兩岸醫療保險制度變革的比較與剖析

A Comparison of Health Insurance Reform between Taiwan and China

邱文達(Wen-Ta Chiu) ； 朱子斌(Tu-Bin Chu) ； 陳欽腎(Chin-Shyan Chen) ； 劉彩卿(Tsai-Ching Liu)

《醫務管理期刊》 2卷3期 (2001/09) Pp. 1-26

https://doi.org/10.6174/JHM2001.2(3).1

摘要

本研究的目的擬就兩岸醫療保險制度的變革，做一介紹；同時深入地比較及分析兩岸現行醫療保險制度的法律規章。結果發現以涵蓋範圍而言，台灣全民健保制度涵蓋面較廣，包括所有民眾；大陸採行城鎮職工基本醫療保險僅涵蓋在職職工及退休人員。以制度的設計而言，台灣整個制度規劃較大陸簡單明瞭。大陸制度分為三個層級：個人醫療儲蓄帳戶、自負額（最低起付標準）及統籌永金，各個層級亦各有法則規範，相對繁文褥節，不易瞭解。至於個人財務負擔而言，台灣全民健保個人負擔亦較輕微，不僅保費負擔輕，就醫醫療費用部份負擔比例亦較低。此外，由於台灣全民健保對個人醫療費用有負擔上限規定，而大陸卻對保險醫療費用支付有最高額度限制。因此，意味著前者制度較接近社會保險精神，後者則偏向商業性保險。整體而言，由於制度設計的差異，台灣全民健康保險對民眾所提供之醫療保障，較之大陸城鎮職工基本醫療保險尤過之而無不及。

關鍵字

全民健保 ； 城鎮職工基本醫療保險 ； 醫療保險變革 ； 台灣 ； 大陸

並列摘要

The purpose of this paper is to investigate the reform and regulation of health insurance system between Taiwan and Mainland China. The findings are as follows: First, Taiwan's National Health Insurance (NHI) includes more beneficiaries than those in China's reform. Taiwan's system covers all residents (except the incarcerated), but China's system only includes the employees and the retired; second, personal financial burden, including premiums and copayments, in Taiwan is less than that in China; third, there is a ceiling on copayments in Taiwan, but on the contrary a maximum payment limit in China, Since the characteristic of National Health Insurance in Taiwan is close to a social insurance system, the payment is more generous than that in China, which is similar to private health insurance. Additionally, compared to China's complicated reform, which has three tires: Medical Saving Accounts (MSAs), deductible, and social risk-pool fund, Taiwan's NHI is much more simplified.

並列關鍵字

NHI ； urban labor health insurance ； health insurance reform ； Taiwan ； China