台灣與韓國醫療財務負擔之比較

Abstract

背景: 台灣和韓國在東亞地區發展了相似的醫療體系。隨着兩國醫療支出不斷增加，審視是否能因應預期的成本上升是至關重要的。兩國的醫療改革，由不同的政治及文化背景所推進，包括健保收費制度，藉由深入理解可獲得參考數據及洞悉出革新方向。

目的: 本研究比較台灣和韓國醫療體系的財務負擔，著重於全民健康保險收費制度和醫療保健支出。研究重點是以兩國的家庭爲中心試算出保費、部分負擔以及健保不涵蓋的自費部分。這解釋了制定保費和計算醫療費用上的差異，進而統計數據的詳細分析。

方法: 本研究主要運用文獻比較法對相關資料進行深入探討。透過蒐集及彙整全民健康保險統計、醫療保健支出和家庭收支調查，並予以歸納及分析。

結果: 2011年，韓國的經常性醫療保健支出（Current Health Expenditure）占國內生產毛額 (GDP)的比重從6%大幅增至2021年的9.3%。台灣同期的增長相對較爲溫和，只從6.5%上升至6.8%，主要是由於其較高的GDP增長率。兩國的醫療保健支出比重維持在OECD國家平均值之下（從2011年的8.7%至2021年的9.7%）。2021年，韓國的每人平均醫療保健支出爲3,266美元，而台灣則爲2,239美元。

① 全民健康保險保費: 兩國在收費方面存在差異。在2021年，台灣的一般受僱者 (第1類別第一到第三項目)平均保費率是月薪的2.37%，比韓國的3.43%低。保費總額中，台灣被保險人的補充保費比例是4.3%。韓國則是7.5% (1%為職場投保人的月薪以外所得，6.5%為地區投保人的財產和汽車徵收)。此外，台灣的眷屬需繳納保費，韓國則不收取。

② 家庭自費 (自費、部分負擔): 在台灣，經常性醫療保健支出中的家庭自費占比是30.72%，其中包含28.12%的非健保自費和2.6%的部分負擔。韓國的占比是29.1%，包含15.98%的非健保的自費和13.11%的部分負擔。由此推算出韓國的個人自費比台灣高出1.2到1.6倍，其中部分負擔為6.2到8.6倍，而健保不納入的自費與台灣相比為0.7到1倍。

結論: 本研究採用政府公開的報告和研究數據，但在可得性限制下會影響精確度。台灣的健保保障率較高，保費和部分負擔比例較低，這使得醫療服務更加便利，唯獨自費部份些許高於韓國。近年來，韓國在保費收取方面也不斷實施相關改革，回應民眾的要求。醫療體制的有效及效率性關乎著民眾的健康，因此需要政府的密切監督和及時調整。

Background: Taiwan and South Korea (Korea hereafter) have developed similar healthcare systems in East Asia. With health expenditures continuously increasing, reviewing whether these systems can handle the anticipated rise in costs is essential. Their healthcare reforms, shaped by unique political and cultural contexts, provide valuable insights and primary data for future health policy and system improvements, including reforms in insurance premium collection.

Objective: The study compares the financial burden of healthcare systems in Taiwan and Korea, focusing on national health insurance (NHI) premium collection and health expenditures. The core of the study is to calculate and estimate the financial burden of households and individuals in both countries on premiums, copayments, and out-of-pocket expenses. It also explains how health insurance premiums and medical costs are calculated in both countries and compares statistical data.

Methods: This study conducted a literature review and data analysis (archival analysis). It primarily uses official government reports, such as NHI statistics, national health accounts (national health expenditure), and household income and expenditure surveys.

Results: Korea's current health expenditure (CHE) as a percentage of GDP surged from 6.0% in 2011 to 9.3% in 2021. Taiwan's increase was more modest, from 6.5% to 6.8% during the same period, primarily due to its higher GDP growth rate. Both countries maintain relatively lower proportions than the OECD countries average (from 8.7% in 2011 to 9.7% in 2021). In 2021, CHE per capita was 3,266 USD in Korea and 2,239 USD in Taiwan.

① NHI premium: The main difference in premium collection between Taiwan and Korea is that Taiwan collects premiums from dependents, while Korea does not. As of 2021, Taiwanese workers (Category 1 Items 1-3) paid an average of 2.37% of their monthly salary as premiums, while Korean workers paid 3.43%. As of 2021, supplementary premiums for the insured accounted for 4.3% of the total premiums in Taiwan. In Korea, supplementary premiums for the insured comprised 7.5% of total premiums (1% for employees and 6.5% for the self-employed).

② Household out-of-pocket (out-of-pocket, copayment): In Taiwan, the household out-of-pocket (OOP) share of total current health expenditures was 30.72%, of which 28.12% was out-of-pocket (non-insurance), and 2.6% was copayments. The household out-of-pocket share in Korea was 29.1%, with 15.98% out-of-pocket (non-insurance) and 13.11% copayments. Korea's household out-of-pocket expenditures per capita are 1.2 to 1.6 times that of Taiwan's. Broken down, it is 0.7 to 1.0 times for out-of-pocket (non-insurance) and 6.2 to 8.6 times for copayment.

Conclusion: This study employed publicly available government reports and research data; there were limitations in data availability and level of precision. Taiwan’s NHI offers extensive coverage with lower premiums and copayments, ensuring a high level of accessibility to medical services despite slightly higher OOP expenses than Korea. Meanwhile, Korea has consistently implemented relevant reforms in premium collection in recent years. The effectiveness and efficiency of healthcare systems affect people's health, which requires vigilant government monitoring and prompt adjustments in both countries.