補充保險費對解決健保財源不足問題的效果

Determining the effectiveness of using the supplementary insurance premium to solve the financial problems of the National Health Insurance

我國全民健康保險自2002年7月起全面推動總額支付制度，雖然保險成本得以有效控制，不過於2009年卻累計近600億元的財務虧損，隔年將費率自4.55%調升至5.17%，才暫時解除健保財務危機，其主要原因在於保費收入成長有所侷限。為改善此問題，我國全民健康保險收費方式自2013年起出現重大變革，除維持現行健保計費方式之外，另行課徵雇主及保險對象補充保險費。雖然健保新制實施第一年（2013年）收取的補充保險費高達402億元，然此新制到底只是短暫改善財務問題的措施，亦或是長久改善財源不足問題的改革呢？本文推估一般保險費之平衡費率至2023年，研究結果發現十年內的平衡費率將突破法定費率的上限（6%），屆時勢必恐將面臨全民健康保險法再度修法的壓力。此外，健保新制的實施能緩衝或延後修法的時間僅有一至三年，補充保險費只是短暫改善財務問題的措施，並無法長久改善健保財務收支失衡的問題。本文希冀透過各種情境下所估算的平衡費率資訊，做為主管機關規劃健保財務時之參考。

The National Health Insurance (NHI) officially promoted the global budget payment system in July 2002. Although this system effectively controlled insurance costs, approximately NT$60 billion in accrual deficit accumulated during 2009. The premium rate increased from 4.55% to 5.17% in 2010, temporarily relieving the NHI financial crisis. The main cause for the financial problems was the limited growth of premium revenues. To resolve this problem, major reforms in the payment methods of the NHI were enacted in 2013. In addition to maintaining the existing payment methods, the supplementary insurance premium on employers and beneficiaries were added. Although the supplementary insurance premium collected NT$40.2 billion during the first year of implementing the new financing mechanism, whether this mechanism is a short-term or long-term solution remains unknown. This study evaluated the balance of payment rates until 2023, indicating that the statutory premium rate ceiling (6%) will be exceeded within 10 years, at which time a reamendment of the NHI Act will likely be required. This study provided the balance of payment rate estimated according to various scenarios, which can be used as a reference by the authority when making future adjustments.