人口因素對健保費缺口的相關影響－－應用隨機性統計邊界法

The Population Factors on the Influence of Overdue Payment of Health Insurance－Applying the Stochastic Statistical Frontier Approach

健保財務在總額支付制度下，自1998年起卻開始呈現「保費收入」不足支應「醫療支出」的問題，其中有一主要原因是欠繳保費所引起。探討有哪些因素是顯著造成欠繳保費乃是值得研究，但一般文獻若是以統計迴歸模型探討時，則在作法上多是將未討論的其他因素，籠統地假設均屬隨機誤差項，此會造成估計結果的偏誤，甚至造成結論錯誤。本文主要透過討論各種人口變動變數，及健保局的一些行政措施，來討論對欠繳保費(即「應收」與「實收」健保費間之「缺口」)之可能相關性，利用隨機性統計 邊界法(Stochastic Statistical Frontier Approach)以避免上述的估計偏誤，使檢定結果的顯著性更具參考價值。實證發現，人口成長率及非農業人口率與欠繳保費呈顯著正相關，值得有關單位之參考。另外，老年人口率與幼年人口率則均呈顯著負相關；又健保費轉帳率具有顯著降低缺口的效果，應廣為宣導推行。

Since 1998, the finance of Bureau of National Health Insurance has shown inadequate “payment income” to cope with “medical expenditure”. This article indicates the factors that are significant and worth studying. The traditional regression model only assumes single error term to contain the other possible factor and the random factor. The coefficient estimates of discussed factors may cause biases. To avoid the biases and to enhance the value for referenve, this article applies Stochastic Statistical Frontier Approach to estimating the relation between the overdue payment (i.e. the gap of healthcare premium receivable and actual healthcare premium received) and each factor about the varied population changes or administration measures of the health insurance office. The empirical results are as follows: the relation between the overdue payment and the population growth rate is obviously positive, and so is the non-agricultural employee rate. However, the both population rates of old-age and young-age all show obviously negative relations with the overdue payment. Besides, increasing the transfer rate of healthcare premium has obviously reduced the overdue payment. Therefore the Health Insurance Branch should energetically guide people to pay the healthcare premium by transfer account method.