疾病篩檢於社會健康保險之定位

The Role of Disease Screening in Social Health Insurance

台灣自1995年起實施之全民健康保險，以增進全體國民健康為目的，為最重要之社會健康保險制度，其中本有預防保健相關規定，但2011年全民健康保險法修法時將其刪除，將疾病篩檢等預防保健業務全部歸屬國民健康署負責，無法與全民健保制度聯結以強調被保險人之個人責任，致缺乏有效之誘因，民眾普遍將政府提供之免費檢查視為「權利」，而無配合義務，造成疾病篩檢率偏低。疾病篩檢雖不適合以罰鍰等公權力強制手段強迫人民接受，但社會健康保險制度可透過保險原理，強調個人健康風險控制，免費提供高經濟效益且低侵犯性之篩檢項目，並聯結社會連帶理念之個人責任，對不注意自身健康而造成健保資源不當耗費者，視為權利濫用而加重未依法篩檢者之部分負擔，提高民眾篩檢誘因，以降低罹病率並減少醫療資源之耗費，達成增進國人健康之目的。

The National Health Insurance has been conducted in Taiwan since 1995. The purpose of National Health Insurance is to promote health for all, and social health network. National Health Insurance Act amended the chapter of the disease screening, prevention and care, and transferred the related affairs to Health Promotion Administration, Ministry of Health and Welfare in 2011. Due to different authority, the insurer has no right to request and the insured are lack of incentive to screen. The insured think disease screen is his right, and not obligations to cooperate. Penalty is not suitable to intervene disease screening, but Social Health Insurance can take the measurement to control individual risk, to decrease the morbidity rate and to lower the expenditure of medical resource. National Health Insurance provides free, low invasive and cost-effective disease screening; meanwhile, for those who not care their health and waste the resource shall increase the copayment.