我國收容人納入全民健保──一個以國際文件分析及初步證據為基礎之政策評估

The Study on the Health Care System of National Health Insurance for Inmates and Its Implementation Effect

我國二代健保的改革將矯正機關收容人納入健保，完成我國享譽國際的全民健保落實全民覆蓋的最後一哩路。本研究廣泛蒐集國際性組織及先進國家相關文件，採用文件分析方法，評價我國是項政策的價值與意義，並以實施納保兩年來的初步統計分析為基礎，評估其政策效應，作為後續評估收容人納入全民健保政策評估的張本。經由本研究的分析，發現我國收容人納入全民健保的政策，具有幾項重要的意義：與世界衛生組織對健康監獄的倡導合轍，落實對收容人的健康照護；使台灣成為世界監所健康主流化的一員，具有提升台灣關注人權的形象；是為結合獄政、衛政、社政的關鍵，作為全面提升公共衛生的協作平台；收容人醫療費用由公費負擔是先進國家的共同作法。實證分析則顯示納入健保之後，收容人就醫有朝向戒護外醫的傾向。本文也建議在收容人納入健保之後，衛政與獄政當局可進一步採行積極的行動（pro-active measures），例如監所健康的需求評估與健康促進等，以促進收容人的健康，並使之出獄之後，能更順利回歸社區。 One of the amendments of the so-called “2nd Generation NHI reform” is to bring the inmates in the correctional institutions under the coverage of the National Health Insurance, finishing up the last mile of health care for all in Taiwan. This article is to conduct an evaluative study on this policy based on a document analysis of the international literature and the preliminary statistical evidence, and aims to put this policy in the perspective of the mainstream of mainstreaming health care in prisons. This study is to lay a foundation on which further research on the issue of extending the NHI coverage to the inmates by searching for the value and implication for this policy, and to search for further action to improve inmate health. Our evaluation has led to four major conclusions: that that extending the NHI coverage to the inmates is in line with the concept of “healthy prisons” advocated by international organizations such as the World Health Organization; has pushed Taiwan into the rank of very few countries who have achieved mainstreaming health care in prisons, and elevated Taiwan's status in guarding human rights；the policy has constructed a platform to facilitate the joint efforts of the correctional, health, and social to promote public health in general; that the premium paid with public budget is in line with the international practice in many countries. Statistical evidence suggested that the inmates tended to seek health care via escorted visits or hospitalization. Our study also identified that more pro-active measures, such as needs assessment and health promotion, are necessary for further improvement in inmates' health and would facilitate in the inclusion of the inmates by the community after serving the time.