刚刚收到Taipei Times主编来信,文章这一两天就会登出来 这里先让Single版版友先睹为快 Singles Should Not Afford Higher Premiums under the National Health Insurance in Taiwan Michelle Ma, Ph.D. Assistant Professor, Graduate Institute of Healthcare Administration, Kaohsiung Medical University Taiwan's National Health Insurance (NHI), a universal health insurance program implemented in 1995, covers comprehensive health care services. The NHI is a government-run, single-payer national health insurance scheme, financed through a mix of premiums and taxes, which compensates a mixed public and private delivery system predominantly on case-payment and fee-for-service bases. The insured, employers and government each pay a share of premiums. Recently, the Department of Health (DOH) has been planning to introduce a new premium scheme because soaring health care expenditure has aggravated the financial pressure on the NHI. The DOH has proposed that an individual whose marital status is single (including divorced, widow, widower, gay and lesbian) should bear two to four times the current premium. For example, a single individual whose monthly income is NT$50,000 would have to pay NT$1,600 for the NHI premium per month under the new premium scheme, which twice than the amount he or she has to pay now. On the other hand, an individual who whose monthly income is NT$50,000 but has three children would also pay NT$1,600 per month for the NHI premium under the new scheme. In order to convince the Legislature to pass the bill, Minister of Health Dr. Yaung Chih-Liang told lawmakers that singles should bear higher premiums under the new premium scheme because this population is more likely to suffer from mental illness. He cited Google search results using keywords “marriage” and “health” as indicating that all international studies have shown a statistically significant correlation between marriage and health. Dr. Yaung’s arguments have been criticized a lot and do not make sense to many people. Why? First of all, statistical correlation does not necessarily indicate causality. Does marriage make people mentally healthier, or do mentally ill people have a lower likelihood of getting married? The answer could be either of the two, or both. Anyway, regardless of what the real answer is, marital status should never be used to determine NHI premium rates because the NHI is a social insurance, and wide pooling of risks is one of the special characters of social insurance, which is quite different from traditional private insurance. Besides, marital status is not the most important determinant of health and health care utilization. Second, patients with psychiatric illnesses are still stigmatized in Taiwan. If Dr. Yaung thinks mentally ill people should have to bear higher premiums just because they are mad, it would worsen discrimination against mentally ill people and retard the development of a better mental health care system, as well as frustrate the endeavors of many mental health professionals in Taiwan. Third, although Taiwanese society has become more diverse than before, same-sex marriage is still not legally recognized in Taiwan. Asking gays and lesbians to pay higher premiums is tantamount to inflicting a punishment on them. The rights of divorced people, widows, and widowers should not be sacrificed by the DOH's new policy either, because their medical and living expenses could be even higher than those of married people. Finally, the new policy would also be unfair to infertile couples. In Taiwan, assisted reproductive technology (ART) is not covered by the NHI, and infertile patients have pay for costly ART treatment themselves. Under the new NHI premium scheme, infertile couples would need to pay more than those couples with similar household income who have children. Dr. Yaung further insists that this new policy can stimulate Taiwan's fertility rate, which as been declining. He is telling people: if you don't want to pay higher premiums, why don't you get married and have children? In reality there are a variety of reasons for Taiwan's rapidly declining fertility, such as economic recession, lower wages, postponement of marriage and later childbearing age. Singles should not be punished for Taiwan's declining fertility and the increasing costs of bearing children by being charged higher premiums. Again, being single is not the true reason for either the NHI’s financial burden or Taiwan's low fertility. The potential effects of financial incentives on people's fertility decisions remain ambiguous and controversial. While pronatalist policies may stimulate fertility rates, they also lower the cost of preventing births for eugenic or whatever reasons. NHI reform policies and those aimed at stimulating fertility rates should be discussed separately. ---------------------------------------------------------------------------- 抱歉排版比较乱,到时候我会把文章网址转过来 杨志良你不是很喜欢在国际上自我感觉良好地宣传台湾健保吗? 你坚持要二代健保要单身者多付保费一天,我就呛你一天 我不只会在台湾呛你,将来还要到国际会议跟国际期刊去呛你 你等着丢脸丢到国外去好了! -- 平生所愿：看到狗官杨志良身败名裂，滚入19层地狱，永世不得超生！ --

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