- 學位論文
全民健康保險收入改革方案對健保財務之影響評估
Assessing the Impact of the National Health Insurance Revenue Reform Proposal on Health Insurance Finance
摘要
近年來台灣因人口老化與少子化之影響，全民健康保險財務狀況面臨嚴重赤字，若不加以改革，以現行制度推估至2060年其保費費率恐高達40%，超過全民健康保險法第18條費率上限6%之規定。且為維持財務平衡，費率呈現階梯式成長，亦即每兩三年需調漲保費費率，可能引起民眾的反彈。故本研究從全民健康保險收入面進行改革，以家戶總所得取代現行制度下的一般保費與補充保費，或將現行制度微調，調升營業稅稅率、課徵食品健康捐或環境稅作為健保其他補充收入，探討是否能夠有效改善全民健康保險財務狀況。研究結果發現，短期政策建議將現行制度微調，並加入補充性財源，將營業稅稅率調升、課徵食品健康捐或課徵環境稅作為健保其他收入，可抑制保費上升的速度。從長期來看建議推動家戶總所得制度，家戶總所得制度除了擴大保費費基，增加保費收入的彈性外，亦可延緩費率上漲的速度，且有效改善健保的財務狀況。
並列摘要
In recent years, Taiwan's national health insurance has suffered a serious financial deficit due to the country's aging population and dropping birthrate. If no reforms are implemented, it is anticipated that by 2060, the insurance premium rate under the current system might reach 40%, exceeding the 6 percent cap specified in Article 18 of the National Health Insurance Act. Moreover, in order to maintain financial stability, the insurance premium rate has exhibited a gradual increase; that is, the premium rate must be raised every two or three years, which may result in a public backlash. Consequently, this research has examined, from the perspective of national health insurance income, whether replacing the general and supplementary premiums under the current system with the total household income, or fine-tuning the current system, increasing the business tax rate, levying food health surcharges or environmental taxes as other supplementary income can effectively improve the financial situation of national health insurance. According to the findings of the study, the immediate policy recommendations are to fine-tune the current system and add additional financial resources. Increasing the company tax rate, levying food health surcharges, or imposing environmental fees as new sources of funding for health insurance can help to keep insurance costs from rising. Long-term implementation of the total household income system is advised. In addition to expanding the premium base and enhancing the flexibility of premium income, the total household income system can significantly improve the financial situation of health insurance by delaying the pace of premium rate increases.
參考文獻
延伸閱讀
- 劉宜君（2016）。全民健康保險會運作效能之評估研究：健保會委員之觀點。社會政策與社會工作學刊，20(1)，85-128。https://doi.org/10.6785/SPSW.201606_20(1).0003
- 劉夷生、郝宏恕、劉紹興、江淑娥（2005）。全民健康保險實施醫院門診合理量對醫療服務之影響評估。醫務管理期刊，6(4)，347-360。https://www.airitilibrary.com/Article/Detail?DocID=16086961-200512-6-4-347-360-a
- 陳惠芳、謝明娟、陳俞成（2006）。全民健保實施前後醫院財務面經營績效之研究。嘉南學報（人文類），(32)，303-316。https://doi.org/10.29539/CNABH.200612.0001
- 林振輝、羅紀瓊（1999）。以保險費為自負額之改革對健保財務影響之分析。經濟研究，36(2)，121-144。https://www.airitilibrary.com/Article/Detail?DocID=10181245-199907-36-2-121-144-a
- 連賢明（2008）。How to Use National Health Insurance Data to Conduct Health Economics Research。經濟論文叢刊，36(1)，115-143。https://doi.org/10.6277/ter.2008.361.4