建立全民健保職業工會財務異常管理機制之研究

Establishment of a financial anomaly management mechanism of National Health Insurance for craft unions

目標：職業工會健保費採「集體預收、分期彙繳」模式，潛藏極大已收未繳風險，本研究旨在找出財務異常關鍵指標，提出工會財務異常管理機制之建議。方法：本研究結合質性與量化方法，與勞保局實地訪談，並就中彰投勞政主管機關及303家曾受健保實地訪查工會，進行問卷調查，再就2012－2016年間，工會健保財務訪查缺失實績值及欠費紀錄，進行健保資料探勘及統計檢定分析，最後以三角驗證法交叉檢驗。結果：勞保局透過罰則以「補助款撥付權」為「工會財務監控手段」，且85％工會財務查核項目與健保署相同。中彰投勞政主管機關在異常工會管理具勞健保跨域合作意願；有24.8％工會內控不足無財務管理辦法，87.6％工會基層支持外部財務稽查，並建議嚴查健保費是否被挪用。經綜整實地訪談、問卷調查、卡方檢定及羅吉斯迴歸分析，確立4項工會財務異常（欠費）關鍵指標，包括：「健保費未設立專戶儲存」、「專戶存儲之保險費移作他用」、「健保費專戶未2人以上共同開戶及管理」、「健保費存款餘額不足」。結論：健保署、勞保局及縣市政府工會財務查核之共同項目，可作為跨機關聯合監控基礎。本研究結合4項財務異常關鍵指標及現行27項健保工會訪視紀錄表查核項目，將訪查缺失影響程度分為：重大、中度、輕微3級，綜整研究結果及健保署中區業務組執行現況，建構全民健保職業工會財務異常分級管理模式，並提出具體執行建議。 Objectives: Craft unions typically collect the national health insurance premiums from all members at one time and then pay the premiums in instalments. However, this method involves a high risk that the premiums have been collected but not paid. This study identified the key factors for financial anomalies and proposed suggestions for craft unions regarding financial anomaly management mechanisms. Methods: Combining qualitative and quantitative methods, this study conducted onsite interviews on the personnel of the Bureau of Labor Insurance and performed questionnaire survey on the personnel of government authorities on labor affairs as well as 303 craft unions that participated in the national insurance program in Taichung, Changhua, and Nantou, Taiwan. Moreover, data mining and statistical analysis were performed on the actual data missing in the financial inspection on craft unions’ health insurance premiums and the unions’ overdue payment records from 2012 to 2016. Finally, triangulation was conducted for data cross-validation. Results: The Bureau of Labor Insurance facilitated financial monitoring on craft unions by imposing the penalty of terminating grant disbursement. In addition, 85% of the financial audit items used by the unions were consistent with that adopted by the National Health Insurance Administration. Government authorities on labor affairs in Taichung, Changhua, and Nantou were willing to collaborate with health insurance authorities for the management of craft unions with financial anomalies. Moreover, 24% of the craft unions showed insufficient internal control and lacked a financial management mechanism; 87.6% of the union members supported external financial audit and suggested strictly examining whether the insurance premiums were misappropriated. Through onsite interview, questionnaire survey, chi-square analysis, and logistic regression analysis, four key factors for financial anomalies (overdue bills) among craft unions were determined, namely “no exclusive account established for health insurance premiums”, “misappropriation of the premiums saved in the exclusive account”, “the exclusive account for health insurance premiums not opened and managed by more than two people”, and “insufficient balance of the health insurance premium deposit”. Conclusions: The items used in the craft union financial audit that are commonly adopted by the National Health Insurance Administration, Bureau of Labor Insurance, and county and city governments can be used as the basis for collective financial monitoring across agencies. This study combined four key factors for financial anomalies with the current 27 items used in the financial inspections on craft unions’ health insurance premiums and divided the level of influence of missing inspection data into strong, moderate, and weak. Finally, this study constructed a health insurance financial anomaly classification management model for craft unions and proposed concrete suggestions according to the research results and the current work status of the Central Division of the National Health Insurance Administration.