跨境傳染性疾病與國家醫療制度之關聯性研究：以COVID-19為例

A Study of the Correlation between Transboundary Infectious Diseases and National Healthcare System: Taking COVID-19 for Example

2020年新型冠狀病毒肺炎橫行全球形成大流行，導致許多國家成為疫情下的受難者。然而，令人頗感意外的是，以往被評價為公衛治理能力優異的已開發工業先進國家（或所謂的北方國家），在這波疫情襲擊下有不少國內疫情十分嚴重，不僅確診總人數極高，甚至在執行封城措施或施打疫苗後，仍陸續出現第二、第三波之疫情。學界目前雖已有若干文獻對此現象做出分析，指出：（1）民主政體欠缺效率；（2）全球化使得邊境防疫困難；（3）個體自由主義意識過強等因素，係導致防疫效果不佳的原因，但這些解釋較少從公衛治理的本身切入。有鑑於此，本研究從國家醫療制度的面向切入，比較歐美及東亞已開發工業先進國家間的差異，發現嚴謹的「分級醫療」制度是導致歐美已開發工業先進國家境內疫情擴散的關鍵原因。相較之下，在東亞地區的已開發工業先進國家因為「分級醫療」的嚴謹程度明顯較低，加上政府施行單一給付醫療費用的財政模式，使其在防疫上呈現較優之結果。

In 2020, novel coronavirus (2019-nCoV or COVID-19) was rampant around the world, causing the first global pandemic and leading many countries to become victims. However, it is quite surprising that developed and industrialized countries (the so-called Northern countries) which have been identified as enjoying the good public health governance, severely suffered from epidemics—not only the total number of domestic confirmed cases is extremely high, but also the second and third waves of epidemics continue to occur even after the lockdown policies and/or nationwide COVID-19 vaccination campaigns.A number of studies in the field of political science have analyzed this phenomenon, suggesting that: (1) democracy is to some extent inefficient; (2) globalization makes the task of border control more difficult; and (3) people in democracies usually have a strong individualistic orientation and awareness. However, the existing literature rarely focuses on public health per se. To address this problem, we begin by analyzing national healthcare system (NHS), then comparing the differences between advanced industrial countries in Europe, America and East Asia. We find that the more rigorous a system of ‘graded medical treatment’ is in one country, the more severe spread of epidemics could be in that country. On the contrary, some advanced industrial countries in East Asia have not adopted a rigorous system of ‘graded medical treatment’, whereas their governments have implemented a single-payermechanism by which healthcare is paid for by a single public authority, not a private authority, nor a mix of both. Precisely because of the differences mentioned above, some advanced industrial countries in East Asia show a better performance in epidemic response to COVID-19.