總額成長率計算公式調整方案對全民健保財務的影響評估

Assessing the Impact of the National Health Insurance Expense Reform Proposal on Health Insurance Finance

林玟嘉(Wen-Chia Lin)

指導教授 ： 韓幸紋

淡江大學/商管學院/會計學系碩士班/碩士(2022年)

https://doi.org/10.6846/TKU.2022.00290

摘要

台灣在2021年正式進入高齡社會，加上新藥及新醫療科技的進步，因此醫療費用年年攀升，且用以評估總額支出的協商因素指標也不符合實際狀況，為了使健保財務收支平衡，衛福部在2020年曾調漲保費費率，若費率超過健保法第18條6％上限規定，將重新制定給付範圍，造成健康保險巨大的財務壓力，故本研究將從支出面進行改革，重新制定「協商因素」的計算方式，將新藥及新醫療科技因子採用生技醫療產業裡「製藥」及「醫療器材」中的無形資產佔總資產的成長率作為指標，並加入歷年協商因素對未來進行推估。另外假設保險給付支出增加營業稅5％，最後再籍由公式推導出平衡費率。研究結果顯示現行制度與各個方案間差異不大，但額外的預算可給付新藥及新科技所衍生的費用，利用徵收營業稅的方式可使金流互相勾稽。本研究建議應將總額成長率計算公式依現況進行修正，並配合收支連動機制，方能使健保永續發展。

關鍵字

全民健康保險 ； 總額支付制度 ； 協商因素

並列摘要

Taiwan officially entered an aging society in 2021; combined with the development of new drugs and medical technology, medical expenses have been rising annually, and the negotiation indicators used to determine total expenses do not reflect the actual situation. The Ministry of Health and Welfare increased health insurance premium rate in 2020 in order to balance health insurance earnings and expenses. If the rate surpasses the 6 percent cap specified in Article 18 of the National Health Insurance Act, the scope of benefits will be redrawn, resulting in significant financial pressure on health insurance. Consequently, this research has implemented reforms from the expense side, reformulated the calculation method of "negotiation factors," and used the new drugs and new medical technology factors to account for the growth of total assets using the intangible assets of "pharmaceuticals" and "medical equipment" in the biotechnology medical industry. The rate was employed as an indicator, and the negotiation factors over the years were included to anticipate future development. In addition, it is anticipated that the insurance payment expense will increase by 5％ of the business tax, and the formula deduces the balance rate. The research findings have indicated that there is minimal distinction between the current system and other solutions. However, the additional budget can be used to cover the costs associated with new drugs and technology, and the usage of business taxes can connect the money flows. This research has suggested that the formula for determining the overall growth rate should be updated to reflect the current scenario and integrated with the revenue-expenditure linkage mechanism in order for the health care industry to grow sustainably.

並列關鍵字

National Health Insurance system ； global budget ； negotiation factors

參考文獻

參考文獻

中文部分

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