全民健康保險制度安全準備餘絀影響因素分析

The Influencing Factor Analysis of Security Reserve Fund for Taiwan's National Health Insurance Program

蕭志同(Chih-Tung Hsiao) ； 劉仲戌(Chung-Shu Liu) ； 梁秀精(Hsiu-Ching Liang) ； 吳靜芳(Ching-Fang Wu)

《臺灣企業績效學刊》 5卷2期 (2012/06) Pp. 241-255

https://doi.org/10.6697/TBPJ.201206_5(2).0004

摘要

台灣自1995年開辦全民健康保險制度以來，不久即產生收支長期失衡，使得安全準備餘絀不斷地遞減而成為重要的議題。雖然政府總是希望調漲保險費率增加收入，維持財務平衡與制度的正常運作，然而因為部分地方政府拖欠保費，醫院採購的藥價黑洞，健保局人員高額年終獎金爭議，部分民眾浪費醫療資源，醫院詐領保費事件層出不窮以及受政治等因素影響，使得保險費率調整非常不易。事實上影響全民健保制度之安全準備餘絀的因素眾多，這些變數交互影響而形成一個複雜系統。本研究以宏觀角度，透過系統動態學方法論，探討影響安全準備餘絀因素之間，彼此互動之因果關係結構，以增加此複雜系統行為之了解。本文亦討論二代健保政策、人口老化、醫療科技的進步，對於醫療費用支出與安全準備餘絀可能的影響。

關鍵字

全民健保 ； 安全準備餘絀 ； 系統動態學

並列摘要

Taiwan's national health program system has been commenced in 1995, and it successfully reduces the gap in access and health among different income levels and groups. However, soon after its inauguration, the system encountered the balance problem of budget. Although the Government always wants to adjust the premium rates so as to increase the revenue to meet the fast growth of payments and to maintain the normal operation of the system, it is difficult to get consent from the public and legislative representatives because of some controversial issues, such as delayed payments by various branches of government, the drug price black hole, the controversy over high annual year-end bonuses for employees of Health Insurance Bureau, the waste of medical resources by some people, the growing incidence of fraud premium claims from some hospitals, and other political factors. In fact, many factors affect the accumulation of reserve fund of National Health Insurance, and they interact and influence each other to form a complex structure. In this study, we take a whole view and apply system dynamics to investigate the interaction and causality among factors that affect the balance of NHI reserve fund to increase the understanding of this complex behavior. The impacts of the second-generation health insurance policy, aging population and advances in medical technology on the NHI fund reserve are also discussed in this paper.

並列關鍵字

National Health Insurance ； System Dynamics ； Security Reserve Fund

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