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台灣全民健保被保險人保費負擔與其醫療費用支出之公平性研究 / Equity between the Insurees' premium Burden and Their Medical Care Expenditures in Taiwan's National Health Insurance Scheme

通常在談論健康照護的公平性時,主要分成垂直公平與水平公平兩種。在健康照護財務面的垂直公平意指有較高所得或經濟能力者,應支付較高的保費;水平公平意指,有相同所得或經濟能力者,應支付相同的保費。在健康照護提供面的垂直公平意為有不同需要者,應有不同的治療;水平公意為有相同需要者,應有相同的治療。然而由於提供面的垂直公平較難界定其程度,故多數學者在提供面僅談水平面,而本研究亦採相同的論點來分析被保險人在保費負擔與其醫療費用支出之公平性問題。
本研究資料係採用鄭文輝教授等在1996、1997年研究之原始資料,包括85年度的健保承保檔、醫療利用紀錄檔及財稅資料中心之綜合所得稅檔。利用逐步迴歸或probit二分法迴歸方式進行保險對象自付保費負擔與其醫療費用支出之間的公平性探討。
本研究實證結果簡述如下:
一、在被保險人自付保費負擔公平性方面,存在違反垂直公平或水平公平的情況,可能之原因如下:
1.投保金額分級表的上下限差距過小,使所得愈高,其保費增加的比例形成累退。
2.在投保金額分級表中每一等級仍有上下限之規定。
3.三類投保金額過低,與其所得分配差異過大。
4.眷口數計費採論口計費,而通常所得愈低,眷口數有愈多的現象,故論口計費將使得所得較低者之保費負擔加重或同樣所得水準者,負擔不相同的保費情形。
5.各類目均適用同一費率,且同一類目之自付比率均相同,無法有效發揮所得重分配效果。
二、個人醫療費用支出的差異及其與保費或所得高低之間的公平性
1.門診費用受到所得因素影響,個人所得愈高,門診費用有愈高的現象;且因為重症而就醫者仍為少數,以其他一般症狀就醫者仍占多數。
2.重症患者或罹患十大死因患者,多以所得較低或保費較低者居多,顯示全民健保的開辦,確實為較低收入者或較弱勢族群減輕就醫上之財務負擔。
3.由於男性罹患重症之比率較女性高,故雖然女性的門診次數與費用較男性高,但在個人總醫療費用上均以男性較高,可能與其生活、就醫習慣有關;而隨著年齡的增加,個人醫療利用情形與費用均逐漸增加,但對於中壯年人口之男性而言,個人醫療費用有逐漸上升趨勢,值得注意。
故對我國全民健保之政策性建議,為使所得重分配的效果得以發揮,在保費負擔方面,建議提高投保金額分級的上下限差距,且縮短等級之間的上下限,分級數愈多,愈能表現出公平性;眷口數計費改採論被保險人計費;三類投保金額與自付比率應調高。在醫療費用分配方面,為抑制所得較高或保費負擔較多者對醫療資源的不當利用,本文建議改採定率部分負擔、改善城鄉醫療資源分配,保障內容改採保大不保小,抑制不必要及小額的醫療支出,讓社會保險的自助、互助及他助精神得以發揮。
未來期能利用數年的歷年資料,來分析個人或家戶在時間上之所得、保費負擔與醫療費用支出三者之間的分配情形,以更能深入瞭解政策之改變,帶來之效果。 / Equity is widely acknowledged to be an important policy objective in the health care field. The principle comes in two versions: a horizontal version (persons in equal need should be treated the same) and a vertical version (persons with greater needs should be treated more favourably the those with lesser needs).
The purpose of this study is to investigate the equity between the insurees’ premium burden and their medical care expenditures in Taiwan's National Health Insurance Scheme. The sample combines two sets of data, which are data for the insured and their dependents’ premiums and medical expenditures of utilization obtained from the Bureau of NHI ; individual income tax return data obtained from the Data Processing Center of the Ministry of Finance. According the data, we will be able to use the regression model of stepwise and probit methods to analysis the purpose of this study.
The major findings are twofold: First, at present the regulations in the premium exists the horizontal and vertical the inequity, so the system can't bring the income replaecment, About medical dilvery, NHI is favorable person lower-income. To achieve ability to pay, the gap between the upper and bottom of insured payroll-related amount class should be lengthened. And to lighten the burden of insuree with dependents. Second, in the medical delivery deductible amounts paid by beneficiaries will be changed from fixed amounts to fixed rate to control the wasting medical resource.

Identiferoai:union.ndltd.org:CHENGCHI/A2002002026
Creators黃子溦, Huang, Tzu-Wei
Publisher國立政治大學
Source SetsNational Chengchi University Libraries
Language中文
Detected LanguageEnglish
Typetext
RightsCopyright © nccu library on behalf of the copyright holders

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