Household Composition and Inequality in Health Care Financing in Taiwan, 1995-2000

家戶組成與台灣健康照護財務負擔的公平性，1995-2000

10.6277/ter.2003.314.4

蔡貞慧(Jen-Huoy Tsay)

家戶組成 ； 全民健康保險 ； 所得分配 ； 賦稅歸宿 ； household composition ； national health insurance ； income distribution ； tax incidence

經濟論文叢刊

31卷4期（2003 / 12 / 01）

483 - 505

英文

本研究運用1995-2000家庭收支調查檢驗台灣自1995年實施全民健康保險以來健康照護財務負擔在家戶之間分配的公平性。該調查資料已包括有家戶全民健保、商業健康保險的保費支出及自付醫療費用。至於政府補助全民健保保費部分則依據兩組賦稅歸宿假設而設算出各家戶的賦稅負擔。本研究首先以全部家戶所得高低排序來計算健康照護支出的不均度指數，之後，再根據兩組分別調整家戶大小及家戶等成人數後的所得排序重新計算不均度指數。結果發現三組不同所得定義下排序所計算出的不均度指數差異極大，顯示家戶組成是影響健康照護財務負擔分配的因素，同時，其對不同財源的影響也不同，值得進一步研究。

By using the 1995ñ2000 Survey of Family Income and Expenditure, this study examines changes in the distribution of health care financial burdens among households since the enactment of National Health Insurance (NHI) in 1995. The survey provides household information on health insurance premiums and out-of-pocket health care expenditures. The government subsidy to the NHI was allocated to each household based on two sets of tax incidence assumptions. This study first used total household income to rank households' economic well-being and derive an income inequality index. The study also conducted sensitivity analyses on robustness of the income distribution and income inequality index using both adjusted household size and adult equivalent household income. The large variation in inequality indices observed from using different measures of household economic well-being implies that household composition might affect the distribution of the health care financing burden and its impact might vary over health care financing sources.

1. 蔡貞慧 Tsay, Jen-Huoy、 周穎政 Chou, Yiing-Jenq(2002)。臺灣全民健康保險的醫療支出重分配效果，1995-2000 Redistributional effects of health care expenditures under the national health insurance program in Taiwan, 1995-2000。臺灣公共衛生雜誌 Taiwan Journal of Public Health，21(5)
   連結：
2. (1990).Poverty, inequality and income distribution in comparative perspective: The Luxembourg Income Study (LIS).New York:Harvester Wheatsheaf.
3. Aronson, J. R., Johnson, P., Lambert, P. J.(1994).Redistributive effect and unequal income tax treatment.Economic Journal,104
4. Browning, E. K., Johnson, W. R.(1979).The Distribution of the Tax Burden.Washington, D. C., US:American Enterprise Institute for Policy.
5. Dong, R. B.(1983).National Taiwan University.
6. Hsiao, W. C., Lu, J. C.(2000).Taiwan's national health insurance: The balance between equity and efficiency.Kuo-Shu Liang's Memorial Conference,Taipei:
7. Hsu, W., Wang, C., Wang, W.(1989).Distribution of Tax Burden among Households in TaiwanDistribution of Tax Burden among Households in Taiwan,Taipei:Ministry of Finance.
8. Kakwani, N. C.(1977).Measurement of tax progressivity: An international comparison.National Tax Journal,61
9. Pechman, J. A., Okner, B. A.(1974).Who Bears the Tax Burden?.Washington, D. C., US:Brookings Institution.
10. Schultz, T. P.(1999).The Political Economy of Taiwan's Development into the 21st Century: Essays in Memory of John C. H. Fei, Volume 2.Cheltenham, UK:Edward Elgar.
11. Wagstaff, A., Van Doorslaer, E.(1992).Equity in the Finance of health care: Some international comparisons.Journal of Health Economics,11
12. Wagstaff, A., Van Doorslaer, E.(1999).Equity in the Finance of health care: Some further international comparisons.Journal of Health Economics,18
13. Yeh, H. J.(1999).An empirical examination of the equality in health care delivery in Taiwan.International Conference on Family, Social Policy and Financial Strategy,Taipei:
14. Yeh, J. B.(1995).National Chun Hsing University.
15. Yu, T. S.(1983).Income Distribution in Taiwan.Taipei:The Institute of Economics, Academia Sinica.
16. Yung, S. L.(1999).National Chengchi University.
17. 朱雲鵬 Chu, Yun-Peng(1991)。家戶大小與所得分配：1980與1989年台灣實證研究 Household size and income distribution: Empirical study on Taiwan, 1980 and 1989。中國經濟學會年會論文集 The Chinese Economic Association Annual Conference Proceedings
18. 吳慧瑛 Wu, Huo-Ying(1998)。家戶人口規模與所得分配，1976-1995 Household Size and Income Inequality in Taiwan, 1976-1995。經濟論文 Academia Economic Papers，26(1)
19. 劉彩卿 Liu, Tsai-Ching, 陳欽賢 Chen, Chin-Shyan(2002).An analysis of private health insurance purchasing decisions with national health insurance in Taiwan.Social Science and Medicine,55
20. 鄭文輝 Cheng, Peter Wen-Hui、 葉秀珍 Yeh, Hsiu-Jen、 蘇建榮 Su, Jain-Rong(1998)。全民健保保險對象家庭財務負擔與醫療使用之探討 The Distribution of Financial Burden and Medical Utilization among the Insured Families in Taiwan's National Health Insurance全民健保保險對象家庭財務負擔與醫療使用之探討 The Distribution of Financial Burden and Medical Utilization among the Insured Families in Taiwan's National Health Insurance,台北:中央健康保險局。
21. 鄭文輝 Cheng, Peter Wen-Hui、 蘇建榮 Su, Jain-Rong、 周麗芳 Chou, Li-Fang、 梁正德 、 何怡澄(1996)。我國全民健康保險投保金額計算基礎與保費分擔比率之研究 A Study on the Basis of Calculating Contribution Payment and Its Division among Related Parties in Taiwan's National Health Insurance我國全民健康保險投保金額計算基礎與保費分擔比率之研究 A Study on the Basis of Calculating Contribution Payment and Its Division among Related Parties in Taiwan's National Health Insurance,台北:中央健康保險局。
22. 鄭文輝 Cheng, Peter Wen-Hui、 蘇建榮 Su, Jain-Rong、 梁正德 、 何怡澄 、 陳俊全 Chen, Chiun-Chuan(1998)。我國全民健康保險財務收支歸宿之研究 The Incidence of Contributions and Benefits in Taiwan's National Health Insurance我國全民健康保險財務收支歸宿之研究 The Incidence of Contributions and Benefits in Taiwan's National Health Insurance,台北:中央健康保險局。
23. 羅紀琼 Lo, Joan Chi-Chiung(1998)。全民健康保險對所得分配的影響 The impacts of national health insurance on income distribution。自由中國之工業 Industry of Free China，88(11)

1. 蔡貞慧(2004)。我國全民健康保險的所得重分配效果：1995~2000。社會政策與社會工作學刊，8(1)，221-250。
2. 蔡貞慧、高豐渝(2010)。我國健康照護財務負擔的公平性：1995-2006。社會政策與社會工作學刊，14(1)，81-117。
3. 蔡貞慧、張鴻仁、王本仁(2005)。2002年調整保費及部分負擔對全民健康保險財務公平性之影響。人文及社會科學集刊，17(1)，1-31。