健康促進與預防保健政策對國民健康影響之比較：以台灣與韓國為例

Abstract

研究背景與目的： 在全球面臨人口老化與慢性病盛行的挑戰下，愈來愈多國家重視健康促進與預防導向的政策架構。台灣與韓國皆採行全民健康保險制度，並面對類似的人口與健康負擔。然而，兩國在健康促進政策的制度化、法制架構與執行方式上呈現顯著差異。本研究旨在比較台灣與韓國在健康促進與預防醫學方面的政策結構、介入策略與健康結果，進一步探討制度設計與治理模式對國民健康結果的影響。 研究方法：本研究採比較政策分析法，聚焦三大面向：（一）組織與財政結構，包括主管機關、法制架構、健康支出架構（NHE/CHE）、醫療人力與病床資源；（二）健康促進與預防政策，包括法制化程度、成人健康檢查制度、癌症篩檢政策與跨部會治理機制；（三）健康結果，包括平均餘命（LE）、健康平均餘命（HALE）、癌症篩檢涵蓋率與人均醫療支出。資料來源涵蓋2010年至2023年間的官方統計、法規文件及OECD與WHO等國際資料庫。 研究結果：研究顯示，韓國透過《健康增進法》與《健康計畫2030》建立以預防為導向的制度，並設有專責財源與透過法規告訴民眾有責任參與成人健檢機制，成功提升癌症篩檢率並延長健康平均壽命。相較之下，台灣的健康促進政策在法制與財政面整合度較低，穩定性也較不足。儘管兩國平均壽命皆逐年提升，韓國在HALE與癌症篩檢參與率方面表現優於台灣，突顯制度設計對健康結果的關鍵影響。 研究結論：健康促進政策的法制化與穩定的財政規劃，對提升國民健康與健康平等具有關鍵作用。建議台灣強化預防性投入、穩定健康促進財源、健全法源架構，並強化跨部門治理。借鏡韓國整合型政策經驗，有助於台灣打造更具韌性與公平性的健康體系。

Background and Objective: Amid the growing challenges of population aging and chronic disease prevalence, countries worldwide have increasingly emphasized health promotion and preventive policy frameworks. Taiwan and South Korea both implement universal health insurance systems and face similar demographic and health burdens. However, significant differences exist in their institutionalization, legal frameworks, and implementation of health promotion policies. This study aims to compare the policy structures, intervention strategies, and health outcomes of health promotion and preventive medicine in Taiwan and Korea, and to explore how system design and governance influence national health outcomes. Methods: This study adopts a comparative policy analysis approach, focusing on three major dimensions: (1) organizational and financial structures, including governing agencies, legal frameworks, health expenditure structures (NHE/CHE), medical workforce, and hospital bed capacity; (2) health promotion and preventive policies, including legal institutionalization, adult health check-up programs, cancer screenings, and intersectoral governance mechanisms; and (3) health outcomes, including life expectancy (LE), healthy life expectancy (HALE), cancer screening coverage, and per capita healthcare expenditure. Data were collected from 2010 to 2023 using official government statistics, legal documents, and international sources such as the OECD and WHO. Results: The findings show that Korea has established a legally supported, prevention-oriented system through the National Health Promotion Act and Health Plan 2030, with dedicated funding and promoted adult health check-up programs. These efforts have resulted in increased screening rates and improvements in HALE. In contrast, Taiwan’s system displays fragmented policy integration and less stability in legal and fiscal frameworks. While both countries have steadily improved life expectancy, Korea outperforms Taiwan in HALE and cancer screening participation, underscoring the impact of institutional design on health outcomes. Conclusion: Legal institutionalization and stable fiscal planning are critical to the success of health promotion. Taiwan is encouraged to strengthen its investment in prevention, secure sustainable health promotion funding, reinforce its legal framework, and improve interministerial coordination. Drawing from Korea’s integrated approach may help Taiwan develop a more resilient and equitable health system.