從人口老化及薪資停滯角度探討──全民健保財務及保費負擔世代分配問題

NATIONAL HEALTH INSURANCE FINANCIAL MECHANISMS AND INTERGENERATIONAL PREMIUM BURDENS IN THE FACE OF POPULATION AGING AND WAGE STAGNATION

有鑒於我國人口老化快速， 且因青年薪資停滯等因素， 不僅對於全民健 保財務形成負面影響， 亦導致世代分配問題。故本文將人口老化及薪資停滯 因素納入健保費率推估模型中， 以時間序列模型推估未來健保費費基、保險 給付支出、平衡費率及個人所得， 並計算平衡費率及不同各世代的健保保費 負擔金額及負擔比例。在一般保費無費率上限 6%下， 且在「中人口推估&中 協商成長」的情境假設下， 健保平衡費率將從現行的 4.69%， 預估於 2041 年 上升至12.28%，且越晚出生的世代負擔越重。故本文建議為降低人口老化及 薪資停滯對青年世代健保保費負擔的不利影響， 以平衡世代負擔的分配差異， 未來宜從收支連動機制、保費計費基礎、釐清財務責任歸屬等面向加以改革， 其研究結果可供全民健保未來財務改革方案之參考。

Rapid population aging and wage stagnation among young people have negatively affected the finances of the National Health Insurance (NHI) program as well as exacerbated intergenerational inequality in Taiwan. In this study, population aging and wage stagnation were included in the model to estimate premium bases and benefit payments, which were then used to calculate the balance of payment rates and intergenerational premium burdens of NHI. Given the general premium rate without the rate ceiling of 6% and an estimated scenario with moderate population projection and moderate negotiated budget growth, the current 4.69% premium rate of the NHI would rise to 12.28% in 2041, and the rate would be higher for people born in later years. To mitigate the negative effects of population aging and wage stagnation that disproportionately impose the financial burden of paying NHI premiums on younger generations and eliminate the intergenerational inequality in NHI, reforms are necessary that implement a revenue-paymentlinked mechanism, adjust the premium bases, and accurately determine financial responsibilities. This study is expected to provide a reference for efforts to reform the NHI program's financial structure.