醫療體系中的法律關係之研究
—以加拿大、德國、台灣和美國的公共衛生基礎設施改革趨勢作為實際模型

中文摘要健康權的概念最早出現於1948年的世界衛生組織憲法，其中闡明了人人享有可達最高標準健康的權利。在其他國際協定中，例如：世界人權宣言，國際經濟，社會，文化權利公和殘疾人權利公約中更進一步定義，“人人有權享有足以使自己及其家人的健康和福利，包括食物，衣物，居住和醫療以及必要的社會服務。世衛組織在2016一項政策簡報中指出，全民健保可完善公眾的健康權；隨者時間的演進，世衛組織更將2018定為全民健保目標年。健保的可近性，品質，醫療普及度非一日可及。美國聯邦最高法院 National Federation of Independent Business v. Sebelius”，567 U.S. 519(2012) 判決強調，所有美國人在西元 2014年前都應具有醫療保險，King v. Burwell, 576 U.S. ___ (2015) 更進一步裁定，保險費免稅額可適用於在州和聯邦之間進行醫療保險交易市場的人民。上述二件判決意見，足見維護國民健康的決心已儼然成為世界衛生組織及各國政府的共識。本論文著重研究分析健康機構，醫療人員，保險公司和保險人之間的法律關係，以便就醫療保險制度改革問題提出法院意見並總結學者的意見。國家健康保險制度是在不同國家的實踐，如台灣和加拿大，以低百分比的保險費率適用於照護系統而聞名，且其覆蓋率亦達高百分比的人口數。然而，沒有一個系統是完美的，加拿大手術等待名單問題和在過去十年台灣醫療工作者過度勞累問題也在提高。由於文化性和根本性的差異，在不同國家的比較醫療照護系統之間政策和費用是極其困難的。通過了解每個醫療照護系統的強項和優點，作者期望能找到未來可能的改善方案和各公共衛生照護系統的進步空間。

關鍵字

健康權

並列摘要

The idea of Right to Health was first appear on the Constitution of World Health Organization in 1948, illustrated the right that “the enjoyment of the highest attainable standard of health. In other international agreement, such as: The Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights and the Convention on the Rights of Persons with Disabilities also states that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.” In a recent policy briefing of WHO states that “Universal Health Care system will improve general public’s Right to Health.” Under the Constitutional reviews in the United States, National Federation of Independent Business v. Sebelius, 567 U.S. 519(2012) upheld that obligation that all American need to be health insured by 2014 and King v. Burwell, 576 U.S. ___ (2015), the court decided that the expense of premium tax credit to qualifying persons in federally-run and states-run exchanges. As the time goes by with the author’s research that in 2018, 70th anniversary year of WHO with its goal of Universal Health Care in 2018 marking World Health Day 2018 - Universal Health Coverage. The Author wishes to examinate different reformation effect from a legal researcher point of view with relative medical efficiency of each system. , WHO is calling on world leaders to live up to the pledges they made when they agreed the Sustainable Development Goals in 2015, and commit to concrete steps to advance #HealthForAll. This means ensuring that everyone, everywhere can access essential quality health services without facing financial hardship. This study will analyze the legal relationship between insurer, payee, and health institute and medical workers to brief court opinions and summarize scholar review on the issue of health care system reform. Universal health care systems were practiced in different countries, such as Taiwan and Canada. They are famous for putting low percentage of rate into the funding pool of health care system but cover highly percentage of the population. However, none of the system is perfect with problems of long-waiting-list for surgery in Canada and overwork issues among Taiwanese medical workers also rising in past decade. With cultural and fundamental differences, it is tremendously difficult to compare policy and expense between the health care systems in different countries. By appreciating the strength and benefit each health care system has, the writer expects to find possible future improvements and progression in public health care systems. Issues that related to my research legal problem will be many medical doctors, health policy analysts, public health researchers, health economist, had been working on these topics and are still developing in theories, laws, and economy models to help development in health care system in many different countries. This paper wrote about one specific compensation concern in Medicare Part C in the United States of America. The author’s next research interest will be study some of the studies done by those researchers. The author, myself, am Taiwanese and would like to write more about Taiwanese National Insurance Health system in comparison with Canada and the system in United States of America. Also, as many scholars predicted that the Health care system in USA after reformation will be most similar to the Health care system in Germany. That will be author’s next study interest as well.