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  • 學位論文

二代健保合法化過程之研究-以補充保險費為焦點

The Study of the Legitimation Process for the Second-Generation National Health Insurance System in Taiwan:Focusing on Supplementary Premium

指導教授 : 林子倫

摘要


全民健康保險開辦係沿續公、勞、農保之醫療保險,將原來未有任何社會醫療保障的國民納入單一醫療保險制度,使全民享有同一標準的醫療給付;而保險費繳納是將原來公、勞、農保收費方式堆疊在一起,以經常性薪資為主,依職業別分為六類十四目。而自1995年3月1日施行以來,隨著老年人口快速成長、重大傷病持續增加、新藥及高科技醫療器材使用,健保醫療費用每年以4%成長,與保費收入間存在2%落差。為解決健保保險費費基僵化導致財務收支失衡及解決依職業別分類並加計眷口數、高收入低保費的不公平現象,於2001年以二代健保為名開始規劃,並於2011年1月4日完成三讀程序。 二代健保於立法院合法化過程中,牽涉之利害關係人非常多元,影響二代健保合法化因素亦相當複雜,本論文以二代健保改革之核心「家戶總所得制」於二、三讀前轉變為原來以經常性薪資對照投保金額之「一般保險費」加上「補充保險費」為討論焦點,以文獻分析並輔以利害關係人深度訪談為研究方法,據以建構爭議問題之全貌。討論並分析被保險人及雇主規避補充保險費扣取之爭議,以及行政部門間之互動、立法委員行為及黨團協商機制對「家戶總所得制」未能完成立法之影響。 研究發現:一、二代健保保費結構性改革功虧一簣。二、行政部門協調統合機制不足。三、立法委員政黨取向凌駕專業判斷。四、立法院黨團協商實為密室協商。五、黨團協商結論如隨機碰撞之結果。 本論文提出六點研究建議:一、增加補充保險費結算程序。二、加強行政院跨部會協調整合機制。三、提升立法院委員會功能,建立資深制。四、加強民間及黨政溝通。五、明定啟動黨團協商之規定。六、落實黨團協商制度透明化。

並列摘要


National Health Insurance was established as a continuation of public, labor, and agricultural medical insurance, which consolidated citizens who originally did not have any social medical insurance into a single medical insurance system so that the entire nation enjoys the same standard of medical benefits. Payment of insurance premiums is a combination of public, labor, and agricultural insurance payment methods, primarily based on regular wages and divided into 6 categories and 14 subgroups based upon occupation. Since the implementation of National Health Insurance on March 1st, 1995, NHI medical fees have grown by 4% annually due to the rapid growth of the elderly population, continual increase in Catastrophic illness patients, new medication, and the use of high tech medical equipment. This has created a 2% difference between cost and income from health insurance premiums. In order to resolve the unfair phenomenon of NHI insurance premium fee basis stiffening resulting in a revenue and expenditure imbalance, calculations based upon occupation category and additional members, as well as those with high income paying low premiums, planning for second-generation national health insurance began in 2001. The third reading procedure completed on Januarys 4th, 2011. Throughout the legislative process for second-generation national health insurance in the Legislative Yuan, a diversity of stakeholders were involved, contributing to the complex reasons impacting the legalization of second-generation national health insurance. The focus of the discussion in this thesis lies in how the core of second-generation health insurance reform, the household income system, transformed into regular premiums and additional supplementary premiums based upon regular wages before the second and third reading. Research methodology utilized includes document analysis in addition to conducting in-depth interviews with stakeholders in order to construct a comprehensive view of this controversial issue. Controversies over how the insured and employers avoid deduction of supplementary premiums are also discussed and analyzed, as well as interactions between administrative departments, the Legislative Yuan, and the impact that the system for party caucus negotiation had on the household income system not being written into law. The findings of the study include: 1. Structural reform of the first and second-generation health insurance premiums leave more to be desired; 2. The negotiation and consolidation mechanism between administrative departments is inadequate;3. Political considerations from political parties outweight professional judgment for legislators; 4. Party caucus negotiation in the Legislative Yuan is secretive and behind closed doors; 5. The conclusions of party caucus negotiations appear to be random. This thesis proposes six policy suggestions: 1. Increase supplementary premium settlement procedures. 2. Strengthen the Executive Yuan’s cross-departmental negotiation and coordination mechanism. 3. Enhance the Legislative Yuan Committee’s function and establish a seniority system. 4. Enhance communication between citizens and political parties. 5. Establish clear regulations to activate party caucus negotiations. 6. Implement a transparent system for party caucus negotiations.

參考文獻


臺灣政治學會年會會議論文。
詹月金,1995,〈我國全民健康保險政策合法化過程之研究〉,臺
兼評司法院釋字第613號解釋〉,《臺大法學論叢》,38(2):
對象家庭財務負擔與醫療服務使用公平性探討》,行政院衛生署民
江盈儀,2011,〈全民健康保險監理委員會之監督機制探討〉,臺

被引用紀錄


張藝騰(2015)。「節能減碳」政治可行性分析〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2015.01518

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