地方政府負擔全民健保保費補助款制度爭議問題之研究－以臺北巿為例

從1995年3月1日開始實施的全民健康保險制度，以全體國民為保障對象，並提供完善的醫療保健服務。但當全民健保制度開始施行後，保險財務的問題卻日益嚴重，其中地方政府負擔健保保費補助款的部分，尤其是臺北巿政府，在司法實務與政策執行上持續地引發爭議問題。地方政府負擔全民健保保費補助款制度使中央健康保險局與臺北巿政府間發生權限衝突的爭議問題。雖然司法實務上有大法官會議解釋及行政法院的裁定或判決，然而至今臺北巿政府仍積欠應負擔的保險費。本文為求深入分析問題，除了介紹相關法律規定與司法實務見解外，更嘗試從政策網絡及府際管理的觀點，探討地方不願負擔健保費的原因，希望能釐清中央與地方爭議之焦點所在。根據研究結果，筆者贊同全民健康保險法第二十七條規定地方政府應負擔健保費具有合憲性，但考量地方財政狀況與健保保險財務的性質後，未來應修改本條規定，由中央負擔全部的健保費；至於地方積欠的健保費，也應溯及既往不再追究。其次，從政策網絡類型觀察，地方負擔健保費補助款屬於「議題網絡」；在中央與地方負擔健保費的互動關係中，則為「衝突與議價模式」的政策執行力模式，使得地方不願配合中央的健保政策。最後，中央與地方仍要盡力維持和諧的關係，協力達成行政目的，如採用行政訴訟的方式解決地方負擔健保費的爭議問題，則應選擇「一般給付訴訟」的訴訟類型作為爭議解決途徑。

關鍵字

地方政府；全民健保；政策網絡；府際管理；中央與地方政府

並列摘要

From the mid-1990s run by the National Health Insurance(NHI) system to all citizens for the protection of objects, and to provide comprehensive health care services.However, the beginning of the implementation of NHI system, the insurance financial problems are becoming increasingly serious, which the local government health insurance premium subsidy burden on some, especially the Taipei Municipal Government, in the judicial practice and policy implementation on the issue of continuing controversy. Burden on local government NHI premium subsidy system to enable the Central HealthInsurance Bureau and the Taipei Municipal Government of conflict between rightsissues.Although the practice of judicial interpretation of some High Court judges and the Administrative Conference of the award or decision, however, still has the Taipei Municipal Government shall pay the premium owed. Depth analysis for the sake of this article, apart from introducing the relevant substantive law and judicial opinion, but more attempts from the policy network and intergovernmental management point of view to explore the places are not willing to pay health insurance for various reasons, hoping to clarify the central and local focus of controversy. Based on the findings, I believe that the 27th National Health Insurance Act provides health insurance costs should be burden by the local government still has a constitutionality, but considering the financial situation of local finance and the nature of health care insurance, the future should be to amend the provisions of this article, the burden of all by the Central Health Insurance fees; As health insurance costs of local debt, it should not be held retroactive. Secondly, the burden of health insurance costs of local subsidies are "Issue network" policy network type; in the central and local health care costs burden on the interactive relations, is "conflict and bargaining model" mode of execution of implementability, with the central authorities do not want to make local health care policy. Finally, the central and local governments still have to make every effort to maintain a harmonious relationship, such as settlement of administrative proceedings where the burden of the contentious issue of health care costs, you should select the "General Payment litigation " type of litigation as a means of dispute resolution.