剛剛收到Taipei Times主編來信,文章這一兩天就會登出來 這裡先讓Single版版友先睹為快 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. ---------------------------------------------------------------------------- 抱歉排版比較亂,到時候我會把文章網址轉過來 楊志良你不是很喜歡在國際上自我感覺良好地宣傳台灣健保嗎? 你堅持要二代健保要單身者多付保費一天,我就嗆你一天 我不只會在台灣嗆你,將來還要到國際會議跟國際期刊去嗆你 你等著丟臉丟到國外去好了! -- 平生所願：看到狗官楊志良身敗名裂，滾入19層地獄，永世不得超生！ --

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