從法制面探討影響我國全民健康保險財務之因素

A Study on the Factors Affecting the Finance of the NHI -Through Legal Aspects

健保施行21年，迎接許多的財務挑戰與政策調整及修法歷程，財務規模從開辦時約新臺幣2千億元，迄今已超過6千億元，政府、雇主及民眾的健保財務負擔，同趨沉重。本文嘗試從法制面向探討影響我國健保財務之因素，從收入面檢視健保財務制度之體制問題：費基健全與彈性、財源充足與公平性、合理的費率調整機制、開源之方向等；並從支出面，討論總額支付制度之功過、無效醫療與支出制度改革，以及近期關涉健保財務健全的法規制（訂）定、修正等程序問題，期能建立適法的正當程序，妥為規劃財源，減少制度的運作風險；並提出開源節流之建議，強調依法行政，藉以實踐醫療人權。

In the past 21 years since the implementation of NHI, many a financial challenge, policy redirection and amendment of regulations have been experienced. The financial scale escalated from 200 billion NTD to over 600 billion and the heavy burden falls on government, employers and individual insuree simultaneously. This study attempts to look into the factors affecting the NHI finance through legal aspects. From the side of revenues to examine the institutional financial system: the soundness and elasticity of the base of premium, its sufficiency and fairness, reasonable mechanism for rate adjustment and other measures to explore new funding resources. From the side of expenses, the good and bad about global budget system, futile medical care and the reformation of expenditure system are discussed. Another issue involves procedural review of recent enactment and amendment of laws and regulations related to the soundness of NHI finance is discussed as well, so that a due process of law can be assured to secure the funding resources and to minimize the risk of the system. Suggestions for better NHI finance were made and administration by law is emphasized to realize the human right to have medical care.