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題名 | 全民健保法評析--以德國相關法制為例之心較觀察 |
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作者 | 郭明政; | 書刊名 | 經社法制論叢 |
卷期 | 15 1995.01[民84.01] |
頁次 | 頁187-218 |
分類號 | 412.56 |
關鍵詞 | 全民健保法; 德國; |
語文 | 中文(Chinese) |
中文摘要 | 從缺少共而紛擾不堪的立法程序,從走上街頭的工人抗議聲中,皆可得知,全民健保法乃是一個廣受質疑的法案。由此亦可見,全民健保法乃是一個不健康而亟需即時斷的新生制度。然而,問題何在?透過比較法之觀察,本文期望能據以找出全民健保法之癥結所在,並進而提出條正建議。 本文之比較國家主要為健康保險及社會保險的創始國-德國。正如同其它經社制度一樣,德國的全民健保絕非完全無缺,惟可以確信者,德國的健保制度業已經歷了百年以上的考驗而屹立不搖。因此,德國的經瞼實是臺灣所不可忽視的比較對象。在本文中,主要係針對保險對象、給付、財務、支付制度及組織等五大問題加以探討。與德國相較,臺灣所採行全民強制之作法乃是是與國經驗相左,而且是最大相異之所在。在此岐異下,遂產生了一個獨買而全民健保局所壟斷的醫療市場。在此制度下,除了十一萬低收入戶外,為數眾多無力繳納保費之較低所得者亦強行納入,而將使得眾多家庭之經濟受到重大影響,而市場襲斷的結果亦將使醫療體系受到重大之衝擊。一個沒有效率的官僚醫療體系,也將因此形成。其結果,受害者將不只是醫療提供者,而包括廣大民眾。 在財務問題上,全民健保未能將不平等補貼之問題加以解決,而且對於眷屬亦徵收保費,以致可能高達所得百分之二十五之高保費,皆屬相異於德國經驗之重大問題。惟在給付上,全民健保法之給付內容卻又遠遜於德國之健保制度。 經由本文之皆玎,全民健保法存有太多問題而亟待修正。惟應予注意者,此等問題絕非枝節的支術問題,而是在基本架構上,基本原則上出了重大問題,往後的修正,除非能重新檢討“全民強制”以及“單一組織”等基本問題,否則枝節的修正對對整體制度之改善少有 助益。 至於產生等重大問題之原因雖有多端,惟對於外國相關法制瞭解上之欠缺,諸如德國相關法制之陌生(其或出於無能力、疏忽或刻意棄如敝屣)則是一項重大原因。因此,在往後修法過程中,此等外國經驗應格外予以珍惜。 |
英文摘要 | From the controversial legislation process and fiery protests of the workers on the street, it is obviors that the National Health Insurance Act (NHIA hereafter) leaves much to desired. Through a comparative study between NHIA and the German Health Insruance Regulations, this paper tries to point out some of the main problems of the Act, and then make a few suggestions for future revisions. Begun with a historical introduction, this paper is then devided into five parts: insured persons, benefits, financing, payment system, and organization. The most significant feature of NHIA is its compulsory universal coverage. It is an entirely different different case in Germany. Under the terms of the compulsory universal coverage, every one is covered regardless of their profession or income status (except the approximately 110,000 so-called "registered poor"). It will be impossible to expect that everyone can and will pay his/her premium. Meanwhile, the Act will inevitable require a bureaucratic, rather than a market-based, medical system. Both the medical delivery and the benefits of the insured people will be jeopardized under this design. In terms of financing, the unfair subventions is still an unresolved issue. As one may have to pay a premium as high as 25% of his/her income, the premium poses a heavy burden to a majority of household. What's worse, while this rate is itself much higher than that in Germany, its benefit level is significantly lower than its counterpart. As analyzed in this paper, the NHIA should be revised throughout, especially in the following main issues: -Is the compulsory universal coverage necessary? -What other alternative is there to the monopoly of the State Health Insurance Agent? When one asks why there are so many problems with NHIA, there will be different answers. But the ignorance of the experience of the industrialized countries, such as Germany, plays an important role. Hence, for the next revision of the Act, an understanding of some foreign experiences will be absolutely indispensable. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。