論公共安全事故保險人的代位權-以全民健康保險法代位求償制度為範圍

Examining Subrogation in Association with National Health Insurance in Public Safety Accidents

何盈蓁(Ying-Chen He)

指導教授 ： 劉宗榮

共同指導教授 ： 汪信君(Hsin-Chun Wang)

國立臺灣大學/法律學院/法律學研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.01650

摘要

我國自民國84年3月1日開始施行全民健康保險法，並將原其他社會保險醫療保障部分整併為全民健保，使台灣正式進入全民保險。然而，醫療費用支出逐年增加，健保開辦不過數年自民國87年開始財政上已入不敷出，筆者認為檢討現行健保局代位求償制度，並進一步改進落實，有助於健保財務之改善。
雖全民健康保險法於94年將中央健保局行使代位求償權的範圍擴及至公共安全事故、其他重大之交通事故、公害或食品中毒事件等。然而，上開擴大代位求償制度雖已建立，但就健保局代位求償權之性質、求償範圍等傳統上之爭點並未進一步釐清，且新增訂之法規將公共安全事故、其他交通事故、公害及食品中毒事件分立為2款，適用上容易產生矛盾，又現行各法規強制投保之規定紛亂，均額外增加健保局行使代位求償權之複雜性。再者，擴大代位求償制度自開始行使迄今8年，成效始終不佳，無論於案件數量及請求之金額均不及同條第1款於汽車交通事故中向強制汽車責任保險保險人代位請求之效果，請求的成本亦遠高於汽車交通事故。
針對上開擴大代位求償制度衍生之問題，筆者希望藉此論文，參酌相關立法例、學說理論、判決實務及實際數據之分析比較中，為我國全民健康保險於公共安全事故之代位制度，尋求檢討改進之方法。

關鍵字

全民健康保險法 ； 公共意外安全事故 ； 代位求償權 ； 責任保險 ； 公共意外責任保險 ； 強制保險

並列摘要

The National Health Insurance Act came into force on March 1, 1995 which consolidated the original portions of social insurance and medical care into National Health Insurance (NHI) as a whole, facilitating in Taiwan's progress in a universal coverage. However, medical expenses increased year by year that since 1998, NHI has caused to make ends meet financially with its being launched not a few years ago; I believe that the review of existed subrogation system of National Health Insurance Bureau (BNHI) and further improvement as well as implementation may be helpful to improve finance condition behind NHI.
Although the National Health Insurance Act expanded the scope of subrogation rights exercised by BNHI to a range of public safety accidents, other severe accidents, pollution or food intoxication. However, even though the aforementioned expanded subrogation system has been established, for the contention as to traditions including but not limited to the nature of subrogation, claiming scope have not been further clarified, plus that in the supplementary version of the Act, such events as public safety accidents, other types of traffic accidents, pollution and food intoxication are divided into two subsections, which are prone to cause conflict; besides, the chaos derived from each existed provision as to the compulsory insurance have extra complexity in the exercise of subrogation rights by BNHI. Furthermore, it has been 8 years since such expanded subrogation system was exercised that results have been poor, where no matter the number of case or amount in the request, has not reached subrogation requested to the insurer in the compulsory automobile liability insurance for car accident set forth in Subsection 1 of the same article and the cost behind is also much higher than that in a car accident.
For some issues incurred with the aforementioned expansion of subrogation system, I would like to consider some sorts of analysis and comparison as to relevant legislations, academic theories, practices of judgments and actual data in this thesis to seek any way of reviewing and improving such subrogation system specified for NHI applying public safety incident.

並列關鍵字

The National Health Insurance Act ； public safety accident ； subrogation ； liability insurance ； public liability insurance ； compulsory insurance

參考文獻

9. 全民健康保險監理委員會第203次會議紀錄 (2012)。

8. 林群弼 (2003)。保險法論，增訂二版。三民書局。

11. 林輝榮著 (1974)。論保險代位一以其理由根據為中心，台大法學論叢第3卷第2期，頁367以下。

10. 林李達 (2002)。我國全民健康保險代位求償之研究，國立成功大學法律學研究所碩士論文。

18. 游淑君 (2007)。兩岸強制汽車責任保險法制重要問題比較研究，國立政治大學風險管理與保險研究所碩士班論文。