美國國家兒童健康保險計劃執行成效之分析

A Study on the Effects of the Implementation of SCHIP

陳雅屏(Chen-Ya Ping)

指導教授 ： 翁興利

國立臺北大學/公共事務學院/公共行政暨政策學系/碩士(2010年)

摘要

美國的健康保險制度乃透過市場運作，以商業保險為主要，政府提供的健康保險主要為彌補商業保險之不足，加以國家負有保障人民健康的責任與義務，故於1997年建立了國家兒童健康保險計劃，提供予低收入家庭兒童健康保險，以降低兒童於就醫時遇到障礙，並提高兒童的醫療服務品質。
本文以美國50州包括哥倫比亞特區的國家兒童健康保險計劃為研究對象，期望探討國家兒童健康保險計畫執行之成效，將研究目的分為三部分：
第一，透過相關研究整理，瞭解美國健康保險的發展，以及SCHIP內涵與影響。
第二，瞭解SCHIP的實行是否能有效提高兒童健康保險人數與比率。
第三，探討影響SCHIP兒童參加人數與健康保險比率之相關因素，並進一步檢視其相關因素之影響效力與可能原因。
研究方法是透過描述性統計、差異性分析與多元迴歸模型方法作實證研究，將自變數分為法案屬性、人口統計與社會經濟屬性，與類別變數；依變數則以低收入兒童健康保險比率作為SCHIP執行成效的測量，透過推論統計方式探討自變數與依變數之間的關係與影響程度。研究結果可以提供未來政府作相關政策擬定時之參考，並提出後續研究建議。
實證分析結果顯示：兒童參與SCHIP比率、聯邦政府提撥率、貧窮人數比率、出生率、淨移民率，與失業率等對於低收入兒童保險比率具有顯著的正向影響力；而SCHIP支出比率、家庭所得、西班牙裔比率，與19歲以下私人保險比率等對於低收入兒童保險比率具有顯著且負向的影響力；此外，州的政黨政治、SCHIP計畫類型，與地理區位亦會顯著影響低收入兒童保險比率。透過文獻整理與實證分析結果，將研究結論歸納為以下幾點：
一、低收入兒童的未保險比率確實降低。
二、SCHIP改善了兒童醫療的可近性與品質。
三、存在私人保險之替代性。
四、州的經費支出、富裕程度、種族/族群與移民會影響SCHIP的執行成效。
五、SCHIP計畫類型、政黨政治、地理區位會對低收入兒童保險比率產生影響。

關鍵字

可近性 ； 醫療服務 ； 健康保險 ； 低收入兒童 ； 承保範圍 ； 國家兒童健康保險計劃

並列摘要

The U. S. health insurance system is operated in an open market. Within this system, business insurance is the main insurance provider, and the governmental health insurance only plays a compensating role to make up the lack of it. Under the responsibility of protecting the citizens, the U. S. government established the State Children’s Health Insurance Program (SCHIP) based on the Balanced Budget Act of 1997, under title XXI of the Social Security Act. In order to lessen the obstacles to the provision of children’s medical care, and enhance the quality of medical service for children, SCHIP offers health insurance coverage for those uninsured children from low-income families.
The main purpose of this study is to investigate the effects of the implementation of SCHIP among the fifty states, including the District of Columbia, in the United States. This study is composed of three sections: First, examine the literature concerning the development of the U.S. health insurance system, its growth¸ and the impact of SCHIP. Second, investigate whether the implementation of SCHIP increases the number and rate of children’s health insurance. Third, explore the main factors of children enrolling health coverage, and further survey the influences and reasons behind these factors.
The independent variables in this study include act attribute, demographic and socioeconomic attribute, and category variables. The dependent variable is the rate of children health insurance. This study uses deduction statistics to understand the relation and effects between the above mentioned independent variables and dependent variable.
By using the methods of descriptive statistics, independent-sample T test, analysis of variance and multiple regression analysis, this study provides some suggestions as guidance for policy makers, and further researchers. The empirical findings reveal that the children’s enrollment rate, federal SCHIP matching rate, poverty rate, bath rate, net migration rate and unemployment rate positively and significantly affect the rate of low-income children with health insurance. Moreover, SCHIP expenditure rate, household income, Hispanic population rate, and private health insurance rate negatively and significantly affect the rate of low-income children with health insurance. In addition, the state’s political party, SCHIP’s type, and geographic regions also have reached statistical significance. The main results of this study are as follows：
1. The rate of uninsured children from low-income families actually fell.
2. SCHIP has improved the access and quality of children’s medical service.
3.The substitution of private health insurance exists through the provision of government health insurance.
4.State’s financial expenditure, degree of state’s wealth, racial/ethnic and migration may influence the effect of the implementation of SCHIP.
5.State’s SCHIP type, political party and geographic region may affect the health insurance of children from low-income family.

並列關鍵字

access ； medical service ； health insurance ； children in low-income family ； health insurance coverage ； SCHIP

參考文獻

Rosenberg, Charles E. 1987. The Care of Strangers. New York: Basic Books, Inc.

Genevieve, Kenney and Justin Yee. 2007. “SCHIP At A Crossroads: Experiences To Date And Challenges Ahead,” Health Affairs, Vol.26 , No.2,March 2007 ,pp.356-369.

Kronebusch, Karl, and Brian Elbel. 2004. “Enrolling Children in Public Insurance: SCHIP, Medicaid, and State Implementation,” Journal of Health, Politics Policy, and Law , Vol.29,2004, pp.451–470.

Lambrew ,Jeanne M. 2007. “The State Children’s Health Insurance Program: Past, Present, and Future,” The Commonwealth Fund, Vol.49, January 2007,pp.1-32.

LoSasso, Anthony, and Thomas Buchmueller. 2004. “The Effect of State Children’s Health Insurance Program on Health Insurance Coverage,” Journal of Health Economics ,Vol.23, 2004, pp.1059–1082.