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研究生:樊淑娥
研究生(外文):Fan, Shu-O
論文名稱:以流行病學方法探討全民健保具公勞保身份被保險人投保金額之差異及合理性--以高屏分局為例
論文名稱(外文):An Epidemiologic Study on the Difference and Rationality of Reported Payroll Among Three Categories of Insureds Under National Health Insurance
指導教授:江宏哲江宏哲引用關係
指導教授(外文):Hsiu-Hua Pai
學位類別:碩士
校院名稱:高雄醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:1998
畢業學年度:86
語文別:中文
論文頁數:96
中文關鍵詞:全民健保投保金額
外文關鍵詞:National Health Insurancepremium
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我國全民健康保險的開辦對整體醫療生態及全國民眾的健康都有重要的影
響.實施兩年多以來,不僅受到其他國家的肯定,民眾的滿意度也有顯著提
升.但是全民健康保險能否永續經營,端賴其財務是否穩固健全.在全民健
康保險的六類被保險人中,第一.二類(具公.勞保身分)被保險人佔總人數
的七成左右, 其投保金額對健保保費有決定性的影響.同時,自從全民健保
開辦之後,這些具公.勞保身分被保險人的健保投保金額就爭議不斷.因此,
在健保資料已達穩定的現在,應該再次針對具公勞保身分被保險人的投保
金額進行研究,作為未來保費收繳及修法的參考. 本研究將高屏分局轄區
中具公.勞保身分被保險人納入為對象,分別探討年齡.單位大小.性別.行
業別等變數對四類被保險人健保投保金額的影響.研究對象共計1,099,149
人,其中公務人員為84,545人(7.7%),公營機構人員20,915人(1.9%),民營
機構人員641,636人(58.4%),工會會員352,053人(32.0%).研究結果顯示,
公保被保險人雖以本俸投保健保,但其平均投保金額仍比以全薪投保之勞
保被保險人高出7%-8%.而年齡等四項變數對投保金額的影響程度也因被保
險人之身分類別而異:年資累積對投保金額的正面效果以公保身分被保險
人最為明顯;具勞保身分的民營機構人員投保金額主要受單位規模大小的
影響;而工會會投保金額則近於定額申報,幾乎不受任何變項影響.此外,與
主計處各業員工月平均薪資的比較結果也發現,在全民健保開辦二年多以
後,勞保身分被保險人的健保投保金額仍然低報約30%,公保身分被保險人
的健保平均投保金額也因未能以全薪加保而比全國各業員工平均薪資低報
約24%左右.這些不合理現象顯示,健保保費要達到量能付費仍有待努力.

The inauguration of the national health insurance scheme(NHI) in
Taiwan has cast a great influence on both the medical ecology
and national health. Since the adoption of the scheme two years
ago, not only does it receive acclaims from other countries but
also increasing satisfaction from the public. However, the
smooth running of the scheme all depends on a healthy financial
structure. Among the six categories of insured within the NHI,
the insured belonging to the first and second categories(those
who holda civil servant and labor insurance status) shares
approximately 70% of the total, which means that their premium
will play a decisive role to the NHI. Moreover, the amount of
premium of the insured of these two categories has been the
target of public criticism. Therefore, when the NHI data has
already been well established, it is time to review the premium
policy of the insured holding civil servant and labor insurance
status. The subjects included in this research are the four
categories of the insured holding such status within the
jurisdiction of Kaohsiung and Pingtong substation, and the
impact on the premium will be studied in terms of the following
four variables-age,scale of unit, gender and occupation type.
There is a total of 1,099,149 subjects, among whom 84,545(7.7%)
are civil servant, 20,915(1.9%) are state business employees,
641,636(58.4%) are private sector employees, and 352,053(32.0%)
are trade union members. The results indicate that though the
insured holding a civil servant status is insured according to
their base salary, the average premium is still higher by 7%-8%
than that of the insured holding a labor insurance status
insured with the full salary. Also, different status of the
insured will cast a different degree of impact on the premium
according to the aforesaid four variables. The most apparent
positive effect on premium according to seniority is found in
civil servants; the degree of impact on premium in the labor
depends on the scale of private sectors; and the inpact on
premium in the 'trade union category' remains also stationary.
Moreover, in contrastive study with the average monthly salary
announced by the Directorate-general of Accounting, Statistics
and Budget, we discovered that though it has been over two years
now since the inauguration of the NHI, the NHI promium of the
insured holding a labor status is still lower than their salary
by 30% in reality, while the premium of the insured holding a
civil servant status is still lower than that of the average
salary of other occupations by 24%, as it is based on the base
salary. All these indicate that there is sill room for
improvement to attain the goal of 'payment according to income'.

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