⺰ ᢥක≮଻㒾೙ᐲᡷ㕟ߣ▤ℂ┹੎㧦ࠝ࡜ࡦ࠳ߩ⚻㛎ߦቇ߱ *߽ߣ߭ࠈ૒ ⮮  ਥ  శ **㧔৻ᯅᄢቇᄢቇ㒮⚻ᷣቇ⎇ⓥ⑼㧘࿖㓙࡮౏౒᡽╷ᄢቇ㒮ಎᢎ᝼㧕㧔೨ળ⸘ᬌᩏ㒮․೎⎇ⓥቭ㧕䋱䋮䈲䈛䉄䈮㩷
90 ᐕઍએ㒠᰷Ꮊ⻉࿖ߢߪ‫ޟ‬Ꮢ႐㧔┹੎㧕ේℂ‫ߩޠ‬ዉ౉ࠍࡌ࡯ࠬߣߒߚක≮೙ᐲᡷ㕟߇⹜ߺࠄࠇߡ߈ߚ‫ޕ‬80 ᐕઍ߹ߢߩ‫▚੍✚ޟ‬೙‫∛ޟ߿ޠ‬ᐥⷙ೙‫ࠍޠ‬฽߻✚㗵▤ℂ᡽╷ߪක≮⾌ߩ᜛ᄢࠍᛥ߃ࠆߎߣߢߪ৻ቯߩᚑ
ᨐࠍ᜼ߍߡ޿ߚ߇㧘ࡒࠢࡠ࡮࡟ࡌ࡞ߢߺࠆߣක≮⾗Ḯߩല₸⊛ߥ㈩ಽࠍ៊ߥߞߡ޿ߚߣߐࠇࠆ‫ဳౖߩߘޕ‬଀߇⧷࿖╬ߦߺࠄࠇࠆᓙᯏ࡝ࠬ࠻ߢ޽ࠆ‫៊߽ߘ߽ߘޕ‬ᄬ଻㓚ߐࠇࠆ౏⊛଻㒾⠪㧔∔∛㊄ᐶ㧕ߦߪ⥄ᓞ⊛ߦࠦࠬ࠻೥ᷫ߿ක≮ߩ⾰ߩะ਄ߦദ߼ࠆ⺃࿃߇ߥߊ㧘‫ߊߥߣߎ߁ߥ៊ࠍ⾰ߩࠬࡆ࡯ࠨޟ‬ක≮⾌ߩㆡᱜൻ‫߇ޠ‬ㅴ߼ࠄࠇߡ߈ߚߣߪ⸒޿㔍޿‫ ߢߎߘޕ‬90 ᐕઍ߆ࠄߪࡑࠢࡠ▤ℂ߆ࠄࡒࠢࡠ࡮࡟ࡌ࡞ߢߩක≮⾗Ḯ㈩ಽ࡮⺃࿃ലᨐࠍ㊀ⷞߔࠆᣇะ߳ߩක≮᡽╷ߩォ឵߇ߥߐࠇߚ‫ౕޕ‬૕⊛ߦߪ࠼ࠗ࠷߿ࠝ࡜ࡦ࠳ߦ߅ߌࠆട౉⠪ߦࠃࠆ଻㒾⠪㧔∔∛㊄ᐶ㧕ߩ⥄↱ߥㆬᛯ㧘଻㒾⠪ߦࠃࠆක≮ᯏ㑐ߩㆬᛯ߿୘೎੤ᷤߥߤ߇᜼ߍࠄࠇࠆ‫ߩࠇߕ޿ޕ‬ᡷ㕟߽㧘Ꮢ႐㧔┹੎㧕ේℂߩዉ౉ߣಽᮭൻ㧔଀㧦଻㒾⠪ߩⵙ㊂ߩ᜛ల㧕ࠍࡌ࡯ࠬߣߒߡ޿ߚ‫ߒߛߚޕ‬㧘␠ળ଻㒾ߩℂᔨߚࠆ␠ળㅪᏪߪၷᜬߒߡ߅ࠅ㧘౏⊛ක≮଻㒾೙ᐲ⥄૕ߩ᳃༡ൻ߿࿖᳃ోߡ߳ߩᦨૐ㒢ߩක≮߳ߩࠕࠢ࠮ࠬߩ᡼᫈ࠍᗧ࿑ߒߡ޿ߚࠊߌߢߪߥ޿‫ޕ‬ࠊ߇࿖ߢ߽଻㒾⠪ᯏ⢻ߩᒝൻ߇࿑ࠄࠇߡ޿ࠆ‫ޕ‬2006 ᐕߩක≮଻㒾೙ᐲᡷ㕟ߦ߅޿ߡ᡽▤ஜ଻߿Ꮢ↸᧛࿖଻ߩㇺ㆏ᐭ⋵න૏ߢߩಽഀ࡮⛔ว߿࿾ၞဳஜ଻⚵วߩ⸳┙ߥߤߪ଻㒾⠪ߩౣ✬ᚑ࡮⽷᡽ၮ⋚ߩ቟ቯൻߣว
ࠊߖߡ㧘‫଻ޟ‬㒾⠪ᯏ⢻߇⊒ើߐࠇࠆਥ૕ߦࠃࠆ଻㒾ㆇ༡‫ޟ߼ߚߩߘޕࠆ޿ߡߒߣ޿⁓ࠍޠ‬ౣ✬ߐࠇߚ଻㒾⠪ߪ㧘࡟࠮ࡊ࠻ὐᬌ╬ߩข⚵ࠍᦝߦᒝൻߔࠆߣߣ߽ߦ㧘ⵍ଻㒾⠪⋧⺣㧘࿾ၞߩක≮ࠨ࡯ࡆࠬ╬ߦ㑐ߔࠆᖱႎឭଏ㧘߈߼⚦߆ߥ଻ஜ੐ᬺߦߟ޿ߡㇺ㆏ᐭ⋵න૏ߢ౒หታᣉࠍផㅴߔࠆ‫ ࠆࠇߐߣߩ߽ޠ‬1)‫ޕ‬ஜᐽჇㅴኻ╷ߦߟ޿ߡ߽ 2008 ᐕ 4 ᦬ࠍ⋡ㅜߦ‫↢ޟ‬ᵴ੍㒐ߦߟ޿ߡߩ଻㒾⠪ߩᓎഀࠍ᣿⏕ߦߒ㧘ⵍ଻㒾⠪࡮ⵍᛔ㙃⠪ߦኻߔࠆലᨐ⊛࡮ല₸⊛ߥஜ⸻࡮଻㒾ᜰዉࠍ⟵ോઃߌࠆ‫ޠ‬2)ߣߒߡ޿ࠆ‫߃޿ߪߣޕ‬㧘଻㒾⠪⥄り߇ක≮ᯏ㑐ࠍㆬ೎ߒߚࠅ㧘⸻≮ႎ㈽߿ක≮ߩ⾰ߦߟ޿ߡ୘೎ߦ੤ᷤࠍⴕߞߚࠅߢ߈ࠆࠊߌߢߪߥ޿‫⟵ޕ‬ോ࡮⽿છࠍ⽶ߞ* ᧄⓂߪ⪺⠪߇ળ⸘ᬌᩏ㒮․೎⎇ⓥቭ࿷છਛߩ 2006 ᐕ 9 ᦬ߦታᣉߒߚᶏᄖⴕ᡽ታᘒ⺞ᩏߩᚑᨐߦၮߠߊ߽ߩߢ޽ࠆ‫ޕ‬** 1969 ᐕ↢߹ࠇ‫ޕ‬92 ᐕ৻ᯅᄢቇ⚻ᷣቇㇱතᬺ㧘98 ᐕࠢࠖ࡯ࡦ࠭ᄢቇ⚻ᷣቇㇱ Ph.D ขᓧ‫ޕ‬99 ᐕ৻ᯅᄢቇᄢቇ㒮⚻ᷣቇ⎇ⓥ⑼ኾછ⻠Ꮷࠍ⚻ߡ㧘
02 ᐕࠃࠅ⃻⡯‫ߩߎޕ‬㑆㧘05 ᐕ 4 ᦬߆ࠄ 07 ᐕ 3 ᦬߹ߢળ⸘ᬌᩏ㒮․೎⎇ⓥቭ‫ޕ‬ኾ᡹㧦࿾ᣇ⽷᡽㧘౏౒⚻ᷣቇ㧘␠ળ଻㓚‫ޕ‬ᚲዻቇળ㧦ᣣᧄ⚻ᷣቇળ㧘ᣣᧄ⽷᡽ቇળ‫ޕ‬‫ޟ‬ක≮଻㒾೙ᐲ૕♽෸߮⸻≮ႎ㈽૕♽ߦ㑐ߔࠆၮᧄᣇ㊎ߦߟ޿ߡ‫ޠ‬㧔ᐔᚑ 15 ᐕ 3 ᦬ 28 ᣣ㑑⼏᳿ቯ㧕‫ޟ‬ஜᐽ଻㒾ᴺ╬ߩ৻ㇱࠍᡷᱜߔࠆᴺᓞ᩺ߦߟ޿ߡ‫ޠ‬㧔ෘ↢ഭ௛⋭㧕- 41 -

ળ⸘ᬌᩏ⎇ⓥ No.36㧔2007.9㧕ߡ߽ක≮ᯏ㑐߳ߩⷙᓞઃߌ╬㧘ᔅⷐߥᮭ㒢߇ઃਈߐࠇߥ޿ߥࠄ߫㧘଻㒾⠪߇ක≮⾌ㆡᱜൻߦะߌߚദജࠍ
ᛄ߁૛࿾ߪߥ޿‫ޕ‬
ᧄⓂߢߪ㧘ࠝ࡜ࡦ࠳ߩ⚻㛎߆ࠄࠊ߇࿖ߩ޽ࠆߴ߈ක≮଻㒾೙ᐲᡷ㕟ߦߟ޿ߡ⠨߃ߡ޿߈ߚ޿‫߫ߒ߫ߒޕ‬㧘
┹੎ේℂߪല₸ᕈߩㅊ᳞ߣᒙ⠪ߩಾᝥߡࠍ᜗ߊߣ⸒ࠊࠇߡ߈ߚ‫ߒ߆ߒޕ‬㧘┹੎ࡔࠞ࠾࠭ࡓߪߘࠇ߇ㆡಾߦ
▤ℂߐࠇߡ޿ࠆߥࠄ߫㧘␠ળ଻㒾ߩ‫ޟ‬ㅪᏪ‫ޠ‬㧔ౣಽ㈩㧕ߩේೣߣ⍦⋫ߒߥ޿ߎߣ߇㧘ࠝ࡜ࡦ࠳ߩᡷ㕟߆ࠄ߽᣿ࠄ߆ߦߥࠆ‫ᧄޕ‬Ⓜߩ᭴ᚑߪᰴߩߣ߅ࠅߢ޽ࠆ‫ޕ‬2 ▵ߢߪ੺⼔଻㒾㧘᳃㑆଻㒾ࠍ฽߻ਃጀ߆ࠄߥࠆࠝ࡜ࡦ
࠳ߩක≮଻㒾೙ᐲࠍ᭎ⷰߔࠆ‫ޕ‬90 ᐕઍߦ౏⊛ක≮೙ᐲߩᨒౝߢዉ౉ߐࠇߚ‫▤ޟ‬ℂ┹੎‫ ߪߡ޿ߟߦޠ‬3 ▵ߢㅀߴࠆ‫଻ޕ‬㒾⠪㑆ߢߩ┹੎ࠍଦߒߟߟ␠ળㅪᏪࠍᔀᐩ㧘߆ߟ࡝ࠬࠢㆬᛯߩ⺃࿃ࠍㆱߌࠆߚ߼ߩ‫ࠢࠬ࡝ޟ‬᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ‫ߩޠ‬ℂ⺰ߣታ㓙ߪ 4 ▵ߢ⺑᣿ߔࠆ‫ ߪ࠳ࡦ࡜ࠝޕ‬2006 ᐕߦᓥ᧪ߩ∔∛㊄ᐶߣ᳃㑆଻㒾ࠍ⛔
วߒߚක≮଻㒾೙ᐲᡷ㕟ࠍታᣉߒߡ޿ࠆ‫ޕ‬5 ▵ߢߪߘߩ᭎ⷐߦߟ޿ߡㅀߴࠆ‫ޕ‬6 ▵ߪ⚿⺆ߢ޽ࠆ‫ޕ‬䋲䋮䉥䊤䊮䉻䈱ක≮଻㒾೙ᐲ䈱᭎ⷐ㩷ߪߓ߼ߦࠝ࡜ࡦ࠳ߩක≮೙ᐲࠍ᭎ⷰߒߚ޿‫ޕ‬࿑⴫ 1 ߩߣ߅ࠅ㧘ห࿖ߩ৻ੱᒰߚࠅක≮⾌㧔2004 ᐕ㧕ߪ 3,661
࡙࡯ࡠߢ㧘GDP ߩ 12.8㧑޽߹ࠅࠍභ߼ࠆ 3)‫ޕ‬ห࿖ߩක≮଻㒾೙ᐲߪࠊ߇࿖ห᭽㧘␠ળ଻㒾ᣇᑼࠍၮ␆ߦ㧔1㧕㐳ᦼ౉㒮߿੺⼔╬ߦⷐߔࠆක≮⾌ࠍ⵬ఘߔࠆ╙ 1 ጀ㧘
㧔2㧕ᕆᕈ∔ᖚࠍਥߦኻ⽎ߣߔࠆ╙ 2 ጀ㧘
㧔3㧕౏⊛ක
≮⛎ઃએᄖࠍ฽߻╙ 3 ጀ߆ࠄ᭴ᚑߐࠇࠆ‫ߜ߁ߩߎޕ‬㧘ᧄⓂ߇⌕⋡ߔࠆߩߪ╙ 2 ጀߢ޽ࠆ‫ޕ‬࿑⴫ 㪈㩷 䉥䊤䊮䉻䈱ක≮೙ᐲ䈱᭎ⷐ㩷৻ੱ޽ߚࠅක≮⾌

2004 ᐕ

3,661࡙࡯ࡠක≮⾌㧔ኻ GDP Ყ㧕

2004 ᐕ

12.80㧑

20 ᱦએਅੱ ญ ᭴ ᚑ24.3㧑2006 ᐕ

20 ᱦએ਄ 65 ᱦએਅ
65 ᱦએ਄

14.3㧑

ੱญජੱ޽ߚࠅකᏧᢙ

2003 ᐕ

ੱญජੱ޽ߚࠅ⋴⼔Ꮷᢙᐔဋ࿷㒮ᣣᢙ

৻

⥸

∛

61.4㧑

㒮

2003 ᐕ

ᄢቇ㧔ࠕࠞ࠺ࡒ࠶ࠢ㧕∛㒮

3.1 ੱ
13 ੱ
7.2 ᣣ
8.7 ᣣ

ක≮⾌ߦභ߼ࠆഀว㧔2000㧕╙㧝ጀක≮଻㒾೙ᐲ

╙2ጀ
╙3ጀ

․೎ක≮⾌⵬ఘ೙ᐲ

44㧑

∔∛㊄ᐶ

37㧑

᳃㑆଻㒾

16㧑

⵬ቢ⊛଻㒾

3㧑

಴ᚲ㧦ࠝ࡜ࡦ࠳ળ⸘ᬌᩏ㒮ឭଏ⾗ᢱ㧘Lamers et all㧔2003㧕

OECD ၮḰ㧔‫଻✚ޟ‬ஜක≮ᡰ಴‫ޠ‬㧕ߢߪ߆ࠆߣኻ GDP Ყߪ 9.8㧑㧔2003 ᐕ㧕ߦ⇐߹ࠆ߇㧘ࠊ߇࿖ߩኻ GDP Ყ㧔หᐕ 7.9㧑㧕ࠃࠅ߽㜞޿‫ޕ‬- 42 -

ක≮଻㒾೙ᐲᡷ㕟ߣ▤ℂ┹੎╙ 㪈 ጀ䋺㪘㪮㪙㪱㩷╙ 1 ጀߦ޽ߚࠆ‫․ޟ‬೎ක≮⾌⵬ఘ೙ᐲ‫ޠ‬㧔AWBZ㧕 ߪ 1968 ᐕࠃࠅታᣉߐࠇ㧘㐳ᦼ౉㒮㧔৻ᐕએ਄㧕㧘♖␹⑼ᴦ≮ߩ߶߆㧘㜞㦂⠪࡮㓚ኂ⠪ߩߚ߼ߩᣉ⸳࡮࿷ቛ੺⼔ߥߤࠍࠞࡃ࡯ߔࠆ೙ᐲߢ޽ࠆ㧔ᑝἑ(2000)㧕
‫ޕ‬AWBZ
ߪࠝ࡜ࡦ࠳ߩක≮ᡰ಴ߩ 44㧑޽߹ࠅࠍභ߼ࠆ㧔࿑⴫ 1㧕‫⛎ޕ‬ઃ⾗ᩰߦᐕ㦂೙㒢ߪߥߊ㧘ࠝ࡜ࡦ࠳ዬ૑⠪࡮ⵍ↪⠪ࠍኻ⽎ߣߒߚ࿖᳃ᒝ೙଻㒾ߢ޽ࠆ‫⛎ޕ‬ઃኻ⽎ߪ᜛ᄢߒߡ߈ߡ߅ࠅ㧘⃻࿷㧔2006 ᐕᤨὐ㧕ߪ㧔1㧕ኅ੐េഥ㧔㘩੐ߩḰ஻㧘᝹㒰╬㧕㧘
㧔2㧕り૕੺⼔㧘㧔3㧕⋴⼔࡮↢ᵴᜰዉ㧘
㧔4㧕↢ᵴᡰេ㧘㧔5㧕㧔ᔃり㓚ኂ⠪߿໧㗴ⴕേ⠪߳ߩ㧕࠮࡜ࡇ࡯㧘㧔6㧕㧔∔∛߆ࠄߩ࿁ᓳᤨߩ㧕࡝ࡂࡆ࡝㧔‫ ╙ޟ‬3 ᰴ੍㒐‫ޠ‬㧕㧘
㧔7㧕ᣉ⸳ࠤࠕߣ޿ߞߚ
‫ޟ‬ᯏ⢻‫ޠ‬
㧔Function㧕ࠍᜂ߁‫ޕ‬ᣉ⸳㧘࿷ቛ㧘࡝ࡂࡆ࡝࡮࠮ࡦ࠲࡯ߣ޿ߞߚଏ⛎ࡌ࡯ࠬߢߪߥߊ㧘ⷐ⺧ߐࠇࠆᯏ⢻㧔࠾࡯࠭㧕ߦၮߠ޿ߡ⾗ᩰⷐઙ㧔Entitlement㧕߇ቯ⟵ߐࠇࠆߩ߇․ᓽ⊛ߢ޽ࠆ‫ࠅࠃߦࠇߎޕ‬㧘㘃ૃߒߚࠨ࡯ࡆࠬ㧔ࠤࠕ㧕ࠍឭଏߔࠆਥ૕㧔∛㒮㧘ᣉ⸳㧘ࠗࡦࡈࠜ࡯ࡑ࡞࡮ࠤࠕ㧕߿ߘࠇࠄࠍ㔛ⷐߔࠆᖚ⠪ߪᡰᛄ޿㧘ⷙ೙࡮⋙〈਄㧘ห৻ߦᛒࠊࠇࠆ‫৻ޕ‬ᣇ㧘ࠊ߇࿖ߢߪᣉ⸳ࠤࠕ㧔㐳ᦼ≮㙃㧕ߢ޽ߞߡ߽․೎㙃⼔⠧ੱࡎ࡯ࡓ㧔␠ળ⑔␩ᴺੱ㧕㧘੺⼔⠧ੱ଻ஜᣉ⸳෸߮≮㙃ဳ∛ᐥ⟲ߩ㑆ߢߪⷙ೙㧔කᏧ࡮⋴⼔Ꮷߩ㈩⟎╬㧕߇⇣ߥࠆ‫ߦᦝޕ‬㧘≮㙃ဳ∛ᐥ⟲ߢ޽ߞߡ߽ක≮଻㒾ㆡ↪ߣ੺⼔଻㒾ㆡ↪ߢߪ⛎ઃ▸࿐࡮ႎ㈽૕♽㧔੺⼔଻㒾ㆡ↪ߪ౉㒮߇㐳ᒁ޿ߡ߽ක≮଻㒾ߩࠃ߁ߥႎ㈽ߩㅛᷫ೙ߪߥ޿㧕ߦ㆑޿߇޽ࠆ‫ޕ‬AWBZ ߆ࠄ⛎ઃࠍฃߌࠆߦߪ㧘‫್ࠕࠤޟ‬ቯ࠮ࡦ࠲࡯‫ޠ‬
㧔Care Indication Determination center㧔CIZ㧕㧕߆ࠄߩ⹺ቯ߇ᔅⷐߢ޽ࠆ‫ޕ‬ᣣᧄߩ੺⼔଻㒾೙ᐲߩࠃ߁ߥⷐ੺⼔ᐲߦࠃࠆ඙ಽߪߥ޿߇㧘ᔅⷐߥࠤࠕߩ⒳㘃㧘ᤨ㑆㧘ᦼ㑆ߥߤ߇ CIZ ߦࠃߞߡ᳿߼ࠄࠇࠆ‫߇ࠊޕ‬࿖ߩ੺⼔଻㒾೙ᐲߣߩ㗼⪺ߥ⋧㆑ߪ‫ޟ‬୘೎ࠤࠕ੍▚‫߁޿ߣޠ‬ᒻߢߩ⃻㊄⛎ઃ߇⹺߼ࠄࠇߡ޿ࠆߎߣߦ޽ࠆ‫ߩߎޕ‬೙ᐲߪ 1996 ᐕߦዉ౉ߐࠇ㧘AWBZ ኻ⽎⠪ߪᏗᦸߔࠇ߫㧘ᒰዪ߇ᄾ⚂ߒߚ੐ᬺ⠪߆ࠄߩ⃻‛⛎ઃߦઍ߃ߡ㧘࿷ቛ੺⼔࡮ᡰេะߌߩ੍▚㧔⃻㊄⛎ઃ㧕ࠍฃߌขࠅ㧘੺‫⼔੺ޕ‬⠪ߪኅᣖ㧘෹ੱ㧘ㄭ㓞૑᳃ߢ߽ࠃ޿‫ޕ‬
㧔․ߦ⾗ᩰߪ໧ࠊࠇ
⼔⠪߳ߩᡰᛄ޿ߦలᒰߔࠆ㧔CVZ(2005)㧕
ߥ޿‫ޕ‬㧕ታ㓙㧘੍▚ 4 ഀᒙ߇ࠗࡦࡈࠜ࡯ࡑ࡞࡮ࠤࠕ㧔ኅᣖ㧘⍮ੱ╬߳ߩᡰᛄ޿㧕ߦలߡࠄࠇߡ޿ࠆ㧔࿑⴫ 2㧕‫ޕ‬੺⼔੐ᬺ⠪߆ࠄ⋥ធࠨ࡯ࡆࠬࠍ⾼౉ߔࠆߎߣ߽ߢ߈ࠆ‫ߒߛߚޕ‬㧘୘೎੍▚ࠍᣉ⸳ࠤࠕߦలᒰߔࠆߎߣߪ⹺
߼ࠄࠇߡ޿ߥ޿‫ޕ‬࿑⴫ 㪉㩷 ୘೎䉬䉝੍▚㩷೑↪

⠪

2005/9/1 ᤨὐᢙᦨૐ✚㗵㧔100 ਁ࡙࡯ࡠ㧕೑↪

ᐔဋ੍▚㗵㧔࡙࡯ࡠ㧕85㧑
ࠬ

14,000⥄ Ꮖ ⽶ ᜂ1,000

ࡀ13,000ࠣࠗࡦࡈࠜ࡯ࡑ࡞࡮ࠤࠕ

994.3

2005 ᐕ

₸77,883 ੱࡠ࠶࠻หዬੱ߳ߩᡰᛄ޿

21㧑หዬੱએᄖ߳ߩᡰᛄ޿

17㧑

ว



- 43 -

⸘38%ળ⸘ᬌᩏ⎇ⓥ No.36㧔2007.9㧕

AWBZ ߪ᡽ᐭ߆ࠄߩ⵬ഥ㊄㧔౏⾌㧕ߩ߶߆଻㒾ᢱߦࠃߞߡ⾔ࠊࠇࠆ‫଻ޕ‬㒾ᢱߪᚲᓧߦኻߒߡ⺖ߐࠇ㧘2005
ᐕߩ଻㒾ᢱ₸ߪ 13.45㧑ߢ޽ߞߚ‫↪ⵍޕ‬⠪ߩ AWBZ ଻㒾ᢱߪᚲᓧ⒢߿ઁߩ଻㒾ᢱߣวࠊߖߡḮᴰᓽ෼ߐࠇࠆ৻ᣇ㧘⥄༡ᬺ⠪࡮ᐕ㊄↢ᵴ⠪╬ߪ⒢ോ⟑߆ࠄ㧔ᚲᓧ⒢ห᭽㧕⾮⺖ᓽ෼ߐࠇࠆ‫߅ߥޕ‬㧘ࠤࠕ⛎ઃᤨߦߪ⥄Ꮖ⽶ᜂ߽޽ࠆ‫⥄ޕ‬Ꮖ⽶ᜂߪ୘ੱߩ⺖⒢ᚲᓧ߿ዬ૑⁁ᴫ㧔࿷ቛ߆ᣉ⸳߆㧕ߦଐሽߔࠆ‫଻ޕ‬㒾⠪ߪ࿖ߢ޽ࠆ߇㧘੐ᬺ⠪ߣߩᄾ⚂╬଻㒾⠪ᯏ⢻ࠍ⊒ើߔࠆߩߪ࿾ၞߏߣߦ⸳ߌࠄࠇࠆࠤࠕ࡮ࠝࡈࠖࠬߢ޽ࠆ㧔ᄢ᫪(2001)㧕
‫ޕ‬╙ 㪉 ጀ㩷
╙ 2 ጀߪ AWBZ ߦ฽߹ࠇߥ޿ᕆᕈ∔ᖚ㧘1 ᐕએౝߩ౉㒮ߥߤࠍࠞࡃ࡯ߔࠆ߽ߩߢ㧘2006 ᐕએ೨ߪ∔∛㊄ᐶ෸߮᳃㑆଻㒾߇ਗ┙ߒߡ޿ߚ‫ޕ‬ක≮ᡰ಴ߦභ߼ࠆഀวߪ 53㧑޽߹ࠅ㧘߁ߜ∔∛㊄ᐶ㧘᳃㑆଻㒾ߩࠪࠚࠕߪฦ‫ޘ‬37㧑㧘16㧑ߢ޽ࠆ㧔࿑⴫ 1㧕‫଻ޕ‬㒾⛎ઃߩ▸࿐ߦߪ৻⥸ක㧔GP㧕ฃ⸻㧘ኾ㐷කᴦ≮㧘౉㒮㧔1 ᐕએౝ㧕㧘ᱤ⑼ᴦ≮㧔18 ᱦએਅ㧕࡮⟵ᱤ㧘ක≮ౕེ㧘ౝ᦯⮎࡮⮎೷ᴦ≮㧘಴↥㧘ᢇᕆゞ╬ᖚ⠪ㆇ៝㧘ℂቇ≮ᴺ㧘଻ஜᜰዉ߇฽߹ࠇࠆ‫ޕ‬ᚲᓧ߇৻ቯ㗵એਅߩⵍ↪⠪ߪ∔∛㊄ᐶ߳ߩട౉߇⟵ോઃߌࠄࠇߡ޿ࠆ‫ޕ‬2000 ᐕ߆ࠄߪૐ
ᚲᓧߩ⥄༡ᬺ⠪㧔ㆊ෰ 3 ᐕߩ‫⺖ޟ‬⒢ᚲᓧ‫ޠ‬ᐔဋ 18,695 ࠡ࡞࠳࡯એਅ㧕߿ᐕ㊄ฃ⛎⠪㧔1,860 ࠡ࡞࠳࡯એਅ㧕ߦ߽ട౉⟵ോ߇⺖ߖࠄࠇࠆߎߣߦߥߞߚ㧔Pott-Buter (2000)㧕
‫ޕ‬ᓟㅀߔࠆࠃ߁ߦ∔∛㊄ᐶߪਛᄩၮ㊄㧔Central
Fund㧕߆ࠄ㈩ಽߐࠇࠆ‫ࠢࠬ࡝ޟ‬᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ‫଻ⵍߣޠ‬㒾⠪߆ࠄ⋥ធᡰᛄࠊࠇࠆ㧔ᚲᓧߦଐሽߒߥ޿㧕‫ޟ‬ቯ㗵㧔৻ᓞ㧕଻㒾ᢱ‫ޕࠆࠇߐࠬࡦ࠽ࠗࠔࡈߡߞࠃߦޠ‬ᓟㅀߔࠆࠃ߁ߦ 1992 ᐕએ㒠㧘ⵍ଻㒾⠪ߪ∔∛㊄ᐶࠍㆬᛯߢ߈ࠆࠃ߁ߦߥߞߚ‫ޕ‬
2006 ᐕએ೨㧘㜞ᚲᓧ⠪ߪ᳃㑆଻㒾߳છᗧട౉ߒߡ޿ߚ‫ޕ‬㧔ࠊ߇࿖ߣ⇣ߥࠅ㧘࿖᳃⊝଻㒾ߩ઀⚵ߺߦߪߥߞߡ޿ߥ߆ߞߚ‫ޕ‬
㧕⑳⊛଻㒾ߪ∔∛㊄ᐶߣ߶߷ห৻ߩක≮࡝ࠬࠢࠍࠞࡃ࡯ߒߡ޿ࠆ߇㧘∔∛㊄ᐶߣ⇣ߥࠅ଻㒾ᢱߪ㧘ஜᐽ࡝ࠬࠢࠍ෻ᤋߔࠆࠃ߁᳿߹ߞߡߊࠆ‫⥄ᤨ≮⸻ޕ‬Ꮖ⽶ᜂ߇⺖ߖࠄࠇࠆ႐ว߽޽ࠆ‫߽ߣߞ߽ޕ‬㜞࡝ࠬࠢ㧘․ߦ㜞㦂⠪ߦኻߔࠆ଻㒾ᢱ߇ᕆ㛛ߒߚߩࠍฃߌߡ㧘86 ᐕ߆ࠄ଻㒾ᢱ₸ߦ೙㒢߇ട߃ࠄࠇࠆࠃ߁ߦ
ߥߞߚ‫ޕ‬

࿑⴫ 㪊㩷 ଻㒾ળ␠ᢙ䈱ផ⒖㩷
2001

2002

2003

2004㧔ᐕ㧕∔ ∛ ㊄ ᐶ

25

25

22

22㧔␠㧕

᳃ 㑆 ଻ 㒾

47

46

44

35㧔␠㧕

72

71

66

57㧔␠㧕

ว

⸘

಴ᚲ㧦
‫ޟ‬ක≮ߦ㑐ߔࠆᬌ⸽㧦2005 ᐕᐲᐕႎ‫ޠ‬

2006 ᐕ㧘ක≮଻㒾Ꮢ႐ߢ 33 ߩක≮଻㒾ળ␠߇༡ᬺ㧘ߎࠇࠄࠍડᬺࠣ࡞࡯ࡊߏߣߦಽߌࠆߣ 14 ߩ଻㒾ឭଏ⠪ߦ߹ߣ߼ࠄࠇࠆ㧔‫ޟ‬2006 ᐕߩක≮଻㒾Ꮢ႐ߩ․ᓽ‫ޠ‬㧕‫ޕ‬ක≮଻㒾ળ␠ᢙߪᄢ᏷ߦᷫዋߒߡ߈ߡ޿ࠆ㧔࿑
⴫ 3㧕‫ޕ‬2003 ᐕߦߪ 66 ␠ߩ଻㒾ળ␠㧔∔∛㊄ᐶ࡮᳃㑆଻㒾㧕߇ሽ࿷ߒߚ߇㧘2004 ᐕߦߥࠆߣߘߩᢙߪ 57
␠ߦᷫߞߚ‫଻ߩ߆ߟߊ޿ޕ‬㒾ળ␠ߪ㧘ว૬߿ᒁ⛮߉ߦࠃߞߡߘߩᏒ႐ࠪࠚࠕࠍ㧔ߐࠄߦ㧕᜛ᄢߒߡ޿ࠆ㧔‫ޟ‬ක≮ߦ㑐ߔࠆᬌ⸽㧦2005 ᐕᐲᐕႎ‫ޠ‬㧕‫⚿ޕ‬ᨐ⊛ߦ㧘৻ីࠅߩᏂᄢߥડᬺࠣ࡞࡯ࡊ߇⊒↢ߔࠆ৻ᣇߢ㧘ઁᣇߢߪᲧセ⊛ዊߐߥක≮଻㒾ળ␠ߩࠣ࡞࡯ࡊ߽ሽ࿷ߔࠆߣ޿߁⁁ᴫ߇↢ߓߚ‫ߦ․ޕ‬ᒝ೙ஜᐽ଻㒾ળ␠߿᳃㑆଻㒾ળ␠ࠍๆ෼ߒߚᄢᚻ 5 ♽೉ߩᏒ႐භ᦭₸ߪ 72㧑޽߹ࠅߦ਄ࠆ㧔‫ޟ‬ක≮ߦ㑐ߔࠆᬌ⸽㧦2005 ᐕᐲᐕႎ‫ޠ‬㧕‫ޕ‬- 44 -

ක≮଻㒾೙ᐲᡷ㕟ߣ▤ℂ┹੎╙ 㪊 ጀ㩷
╙ 3 ጀߪ AWBZ ߿∔∛㊄ᐶ㧔౏⊛ක≮଻㒾㧕ߩ⛎ઃኻ⽎ߣߥࠄߥ޿ 18 ᱦએ਄ߩᱤ⑼㧘㜞ᐲవㅴක≮㧘ઍᦧක≮㧘࿷ቛ੺⼔㧘੍㒐࡮ᬌᩏߥߤࠍࠞࡃ࡯ߔࠆ‫⵬ޟ‬ቢ଻㒾‫଻ߩߎޕࠆߥࠄ߆ޠ‬㒾ߪ᳃㑆଻㒾ߦࠃߞߡឭଏߐࠇ㧘⾼౉ߪછᗧߢ޽ࠆ߇㧘ⵍ଻㒾⠪ߩ⚂ 9 ഀ߇ട౉ߒߡ޿ࠆ‫⊛౏ޕ‬㧔ᴺቯ㧕⛎ઃߩ▸࿐ߩ೥ᷫߦ઻
޿㧘ㆊ෰ 10 ᐕ㑆ߦ߅ߌࠆ⵬ቢ⊛଻㒾ߩᄁ਄㜞ߪ 14 ୚ߦჇᄢߒߡ޿ࠆ‫ޕ‬2004 ᐕߦߪ∔∛㊄ᐶߩ⛎ઃ▸࿐߇ᄢ᏷ߦ೙㒢ߐࠇߡ޿ࠆ߇㧘೥㒢ߐࠇߚㇱಽߩᄢඨߪ㧘⵬ቢ଻㒾ߦᒁ߈⛮߇ࠇߚ㧔‫ޟ‬ක≮ߦ㑐ߔࠆᬌ⸽㧦2005
ᐕᐲᐕႎ‫ޠ‬㧕‫ޕ‬䋳䋮▤ℂ┹੎䈱ዉ౉㩷▤ℂ┹੎䈫䈲䋿㩷
▤ℂ┹੎ߪ Enthoven(1988)ߦࠃߞߡ⊒ዷߐࠇߚ᭎ᔨߢ޽ࠅ㧘ࠝ࡜ࡦ࠳ࠍߪߓ߼᰷Ꮊ⻉࿖ߩක≮೙ᐲᡷ㕟ߦᄙᄢߥᓇ㗀ࠍ෸߷ߒߡ޿ࠆ‫▤ޕ‬ℂ┹੎ߪ⥄↱┹੎ࠍᗧ๧ߒߥ޿‫⊛౏ޕ‬ක≮೙ᐲߩ᳃༡ൻ㧘޽ࠆ޿ߪⷙ೙
✭๺ߣ޿߁ࠃࠅ߽㧘ⷙ೙ߩᄌᦝߣ޿߃ࠆߛࠈ߁‫ޕ‬વ⛔⊛ߦ᡽ᐭߩⷙ೙ߪ┹੎ឃ㒰⊛ߢ޽ࠅ㧘଻㒾⠪߿ක≮ᯏ㑐ߦࠃࠆഃᗧᎿᄦࠍଦߔߎߣߪߥ߆ߞߚ‫ߒ߆ߒޕ‬㧘ක≮ࠨ࡯ࡆࠬߩଏ⛎ᒻᘒ㧘㔛ⷐ߇ⶄ㔀ߦߥࠆ߶ߤ㧘ߘߩోߡࠍ᡽ᐭ߇㓸ᮭ⊛ߦࠦࡦ࠻ࡠ࡯࡞ߔࠆߎߣߪ࿎㔍ߦߥߞߡߊࠆ‫ޕ‬୘೎ߩක≮࠾࡯࠭ߦ㑐ߔࠆᖱႎ෼
㓸߿ଏ⛎૕೙߳ߩࡈࠖ࡯࠼ࡃ࠶ࠢߪᏒ႐ᯏ⢻ࠍ੺ߒߡⴕ߁㧘ߟ߹ࠅ㧘┹วߔࠆ଻㒾⠪ߦߘߩᓎഀࠍᆔߨࠆ
ߎߣ߇߻ߒࠈല₸⊛ߣ޿߃ࠆ‫ޕ‬᡽ᐭߪ‫଻ⵍߡߒߣޠ࡯ࠨࡦࡐࠬޟ‬㒾⠪ߩ೑⋉ࠍઍᑯ㧘Ꮢ႐ߩஜోߥᯏ⢻ࠍࠨࡐ࡯࠻ߔࠆ‫ౕޕ‬૕⊛ߦ޿߃߫㧘᡽ᐭߪ଻㒾⠪߇ឭଏߔࠆߴ߈ᦨૐ㒢ߩ଻㒾ࠨ࡯ࡆࠬ㧔଻㒾ߩኻ⽎ߣߥࠆක≮ࠨ࡯ࡆࠬ㧕ࠍቯ߼㧘୘ੱ߇଻㒾ട౉ߦ㑐ߒߡᱜߒ޿ㆬᛯ߇ߢ߈ࠆࠃ߁ᖱႎࠍឭଏߔࠆ‫ޕ‬ᓟㅀߔࠆ࡝ࠬ
ࠢㆬᛯࠍ࿁ㆱߔࠆߴߊ㧘ࠃࠅ♖ᐲߩ㜞޿࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ㐿⊒߽᡽ᐭߩᨐߚߔߴ߈㊀ⷐߥᯏ⢻ߢ޽ࠆ‫ޕ‬ක≮଻㒾㧘ක≮ࠨ࡯ࡆࠬᏒ႐ࠍ⛘߃ߕ⋙ⷞ㧘⹏ଔߔࠆߎߣ߽᳞߼ࠄࠇࠆ‫ޕ‬䊂䉾䉦䊷䊶䊒䊤䊮㩷ࠝ࡜ࡦ࠳ߢߪ 80 ᐕઍࠍㅢߓߡ㧘ක≮ឭଏਥ૕㧔∛㒮࡮ኾ㐷ක╬㧕ߦኻߒߡⷙ೙ࠍᒝൻߔࠆߎߣߢක≮⾌ߩᛥ೙ࠍ࿑ߞߡ߈ߚ‫∛ޕ‬㒮ߦኻߔࠆ✚੍▚ᨒ೙㧔Global Budget System㧕ߪ 1983 ᐕߦዉ౉ߐࠇߚ‫ޕ‬ᒰೋߪ∛㒮ߩ⚻Ᏹ⚻⾌ߩߺࠍኻ⽎ߣߒߡ޿ߚ߇㧘⠉ 84 ᐕߦߪ౉㒮ᴦ≮ో૕ߦㆡ↪ߐࠇࠆࠃ߁ߦߥߞߚ‫∛ޕ‬㒮ߩนᄌ⾌↪߳ߩ੍▚㈩ಽߪ㧘∛㒮ߩ೑↪⁁ᴫ㧔౉㒮₸㧘౉㒮ᣣᢙ㧘ᄖ᧪ฃ⸻₸╬㧕߳ߩ⷗ㄟߺߦଐ᜚ߒߡ޿ࠆ‫ޕ‬ߚߛߒ㧘ߘߩ⷗ㄟߺ⥄૕㧘∛㒮ߣ଻㒾⠪ߣߩ㑆ߢߩ੤ᷤߢ᳿߼ࠄࠇߡ޿ߚߎߣߢ޽ࠅ㧘੤ᷤߩ⿠ὐߪㆊ෰
ߩታ❣߆ࠄ⁛┙ߢߪߥ޿ߚ߼㧘ߎߩ✚੍▚ᨒ೙߇∛㒮߳ߩቢోߥ‫ޟ‬൮᜝ᛄ޿‫∛ޕ޿ߥߪߢߌࠊߚߞ޽ߢޠ‬㒮߳ߩ੍▚㈩ಽ࡞࡯࡞ߪ 1988 ᐕߦߪ৻ጀߩ♖✺ൻ㧔ⶄ㔀ൻ㧕߇ߥߐࠇߡ޿ࠆ
㧔Schut and Van de Ven (2005)㧕
‫ޕ‬∛㒮߳ߩᡰᛄ޿ߩ߶߆㧘ኾ㐷ක߳ߩ⸻≮ႎ㈽ߩᛥ೙߽ታᣉߐࠇߡ߈ߚ‫ޕ‬1984 ᐕߦߪኾ㐷කදળߣ᡽ᐭߩว
ᗧߦࠃࠅ㧘ᚲቯߩ⋡ᮡ᳓Ḱࠍ⿥ㆊߒߚᖚ⠪ߩᴦ≮ߦኻߒߡߪႎ㈽㧔಴᧪㜞ᛄ޿㧕ࠍࠞ࠶࠻ߔࠆ‫ޟ‬ㅛᷫဳ⸻≮ႎ㈽‫߇ޠ‬ታᣉߐࠇࠆࠃ߁ߦߥߞߚ‫ߒߛߚޕ‬㧘ᖚ⠪ߩታᢙࠍᛠីߔࠆߎߣ߇࿎㔍ߥߚ߼㧘ߎߩ᡽╷ߩࠦࠬ࠻ᛥ೙ലᨐߪ㒢ࠄࠇߡ޿ߚ‫ޕ‬1989 ᐕߦߪኾ㐷කᴦ≮ߦኻߔࠆ✚ᡰ಴೙㒢߇⺖ߐࠇߡ޿ࠆߦ⥋ߞߚ‫ޕ‬ߘߩ৻ᣇߢ୘‫଻ߩޘ‬㒾⠪߿ක≮ᯏ㑐ߥߤ߇ࠗ࠾ࠪࠕ࠹ࠖࡉࠍ⊒ើߔࠆ૛࿾ߪ߶ߣࠎߤᱷߐࠇߡ޿ߥ߆
ߞߚ‫ޕ‬ฦ∔∛㊄ᐶߪ࿾ၞ⁛භ㧘ක≮ᯏ㑐߳ߩ⸻≮ႎ㈽ᡰᛄ޿ߪᦨ⚳⊛ߦోߡਛᄩၮ㊄ߦࠃߞߡ⵬ఘߐࠇࠆ
ߚ߼㧘⾌↪೥ᷫദജࠍⴕ߁⺃࿃߽ߥ߆ߞߚ‫ޕ‬᭽‫࡯࠳࡞ࡎࠢࠗ࠹ࠬߥޘ‬㧔଻㒾⠪㧘ක≮ᯏ㑐㧘ഭ௛⚵วߥߤ㧕- 45 -

ળ⸘ᬌᩏ⎇ⓥ No.36㧔2007.9㧕

߇ടࠊࠆߎߣߢ㧔‫ߡߒߣޠࡓ࠭ࠖ࠹࡜ࡐ࡯ࠦޟ‬⍮ࠄࠇࠆࠃ߁ߦ㧕᡽╷᳿ቯߩࡊࡠ࠮ࠬ߇ⶄ㔀ൻߦߥࠅ߇ߜߛ
ߞߚ‫ޕ‬ක≮ߦ㑐ࠊࠆ⸘↹┙᩺㧔∛㒮ᛩ⾗ߥߤ㧕ߣߘߩ⽷Ḯ⺞㆐ߦ㑐ࠊࠆ᳿ቯߪ⛔৻⊛ߦⴕࠊࠇߡ޿ߥ߆ߞ
ߚߎߣߥߤ߽ᡰ಴߳ߩ⽷᡽⽿છࠍਇ᣿⍎ߦߒߚߣߐࠇࠆ㧔Van de Ven and Schut (2000)㧕
‫ޕ‬∛㒮߳ߩ‫▚੍✚ޟ‬ᨒ೙‫╬ޠ‬㧘ଏ⛎ࠨࠗ࠼߳ߩⷙ೙ߩ⚿ᨐ㧘ක≮⾌ߩኻ GDP Ყߪ 8㧑೨ᓟߦᛥ߃ࠄࠇߡ߈
ߚ‫ߒ߆ߒޕ‬㧘✚㊂ⷙ೙ߦ઻߁ක≮⾗Ḯߩ㈩ಽߩ㕖ല₸ൻ㧘‫ޟ‬ᓙᯏ࡝ࠬ࠻‫ߩޠ‬᜛ᄢߥߤක≮ࠨ࡯ࡆࠬߩ⾰ૐਅ߳ߩ ᔨ߽⴫㕙ൻߒߚ‫⛔߼ߚߩߘޕ‬೙ߢߪߥߊᒰ੐⠪㧔ක≮ᯏ㑐࡮଻㒾⠪㧕ߩ⺃࿃ߦ௛߈߆ߌߚല₸ൻ߇ᮨ⚝ߐࠇߪߓ߼ߚ‫ޕ‬ਛ㆏ฝᵷ᡽ᮭߩਅߢ⊒⿷ߒߚ࠺࠶ࠞ࡯ᆔຬળߪ␠ળ଻㒾ߩේೣߢ޽ࠆ౏ᐔᕈ㧔ోߡߩ୘ੱߩක≮ࠨ࡯ࡆࠬ߳ߩࠕࠢ࠮ࠬߩ଻⸽㧕ࠍ⏕଻ߒߟߟ㧘଻㒾⠪࡮ක≮ᯏ㑐߳ߩ⽷᡽⊛ⷙᓞߠߌࠍㅢߓߚ
ല₸⊛ㆇ༡ߩଦㅴࠍ⋡ᜰߒߚ‫ޕ‬หᆔຬળߪല₸ߣ౏ᐔߩ㑆ߩࡃ࡜ࡦࠬࠍᮨ⚝ߒߟߟ㧘ᓥ᧪ߩᣇ㊎㧔᡽ᐭߦࠃࠆ⋥ធⷙ೙㧕ߣߪోߊ⇣ߥࠆᏒ႐ᔒะဳߩᡷ㕟᩺㧔1987 ᐕ㧕ࠍឭ␜ߒߚ‫ޕ‬࿑⴫ 㪋㩷 䊂䉾䉦䊷䊶䊒䊤䊮㩷䉴䊘䊮䉰䊷␠ળ଻㒾ᢱ䋨ᚲᓧଐሽ䋩䇭䇭䇭䊥䉴䉪᭴ㅧ⺞ᢛ䊒䊧䊚䉝䊛㻛␠ળ଻㒾ᢱ

୘ੱ

଻㒾⠪
ቯ㗵଻㒾ᢱ
⸻≮ႎ㈽
䇭ක≮ᯏ㑐




ᡷ㕟᩺ߩ᭎ⷐߪએਅߩࠃ߁ߦ߹ߣ߼ࠄࠇࠆ㧔࿑⴫ 4 ෳᾖ㧕‫ޕ‬(a) ߎࠇ߹ߢಽ┙ߒߡ޿ߚ⑳⊛଻㒾࡮∔∛㊄ᐶ࡮AWBZ ╬ߩක≮଻㒾೙ᐲࠍ⛔วߒ㧘ක≮㧔ᕆᕈ࡮ᘟᕈ∔ᖚ㧕ߣߘࠇߦ㑐ㅪߔࠆ␠ળ⑔␩ࠨ࡯ࡆࠬ㧔ᣉ⸳੺⼔ߥߤ߽฽߻㧕ࠍ൮᜝⊛ߦឭଏߔࠆၮ␆଻㒾ࠍ⸳┙ߔࠆ‫ޕ‬ක≮ߣ੺⼔߇೙ᐲ⊛ߦ඙೎ߐࠇࠆߎߣ߽ߥ޿‫ߩߎޕ‬ၮ␆଻㒾ߪోੱญࠍኻ⽎ߣߒߚᒝ೙଻㒾ߢ޽ࠅ㧘ක≮⾌ో૕ߩ85㧑ࠍࠞࡃ࡯ߔࠆ߽ߩߣߔࠆ‫ޕ‬ᱷࠅߪ⵬ቢ⊛଻㒾෸߮⥄Ꮖ⽶ᜂߢ߽ߞߡ⾔ࠊࠇࠆ‫ޕ‬(b) ଻㒾⠪ߪක≮ࠨ࡯ࡆࠬឭଏਥ૕ߣ⥄↱ߦᄾ⚂ࠍ⚿߱ߎߣ߇ߢ߈ࠆ‫ޕ‬ᄾ⚂ߩ⹦⚦߽ᒰ੐⠪㑆ߩ੤ᷤߦᆔߨࠆ‫ޕ‬ฦ⒳ක≮ࠨ࡯ࡆࠬߦߟ޿ߡ㧘ᄾ⚂ኻ⽎ߪ∛㒮࡮ᣉ⸳೎ߦⷙቯߐࠇߡ޿ࠆࠊߌߢߪ
ߥߊ㧘ක≮᳓Ḱ㧔⾰㧕ߦ㑐ߔࠆᚲቯߩၮḰࠍḩߚߒߡ޿ࠆߥࠄ߫㧘ߤߩଏ⛎ਥ૕ߣ߽ᄾ⚂ࠍ੤ࠊߔߎߣ߇ߢ߈ࠆ‫ޕ‬(c) ␠ળ଻㒾ᢱߪ㧘⋥ធ୘ੱ߆ࠄ଻㒾⠪ߦᡰᛄࠊࠇࠆߩߢߪߥߊ㧘޿ߞߚࠎਛᄩၮ㊄ߦ㓸߼ࠄࠇࠆ‫ޕ‬ਛᄩၮ㊄ߪ଻㒾⠪ߦኻߒߡⵍ଻㒾⠪ߩ࡝ࠬࠢࠍ⺞ᢛߒߚ‫ࠢࠬ࡝ޟ‬᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ‫ࠍޠ‬㈩ಽߔࠆ‫ޕ‬(d) ฦ଻㒾⠪߇ਛᄩၮ㊄߆ࠄฃߌขࠆߩߪᐔဋ⊛⚻⾌ߩ 75㧑޽߹ࠅߢ㧘ᱷࠅߩ 25㧑ߪోട౉⠪߳৻ᓞߦ⺖ߔቯ㗵଻㒾ᢱ㧔Nominal Premium㧕ߢ߽ߞߡ⾔ࠊࠇࠆ‫ޕ‬(e) ୘ੱߪ଻㒾⠪ࠍ⥄↱ߦㆬᛯߔࠆߎߣ߇ߢ߈ࠆ‫ޕ‬
- 46 -

ක≮଻㒾೙ᐲᡷ㕟ߣ▤ℂ┹੎࿑⴫ 㪌㩷 䇸䊒䊧䊚䉝䊛䇹䈱⒳㘃䈫ᯏ⢻㩷

␠

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ᯏ  ⢻㒾ᢱ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ
ቯ

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ᚲ

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ᦼᓙߐࠇࠆലᨐ
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଻㒾⠪ߩ࡝ࠬࠢ࡮ࡋ࠶ࠫ࡝ ࠬ ࠢ ㆬ ᛯ ߩ ࿁ ㆱଔല ₸ ᕈ ߩ ଦ ㅴ

ᩰ

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࠺࠶ࠞ࡯࡮ࡊ࡜ࡦߦࠃࠇ߫㧘ᓥ᧪ߩ⋥ធⷙ೙ߦઍ߃ߡ㧘᡽ᐭߩᓎഀߪ౏⊛଻㒾೙ᐲౝߦഃ⸳ߐࠇߚ଻㒾Ꮢ႐㧘ක≮ࠨ࡯ࡆࠬᏒ႐ࠍ‫▤ޟ‬ℂ‫ޕࠆߥߦߣߎࠆߔޠ‬᡽ᐭߩⷙ೙ߪᏒ႐ߩᯏ⢻ࠍઍᦧߔࠆߩߢߪߥߊ㧘߻ߒࠈ⵬ቢߔࠆ߽ߩߢ޽ࠆߴ߈ߢ޽ࠆߣ޿߁ߩ߇ᡷ㕟᩺ߩၮᧄ⊛┙႐ߢ޽ࠆ‫ౕޕ‬૕⊛ߦߪ㧔i㧕ਛᄩၮ㊄ߩㆇ༡㧘␠ળ଻㒾ᢱߩ᳿ቯߣߣ߽ߦ㧘
㧔ii㧕ၮ␆଻㒾೙ᐲ߇ࠞࡃ࡯ߔࠆක≮ࠨ࡯ࡆࠬߩ▸࿐ߣߣ߽ߦ㧘ᦨૐ㒢଻⸽ߐࠇࠆߴ߈᳓Ḱࠍⷙቯ㧘
㧔iii㧕଻㒾⠪߿ක≮ᯏ㑐ߩㆡᩰᕈࠍ⺞ᩏ࡮⹏ଔ㧘㧔iv㧕୘ੱ߇଻㒾⠪ࠍㆬᛯߔࠆ
਄ߢᔅⷐߥᖱႎ㧔ฦ଻㒾⠪ߩឭଏߔࠆࠨ࡯ࡆࠬߩౝኈ࡮⾰߳ߩ⹏ଔ㧘ቯ㗵଻㒾ᢱ᳓Ḱߥߤ㧕ࠍឭଏߔࠆߎ
ߣ߇᜼ߍࠄࠇࠆ‫ޕ‬൮᜝⊛ߥක≮ࠨ࡯ࡆࠬࠍࠞࡃ࡯ߔࠆᒝ೙⊛ၮ␆଻㒾೙ᐲߩഃ⸳ߪ㧘଻㒾⠪߇ห╬ߩലᨐࠍᜬߟක≮ࠨ࡯ࡆࠬ⟲ߩਛ߆ࠄᦨ߽ല₸⊛ߥ߽ߩࠍㆬᛯ࡮ឭଏߔࠆߎߣࠍน⢻ߦߒ㧘ක≮ࠨ࡯ࡆࠬ㑆ߩઍᦧࠍଦㅴߔࠆ‫ޕ‬ߎࠇ߹ߢߩ଻㒾⠪ߦᦼᓙߐࠇߡ޿ߚߩߪක≮ᯏ㑐߆ࠄߩ⸻≮ႎ㈽⺧᳞ߩಣℂߣ޿ߞߚਥߣߒߡ੐ോಣℂ⢻
ജߢ޽ߞߚ‫ޕ‬ᡷ㕟ߪ଻㒾⠪ߦ࡝ࠬࠢ▤ℂਥ૕ߣߒߡߩ㧘ࠃࠅડᬺኅ⊛ߥᯏ⢻ࠍઃਈߔࠆߎߣࠍ⋡⊛ߣߒߡ޿ࠆ‫↪⾌ޕ‬೥ᷫദജߣ㜞޿ක≮ߩ⾰ߩ⏕଻߳ߩ⺃࿃ߪ㧘୘ੱߦ⹺߼ࠄࠇߚ⥄↱ߥ଻㒾⠪ㆬᛯߣߘࠇߦ⿠࿃
ߔࠆ଻㒾⠪㑆┹੎ߦࠃߞߡଦㅴߐࠇࠆ‫଻ޕ‬㒾⠪㑆┹੎ߪ⾰ߣଔᩰߩਔ㕙߇޽ࠅ㧘ᓟ⠪ߪ଻㒾⠪ߩࠦࠬ࠻ࡄ
ࡈࠜ࡯ࡑࡦࠬࠍ෻ᤋߔࠆቯ㗵଻㒾ᢱࠍㅢߓߡⴕࠊࠇࠆߎߣߦߥࠆ㧔࿑⴫ 5㧕‫ޕ‬ቯ㗵଻㒾ᢱߪหߓ଻㒾⠪ߣห৻ߩ଻㒾ᄾ⚂ࠍ੤ࠊߒߡ޿ࠆ୘ੱ㑆ߢߪဋ৻ߢ޽ࠆ߇㧘଻㒾⠪㑆ߢߪല₸ᕈߩ㆑޿ࠍ෻ᤋߒߡ⇣ߥߞߡߊࠆ‫ޕ‬ട౉⠪ߩ଻㒾ᢱ⽶ᜂߪᚲᓧଐሽဳ␠ળ଻㒾ᢱߣߎߩቯ㗵଻㒾ᢱߩว⸘ߣߥࠆ‫ߜ߁ߩߎޕ‬ᚲᓧଐሽဳ଻㒾ᢱߣ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ⚵ߺวࠊߖߪ‫␠ޟ‬ળㅪᏪ‫ޠ‬㧔ౣಽ㈩㧕ࠍၷᜬߔࠆ߽ߩߢ޽ࠅ㧘ቯ㗵଻㒾ᢱߪଔᩰࡔࠞ࠾࠭ࡓߣߒߡᯏ⢻ߔࠆ㧔࿑⴫ 5㧕‫଻ޕ‬㒾⠪㑆┹੎ߪ㧘ട౉⠪₪ᓧߩߚ߼㧘ฦ଻㒾⠪ߦኻߒ㧘ࠃࠅല₸⊛ߥක≮ᯏ㑐ߣᄾ⚂ࠍ⚿߱⺃࿃ࠍਈ߃㧘ߎࠇ߇ක≮ࠨ࡯ࡆࠬឭଏਥ૕㑆ߢߩ┹੎ࠍᵴ⊒ൻߔࠆߛࠈ߁‫ޕ‬ᓥߞߡ㧘଻㒾⠪㑆┹੎෸߮ଏ⛎ਥ૕㑆┹੎ߩଦㅴߪᡷ㕟᩺ߦ߅޿ߡ㧘৻૕ߦߥߞߡ޿ࠆ‫ޕ‬ᡷ㕟᩺ߦߪ‫ޟ‬㓸ᮭൻ‫ޟߣޠ‬ಽᮭൻ‫ߩޠ‬ਔ㕙߇฽߹ࠇߡ޿ࠆ‫ޕ‬᡽ᐭߦࠃࠆක≮ࠨ࡯ࡆࠬ߳ߩଔᩰ࡮ᢙ㊂ⷙ೙ࠍᑄߒ㧘Ꮢ႐ࠍㅢߓߚߘࠇࠄߩ᳿ቯࠍኈ⹺㧔ಽᮭൻ㧕ߔࠆ৻ᣇ㧘଻㒾೙ᐲߩ৻రൻ㧘ਛᄩၮ㊄ࠍㅢߓߚ࡝ࠬࠢߩࡊ࡯࡞ൻ㧔㓸ᮭൻ㧕ߥߤ␠ળ଻㒾ߣߒߡߩⷐ⚛߽⛽ᜬߔࠆߎߣࠍᗧ࿑ߒߡ޿ߚߣ޿߃ࠆ‫ޕ‬᡽ᐭߩⷙ೙ߪᱷࠆ߇㧘਄ㅀߩࠃ߁ߦၮ␆଻㒾ߢࠞࡃ࡯ߔࠆක≮ࠨ࡯ࡆࠬߩ▸࿐߿ᦨૐ᳓Ḱߩⷙቯ㧘଻㒾⠪߳ߩ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩᡰᛄ޿㧘଻㒾⠪㑆ࠞ࡞࠹࡞ߩ㒐ᱛߥߤ㧘Ꮢ႐ᯏ⢻ࠍઍᦧߔࠆߩߢߪߥߊ㧘߻ߒࠈߘߩஜోߥᯏ⢻ࠍࠨࡐ࡯࠻ߔࠆߎߣࠍ⋡ᜰߔ‫ޕ‬- 47 -

ળ⸘ᬌᩏ⎇ⓥ No.36㧔2007.9㧕ᡷ㕟᩺䈻䈱ୃᱜ䈫䈠䈱ᓟ䈱⚻✲䋨㪐㪇 ᐕઍ䋩㩷
Helderman et al (2005) ߪ࠺࠶ࠞ࡯࡮ࡊ࡜ࡦએ㒠ߩක≮ᡷ㕟ߩᵹࠇࠍ㧔1㧕Ꮢ႐ේℂߩዉ౉߇࿑ࠄࠇߚᦼ㑆
㧔1988-1994 ᐕ㧕㧘㧔2㧕▤ℂ┹੎ߣⷙ೙࡮⛔೙ߩ㑆ߢំࠇߚᦼ㑆㧔1994-2000 ᐕ㧕෸߮㧔3㧕࠺࠶ࠞ࡯࡮ࡊ࡜
ࡦ߇ᓳᵴߒߚ 2000 ᐕએ㒠ߦ඙ಽߒߡ޿ࠆ‫ޕ‬࠺࠶ࠞ࡯࡮ࡊ࡜ࡦߪ൮᜝⊛㧘߆ߟ࡜࠺ࠖࠞ࡞ߥ߽ߩߢ޽ߞߚ‫ߒ߆ߒޕ‬㧘90 ᐕઍೋ㗡㧘᡽ᴦ⊛ᅷදߣᡷ㕟ࠍታᣉߒߡ޿ߊ਄ߢ↢ߓߚ㧔࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ⸳⸘ߣ޿ߞߚ㧕ᛛⴚ⊛໧㗴ߦࠃࠅ㧘ᡷ㕟᩺ߪୃ
ᱜࠍ㊀ߨ㧘ᡷ㕟ߩࠬࡇ࡯࠼߽✭߼ࠄࠇߡ޿ߞߚ㧔ᡷ㕟ߩផ⒖ߪ࿑⴫ 6 ߦ߹ߣ߼ߚㅢࠅ㧕‫߽ߣߞ߽ޕ‬㧘ᡷ㕟ߩᣇะߪၮᧄ⊛ߦ⛽ᜬߐࠇߡ߈ߡ޿ࠆ‫ޕ‬90 ᐕߩ⺀↢ߒߚਛ㆏Ꮐᵷ᡽ᮭߪ㧘‫ࠍޠࡦ࡜ࡊ࡮࡯ࠞ࠶࠺ޟ‬ଔᩰ┹੎ߩⷐ⚛ࠍᒙ߼ࠆᒻߢୃᱜߒߚ‫ࠍޠ↹⸘࠭ࡦࡕࠗࠨޟ‬ᛂߜ಴ߒߚ‫ޕ‬ห⸘↹ߢߪ㧔i㧕ၮ␆଻㒾ߩࠞࡃ࡯ߔࠆ▸࿐ࠍᒰೋߩ 85㧑߆ࠄ 96㧑߹ߢᒁ਄ߍࠆ㧔ߘߩಽ⵬ቢ⊛଻㒾ߩᓎഀ߇ૐਅ㧕߶߆㧘
㧔ii㧕଻㒾⠪෼౉ߦභ߼
ࠆਛᄩၮ㊄߆ࠄߩ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߣ৻ᓞࡊ࡟ࡒࠕࡓߩᲧ₸ࠍᡷ㕟᩺ߩ 75 ኻ 25 ߆ࠄ㧘85 ኻ 15ߦᄌᦝߔࠆ‫ߦࠄߐޕ‬㧘ᄖ᧪߿⺞೷ߥߤࠍᣂߚߦ⛎ઃኻ⽎ߣߔࠆߥߤAWBZࠍ᜛లߔࠆߎߣߢၮ␆଻㒾߳ߩ⒖ⴕࠍ⋡ᜰߒߚ߇㧘␠ળ଻㒾ߩ⤘ᒛߣ౏⊛⽶ᜂߩჇᄢߦ⚳ࠊߞߚ㧔Helderman et al (2005)㧕
‫⚿ޕ‬ዪ㧘95 ᐕߦߪක≮଻㒾ߩ৻రൻߩᣇ㊎ࠍ᡼᫈㧘AWBZߦߟ޿ߡߪᓥ᧪ߩ᡽ᐭⷙ೙ࠍ⛮⛯㧘╙ 1 ጀ߳ߩᏒ႐ේℂߩዉ౉ߪ⷗ㅍࠆߎߣߦߥߞߚ‫▤ޕ‬ℂ┹੎ߩὶὐߪ╙ 2 ጀࠍ᭴ᚑߔࠆ∔∛㊄ᐶߦ⒖ߞߡ޿ߞߚ 4)‫ޕ‬࿑⴫ 㪍㩷 䉥䊤䊮䉻ක≮ᡷ㕟䈱ផ⒖㩷
1987 ᐕ㧦‫ޠࡦ࡜ࡊ࡮࡯ࠞ࠶࠺ޟ‬1990 ᐕ㧦‫ޠ↹⸘࠭ࡦࡕࠗࠨޟ‬1992 ᐕ㧦 i㧕∔∛㊄ᐶ߇ో࿖࡟ࡌ࡞ߢᵴേߔࠆߎߣࠍ⸵น
 ii ട౉⠪߇ 2 ᐕߦ 1 ࿁㧘∔∛ၮ㊄ࠍ⒖ࠆߎߣࠍ⸵น      㧔96 ᐕએ㒠ߪᐕ 1 ࿁ߩࡍ࡯ࠬ㧕
1993 ᐕ㧦࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩዉ౉
㧦∔∛ၮ㊄߇ኾ㐷කࠍㆬᛯ㧘ᄾ⚂ࠍ⚿߱ߎߣࠍ⸵น
1995 ᐕ㧦AWBZ ࠍ฽߻ක≮଻㒾೙ᐲߩ৻రൻࠍᢿᔨ  
2005 ᐕ㧦଻㒾⠪ߣක≮ᯏ㑐㧔∛㒮㧕ߩ୘೎੤ᷤ㧔੍▚ߩ 10㧑㧕ࠍ⸵น  
2006 ᐕ㧦∔∛㊄ᐶߣ᳃㑆଻㒾ߩ⛔ว㧔2006 ᐕᡷ㕟㧕ട౉⠪ߦࠃࠆ଻㒾⠪ㆬᛯߪ 1992 ᐕ߆ࠄน⢻ߦߥߞߚ‫ޕ‬ᒰೋߪ 2 ᐕߦ৻࿁ߩࡍ࡯ࠬߛߞߚ߇㧘96 ᐕ߆ࠄߪ଻㒾⠪ࠍ⒖ࠆᯏળߪᐕ৻࿁ߣߐࠇߡ޿ࠆ‫߅ߥޕ‬㧘࠼ࠗ࠷ߦ߅޿ߡ߽หᐕ‫ޟ‬ㅪᏪਅߩ┹੎‫଻ߡߒߣޠ‬㒾⠪㧔∔∛㊄ᐶ㧕ㆬᛯ߇ో㕙⊛ߦዉ౉ߐࠇߡ޿ࠆ‫ޕ‬93 ᐕ߆ࠄߪ㧘ࠝ࡜ࡦ࠳ߩ∔∛ၮ㊄ߪኾ㐷කߣㆬᛯ⊛ߥᄾ⚂ࠍ⚿߱ߎߣ߇ߢ߈ࠆࠃ߁ߦߥߞߚ‫ޕ‬㧔ߚߛߒ㧘∛㒮ߣߩ୘೎ᄾ⚂ߪ 2005 ᐕ߹ߢ⹺߼ࠄࠇߡ޿ߥ޿‫ޕ‬㧕߽ߞߣ߽଻㒾⠪㧔∔∛㊄ᐶ㧕߇ઃਈߐࠇߚᮭ㒢ࠍⓍᭂ⊛ߦⴕ૶ߒߡ޿ߥ߆ߞߚ‫ߪࠇߎޕ‬㧘ᓟㅀߔࠆࠃ߁ߦ଻㒾⠪ߚߛߒ㧘Ꮢ႐ේℂ߇╙ 1 ጀ߆ࠄቢోߦឃ㒰ߐࠇߚࠊߌߢߪߥ޿‫ޕ‬97 ᐕߦߪࠨ࡯ࡆࠬଏ⛎ਇ⿷ߦࠃࠆ‫ޟ‬ᓙᯏ࡝ࠬ࠻‫ߩޠ‬Ⴧടߦኻಣߔߴߊ㧘༡೑ߩ࿷ቛ੺⼔੐ᬺ⠪ߩෳ౉߇⹺߼ࠄࠇߚ‫ޕ‬༡೑੐ᬺ⠪ߩ࡝ࠬࠢㆬᛯ㧔ࠢ࡝࡯ࡓ࡮ࠬࠠࡒࡦࠣ㧕߇㗼⪺ߛߞߚߚ߼㧘৻ᤨਛᢿߐࠇߚ߇ 2000 ᐕ߆ࠄߪෳ౉߇ౣ㐿ߐࠇߡ޿ࠆ㧔Helderman et al (2005)㧕
‫ޕ‬- 48 -

ක≮଻㒾೙ᐲᡷ㕟ߣ▤ℂ┹੎ߩ‫⽷ޟ‬᡽⽿છ‫ޠ‬㧔࡝ࠬࠢ⽶ᜂ㧕߇චಽߦ⏕┙ߒߡ޿ߥ޿㧔៊ᄬߩ 97.5㧑߇੐ᓟ⊛ߦ⵬Ⴏߐࠇߡ޿ߚ㧕ߎߣߦ⿠࿃ߔࠆ߽ߩߣ⠨߃ࠄࠇࠆ‫৻ߩߘޕ‬ᣇߢ∔∛㊄ᐶ㑆ߩว૬߿㧔หߓ଻㒾ࠣ࡞࡯ࡊߩ஺ਅߦ∔∛㊄ᐶߣ᳃㑆଻㒾߇౉ࠆߥߤ㧕∔∛㊄ᐶߣ᳃㑆଻㒾ߩ⚻༡ㅪ៤߇ㅴࠎߛ‫┹ޕ‬੎߇ᯏ⢻ߔࠆ೨ߦ㧘Ꮢ႐ߩኦභൻ߇ㅴࠎߛ
ߩߢ޽ࠆ‫ޕ‬㧔ή⺰㧘଻㒾⠪ߩ⛔วߪⷙᮨߩ⚻ᷣ߿࡝ࠬࠢ▤ℂߩ⍮⼂ߩ⫾Ⓧ╬ߦࠃࠆ⚻༡ല₸ߩะ਄ߥߤᦸ߹
ߒ޿஥㕙߽޽ࠆ‫ޕ‬㧕
90 ᐕઍࠍㅢߓߡᡷ㕟ߩࡍ࡯ࠬ߇ㆃ߆ߞߚℂ↱ߣߒߡߪ㧘╙ 1 ߦਛᄩၮ㊄߆ࠄ଻㒾⠪ߦᡰᛄࠊࠇࠆ࡝ࠬࠢ
᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ♖ኒൻ߇ㅴࠎߢ޿ߥ߆ߞߚߎߣ߇᜼ߍࠄࠇࠃ߁‫ޕ‬4 ▵ߢ⹦ㅀߔࠆࠃ߁ߦ࡝ࠬࠢⷐ࿃
ߣߒߡ㧘ᕈ೎࡮ᐕ㦂ߩ߶߆ߦዬ૑࿾߿り૕㓚ኂߩ᦭ή߇ട߃ࠄࠇࠆࠃ߁ߦߥߞߚ߽ߩߩ㧘୘ੱߩஜᐽ࡝ࠬ
ࠢࠍᱜߒߊ෻ᤋߔࠆ㧘ࠃࠅᱜ⏕ߦ޿߃߫㧘଻㒾⠪ࠄ߇⹺⼂ߒߡ޿ࠆ୘ੱߩ࡝ࠬࠢߣ৻⥌ߔࠆߦߪ⥋ߞߡ޿ߥ޿‫ޕ‬ᓥߞߡ㧘࡝ࠬࠢㆬᛯߩน⢻ᕈ߇ឃ㒰ߢ߈ߕ㧘ਛᄩၮ㊄ߪ∔∛㊄ᐶߣߩࠦࠬ࠻࡮ࠪࠚࠕ࡝ࡦࠣࠍ૛௾
ߥߊߐࠇߡ޿ࠆߩߢ޽ࠆ‫଻߇ࠇߎޕ‬㒾⠪ߩല₸⊛⚻༡㧔ല₸⊛ක≮ᯏ㑐ߩㆬ೎㧕ߩ⺃࿃ࠍ៊ߨ㧘ᡷ㕟ߩലᨐࠍૐ߼ߡ޿ࠆߣ⠨߃ࠄࠇࠆ‫ ╙ޕ‬2 ߦ଻㒾⠪࡮ක≮ᯏ㑐ߩឭଏߔࠆࠨ࡯ࡆࠬߩ⾰ߥߤߦ㑐ߔࠆᖱႎ߇චಽ
ߦឭଏߐࠇߡߎߥ߆ߞߚ‫଻ޕ‬㒾⠪ࠍㆬ߱ߦᒰߚߞߡ୘ੱ߇ᱜߒ޿ㆬᛯࠍⴕ߁ߦߪ㧘ᓐࠄߦᱜߒ޿ᖱႎ߇ឭ
ଏߐࠇߡ޿ߥߊߡߪߥࠄߥ޿‫ޕ‬ฦක≮ᯏ㑐࡮଻㒾⠪ߩࠨ࡯ࡆࠬߦ㑐ߔࠆᖱႎࠍ࠺࡯࠲࡮ࡌ࡯ࠬൻߒߡߘߩ
ขᓧࠍኈᤃߦߔࠆߣߣ߽ߦ㧘ක≮ߩ⾰࡮ࠦࠬ࠻ࠍቴⷰ⊛ߦ᷹ࠆᜰᮡߩ㐿⊒ߥߤၮḰൻߦࠃߞߡ㧘ߘ߁ߒߚᖱႎࠍᲧセߢ߈ࠆࠃ߁ߥⅣႺᢛ஻߇ᔅⷐߣߐࠇߡ޿ࠆ‫ޕ‬ߣߪ޿߃ᡷ㕟⥄૕߇㗐ᝂߒߚࠊߌߢߪߥ޿‫∛∔ޕ‬㊄ᐶ߳ߩ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ♖✺ൻߣߣ߽ߦ㧘଻㒾⠪ߩ⽷᡽⽿છ߽ 3㧑⒟ᐲ߆ࠄ 2004 ᐕߦߪ 50㧑޽߹ࠅߦ߹ߢᒁ߈਄ߍࠄࠇߚ㧔4 ▵ෳᾖ㧕‫ޕ‬ቯ㗵଻㒾ᢱߩഀว߽ක≮ᡰ಴ߩ 10㧑߆ࠄ 15㧑߶ߤࠍභ߼ࠆࠃ߁ߦߥࠅ㧘∔∛㊄ᐶ㑆ߢߩ଻㒾ᢱߩᩰᏅ߽ᐢ߇ߞߚ‫ᤨޕ‬㑆ߩ⚻ㆊߣߣ߽ߦଔᩰ┹੎߇ᶐㅘߒߟߟ޽ࠆ‫ޕ‬ኾ㐷කߣߩㆬᛯ⊛ᄾ⚂ߩ߶߆㧘ᒰೋߪ⹺߼ࠄࠇߡ޿ߥ߆ߞ
ߚ∛㒮ߣߩ୘೎੤߽ᷤ 05 ᐕ߆ࠄ㒢ቯ⊛ߥ߇ࠄน⢻ߦߥߞߡ߈ߡ޿ࠆ‫ޕ‬ታ㓙㧘∛㒮ߣᖚ⠪ߩᦨᄢᓙᯏᦼ㑆㧔waiting time㧕 ߦߟ޿ߡ⁛⥄ߦวᗧߔࠆ଻㒾ળ␠߽⃻ࠇߡ޿ࠆ‫߽ߢ࠷ࠗ࠼ޕ‬ኾ㐷ක߿∛㒮ߣߩ⸻≮ႎ㈽੤
ᷤߪ㧔৻ㇱࠍ㒰߈㧕∔∛㊄ᐶㅪวળߦᆔߨࠄࠇߡ޿ߚ‫ޕ‬2000 ᐕ߆ࠄߪ଻㒾කදળߣߩ㓸࿅੤ᷤߦઍ߃㧘ක
⑼࡮ᱤ⑼ᄖ᧪ߦߟ޿ߡߪ୘‫∛∔ߩޘ‬㊄ᐶ߇଻㒾ක࡮∛㒮ߣ⋥ធᄾ⚂ࠍ੤ࠊߔ‫⛔ޟ‬วࠨ࡯ࡆࠬ‫߇ߺ⚵઀ߩޠ‬ዉ౉ߐࠇߡ޿ࠆ㧔↰ਛ(2006)㧕
‫߽ߣߞ߽ޕ‬㧘ᒰ੐⠪㑆ߩ੤ᷤ߇㔍⥶ߒ㧘ߎߩ‫߹ߪޠࠕࠤ࠼ࠫࡀࡑဳ࠷ࠗ࠼ޟ‬ߛ᥉෸ߔࠆߦߪ⥋ߞߡ޿ߥ޿ߣߩᜰ៰߽޽ࠆ㧔↰ਛ(2003)㧕
‫ ߪߢ࠳ࡦ࡜ࠝޕ‬2002 ᐕߩ✚ㆬ᜼ᓟߩ㧔଻቞࡮ਛ㆏߆ࠄߥࠆ㧕ㅪ┙᡽ᮭߪⷙ೙✭๺㧘┹੎ߩଦㅴࠍឝߍ㧘5 ▵ߢ⹦ㅀߔࠆ∔∛㊄ᐶߣ᳃㑆଻㒾ߩ⛔วࠍ฽߻Ꮢ႐ᔒะဳᡷ㕟ࠍ 2006 ᐕߦታ⃻ߔࠆߦ⥋ߞߚ㧔Helderman et al (2005)㧕
‫ޕ‬䋴䋮䇸䊥䉴䉪ㆬᛯ䇹䈻䈱 ᔨ䈫䊥䉴䉪᭴ㅧ⺞ᢛ䊒䊧䊚䉝䊛㩷‫ࠢࠬ࡝ޟ‬᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ‫଻ⵍߪޠ‬㒾⠪ߩஜᐽ࡝ࠬࠢࠍ෻ᤋߐߖߚ‫ޟ‬൮᜝ᛄ޿‫ޕࠆ޽ߢޠ‬ஜᐽߦᓇ㗀ࠍ෸߷ߔߣ੍ᗐߐࠇࠆ୘ੱߩዻᕈ㧔଀㧦ᐕ㦂㧘ᕈ೎㧘ㆊ෰ߩ∛ᱧ╬㧕ߩ㓸วࠍ : ߢ޽ࠄࠊߔߥࠄ߫㧘࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߪ㧘ߎߩ୘ੱ߆ࠄᦼᓙߐࠇࠆක≮⾌ hi { E[c | :i ] 㧔᧦ઙߟ߈ᦼᓙ୯㧕ߦ৻⥌ߔࠆߎߣ߇ᦸ߹ߒ޿ 5)‫ߒߛߚ ޕ‬㧘ᰴߩ 2 ὐߦ⇐ᗧߔࠆᔅⷐ߇޽ࠆ‫ ╙ޕ‬1 ߦ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߪᒰ⹥ⵍ
଻㒾⠪ߦታ㓙ߦⷐߒߚ⾌↪ߣ৻⥌ߔࠆᔅⷐߪߥ޿‫ޕ‬ታ⃻ߒߚක≮⾌ߪ㧔1㧕ⵍ଻㒾⠪ߩஜᐽ࡝ࠬࠢࠍ෻ᤋߔ

ⵍ଻㒾⠪ i ߩ╙ k ࡝ࠬࠢⷐ࿃㧔଀㧦ᕈ೎࠳ࡒ࡯㧕ࠍ xi 㧘ߘߩ࠙ࠚࠗ࠻ࠍ E 㧔╙ k ࡝ࠬࠢⷐ࿃߇ᦼᓙක≮⾌ߦᓇ㗀ߔࠆ⒟ᐲ㧕ߣߔࠇ߫㧘kk

E[c | : i ] Const  ¦ k E k xi k- 49 -

ળ⸘ᬌᩏ⎇ⓥ No.36㧔2007.9㧕ࠆㇱಽߣ㧔2㧕଻㒾⠪ߩක≮⾌ㆡᱜൻദജࠍ෻ᤋߒߚㇱಽߦ඙೎ߐࠇࠆ‫ޕ‬᡽ᐭ߇଻㒾⠪ߦ଻㓚ߔࠆߴ߈ߪ೨
⠪ߩߺߢ޽ࠅ㧘ᓟ⠪ߦߟ޿ߡߪᏒ႐ߢߩଔᩰ┹੎ߦᆔߨࠆߎߣߢ⚻༡ല₸ࠍଦㅴߔࠆ਄ߢᦸ߹ߒ޿‫߇ࠊޕ‬࿖ߢ߽೨ᦼ㜞㦂⠪㧔65 ᱦ-74 ᱦ㧕ߩක≮⾌ߪ଻㒾⠪߇㧔75 ᱦᧂḩ㧕ട౉⠪ᢙߦᔕߓߡಽᜂߔࠆߥߤ㧘࡝ࠬࠢ᭴ㅧ⺞ᢛ߇࿑ࠄࠇߡ޿ࠆ‫ߒ߆ߒޕ‬㧘ߘߩ⽷᡽⺞ᢛߪ଻㒾⠪ߩ៊ᄬ㧔⽶ᜂߩਇဋⴧ㧕ࠍ⵬߁ߣ޿߁ᗧ๧ߢ
‫⁁⃻ޟ‬ㅊ⹺⊛‫ޠ‬
㧔Retrospective㧕ߦㆊ߉ߥ޿‫᧪ᧄޕ‬㧘଻㒾⠪ߦක≮⾌ᛥ೙࡮ല₸ൻࠍ⺃࿃ߠߌࠆߦߪ㧘‫࡝ޟ‬ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ‫ߥ߁ࠃߩޠ‬ේೣ㧔ታ㓙ߩක≮⾌ߢߪߥߊ㧘ⵍ଻㒾⠪ߩዻᕈߦଐ᜚ߒߚ࡝ࠬࠢⷐ࿃
ߦၮߠߊ㧕‫ޟ‬൮᜝ᛄ޿‫ޠ‬
㧔Prospective㧕ߢߪߥߊߡߪߥࠄߥ޿‫ޕ‬╙ 2 ߦ㧘 hi { E[c | :i ] ߪߎࠇࠍ૞ᚑߒ㈩ಽߔࠆ᡽ᐭ㧔ࠬࡐࡦࠨ࡯㧕ߣᡰᛄ޿ࠍฃߌࠆ଻㒾⠪ߣߩ㑆ߢหߓᖱႎ㧔 : 㧕ߦၮߠߊᔅⷐ߇޽ࠆ‫଻ޕ‬㒾⠪߇ⵍ଻㒾⠪ߦߟ޿ߡࠬࡐࡦࠨ࡯ࠃࠅ߽⹦⚦ߥᖱႎ㧔଀߃߫㧘ㆊ෰ߩ∛ᱧ࡮↢ᵴ⠌ᘠ∛ߥߤ㧕ࠍ᦭ߒߡ޿ࠆߥࠄ߫㧘ߘߩᖱႎࠍ૶ߞߡ‫ࠢࠬ࡝ޟ‬ㆬᛯ‫߁ⴕࠍޠ‬㧔଻㒾⠪߇੍ᗐߔࠆක≮⾌ߦኻߒߡ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ߇⷗วࠊߥ޿୘ੱࠍ࿁ㆱߔࠆ㧕⺃࿃ࠍᜬߟߎߣߦߥࠆ
ߛࠈ߁‫ޕ‬
ࠝ࡜ࡦ࠳ߢߪᚲᓧଐሽߩ␠ળ଻㒾ᢱߪਛᄩၮ㊄ߦ㓸߼ࠄࠇ㧘ቯ㗵଻㒾ᢱߩߺ߇ⵍ଻㒾⠪߆ࠄ⋥ធᡰᛄࠊࠇࠆ‫଻ޕ‬㒾⠪ߪട౉⠪ߩஜᐽ࡝ࠬࠢࠍᒁ߈ฃߌࠆߎߣߪ޽ߞߡ߽㧘ᓐ╬ߩᚲᓧߦࠃߞߡᓇ㗀ߐࠇࠆߎߣߪ
ߥ޿‫ޕ‬࡝ࠬࠢ᭴ㅧ⺞ᢛߪᢥሼߤ߅ࠅ଻㒾⠪ߩ㑆ߢߩஜᐽ࡝ࠬࠢ㓸࿅ߩᏅ⇣ࠍၒ߼วࠊߖࠆߩߢ޽ࠆ‫ޕ‬৻ᣇ㧘࠼ࠗ࠷ߩࠃ߁ߦᚲᓧଐሽဳ଻㒾ᢱ߇଻㒾⠪ߦኻߒߡ⋥ធᡰᛄࠊࠇࠆ႐ว㧘଻㒾⠪ߪஜᐽ࡝ࠬࠢߩߺߥࠄߕ㧘ⵍ଻㒾⠪ߩᚲᓧߩᓇ㗀ࠍⵍߞߡߒ߹߁‫ߡߞࠃޕ‬㧘࡝ࠬࠢ᭴ㅧ⺞ᢛߪ଻㒾⠪㑆ߩᚲᓧᩰᏅ߽⠨ᘦߦ౉ࠇߥߊ
ߡߪߥࠄߥ޿‫ޕ‬ታ㓙㧘࠼ࠗ࠷ߩ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߪᚲᓧࠍ⺞ᢛᄌᢙߣߒߡ฽ࠎߢ߅ࠅ㧘∔∛㊄ᐶ
㑆ߩ⒖ォߩ 7 ഀ޽߹ࠅ߇ߎߩᄌᢙߦ᜚ࠆߣߐࠇࠆ㧔Buchner and Wasem (2003)㧕6)‫ޕ‬䊥䉴䉪ㆬᛯ䈻䈱 ᔨ㩷࡝ࠬࠢㆬᛯߪ᡽ᐭߣ଻㒾⠪ߣߩ㑆ߩ‫ޟ‬ᖱႎߩ㕖ኻ⒓ᕈ‫ޠ‬㧔ᒰዪ߇଻㒾⠪ߩ᦭ߒߡ޿ࠆᖱႎࠍ࡝ࠬࠢ᭴ㅧ
⺞ᢛࡊ࡟ࡒࠕࡓߦ෻ᤋߢ߈ߥ޿ߎߣ㧕ߦ⿠࿃ߔࠆ‫ޕ‬଻㒾⠪߇ⵍ଻㒾⠪ߦ㑐ߒߡ⁛⥄ߦᖱႎࠍᓧࠆᚻᲑߪ᭽‫ޘ‬ߢ޽ࠆ‫ޕ‬ㆊ෰ߩ∛ᱧߪ୘ੱߩ࡝ࠬࠢ࡮࠲ࠗࡊࠍ⍮ࠆ਄ߢ߆ߥࠅ᦭↪ߢ޽ࠆ‫ޕ‬ᄖ⷗߆ࠄ߽୘ੱߩஜᐽ⁁ᘒߪ㘃ផน⢻߆߽ߒࠇߥ޿‫ޕ‬ᱤߩ޽ࠆ㧘޽ࠆ޿ߪ⿷⣶ߩߒߞ߆ࠅߒߡ޿ࠆ㜞㦂⠪ߢ޽ࠇ߫㧘ૐ࡝ࠬࠢߦಽ㘃ߢ߈ࠆߛࠈ߁‫ࠢࠬ࡝ޕ‬ㆬᛯߩ⺃࿃ߪ㧘୘ੱߦࠃࠆ଻㒾⠪ㆬᛯ߇ᰳᅤߒߚ⁁ᘒߢߪ⿠ߎࠅᓧߥ޿ߎߣߦᵈᗧߖࠃ‫ޕ‬ዬ૑࿾㧘߽ߒߊߪ⡯ᬺߦࠃߞߡ੍߼ട౉ߔࠆ଻㒾⠪߇᳿߹ߞߡ޿ࠆ㒢ࠅ㧘଻㒾⠪ߦ߽ട౉⠪ࠍㆬᛯߔࠆᚻᲑߪߥ޿߆ࠄߛ‫ߡߞࠃޕ‬㧘࡝ࠬࠢㆬᛯߩ໧㗴ߪ┹੎⊛଻㒾Ꮢ႐ߦ࿕᦭ߩ߽ߩߣ޿߃ࠆߛࠈ߁‫ޕ‬ട߃ߡ༡೑ડᬺߩ႐ว㧘ᩣਥߦࠃࠆ೑Ảᦨᄢൻߩⷐ⺧߆ࠄ࡝ࠬࠢㆬᛯ߳ߩ⺃࿃ߪ㜞޿߽ߩߣ⠨߃ࠄࠇࠆ‫ࠢࠬ࡝ޕ‬ㆬᛯࠍឃ㒰ߔࠆࠃࠅ⋥ធ⊛ߥᚻᲑߣߒߡߪ㧘଻㒾⠪ߦኻߒోߡߩട౉Ꮧᦸ⠪ߩฃߌ౉ࠇࠍᒝ೙ߔࠆ Openenrollment ߇޽ࠆ‫ߪࠇߎޕ‬㧘ട౉ᜎุߩࠃ߁ߥ㧘޽߆ࠄߐ߹ߥ࡝ࠬࠢㆬᛯߪឃ㒰ߔࠆߛࠈ߁‫ߒߛߚޕ‬㧘ߎߩട౉ฃߌ౉ࠇ⟵ോߪࠝ࡜ࡦ࠳ߩ⵬ቢ଻㒾ߦߪㆡ↪ߐࠇߥ޿‫଻ⵍޕ‬㒾⠪ߪㅢᏱ㧘ၮ␆଻㒾ߣ⵬ቢ଻㒾ࠍหߓ଻㒾⠪߆ࠄ⾼౉ߔࠆߎߣ߆ࠄ㧘⵬ቢ଻㒾ߩ⛎ઃ▸࿐ࠍᠲ૞ߔࠆ㧔੍㒐ක≮ߥߤ⛎ઃኻ⽎ࠍૐ࡝ࠬࠢߥ୘
ੱߦߣߞߡᅢ߹ߒ޿߽ߩߦ㒢ቯߔࠆ╬㧕ߎߣߢஜᐽ࡝ࠬࠢߩ㜞޿ⵍ଻㒾⠪ࠍ࿁ㆱߔࠆߎߣ߽น⢻ߢ޽ࠆ‫ޕ‬ࠝ࡜ࡦ࠳ห᭽㧘଻㒾⠪ㆬᛯࠍዉ౉ߒߚ࠼ࠗ࠷ߢߪᒰೋ㧘㊀ᐲ㓚ኂఽࠍᛴ߃ࠆኅᣖߩട౉↳⺧ࠍᒁ߈િ߫ߒ
ߚࠅ㧘੐ോᚲࠍ㜞㦂⠪߿ゞ᫹ሶߩੱ߇਄߇ࠇߥ޿ࠃ߁ߥࠛ࡟ࡌ࡯࠲ߩࡆ࡞ߩ਄㓏ߦ⟎޿ߚࠅߔࠆⴕേ߇⷗
ฃߌࠄࠇ㧘␠ળ⊛ᛕ್ࠍ᜗޿ߚ㧔↰ਛ(2006)㧕
‫ޕ‬∔∛㊄ᐶߩஜᐽ࡝ࠬࠢ㧔ක≮࠾࡯࠭㧕ߣวࠊߖߡ෼౉ࠍട๧ߒߡ޿ࠆὐߢ࠼ࠗ࠷ߩ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩࡈࠜ࡯ࡒࡘ࡜ߪࠊ߇࿖ߩ࿾
ᣇ੤ઃ⒢㧔᡽ᐭ㑆⽷᡽⒖ォ㧕೙ᐲߦૃߡ޿ࠆ‫ޕ‬- 50 -

ක≮଻㒾೙ᐲᡷ㕟ߣ▤ℂ┹੎࡝ࠬࠢㆬᛯ߇ᷓೞߥ໧㗴ߦߥࠅ߁ࠆߎߣࠍᜰ៰ߔࠆ⎇ⓥ߽ᢙᄙ޿‫ࠢࠬ࡝ޕ‬ㆬᛯߩ᦭ήߪ଻㒾⠪߇࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߦ❱ࠅㄟ߹ࠇߡ޿ࠆ࡝ࠬࠢⷐ࿃એᄖߦ㧘ട౉⠪ߩ࡝ࠬࠢ࡮࠲ࠗࡊ㧔⸻≮ࠦࠬ࠻㧕ࠍ੍⷗ߔࠆ਄ߢ᦭↪ߥᖱႎࠍ᦭ߒߡ޿ࠆ߆ߤ߁߆㧘߆ߟ㧘ߘߩᖱႎࠍ↪޿ߡട౉⠪ࠍㆬ೎ߔࠆߎߣߦ઻߁೑⋉߇㜞޿߆ߤ߁߆ߦࠃߞߡ޿ࠆ‫ޕ‬Hamilton(1995)ߪࠝ࡜ࡦ࠳ߩࠤ࡯ࠬࠍขࠅ਄ߍߚታ⸽⎇ⓥࠍ⚫੺ߒߡ޿ࠆ‫ޕ‬ߎߩ⎇ⓥߦࠃࠇ߫㧘ኅᣖᢙ࡮㓹↪᧦ઙ㧘␠ળ⚻ᷣ⊛ⷐ࿃㧔ዬ૑࿾ߩㇺᏒൻߩᐲว޿ߥߤ㧕㧘ᘟᕈ∔ᖚߥߤ଻
㒾⠪ߦߣߞߡ߽Ყセ⊛ኈᤃߦ౉ᚻน⢻ߥ࠺࡯࠲ࠍ↪޿ࠆߎߣߢ㧘ᕈ೎ߣᐕ㦂ߒ߆෻ᤋߒߥ޿㧔ਛᄩၮ㊄߆ࠄ∔∛㊄ᐶߦᡰᛄࠊࠇࠆ㧕࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓࠃࠅ߽ᱜ⏕ߦ㧘ട౉⠪ߩක≮ࠦࠬ࠻ࠍ੍᷹ߔࠆߎߣ
߇ߢ߈ࠆ‫ࠢࠬ࡝ޕ‬ㆬᛯߩ᦭ήࠍ⋥ធ⊛ߦ⏕⹺ߒߡ޿ࠆࠊߌߢߪߥ޿߇㧘଻㒾⠪㧔∔∛㊄ᐶ㧕ߪ㧘ࡊ࡟ࡒࠕࡓߦ⷗วࠊߥ޿ട౉⠪ࠍឃ㒰ߔࠆߎߣ߆ࠄ↢ߓࠆ೑⋉߇㜞޿㒢ࠅ㧘ߎ߁ߒߚᖱႎߦၮߠ޿ߡታ㓙ߦ㜞࡝ࠬࠢߥട౉⠪ࠍឃ㒰ߔࠆ⺃࿃ࠍᜬߟߛࠈ߁‫ޕ‬࡝ࠬࠢㆬᛯࠍᅤ૗ߦขࠅ㒰ߊ߆߇㧘▤ℂߐࠇߚ┹੎ࠍ᦭ലߦᯏ⢻ߐߖߡ޿ߊ਄ߢ㧘㊀ⷐߢ޽ࠆ‫ߥ߽ߐޕ‬ߌࠇ߫㧘଻㒾⠪㑆┹੎ߪૐ࡝ࠬࠢࠍᎼࠆ߽ߩߦ㒢ቯߐࠇ㧘ᦨ߽଻㒾ࠍᔅⷐߣߒߡ޿ࠆ㜞࡝ࠬࠢ⠪߇ක≮଻㒾೙ᐲ߆ࠄឃ㒰ߐࠇࠆ߅ߘࠇ߇޽ࠆ߆ࠄߛ‫ޕ‬ട౉⠪ߩஜᐽ࡝ࠬࠢࠍน⢻ߥ㒢ࠅ࡝ࠬࠢ᭴ㅧ⺞ᢛߦ෻ᤋߐߖ
ࠆᔅⷐ߇޽ࠆ‫ޕ‬Enthoven(1988)߿ Van de Ven and van Vliet (1992)ߪㆊ෰ߩ∛ᱧ࡮౉㒮⸥㍳߿⸻≮ࠦࠬ࠻ࠍ࡝
ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߦ෻ᤋߐߖࠆߎߣࠍឭ໒ߒߡ޿ࠆ‫ޕ‬ታ㓙㧘04 ᐕ߆ࠄߪ㧘∔∛ಽ㘃㧔DRG㧕߇࡝ࠬࠢ᭴ㅧ⺞ᢛߐࠇࠆࠃ߁ߦߥߞߚ‫߽ߣߞ߽ޕ‬㧘ㆊ෰ߩ⸻≮ࠦࠬ࠻㧘౉㒮╬⸻≮ⴕὑߩㆬᛯߪක≮ᯏ㑐࡮଻㒾⠪ߩࠗࡦ࠮ࡦ࠹ࠖࡉߦࠃߞߡ߽Ꮐฝߐࠇࠆ‫⃻ޕ‬࿷ߩട౉⠪ߩ⸻≮ࠦࠬ࠻߇዁᧪ߩ࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕ
ࡓߦ❱ࠅㄟ߹ࠇࠆߎߣࠍ଻㒾⠪߇⷗⿧ߒߡ޿ࠆߥࠄ߫㧘ක≮ᯏ㑐߳ߩࡕ࠾࠲࡝ࡦࠣ㧘ㆬ೎ࠍㅢߓߚࠦࠬ࠻
೥ᷫദജ߇៊ߥࠊࠇࠆน⢻ᕈ߇޽ࠆ‫ࠢࠬ࡝ޕ‬᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ૕♽ߩ᭴▽ߦ޽ߚߞߡߪ㧘ߎ߁ߒߚࡑࠗ
࠽ࠬ㕙߽⠨ᘦߐࠇߥߊߡߪߥࠄߥ޿‫ޕ‬䉥䊤䊮䉻䈱䊥䉴䉪᭴ㅧ⺞ᢛ䊒䊧䊚䉝䊛㩷࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓ߇ዉ౉ߐࠇߚ 1993 ᐕᤨὐߢ࡝ࠬࠢⷐ࿃ߦ❱ࠅㄟ߹ࠇߡ޿ߚߩߪ㧘㧔i㧕ᕈ೎ߣ
㧔ii㧕ᐕ㦂ߩߺߢ޽ߞߚ‫ޕ‬95 ᐕએ㒠ߪ࡝ࠬࠢ᭴ㅧ⺞ᢛߦᕈ೎㧘ᐕ㦂ߩ߶߆㧘
㧔iii㧕ዬ૑࿾෸߮㧔iv㧕り૕㓚ኂߩ᦭ή㧔99 ᐕએ㒠ߪ㓹↪࡮␠ળ଻㒾⛎ઃߩ᦭ήߦᄌᦝ㧕߇ട߃ࠄࠇࠆߥߤ♖ᐲ㧔ട౉⠪ߩ‫ޠࠢࠬ࡝ߩ⌀ޟ‬ߣߩㆡวᕈ㧕ߩᡷༀ߇࿑ࠄࠇߡ߈ߡ޿ࠆ 7)‫ޕ‬2002 ᐕ߆ࠄߪᘟᕈ∔ᖚߩ࡝ࠬࠢⷐ࿃ߣߒߡ㧔v㧕⺞೷⾌ಽ㘃㧔Pharmacy Based Cost Groups㧔PCGs㧕㧕߇㧘04 ᐕ߆ࠄߪ౉㒮ᴦ≮ߩ࡝ࠬࠢⷐ࿃ߣߒߡ㧔vi㧕∔∛೎⾌↪ಽ㘃㧔Diagnostic Cost Groups㧔DCG㧕㧕 ߇⠨ᘦߐࠇࠆࠃ߁ߦߥߞߡ޿ࠆ‫ޕ‬
㧔PCGsߪᄖ᧪ߩ⺞೷ 13 ⒳㘃ࠍኻ⽎ߣߒߡ߅ࠅ㧘ᄖ᧪ᴦ≮⾌ߩઍℂᄌᢙߣ߽⠨߃ࠄࠇࠆ㧔Van de Ven et al (2004)㧕
㧕‫ޕ‬એਅߢߪ㧘ࠝ࡜ࡦ࠳ߩ࡝ࠬ
ࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ▚ቯࠍ᭎ⷰߔࠆ‫ޕ‬ⵍ଻㒾⠪ߩ㧔᡽ᐭ߇࡝ࠬࠢ⺞ᢛߔࠆ㧕ᦼᓙක≮⾌ߪ㧘Ԙᄖ᧪㧔Outpatient care㧕ԙኾ㐷කᴦ≮㧔Specialist care㧕Ԛ∛㒮ࠦࠬ࠻㧔⚻Ᏹ⾌㧕ԛ∛㒮ࠦࠬ࠻㧔⾗ᧄ⚻⾌㧕ߏߣߦ▚಴ߐࠇ㧘࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߦ෻ᤋߐ
ࠇࠆ‫↪⾌ޕ‬㗄⋡ߏߣߦࡊ࡟ࡒࠕࡓߩ▚ቯߪ࿑⴫ 7 ߩㅢࠅᰴߩ 4 Ბ㓏߆ࠄߥࠆ㧔Lamer et al(2003)㧕
‫ޕ‬╙ 1 Ბ㓏ߣߒߡⵍ଻㒾⠪ߩᕈ೎࡮ᐕ㦂╬࡝ࠬࠢⷐ࿃ࠍ❱ࠅㄟࠎߛࡊ࡟ࡒࠕࡓ RIj 㧔 j =⾌↪㗄⋡㧕߇∛㒮ࠦࠬ࠻㧔⾗ᧄ⚻⾌㧕ࠍ㒰ߊ 3 㗄⋡ߦߟ޿ߡ⸘▚ߐࠇࠆ‫ౕޕ‬૕⊛ߦߪᐕ㦂㧘ᕈ೎ߩಽ㘃ࠍฦ‫ ޘ‬a, s ߣ߅ߊߣ㧘ฦ (a, s ) ߩᐔဋ⊛ක≮⾌ cas ࠍ⸘▚㧘ߐࠄߦ㧔4 ᐕ㦂ࠣ࡞࡯ࡊߏߣߦ㧕㓚ኂ⠪ᚻᒰ࡮౏⊛ᐕ㊄࡮ᄬᬺᚻᒰ╬␠ળ଻㓚ߩฃ⛎ߩ᦭ήࠍ❱ࠅㄟࠎߛଥᢙ mag 㧔 a =ᐕ㦂ࠣ࡞࡯ࡊ㧘 g =␠ળ଻㓚ࠞ࠹ࠧ࡝࡯㧕෸߮㧔5 Ბ㓏ᐕ㦂ߪ 5 ᱦߏߣߦว⸘ 18 ߩࠣ࡞࡯ࡊߦಽߌࠄࠇࠆ‫ޕ‬㓹↪࡮␠ળ଻㒾⛎ઃߩ᦭ήߪ㧘(i)ⵍ㓹↪⠪㧘(ii)ᐕ㊄ฃ⛎⠪㧘(iii)り૕㓚ኂ⠪ᚻᒰߡฃ⛎
⠪㧘(iv)ᄬᬺ⠪ߥߤߩࠞ࠹ࠧ࡝࡯߆ࠄߥࠆ‫ޕ‬- 51 -

ળ⸘ᬌᩏ⎇ⓥ No.36㧔2007.9㧕ߢಽ㘃ߐࠇߚ㧕ㇺᏒൻߩ⒟ᐲ f u ߢ߽ߞߡ⺞ᢛߐࠇࠆ‫ ޕ‬casmag

f u ߪฦⵍ଻㒾⠪ߏߣߦ▚ቯߐࠇࠆ߇㧘ߎࠇࠍട౉⠪ߦߟ޿ߡว⸘ߔࠇ߫㧘⾌↪㗄⋡ j ߏߣߦ

RIj㧔ࠬ࠹࠶ࡊ 1㧕¦ asgu nasgu cas masfu਄ߢ⺑᣿ߒߡ޿ߚ‫ޟ‬੐೨⊛൮᜝ᛄ޿‫ࠢࠬ࡝ߩߡߒߣޠ‬᭴ㅧ⺞ᢛߪߎߩ RIj ߦ޽ߚࠆ‫ޕ‬‫ޟ‬ㆡᱜߥක≮⾌‫ߣޠ‬ߒߡߩ cas ߪታ❣୯ࠍࡌ࡯ࠬߣߒߟߟ߽㧘∔∛㊄ᐶᆔຬળ㧔The Sickness Fund Council㧕ߢ߽ߞߡ᳿߼ࠄࠇ
ߡ߈ߚ‫ߒ߆ߒޕ‬㧘଻㒾⠪ߩⵙ㊂߇Ⴧߔߦߟࠇ㧘⹏ଔ߽ⶄ㔀ൻߒߡ޿ࠆ‫৻ޕ‬ᣇ㧘࠼ࠗ࠷ߢߪᐔဋක≮⾌ߩታ⃻୯߇ߘߩ߹߹↪޿ࠄࠇߡ޿ࠆ㧔Buchner and Wasem(2003)㧕
‫ⷙޕ‬ᮨߩᄢ߈޿∔∛㊄ᐶ߇ሽ࿷ߔࠆ႐ว㧘‫ޟ‬ᐔဋක≮⾌‫ߦޠ‬ኻߒߡᓇ㗀ജࠍⴕ૶ߔࠆߎߣ߇ߢ߈ࠆߚ߼㧘ක≮⾌ㆡᱜൻ߳ߩ⺃࿃ࠍ៊ߥ޿߆ߨߥ޿‫ޕ‬ታ㓙ߩߣߎࠈ㧘 RIj ߩว⸘߇ߘߩ߹߹଻㒾⠪ߦᡰᛄࠊࠇࠆࠊߌߢߪߥ޿‫ ╙ޕ‬2 Ბ㓏ߣߒߡ㧘ㆊ෰ߦታ㓙ߦⷐߒߚ⾌↪㧔Historical cost㧕߇⠨ᘦߐࠇࠆ‫∛ޕ‬㒮ߩ⾗ᧄࠦࠬ࠻߳ߩ⵬Ⴏߪ 100㧑㧘ㆊ෰ߩታ❣ߦၮߠߊ‫ޕ‬৻ᣇ㧘ᄖ᧪ߣ∛㒮⚻Ᏹ⚻⾌ߦኻߔࠆ࡝ࠬࠢ⺞ᢛߩ߁ߜ 30㧑ߪㆊ෰ߩࠦࠬ࠻ߦࠃࠆ㧦

RIIj㧔ࠬ࠹࠶ࡊ 2㧕

0.7 RIj  0.3 ㆊ෰ߩࠦࠬ࠻ 㧔 j 㧩ᄖ᧪㧘∛㒮⚻Ᏹ⚻⾌㧕ߐࠄߦ㧘ᄖ᧪ߣ∛㒮⚻Ᏹ⚻⾌ߦଥࠊࠆ㜞㗵ක≮⾌㧔Outlier risk㧕ࠍ੐ᓟ⊛ߦ⵬Ⴏߔࠆ઀⚵ߺ߇޽ࠆ‫ౕޕ‬૕㧕ࠍࡊ࡯⊛ߦߪ଻㒾⠪߇੍߼ RIIj ߩᚲቯߩᲧ₸ f 㧔2001 ᐕᤨὐߢ f =0.066㧔ᄖ᧪㧕, 0.106㧔∛㒮⚻Ᏹ⚻⾌㧕࡞ߒ㧘ฦⵍ଻㒾⠪ߦߟ߈ᄖ᧪ߣ∛㒮⚻Ᏹ⚻⾌ߩว⸘㗵߇৻ቯ㗵㧔4,538 ࡙࡯ࡠ㧕ࠍ⿥ㆊߒߚಽߩ 90㧑ࠍ੐ᓟ⊛ߦఘㆶߔࠆ߽ߩߢ޽ࠆ㧦

RIIIj㧔ࠬ࠹࠶ࡊ 3㧕

(1  f ) R j II  0.9 㜞㗵ක≮⾌㧔⿥ㆊಽ㧕㧔 j 㧩ᄖ᧪㧘∛㒮⚻Ᏹ⚻⾌㧕ᦨᓟߦ㧘⾌↪㗄⋡ߏߣߦታ⃻ߒߚࠦࠬ࠻ߩ৻ቯഀวࠍ੐ᓟ⊛ߦ⵬Ⴏߔࠆ㧔Ყ଀⊛ߦ࡝ࠬࠢࠪࠚࠕߔࠆ㧕ߎߣߦߥࠆ‫⵬ޕ‬Ⴏߩഀว p ߪ㧘ኾ㐷කᴦ≮߇ 70㧑㧘∛㒮ߩ⚻Ᏹࠦࠬ࠻߇ 25㧑㧘⾗ᧄࠦࠬ࠻߇ 95㧑޽߹ࠅߣߥࠆ㧔࿑⴫ 7㧕‫ޕ‬࿑⴫ 㪎㩷 ଻㒾⠪䈻䈱⒖ォ㩷
⾌↪㗄⋡
ᄖ

ㆊ෰ߩ⚻⾌

Outlier risk

੐ᓟ⊛⺞ᢛ

Σ

Τ

Υ

Φ

030㧑

޽ࠅ

00㧑

᧪

ኾ㐷කᴦ≮
∛㒮ࠦࠬ࠻

࡝ࠬࠢ⺞ᢛ

ᕈ೎࡮ᐕ㦂╬

70㧑

⚻Ᏹ

030㧑

⾗ᧄ

100㧑

಴ᚲ㧦Lamer et al (2003)

- 52 -

޽ࠅ

25㧑
95㧑

ක≮଻㒾೙ᐲᡷ㕟ߣ▤ℂ┹੎RVIj㧔ࠬ࠹࠶ࡊ 4㧕

(1  p ) R j III  p ታ⃻ߒߚࠦࠬ࠻

ਛᄩၮ㊄߆ࠄ଻㒾⠪߳ߩᡰᛄ޿ߪᦨ⚳⊛ߦ㧔᳿▚Ბ㓏ߢ㧕 RVIj ߩว⸘୯ߦ╬ߒ޿‫ ࡊ࠶࠹ࠬޕ‬2-4 ߆ࠄ㧘
ߎߩ⒖ォߪቢోߦ൮᜝⊛ߥࠊߌߢߪߥߊ㧘੐೨⊛▚ቯ㧔ࠬ࠹࠶ࡊ 1㧕ߦ੐ᓟ⊛⺞ᢛࠍᣉߒߚ߽ߩߢ޽ࠆߎ
ߣ߇ಽ߆ࠆߛࠈ߁‫ޕ‬ㆊ෰ߩ⚻⾌㧔ࠬ࠹࠶ࡊ 2㧕ߩ▚౉ߦߟ޿ߡ߽㧘੹ᦼⷐߒߚࠦࠬ࠻ߩ৻ㇱ߇዁᧪⊛ߦ⵬Ⴏߐࠇࠆࠊߌߛ߆ࠄ㧘଻㒾⠪ߪ዁᧪ฃߌขࠆࡊ࡟ࡒࠕࡓࠍᗧ࿑⊛ߦᠲ૞ߢ߈ࠆߎߣߦߥࠆ‫ޕ‬਄ߩ 4 ᑼࠍว
ࠊߖࠆߣ

RVIj

0.7 (1  f ) (1  p ) R jI  ੐ᓟ⊛⵬Ⴏ= (1  0.7) R jI  ੐ᓟ⊛⵬Ⴏ= ੐ᓟ⊛⵬Ⴏ

j ᄖ᧪㧘∛㒮⚻Ᏹ⚻⾌ߩ႐วj ኾ㐷කᴦ≮ߩ႐วj ∛㒮⾗ᧄࠦࠬ࠻ߩ႐ว

ߣߥࠆ‫ޕ‬
ᒰೋ㧔93-95 ᐕ㧕㧘੐ᓟ⊛࡝ࠬࠢ⵬Ⴏ㧔Ყ଀⊛࡝ࠬࠢࠪࠚࠕ㧩 p 㧕ߪ⒖ォ㗵ో૕ߢߺߡ 97.5㧑޽߹ࠅߢ޽
ߞߚ‫ࠅ߹ߟޕ‬㧘଻㒾⠪ߩ៊ᄬߩ 97.5㧑߇ਛᄩၮ㊄ߦࠃߞߡ⵬Ⴏߐࠇࠆ㧔ㅒߦ޿߃߫㧘∔∛㊄ᐶߪ⿒ሼߩ 2.5㧑ߩߺߦኻߒߡ⽷᡽࡝ࠬࠢࠍ⽶߁㧕ߩߢ޽ࠆ‫ޕ‬ㅒߦ㤥ሼ߇಴ߚ႐วߪ㧘97.5㧑ࠍਛᄩၮ㊄ߦ㄰⚊ߔࠆᔅⷐ߇
޽ࠆ‫ߪࠇߎޕ‬㧘࡝ࠬࠢ᭴ㅧ⺞ᢛ߇♖✺ߢߪߥ޿㧔ᒰೋ㧘࡝ࠬࠢ⺞ᢛߐࠇߡ޿ߚߩߪᕈ೎ߣᐕ㦂ߩߺ㧕ߚ߼㧘଻㒾⠪㧔∔∛㊄ᐶ㧕ߦࠃࠆ࡝ࠬࠢㆬᛯ߿଻㒾⠪⽷᡽ߩᖡൻ߇ ᔨߐࠇߚߚ߼ߢ޽ࠆ‫ߒ߆ߒޕ‬㧘࡝ࠬࠢ᭴ㅧ
⺞ᢛࡊ࡟ࡒࠕࡓߩᡷༀ㧔࡝ࠬࠢⷐ࿃ߩㅊട㧕ߦวࠊߖߡ㧘∔∛㊄ᐶߩ࡝ࠬࠢ⽶ᜂߩ⒟ᐲߪᒁ߈਄ߍࠄࠇߡ
߈ߡ޿ࠆ㧔㧩៊ᄬ⵬ߡࠎ߇೥ᷫߐࠇߡ߈ߡ޿ࠆ㧕‫⺞ࠢࠬ࡝ޕ‬ᢛߦ࿾ၞ㧘㓹↪࡮␠ળ଻㓚ฃ⛎ߩ᦭ή߇ടࠊߞ
ߚ 1999 ᐕ㧘⽷᡽࡝ࠬࠢߪ 35㧑ߦߥߞߚ‫ߩߘޕ‬ᓟ㧘2002 ᐕߦ⺞೷⾌߇㧘04 ᐕߦ∔∛ಽ㘃߇࡝ࠬࠢ⺞ᢛߐࠇࠆࠃ߁ߦߥࠆߣߣ߽ߦ⽷᡽࡝ࠬࠢߪ 50㧑એ਄ߦ㜞߹ߞߡ߈ߡ޿ࠆ㧔࿑⴫ 8㧕8)‫ޕ‬࿑⴫ 㪏㩷 ∔∛㊄ᐶ䈱⽶䈉⽷᡽䊥䉴䉪㩷

1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004

ᄖ᧪ක≮⾌ (㧑)
0
3
3
3
20
42
48
63
66
65
65
92
96

౉㒮ක≮⾌ (㧑)
0
3
3
3
9
15
15
16
16
20
24
23
26

ว

⸘ (㧑)

࡝ࠬࠢ⺞ᢛᄌᢙ
0 ᐕ㦂㧘ᕈ೎
3
3
3
ᐕ㦂㧘ᕈ೎㧘ዬ૑࿾㧘
13
㓚ኂߩ᦭ή
27
28 ᐕ㦂㧘ᕈ೎㧘࿾ၞ㧘
35 㓹↪࡮␠ળ଻㓚ฃ⛎ߩ᦭ή
36
+⺞೷⾌
38
41
+∔∛ಽ㘃(DRG)
52
53

಴ᚲ㧦Van de Ven, W.P.M.M., R.C.J.A.,Van Vliet, and L.M. Lamers (2004)࡝ࠬࠢ᭴ㅧ⺞ᢛߩ♖ኒൻߪ࠼ࠗ࠷ߢ߽࿑ࠄࠇߡ޿ࠆ‫ޕ‬2007 ᐕ߆ࠄ‫ࠢࠬ࡝ࠍޠ₸∛᦭ޟ‬ᜰᮡߣߒߡ↪޿ࠆߎߣߦߥߞߚ㧔↰ਛ(2006)㧕
‫ޕ‬- 53 -

ળ⸘ᬌᩏ⎇ⓥ No.36㧔2007.9㧕䋵䋮䉥䊤䊮䉻䈱 㪉㪇㪇㪍 ᐕᐲᡷ㕟㩷‫ޟ‬ක≮଻㒾ᴺ‫ ߇ޠ‬2006 ᐕ 1 ᦬ 1 ᣣߦᣉⴕߐࠇߚ‫ޕ‬หᴺߩਅߢߪ㧘ߎࠇ߹ߢಽ┙ߒߡ޿ߚ∔∛㊄ᐶ㧘᳃㑆଻㒾ࠍ⛔ว㧘╙ 2 ጀߦ޽ߚࠆᕆᕈ∔ᖚ࡮⍴ᦼߩ౉㒮╬ߦଥࠊࠆක≮଻㒾ߪ᳃㑆଻㒾ળ␠ߦࠃߞߡឭଏߐࠇ
ࠆߎߣߦߥߞߚ‫ޕ‬ක≮଻㒾ળ␠ߪၮᧄ଻㒾ߦട߃ߡ⵬ቢ⊛଻㒾ࠍឭଏߔࠆ‫ޕ‬ᓥ᧪㧘∔∛㊄ᐶߪ㕖༡೑ߢ޽ߞߚ߇㧘ක≮଻㒾ᴺߪ଻㒾⠪ߦࠃࠆ༡೑ࠍ⹺߼ߡ߅ࠅ㧘᳃㑆଻㒾ળ␠ߪᩣਥߦኻߒߡ㈩ᒰࠍᡰᛄ߁㧔೑⋉ಣಽߔࠆ㧕ߎߣ߽ߢ߈ࠆ‫଻ⵍޕ‬㒾⠪ߪ଻㒾ળ␠ࠍㆬᛯน⢻ߛ߇㧘޿ߕࠇ߆ߩක≮଻㒾ߩ⾼౉߇⟵ോઃߌࠄࠇߡ޿ࠆ㧔‫ޟ‬ᒝ೙଻㒾‫ࠆ޽ߢޠ‬㧕‫ޕ‬06 ᐕએ೨ߪ㧔∔∛㊄ᐶߩട౉߇⹺߼ࠄࠇߥ޿㧕৻ቯᚲᓧએ਄ߩ୘ੱߩ᳃
㑆ක≮଻㒾ߩ⾼౉ߪછᗧߢ޽ߞߚ‫੹ޕ‬࿁ߩක≮଻㒾ᴺߦࠃࠅ㧘೙ᐲ⊛ߦ‫ޟ‬࿖᳃⊝଻㒾‫߇ޠ‬ታ⃻ߒߚߎߣߦ
ߥࠆ‫଻ޕ‬㒾⠪ߪട౉Ꮧᦸߩ୘ੱߩฃߌ౉ࠇࠍᜎุߢ߈ߥ޿ Open enrollment ߇⺖ߐࠇߡ޿ࠆ‫ߒߛߚޕ‬㧘਄ㅀߩࠃ߁ߦ⵬ቢ⊛଻㒾ࠍ↪޿ߚ࡝ࠬࠢㆬᛯߩน⢻ᕈ߇ᱷߐࠇࠆ‫ޕ‬ᄢㇱಽߩⵍ଻㒾⠪ߪၮᧄ଻㒾ߣ⵬ቢ⊛଻㒾ࠍห৻଻㒾ળ␠߆ࠄ⾼౉ߒߡ޿ࠆ߆ࠄߛ‫ޕ‬ක≮଻㒾ળ␠ߪ㧘⇣ߥࠆ଻㒾ᄾ⚂ࠍᏒ႐ߢᄁࠅ಴ߔߎߣ߇ߢ߈㧘2006 ᐕߦߪ 43 ⒳㘃ߩ㧔ᴺቯ⛎ઃࠍࠞࡃ࡯ߒߚ㧕ၮᧄ଻㒾߇Ꮢ႐ߦ಴ߐࠇߡ޿ࠆ㧔‫ޟ‬2006 ᐕߩක≮଻㒾Ꮢ႐ߩ․ᓽ‫ޠ‬㧕‫ߩ࠳ࡦ࡜ࠝޕ‬ක≮଻㒾⠪ߪ࿾ၞන૏ߦ㒢ቯߐࠇߡ޿ࠆࠊߌߢߪߥ޿‫ޕ‬ක≮଻㒾ᴺ㧔╙ 29 ᧦╙ 2 㗄㧕ߪᄢⷙᮨߥ଻㒾⠪ߦߟ޿ߡߪ㧘ߔߴߡߩᎺߦ߅ߌࠆ଻㒾ឭଏࠍ⟵ോઃߌߡ޿ࠆ‫଻ⵍޕ‬㒾⠪ߪක≮଻㒾ળ␠ࠍㆬᛯߢ߈ࠆ߇㧘⥄ಽ߇ዬ૑ߔࠆ
Ꮊߢᄾ⚂ߔࠆߎߣߦߥࠆ‫ޕ‬଻㒾ߩࡕ࠺࡞ᄾ⚂ߩᒻᘒߣߒߡߪ㧘
㧔1㧕⃻‛⛎ઃဳ଻㒾㧘
㧔2㧕ఘㆶဳ଻㒾෸߮㧔3㧕ⶄวဳ଻㒾߇޽ࠆ‫ޕ‬⃻‛⛎ઃ㧔ߩᒻߢߩක≮ࠨ࡯ࡆࠬឭଏ㧕ߪක≮଻㒾ળ␠߇ᄾ⚂ߒߚක≮ឭଏᯏ㑐ߦࠃߞߡߥߐࠇࠆ‫ߛߚޕ‬ߒ㧘ⵍ଻㒾⠪߇㕖ᄾ⚂ߩක≮ឭଏ⠪ࠍㆬ߱ߎߣࠍᅹߍࠆ߽ߩߢߪߥ޿‫ߩߘޕ‬႐วߦߪⵍ଻㒾⠪ߪ⾌↪ߩ৻ㇱࠍᡰᛄࠊߥߌࠇ߫ߥࠄߥ޿‫ޕ‬ఘㆶဳߩ଻㒾ߩ႐วߦߪ㧘ⵍ଻㒾⠪ߪ⥄ಽߢක≮ឭଏ⠪ࠍㆬ߱ߎߣ߇ߢ߈
ࠆ࠲ࠗࡊ㧔ᄾ⚂ක≮ߥߒ㧕ߩ߶߆㧘଻㒾⠪߇ᄾ⚂ߒߚක≮ᯏ㑐ࠍฃ⸻ߔࠆቢోߥᄾ⚂ක≮㧘߽ߒߊߪ৻ㇱᄾ⚂ක≮߇޽ࠆ‫଻ⵍޕ‬㒾⠪ߩ 3 ಽߩ 2 ߪ⃻‛⛎ઃဳࠍㆬᛯߒߡ޿ࠆ㧔‫ޟ‬2006 ᐕߩක≮଻㒾Ꮢ႐ߩ․ᓽ‫ޠ‬㧕‫ޕ‬ⵍ଻㒾⠪ߪ఺⽿೙㧔৻ቯ㗵߹ߢߩක≮⾌ࠍ⥄Ꮖ⽶ᜂ㧕ߩ޽ࠆ଻㒾ᄾ⚂߽ㆬᛯߢ߈ࠆ‫ߩ⽿఺ޕ‬਄㒢ߪ 100 ࡙࡯ࡠ߆ࠄ 500 ࡙࡯ࡠ߹ߢߣᄾ⚂ߦࠃߞߡ⇣ߥࠆ߇㧘఺⽿ߦᔕߓߡⵍ଻㒾⠪ߦኻߔࠆቯ㗵଻㒾ᢱߪഀᒁߐࠇ
ࠆ‫ߒߛߚޕ‬㧘఺⽿ࠍㆬᛯߔࠆⵍ଻㒾⠪ߪߏߊ௖߆ߦㆊ߉ߥ޿ߣ޿ࠊࠇࠆ‫ޕ‬ⵍ଻㒾⠪ߪᚲᓧߦଐሽߒߚ଻㒾ᢱࠍ⽶ᜂߔࠆ‫଻ߩߎޕ‬㒾ᢱߪ‫ޟ‬ක≮଻㒾ၮ㊄‫ޠ‬㧔2006 ᐕએ೨ߩਛᄩၮ㊄㧕߳ᝄࠅㄟ߹ࠇࠆ‫↪ⵍޕ‬⠪ߩ႐ว㧘଻㒾ᢱ㧔ᢱ₸ 6.5㧑㧕ߪ⾓㊄߆ࠄḮᴰᓽ෼ߐࠇࠆ߇ක≮଻㒾ᴺߪ㓹↪ਥߦኻߒߡᒰ⹥଻㒾ᢱ⽶ᜂࠍ⵬ఘߔࠆ㧔⾓㊄ߦ਄ਸ਼ߖߔࠆ㧕⟵ോࠍ⺖ߒߡ޿ࠆ‫ޕ‬ᓥߞߡ㧘ታ⾰⊛ߦߪᚲᓧଐሽ
଻㒾ᢱߪ㓹↪⠪ߦࠃࠆ᜚಴ߣ޿߃ࠆ‫⥄ޕ‬༡ᬺ⠪߿ᐕ㊄↢ᵴ⠪ߦߪ㓹↪⠪⵬ఘߪߥ޿߇㧘଻㒾ᢱ₸ߪ 4.4㧑ߦシᷫߐࠇߡ޿ࠆ‫↪ⵍޕ‬⠪㧘⥄༡ᬺ⠪ߣ߽ᒰ⹥଻㒾ᢱߩ਄㒢ߪᐕ㑆 30,015 ࡙࡯ࡠߢ޽ࠆ‫߅ߥޕ‬㧘଻㒾ᢱߩᓽ෼ߦߪౝ࿖ᱦ౉ᐡ㧔ᓽ⒢ᯏ㑐㧕߇޽ߚࠆ㧔࿑⴫ 9㧕9)‫ޕ‬ᚲᓧଐሽ଻㒾ᢱߦട߃ߡ㧘18 ᱦએ਄ߩⵍ଻㒾⠪ߪട౉ߔࠆ଻㒾⠪ߦኻߒߡቯ㗵଻㒾ᢱࠍᡰᛄ߁‫ޕ‬ቯ㗵଻㒾ᢱߩᐔဋߪ 2006 ᐕᤨὐߢ 1,000 ࡙࡯ࡠ㧔1 ࡩ᦬ 92 ࡙࡯ࡠ㧕⒟ᐲߣ⷗ㄟ߹ࠇࠆ‫ޕ‬หߓ࠲ࠗࡊߩ଻㒾ᄾ⚂ߢ޽ࠇ߫ቯ㗵଻㒾ᢱߪဋ৻ߢߥߊߡߪߥࠄߥ޿‫଻ⵍޕ‬㒾⠪ߩㆊ෰ߩ∛ᱧ╬ක≮࡝ࠬࠢߢᏅ೎ൻߔࠆߎߣ㧔෸߮ട౉ࠍ⸵นߔࠆߎߣ㧕ߪ⹺߼ࠄࠇߡ޿ߥ޿‫৻ޕ‬ᐕ㑆㧘ක≮⛎ઃࠍฃߌߥ߆ߞߚⵍ଻㒾⠪ߪ଻㒾ᢱߩㆶઃ㧔ᐕ㑆ᦨᄢ 255 ࡙࡯ࡠ㧕ࠍฃߌࠆߎߣ߇ߢ߈ࠆ㧔No Claim Fund㧕‫⥸৻ޕ‬කߩߺߩฃ⸻㧘಴↥ߩߺߩ႐วߢ
࠼ࠗ࠷ߢ߽‫⊛౏ޟ‬ක≮଻㒾┹੎ᒝൻᴺ‫ޠ‬㧔2007 ᐕ 2 ᦬㧕ߦ߅޿ߡࠝ࡜ࡦ࠳ߩਛᄩၮ㊄ߦ޽ߚࠆක≮ၮ㊄ࠍഃ⸳㧘⽷Ḯࠍ৻ᧄൻߒߡోߡߩⵍ଻
㒾⠪ߩ଻㒾ᢱ₸ࠍห৻ߦߔࠆߣߣ߽ߦ㧘หၮ㊄ࠍㅢߓߡ∔∛㊄ᐶ㑆ߢ࡝ࠬࠢ᭴ㅧ⺞ᢛࠍⴕ߁ߣߒߡ޿ࠆ‫ߦࠄߐޕ‬ฦ∔∛㊄ᐶߪട౉⠪߆ࠄ⽷Ḯਇ⿷ߦᔕߓߡઃട଻㒾ᢱࠍᓽ෼ߔࠆ‫∛∔ޕ‬㊄ᐶߣ᳃㑆଻㒾ߩਗ┙ߪᱷࠅ㧘ᓟ⠪ߪ࡝ࠬࠢ᭴ㅧ⺞ᢛߩኻ⽎ߦߪߥࠄߥ޿߽ߩߩࠝ࡜ࡦ࠳ဳߩක≮೙ᐲߦㄭߠߊᡷ㕟ߣ޿߃ࠆ‫ޕ‬- 54 -

ක≮଻㒾೙ᐲᡷ㕟ߣ▤ℂ┹੎޽ߞߡ߽଻㒾ᢱㆶઃࠍฃߌࠄࠇࠆ‫ߚ߹ޕ‬㧘ቯ㗵଻㒾ᢱߩ⽶ᜂࠍシᷫߔࠆߚ߼ૐᚲᓧ⠪ะߌߦஜᐽᚻᒰ㧔Health Care Allowance㧕߇⛎ઃߐࠇߡ޿ࠆ‫ޕ‬ᚻᒰߪ㧔ታ㗵ߢߪߥߊ㧕‫ޟ‬ᐔဋቯ㗵଻㒾ᢱ‫↪⾌⊛▸ⷙߣޠ‬㧔⽶ᜂน⢻ߥࠦࠬ࠻㧕ߩᏅ㗵ߦ╬ߒߊ㧘නり਎Ꮺ㧘߆ߟᐕ㑆ߩ㧔☻㧕ᚲᓧ߇ 25,000 ࡙࡯ࡠએਅߢ޽ࠇ߫ᦨᄢ 400
࡙࡯ࡠ㧘㈩஧⠪࡮ࡄ࡯࠻࠽࡯߇޿ࠆ਎Ꮺߢᐕ㑆ߩ਎Ꮺ㧔ว▚㧕ᚲᓧ߇ 40,000 ࡙࡯ࡠએਅߢ޽ࠇ߫ᦨᄢ 1,155
࡙࡯ࡠߣߥߞߡ޿ࠆ‫଻ޕ‬㒾⠪㑆ߩଔᩰ┹੎ࠍ៊ߥ߁ߎߣߥߊ㧘౏ᐔߦ㈩ᘦߒߚ೙ᐲߣ޿߃ࠆ‫ޕ‬࿑⴫ 㪐䋺ක≮଻㒾䈱଻㒾ᢱ㩷଻ 㒾 ᢱ ₸․೎ක≮⾌⵬ఘ೙ᐲ

ᦨ㜞ᡰᛄ㗵㧔ᐕ㗵㧕଻㒾ᢱ₸ᒝ೙ஜᐽ଻㒾೙ᐲⵍ↪⠪╬㧔㓹↪⠪⵬ఘ޽ࠅ㧕⥄༡ᬺ⠪╬㧔㓹↪⠪⵬ఘߥߒ㧕ᦨ㜞ᡰᛄ㗵㧔ᐕ㗵㧕଻㒾ή⺧᳞ႎᅑ㊄ቯ 㗵 ଻ 㒾 ᢱᐕ㗵ෘ↢⑔␩ࠬࡐ࡯࠷⋭⹜▚㧔ᐕ㗵㧕

12.55㧑
30,631
࡙࡯ࡠ
6.5㧑
4.4㧑
30,015
࡙࡯ࡠ
255
࡙࡯ࡠ
1,106
࡙࡯ࡠ

಴ᚲ㧦
‫ޟ‬2005 ᐕᐲࠝ࡜ࡦ࠳ක≮଻㒾ળ␠ㅢା‫ޠ‬଻㒾⠪ᯏ⢻ߩᒝൻ߽࿑ࠄࠇߡ޿ࠆ‫∛∔ޕ‬㊄ᐶߪ 93 ᐕએ㒠㧘කᏧߣ୘೎ߦ੤ᷤߔࠆߎߣ߇⹺߼ࠄࠇߡ޿
ߚ߇㧘ኾ㐷කߩ᡽ᴦജߩᒝߐߥߤ߆ࠄታ❣߇߶ߣࠎߤߥ߆ߞߚ‫ߒ߆ߒޕ‬㧘1998 ᐕߩ┹੎ᴺߩᡷᱜߦࠃࠅ㧘┹੎ࠍ㒖ኂߔࠆ⚿⸤࡮ଔᩰࠞ࡞࠹࡞╬ߪᒰ੐⠪߇ߘߩ␠ળ⊛೑⋉ࠍ┙⸽ߢ߈ߥ޿㒢ࠅ㧘ߔߴߡ⑌ᱛߐࠇࠆ
ߎߣߦߥߞߚ‫ޕ‬
㧔98 ᐕએ೨ߪ⚿⸤߇␠ળ⊛೑⋉ߦ෻ߔࠆߎߣࠍ᜼⸽ߔࠆ⽿છߪ᡽ᐭߩ஥ߦ޽ߞߚ‫ޕ‬㧕ߎߩ┹੎ᴺߪක≮ឭଏߩ 3 ಽߩ 1 ޽߹ࠅߦ㑐ࠊߞߡ޿ࠆ‫ޕ‬หᴺߦၮߠ߈౏ᱜขᒁᆔຬળ㧔Competition Authority㧕߇ߎࠇ߹ߢᘠⴕߣߒߡⴕࠊࠇߡ޿ߚකᏧࠄ㧔৻⥸ක㧘࠮࡜ࡇࠬ࠻╬㧕ߦࠃࠆଔᩰࠞ࡞࠹࡞ࠍ⑌ᱛߒߚ‫ޕ‬଻㒾⠪߆ࠄක≮ᯏ㑐㧔∛㒮࡮කᏧ㧕߳ߩᡰᛄ޿ߩ൮᜝ൻ߽࿑ࠄࠇߡ߈ߡ޿ࠆ‫≮⸻ޕ‬ႎ㈽ߩ൮᜝ൻߦߪක
≮ࠨ࡯ࡆࠬߩಽ㘃㧔ᚲቯߩ∔∛ߦኻߔࠆ⸻≮ⴕὑߩᮡḰൻ㧕߇ਇนᰳߢ޽ࠆ‫ޕ‬᡽ᐭߪ 2000 ᐕߦ∔∛⸻ᢿ࡮⸻≮ⴕὑߦ㑐ߔࠆ⎇ⓥࡊࡠࠫࠚࠢ࠻ࠍ⊒⿷㧘∛㒮ߩᄖ᧪࡮౉㒮ᴦ≮ࠍಽ㘃ߔࠆၮḰߣߒߡ DBC㧔∔∛࡮ᴦ≮ಽ㘃㧕ࠍ㐿⊒ߒߚ‫ޕ‬DBC ߩ⒳㘃ߪ 400-600 ߶ߤߢ޽ࠅ㧘05 ᐕ߆ࠄߪ∛㒮⚻⾌ߩ 10㧑ߦߟ޿ߡߪ㧘ߎߩ
DBC㧔ߦߣߞߡቯ⟵ߐࠇߚක≮ࠨ࡯ࡆࠬ 100 ⒟ᐲ㧕ߏߣߦଔᩰߠߌࠍⴕ߁ߎߣߦߥߞߡ޿ࠆ㧔Schut and Van
de Ven (2005)㧕
‫଻ߢ߹ࠇߎޕ‬㒾⠪ߪ∛㒮ߣߩ୘೎੤ᷤߪ⹺߼ࠄࠇߡ߅ࠄߕ㧘ߘߩ੍▚ߦߟ޿ߡ∛㒮ߣߩ㓸࿅੤ᷤ߳ߩෳട߇⟵ോઃߌࠄࠇߡ޿ߚ‫ޕ‬2006 ᐕࠃࠅ଻㒾⠪ߪ DBC ߦၮߠ߈∛㒮ߣ୘೎ߦᄾ⚂ࠍ੤ࠊߔߎߣ
߇ߢ߈ࠆࠃ߁ߦߥߞߚ‫ߒߛߚޕ‬㧘ะߎ߁ 5 ᐕ㑆ߪ⒖ⴕᦼ㑆ߣߐࠇ㧘∛㒮੍▚ߩ 90㧑ߪ㧔ᓥ᧪ߩ✚੍▚ᨒ೙ߦၮߠ߈㧕᡽ᐭߦࠃߞߡ᳿߼ࠄࠇ㧘ᱷࠅߩ 10㧑ࠍᒰ੐⠪㑆ߢߩଔᩰ੤ᷤߦᆔߨࠆੑర೙ᐲ߇ߣࠄࠇߡ޿ࠆ‫ޕ‬ᓟ⠪ߩᲧ₸ߪ੹ᓟ㜞߼ࠄࠇߡ޿ߊ⷗ㅢߒߢ޽ࠆ‫ޕ‬- 55 -

ળ⸘ᬌᩏ⎇ⓥ No.36㧔2007.9㧕㪘㪮㪙㪱 䈱❗ዊ㩷
1968 ᐕߩዉ౉એ᧪㧘⛎ઃ▸࿐ߩ᜛ᄢߣߣ߽ߦ㧘AWBZ ᡰ಴㗵ߪჇടߒ⛯ߌߡ޿ࠆ‫⼔੺ޕ‬㧘㐳ᦼ౉㒮ߥߤߦኻߔࠆ࿖᳃ߩ㜞޿࠾࡯࠭߇⢛᥊ߦ޽ࠆߣߒߡ߽㧘ߎߩ߹߹⤘ᒛ߇⛯ߌ߫㧘AWBZ ߩ଻㒾ᢱ߇ 2030 ᐕߦߪ 25㧑޽߹ࠅߦߥࠆߣߩ⹜▚߽޽ࠆ㧔MHWS(2004)㧕
‫ޕ‬2000 ᐕએ㒠ߪࠨࠗࡕࡦ࠭⸘↹߆ࠄ৻ォ㧘AWBZ ࠍ㒢ቯߔࠆᣇะߦ޽ࠆ‫ޕ‬2007 ᐕߦߪ♖␹⑼ᴦ≮㧔1 ᐕએౝ㧕߇ක≮଻㒾೙ᐲ㧔╙ 2 ጀ㧕ߦ⒖ߐࠇࠆ߶߆㧘WMO
ᴺ㧔␠ળ⊛ࠨࡐ࡯࠻ߦ㑐ߔࠆᴺᓞ㧕ࠍᣉⴕ㧔2007 ᐕ 1 ᦬㧕ߒߡ࿷ቛࠤࠕࠍ࿾ᣇ⥄ᴦ૕ߦᜂࠊߖࠆߥߤಽᮭ
ൻ㧔੺⼔ᡰេߦ߅ߌࠆ࿾ᣇ⥄ᴦ૕ߩ⽿છߩ᜛ల㧕߇ㅴ߼ࠄࠇߡ޿ࠆ㧔MHWS(2004)㧕
‫ߒߛߚޕ‬㧘੺⼔ᣉ⸳ߪᘟᕈ⊛ߥଏ⛎ਇ⿷ߦ޽ࠅ㧘ᓙᯏ࡝ࠬ࠻߽⸃ᶖߒߡ޿ߥ޿‫∛ޕ‬㒮ࠍ಴ߚᖚ⠪߇‫⼔੺ޟ‬㔍᳃‫ߚߞߥߦޠ‬੐଀ߪ⍮ࠄࠇߡ޿ߥ޿߇㧘ߘߩ ᔨߪ᜞߃ߥ޿㧔ᄢ᫪(2006)㧕
‫ޕ‬଻㒾⠪䈻䈱ⷙ೙㩷ක≮଻㒾ࠍឭଏߔࠆ᳃㑆଻㒾ળ␠ߦኻߒߡߪ㧘ߘߩ⽷ോ࡮ᛩ⾗㧘଻㒾ߩឭଏ㧘଻㒾ᢱߩᓽ෼㧘┹੎╬㧘᭽‫ߥޘ‬ዪ㕙ߢⷙ೙߇ሽ࿷ߒߡ޿ࠆ‫ⷙߩߘޕ‬೙ߦߪක≮㑐ㅪߦ㒢ࠄߕ㧘ක≮એᄖߩ଻㒾ળ␠ห᭽㧘᳃㑆଻㒾࡮༡೑ડᬺߦኻߔࠆ߽ߩ߽฽߹ࠇࠆ‫ⷙޕ‬೙ᒰዪߣߒߡߪ㧘
㧔1㧕ਛᄩ㌁ⴕ㧘㧔2㧕㊄ⲢᏒ႐ⷙ೙ᒰዪ㧘
㧔3㧕┹੎
᡽╷ᒰዪ㧘
㧔4㧕
ක≮଻㒾⋙ⷞᯏ᭴
㧔CTZ㧕㧔ஜᐽෘ↢ࠬࡐ࡯࠷⋭㧕෸߮㧔5㧕ක≮଻㒾ᯏ᭴߇޽ࠆ
㧔MHWS(2006)㧕
‫ޕ‬଻㒾⠪ߪ᳃㑆଻㒾ળ␠ࠍ⋙〈ߔࠆ‫଻ޟ‬㒾⋙〈ᴺ㧔Insurance Supervision Act㧕1993‫ߩޠ‬ㆡ↪ࠍฃߌࠆ‫ޕ‬หᴺߪ᳃㑆଻㒾ળ␠߇଻㒾ᄾ⚂ࠍጁⴕߔࠆߩߦᔅⷐߥ⽷ോ਄ߩஜోᕈ߿଻㒾⚻༡ߩ⛮⛯ᕈࠍ⋙〈ߔࠆ߽ߩߢ޽
ࠅ㧘ਛᄩ㌁ⴕ߇ⷙ೙ᒰዪߣߒߡၫⴕߦ޽ߚߞߡ޿ࠆ‫ޕ‬㊄Ⲣⷙ೙ᒰዪߪ㧘ක≮଻㒾ળ␠߇ⵍ଻㒾⠪ߦኻߒߡ଻㒾ᄾ⚂ߩࠝࡊ࡚ࠪࡦ㧘ቯ㗵଻㒾ᢱߦ㑐ߔࠆᖱႎࠍⵍ଻㒾⠪ߦᱜߒߊ㐿␜ߒߡ޿ࠆ߆ࠍ⋙ⷞߔࠆ‫ߦࠄߐޕ‬หዪߪ଻㒾⠪ߩ⽷ോ▤ℂ࡮ᛩ⾗ߩㆡᱜ߽ክᩏߔࠆ‫ޕ‬ක≮଻㒾ળ␠޽ࠆ޿ߪක≮ឭଏᯏ㑐ߩ㑆ߢߩ⚿⸤ࠍ㒐ᱛ࡮៰⊒ߔࠆ㧔ஜోߥ┹੎ࠍ଻ᜬߔࠆ㧕ߩ߇┹੎᡽╷ᒰዪߩᓎഀߢ޽ࠆ‫৻ޕ‬ᣇ㧘CTZ ߪട౉⠪ฃߌ౉ࠇ⟵ോߩㆩ቞߿ห৻଻㒾ᄾ⚂ߦኻߔࠆ଻㒾ᢱߩㆡᱜᓽ෼㧔Ꮕ೎ൻߩ᦭ή㧕ࠍ⋙ⷞߔࠆ‫ߚ߹ޕ‬㧘CTZ ߪක≮଻㒾
ᴺߢⷙቯߐࠇߚ౏⊛ක≮଻㒾⛎ઃࠍⵍ଻㒾⠪߇ฃߌߡ޿ࠆ߆ߤ߁߆ࠍࡕ࠾࠲࡯ߔࠆ߶߆㧘ᓟㅀߔࠆක≮଻㒾ᯏ᭴߆ࠄߩⷐ⺧߇޽ࠇ߫଻㒾⠪ߩᩏኤ߽ⴕ߁‫ߚߒ߁ߎޕ‬ක≮଻㒾Ꮢ႐ߩ⋙〈ߪࠤࠕⷙ೙ᒰዪ㧔Care
Authority㧕ߦ⒖ⴕߐࠇࠆߎߣߦߥߞߡ޿ࠆ‫ޕ‬‫ޟ‬ஜᐽᴺ㧔Health Care Act㧕‫ߦޠ‬ၮߠ޿ߡ⸳┙ߐࠇࠆࠤࠕⷙ೙ᒰ
ዪߪ AWBZ㧔╙ 1 ጀ㧕ࠍ฽߼ක≮଻㒾ߩㆡᱜߥၫⴕ╬㧘଻㒾⠪ߩ଻㒾ㆇ༡ࠍ⋙ⷞߔࠆᯏ⢻ࠍ᦭ߔࠆߎߣߦ
ߥࠆ‫ᦨޕ‬ᓟߦක≮଻㒾ᯏ᭴ߪ㧘‫ޟ‬ක≮଻㒾ᴺ‫ߩޠ‬ਅߢ଻㒾Ꮢ႐ߩㆇ༡ో૕ࠍ⋙〈㧘଻㒾ᄾ⚂ߩ᣿⍎ᕈߩଦㅴ㧘଻㒾࡮ࠨ࡯ࡆࠬឭଏߦ㑐ࠊࠆᜰ㊎ߩ૞ᚑ㧘ක≮଻㒾ߣ AWBZ ߩ㑆ߩᢛวᕈߩ⏕଻㧘࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒ
ࠕࡓࠍ㈩ಽߔࠆක≮଻㒾ၮ㊄ߩ▤ℂ෸߮หࡊ࡟ࡒࠕࡓ⒖ォߩታᣉߥߤࠍᜂ߁‫ޕ‬
2006 ᐕએ㒠㧘CTZ ߦࠃࠆട౉⠪ฃߌ౉ࠇ⟵ോߪ᳃㑆଻㒾ળ␠ߦㆡ↪ߐࠇߡ߈ߡ޿ࠆ‫ߒ߆ߒޕ‬㧘EU ߢߪ᳃㑆ડᬺߩ੐ᬺ߳ߩ᡽ᐭߩ⛔೙ࠍ⑌ߓߡ߅ࠅ㧘ߎࠇߦ Open enrollment ߇ᛶ⸅ߔࠆน⢻ᕈ߽ᜰ៰ߐࠇߡ޿ࠆ
㧔Van de Ven ࠛ࡜ࠬࡓࠬᄢቇᢎ᝼⺣㧕‫੹ޕ‬࿁ߩᡷ㕟ߦ޽ߚߞߡ㧘ࠝ࡜ࡦ࠳᡽ᐭߪ੐೨ߦ EU ߩ┹੎ᆔຬળߦ
ኻߒߡ⏕⹺㧘EU ⷙ೙ߦ⍦⋫ߒߥ޿ߢ޽ࠈ߁ߣ޿߁ᆔຬ㐳ߩ⸒⾰ࠍᓧߡ޿ࠆ߇㧘EU ߩ౏ᑼ⷗⸃ߣ޿߁ࠊߌ
ߢߪߥ޿‫ޕ‬଻㒾⠪㑆┹੎䈱ታ㓙㩷ቯ㗵଻㒾ᢱߪⵍ଻㒾⠪ߩᚲᓧߦߪଐሽߖߕ㧘଻㒾ᄾ⚂࠲ࠗࡊߏߣߦ㊄㗵߇᳿߼ࠄࠇߡ޿ࠆ‫ޕ‬㧔ߚߛߒ㧘ૐᚲᓧ⠪ߩ⽶ᜂ߳ߩ㈩ᘦߪ Health Care Allowance Act ߩਅߢ‫ޟ‬ක≮ᚻᒰ‫ߡߞ߽ߢޠ‬ኻಣߐࠇࠆ‫ޕ‬
㧕90 ᐕઍೋ
㗡ߪ㧘∔∛㊄ᐶߦኻߔࠆ੐ᓟ⊛⵬Ⴏߩഀว߇㜞߆ߞߚ㧔93 ᐕߪ 97.5㧑㧕ߎߣ߿ක≮ᯏ㑐ߩㆬ೎߽⊝ήߢ޽
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ක≮଻㒾೙ᐲᡷ㕟ߣ▤ℂ┹੎ߞߚߎߣ߆ࠄ଻㒾⠪㑆ߢቯ㗵଻㒾ᢱߦᩰᏅ߇߶ߣࠎߤߥ߆ߞߚ‫ߒ߆ߒޕ‬㧘࡝ࠬࠢ᭴ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ♖✺ൻ㧔ߘࠇߣวࠊߖߚ੐ᓟ⊛⵬Ⴏߩࠪࠚࠕߩૐਅ㧕߿଻㒾⠪ߩ⚻༡⢻ജߩะ਄ߣߣ߽ߦᩰᏅ߇㗼⪺ߦߥߞߡ߈ߡ޿ࠆ㧔࿑⴫ 10㧕‫ޕ‬2006 ᐕߦ߅ߌࠆߎߩቯ㗵଻㒾ᢱߩᦨ㜞㗵㧔ᄾ⚂ක≮ߥߒߩ⵬ఘဳ଻㒾㧕ߪ 1,172
࡙࡯ࡠߢ޽ࠅ㧘ᦨૐ㗵㧔ᄾ⚂ක≮ઃ߈ߩ⵬ఘဳ଻㒾㧕ߪ 990 ࡙࡯ࡠߢ޽ࠆ‫଻ޕ‬㒾ߦࠃࠆଔᩰߩᏅߪ 10㧑એ਄ߦ㆐ߔࠆ‫଻ⵍޕ‬㒾⠪ߦࠃߞߡㆬᛯߩ⥄↱߇ߥ޿଻㒾໡ຠ㧔⃻‛⛎ઃဳ଻㒾㧕ߪ቟ଔߥ㧘ㆬᛯߩ⥄↱߇ᄙ޿଻㒾໡ຠ㧔⵬ఘဳ଻㒾㧕ߩ႐วߪ㜞ଔߥ‫ޟ‬ଔᩰߠߌ‫ߣߩ߽ࠆ޿ߡ߈ߡࠇߐߥ߇ޠ‬⠨߃ࠄࠇࠆ‫ߒߛߚޕ‬㧘޽ࠆ଻㒾ળ␠ߩᄾ⚂ක≮ઃ߈ⶄวဳ଻㒾෸߮⵬ఘဳ଻㒾ߪ㧘೎ߩ଻㒾ળ␠ߩ⃻‛⛎ઃဳ଻㒾ࠃࠅ߽቟ଔߥ
႐ว߇޽ࠅ߁ࠆ㧔‫ޟ‬2005 ᐕᐲࠝ࡜ࡦ࠳ක≮଻㒾ળ␠ㅢା‫ޠ‬㧕‫ޕ‬࿑⴫ 㪈㪇㩷 ቯ㗵଻㒾ᢱᩰᏅ䈱᜛ᄢ㩷

40

100
90

35

80
30
70
25

60
䊡䊷䊨 50

20 䋦

40

15

30
10
20
5

10

0

0
1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

ᐕ
଻㒾ᢱᩰᏅ䋨䋽ᦨᄢ䋭ᦨዊ䋩䋨Ꮐゲ䋩

∔∛㊄ᐶ䈱⽷᡽䊥䉴䉪䋨ฝゲ䋩಴ᚲ㧦L. M. Lamers, R. C.J.A. van Vliet and W P.M.M. van de Ven (2003)

Schut and Hassink(2002)ߪ 96 ᐕ߆ࠄ 98 ᐕ߹ߢߩࡄࡀ࡞࠺࡯࠲ࠍ↪޿ߡࡊ࡟ࡒࠕࡓߩᒁ߈਄ߍ߇ᒰ⹥଻㒾⠪ߩᏒ႐ࠪࠚࠕߦ෸߷ߔࡑࠗ࠽ࠬലᨐߪૐߊ㧘∔∛㊄ᐶ㑆ߢߩଔᩰ┹੎߇㒢ቯ⊛ߢ޽ߞߚߎߣࠍ␜ߒߚ‫ޕ‬∔∛㊄ᐶࠍᄌ߃ࠆⵍ଻㒾⠪ߩഀวߪᲤᐕ 2-3㧑ߦ⇐߹ࠆߣߩႎ๔߽޽ࠆ㧔Lamers et al(2003)㧕
‫߅ߦ࠷ࠗ࠼ޕ‬ߌࠆⵍ଻㒾⠪⒖േ߽ 3-4㧑⒟ᐲߣߐࠇࠆ㧔Buchner and Wasem(2003)㧕
‫ޕ‬୘ੱߦኻߔࠆචಽߥᖱႎ㧔଻㒾ࡊ࡜ࡦ࡮ឭଏߐࠇࠆක≮ࠨ࡯ࡆࠬߩౝኈ╬㧕߇ⴕ߈ᷰࠄߥ߆ߞߚߎߣ߇㧘⥄↱ߥ଻㒾⠪ㆬᛯߩᮭ೑߇ⴕ૶ߐࠇ
ߥ޿ේ࿃ߩ৻ߟߦ᜼ߍࠄࠇࠆ㧔Van de Ven(1991)㧕
‫ߒ߆ߒޕ‬㧘2006 ᐕߪⵍ଻㒾⠪ߩ⚂ 18㧑߇೎ߩක≮଻㒾ળ
␠ߦ⒖ߞߚߣߐࠇࠆ㧔࿑⴫ 11 ෳᾖ㧕‫ޕ‬ห৻଻㒾⠪ߦߣߤ߹ߞߡ߽㧘೎ߩක≮଻㒾ࠍㆬᛯߔࠆߎߣ߽޽ࠅ߁
ࠆ‫ߚߒ߁ߎޕ‬ౝㇱߢߩ⒖ォߪ 5㧑߆ࠄ 10㧑ߦ෸߽߱ߩߣ⷗Ⓧ߽ࠄࠇߡ޿ࠆ‫ߩઁޕ‬ක≮଻㒾ળ␠߳ߩ⒖ォ෸߮ห৻ળ␠ౝߩ⒖ォߩᢙ୯ࠍ૬ߖࠆߣ㧘ⵍ଻㒾⠪ߩ 23㧑߆ࠄ 28㧑߇㧘2005 ᐕᧃߩᤨὐߢᓥ᧪ߩක≮଻㒾

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ળ⸘ᬌᩏ⎇ⓥ No.36㧔2007.9㧕ᄾ⚂ࠍᄌᦝߒߚߎߣߦߥࠆ‫ޕ‬೙ᐲᡷ㕟ߦࠃࠆ৻ᤨ⊛ߥ⃻⽎ߣ߽޿߃ࠆ߇㧘ⵍ଻㒾⠪߇ᯏળ㧔ߣᖱႎ㧕߇޽ࠇ߫㧘‫ߦ⿷ޟ‬ᛩ␿‫ޠ‬ᮭࠍⴕ૶ߔࠆߎߣࠍ␜ߔ੐଀ߢ޽ࠆ‫ޕ‬࿑⴫ 㪈㪈㩷 㪉㪇㪇㪈 ᐕ䈎䉌 㪉㪇㪇㪍 ᐕ䉁䈪䈱ⵍ଻㒾⠪䈱นേᕈ㩷ᐕᐲᒝ೙ஜᐽ଻㒾ળ␠ߩⵍ଻㒾⠪᳃㑆଻㒾ળ␠ߩⵍ଻㒾⠪

2001

2.6㧑

6.6㧑

2003

2.8㧑

8.6㧑

2004

2.4㧑

ਇ᣿

2005

4.2㧑

8.7㧑

2006

18㧑

಴ᚲ㧦
‫ޟ‬2006 ᐕߩක≮଻㒾Ꮢ႐ߩ․ᓽ‫ޠ‬䋶䋮⚳䉒䉍䈮㩷
ࠊ߇࿖ߢ߽‫ޟ‬ㆬᛯߣ┹੎‫ࠍޠ‬ଦㅴߔߴߊ‫▤ޟ‬ℂ┹੎‫ߩޠ‬ዉ౉߇ឭ⸒ߐࠇߡ޿ࠆ㧔ᐢ੗(1998)㧘(1999)㧕
‫ޕ‬␠ળ଻㒾ߦ߅ߌࠆ␠ળㅪᏪ㧔ౣಽ㈩㧕ߣല₸ᕈߩㅊ᳞ߪᔅߕߒ߽⋧෻ߒߥ޿ߎߣߪᒝ⺞ߦ୯ߔࠆ‫ࡦ࡜ࠝޕ‬࠳ߩࠃ߁ߦ଻㒾⠪ߩᯏ⢻㧔ᮭ㒢㧕ᒝൻߣ଻㒾⠪㑆┹੎ࠍଦߒߚ਄ߢ㧘Ԙᚲᓧଐሽဳ␠ળ଻㒾ᢱߣ࡝ࠬࠢ᭴
ㅧ⺞ᢛࡊ࡟ࡒࠕࡓߩ⚵ߺวࠊߖߢ߽ߞߡ␠ળㅪᏪࠍ⛽ᜬߔࠆ৻ᣇ㧘ԙቯ㗵଻㒾ᢱߦක≮଻㒾߳ߩଔᩰࡔࠞ
࠾࠭ࡓߣߒߡߩᓎഀࠍ߽ߚߖࠆߎߣ߽น⢻ߢ޽ࠆ‫ޕ‬ቯ㗵଻㒾ᢱߩ৻ㇱࠍ⵬ഥ㧔ᚻᒰ⛎ઃ㧕ߔࠇ߫㧘ૐᚲᓧ⠪ߦߣߞߡ߽౏ᐔߥ઀⚵ߺߣߥࠆߛࠈ߁‫┹ޕ‬੎ේℂߦࠃࠆක≮⾗Ḯߩല₸ൻ㧔ࡒࠢࡠല₸ᕈߩᡷༀ㧕ߪක≮⾌ࠍ⽷᡽⊛ߦᜬ⛯น⢻ߥ㧔‫ޟ‬りߩਂ‫ߦޠ‬วߞߚ㧕᳓Ḱߦ⇐߼ࠆ㧔ࡑࠢࡠല₸ᕈߩ⏕଻㧕ࡑࠢࡠ✚㗵▤ℂߣ߽⵬ቢ⊛ߦߥࠅ߁ࠆ㧔૒⮮(2007)㧕
‫ޕ‬
Ꮢ႐ේℂ߳ߩ޽ࠅ߁ࠆᛕ್ߣߒߡߪ㧘୘ੱߪක≮ࠨ࡯ࡆࠬߦ㑐ߔࠆචಽߥᖱႎࠍᜬߚߕ㧘ࠃߞߡ଻㒾⠪߿ක≮ᯏ㑐߇னࠅߩᖱႎ㧔޽ࠆ޿ߪࠗࡔ࡯ࠫᚢ⇛㧕ߦᏀฝߐࠇࠆߎߣ߇᜼ߍࠄࠇࠃ߁‫ޕ‬ක≮ᯏ㑐࡮଻㒾⠪ߦ㑐ߔࠆᖱႎߪࠬ࠲ࡦ࠳࡯࠼ൻߒ㧘Ყセน⢻ߦߔࠆᎿᄦ߇ᔅⷐߢ޽ࠈ߁‫ޕ‬ᖱႎ㐿␜ߩਥ૕ߪ଻㒾⠪㧘ක≮ᯏ㑐⥄૕ߢ߽ࠃ޿߇㧘ߘߩᖱႎߩᱜ⏕ߐࠍ⺞ᩏ࡮౏⴫ߔࠆ╙ 3 ⠪ᯏ㑐ߩ⸳┙߇ਇนᰳߢ޽ࠆ‫ ╙ߩߎޕ‬3 ⠪ᯏ㑐ߦߪᩏኤ㧘ࡍ࠽࡞࠹ࠖ࡯ࠍ⺖ߔᮭ㒢߇ઃਈߐࠇߡߥߊߡߪߥࠄߥ޿‫ޕ‬೑ኂᒰ੐⠪㧔଻㒾⠪㧘ක≮ᯏ㑐㧕ࠄߦࠃࠆ⥄ਥ⊛ߥⷙ೙ߢߪߥߊ㧘ᒝ޿ᮭ㒢ࠍ᦭ߒߚ╙ 3 ⠪ߩ㑐ਈ߇౏㐿ߐࠇߚᖱႎߩା㗬ᕈࠍ㜞߼ࠆߎߣ
ߦ⽸₂ߔࠆߛࠈ߁‫ߚ߹ޕ‬㧘଻㒾⠪߿ක≮ᯏ㑐ࠍ⹏ଔߔࠆᩰઃߌᯏ㑐ߩෳ౉ࠍ⹺߼ࠆߎߣ߽ᖱႎ౏㐿ࠍߐࠄߦଦㅴߔࠆ߽ߩߣ⠨߃ࠄࠇࠆ‫ޕ‬චಽ㧘߆ߟᱜ⏕ߥᖱႎߩਅߢߩߺ୘ੱߪ⽿છ޽ࠆㆬᛯࠍߣࠆߎߣ߇ߢ߈ࠆ‫ޕ‬଀߃߫㧘☨࿖ߢߪ㧘଻㒾⠪ᯏ⢻ࠍ⊒ើߔࠆ᳃㑆଻㒾㧔HMO ࠍ฽߻㧕ߦኻߒߡ㧘଻㒾⠪࡮଻㒾໡ຠߩ⾰ߩ⹏ଔ࡮⹺ቯࠍⴕ߁ᯏ㑐㧔National Committee for Quality Assurance㧔NCQA㧕㧕߇ሽ࿷㧘଻㒾⠪ᯏ⢻ߩⴕ߈ߔ߉
ࠍ࠴ࠚ࠶ࠢߒߡ޿ࠆ㧔᧻ේ(2002)㧕
‫ޕ‬ක≮ߦ㒢ࠄߕ೙ᐲᡷ㕟ߪ৻ᄛߦߒߡߥࠆ߽ߩߢߪߥ޿‫ࡦ࡜ࡊ࡮࡯ࠞ࠶࠺ߪ࠳ࡦ࡜ࠝޕ‬㧔1987 ᐕ㧕߆ࠄ
2006 ᐕᡷ㕟߹ߢ 20 ᐕㄭ޿᦬ᣣࠍⷐߒߚ‫ߩߘޕ‬㑆㧘೙ᐲᡷ㕟ߪẋㅴ⊛㧘߆ߟ⹜ⴕ㍲⺋⊛ߢ޽ߞߚ߇㧘଻㒾⠪ᯏ⢻ߩᒝൻߣ┹੎ේℂߩዉ౉ߣ޿߁ၮᧄේೣߦ߱ࠇߪߥ߆ߞߚ㧔࿖᳃⊛࡮⿥ౄᵷ⊛วᗧ߇޽ߞߚ㧕ࠃ߁- 58 -

ක≮଻㒾೙ᐲᡷ㕟ߣ▤ℂ┹੎ߦᕁࠊࠇࠆ‫ޕ‬␠ળߩ㜞㦂ൻߣ⽷᡽ᖡൻߩਛ㧘‫ޟ‬዁᧪਎ઍߦ⽶ᜂࠍవㅍࠅߒߥ޿␠ળ଻㓚೙ᐲࠍ⏕┙‫ޠ‬ߒߟߟ㧘ᔅⷐ߆ߟㆡಾߥක≮ࠨ࡯ࡆࠬߩឭଏࠍଦㅴߔߴߊක≮೙ᐲߩౣ᭴▽߇ᕆോߦߥߞߡ޿ࠆ‫ߢߎߘޕ‬᳞߼ࠄࠇߡ޿ࠆߩߪ႐ᒰߚࠅ⊛ߥ⽷Ḯ⏕଻㧔౏⾌ߩᛩ౉㧕߿⸻≮ႎ㈽ߩࠞ࠶࠻ߢߪߥߊ㧘ක≮೙ᐲߩ‫ޟ‬ၮᧄේೣ‫ޠ‬ߣ␠ળ⊛ࠦࡦ࠮ࡦࠨࠬߩ⏕┙ߢ޽ࠈ߁‫ޕ‬䋼ෳ⠨ᢥ₂䋾㩷
ᄢ᫪ᱜඳ(2001)‫ߩ࠳ࡦ࡜ࠝޟ‬ක≮೙ᐲᡷ㕟ߣ‫଻ޟ‬㒾⠪ᯏ⢻‫ޠ‬‫ޠ‬‫ޡ‬ᶏᄖ␠ળ଻㓚⎇ⓥ‫ޢ‬No.136㧘pp.59-71㧘࿖┙␠ળ଻㓚࡮ੱญ໧㗴⎇ⓥᚲ
ᄢ᫪ᱜඳ(2006)‫ࠆߌ߅ߦ࠳ࡦ࡜ࠝޟ‬ක≮ߣ੺⼔ߩᯏ⢻ಽᜂߣㅪ៤‫ޠ‬‫ޡ‬ᶏᄖ␠ળ଻㓚⎇ⓥ‫ޢ‬No.156㧘pp.75-90㧘࿖┙␠ળ଻㓚࡮ੱญ໧㗴⎇ⓥᚲ
૒⮮ਥశ(2007)‫ޟ‬ක≮଻㒾೙ᐲᡷ㕟ߩ⺖㗴‫ޠ‬‫ޡ‬ળ⸘ᬌᩏ⎇ⓥ‫ ╙ޢ‬35 ภ㧘pp.7-25↰ਛ⠹ᄥ㇢(2003)‫ߩ࠷ࠗ࠼ޟ‬ක≮଻㒾೙ᐲᡷ㕟‫ޠ‬‫ޡ‬ᶏᄖ␠ળ଻㓚⎇ⓥ‫ޢ‬No.145㧘pp.14-25㧘࿖┙␠ળ଻㓚࡮ੱญ໧㗴⎇ⓥᚲ↰ਛ⠹ᄥ㇢(2006)‫࠷ࠗ࠼ޟ‬ක≮೙ᐲߦߺࠆ‫ޟ‬ㅪᏪਅߩ┹੎‫ޠ߃ߊࠁߩޠ‬‫ޢ࡯ࡘࡆ࡟࡞ࡖࠪࡦ࠽ࠖࡈޡ‬80 ภ㧘
pp.4-32ᐢ੗⦟ౖ(1998)‫ޡ‬ක≮଻㒾ᡷ㕟ߩ᭴ᗐ‫ޢ‬ᣣᧄ⚻ᷣᣂ⡞␠ᐢ੗⦟ౖ✬(1999)‫ޡ‬ක≮ᡷ㕟ߣࡑࡀࠗࠫ࠼࡮ࠤࠕ‫᧲ޢ‬ᵗ⚻ᷣᣂႎ␠
ᑝἑ⌀ℂሶ(2000)‫ߩ࠳ࡦ࡜ࠝޟ‬㐳ᦼක≮࡮੺⼔଻㒾‫ޠ‬‫ޡ‬ᶏᄖ␠ળ଻㓚⎇ⓥ‫ޢ‬No.131㧘pp.47-55㧘࿖┙␠ળ଻㓚࡮ੱญ໧㗴⎇ⓥᚲ
᧻ේ↱⟤(2002)‫ޟ‬ක≮ឭଏ૕೙ߣ଻㒾⠪ᯏ⢻‫ޠ‬‫ޡ‬ක≮ߣ␠ળ‫ޢ‬vol. 12(1)㧘pp.27-35
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