全民健康保險第一類被保險人投保金額的區域差異性分析

Abstract

本研究主要的目的在於探討各健保區之第一類被保險人平均投保金額不同的原因所在。尤其是，中區分局第一類保險人平均投保金額明顯地低於其他五個分區，這與吾人一般認為中區的經濟活動水準在台灣應名列前茅的印象不符，其中是否有匿報或短報投保金額的情況，還是因為某種潛在的因素或事實所造成的結果，這正是本研究所要深入探討的問題。在廣為蒐集政府所出版的各類統計資料之後，本研究依序對各健保區的薪資、所得與支出、就業與人口、投保單位特性、地下經濟活動及攤販與申報所得等，進行深入的分析。結果發現，中區分局第一類被保險人平均投保金額最低的可能原因為以下幾點：(1)中區分局場所單位員工平均全年薪資為各分局最低，尤其以彰化縣為各縣市最低，台中縣為第四低。就行業別而言，中區分局的製造業員工薪資最低，而且各行業中以從事製造業的員工人數最多。(2)中區分局多為大家庭，且家庭所得收入者的負擔較重，可能考慮到自身及眷屬的保費負擔，而有誘因透過加入工會等方式轉移投保身份，或低報投保薪資以逃避高額保費。(3)沖區分局製造業企業單位比例最高且規模較小，容易發生投保單位低報被保險人投保金額的現象。(4)中區分局第四目被保險人所佔比例最高且所得偏高，較可能發生低報投保金額的情形。(5)中區分局非法地下經濟活動嚴重。(6)中區分局的攤販業家數多，且規模最大。(7)中區分局攤販從業人員收入最高，從事攤販業而逃漏的租稅，或是逃漏的健保投保金額當然也就相對較大。(8)中區分局綜合所得稅中薪資所得申報核定金額為最低，尤其以彰化縣、台中縣、及南投縣的薪資所得偏低情況較為嚴重。從上述八項結論可知，中區分局的薪資所得最低、地下經濟猖獗、攤販業充斥，為其第一類被保險人平均投保金額偏低的主要原因，而另外由統計數據推測的可能原因為：中區分局大家庭的被保險人可能考慮到自身及眷屬的保費負擔，而有誘因透過加入工會等方式轉移投保身份，或低報投保薪資以逃避高額保費；中區分局企業單位比例最高且規模較小的製造業投保單位可能存在低報被保險人投保金額的現象；中區分局第四目被保險人所佔比例最高且所得偏高，較可能發生低報投保金額的情形。因此，雖然一般認為中區分局的經濟活動水準在台灣應屬前茅，其平均投保金額不應最低，但本研究結果發現，中區分局第一類被保險人平均投保金額偏低應為市場經濟運作的自然結果。根據本研究的分析結果，我們有以下的幾項政策建議：(1)中區分局的薪資所得最低，造成其第一類被保險人平均投保金額最低，但觀察其所得收入並非六區之末，由於薪資所得僅為總所得的一部分，因此建議投保金額應考慮薪資所得以外的其他所得收入。(2)中區分局地下經濟猖獗、攤販業充斥，這主要原因為稅賦及管制所造成，所以政府應對租稅及管制政策作一全盤的檢討，以降低地下經濟活動及攤販業的擴張，使業者能依照應有的投保身份與薪資申報投保金額。(3)對於中區分局大家庭的被保險人為了逃避高額保費，而透過加入工會等方式轉移投保身份，或低報投保薪資的現象，建議應拉近各類別被保險人的負擔比例，減少其移轉身份投保的誘因。(4)針對中區分局低報被保險人投保金額的現象，應加強對製造業投保單位及第四目被保險人的查核。 This paper is to study the average insured payroll-related amount of category I in BNHI branches, especially, we focus on the Central Branch to investigate the reasons attributing its lower average insured payroll-related amount than other BNHI branches. The different sources of official data are used to analyze, the results show that: (1) In the Central Branch, employee`s average annual salary is the lowest among BNHI branches. By the industry, Central Branch manufacture employee`s salary is the lowest, and the number of employee is the largest. (2) The Central Branch has a high proportion of big family, this may induce the beneficiaries to transfer their beneficiary category, or to underrate insured payroll amount in order to reduce the burden of premium. (3) The Central Branch has a high proportion of small or medium size manufacture business, it is easy for the group insurance applicants to underrate the insured payroll amount. (4) The Central Branch has the largest proportion of beneficiaries in item 4, and the beneficiaries in this item has a higher income, this may lead to underrate the insured payroll amount. (5) In the Central Branch, the underground economic activities are popular. (6) In the Central Branch, it has a number of large sizes vending business. (7) In the Central Branch, the vender`s income is higher than other BNHI branches, underrate the insured payroll amount will be more relatively. (8) In the Central Branch, the reported salary of income tax is the lowest in Taiwan. By the above findings, we can say that lower average insured payroll-related amount in the Central Branch is a natural result of market economy. Based on the study, we have the following policy suggestions: (1) The insured amount may include the alternative income other than payroll. (2) The government should adopt policies to reduce underground economy and the number of vending business, this will be helpful for the beneficiaries to report a true insured amount. (3) Narrowing the premium sharing percentage of the Category insured is helpful for reducing the incentive of shifting beneficiary category. (4) In order to improve the lower insured payroll amount in the Central Branch, the government should pay more attention to check manufacture group insurance applicants and item 4 insured.