gian toi 79 3.1.1 Trien vong cua thi trudng Bao hiem sue khoe d Viet Nam thoi gian toi 79 3.1.2 Phuong hudng phat trien nghiep vu BHSK cua Tong cong ty Bao hiem PVI thoi gian toi 80 3.2 Giai phap phat trien nghiep vu BHSK tai Tong Cong ty Bao hiem PVI 81 3.2.1 Trong cong tac phat trien san pham 82 3.2.2 Trong cong tac phat trien kenh phan phoi 83 3.2.3 Trong cong tac trien khai nghiep vu 84 3.2.4 Mot so giai phap ho trp khac 88 3.3 Mot sd kien nghi 90 3.3.1 Doi vdi Bo Tai chinh - Co quan quan ly Nha nude ve bao hiem 90 3.3.2 Doi vdi Hiep hoi Bao hiem Viet Nam 92 KET LUAN 94 DANH MUC TAI LIEU THAM KHAO 96 DANH MUC CAC CHU VIET TAT BHCNPNT Bao hiem nguoi phi nhan tho BHNT Bao hiem nhan tho BHPNT Bao hiem phi nhan tho BHSK Bao hiem sue khde BHXH Bao hiem xa hoi BHYT Bao hiem y te CNTT Cong nghe thong tin DNBH Doanh nghiep bao hiem GYCBH Giay yeu cau bao hiem HDBH Hop dong bao hiem KDBH Kinh doanh bao hiem STBH So tien bao hiem STBT So tien boi thuong TNDS Trach nhiem dan su DANH MU C BANG BIEU • Bang 1.1: Doanh thu va ty le tang truong doanh thu cua thi truong BHPNT va nghiep vu BHSK o Viet Nam (2009 - 2013) 27 Bang 2.1: Co cau co dong cua PVI 219 Bang 2.2: Danh muc nghiep vu bao hiem cua Bao hiem PVI 35 Bang 2.3: Doanh thu va thi phan cua Tong cong ty Bao hiem PVI (2009 - 2013) 36 Bang 2.4: Tinh hinh chi tra boi thuong cua Tong Cong ty Bao hiem PVI (2009 - 2013) 39 Bang 2.5: So tien bao hiem cua cac san pham BHSK tai Bao hiem PVI 40 Bang 2.6: Doanh thu phi san pham BHSK cua Bao hiem PVI (2009 - 2013) 47 Bang 2.7: So lieu chi tra bao hiem san pham BHSK cua Bao hiem PVI (2009 - 2013) 47 Bang 2.8: Tinh hinh phat trien BHSK theo kenh phan phoi cua Bao hiem PVI nam 2012 - 2013 52 Bang 2.9: Doanh thu phi theo nhom nghiep vu bao hiem cua 53 Bang 2.10: Co cau ve san pham BHCN cua DNBH dan dau thi truong nam 2013 54 Bang 2.11: Dong gop cua nghiep vu BHSK vao doanh thu He thong ban le cua Bao hiem PVI (2009 - 2013) 56 Bang 2.12: Tinh hinh doanh thu phi bao hiem cac nghiep vu BHSK cua Tong Cong ty bao hiem PVI (2009 - 2013) 57 Bang 2.13: Tinh hinh chi giai quyet quyen lpi bao hiem nghiep vu BHSK cua Bao hiem PVI (2009-2013) 61 Bang 2.14: Co cau cac khoan chi phat sinh qua trinh trien khai cac nghiep vu BHSK cua Bao hiem PVI (2009 - 2013) 65 Bang 2.15: Ket qua kinh doanh nghiep vu BHSK cua Bao hiem PVI (2009 - 2013) 66 Bang 2.16: Hieu qua kinh doanh nghiep vu BHSK cua Bao hiem PVI (2009 - 2013) 68 DANH MUC BIEU DO VA SO DO Bieu do: Bieu 2.1: Tang truong nhan sir cua Bao hiem PVI 2010 -2013 32 Bieu 2.2: Doanh thu bao hiem cua Tong cong ty Bao hiem PVI (2009 - 2013) 36 Bieu 2.3: Thi phan cua cac DNBH tren thi trudng BHSK nam 2013 55 Bieu dd 2.4: So sanh doanh thu nghiep vu BHSK cua Bao hiem PVI va Bao Viet (2009- 2013) 57 Bieu 2.5: Tang trudng so luqng khach hang tham gia BHSK tai Bao hiem PVI 2009 -2013 60 Bieu 2.6: Tinh hinh chi tra giai quyet quyen lqi bao hiem nghiep vu BHSK tai Bao hidm PVI (2009 - 2013) 62 Bidu dd 2.7: Co cdu chi tra bao hidm BHCN cua Bao hiem PVI (2009 - 2013) 63 Bieu 2.8: Lai nhuan nghiep vu BHSK cua Bao hiem PVI (2009 - 2013) 67 Bieu 2.9: So sanh lqi nhuan cac nghiep vu cua Bao hiem PVI nam 2013 68 So- do; Sa 2.1: Co cau to chuc cua Bao hiem PVI hien .31 P n TRl/ONG DAI HOC KINH TE QUOC DAN ■ ■ BOK> r r a Cuoc song an chua vo van nhung rui ro bat trac, xa hoi phat trien dong nghia vdi viec ngudi doi mat vdi nhieu tai nan va benh tat nguy hiem hon Bdi vay, bao hiem noi chung va cac san pham bao hiem sire khde noi rieng ddi nhu mot bien phap de gop phan bao ve va dam bao lgi ich cho ngudi cuoc r r \ r song Cung vdi su phat trien cua nen kinh te va su tien bo nhan thuc cua ngudi dan, bao hiem sue khde dang dan trd mot phan tat yeu khong the thieu, song hanh cung vdi he thong BHXH, BHYT, la diem tua vung chac de moi ngudi vung vang va yen tarn budc tren moi chang dudng cuoc ddi minh Tong cong ty Bao hiem PVI la mot nhung doanh nghiep bao hiem tien phong dan dau tren thi trudng bao hiem phi nhan tho Viet Nam PVI hoat dong ldn manh d rat nhieu cac nghiep vu bao hiem, Bao hiem sue khde la mot nhung nhom nghiep vu the manh, luon dugc Tong cong ty chu trien khai rong rai, khong nhung gop phan nang cao doanh thu, md rong thi phan va cung co hinh anh cua Tdng cong ty ma dong gop khdng nho vao su phat trien an toan cua toan xa hoi Nhan thay tarn quan va y nghia cua loai hinh bao hiem va vdi mong muon phan tich sau hon thuc trang trien khai, tir dua nhung giai phap vugt qua nhung kho khan, han che dang ton tai de phat trien hon nua nghiep vu # 7 A Bao hiem sire khde tai Tong Cong ty Bao hiem PVI, tac gia da lua chon de tai: “Phat trien nghiep vu Bao hiem sue khde tai Tong Cong ty Bao hiem PVI” dd nghien cuu r r \ r Tren co sd he thong hoa cac van de ly thuyet lien quan, phan tich va danh gia thuc trang phat trien Bao hiem sue khde cua Tdng cong ty Bao hiem PVI, muc tieu nghien cuu cua luan van la de xuat cac giai phap tiep tuc phat trien va nang cao hieu qua trien khai nghiep vu Bao hiem sue khde cua Tdng cong ty Xac dinh ddi tugng nghien cuu la ly luan va thuc tien su phat trien Bao hiem sue khde, bao gom su phat trien san pham, he thong kenh phan phoi, quy trinh trien khai loai hinh nghiep vu tai Tdng cong ty Bao hiem PVI, Luan van su dung phoi hop cac phuong phap nghien cuu sau: thu thap tdng hop, phan tich thong tin va thong ke 90 3.3 Molt so kien nghi - Bo Tai chinh cdn thuc hien tdt cong tac quan ly, hoan thien hanh lang phap ly, tao dupc moi trudng phap ly thuan loi, dong thdi co nhung co che chinh sach uu dai de nganh bao hiem co dupc nhung budc phat trien on dinh va dung hudng Muc tieu tao lap va tri mot moi trudng kinh doanh an toan, on dinh, binh dang va thuan lpi trudc het duoc thuc hien d viec xay dung mot khuon kho phap ly phu hpp vdi su van dong cua co che thi trudng, dong thdi doi mdi phuong thuc va nang cao nang luc cua Nha nudc doi vdi hoat dong kinh doanh bao hiem, tien tdi dan thuc hien cac nguyen tac va chuan muc quan ly bao hiem quoc te Doi vdi rieng nghiep vu BHSK, Bo Tai chinh can ban hanh cac van ban hudng dan thi hanh Luat kinh doanh bao hiem cung nhu hudng dan trien khai cac nghiep vu BHSK kip thdi, phu hpp vdi tinh hinh phat trien cua thi trudng vao tung hoan canh cu the Song song vdi la tang cudng cac quy dinh quan ly chat che ve trich lap cac quy du tru, quan ly tai chinh, kha nang toan, cac chi tieu ve nang suat, hieu qua ; sua doi quy dinh ve ke toan DNBH phi nhan tho cho phu hop vdi yeu cau mdi, van hanh tren co sd CNTT Trong qua trinh ban hanh, trien khai ap dung, Co quan quan ly can thudng xuyen theo doi, danh gia qua trinh hoat dong de kip thdi co nhung bien phap bo sung, dieu chinh han che thieu sot Dong thdi phai tuyen truyen, bien rong rai cac van ban luat den ngudi dan thong qua cac phuong tien thong tin dai chung tren ca nudc Hanh lang phap ly co dupc hoan thien thi mdi co co sd tien de de thi trudng BHSK tiep tuc phat trien tung khau cu the - Bo cung can day manh nhung giai phap han che hanh vi canh tranh khong lanh manh tren thi trudng BHSK hien bang cach: + Sdm soat, hoan thien hanh lang phap ly de thi trudng van hanh theo chuan muc quoc te, tao moi trudng canh tranh lanh manh + Thuc hien kiem soat, kiem toan noi bo nham phong chong cac bieu hien tieu cuc qua trinh hoat dong + Cung co bo phan tra Cuc quan ly giam sat bao hiem, thudng xuyen theo sat dien bien thi trudng, tang cudng kiem tra, phat hien va xu ly nghiem khac cac hanh vi canh tranh khong lanh manh, truc lpi, khong tuan thu cac yeu cau tai chinh lam anh hudng den quyen va lpi ich chinh dang cua ngudi tham gia bao hiem Thdi gian tdi day can dua cac che tai xu phat mot cach ro rang, cu the va co 91 ca sa phap ly de thac hien nghiem khac, than trong, khach quan, chinh xac viec xu phat vi pham + Xay dang cac quy tac ve quan ly nganh, vua dam bao dung thong le quoc te vua phai can doi vdi viec bao ve lqi ich cua cac DNBH nudc dieu kien hoi nhap kinh te quoc te - Hien cac DNBH khong bi gidi han ve nghiep vu bao hiem, so tien bao hiem duqc chap nhan bao hiem cung nhu dia ban va pham vi hoat dong Chinh dieu khien cho cac DNBH chu yeu bat chudc nhau, canh tranh quyet liet va khach hang r r r r r \ \ rat kho de nhan biet DNBH nao tot han De giai quyet van de tren, Bo Tai chinh can dua tieu chi nang luc khai thac tuang ung vdi von chu sa huu thac co (tru lo) hay tong tai san phu hqp theo so luqng san pham bao hiem duqc phep trien khai, so luqng chi nhanh duqc phep hoat dong, gia tri mot dich vu bao hiem duqc phep khai thac, gia tri cac dich vu duqc phep khai thac vdi mot khach hang Co nhu vay, nhung DNBH co von chu sa huu thuc co hay tong tai san thap di lien vdi nang luc khai thac thap buoc phai hop tac cung dong bao hiem, tai bao hiem tuang tu nhu quy dinh cua Ngan hang Nha nudc ve dong tai trq giua cac ngan hang thuang mai - Bo Tai chinh can phoi hop vdi BHXH Viet Nam, Bo Y te de to chuc giam dinh y khoa (BHXH lam giam dinh doc lap cho cac DNBH cac vu co nghi van truc lqi bao hiem); phoi hop vdi ca quan cong an (canh sat giao thong, canh sat phong chay chua chay) cung cap ho sa hien truang va dieu tra giai quyet vu tai nan cho DNBH Hanh vi truc lqi bao hiem cung can dua vao toi pham hinh su de tang tinh ran de; cho phep lap trung tam phong chong truc lqi bao hiem cua nganh bao hiem - Ben canh viec kiem tra giam sat, Bo Tai chinh cung can tang quyen chu dong va tu chiu trach nhiem cho cac DNBH ve cac van de lien quan den tai chinh, hoat dong kinh doanh va tuan thu quy dinh cua phap luat, han che dan su can thiep hanh chinh cua Nha nudc vao hoat dong cua doanh nghiep r r r a a - Thiet lap cac he thong dich vu doi tac cua bao hiem nham nang cao chat luqng dich vu va tinh khach quan cua hoat dong bao hiem nhu: A 7 r + Thanh lap Hoi bao ve quyen lqi nguai duqc bao hiem de giai quyet hoa giai cac tranh chap giua DNBH va nguai duqc bao hiem 92 + Thanh lap ca quan giam sat cac san pham bao hiem bat buoc nham dam bao cac quy dinh cua Nha nude ve bao hiem bat buoc la hop ly, cong bang va dupe chap hanh nghiem tuc + Tieu chuan hoa dai ly bao hiem thdng qua cong tac dao tao tap trung nhu quy dinh cua Cue quan ly giam sat bao hiem + Xay dung he thdng co sd du lieu toan nganh phuc vu viec tinh phi va cd lo trinh bat buoc cac DNBH cd du lieu va chia se du lieu de tinh phi bao hiem - Hien san pham BHSK dang cd nhu cau ldn tir xa hoi, vdi doanh thu dung r < thu hai sau bao hiem xe co gidi va toe tang trudng tren 20%/nam Song viec thiet