| Summary: | 碩士 === 國立中正大學 === 社會福利學系暨研究所 === 101 === The National Health Insurance (NHI) has been implemented over 18 year, and it reached a number of achievements. However, it has been beset by financial crisis, which will be getting more and more serious over time. From the beginning of the National Health Insurance, it encountered great difficulties in financial adjustment and reform. Unfortunately, in the past 10 years, the 2nd generation NHI also suffered the same situation. Until January 2011, in reform of the 2nd generation NHI process, two important ideas were abandoned: Cancellation of all classification among all enrollees and Collecting contribution by household income. This study is to probe into the cause of restrictions of NHI financial adjustment and reform, and these restrictions would contribute to what kind of institutional change. Through the theory of gradual institutional change to explain institutional change modes, and can be summarized in two institutional change modes: before 2011, 2nd generation NHI was not passed, Government did nothing on financial adjustment and reform. We claim that the period is the “drift”. After 2011, 2nd generation NHI had passed, this period called the “layering”. Drift implicates that ability-to-pay principal of taxation of social insurance was eroded. Layering signifies that “Supplementary premiums” would become the momentum of institutional change.
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