台灣二代健保精進策略之探討

A Study of the Improvement Strategies of the Second Generation of Taiwan’s National Health Insurance

黃銘良(Ming-Liang Huang)

指導教授 ： 田瑞駒

義守大學/管理學院/財務金融學系/碩士(2014年)

https://doi.org/10.6343/ISU.2014.00001

摘要

本文主要進行下列兩大方向的研究，其一是二代健保的現況探討，其二是提出精進方案，讓全民健保可以因此而永續經營下去。從二代健保現況探討中得知，目前有以下四個缺點：(1)不同職業不同健保費；(2)財務結構脆弱；(3)重覆就醫浪費大；(4)華僑回國就醫率高。這些缺點是需要改進的。而本研究從整理、分析文獻資料中提出精進方案為以下四個：(1)以家戶總所得作為費基；(2)提高營業稅來補充全民健保費；(3)提高自付額和宣導正確就醫知識；(4)取消歸國華僑用健保就診。做到開源（健全全民健保的財務）以及節流（減少醫療費方面支出），如此一來，全民健保的財務結構才會穩固，才可以永續經營，繼續造福全國民眾。
我國的全民健保制度是否可以像英國政府一樣，實施「以稅收為基礎的公醫制度」，落實我國憲法157條的規定，由政府以稅收支應，值得後續進行研究。

關鍵字

二代健保 ； 家戶總所得 ； 營業稅

並列摘要

This study has two major research foci. One is to investigate the status of the second-generation National Health Insurance (NHI). The other one is to provide feasible proposals, so as to sustain the NHI. After a thorough investigation of the second-generation NHI, four drawbacks are found and need to be improved: (1) different occupations with different health care rates, (2) a vulnerable financial structure, (3) repeated medical care waste, and (4) high percentage of medical treatment for returned overseas Chinese. Grounded in the results of extensive literature review on the NHI, four proposals for improvement are provided: (1) using the household gross income as the base for the fee, (2) improving sales tax to supplement the NHI fee, (3) increasing self-pay fee and enhancing proper medical knowledge, and (4) cancelling the health care for returned overseas Chinese. By increasing the income (establishing a sound NHI financial system) and decreasing the expenditure (reducing the medial expenses), the NHI financial system can be consolidated and sustained and continue to benefit the citizens across the country.

Whether the Taiwanese NHI system can be the same as the British system, which implements the tax-based public health system and whether the Taiwanese government would implement the provision of Constitution 157, which specifies the NHI to be paid by tax, are two issues worth further exploration.

並列關鍵字

second-generation national health insurance (NHI) ； household gross income ； sales tax

參考文獻

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