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    题名: 全民健保財務精算之研究
    其它题名: Actuarial and Solvency Study for the National Health Insurance System
    作者: 張士傑;黃泓智;蔡政憲
    贡献者: 國立政治大學風險管理與保險學系
    行政院衛生署
    关键词: 全民健康保險;安全準備;平衡財務收支
    National health insurance;safety reserve;financial solvency;premium rates
    日期: 2001
    上传时间: 2012-10-22 15:43:32 (UTC+8)
    摘要: 全民健康保險自民國84年3月開辦以來費率一直為4.25%，而開辦前三年每年保險收入均超過醫療費用，但由於平均眷口數逐漸調降以及醫療費用持續成長，自民過87年3月起當月保險收入極小於當月醫療支出，此後月份收支差異繼續擴大，應計基礎安全準備餘額也由初期約三個月的平均醫療費用迅速減少致一個半月的平均醫療費用，全民健保已面臨財務壓力。 本研究是依據現行健保支付制度及財務收入模型下: Pt（r）=Bt+ΔSt t:1,2,…n St=St-1+ΔSt ＋i×（St-1＋ΔSt/2） t:1,2,…n t：projected period Bt：projected medical expense at year t Pt：projected premium income at year t ΔSt：contribution for safety reserve at year tS0：accumulated safety at year 1995 St：accumulated safety at year t i： returns of safety reserve r： premium rate 全民健保是社會保險，應維持財務的自給自足即收入支出的平衡。在積極施行各項開源節流措施之後，若無法解除財務危機，則就必須考慮在追求社會公平原則下，檢討調整費率，由全民本於使用者付費的觀念，共同承擔健保財務的社會責任；若小幅度的增加負擔，可換得全民健保的穩定經營、保險給付的持續提供，以及醫療品質的有效提昇。
    The premium rate for the national health insurance is set at 4.25 percent since the plan commences in March 1995. For the first three years of the plan, the medical expenses paid are less than the premiums received. Due the average numbers of insured are reduced in premium calculations and rapid increases in the medicalexpenses, premiums received are less than the medical expenses. Ever since the mismatch of the cash inflow and cash outflow of the plan continue to develop. Accrued basis reserves are reduced from the three month averaged medical expenses to one and half month. National health insurance plan has begun to face the financial stress. This study is based on the current Taiwan national health insurance payment system and financial income model. The purpose of the proposed actuarial model aims at estimating the future premium rates to maintain the plan financial solvency. Premium model is briefly listed in below. Pt?]r?^=Bt+?GSt t:1,2,?Kn St=St-1+?GSt ??i???]St-1???GSt/2?^ t:1,2,?Kn t?Gprojected period Bt?Gprojected medical expense at year tPt?Gprojected premium income at year t?GSt?Gcontribution for safety reserve at year tS0?Gaccumulated safety at year 1995 St?Gaccumulated safety at year t i?G returns of safety reserve r?G premium rate ational health insurance belongs to social insurance. Financial balance is maintained through the premium policy and benefit program. If there is a tendency for financial deficit or insolvent, actuarial determined premiums are required in the premium policy based on the social equality. Through the risk pooling and risk sharing principle, the health care user of the plan should pay the premium. Finally, national health care insurance program can properly maintain its functions.
    關聯: 應用研究
    委託研究
    研究期間:9008 ~ 9107
    研究經費:900仟元
    数据类型: report
    显示于类别:[風險管理與保險學系] 國科會研究計畫

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