探討健保財務收支失衡：健保收入租稅化以及醫療商品化

Investigation of the Financial Imbalance: Taxability of Health Insurance Revenue and Medical Commercialization

高淑芬(SHU-FEN KAO)

指導教授 ： 黃世鑫

國立臺北大學/公共事務學院/財政學系/碩士(2014年)

摘要

過去學者在探討影響健保財務收支失衡的原因時，多是基於支出面的分析而提出以下的因素：人口老化及少子化現象、衛教觀念缺乏、疾病型態改變、醫療科技進步、醫療服務內容增加以及藥價黑洞。然而，這些對於阻止醫療費用的成長仍舊不足。因此，此篇論文納入健保財務收入面的因素，為了探討影響健保財務收支失衡的支出面以及收入面。
　　依據歷史制度主義中Krasner的斷續均衡分析，此篇論文指出健保財務狀況的演變與健保財務收支失衡之間的關聯性。研究結果發現健保的財務制度改革本身即呈現週期性的動態循環過程。
　　探討健保財務失衡可分二個層面：收入面以及支出面，也就是健保收入租稅化和醫療商品化。依照比較政治經濟制度的觀點來區分一般租稅、指定用途稅與保險費，有助於釐清健保收入的本質是不易調漲的稅收。另一方面，此篇論文探討非營利醫院商業化所形成的醫療商品化，造成醫療支出的不斷成長。
　　總結表示，此篇論文在於探討健保收入租稅化以及非營利醫院商業化之趨勢，進一步找出造成健保財務收支失衡之關鍵所在。

關鍵字

健保收入租稅化 ； Krasner的斷續均衡 ； 歷史制度主義分析 ； 醫療商品化

並列摘要

Researchers of health insurance financial imbalance have often focused on the aspects of expenditure, which include the aging of population and the phenomenon of fewer children, the lack of hygiene education, the change of disease patterns, the advance of medical technology, the increase in medical services, and the black hole in medicine price. However, research which has documented prevention from the medical expense increase is scant. Therefore, the aim of this thesis attempts to involve health insurance financial revenue and explore how expenditures and revenues cause health insurance financial imbalance.
The analysis of the link between the evolution of health insurance financial status and health insurance revenue-expenditure imbalance is based on Krasner’s punctuated equilibrium in historical institutionalism analysis. Results of this study show that the evolution of health insurance financial institution has a cyclical dynamic cycle.
In this thesis, I focus on the two aspects—revenue and expenditure (taxability of health insurance revenue and medical commercialization). Based on the comparative political economic institution, I distinguish among the general tax, earmarked tax, and insurance premiums to give evidence to the viewpoint that health insurance revenue can be seen as an inflexible tax. On the other hand, the commercialization of nonprofit hospitals which causes the medical commercialization has the phenomenon of medical expense increase.
To conclude, this study may be of importance in explaining the taxability of health insurance revenue and commercialized nonprofit hospitals, as well as in providing readers with a better understanding of the cause of health insurance financial revenue-expenditure imbalance.

並列關鍵字

Taxability of Health Insurance Revenue ； Krasner's Punctuated Equilibrium Model ； Historical Institutionalism Analysis ； Medical Commercialization

參考文獻

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