臺灣全民健康保險的醫療支出重分配效果，1995~2000

Redistributional Effects of Health Care Expenditures Under the National Health Insurance Program in Taiwan, 1995-2000

蔡貞慧(Jen-Huoy Tsay) ； 周穎政(Ying-Jenq Chou)

《台灣公共衛生雜誌》 21卷5期 (2002/10) Pp. 373-379

https://doi.org/10.6288/TJPH2002-21-05-07

摘要

目標：全民健保的實施乃為減少個人就醫的財務障礙，然而，過去幾個橫斷面研究均指出，其保費負擔呈不利窮人的累退分配。由於全民健保自實施以來已歷經多次與保費、部分負擔相關之政策調整，家戶醫療支出重分配效果有必要以時間趨勢的層面作政策評估。方法：本研究究運用1995至2000年主計處家庭收支調查資料，分析不同所得水平間家戶保費負擔及自付醫療費用占可支配所得的比例，並以卡克萬尼指標測量其分配累進程度。結果：(１)與過去研究一致，1995至2000年的家戶保費支出均呈累退分配，惟，其累退性逐年趨緩。(2)1995至2000年的家戶自付醫療費用均比保費負擔呈更明顯的累退分配，惟，其累退性逐年趨。結論：我國的保費分配及自付醫療費用分配的累退程度，與許多OECD國家相仿。不過，保費分配累退性仍有改善空間。此外，全民健保有助於減緩家戶自付醫療費用分配累退性，然而，捨棄對保費結構的調整，而以增加部份負擔揖注健保收入的做法，將不利於家戶醫療支出的分配公平性。

關鍵字

全民健保,保費,自付醫療費用,所得分配,累進位

並列摘要

Objectives: One major objective of Taiwan's National Health Insurance Program (NHI) is to remove financial barriers to health care access. Several cross-sectional studies indicate that the distribution of the NHI premium burdens makes low-income people worse off. As the NHI premium structure and co-payment schemes have undergone many changes since its implementation in March 1995, it is essential to examine the distribution of household health care expenditures under him NHI program longitudinally. Methods: By using 1995-2000 Family Income and Expenditure Survey in the Taiwan Area, this study examines the distribution of household premium burdens as well as out-of-Pocket expenditure across income levels. The progressitity of distribution is measured by the Kakwani index. Results: The distributions of premium burdens were all regressive between 1995 and 2000, whereas the regressivity was decreased annually during this period. The distribution of out-of-pockets was more regressive than that of premium, whereas the regressivity also decreased annually. Conclusion: The distributional regressivity of premium burdens and out of-pockets is similar to many OECD countries. However, the equity of premium distribution could be improved by restructuring the payroll taxing scheme. Although the NHI program improves the distributional equity of household out-of-pocket expenditures on health care, expanding co-payment schemes instead of restructuring the payroll taxing design to increase NHI revenue would harm the distributional equity of household health care expenditures across income levels.

並列關鍵字

National Health Insurance,Premium,Out-of-Pocket,Income Distribution,Porgressivity

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