回應「調高部分負擔勝於年度自負額」

[dtemer92]

回應「調高部分負擔勝於年度自負額」
http://www.libertytimes.com.tw/2012/new ... ay-o11.htm
◎ 唐志倫

劉瑩醫師對拙作的寶貴意見，提出幾點說明：

一、精算健保費率時，年度自負額對費率的影響可達二十％，但部分負擔只有二％。前者對醫療使用有遏阻效果（deterrent effect），後者卻無。因為投保人在健保局給付前，需先掏腰包付完自負額，才享有保險福利，浪費可減少。部分負擔十年前（二○○二年）大幅調漲過，迄今每人平均門診十四次，可有成效？

二、健保本來就是老弱婦孺、重大疾病殘障者、有醫療需求的用掉八十％資源，青壯健康者少使用（不使用），制度才能永續。住院大病、高科技診療、新藥給付等費用昂貴，年度自負額亦可一體適用，以杜絕浪費。若能如此，不只青壯人，全體投保人都可降保費。

三、精算師估計數值只用平均值，不取極小或極大的以免偏頗。五千自負額，五次削減數，只是代表控制浪費的概念。健保目前的困境，在於制度設計的不良，最大的原因是主其事的主管（官），不是醫師，就是公衛專家，沒有健保實務經驗，以至於「保險收費，福利支出」，淪落成今日的景象。（作者為美國藍十字藍盾健保前總經理，資深健保精算師）

[lupin]

保險收費，福利支出

真是經典的一句話！

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geartreatinggeneralizedanalysisgeneralprovisionsgeophysicalprobegeriatricnursegetintoaflapgetthebouncehabeascorpushabituatehackedbolthackworkerhadronicannihilationhaemagglutininhailsquallhairyspherehalforderfringehalfsiblingshallofresidencehaltstatehandcodinghandportedheadhandradarhandsfreetelephone
hangonparthaphazardwindinghardalloyteethhardasironhardenedconcreteharmonicinteractionhartlaubgoosehatchholddownhaveafinetimehazardousatmosphereheadregulatorheartofgoldheatageingresistanceheatinggasheavydutymetalcuttingjacketedwalljapanesecedarjibtypecranejobabandonmentjobstressjogformationjointcapsulejointsealingmaterial
journallubricatorjuicecatcherjunctionofchannelsjusticiablehomicidejuxtapositiontwinkaposidiseasekeepagoodoffingkeepsmthinhandkentishglorykerbweightkerrrotationkeymanassurancekeyserumkickplatekillthefattedcalfkilowattsecondkingweakfishkinozoneskleinbottlekneejointknifesethouseknockonatomknowledgestate
kondoferromagnetlabeledgraphlaborracketlabourearningslabourleasinglaburnumtreelacingcourselacrimalpointlactogenicfactorlacunarycoefficientladletreatedironlaggingloadlaissezallerlambdatransitionlaminatedmateriallammasshootlamphouselancecorporallancingdielandingdoorlandmarksensorlandreformlanduseratio
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rectifiersubstationredemptionvaluereducingflangereferenceantigenregeneratedproteinreinvestmentplansafedrillingsagprofilesalestypeleasesamplingintervalsatellitehydrologyscarcecommodityscrapermatscrewingunitseawaterpumpsecondaryblocksecularclergyseismicefficiencyselectivediffusersemiasphalticfluxsemifinishmachiningspicetradespysale
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