| 摘要: | 台灣在沒有全民健康保險以前，政府所舉辦的保險參與只有六成的民眾，參與者都是有特定身分者。政府為了保障全民的醫療權利還有促進健全的醫療體系，創辦了全民健保。全民健保也讓所有人民擁有了基本的醫療保障，在公平性上實有很大的進展。但第一代健保也揭露不少問題，諸如醫療資源短缺，面臨到的是醫療資源短缺，不管是在物資上面的運用，又或者是醫護人員的配置等，都是醫療資源分配的問題。 本文反省辛格(Peter Singer)之偏好功利主義和他所提倡的利益平等考量原則以及丹尼爾斯(Norman Daniels)之公平健康照護理論，試圖初步探討全民健康保險制度的公平性與效率問題。當有限的醫療資源面對人人所需要的醫療資源及大家都應在同一個公平的狀態下，其應擁有的醫療資源分配該是如何，才是社會公義的表現。本文探討全民健保要依照辛格的「偏好功利理論或者是利益平等考量」，還是丹尼爾斯的「公平平等機會原則」，促使所有人都享有平等的競爭機會，與可以滿足個人的偏好且達到一個資源分配的最好狀況。 本文嘗試把辛格與丹尼爾斯的理論延伸到全民健保的公平性上，利用上述兩位學者對全民健保和二代健保進行分析，以見出公平的醫療資分配所涉及的不只是在效率上，還有當病人需要醫療資源時，是否可以有效的且恢復病人的正常物種功能，且也可以滿足人的偏好而達到運用資源達到最好的結果。二代健保制度比一代健保較為完善，但仍有許多需要改進的地方。In Taiwan, before the establishment of National Health Insurance (NHI), only about 60% of people of certain kind of profession, such as civic servants, teachers, military units, farmers and some others had medical insurance run by government. In order to offer medical protection for all, the government established the National Health Insurance. The National Health Insurance improves greatly the fairness of medical coverage for all. However, since its establishment, the first generation of NHI reveals a number of problems in the shortage of resources, medical institutions and officials allocations and distribution, which are basically medical resources distribution problems. This paper first gives an analysis on Singer’s preference utilitarianism and his principle of equal consideration, and Norman Daniels’s just health care theory, in order to probe into the problems of fairness and efficiency in medical resources distribution.. With limited resource and unlimited need, it is a big problem how to distribute medical resource fairly. This paper enquires whether the National Health Insurance should follow with Singer’s "preference utilitarian theory, or, Daniels’s the principle of fair and equal opportunities, to meet individual preferences and reach the best condition of a resource allocation. This article attempts to extend Singer’s and Daniels’s theory to the problem of fairness of the NHI, to analyze and how to improve the second generation of NHI. Proposals are suggested as to how equitable allocation of medical resources includes not only efficiency, but also provides adequate treatments for patients to return to their normal species functioning. It could satisfy the individual preference with the best results. In general, our estimation confirms that the second generation NHI is fairer one than the first generation, but there are still many areas need further improvement. |
