自願性健康保險在全民健康覆蓋體系中的角色：跨國比較的觀點

The role of voluntary health insurance under universal health coverage: from the comparative health system perspectives

目標：本研究以跨國比較的觀點，探討健康體系特性與自願性健康保險在全民健康覆蓋體系中的角色。方法：本研究為一跨國比較研究，採比較個案研究法，選取六個案例國家（德、日、加、澳、星、韓），透過蒐集彙整既有文獻、報告及政府網站等資料，並輔以專家諮詢，針對現行體制給付內容（包括給付服務項目、民眾自付費用）及政府對自願性健康保險之政策，進行跨國比較分析。結果：自願性健康保險常於健保保障不足或政府強調個人對健康之責任時扮演補位角色。部分國家積極與之協作以強化保障，部分則因考量健康服務利用之公平性、健康體系之財務永續及防止資源分布不均而加以管制。政府的協作程度與健康保障高低無絕對關係，而是取決於健康體系的制度設計、政府的政策立場以及對自願性健康保險的角色期許。結論：參酌他國對自願性健康保險之政策時，應瞭解台灣健康體系與他國之差異，辨別其政策目標及對台灣的適用性，依據未被滿足需要之性質研議政策與配套，以強化民眾醫療保障，並維持健康體系之互助公平與永續發展。

Objectives: This study examines the role of voluntary health insurance (VHI) within universal health coverage (UHC) systems from an international comparative perspective. Methods: Synthesizing academic literature, policy reports, government publications/website in¬formation, and relevant regulatory materials—supplemented by expert consultations—this study analyzes the role of VHI across six countries: Germany, Japan, Canada, Australia, Singapore, and South Korea. The comparison focuses on statutory benefit design (service coverage and out-of-pocket payments) alongside governmental regulatory frameworks. Results: VHI typically plays a complementary or supplementary role where statutory benefits are limited or where public policies emphasize personal responsibility. While certain countries integrate VHI to enhance financial protection, others enforce strict regulations to prevent resource misallocation, preserve equity in access, and maintain fiscal sustainability. The degree of reliance on VHI does not inherently correlate with better financial protection; rather, outcomes depend on overall health system architecture, policy objectives, and the defined role of private insurance. Conclusions: When drawing on international experiences with VHI to strengthen financial protection in Taiwan, policymakers must carefully account for institutional differences and assess the contextual applicability of external policy models. Reform efforts should address specific unmet needs and incorporate targeted safeguards to enhance financial protection while preserving system solidarity, equity, and long-term sustainability.