臺灣全民健康保險的醫療支出重分配效果，1995-2000

Objectives: One major objective of Taiwan's National Health Insurance Program (NHI) is to remove financial barriers to health care access. Several cross-sectional studies indicate that the distribution of the NHI premium burdens makes low-income people worse off. As the NHI premium structure and co-payment schemes have undergone many changes since its implementation in March 1995, it is essential to examine the distribution of household health care expenditures under the NHI program longitudinally. Methods: By using 1995-2000 Family Income and Expenditure Survey in the Taiwan Area, this study examines the distribution of household premium burdens as well as out-of-pocket expenditure across income levels. The progressitity of distribution is measured by the Kakwani index. Results: The distributions of premium burdens were all regressive between 1995 and 2000, whereas the regressivity was decreased annually during this period. The distribution of out-of-pockets was more regressive than that of premium, whereas the regressivity also decreased annually. Conclusion: The distributional regressivity of premium burdens and out-of-pockets are similar to many OECD countries. However, the equity of premium distribution could be improved by restructuring the payroll taxing scheme. Although the NHI program improves the distributional equity of household out-of-pocket expenditures on health care, expanding co-payment schemes instead of restructuring the payroll taxing design to increase NHI revenue would harm the distributional equity of household health care expenditures across income levels.