醫療保健財務籌集多元化－－健康保險與醫療儲蓄帳戶的搭配

A MIXED FINANCING SYSTEM FOR MEDICAL EXPENDITURES THE COMBINATION OF MEDICAL SAVING ACCOUNTS AND NATIONAL HEALTH INSURANCE

本文利用個別消費者的兩期模型，分析定率、定額負擔的健康保險、 以及醫療儲蓄帳戶等各種單一與混合之醫療保健財務籌集制度的經濟 效果。研究結果發現：相較於定率負擔的健康保險，定額負擔的保險可使被保險人自行承擔的疾病財務風險限縮在自負額的範圍以內，比較符合消費者希望消除重大疾病風險之保險需求。雖然就保險與醫療服務市場的效率性而言，定額負擔的保險有其優越性，但提供的風險保護效果並不完全。另外，醫療儲蓄帳戶則可對存款額度以內的疾病風險，提供完全保護。所以，結合自負額設計的健康保險與個人醫療儲蓄帳戶的混合制度，自負額以上的醫療費用由保險分攤、自負額以下的醫療費用則由帳戶支應，可提供優於任何單一制度的風險保護效果、並保有自負額制度的效率性。而且，混合制度使醫療保健財務籌集趨向多元化，將兼具社會成員水平風險分攤與個人跨期垂直風險分攤的精神。

This paper analyzes the systems of national health insurance and medical saving accounts, and discusses a mixed financing system for medical expenditures, which combines these two systems. The results indicate that health insurance with deductibles could provide protection against the risk of severe diseases and match the insured’s preference for health insurance. Also, deposits of medical saving accounts could cover the illness risk. That is why a mixed financing system, combining medical saving accounts and health insurance with deductible, could provide better protection against illness risk than any individual system such as national health insurance or medical saving accounts. Under the mixed system, the national health insurance covers the medical expenditures exceeding deductibles, and medical saving accounts finance the deductibles. The illness risk of any individual would be shared horizontally among others and vertically during his own lifetime.