新加坡模式與美國醫療專用儲蓄帳戶對我國全民健保改革的啓示

Medisave and MSAs-the Relevance for the Reform of National Health Insurance Scheme in Taiwan

陳孝平(Michael-S. Chen)

《社會政策與社會工作學刊》 3卷2期 (1999/12) Pp. 5-35

https://doi.org/10.6785/SPSW.199912.0005

摘要

在我國全民健保改革方案中，採用醫療儲蓄專用帳戶，使個人承擔部分責任，以節制醫療費用，一直都是為人注意的議題。
本文首先介紹新加坡的Medisave制度以及美國若幹州所推行的醫療儲蓄帳戶(MSAs)制度，包括其實施的背景因素以及其利弊得失。其次檢討台灣在考慮實施此項制度時所要檢討的因素，包括公立醫院已呈式微，金融市場是否足以配合，民間保險公司是否能發揮積極正面的功能，以及因缺乏所得重分配功能對經濟弱勢者的影響。
本文推薦以兩種模式來誰動類似MSAs的制度：一是採用三軌制度的健保模式，而使醫療儲蓄帳戶承擔其中一軌之功能；二是採用「社會性管理式競爭」模式，使儲蓄帳戶作為長期照護的部分財源。
由於變數眾多，本文建議以實驗方式先行檢驗此項制度的利弊得失。

關鍵字

醫療儲蓄帳戶 ； 全民健保 ； 醫療強制儲蓄制度

並列摘要

A system modeled on some sort of medical savings accounts (MSAs) or Singapore's Medisave scheme has been a serious alternative, at least for some, to Taiwan's National Health Insurance program.
This article first examines the Medisave scheme implemented in Singapore and the MSAs system in some states of the United States, including their background and the pro's and con's based on their empirical experience. This article then considers the constraints and difficulties if Taiwan were to implement such a program; factors including: the public medical network has been on the wane, the private insurance sector may not be able to pay a constructive role, and the financial market performance might be less than satisfactory. And, the situation of the indigent may be jeopardized, for a Medisave scheme does not promise income redistribution.
I recommend that two models may be taken to implement a MSAs system: one is to construct a three-tier system, and the MSA will provide the financial resources for one of the tiers; the other is to put in place a so-called social managed competition system, in which a MSA will provide part of the dollars for long-term care.
It is difficult to fathom the impact of the new system; this article therefore suggests an experiment before a full-scale implementation.

並列關鍵字

medical savings accounts ； national health insurance ； Medisave

參考文獻

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Minnesota Department of Health(1994).Medical Savings Accounts: A Feasibility Study for the Minnesota Legislature.Minnesota:Department of Health.

Moon, Marilyn, Nichols, Len M., Wall, Susan(1996).Medical Savings Accounts: A Policy Analysis.Washington D. C.:The Urban Institution.