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題 名 | 民間保險業者在全民健保公辦民營下的角色--一個以焦點團體座談為基礎的分析=The Insurance Industry:Is it a Viable Agent for National Health Insurance Reform? |
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作 者 | 陳孝平; 陳歆華; 李佳儒; | 書刊名 | 國立中正大學學報 |
卷 期 | 8:1(社會科學分冊) 民86.12 |
頁 次 | 頁1-36 |
分類號 | 563.7 |
關鍵詞 | 民間保險業者; 全民健保; 公辦民營; Insurance industry; National health insurance; |
語 文 | 中文(Chinese) |
中文摘要 | 全民健保改制行政院提出保險人以「基金會」型式公辦民營,未來在基 金會逐漸形成財務功能機構,而將保險功能移轉至民間組織承攬部份健保, 民間保險公司自為其中可能的承攬者之一。 本文目的即在探討國內保險業者在全民健保公辦民營下的地位與角色。 本文首先介紹「公辦民營」以及其在我國全民健保改革中的地位,其次採用 「焦點團體法」邀集國內人壽保險業者,分就美商及本土保險公司代表對全 民健保改革諸項議題進行團體座談。研究結果發現:商業醫療保險雖在全民 健保之後有快速之成長,仍處於壽險之附加地位;但在目前壽險市場仍有發 展空間下,業界對介入醫療保險之意願不高。而對社會保險下政府為維護社 會公平正義必要的介入與管制尚難體認,尤其對限制「核保」後所需承擔的 風險卻步。本土公司多半對承攬全民健保業務持消極態度,而外商公司基於 可向母公司取得經驗與技術支援,表現出較大的信心。而本土與外商的共識 在於可承擔健保的行政作業,但避免分擔風險。本文認為,保險公司作為全 民健保改革之動力,一方面可擴大民眾的選擇,提昇競爭,但行政費用的增 加,卻難以避免;而保險公司之風險套利,亦是一項隱憂。因此,可先從釋 出健保行政業務開始,並積極建立風險指標,以消除風險套利的空間;修訂 法令,賦予保險公司適合經營健保的職能,並在長期開放附加方案,使競爭 的效益充分顯現。 |
英文摘要 | The Executive Yuan has proposed that the Bureau of National Health insurance (BNHI) be replaced by a NHI Foundation; the foundation will gradually perform only financial and monitoring functions and delegate risk-bearing to the private sector, a strategy dubbed "publicly sponsored, privately run". Under this strategy, the private insurance companies will become one of the carriers for the NHI. This article is to investigate, with focus-group method, the status quo of the insurance industry in Taiwan, and what role it can play in the NHI reform. We invited representatives from the industry, including domestic and foreign companies and conducted two focus-group interviews. It is found that, while the sales of health insurance policies have increased since the implementation of HNI, health insurance remains subordinate to life insurance in most of those companies. The representatives judged that there was still ample space for the life insurance to grow and did not express keen interest in promoting health insurance, possibly due to high unit costs for health insurance policies. Under the current law, the industry may reject potential enrollees based on existing conditions; they are concerned that, once the government steps in and the principle of solidarity is applied, they may be required to accept any enrollees and would face much higher risk. Also, they would not jeopardize the reputation they now enjoy, and hesitate to take on the health insurance for it might heighten the tension with the medical providers and the public. While the introduction of the insurance industry into the NHI system may offer more choices for the public and enhance competition, this article cautions that it may well increase administrative costs. Should insurance industry be introduced, however, we suggested that the ASO-only approach should be taken first, and law akin to that of the HMO Act in the United States must be legislated to accommodate space for as well as provide regulation on the new type of institutions that embody health care and risk-bearing. In order to eliminate cream skimming, risk factors must be identified and the reimbursement rates must the adjusted accordingly. In the long run, the insurers must be allowed to offer plural benefit packages to further enhance competition. |
本系統中英文摘要資訊取自各篇刊載內容。