論社會保險制度之財務運作原則─兼評中央與地方政府關於健保費補助之爭議問題

Abstract

社會保險制度的重要特徵之一，乃依據保險原則，保費用以支付保險給付，因此社會保險財務具有封閉性，不與政府一般稅收及預算程序相互流通。不過另一方面，政府以稅收挹注社會保險之財務，亦為許多國家之立法明文或為實務運作之常態。我國全民健保為使不同經濟能力之國民均有參與風險分攤團體的能力而採取「混和式」制度，即以社會保險封閉性之財務運作為架構，納入社會救助、社會促進與社會補償等各種單向性給付，因此政府也提供被保險人保費補助，參與社會保險之財務運作。究竟社會保險之財務與國家一般財政關連性如何？國家是否負有法律上之義務，提供被保險人保費補助或對社會保險之整體財務給予補助？如再將原先作概括單一理解的「國家」連結到中央與地方之財政劃分制度上，中央與地方是否均有提供被保險人保費補助之義務？針對上述問題，本文首先探討社會保險財務獨立於一般財政稅收之意涵，進而釐清國家在社會保險制度中扮演的角色。至於政府補助之費用中央與地方究竟應如何分擔，則須逐一探究各類被保險人之補助目的，才能進一步探討其為中央或地方之權限、並依據任務與財政負擔聯結原則判斷其費用承擔者。就此而言，大法官解釋第五五○號僅籠統指出中央與地方均有推行全民健保之義務，最高行政法院決議也僅以「投保地」單一標準界定地方自治團體分擔保費之範圍，均有值得改進補充之處。

Paying premiums for insurance benefits is one of the important characteristics of a social insurance system. The financing of social insurance is absolutely separate from the governmental budget. But it is also a normal practice in many social welfare states that the government often supports its financing with taxes. In Taiwan, due to the compulsory subscription of insurance and premium payment imposed on all citizens, the national health insurance system is not only based on the premium-benefit-principle, but also on the combined factors of social welfare benefits, social compensation and social promotion, namely a combination-type of social insurance. The government subsidizes most of the insured in Taiwan in the payment of their premiums and is therefore involved in the financing of social insurance. In such a case, what is the relationship between the financing of social insurance and that of the governmental budget? Is the government bound to subsidize the insured in paying their premiums or to support the financing of social insurance? In accordance with the vertical division of powers, are local self-governing bodies also obligated to promote the social insurance system and share the financial burden? With regard to the above questions this article is firstly conducted to elucidate the separate financing of social insurance from national budget and clarify the functions of government in the financing of social insurance. This article is further conducted to analyze the social policies which were accomplished through the subsidizing of premiums with respect to different categories of the insured. We have to look directly at the purpose of the subsidy, according to the principle of the connection of duty and finance, so that we may further analyze seperately which policy and its financial burden should be undertaken either by the central government or by local self-governing bodies. In this respect the Judicial Yuan Interpretation No. 550 which declares that not only the central government but also the local self-government bodies have the duty to promote the national health insurance, and the judgment of the Supreme Administrative Court, which clarifies the extent of subsidy to be covered by local self-governing bodies based on the location of the agencies of the insured, requires more consideration and argumentation for improvement and implementation.