Financing National Health Insurance: The Challenge of Fast Population Aging

全民健康保險：快速人口老化之挑戰

10.6277/TER.2015.432.1

徐敏鐘(Minchung Hsu)；廖珮如(Pei-Ju Liao)

全民健康保險 ； 人口老化 ； Financing national health insurance ； Population aging

經濟論文叢刊

43卷2期（2015 / 06 / 01）

145 - 182

英文

許多新興工業化國家正面臨或即將面臨快速人口老化的問題。有鑑於此，本文建構一個工作與儲蓄均為內生決定的動態隨機一般均衡模型，並利用此模型測量快速人口老化對全民健康保險財務狀況之衝擊。在新興工業化國家中，台灣人口老化速度與其他國家類似, 其老年人口占總人口比例將在20年內倍增；此外，台灣亦已於1995年實施全民健康保險。因此，本文選擇台灣作為分析的例子。本文研究結果指出，若人口老化的速度維持不變，在2050年台灣將需額外課徵16%的勞動所得稅以支應人口老化對全民健康保險財務的衝擊。本文也進一步考慮醫療價格上升速度的可能影響。我們發現，若醫療價格上升速度相較於總要素生產力成長速度過快，人口老化對全民健康保險財務的衝擊將無法單從課徵勞動所得稅支應。本文最後討論延後退休年齡和其他可能課稅方式對繳稅負擔和福利之影響。

This paper studies the impact of rapid population aging on financing a national health insurance program, as anticipated and observed in many newly industrialized countries (NICs). A dynamic stochastic general equilibrium model with endogenous working and saving decisions is employed to quantify the impact. Taiwan, which has been implementing its National Health Insurance (NHI) since 1995 and whose elderly population ratio will double within 20 years, is selected as an example for our analysis. Our results suggest that an additional 16 percent labor income tax will be required in 2050 if the current trend of population aging cannot be improved. Moreover, the impact of medical price inflation is also discussed. We find that the NHI would be unsustainable if the annual growth rate of real medical prices is 2 percent higher than productivity growth. Finally, the fiscal and welfare effects of deferring retirement and financing NHI through different methods are discussed.

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