我國健康照護財務負擔的公平性：1995-2006

Inequality in Health Care Finance in Taiwan: 1995-2006

蔡貞慧(Jen-Huoy Tsay) ； 高豐渝(Feng-Yu Kao)

《社會政策與社會工作學刊》 14卷1期 (2010/06) Pp. 81-117

https://doi.org/10.6785/SPSW.201006.0081

摘要

過去研究指出，我國健康照護財務負擔在1995至2000年間，社會保險保費和家戶自付醫療費用的分配累退性均逐年減緩。近年所得分配趨勢或全民健保財源籌措的開源節流措施都有明顯變化，可能影響健康照護財務負擔在各所得水平之間的分配公平性，因此，本研究運用1995至2006年主計處家庭收支調查，檢驗2001至2006年期間的健康照護財務負擔分配情形與1995至2000年期間的對照。研究結果指出：社會保險占總支出的比例減少，然其分配由明顯累退，進步到幾乎與所得成等比例；自付費用占總支出比例增加，而分配累退性也更加劇；至於商業健康保險占總支出的比例更是大幅增加，而其分配累進性也明顯降低。這意謂近年全民健保保費公平性雖提升，低所得者的私部門支出負擔卻加重。

關鍵字

全民健康保險 ； 社會保險保費 ； 自付醫療費用 ； 健康照護支出 ； 不均

並列摘要

Previous studies have indicated that both of the distributional regressivity of Taiwan's national health insurance (NHI) premium contributions and out-of-pocket medical expenses were decelerating annually between 1995 and 2000. After 2000, the NHI financing strategies as well as the income distribution in Taiwan have come across great changes and that may influence the distributional effects of health care financial structure as a whole. Therefore, by applying the 1995-2006 Survey of Family Income and Expenditure, this study compares the inequality of health care finance between two periods: 1995-2000 and 2001-2006. The results show that during 2001-2006, the growth of total medical expenditures was more rapidly than previous stage while its distributional regressivity was decreased. Specifically, the percentage of NHI premium contributions to total medical expenditures has been decreased while its distributional effect has progressed. The percentage of out-of-pocket to total medical expenditures was at the same range while its regressivity has deteriorated. As for the purchase of commercial health insurance, it has grown dramatically for the middle-lower income groups as well as those with middle-higher income. Therefore, its share of total medical expenditures has increased while the progressivity has decreased. The results suggest that although it is policy favorable to see the ongoing progressivity of NHI premium contributions, the growth of private sector medical expenditures and their regressivity to income distribution will harm the middle-lower income households.

並列關鍵字

national health insurance ； social insurance contributions ； out-of-pocket ； health care expenditure ； inequality

參考文獻

湯澡薰、郭乃文、張維容(2002)。全民健保醫療服務使用公平性之探討。醫護科技學刊。4(4)，291-304。

蔡貞慧(2004)。我國全民健康保險的所得重分配效果：1995-2000。社會政策與社會工作學刊。8(1)，221-250。

羅紀琼、詹維玲(2007)。醫院總額預算對費用單價與服務量的影響初探。台灣公共衛生雜誌。26(4)，261-269。

張育嘉、黎依帆、汪芳國、鄭守夏(2006)。全民健保實施總額預算制度之初步影響評估：以牙醫和西醫基層爲例。台灣公共衛生雜誌。25(2)，152-162。

蔡貞慧、周穎政(2002)。臺灣全民健康保險的醫療支出重分配效果，1995-2000。台灣公共衛生雜誌。21(5)，373-379。