台灣全民健康保險的減貧效果

Effect of National Health Insurance on poverty reduction in Taiwan

目標：全民健保的首要目標就是保障公平就醫的權利，並減少因病而貧的狀況。本研究從收入面及支出面探討全民健保的減貧效果。方法：資料來源為1993年至2012年家庭收支調查。我們以全國家戶均等可支配所得中位數的一半作為貧窮線，計算家戶、兒童與老人貧窮率，並以醫療支出佔扣除生存所需的家戶消費的25%與40%為閾值，估計家戶、兒童與老人的醫療財務災難率。結果：1995年，台灣家戶貧窮率在加計社會移轉收支後由13.7%降為7.5%，減貧效果達6.2%，其中1.1%的效果為全民健保的貢獻，到了2012年全民健保貢獻則提高為3.7%。至於對兒童貧窮率及老人貧窮率，全民健保的貢獻在同一期間亦分別由0.5%及3.3%提高為2.0%及8.0%。其次，全民健保開辦後，家戶醫療財務災難率由1993年的7.0%驟降為1998年的1.3%，而兒童與老人的醫療財務災難率，亦分別由2.3%及17.7%降為0.3%及3.7%，但是進入21世紀以後，無論家戶、兒童或老人的醫療財務災難率，皆微幅上升。結論：自從開辦以來，全民健保對於減輕台灣的貧窮現象有重要的貢獻。

Objectives: In 1995 National Health Insurance (NHI) was launched in Taiwan to provide equal access to adequate health care for all, and to protect people from financial hardship. This study determined the effect of the NHI on poverty reduction. Methods: Data were obtained from the Family Income and Expenditure Survey (1993-2012). First, we computed the household, child, and elderly poverty rates using 50% of the national median equivalized disposable income as the poverty line. We then defined catastrophic health spending as household health expenditures exceeding a specific fraction (25% or 40%) of household consumption remaining after subsistence needs. Results: In 1995 the household poverty rate fell from 13.7% to 7.5% after social taxes and transfers (a decrease of 6.2%), of which 1.1% was contributed by the NHI transfers. In 2012 the NHI contribution increased to 3.7%. With respect to child and elderly poverty rates, the NHI contribution also increased from 0.5% and 3.3% to 2.0% and 8.0%, respectively, during the same time period. After implementation of the NHI, catastrophic health spending fell from 7.0% in 1993 to 1.3% in 1998 for households, 2.3% to 0.3% for children, and 17.7% to 3.7% for the elderly. Since the beginning of the 21st century, all three types of catastrophic health spending have increased slightly. Conclusions: The NHI in Taiwan has made a significant contribution to poverty reduction since its implementation. (Taiwan J Public Health.