民眾健康責任歸屬信念、健保議題認知與政策選擇偏好

Public beliefs of health responsibility, perceptions of National Health Insurance issues and policy preferences

余珮婷(Pei-Ting Yu)

指導教授 ： 許玫玲

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2013年)

摘要

全民健保的改革，透過修正政策制定包括補充保費、實施家庭責任醫師制度和擴大民眾參與。
本研究目的為民眾健康責任信念、健保的議題認知例如醫療資源浪費等問題；在健保有限資源之下，民眾若需要擁有家庭醫師，就必須在就醫權益上受到限制；以及為讓健保永續經營的政策偏好選擇為何(增加保費、增加部分負擔、減少給付範圍)。本研究採質性研究方式，研究對象為13為不同背景的受訪者。
本研究結果顯示受訪者認為健康是自己的責任，且認同家庭責任醫師制度。受訪者認為有醫療資源浪費的議題，民眾與醫師都應該要負責。關於解決財務困境的方式，受訪者直覺是為增加部分負擔。有些受訪者對於健保議題有許多的想法，有兩位首訪者認為在參與政策制定之前應該對於議題要有足夠的知能。有四位受訪者認為贊成實施論人計酬制度。僅有一位受訪者認為提高保費，她認為互助精神才是健保初衷。無論如何，健保教育程度較低者對健保議題認知和政策選擇能力較為薄弱，其中僅有一位受訪者不清楚健保議題。
結論，在政策制定民眾扮演一個重要的角色，最重要的是民眾要對健保議題的有足夠的認知，才能獲得具體得建議。

關鍵字

政策選擇偏好

並列摘要

To reform National Health Insurance (NHI), the revised NHI Act included policies such as the introduction of supplementary insurance premium, the vision of implementing an accountable family physician system and more emphasis on the input of public opinions in decision making.
The objectives of the research were to understand individuals’ beliefs of health responsibility, their perceptions regarding NHI issues such as waste in health care utilization, if they need a family physician and if they are willing to give up some freedom in health care use given that health care resources are limited, and finally, which policy options (increase premiums, increase copayment and/or decrease benefits) would they prefer for the long-term sustainability of NHI.
This study used qualitative methods and interviewed 13 people with various backgrounds. Results showed that almost all interviewees agreed individuals are responsible for their own health. Most of them agreed with the idea of family physician and they would rather choose one by themselves. Most of them recognized waste in health care utilization is an issue, for which providers and patients are both accountable. Regarding policy preference to deal with financial deficits of NHI, the most intuitive choice was to increase copayment. Some interviewees with more knowledge about NHI seemed to be more thoughtful. Two expressed that certain conditions should be met before any policy choice being made. Four interviewees even agreed the ideas of capitation. Only one person would choose increasing premium because of the belief in mutual aid society. However, less educated people are less capable of comprehend the NHI issues and policy options. One interviewee acknowledged that she had no idea about NHI issues. In conclusion, for the public to play a more important role in policy decision, it is crucial to understand public perceptions of NHI issues, and how, what and whose opinions are obtained.

並列關鍵字

policy preferences

參考文獻

參考文獻

中文部分

藍忠孚、鄭惠珠(1991)。健康保險部分負擔的理論與論證。公共衛生，18(1)，1-17。

陳金貴(1992)。公民參與的研究。行政學報，24，95-128。

張秀雄(1999)。我們要培養怎樣的公民資質。國立編譯館通訊，12(4)，40-49。