全民健康保險制度的發展與問題

Progress and Problems of Taiwan's National Health Insurance

在國內強大的政治壓力之下，臺灣毅然決然於1995 年3 月1 日，開辦全民健康保險。全民健康保險具有：全民強制納保、以保險費為主要財源、綜合醫療給付、公共單一支付制度，以及國家總額預算制度等五大特色。實施十八年以來，最重大成就是達成保障公平就醫的目標：不但縮小貧富之間的就醫差距，也減少因病而貧的社會問題。就總體經濟效率目標而言，全民健保有一定成就─醫療保健支出佔國內生產毛額比例仍然低於7%，但卻未能達到有效利用醫療資源的個體經濟效率目標，因為儘管中央健保局或署不斷推動改革方案，醫療資源的浪費及無效率似乎仍然無所不在，而錢永遠不夠用將是全民健保永續經營的終極挑戰。歷史的教訓是：未來第三波健保改革，不能再侷限於財務面或支付面的努力，必須積極改革醫療體系，甚至改變社會對醫療的價值及態度。

Under considerable domestic political pressure, the Taiwan government inaugurated the National Health Insurance scheme on 1 March 1995, which is characterized by five main features: universal coverage, payroll tax financing, comprehensive benefits, national global budget, and public single payer. For the past 18 years, the National Health Insurance has significantly closed the gap of access to health care between the rich and the poor, and protected many families from falling into poverty trap. Although the National Health Insurance has also achieved the objective of macro-economic efficiency and kept the health spending below 7% of Gross Domestic Product, it still seems quite distant from reaching the objective of micro-economic efficiency. There always exist issues of waste and inefficiency in health care delivery despite many health care reforms undertaken by the Bureau of National Health Insurance. The limited resources and funding are the ultimate source of challenge to the National Health Insurance. Accordingly, the next wave of health care reforms should go beyond the scope of the National Health Insurance itself, also focusing on the health care system, even changing social values and attitudes towards health care.