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臺灣全民健康保險的醫療支出重分配效果,1995~2000

Redistributional Effects of Health Care Expenditures Under the National Health Insurance Program in Taiwan, 1995-2000

Abstracts


目標:全民健保的實施乃為減少個人就醫的財務障礙,然而,過去幾個橫斷面研究均指出,其保費負擔呈不利窮人的累退分配。由於全民健保自實施以來已歷經多次與保費、部分負擔相關之政策調整,家戶醫療支出重分配效果有必要以時間趨勢的層面作政策評估。方法:本研究究運用1995至2000年主計處家庭收支調查資料,分析不同所得水平間家戶保費負擔及自付醫療費用占可支配所得的比例,並以卡克萬尼指標測量其分配累進程度。結果:(1)與過去研究一致,1995至2000年的家戶保費支出均呈累退分配,惟,其累退性逐年趨緩。(2)1995至2000年的家戶自付醫療費用均比保費負擔呈更明顯的累退分配,惟,其累退性逐年趨。結論:我國的保費分配及自付醫療費用分配的累退程度,與許多OECD國家相仿。不過,保費分配累退性仍有改善空間。此外,全民健保有助於減緩家戶自付醫療費用分配累退性,然而,捨棄對保費結構的調整,而以增加部份負擔揖注健保收入的做法,將不利於家戶醫療支出的分配公平性。

Parallel abstracts


Objectives: One major objective of Taiwan's National Health Insurance Program (NHI) is to remove financial barriers to health care access. Several cross-sectional studies indicate that the distribution of the NHI premium burdens makes low-income people worse off. As the NHI premium structure and co-payment schemes have undergone many changes since its implementation in March 1995, it is essential to examine the distribution of household health care expenditures under him NHI program longitudinally. Methods: By using 1995-2000 Family Income and Expenditure Survey in the Taiwan Area, this study examines the distribution of household premium burdens as well as out-of-Pocket expenditure across income levels. The progressitity of distribution is measured by the Kakwani index. Results: The distributions of premium burdens were all regressive between 1995 and 2000, whereas the regressivity was decreased annually during this period. The distribution of out-of-pockets was more regressive than that of premium, whereas the regressivity also decreased annually. Conclusion: The distributional regressivity of premium burdens and out of-pockets is similar to many OECD countries. However, the equity of premium distribution could be improved by restructuring the payroll taxing scheme. Although the NHI program improves the distributional equity of household out-of-pocket expenditures on health care, expanding co-payment schemes instead of restructuring the payroll taxing design to increase NHI revenue would harm the distributional equity of household health care expenditures across income levels.

References


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石曜堂 Shih, Yaw-Tang、 葉金川 Yeh, Chin-Chuan、 楊漢湶 Yang, Han-Chuan、 羅紀琼 Lo, Joan Chi-Chiung、 張明正 Chang, Ming-Cheng、 吳正儀(1994)。台灣地區國民自付醫療費用調查︰1992年國民醫療保健支出調查之初步發現。中華公共衛生雜誌 Chinese Journal of Public Health。13(6)

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李麗莉(2014)。二代健保合法化過程之研究-以補充保險費為焦點〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU.2014.00945
黃逸芯(2011)。持重大傷病卡患者之就醫公平性:以透析治療及慢性精神疾病為例〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU.2011.00722
劉威辰(2006)。臺灣地區癌症病患使用醫療費用及其財務保障之探討〔碩士論文,亞洲大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0118-0807200916273935
李仁輝(2007)。經濟成長與國民死亡率之關聯─台灣地區之實證研究〔碩士論文,國立中央大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0031-0207200917343165

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