本文探討全民健康保險的正義基礎。本文主張,全民健保現有的集中化制度設計可以達到維持社會基本公平正義的要求,儘管它仍存在著若干可以改善的空間。本文首先分析評估健康保險的三種正義標率,分別是私人配置式正義、社會正義以及程序性正義。其次,作者分析全民健保開辦迄今所達成的正義表現在那些方面,同時限制何在。第三,作者透過對於三種健康照護體系的比較,解譯了全民健保透過了那些機制能確保與弱勢者團結的社會效果。最後,作者分析全民健保仍存在著那些可以進一步改革的空間,並且指出目前那些改革建議可能是不利於全民健保維持基本社會正義的目標。本文的基本立場是健康是屬於社會正義而非私人配置式正義的範疇,因為在缺乏社會正義的保障下,任何追求個別人生目標的希望都將落空,因而健康權的保障是屬於公民的基本權利之一。在此一關於社會正義的規範基礎上,作者批評了私人配置式正義的問題,分析了自一九九五年以來開辦的全民健保在維持社會正義方面所取得的成就,同時也分析了其限制與不足所在。我進一步探討了全民健保做為一種「社會」保險,應該透過公共化的方式加以治理,以確保一個與弱勢者團結的機制,並且節制醫療專業的權力。然而,由於目前被保險人的自我組織力量仍然有限,因而必需透過若干制度性的措施維持程序性正義。
This article aims to search the foundation of justice on which the National Health Insurance (NHI) is based. This article argues that the NHI can fulfill the minimum requirement of social justice in the delivery of health care through its centralization structure. The author firstly discusses three criteria for evaluating justice in the health insurance system: private allocative, social and procedural justice. Secondly, the performance and restriction of NHI in maintaining the equal health status has been discussed. Thirdly, the author discusses why the NHI could be a viable vehicle for effecting 'solidarity with the disadvantaged' through a comparative perspective. Lastly, some reform options for containing the rising cost have been discussed. Distinguishing between demand-side and supply-side reforms, the author argues that procedural justice matters for the maintenance of distributive and social justice in the NHI.