中央健康保險局經營現況之研究－以代理人理論分析

A Study of the Operation of the bureau of National Health Insurance-An Agency Theory Approach

吳育巧(Yuh-Chiao Wu)

指導教授 ： 蘇彩足

國立臺灣大學/社會科學院/政治學研究所/碩士(2005年)

https://doi.org/10.6342/NTU.2005.02834

摘要

臺灣全民健康保險於民國84年3月1日開辦，使社會不分男、女、老、少、貧、富、病、殘，皆擁有共同基準的醫療照護品質，實現廣大民眾就醫的可近性。另對照臺灣家庭醫療保健支出（NHE）占國民生產毛額（GDP）結果，從該社會醫療保險開辦自今，皆持平在6%以下，遠低於英、法、德、美、日等先進國家，中央健保局之經營結果，應有實現全民就醫保障，與不增加政府財政負擔之目標。但中央健康保險局仍難免於面對財務失衡之事實，至民國91年為調整保險費率，引發行政與立法朝野對決下，各界一連串對全民健保制度產生高度的信賴危機，但其間存在因多重代理(multiple-agency)關係之權責混淆、資訊複雜，致使民眾不易釐清責任歸屬，也使各界對此項公共政策之執行，產生交易成本問題。
為釐清社會醫療保險在財務失衡時之經營問題，本研究以醫療具殊價財之特性，及以行政公權經營之角度，以代理人理論，觀察臺灣全民健康保險經營之關聯面向，及其實務上面臨之困境，並蒐集規劃時期相關研究文獻之理性選擇，及健保開辦至今之實務統計資訊，以探討現制保險人之經營成效，並進一步分析其執行過程可能存在多重代理之問題。面對全球化下之民主政治社會環境，終究社會醫療保險制度應有降低醫療供、需間高度的交易成本問題，以發揮促進醫療照護公平之功能，而代理理論將對某些治理安排所洐生的代理成本問題，提供有力的解釋與分析。
總而言之，此項社會保險體制，在其經營運作上，惟有回歸嚴謹的制度化，以實現社會保險自助互助精神、落實保險基金專款專用、提昇行政與財務資訊透明化、擴大各關聯面向之信賴與承諾，才能期待委託與代理人皆能履約且善盡職責，方能為健保之財務平衡目標，找出經營的核心價值與定位。

關鍵字

全民健保 ； 中央健康保險局 ； 委託代理 ； 交易成本 ； 代理成本 ； 多重代理

並列摘要

National Health Insurance (NHI) was established on March 1st, 1995 in Taiwan. Under this system, the availability of medical treatment is achieved and all walks of life enjoy the same standard of quality care. However, since the dawn of NHI, the ratio of NHE to GDP keeps under 6%, far below the corresponding figure of other developed countries (Britain, France, Germany, USA, Japan and etc.). The goal of operation strategy of the agent, Bureau of National Health Insurance (BNHI), is to ensure the national medical care without increasing the financial burden of government. Then again, the operation of BNHI is unavoidably up against financial unbalance. In 2002, confronting position between the government and opposition parties about the adjustment of insurance premium led to a series of distrust crisis to the system of NHI. However, confusions about the authority of multiple-agency and complexity of relevant information not only make the general public mix up the responsibility ruination, but also cause the problem of transaction costs while this policy is executed.
This study aims to rectify the operation of social medical insurance under financial unbalance. Concerning the merit-good property of medical care, observation upon the operation of NHI and the associated dilemma was conducted via the theory of agency from the viewpoint of public administration. Through collection of pertinent documents and statistic data, this study also explored the efficiency of current system and analyzed the derivative issues during execution of multiple-agency. Within an environment of globalization, the function of social medical insurance is to reduce the high transaction cost between medical need and supply and to promote fair medical care. However, under current policy, it seems to arouse some agency-cost problem and the transaction-cost problem from the system itself.
In conclusion, operation of this social insurance must return to exact institutionalization, such as achievement of the spirit of self and mutual assistance, implementation of earmarked specified funds, limpid disclosure of administration/finance information and expansion of the commitment for the system. In this way, the commission and agent proxy could fulfill respective promise and duty, and the orientation and core value of this non-commercial operation system could be found.

並列關鍵字

BNHI ； Multiple-agency ； NHI ； Agency Costs ； Theory of Agency ； Ttransaction Costs

參考文獻

中央健康保險局，2003b（11月初），全民健康保險法規要輯。

行政院衛生署，2001，中華民國九十年衛生統計。

吳英明，1992，〈威權政治體制民主化過程中公共行政的發展〉，《中國行政評論》，第一卷，第二期：1-26。

楊志良主編，1995，《健康保險》，台北：巨流。

中央健康保險局，2003c，全民健康保險九十二年四月業務執行報告，全民健康保險監理委員會第九十六次委員會議（5月30日）。