本研究欲透過社會公平正義的角度，運用亞里士多德與羅爾斯所提出的正義理論，分析一代健保與二代健保的保費負擔制度，並找出造成保費負擔公平性失衡的關鍵，進而提出建議，供未來改革參考。 The National health insurance (NHI) is an important social insurance system in Taiwan. It had been criticized by people on the equity of the insured’s premium payable since 1995.
Under the principle of affordability to pay, NHI calculated the insured’s premiums according to the insured’s occupation class and the number of his /her dependents. However, due to the regular salary of the insured as premium base, the premium payable of the insured could not be consistent to one’s actual earning power . As a result, while the regular salary of the insured is getting high, the premium payable is regressively low. On the other hand, we showed that different insured had significantly different self-payment ratio. It followed that the insured may change their status in exchange for lower premium level. It seriously hurt the equity of the insured’s premium payable in NHI.
When the modified NHI was enforced in 2013, with the help of supplementary premium system, it was expected to achieve the goal of affordability-to-pay principle and solve the problem of evading obligation of premium paid by some people, thus further enhance the equity of the insured’s premium payable. However, for one year past, we found that supplementary premium system still faced the same issue of the equity and the moral hazard problem of premium payable.
This study tries to analyze the equity of premium payable in NHI and modified NHI system according to the justice theories of Aristotle and John Rawls, we find the key points that hurt the spirit of equity. Finally, we provide some suggestions for the Government in order to reform NHI in the future.