我國全民健康保險保費負擔公平性之研究

The study on the equity of premium payable in the National Health Insurance system

王重竣(Chung-Chun Wang)

指導教授 ： 賴曜賢

淡江大學/商管學院/保險學系保險經營碩士班/碩士(2014年)

https://doi.org/10.6846/TKU.2014.00004

摘要

全民健康保險是我國重要的社會保險制度之一。自1995年實施起，其被保險人保費負擔公平性的爭議，一直備受民間探討，一代健保在量能原則的基礎下，被保險人保費負擔方式兼採論職業計費與論口計費的雙軌制。除此之外，投保金額以被保險人的經常性薪資為費基，不僅無法顯示實際所得能力，且當被保險人所得愈高其經常性薪資佔所得比例反而降低，造成保費負擔的累退現象。另一方面，論職業計費與各類目被保險人自付比例的顯著差異，誘使被保險人轉換身份投保規避保費，嚴重破壞保費負擔公平性。

2013年二代健保上路，欲透過課徵補充保費的方式，更加落實量能原則與解決保費規避的問題，提升保費負擔公平性。然而執行一年後，補充保費所生的公平性爭議與規避問題仍層出不窮。

本研究欲透過社會公平正義的角度，運用亞里士多德與羅爾斯所提出的正義理論，分析一代健保與二代健保的保費負擔制度，並找出造成保費負擔公平性失衡的關鍵，進而提出建議，供未來改革參考。

關鍵字

全民健康保險 ； 二代健保 ； 保費負擔 ； 公平性 ； 補充保費

並列摘要

The National health insurance (NHI) is an important social insurance system in Taiwan. It had been criticized by people on the equity of the insured’s premium payable since 1995.

Under the principle of affordability to pay, NHI calculated the insured’s premiums according to the insured’s occupation class and the number of his /her dependents. However, due to the regular salary of the insured as premium base, the premium payable of the insured could not be consistent to one’s actual earning power . As a result, while the regular salary of the insured is getting high, the premium payable is regressively low. On the other hand, we showed that different insured had significantly different self-payment ratio. It followed that the insured may change their status in exchange for lower premium level. It seriously hurt the equity of the insured’s premium payable in NHI.

When the modified NHI was enforced in 2013, with the help of supplementary premium system, it was expected to achieve the goal of affordability-to-pay principle and solve the problem of evading obligation of premium paid by some people, thus further enhance the equity of the insured’s premium payable. However, for one year past, we found that supplementary premium system still faced the same issue of the equity and the moral hazard problem of premium payable.

This study tries to analyze the equity of premium payable in NHI and modified NHI system according to the justice theories of Aristotle and John Rawls, we find the key points that hurt the spirit of equity. Finally, we provide some suggestions for the Government in order to reform NHI in the future.

並列關鍵字

National Health Insurance ； Modified National Health Insurance ； equity ； premium payable ； supplementary premium

參考文獻

行政院衛生署，二代健保規劃叢書-系列2，台北:行政院衛生署，2004年

蔡貞慧、高豐渝，我國健康保險財務負擔的公平性：1995-2006，社會政策與社會工作學刊，2010年6月，頁81-117

韓幸紋、梁景洋，以家戶總所得為費基方案相關爭議之反思，台灣衛誌，第32卷6期，2013年，頁 526-536

韓幸紋，從學理及行政執行面探討保險對象補充保險費課徵之問題，台灣衛誌，2013年

蔡貞慧、張鴻仁、王本仁，2002年調整保費及部分負擔對全民健康保險財務公平性之影響，人文及社會科學集刊，2005年3月，頁1-31