全民健康保險政府財政責任分配之探討－以中央與台北市政府健保爭議案爲例－

An Inquiry about the Responsibilities of Financial Burden between the Central and Local Government on National Health Insurance

陸敏清(Ming-Chin Lu) ； 郝鳳鳴(Feng-Ming Hao)

《中正大學法學集刊》 17期 (2004/10) Pp. 137-175

https://doi.org/10.30094/NCCULJ.200410.0003

摘要

我國健保法施行以來，相關爭議不斷，有關各級政府承擔健保費用一事，更引發中央（健保局）與地方（台北市政府）長期對抗。儘管大法官作成釋字550號，肯定地方自治團體負擔健保財務責任之合憲性，然健保局卻在對北高兩市之追討面臨抗拒，進而循司法程序處理爭議。本文擬以此一爭議案為例，分析健保財務規範之內涵，從而主張要求地方自治團體負擔一定比例之財務責任並無不當，特別是關係著維持住民基本生活之傳統自治任務；而過度要求地方自治團體負擔卻可能危及其財政之穩定與充裕，故本文擬探究：要求地方自治團體負擔健保財務責任之妥當性與分配之合理性；其次，在權責對等之考量下，該分配是否提供地方自治團體適當之參與管道或配套措施？
此外，保險對象之保險費補助亦為本文探討重點。由於對保險對象之保險費補助，現行法乃以職業別或身份別作為基準，而此等設計是否適當？並非無疑義，因其非以補助對象所得之高低為標準，恐有導致不同身份別在繳納保險費上補助失當之情形，使國家補助高所得者而引發公平性之疑慮，甚至影響健保財務之健全性，故本文建議未來宜儘速變更依據所得高低作為補助標準之規定，以符合社會保險之基本精神。

關鍵字

社會法 ； 社會保險 ； 全民健康保險法 ； 健保補助款 ； 保險財務 ； 保險對象 ； 被保險人 ； 投保薪資 ； 眷口數

並列摘要

The article tries to provide a critical review of the financial burden between the central and local governments on National Health Insurance (NHI). Though some constitutional controversies figured out by the Council of Grant Justices' interpretation No.550, it still left few advanced problems worthy to be inquired.
We try to focus our attentions on finding the solutions to the issue at the responsibilities of NHI between central and local governments. For achieving the goal, we first try to discuss the fundamental theories of the duties of financial burden. Second, the article also discusses how to measure out the duties efficiently; it depends on the governments to bear the duties. We suppose that it is not illegal to request the local government to bear partial premiums since local government has the traditional duties to fulfill social security, especially those are related to maintain basic demands of their civics. While oppositely, extreme financial duty means that local government revenues would be deficient in final.
Actually, how to balance the financial burden between central and local government, the key point depends on how to make a thorough examination of the insurance financial system and draft a set of a effective programs to cultivate more sources of revenues and expenses as soon as possible.

並列關鍵字

Social Insurance ； National Health Insurance NHI ； Premium ； Share of Subsidy for Premium ； Responsibility of Financial Burden ； Insurer ； the Insured