我國全民健康保險體制的改革理念

An Economic Perspective on Reforming the National Health Insurance Program

盧端芬(Jui-Fen Rachel Lu) ； 湯明哲(Ming-Je Tang)

《中華公共衛生雜誌》 17卷3期 (1998/06) Pp. 198-205

https://doi.org/10.6288/CJPH1998-17-03-08

摘要

政府公共服務民營化可謂是全球趨勢。自民國82年國內決策者及學者和國外的醫療顧問，即紛紛提出將全民健保承保機關定位為「公辦民營」的觀念，然而終因缺乏具體實施方案，及全民健保相關條件未臻完備的情況下，在立法過程終遭否決。但是全民健保法中亦規定，全民健保實施期滿兩年須提出執行評估及全民健保改制方案。目前全民健保已開辦近兩年，各界的討論改革方案亦紛紛出籠。可見改革一案，如箭在弦上，不得不發。本文將從管制經濟學及公共行政學的學理出發，探究政府管制／市場機制與醫療經營的關係，並提出具體的改革方案。全民健保宜部分開放民營，以引進市場機制，提昇經營效率。顧及民意及全民健保具社會福利的意義，宜採「公辦民營」的方式進行。由中央健保局繼續辦理原先的保險型態，此外開放民間經營的健康維護組織(Health Maintenance Organization, HMO)，使民眾有選擇的機會。

關鍵字

合辦民營 ； 健康維護組織 ； 承保機構之屬性 ； 民營化

並列摘要

Privatization of government services has been a popular trend around the world. Since the inception of National Health Insurance (NHI) in 1993, health policy-makers as well as domestic and foreign consultants have advocated a fundamental change in the administration of NHI Program, namely, toward a quasigovernmental agency program. The concept, however, was not accepted by legislators due to a lack of a concrete implementation proposal and a suitable environment. Nonetheless, the NHI law required that the NHI program would be closely evaluated and proposal for new systems would be presented two years after its implementation. This paper proposes a public-owned private-run system based on the theories on regulatory economics and public administration. We suggest that the NHI program should be partially privatized to introduce market mechanisms, promote competition and to improve the efficiency further. However, the government involvement should be maintained, since the general public prefers the government as a fallback for fear of bankruptcy; and the NHI program has social welfare implications. It is therefore to recommend that Bureau of NHI runs a comprehensive insurance program and call for private HMOs.

並列關鍵字

quasi-governmental agency ； HMO ； privatization ； National Health Insurance NHI