| 摘要: | 本研究關注未成年時期負債對成年後債務償還能力的影響。從實際案例中發現，未成年人積欠健保費無力繳納，可能導致成年後繼續累積欠費，並且受到行政執行程序的追償。相較於無欠費的未成年人，成年即承受健保欠費壓力是否影響成年後的繳納行為，因此本研究以臺灣健保費繳納行為為例，探討未成年負債對成年債務償還能力的影響。
為了解未成年健保欠費對成年健保繳納行為的影響，本研究設定了兩個對立假說：1. 未成年健保欠費對成年健保欠費存在負向關聯，2.未成年健保欠費對成年健保欠費存在正向關聯。本研究利用2007年至2022年的健保資料，設置成年平均累積欠費為被解釋變數，未成年欠費、個人特徵和父母特徵為操作變數，建構了4個線性迴歸模型和4個羅吉斯迴歸模型，進行敘述性統計、相關分析及線性和羅吉斯迴歸分析，以驗證未成年欠費是否對成年欠費存在正向或負向關聯。
統計結果顯示未成年欠費對成年欠費具呈正向關聯。未成年時期欠費高，成年時期平均欠費金額也高。在線性迴歸模型結果未成年高欠費組的成年時期欠費金額是未成年低欠費組的1倍以上，在羅吉斯迴歸結果，勝算比均大於1，未成年高欠費組發生成年高欠費高於未成年低欠費組，未成年時期背負健保費債務確實會影響成年後健保費債務的償還能力。除了前述個模型外，本研究另以成年時期與未成年時期累積欠費之欠費差額為被解釋變數，進一步來確認保險對象是否償還欠費，實證結果為未成年高欠費組比低欠費償還較多欠費。
本研究證實未成年時期的高健保欠費會增加成年後的欠費，進而影響經濟能力並顯示出社會不公平。因此，本研究提出兩點政策建議。首先，建議在健保法中明確賦予法定代理人責任與義務，避免讓未成年人承擔健保費。具體而言，應修訂法規，規定未成年人的保費繳納責任由法定代理人或監護人負責，並在移送行政執行時，以法定代理人名義進行，以保護未成年人不受公法債務追償。此外，法定代理人或監護人應履行扶養義務，負擔未成年人的基本生活費用。
其次，本研究發現，對於未成年高欠費組，補助有助於減少累積欠費。建議健保署利用承保資料進行高風險家庭管控，如發現家庭成員入監服刑或父母死亡等情況，即進行社會關懷網絡通報，透過村里長或社工關懷父母死亡或收容人家庭成員，提供適時協助，或尋求社會資源幫助家庭維持功能，並優先補助通報對象。
;This study focuses on the impact of debt incurred during adolescence on the ability to repay debt in adulthood. It has been found from actual cases that minors with unpaid health insurance premiums may continue to accumulate more debt into adulthood and face administrative enforcement procedures. Compared to minors without unpaid premiums, those who face the pressure of health insurance debt as soon as they reach adulthood may exhibit different payment behaviors. Therefore, this study explores the impact of adolescent debt on the ability to repay debt in adulthood, using Taiwan’s health insurance premium payment behavior as an example.
To understand the impact of unpaid health insurance premiums during adolescence on payment behavior in adulthood, this study sets up two opposing hypotheses: 1) Unpaid health insurance premiums during adolescence have a negative correlation with unpaid premiums in adulthood, and 2) Unpaid health insurance premiums during adolescence have a positive correlation with unpaid premiums in adulthood. This study uses health insurance data from 2007 to 2022, with average cumulative unpaid premiums in adulthood as the dependent variable, and unpaid premiums during adolescence, personal characteristics, and parental characteristics as independent variables. Four linear regression models and four logistic regression models were constructed, and descriptive statistics, correlation analysis, and linear and logistic regression analyses were conducted to verify whether unpaid premiums during adolescence have a positive or negative correlation with unpaid premiums in adulthood.
Statistical results indicate a positive correlation between unpaid premiums during adolescence and those in adulthood. Higher unpaid premiums during adolescence are associated with higher average unpaid premiums in adulthood. Linear regression model results show that the unpaid premiums in adulthood for those with high unpaid premiums during adolescence are more than double those of the low unpaid premiums group. In logistic regression results, the odds ratios are greater than 1, indicating that those with high unpaid premiums during adolescence are more likely to have high unpaid premiums in adulthood compared to those with low unpaid premiums during adolescence. This demonstrates that carrying health insurance debt during adolescence indeed affects the ability to repay health insurance debt in adulthood. In addition to the aforementioned models, this study also uses the difference in cumulative unpaid premiums between adulthood and adolescence as the dependent variable to further confirm whether individuals repay their debt. The empirical results show that those with high unpaid premiums during adolescence repay more debt than those with low unpaid premiums.
This study confirms that high unpaid health insurance premiums during adolescence increase unpaid premiums in adulthood, thereby affecting economic capacity and highlighting social inequality. Therefore, this study presents two policy recommendations. First, it is recommended to clarify the responsibilities and obligations of legal guardians in the National Health Insurance Act to prevent minors from bearing health insurance premiums. Specifically, regulations should be amended to stipulate that the responsibility for paying premiums for minors falls on the legal guardian, and administrative enforcement should be conducted in the name of the legal guardian to protect minors from public debt recovery. Legal guardians should also fulfill their obligation to provide for the essential living expenses of minors.
Secondly, the study finds that subsidizing health insurance for those in the high unpaid premiums group during adolescence can help reduce cumulative unpaid premiums. It is recommended that the National Health Insurance Administration utilize insurance data to monitor high-risk families, such as those with incarcerated family members or deceased parents, and initiate social care network notifications. Through the care of village heads or social workers, families of deceased or incarcerated individuals can receive timely assistance or seek social resources to maintain family functionality. Priority should be given to subsidizing those identified through these notifications. |
