低收入戶醫療照護政策之研究(II)

Abstract

本研究採用文獻法、郵寄問卷法與調查訪問法進行資料之蒐集。首先以文獻法與郵寄問卷法蒐集並整理有關我國醫療補助的歷史和現況,從社政人員方面得知執行的困難和申請者的抱怨,前者有經費負擔、法令不周、醫院不配合、和申請者證件不合等問題;後者有申請費時、額度太低的抱怨。 繼之以文獻法從社會問題與社會政策面來進行我國與美國在醫療補助政策的比較分析。醫療補助的對象為貧窮人士,我國對貧窮原因之界定多放在外在因素、重大災害的看法上;美國則雖同意外在環境因素的重要性,卻更強調個人的因素。值得一提的是我國嚴苛的低收入標準,使孤獨無依老人佔低收入戶一大部分,而其他原因引起之貧窮很難列入低收入戶,自然也很難取得醫療補助。在醫療補助政策方面,較不同的是美國醫療補助與幾個其他社會救助方案相通,而且有所謂的「醫療上需求者」,享有完全相同醫療補助,我國雖有中低收入醫療補助,但額度卻有限制,對一些中低收入卻有重大醫療需求者助益不太大。 問卷訪問法則以大台北地區的一般民眾和列冊低收入戶為抽樣訪問對象,分別詢問其醫療資源使用、社會福利認知態度、醫療福利認知態度、社會福利需求以及醫療滿意度等看法。研究發現低收入戶確和一般民眾有極大不同。 最後本研究除從實證結果給予建議外,更從低收入醫療政策給予建議,認為以過去醫療補助的精神繼續辦理,而非採用現行之低收入健康保險制度。中低收入則和一些類別式中低收入醫療補助辦法合為中低收入民眾健康保險,自行繳納保費或由政府協助繳納部分保費,納入全民健保體係,以求更公平正義之社會。

This study uses literature review, face to face interview, and mailed survey to collect related data. At first, the historical and current health care policies in Taiwan were reviewed by using existing data and mailed questionnaire from governmental social welfare administrator. From the mailed questionnaire, the difficulties of implementation were the financial burden of medic-aid, the incompleteness of legislation, the unwillingness of hospitals to cooperate and the incompleteness of needed information of applicants. The complaint from the applicants were the long waiting time and the limited amount of medical aid. The comparison of the medical aid (or medicaid) between Taiwan and the United States was also employed from the chamber`s analytical framework of social problem and social policy analysis. Poverty, which is the most important reason to get medical aid in both countries, has different sources. In Taiwan, the factor to contribute to poverty seems to focus on the external factors, such as significant disasters. In the United states, though the external factors are important, the individual factors are also emphasized. That is one of the reason why the poor people are so few in Taiwan, and so many in the United States. It is worthy of mentioning that the elders without dependents make up a high proportion of low income households in Taiwan. This is also meant that people in Taiwan have more difficulties to become eligible for medicaid. In addition to the eligibility requirements, the most significant difference between these two countries concerning to medicaid program was: In the United States, medicaid is related to several other public assistance programs and has so called `medical needy` recipients. They enjoy exactly the same benefits as the low income people. In Taiwan, although there has been lower middle class medicaid program, the amount of aid is so limited that most of the time it is not so useful for the people who encounter significant health problems, but whose income is higher than those of the low income households. Face to face interview was also employed to compare the general public and low income households in terms of medical resources utilization, attitude toward social welfare and health welfare policy, social needs and patients` health care satisfaction in Taipei area. The finding shows the different views between these two groups. Finally, the policy of health care in low income people is suggested.