全民健保代位適用範圍與法定債權移轉──由最高法院106年度台上字第816號判決論全民健康保險法第95條

Subrogation in National Health Insurance Act: A Comment on Supreme Court Judgement 106 Tai-Shang-Tzu 816 and a Proposal for Further Amendments

本文以最高法院106年度台上字第816號判決所涉及全民健康保險法第95條（系爭案件當時提文為第82條）適用範圍之爭議為對象，藉由該案所涉及法院目前實務見解以及相關學說內容之討論，進而檢視2016年修法後尚仍解決之問題與法理基礎之再確認。系爭案件乃在被上訴人所請求之損害賠償範圍中，關於醫療費用部分，上訴人主張大部分已由全民健康保險給付醫療費用，故應扣除此部分。此時即涉及全民健康保險法於2011年1月26日修正前第82條（現行法第95條）第1項關於中央健康保險局（下稱「健保局」）得否因給付醫療費用後，依該條規定向應負損害賠償義務人代位行使損害賠償請求權。如認為健保局得代位行使該項權利時，則於提供醫療給付時該項權利業已移轉予健保局，因此被上訴人即不得就此部分再行請求。全民健康保險法第95條雖因八仙塵爆後全民健保保險人得否向八仙樂園與瑞博國際代位請求超過責任保險之數額產生疑義，因此立法院於2017年11月29日進一步修正。同時增列對於公共安全事故，如向責任保險人請求後，「未足額清償時，向第三人請求。」等文字，但實際上全民健康保險法第95條於法院實務判決見解以及相關學說之爭議向來已久，即便於此次修法後，仍存有不少疑義尚待釐清。本文認為現行法主要修法過程仍僅著重於求償成本效益之考量，因此於理論基礎上難以適切說明何以不同侵權行為類型而有不同代位或求償權利，並造成適用上之不當情形。本文另參輔國外立法例尤其加拿大以及英國採行類似全民健康保險制度之國家，進一步認為應回歸全民健保全面代位之本質，至於求償成本效益之考量，應就行使程序與相關方法再行研擬，方為正當。

Based on Supreme Court Judgement 106 Tai-Shang-Tzu 816, the controversial issue is the National Health Insurance Administration (NHIA)’s right to subrogation prescribed in Article 95 of the National Health Insurance Act. In that case, the claimant suffered personal injuries and received medical treatment from the NHIA. It is questionable whether the claimant would be entitled to recover the full amount of medical expense partially covered by National Health Insurance (NHI). Even the NHIA now extends its right to subrogation to recover the cost of treatment from the several types of personal injury accidents after the amendment of article 95 of NHIA, the arguments concerning the principle of unjust enrichment still remain ambiguous. Learning from Canada and United Kingdom with the similar national health insurance system, it is suggested that the NHIA should have the right to recover from all tortfeasors (or other legal wrongdoers) from a legal perspective, but not merely based on a cost-benefit analysis. Article 95 of NHIA should be amended to clarify and extend the NHIA’s right to subrogation for more wide-ranging claims.