全民健保制度自實施以來,一方面民眾逐漸適應,滿意程度也愈來愈高;另一方面則 由於民眾對醫療需求不斷的增加,導致醫療費用呈現節節上升的趨勢。為了避免健保財務可能 產生危機,故有必要未雨綢繆,及早擬定對應的政策,自負額制度即是其中之一。自負額制與現 行全民健保的部分負擔制都具有減少不必要的醫療需求,避免醫療資源浪費的功能,不過二者 仍然有其不同的特色。自負額制的設計,基本上是希望小病由民眾自行負擔,大病才由保險負 擔。不過是否能達到預期的效果,會受到自負額的額度大小、消費者對醫療照護的需求彈性以 及累計時間的長短三點因素的影響。根據本文所蒐集到的資料顯示,目前醫療保健制度採用自 負額制的國家中,美國是最主要的,北歐三國及瑞士、冰島、澳大利亞等國也有採行,且多實施 於醫療需求彈性較大、而費用較低、但使用頻繁的項目上。我國如果要實施自負額制度,門診 醫療應是優先考慮的實施項目。對中央健保局而言,一來可以降低行政費用,二來又可以減少 健保的支出。不過由於民眾的負擔會加重,因此自負額制的額度不能過重,弱勢團體更應免付 自負額,同時保費也應該調降。另外,全面的電腦化連線以及健保卡的配合使用才能避免勾結 行為的產生。至於自負額額度的設定,最好是配合目前全民健保制度的設計,仍以就醫的次數 為單位,再佐以其他必要的規範,以減少新制度帶來的衝擊。

　　　　　Medical expenditures have been increasing since the National Health Insurance (NHI) program was first implemented in 1995. Several policies which include copayment system were used to contain rising costs and to avoid financial crisis. In this paper we focus on another policy called deductible system. Deductibles are some fixed amount that a consumer must pay for medical services before health insurance payments are made. The idea is to make small illness events uninsured and to make serious illness events insured. The effects of deductible system depend on the amount of deductible, demand elasticity of medical care, and time. 'We believe that deductible is feasible in outpatient care in the NHI. It will reduce both administrative costs and medical expenses, and lead medical resources to be used more effectively.