本論文主要在探討產險公司如何建立一個有效且完整的品質管理系統。以結構方程發展出核保及費率制定的核心變數並分別驗證汽車車體損失險及團體傷害保險兩個屬性不同的險種。就汽車車體損失保險而言，驗證結果得知，核保因素之未婚者、地區仍存在逆選擇的現象。未有充分證據顯示事前道德風險的存在。就團體傷害保險而言，費率因素中之團體人數對於實支實付平均保額及住院日額平均保額仍存在逆選擇的現象。住院日額平均保額對於損失率存在事前道德風險的現象。

This dissertation explores the development of an effective and complete quality management system by insurance companies. Using structural equation model to develop the core variables of underwriting and ratemaking. To verify these assumptions, this study examines auto physical damage insurance and group injury insurance, which are two different policies with varying features. In the case of auto physical damage insurance, the risk factors are claims, human, auto, road environment, and place factors. The results indicate that the variables in underwriting factors such as single, region imply the existence of adverse selection. There is no significant evidence to imply the presence of ex-ante moral hazard. For group injury insurance, the risk factors are underwriting, rates, and business factors. The number of groups in the rates of factors support for insured amounts for daily hospitalization indemnity indicate the presence of ex-ante moral hazard.

目   錄
目錄 ……………………………………………………………………Ⅰ
表目錄………………………………………………………………… Ⅲ
圖目錄………………………………………………………………… Ⅴ
第一章	緒論 …………………………………………………………1
1.1	研究動機及目的 ……………………………………………1
1.2	研究架構與流程 ……………………………………………4
第二章	文獻回顧與探討 ……………………………………………6
2.1	核保與業務的品質管理…………………………………… 6
2.2	費率制度 ……………………………………………………8
2.3	各風險因素驗證文獻………………………………………10
2.4     資訊不對稱、逆選擇及道德風險…………………………11
2.5	業務品質管理制度的建立 ……………………………… 13
第三章 研究設計與實施 ……………………………………………18
3.1	研究樣本及變數定義………………………………………18
3.2	研究假設……………………………………………………35
3.3	研究模型……………………………………………………39
第四章	實證結果與分析 ………………………………………… 42
4.1	模型配適度的評估…………………………………………44
4.2	汽車車體損失保險實證結果與討論………………………47
4.3	團體傷害保險實證結果與討論……………………………49
第五章	結論與建議 ……………………………………………… 52
5.1	結論…………………………………………………………52
5.2	建議…………………………………………………………54
參考文獻 ………………………………………………………………55
中文文獻 ………………………………………………………………55
英文文獻 ………………………………………………………………58

表目錄
表1產險公司業務品質管理系統建構階段表………………………… 13
表2汽車車體損失保險與團體傷害保險核保作業流程比較表……… 16
表3產險市場各險種保費表…………………………………………… 18
表4產險市場汽車車體損失保險損失率表…………………………… 19
表5汽車車體損失保險各承保範圍簽單車數表……………………… 19
表6汽車車體損失保險變數操作型定義……………………………… 20
表7汽車車體損失保險被解釋變數件數百分比表…………………… 23
表8汽車車體損失保險各變數描述性統計量………………………… 24
表9產、壽險市場團體傷害保險費占比表…………………………… 26
表10產、壽險市場團體傷害保險損失率表 ………………………… 27
表11個案公司傷害保險市占率表 …………………………………… 27
表12團體傷害保險各變數操作型定義…………………………………28
表13團體傷害保險被解釋變數百分比表………………………………31
表14個案公司團體傷害保險承保與理賠件數比表……………………32
表15團體傷害保險各變數描述性統計量………………………………33
表16汽車車體損失保險研究假設表………………………………… 35
表17團體傷害保險研究假設表……………………………………… 37
表18結構方程式整體模型配適度指標表………………………………42
表19汽車車體損失保險整體模型配適度表……………………………44
表20團體傷害保險整體模型配適度表…………………………………45
表21汽車車體損失保險驗證結果表……………………………………47
表22汽車車體損失險各解釋變數關聯係數表……………………… 47
表23團體傷害保險驗證結果表……………………………………… 49
表24團體傷害保險被解釋變數關聯係數表………………………… 50

圖目錄
圖1 研究架構與流程圖 ………………………………………………4
圖2 汽車車體損失保險業務品質管理作業流程 ……………………14
圖3 團體傷害保險業務品質管理作業流程 …………………………15
圖4 風險因素及被解釋變數間的關聯性 ……………………………35
圖 5 汽車車體損失保險風險因素、承保範圍與理賠金額關聯……36
圖 6 團體傷害保險風險因素、保險金額與損失率關聯圖…………38

參考文獻
一、	中文文獻
王光煜，(2003)，日本保險公司因應費率自由化之政策，核保會報，第12期，9-52。
石泱，(2004)，職業工會勞工參加職業災害保險制度之研究-逆選擇與道德風險的觀點，保險實務與制度，第3卷，第1期，53-76。
江傳賢、許沖河、夏銘賢、呂廣盛，(2001)，傷害及健康保險，台北：財團法人保險事業發展中心。
汪琪玲，(2006)，台灣車體損失險上的動機效果，台大管理論叢，第17期，31-58。
李旭華、許銘元，(2010)，台灣車體損失險逆選擇因素之研究，保險學報第6期，1-14。
李旭華、許銘元、李珍穎，(2013)，決策因素與理賠因素關聯性之實證研究：以車體損失險為例，2013年兩岸保險與危險管理學術研討會，淡江大學。
李旭華、許銘元、李珍穎，(2014)，核保判斷因素及理賠關聯性的實證—以產險公司經營團體傷害保險為個案，保險專刊，第30卷，第2期，167-186。
李沃牆、丁榮光，(2004)，自用車體險核保系統之建構-台灣地區之實證研究， 保險專刊，第20卷，第2期，113-130。
李宗緯，(2001)，開創智慧資產的唯一途徑，數位時代，知識管理特刊，62-68。
邱皓正，(2006)，結構方程模式，台北，雙葉書廊。
呂廣盛，(2008)，個人壽險核保概論，台北：三民書局股份有限公司。
吳明隆、張毓仁，(2010)，結構方程模式—實務運用秘笈，台北：五南圖書出版股份有限公司。
吳萬益，(2005)，企業研究方法，台北：華泰文化事業股份有限公司。
周百隆、姚振華、石佩琇，(2010)，產險業個人傷害保險危險因子分析，核保學報，第18期，29-60。
洪介偉、周志諺，(2004)，自用車車體損失險出險因素之探討，保險專刊，第20卷，第2期，131-157。
許銘元，(2003)，鄉、鎮、市民團體傷害保險費率因素之分析—以土城市市民團體傷害保險為例，國立高雄第一科技大學風險管理與保險系碩士論文。
陳青浩、林明俊、龔彥仲，(2008)，團體保險理賠率之實證分析，風險管理學報，第10卷，第2期，133-155。
陳柏銘，(2001)，知識管理在通路經營之運用—以台北運銷公司為例，國立中興大學農產運銷學系碩士論文。
陳建勝、陳美菁、林明宏，(2004)，我國產險業資本結構與風險對獲利能力影響之研究，風險管理學報，第6卷，第3期，273-290。
陳瑞，(2009)，從知識經濟看保險未來發展，核保會報，第19期，5-12。
陳寬裕、王正華，(2010)，結構方程模型分析實務:AMOS的運用，台北：五南圖書出版股份有限公司。
陳靜慧，(2014)，歐盟的禁止性別歧視原則—以私人保險之男女保險費率平等為中心之研究，台北：文化大學法律學系暨法律學研究所。
張士傑，(2008)，費率自由化監理指標:資本結構、資金成本與核保利潤，風險與保險，第17期，2-9。
黃天牧，(2012)，保險業企業風險管理之研究，台北：財團法人孫運璿學術基金會。
黃芳銘，(2009)，結構方程模式理論及運用，台北:五南圖書出版公司。
詹芳書，(2014)，再探台灣車體保險之道德危險－以2005至2007年資料為證， 經濟論文第42卷，第2期，173 - 195。
廖述源、林慧紋，(2012)，產險核保績效評量指標之探討，核保學報，第20期，67-104。
廖振盛，(2009)，費率自由化對產險業經營效率與生產力影響之分析，保險經營與制度，第8卷，第2期，205-228。
廖振盛，(2010)，費率自由化前後產險業經營效率變化分析—隨機邊界法之應用，臺灣銀行季刊第61卷，第2期，46-59。
劉俊廷、何佳玲、謝淑慧，(2012)，重置成本保險與道德危險—台灣汽車竊盜損失險實證分析，經濟論文，第40卷，第1期，1-33。
蘇志雄、郭良芬，(2006)，商業智慧分析在保險業的應用，數據分析，第1卷，第2期，111-133。
鄭鎮樑，(2014)，保險學原理，台北：五南圖書出版股份有限公司。

二、	英文文獻
Abdel-Aty, M.A., and  Abdelwahab, H.T., (2000). Exploring the Relationship be-tween Alcohol and the Driver Characteristics in Motor Vehicle Accidents. Acci-dent Analysis and Prevention, 32, 473-482.
Akerlof, G.A., (1970). The Market for “Lemons”: Quality Uncertainty and the Market Mechanism. Quarterly Journal of Economics, 84 (3), 488-500.
Alan, B., 1992, Industrial experience with total quality management, Total Quality Management, 3 (2), 147-156.
Altman, D., Cutler, D.M., and Zeckhauser, R.J., (1998). Adverse selection and adverse retention. The American Economic Review, 88 (2),122-126.
A.M. Best Company, (1999). Insolvency: Will historic trends return? Old wick, NJ., USA.
Arrow, K.J., (1963). Uncertainty and the Welfare Economics of Medical Care. The American Economic Review, 53 (5), 941-973.
Bollen, K. A.,(1989). Structural Equations with Latent Variables. N.Y., John Wiley & Sons.
Bollen, K. A., and Long, J. S. (1993). Testing structural equation models , N.Y., Sage.
Chiappori, P.-A. and Salanie, B., (2000). Testing for Asymmetric Information in In-surance Markets. Journal of Political Economy, 108 (1), 56-78.
Cohen, A., (2010), Testing for Adverse Selection in Insurance Markets. The Journal of Risk and Insurance, 77 (1), 39-44.
Cummins, J. D. and Harrington S. E., (1985). Property-Liability Insurance Rate Reg-ulation: Estimation of Underwriting Betas Using Quarterly Profit Data. Journal of Risk and Insurance, 52, 16-43.
Cummins, J. D. and Harrington, S. E., (1988). The Relationship Between Risk and Return: Evidence for Property-Liability Stocks. Journal of Risk and Insurance, 55, 15-31.
Cummins, J. D. and Harrington, S. E., Greg, and Niehaus, (1995). Risk-Based Capital Requirement for Property-Liability Insurers: A Financial Analysis, The Financial Dynamic of Insurance Industry, Homewood, IL: Irwin Professional Publishers.
Cummins, J. D. and Rubio-Misas, (2006). Deregulation, Consolidation, and Efficiency: Evidence from the Spanish Insurance Industry. Journal of Money, Credit, and Banking, 38 (2), 323-356.
Dahlby, B. G., (1983). Adverse Selection and Statistical Discrimination: An Analysis of Canadian Automobile Insurance. Journal of Public Economics, 20, 121-130.
De Meza, D. and Webb, D. C., (2001). Advantage Selection in Insurance Markets, Rand Journal of Economics, 32, 249-262.
Deming, W. E., (1982), Out of the crisis, Mit Press.
Dionne, G., Gourieroux, C., and Vanasse, C., (2001). Testing for Evidence of Adverse Selection in the Automobile Insurance Market: A Comment. The Journal of Po-litical Economy, 109 (2), 444-453.
DiBella, A. and Necis, E. C. (1997). How Organizations Learn: An Integrated Strate-gy for Building Learning Capability. San Francisco, CA, Jossey-Bass.
Dionne, G. and Gagné, R., (2002).Replacement Cost Endorsement and Opportunistic Fraud in Automobile Insurance. Journal of Risk and Uncertainty, 24 (3), 213-230. 
Doug L., (2012). Smart Computing-Big Data, Information Agenda Executive Con-sultant.
Dorfman, M. S., (1998). Introduction to Risk Management and Insurance (Sixth Edi-tion), 89, 137–138, 186–187, Prentice Hall, New Jersey.
Fairley, W. B., Tomberlin, T.J., and  Weisberg, H.I., (1981). Pricing Automobile In-surance Under a Cross-Classification of Risk: Evidence from New Jersey. Journal of Risk and Insurance, 48, 505-514.
Fiske, S. T., Kenny, D. A. and Taylor, S. E., (1982). Structural models for the media-tion of salience efforts on attribution. Journal of Experimental Social Psychology, 18(2), 105-127.
Fred K., (2009). Underwriting Automobile Insurance Using Artificial Neural Net-works. Category: Business Information Systems, 3865-3870.
Hair, J.F., Anderson. R.E., Tatham, R.L. and Black, W. C., (1998). Multivariate data analysis, 5thed. Upper Saddle River, New Jerset: Prentice-Hall International.
Harrington, S. E.,(1983).The Relationship Between Risk and Return: Evidence for Life Insurance Stocks. Journal of Risk and Insurance, 50, 587-610.
Helleloid D. and Simonin, B.. (1994). Organizational Learning and a Firm's Core Competence-Base Competition. N.Y.: John Willey and Sons.
Klefsjo, B., Wiklund, H., and Edgeman, R.L., (2001). Six Sigma Seen as a Method-ology for Total Quality Management, Measuring Business Excellence,15(1),31-35.
Lee, H. H., Hsu, M. Y., and Lee, C. Y., (2013). Limits the insured amount to reduce loss?: Use the group accident insurance as an example. Proceedings of the Insti-tute of Industrial Engineers Asian Conference, July 18-20, 2013, Taipei, Taiwan, 695-704.
Lee, H. H., Hsu, M.Y., Lee, C. Y., (2015a). The Relationships among Risk Factors, Coverage, Claim Amount: A Case Study of Auto Physical Damage Insurance, International Journal of Applied Mathematics and Statistics, 53(3), 73-86.
Lee, H. H., Hsu, M.Y., Lee, C. Y., (2015b). An Empirical Analysis of Relevance among Risk Factors, Selection of Insured Amount and Loss Ratio: A Case Study of Group Injury Insurance, Journal of Applied Sciences 15(3), 500-507.
Lemark, D. J. and Reed, R., (2002). An application of thompson's typology to TQM in service firms. Journal of Quality Management, 5, 67-83.
Li, C. S., Liu, C. C., and Yeh, J. J., (2007). The Incentive Effects of Increasing Pre-Claim Deductible Contracts in Automobile Insurance. Journal of Risk and Insurance,74,441-459.
Luthard , C. M. and Wiening, E.A., (2006). Property and Liability Insurance Princi-ples,
Hau, L. N., & Lin, C. A. (1995). Wave propagation in an inhomogeneous anisotropic plasma. Physics of Plasmas , 2(1), 294-298.
Juran, J. M., (1986). The Quality Trilogy: A Universal Approach to Managing Quality. Quality Progress, 19, 19-24.
Malecki, D. S. and A. I. F. P. A. L. Underwriters, (1986). Commercial liability risk management and insurance. American Institute for Chartered Property Casualty Underwriters/Insurance Institute of America, Malvern, PA., USA.
Maruyama, G.M., (1998), Basics of structural equation modeling. Thousand Oaks, CA:Sage.
Pauly, M.V., (1974). Over insurance and Public Provision of Insurance: The Roles of Moral Hazard and Adverse Selection. The Quarterly Journal of Economics, 88(1), 44-62.
Puelz, R. and Snow, A., (1994). Evidence on Adverse Selection: Equilibrium Signaling and Cross-Subsidization in the Insurance Market. The Journal of Political Economy, 102(2), 236-257.
Poetscher W., and Lim, J., (2015). Usage-based insurance: Next generation solutions for insurance in Asia. Asian insurance review, 19-21.
Pope, N., (2005). Market Deregulation and Insurer Pricing Strategies: the Japanese Experience, The Geneva Papers, 30, 312-326.
Rejda, G. E. , (2005). Principal of Risk Management and Insurance, Addision Wesley, Ninth Edition, 586-603.
Richaudeau, D., (1999), Automobile Insurance Contracts and Risk of Accidents: An Empirical Test Using French Individual Data. The Geneva Papers on Risk and Insurance Theory, 24, 97-114.
Rothschild, M. and Stiglitz, J., (1976). Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information. The Quarterly Journal of Economics, 90 (4), 629-649.
Saito, K., (2006). Testing for Asymmetric Information in the Automobile Insurance Market under Rate Regulation. The Journal of Risk and Insurance, 73(2), 335-356.
Saito, K., (2009). Does Asymmetric Information Matter in the Early Insurance Market? Evidence from the Auto Insurance Market. Applied Economics, 41, 2653-2666.
Shavell, S., (1979).On Moral Hazard and Insurance. Quarterly Journal of Economics, 93, 541-562.
Shlomo B., Yaniv E., and Furman E., (2004). Developing A Framework for Insurance Underwriting Expert system, IJSIT Lecture Notes of International Conference on Informatics, 1(2), 191-197.
Smith, G., (1993). Benchmarking Success at Motorola, Copyright Society of Man-agement Accountants of Canada.
Spahr, R. W. and Escolas, E. L., (1982). Automobile Accident Reports: Do Driver Characteristics Support Rate Discrimination? The Journal of Risk and Insurance, 49, 91-103.
NAIC & CIPR.(2015). Usage-Based Insurance and Vehicle Telematics: Insurance Market and Regulatory Implications.
Wang, J. L., (2004). Asymmetric Information Problems in Taiwan’s Automobile In-surance Market: The Effect of Policy Design on Loss Characteristics. Risk Man-agement and Insurance Review, 7(1), 53-71.
Wang, J. L., Chung, C. F., and Tzeng, L. Y., (2008). An Empirical Analysis of the Ef-fects of Increasing Deductibles on Moral Hazard, The Journal of Risk and Insur-ance, 75(3), 551-566.
Webb, B. L., Harrison C.M., and Markham J.J., (1997). Insurance operations. Ameri-can Institute for Chartered Property Casualty Underwriters/Insurance Institute of America, Malvern, PA., USA.
Zhang, J., Lindsay, J., Clarke, K., Robbins, G., and Mao, Y., (2000). Factors Affecting the Severity of Motor Vehicle Traffic Crashes Involving Elderly Drivers in On-tario. Accident Analysis and Prevention, 132, 117-125.