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本文探讨全民健康保险的正义基础。本文主张,全民健保现有的集中化制度设计可以达到维持社会基本公平正义的要求,尽管它仍存在着若干可以改善的空间。本文首先分析评估健康保险的三种正义标准,分别是私人配置式正义、社会正义以及程序性正义。其次,作者分析全民健保开办迄今所达成的正义表现在哪些方面,同时限制何在。再次,作者通过对三种健康照护体系的比较,解释了全民健保通过了哪些机制能确保与弱势者团结的社会效果。最后,作者分析全民健保仍存在着哪些可以进一步改革的空间,并且指出目前哪些改革建议可能是不利于全民健保维持基本社会正义的目标。本文的基本立场是健康是属于社会正义而非私人配置式正义的范畴,因为在缺乏社会正义的保障下,任何追求个别人生目标的希望都将落空,因而健康权是公民的基本权利之一。在这一关于社会正义的规范基础上,作者批评了私人配置式正义的问题,分析了自1995年以来开办的全民健保在维持社会正义方面所取得的成就,同时也分析了其限制与不足所在。作者进一步探讨了全民健保作为一种“社会”保险,应该透过公共化的方式加以治理,以确保一个与弱势者团结的机制,并且节制医疗专业的权力。然而,由于目前被保险人的自我组织力量仍然有限,因而必须透过若干制度性的措施维持程序性正义。
This article explores the just basis of universal health insurance. This paper argues that the design of the existing centralized system of universal health coverage can meet the requirement of maintaining social basic fairness and justice, although there are still some room for improvement. This article first analyzes and evaluates three kinds of justice standards of health insurance, namely privately-arranged justice, social justice and procedural justice. Second, the author analyzes what aspects of justice have been achieved so far in the run-up to the National Health Insurance and at the same time what the limits are. Thirdly, by comparing the three health care systems, the author explains what mechanisms Medicaid has adopted to ensure the social effect of uniting with the underprivileged. Finally, the author analyzes what there is still room for further reform in universal health coverage, and points out which of the current reform proposals may be detrimental to the goal of universal health protection to maintain basic social justice. The basic position of this article is that health belongs to the category of social justice rather than privately arranged justice because without any guarantee of social justice, any hope of pursuing individual goals will be lost. Therefore, the right to health is one of the basic rights of citizens. Based on this norm of social justice, the author criticizes the issue of private-confounded justice, analyzes the achievements made by NHS in maintaining social justice since 1995, and analyzes the limitations and shortcomings . The author further explores that universal health coverage, as a “social” insurance, should be governed in a public way to ensure a mechanism of solidarity with the underprivileged and to curtail the power of the medical profession. However, due to the limited self-organizing power of the insured nowadays, procedural justice must be maintained through a number of institutional measures.