111 |
台灣地區醫院效率與生產力變動之研究-非參數DEA方法之應用 / Efficiency and Productivity Growth of Hospitals in Taiwan: Nonparametric Data Envelopment Analysis王媛慧 Unknown Date (has links)
本論文對於醫療市場的生產績效研究,係由兩篇獨立的學術研究報告所組成,研究重點在於利用非參數資料包絡分析方法 ( nonparametric DEA approach ),估計醫院的生產技術,以衡量醫院的技術效率及不同年度間之生產力變動,進而分析不同醫院間,生產績效差異的主要原因。本論文所採用的研究方法與探討的主題,不同於國內既有的相關文獻。
第一部分:生產不確定性與醫院效率
本部分主要探討在醫院面對不確定性時的效率評估。一般而言,醫院有兩種生產上的不確定性來源:醫師或醫院的診療結果所導致的生產不確定性;及消費者對醫療服務需求的不確定性 (Arrow, 1963)。當醫院面對生產不確定性時,醫院效率將與廠商如何處理不確定性問題有關,亦即,當廠商事前規劃愈縝密,未來可能的產出失靈水準愈低,則其生產效率表現愈佳。本文利用民國 82 及 83 年(準)醫學中心與(準)區域醫院資料,模擬醫院在面對生產不確定性時,各種可能的產出失靈水準,以chance constrained DEA 模式 (Land, Lovell and Thore, 1993) 估算醫院的隨機技術效率,並與傳統、確定性的DEA模式所得到之結果,做一比較。
Chance constrained DEA模式與傳統DEA模式的不同,在於前者估計出的生產前緣,並不總是包絡所有的樣本點,亦即,允許某廠商之產出超越生產前緣或說允許產出失靈可能性之存在,而後者則否。實證結果發現,在chance constrained DEA模式下,私立醫院的技術效率高於公立醫院,且呈現統計顯著性的差異,但兩者間的差異隨著醫院事前準備程度的提高而縮小;而傳統DEA模式也顯示,私立醫院的技術效率確實顯著地高於公立醫院。此外,若產出失靈水準夠低,則chance constrained DEA模式的效率值與傳統DEA模式的效率值,兩者間的分配會呈現統計顯著性差異。
在面對生產不確定性時,欲提升公立醫院的生產效率,應提高廠商事先規劃的程度,才能與私立醫院之生產效率並駕齊驅。一般而言,廠商事先準備的程度高低,與醫院本身的特性有關,因此,欲改善公立醫院緩衝產能的準備程度,以降低產出失靈水準,有必要進行體制層面的改革,亦即,從進行人事變革、財務之授權與彈性化等方向開始做起,如此應可提高公立醫院的生產效率。
第二部分:全民健康保險制度與醫院生產力變動
全民健保實施後,民眾對醫療服務的可近性提高,醫院間的市場結構改變,因此,醫院生產力與效率的提升,成為眾所關切的焦點。為瞭解醫院在全民健保實施後,資源是否有效配置,本部分利用民國 82 至 86 年醫學中心、區域醫院與地區醫院等大小型醫院資料,以範疇DEA模式估計Malmquist生產力變動指標,並將之分解為技術變動、純技術效率變動、及規模效率變動等三項變動來源。
實證結果發現,從82至86年醫院整體平均效率而言,CRS(VRS)生產技術下的平均效率為 66.00%(74.87%),表示不論大小型醫院,平均而言,皆存在技術不效率的情形。再者,在民國84年,亦即全民健保實施的年度,其效率水準明顯較其他年度為低,其餘年度的效率水準都相對較高,此一結果意謂,政策干擾對於醫院效率表現的影響,是短期性的。另外,小型醫院皆較大型醫院不效率,兩者的效率差異呈現統計顯著性;以權屬別而言,不論是大型醫院或小型醫院中的私立醫院,其生產效率均優於公立醫院,且兩者的效率差異呈現統計顯著性。而透過迴歸分析顯示,全民健保實施、權屬別之虛擬變數、佔床率、平均住院日、及以醫院產出衡量的集中度指標等,是影響醫院生產效率的重要因素。
從Malmquist生產力變動( et al., 1994)來看,平均而言,82-86年間醫院生產力成長率約在 -3.06 % 左右。就生產力變動來源而言,技術成長率(-2.74 %)與整體效率成長率(-0.33 %)均為負,而技術變動則是阻礙生產力成長的主要原因。此外,若以醫院整體效率變動來源來看,平均而言,整體效率退步是由於規模效率變動所致(-0.74%)。
此外,本文著重在 et al.(1994)、Ray and Desli (1997) 及Grifell and Lovell (1998) 三種定義下的Malmquist生產力變動指標之比較。研究結果發現,Grifell and Lovell (1998) 的一般化Malmquist生產力指數,並沒有正確衡量廠商的生產力變動及其變動來源項。而利用Kruskal-Wallis檢定結果發現,三個模式中的生產力變動差異,並不具統計顯著性,而變動來源項(技術變動與規模效率變動)亦顯示相同的結果。 / This dissertation is focused on the efficiency and productivity studies of hospitals in Taiwan. It includes two independent academic papers. The primary intention is to introduce the newly developed ideas in the measurement of efficiency and productivity, rather than to create new ones. The utilization of these ideas has not, however, been discussion in print. And some of the arguments we used and brought together are new regarding to the literature of hospital efficiency and productivity measurement. Utilizing the non-parametric data envelopment analysis (DEA) approaches, efficiency scores and productivity change indexes were estimated. Efforts were made to explain the difference of productivity performance among individual hospitals. Nevertheless, the methods we used and the economic approach behind them distinguish this study from other empirical studies of the medical market.
Part I Market Uncertainty and Hospital Efficiency
This part of the dissertation is focused on the measurement of efficiency of hospitals, incorporating uncertainty. There are stochastic variations in production relationships for hospitals. Generally speaking, the uncertainty of hospitals comes from two major sources: the natural uncertainty of medical cares; and the uncertainty of demands for medical cares (Arrow, 1963). Given the uncertainty in the medical market, the efficiency of hospitals hinges on how decision-makers deal with it. Undoubtedly, an optimal planning of the output buffers improves the efficiency performance.
Using the hospital survey data in 1993 and 1994, and employing the chance constrained DEA model (Land, Lovell and Thore, 1993), the stochastic efficiency indexes of public and private medical centers and regional hospitals were estimated. Compared with deterministic frontier enveloping a given set of sample observations all the time, the chance-constrained frontier envelops them most of the time. That is, the chance constrained DEA allows the possibilities of output failure. Imposing different values of output failure probability, the estimation results were compared with the traditional (deterministic) DEA models.
The empirical evidences of the chance constrained DEA model showed that, on average, private hospitals performed significantly better than public hospitals. This result matches with the result of the traditional DEA model. With Mann-Whitney U test, we compared the distributions of efficiency indexes under chance constrained DEA and deterministic DEA models. The test results showed that the difference between these two different models is statistically significant given a higher probability of output failure.
These results imply that the nature of risk and the manipulation for risk are different for public and private hospitals. We also find that that the efficiency performance of public hospitals could be improved by the increasing of its reserve capacity.
Part II National Health Insurance and Hospital Productivity Change
In this part of the dissertation, we examine the impact of NHI on hospitals, and trace the sources of hospital productivity growth in Taiwan. To pursue our goal, we employ a data consisting of 157 medical centers, regional hospitals and district hospitals over the period 1993 to 1997, and resort to the Malmquist productivity index to measure total factor productivity change. The index could be decomposed into three components: technical change, pure technical efficiency change and scale efficiency change. The estimation technique used in the study is the deterministic non-parametric DEA approach. The results we find are revealing and suggestive to the public and the government in order to promote and assure the efficient delivery of quality health care.
The average efficiency scores are 66.00% (74.87%) for CRS (VRS) technology and it means that there are substantial efficiency losses for the sample hospitals during the study period. The efficiency score of the hospitals as a whole in 1995 (the beginning year of NHI) was much lower than the other 4 years' efficiency scores. A censored Tobit regression analysis is used and identifies that NHI policy, ownership, rate of bed occupancy, average length of stay and the output-specific concentration level were all the significant determinants of technical efficiency.
Empirical results indicate that most medical care regions became more output-specific concentrated. Total factor productivity on average deteriorated at an annual rate of -3.1%, and it was dominated by substantial technical regresses at an annual rate of -2.74%. The small hospitals were severely affected by NHI. Furthermore, within large and small hospital groups, the difference in technical change was statistically significant, but the differences in TFP and the associated components between ownership were not.
Special attention was paid to compare et al.(1994), Ray and Desli (1997) and Grifell and Lovell (1998) approaches to decomposing the Malmquist productivity index. Empirical results indicate that the first 2 approaches yield accurate productivity changes, while GL doesn't. However, they produce almost the same magnitude of average TFP. In addition, no significant differences in the measured technical change and efficiency change were found among the three approaches.
|
112 |
國際海上貨物運送法之新趨勢─國際海事委員會運送法草案之研究梁志偉 Unknown Date (has links)
〈一〉研究動機
國際海事委員會〈International Maritime Committee,簡稱CMI〉係1924年有關載貨證券規定之布魯塞爾公約〈The Brussels Convention of 1924 Relating to Bill of Lading,簡稱海牙規則〉以及1968年統一載貨證券規則國際公約修定協議書〈Protocol to Amend the International Convention for the Unification of Certain Rules of Law Relating to Bill of Lading,1968,簡稱海牙威斯比規則〉之起草者。惟因海上貨物運送日新月異,今日情形遠非從前可比。以海運單據而言,有運送當事人捨棄載貨證券而使用不可轉讓之海上貨運單來證明運送契約者,甚至以電子商務來函往返亦為常見。以運送型態而言,貨櫃運送所承運之貨物,其價值佔所有運送貨物價值之大部,而該類運送,除使用海運外,也多使用公路、或鐵路等內陸運送來完成。故以載貨證券及海運為重心之海牙及海牙威斯比規則,漸有規範不足之感。
除此之外,諸如支付運費、運送人交付貨物、貨方就貨物相關事宜指示運送人的權利、如何讓與運送契約下之權利、誰有權提起訴送或仲裁等議題,則不但海牙及海牙威斯比規則未加規範,就連1978年聯合國海上貨物運送公約〈United Nations Convention on the Carriage of Goods by sea,1978,簡稱漢堡規則〉對此亦束手無策,導致該類議題只得依照各國國內法解決,無法達成法律適用上之一致。
因此,在1998年,CMI決定放下修訂海牙威斯比規則之工作,轉而開始研擬全新的海上貨物運送規範,並於2001年12月提出了運送法文書草案〈CMI Draft Instrument on Transport Law,簡稱草案〉 。不但允許運送契約當事人使用不可轉讓運送單據、或以電子商務往返,更將草案之適用範圍擴及多式運送、及過去國際公約未處理之議題,尤有甚者,草案下之運送人賠償責任制度亦較以往之國際公約來得複雜。
因為現今任何之國際公約皆須由聯合國之機構如UNCITRAL加以起草。CMI便將草案送交予聯合國國際貿易法委員會〈United Nations Commission on International Trade Law,簡稱UNCITRAL〉,在UNCITRAL加入秘書處之說明後,於2002年1月8日,該份草案被製成海上貨物運送文書草案初稿〈Preliminary Draft Instrument on the Carriage of Goods by Sea〉 ,並交由UNCITRAL下之運送法工作小組〈Working Group on Transport Law〉所審議 。雖說UNCITRAL是否會修訂草案,抑或聯合國是否將以之代替漢堡規則,此刻吾人難加逆料,但不論就規範廣度及賠償責任制度方面,相較於海牙及海牙威斯比、漢堡規則,CMI所提出之草案都頗有可觀,極值得吾人加以研究。
〈二〉研究目的
本論文希望達到下列目的
第一、藉由研究草案第1、第4條中有關多式運送之規範,來探討國際海上貨物運送規範應否將適用對象擴張到海上運送之外。
第二、就草案有關電子商務之規定,以及當下未受到國際公約所規範、而草案加以規定之議題,如運費、交貨物、貨方指示運送人的權利、讓與運送契約下權利之方式、提起訴送或仲裁之權利等,透過第2條及第9到第13條之討論,來了解草案之規範是否合理、可行。
第三、對草案之規定中,過去曾受到海牙及海牙威斯比、漢堡規則所規範之議題,如公約之適用範圍、運送人之義務、賠償責任、託運人之賠償責任等,經由草案與前開規則之比較,來研究渠等間之差別、及草案之規範是否妥適。
〈三〉研究範圍與相關文獻探討
本論文係以整部草案為研究對象,並以草案與海牙及海牙威斯比、漢堡規則規則、及英國法之比較為重心。至於國內法之檢討,甚至草案與其他國家之海上運送法的比較,限於與篇幅,擬於嗣後再另文深入研究。
本論文草案於2001年底方告完成,故本論文之參考文獻,除草案立法說明外,以UNCITRAL下之運送法工作小組所釋出資料為主,包括會議記錄、各國家及國際組織之評介,至於國外期刊陸續出現探討草案之文章,亦為研究之列。另外,由於草案多數內容仍值根自海牙、海牙威斯比、漢堡規則等國際公約,因此本論文將博引國內外權威教科書之相關見解。
〈四〉研究方法
在進行草案各條文之討論前,有必要先對草案之擬定過程、草案制定之必要性、以及草案之核心議題加以介紹,簡言之,須說明草案之立法背景。之後草案之研究,因為本論文係以整部草案為探討對象,茲以逐條、項討論之方式來進行。最後則點出草案所代表的國際海上貨物運送法新趨勢。
〈五〉論文結構
本論文共分為四章,茲簡述各章內容如後:
第一章 緒論
說明研究動機及目的、研究範圍及方法、以及論文結構。
第二章 立法背景
本章闡述草案之擬定過程、草案之制定必要、以及草案之核心議題。
第三章 草案釋義
草案之規定,從開始的「定義」直到最後的「契約自由之限制」,共計有17條,茲將第三章分成十七節來探討各條文之得失。
第四章 國際海上貨物運送法之新趨勢─代結論
綜觀草案之規定後,茲提出草案所代表之國際海上貨物運送法之趨勢。
|
113 |
論民事訴訟法第一審失權制度暨其合憲性控制 / The Preclusion Effect in the First Instance of Civil Procedure and its Constitutional Control廖泉勝 Unknown Date (has links)
本論文於結構安排上,首章係為緒論,內容涵蓋有研究動機及目的、研究方法、研究範圍及架構;而於第二章將探討限制提出攻擊防禦方法之法理基礎及所涉基本權干預;第三章則對於事證提出及失權規定立法例之加以介紹;第四章則首就我國民事訴訟法一般訴訟促進義務下之失權制度,為要件及效力之介紹,再以其為基礎下,探討特別訴訟促進義務、特殊訴訟促進義務之失權規定要件、效力介紹及異同比較,並對於具法律重要性之實務見解予以評析;第五章則除探討民事訴訟第一審程序失權規定與其他同法程序制度之價值調和問題,復將對民事訴訟法第196條、第268條之2及第276條規定為合憲性控制之操作;第六章則為本論文綜整及結論。
|
114 |
國際競爭法的調和 / The Harmonization of International Competition Law謝孟珊, Meng-Shan Hsieh Unknown Date (has links)
不論是反全球化或是支持全球化,我們都無法否認,全球化已經是一個現在進行式。另外一個與全球化一樣逐步成長的乃是市場經濟體制,市場經濟體制植基於開放競爭有助於資源合理分配的觀念,而全球化則擴大了資源分配的範圍。然而,全球化和市場經濟體制的發達,貿易壁壘的消除,也帶動跨國界限制競爭活動的發展,反托拉斯不再是單純的國內問題,而是國際問題。
國際反托拉斯所帶來的問題大致可分為下述兩種,一是阻礙國際貿易的發展,二是因為各國不同的反托拉斯標準造成國際緊張以及企業成本。第一類問題可以細分為下述幾種情況:1. 國際卡特爾破壞市場競爭機制以及消費者福祉; 2. 跨國公司在全球濫用獨占力,影響國際競爭秩序和消費者福祉;3. 競爭法的缺乏以及競爭法的不力執行構成市場進入障礙。第二類問題亦可以細分為下屬幾種情況:1. 國際合併的多國標準造成企業的額外成本,不利國際合併之進行,並造成國際緊張;2. 國與國間產業政策以及競爭政策的衝突。
面對上述這些跨國性的反托拉斯問題,各界紛紛提出競爭法調和的呼籲,此議題近來在各國際組織也漸獲重視。事實上為了處理國外限制競爭行為對國內所產生的影響,以保護本國利益,國內法方面已有所謂的「域外適用(extraterritorial application)」對策產生。但是競爭法的域外適用並無法全然解決現時國際限制競爭行為所帶來的問題,反而還帶來了新的問題,並造成國際緊張。為了在國際案件有效執行反托拉斯法,不論是在卡特爾案件或是獨占力濫用案件,各國競爭法主管機關互相合作與協調都是不可或缺的。至於將競爭法提升至國際法層次,避免國家以非關稅措施破壞自由貿易制度,似乎也有需要。
本文目的在於藉著對競爭法調和現況的瞭解和其成就之分析來尋求目前全球化時代,貿易自由化時代下跨國限制競爭問題的解決之道。
全文一共分為六章,第一章為緒論,為本論文做出開端,闡明全球化時代國際競爭秩序的問題,並提出研究範圍與目的。
第二章研究關於國際競爭秩序的雙邊條約,著眼於美國和歐盟,澳洲和紐西蘭,以及我國和世界各國所訂立的條約。討論範圍為該些雙邊關係所建立之合作內容,其具體成效,成功失敗之因素,以及可供世界各國借鏡之處。台灣部分則著眼於我國目前現狀之檢討,和未來走向之研究。
第三章為從事競爭法調和的區域性國際組織,研究範圍包括歐盟、APEC以及NAFTA。其中APEC所從事的活動較近於政策性的調和,屬於競爭政策的宣導;NAFTA則進一步具有競爭法的實體規範;歐盟不但具有實體規範,並具有一套全球獨步的競爭法執行架構。
第四章為國際組織,將討論UN, WTO和OECD在國際競爭法的發展。UN基本上雖為政治組織,但是對於競爭議題也相當重視;WTO部分則將討論目前競爭議題在WTO體系的進展,並進一步討論WTO進行國際競爭法調和工作的可行性和不可行性;OECD對於競爭議題也一直相當重視,本文將探討OECD在競爭議題方面的研究成果。
第五章為全球性的競爭法規範,討論的範圍有UNCTAD所提出的「管制限制性商業行為的一套多邊協議的公平原則和規則(Set of Multilaterally Agreed Equitable Principles and Rules for the Control of Restrictive Business Practices)」以及DIAC。這兩套全球性的競爭法不但都具有實體規範也都提出一套制度性規範,雖然兩者都未能成為具有拘束力的國際競爭法,但是其所提出的實體規範內容和架構設計仍值得我們做進一步的研究。「管制限制性商業行為的一套多邊協議的公平原則和規則」本身是以聯大決議的形式呈現,因此在某一角度而言,「管制限制性商業行為的一套多邊協議的公平原則和規則」並未失敗,然而DIAC原本乃是預定成為WTO的附件之一,唯最後這樣的理想並未實現,因此我們有必要去問,DIAC的失敗因素為何?是基於其實體內容的設計問題,或是制度面的設計問題?或者是因為其他的外在因素?
最後,在第六章的結論,本文將試圖分析各種競爭法調和方式的利弊得失,並且提出建議。 / Some people oppose globalization, while others support globalization. However, it is undeniable that globalization is an on-going trend. Another on-going trend is market-oriented economy structure. The structure of market-oriented economy bases on the theory that competition contributes to reasonable allocation of resource. On the other hand, globalization expands the scope of the allocation of resources. However, the proliferation of globalization and the structure of market-oriented economy and the elimination of trade barriers also promote the development of transnational anticompetitive activities. Antitrust is no more a pure domestic issue, it is also an international issue nowadays.
International antitrust problems could be divided into two parts. First, the international antitrust activities hinder the development of international trade. Second, different antitrust standards of each country cause international tense situation and increase enterprises’ cost. First situation contains following aspects: 1. International cartels ruin market competition system and welfare of consumers. 2. Transnational companies abuse their dominant power all globally and affect international competition order and consumers’ welfare. 3. Absence of competition law and unenforcement of it constitute market entrance obstacles. Second situation also contains following aspects: 1.Different standards of international mergers bring many results, such as increasing enterprises’ extra cost, hindering the proceedings of international mergers, and causing international tensions. 2. The conflict between industry policy and competition policy of countries.
Facing those transnational antitrust problems, the issue of the harmonization of competition law has been raised. This issue is drawing more and more attention in several international organizations day by day. In fact, to deal with the domestic effect of abroad anticompetitive activities to protect national interest, the theory “extraterritorial application” of domestic law has been raised. However, the extraterritorial application of domestic law is unable to solve all the problems that the international anticompetitive activities have brought. Furthermore, it has also made new problems and caused international tensions. To enforce antitrust law effectively in international cases, cooperation and coordination between national competition agencies are unavoidable. In addition, bringing antitrust law up to international law level and avoiding nations ruin free trade system by non-tariff strategy seem also be needed.
The main purpose of this essay is to understand and analysis the current situation of the harmonization of competition law and to find out the solution of transnational competition problems in the era of globalization and the era of free-trade.
This essay has been divided into 6 chapters. The first chapter is the introduction, which illustrates the international competition problems in the era of globalization and brings out the studying scope and purpose of this essay.
The second chapter talks about international competition bilateral treaties between U.S. and E.U., Australia and New Zealand, Taiwan and other countries. The discussing scope contains the cooperation content which was set up by the bilateral treaty, its concrete result, and the reasons of its failure or success. As for Taiwan, this essay focuses on the review of its current situation and where its future is.
The third chapter talks about regional international organizations which involve in the harmonization of competition law, such as E.U., APEC and NAFTA. APEC’s activities are more closer to the harmonization of policies, which promote competition activities. NAFTA has substantial competition regulations. E.U. not only has substantial regulations but also has the first set of enforcement system of international competition law in the world.
The forth chapter is international organization, which talks about the development of international competition law in U.N., WTO and OECD. Although basically U.N. is a political organization, it also highly emphasizes competition issues. In addition, this chapter talks about the development of competition issues in the WTO system and the possibilities of promoting the harmonization of international competition law in WTO. Additionally, OECD also emphasizes competition issues very much. This chapter also talks about the study result of OECD in the competition issues.
The fifth chapter is the global competition regulations, which contains “Set of Multilaterally Agreed Equitable Principles and Rules for the Control of Restrictive Business Practices” of UNCTAD and “ Draft International Antitrust Code”. Both of the global competition laws contain substantial regulations and the design of enforcement systems. Although both of them ended up in unrestrictive regulations, they also deserve further research. “Set of Multilaterally Agreed Equitable Principles and Rules for the Control of Restrictive Business Practices” was brought out with the form of UN General Assembly Resolution, but it is successful in some aspect. DIAC was meant to be an Annex of WTO originally. However this idea was not realized at the end. Why DIAC failed? Was it because of the design of its substantial content or the design of the enforcement structure or other outside factors?
At last, this essay will analysis the shortages and advantages of all kinds of the harmonization of competition law and bring out recommendations in the conclusion of chapter 6.
|
115 |
論全民健康保險法上之公共安全事故代位求償制度陳介然 Unknown Date (has links)
全民健康保險法自民國83年8月9日公告並自民國84年3月1日施行,此一社會保險制度迄今已成為我國醫療保健系統重要支幹,然而,醫療費用每年約上漲8~10%,致使民國87年3月開始,財務已有入不敷出的情形,因此中央健康保險局(保險人)有一連串開源節流的政策
民國94年2月25日全民健康保險監理委員會第117次會議,委員發言多傾向支持擴大代位求償範圍。此外,全民健保公民共識會議之與會人員,一致認為保險事故如果係可明確歸責於第三人之事由所導致,全民健保之保險人於給付後,應該向第三人代位求償,以符公平正義原則,立法院爰於民國94年5月18日修正全民健康保險法第82條,增訂公共安全事故及重大之交通事故、公害或食品中毒事件為代位求償範圍,修正後條文為:「保險對象因發生保險事故,而對第三人有損害賠償請求權者,本保險之保險人於提供保險給付後,得依下列規定,代位行使損害賠償請求權:
一、汽車交通事故:向強制汽車責任保險保險人請求。
二、公共安全事故:向第三人依法規應強制投保之責任保險保險人請求。
三、其他重大之交通事故、公害或食品中毒事件:第三人已投保責任保險
者,向其保險人請求;未投保者,向第三人請求。
前項第三款所定重大交通事故、公害及食品中毒事件之求償範圍、方式及
程序等事項之辦法,由主管機關定之。」
修法之後,雖然擴大了健保局代位求償範圍,但限制仍多,且此次修法亦未明確釐清健保局在其他領域是否亦有代位求償權
本文首先敘述我國自民國84年正式實施全民健康保險時,尚有盈餘,然而自民國87年起首見保險支出超過保險收入,至民國96年時差額更高達新台幣136億元,除了繼續開發新財源與減少支出外,有無可能利用現有的制度切實實施,消除多數國民有「中央健康保險局將全國人民當成提款機的看法」,以及使實現加害者負其責任之公平正義,故本文針對於全民健康保險法第82條第1項第2款中中央健康保險局對公共安全事故強制投保之責任保險保險人代位權之相關問題加以探討,希望對於日益惡化瀕於破產邊緣之財務有所助益,接者大略簡介我國社會保險制度的演進,包括勞工保險、公務人員保險及其相關保險、退休公務人員保險、公務人員眷屬疾病保險、退休公務人員疾病保險、退休公務人員配偶疾病保險、私立學校教職員保險及其相關保險、農民健康保險與全民健康保險之演進與概況,之後於第三章再藉由歐、美等主要國家保險理論探討保險代位求償權之理論基礎以及人身保險適用代位求償權之理由,復接者討論保險代位求償權之性質、民法上行使代位權之限制、保險法上保險人代位權之性質與全民健康保險保險人之代位求償權;於第四章則討論目前我國中央與地方法規中有哪些場所或行業係屬須強制投保公共意外責任保險以及公共安全事故中全民健康保險保險人代位求償權之構成要件;於第五章則討論全民健康保險保險人可代位求償之金額尚須受到中央健康保險局實際所支出之醫療給付與強制責任保險之保險金額限制;於第六章則討論保險對象對於中央健康保險局代位求償權之保全有協助義務以及節妨礙代位之事由與代位求償權之消滅時效;第七章則是探討中央健康保險局行使代位求償權應注意事項;最後於第八章則是結論與建議。
|
Page generated in 0.0206 seconds