癌症新藥多元支持基金推動與法制化課題

A Study on the Promotion and Legalization of Taiwan Modified Cancer Drug Fund

癌症已連續40年為國人十大死因之冠，因癌症所損失的生產力及各種社會成本難以計算，2024年後，隨著新政府將「健康台灣」政策列為施政重點，健康台灣推動委員會目標為2030年將癌症標準化死亡率降低三分之一，為達成此目標，推動百億癌症新藥基金成為短期內的重要政策，以提升癌症新藥治療可近性，避免「因病而貧，因貧而憾」的困境。
本文深入分析現行癌症防治法在財政支持機制上的不足，並檢視菸品健康福利捐在癌症防治資源分配上的侷限性。首先2003年公布的癌症防治法相當精簡，且菸捐挹注癌症防治應建構在專款專用於菸害防制目的上，再者健保資源挹注不足，皆導致新藥給付資源嚴重不足，患者長期面臨自費負擔沉重的困境。
進一步分析癌症新藥基金的兩條法制路徑：一不修法路徑為透過行政程序設立特種基金；另一修法路徑為透過立法修正將基金設立明文化。前者迅捷但缺乏穩定法源支持，而後者則可確保基金具備穩定性與持續性。然而，當前態勢為公務預算專款先行，同時將修法列為中長期目標。然而，菸品健康捐作為癌症新藥基金的財源，其正當性待商榷。菸捐本應專款專用於菸害防治，而將其外溢至廣泛的癌症新藥支出，恐違反特別公課的法理基礎。
癌症新藥基金的設立已成為國家健康政策的重要里程碑，政府不應將修法視為中長期的目標。本文認為，行政院在短期以2025年公務預算挹注50億元於全民健康保險基金，指定用於「癌症新藥暫時性支付專款」同時，也應一併果決地向立法院提出癌症防治法第16條條文修正草案，將癌症新藥基金法制化，明確規範基金的設立、財源與運作模式，確保基金的穩定性與永續性，實現公平且可持續的資源分配與癌症防治政策。

Cancer has been the leading cause of death in Taiwan for 40 consecutive years, resulting in immeasurable losses in productivity and social costs. Following the government’s prioritization of the“Healthy Taiwan”policy in 2024, the Healthy Taiwan Promotion Committee aims to reduce the standardized cancer mortality rate by one-third by 2030.
To achieve this goal, the establishment of the NT$10 billion Taiwan Multi-Support Cancer Drugs Fund has become a key short-term policy, enhancing access to cancer treatments and preventing the financial burdens caused by costly therapies.
This paper critically examines the deficiencies in the financial support mechanisms under the Cancer Control Act and evaluates the limitations of the Tobacco Health and Welfare Surcharge in funding cancer treatment. The Cancer Control Act, enacted in 2003, lacks detailed financial provisions, while tobacco surcharge funds should primarily be allocated for tobacco control rather than broadly covering cancer drug expenses. Additionally, inadequate health insurance funding has resulted in significant out-of-pocket burdens for cancer patients.
The paper explores two legal pathways for establishing the Taiwan Multi-Support Cancer Drugs Fund: (1) an administrative approach via the establishment of a special fund without amending existing laws, and (2) a legislative approach that formalizes the fund through amendments to the Cancer Control Act. While the former is expedient but lacks long-term legal stability, the latter ensures institutional sustainability. The current approach focuses on allocating public budget funds as an interim solution, with legislative amendments as a long-term goal. However, the legitimacy of relying on tobacco surcharge funds for financing remains debatable, as such funds are specifically intended for tobacco-related health issues.
The establishment of the Taiwan Multi-Support Cancer Drugs Fund represents a critical milestone in Taiwan’s health policy. The government should not defer legislative amendments as a long-term goal. In addition to allocating NT$5 billion from the 2025 public budget into the National Health Insurance Fund for temporary cancer drug subsidies, the Executive Yuan must promptly propose amendments to Article 16 of the Cancer Control Act to legalize the fund, clearly defining its establishment, financial sources, and operational framework. This approach will ensure the fund’s stability, sustainability, and fairness in resource allocation, ultimately advancing Taiwan’s cancer prevention and treatment policies.