從德國最新健保改革論其對德國社會保險典範轉變之意義

卑司麥在1883年實施了全世界最早的社會保險制度，然而實施超過一個世紀之久的德國社會保險典範，近來遭遇重大的挑戰。人口結構的變遷、經濟發展全球化與其他制度內外各種因素的影響，使得德國健康保險制度面臨嚴重財務危機，改革無可避免。目前由首位女總理梅克爾所領導的左右派共治大聯合政府，在2007年推動了「健保基金」的改革措施。健保改革方案內容涉及健保基金的設立、稅收補助兒童健保支出以及個人定額醫療給付，強調國家干預、只提供基本健康保障、降低雇主附加成本，這些改革措施可能改變德國社會保險制度原本所具有之自治管理、社會連帶以及雇主社會責任的原則與特徵。本文之研究目的即在透過對德國社會保險典範之特徵與制度限制之探討，分析此次健保基金改革中的各項措施，論述其對德國社會保險制可能轉變之意義。

關鍵字

社會保險典範；健保改革；健保基金；社會連帶；自治管理

並列摘要

The first social insurance was carried out by Bismarck in 1883. The paradigm of social insurance in Germany exists more than one century, with many meaningful institutional characters. But the innovation of health insurance is inevitably, cause of the financial red for many factors. The new reform, namely ”fund of health insurance” from the government of left-right coalition that the first female chancellor Merkel leads, is advanced in 2007. This reform emphasizes on more intervention of state, providing only basic health protection and diminishing additive cost for employer. These measures could change the important and traditional principles of social insurance in Germany potentially, including self-government, social solidarity and social responsibility for employer. This article tries to find out whether this reform is the beginning for the possible change of social insurance paradigm in Germany, by interpreting the institutional characters of paradigm of social insurance in Germany, analyzing the background factors for this reform and the programs of this reform.