《保险研究》20231103-《保险机构经营规范性及其评价指数构建——基于保险纠纷判例大数据》（孙蓉、吴舒祥、万梅雨）

［摘   要］基于保险行为的特殊性，建立保险经营规范性有效识别机制是保险消费者权益保护工作的重要前提。本文基于保险纠纷判例与保险精算理论作为保险经营规范性识别机制构建的理论基础，初步构建了保险经营规范性经济学理论模型及微观层面的传导机制和量化评价方案，并实证检验了传导机制。研究发现，理论模型中的传导机制与中国财产保险市场相吻合，出险率、市场佣金投入密度和利润密度驱动着保险经营规范性投入并进一步影响到保险纠纷量。基于2016~2021年68859个保险民事判决书数据的实证结果显示，当有效业务管理投入占保费收入的比例每增加1个单位，每1亿元保险业务中，展业环节产生的民事诉讼纠纷量会平均减少0.774件，承保环节产生的民事诉讼纠纷量会平均减少0.169件，理赔环节产生的民事诉讼纠纷量会平均减少0.186件；中大型保险机构的保险经营规范性相较于小型保险机构在经营规范性波动上的表现更稳定，但在保险展业、核保和理赔三方面均处于平均水平附近或略低，未起到行业引领作用。故保险监管部门和行业协会等应建立保险经营规范性市场评价机制，通过大数据分析优化保险消费者权益保护工作，引导行业高质量发展。

［关键词］保险规范性；评价指数；保险纠纷大数据；消费者权益保护；保险监管

［基金项目］本研究项目得到国家社科基金项目“中国农村普惠保险缓解贫困脆弱性的机制、效应及政策研究”(19BJY165)资助。

［作者简介］孙蓉，西南财经大学金融学院保险与精算系教授、博士研究生导师，研究方向：保险政策与制度、农业保险等；吴舒祥，西南财经大学金融学院保险与精算系博士研究生，研究方向：保险制度与政策、非寿险精算；万梅雨，西南财经大学金融学院保险与精算系博士研究生、国家金融监督管理总局四川监管局主任科员，研究方向：保险监管。

Operational Compliance of Insurance Institutions and Its Evaluation Index Construction—Based on big data of insurance dispute cases

SUN Rong,WU Shu-xiang,WAN Mei-yu

Abstract：Based on the unique features of insurance behaviors,establishing a standardized and effective identification mechanism for operational compliance is an important prerequisite for protecting the rights and interests of insurance consumers.Using insurance dispute precedents and actuarial theory as the theoretical basis for constructing a standardized identification mechanism for insurance operational compliance,this article preliminarily constructs a theoretical model for insurance operational compliance economics and a transmission mechanism and quantitative evaluation plan at the micro level,and empirically tests the transmission mechanism.The research has found that the transmission mechanism in the theoretical model is consistent with the Chinese property insurance market.The risk probability,market commission input density,and profit density drive the corporate input for investment operational compliance and further affect the amount of insurance disputes.Based on data from 68859 insurance civil judgments from 2016 to 2021,the empirical results show that for every 1 unit increase in the proportion of effective business management input to premium income,the number of civil litigation disputes generated at the sales stage,the underwriting stage,and the claims stage will decrease by 0.774,0.169 and 0.186 on average respectively,for every 100 million yuan of insurance business.Compared to small insurance institutions,the operational compliance performance by large and medium-sized insurance institutions is more stable in terms of the volatility of compliance,but they are near or slightly lower than the average levels in terms of their data at the sales,underwriting,and claims settlement stages,and have not played a leading role in the industry.Therefore,insurance regulatory authorities and industry associations should establish a standardized market evaluation mechanism for insurance operations,optimize the protection of insurance consumer rights and interests through big data analysis,and guide the high-quality development of the industry.

Key words：insurance operational compliance;evaluation index;big data of insurance disputes;protection of insurance consumer′s rights and interests;insurance supervision