美國與臺灣健康保險改革脈絡探討

The Discussion of Train of Thought about Health Insurance Reform for U.S.A. and Taiwan

台灣較美國早四年提出全氏健保規劃報告，兩者國情有很大不同，但規 劃的基本原理則十分類似；亦即提供全體國氏同一適當的綜合性健康照護服 務，重視基層醫療及預防保健，在財務上創造一個獨買的環境，以控制醫療 費用，並期望能促進醫療體系內部合理的競爭，以提高效率和品質。其次， 二者均以保險費為主要財源，貧戶由政府以稅收補助保險費。全民健保的實 施，必然對現有的利益團體影響深遠，是個高度政治性議題，也因之深受原 有政治、經濟與社會制度的影響。 基於此，本文即從影響健康照護體系因素的觀點，分析比較美國1992 健 保改革失敗及台灣1995 健康保險改革成功的脈絡。以作為未來全氏健保發展 方向之參考。

Relatively U.S.A. proposes in early four years for National Health Insurance are strong in protecting and planning the report, the national conditions of the two differ widely in Taiwan, but the basic principle of planning is very similar; Namely offer all people and a proper comprehensive health care service, pay attention to the medical treatment and prevention and health care at the basic level, create an environment bought alone on the financial affairs, in order to control the hospitalization cost, expect to be able to promote the rational competition within the medical system, in order to raising the efficiency and quality. Secondly, two regard insurance premium as main financial, poor household subsidize the insurance premium by government so as to the tax revenue, National Health Insurance are strong in the implementation protecting, must be far-reaching to existing interests group's influence, so must be a highly political topic, must be affected by original politics, economy and social system deeply. Because of this, this text analyses from the view of influencing health care system factor, promptly that compares 1992 American trains of thought that is strong in assuaring the reform failed and 1995 Taiwanese health insurances reformed success. Strong in the reference which protect the developing direction for National Health Insurance as being future.