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  • Interpretation
  • No.472【Compulsory National Health Insurance Case】
  • Date
  • 1999/01/29
  • Issue
    • Are compulsory national health insurance and the imposition of an overdue charge both unconstitutional?
  • Holding
    •         According to Article 155 of the Constitution: "The State, in order to promote social welfare, shall establish a social insurance system." Article 157 of the Constitution also specifies: "The State, in order to improve national health, shall establish extensive services for sanitation and health protection, and a system of public medical service." Furthermore, Article 10, Paragraph 5, of the Additional Articles of the Constitution provides: "The State shall promote national health insurance..." The National Health Insurance Act, promulgated on August 9, 1994, and implemented on March 1, 1995, is for the realization of the aforesaid provisions of the Constitution. Provisions in Article 11-1, Paragraph 1, Article 69-1, Paragraph 1, and Article 87 of the Act regarding compulsory subscription of insurance and premium payment are based on considerations of mutual social support, risk-sharing and the public interest, and therefore conform to the constitutional purpose of promoting national health insurance. The overdue charge prescribed in Article 30 of the Act is necessary to oblige a group insurance applicant or the insured to make a premium payment. The aforesaid Article of the Act does not contradict Article 23 of the Constitution. However, for those who cannot afford to pay the premium, the State shall give appropriate assistance and relief and shall not refuse to pay benefits, in order to fulfill the constitutional purposes of promoting national health insurance and protecting senior citizens, the infirm and the financially disadvantaged.     
      
    •         The inclusion of those already covered, in accordance with law, by insurance for government employees, labor insurance, and insurance for farmers in the compulsory national health insurance system is necessary to promote the public interest, and therefore it is hard to argue that such decision contradicts the principle of trust and protection. Nonetheless, the authorities concerned shall, based on the provisions of Article 85 of the Act regarding presenting improvement proposals within a prescribed time period and this J.Y. Interpretation No. 472, conduct at an appropriate time a full-scale evaluation and implement improvement measures in aspects of insurance operations (including diversification of the insurers), categories of the insured, the insured amount, premium rates, payment of medical insurance, austerity measures and the appropriateness of temporary suspension of insurance benefits.     
  • Reasoning
    •         The Legislative Yuan is responsible for the promulgation and amendment of laws. According to the Constitution, the Executive Yuan may only propose legislation bills to the Legislative Yuan. Article 89 of the National Health Insurance Act stipulates: "Two years after the implementation of the Act, the Executive Yuan shall amend the Act within half a year; otherwise, the Act shall cease to be effective upon such expiration," meaning that the Executive Yuan shall evaluate problems facing implementation of the Act and submit improvement proposals to the Legislative Yuan. Accordingly, the Executive Yuan submitted to the Legislative Yuan on July 23, 1997, a Draft Amendment Bill to the National Health Insurance Act. The legal effect of the Act is therefore beyond doubt. 
      
    •         "The State, in order to promote social welfare, shall establish a social insurance system"; "The State, in order to improve national health, shall establish extensive services for sanitation and health protection, and a system of public medical service"; and "The State shall promote national health insurance" are all basic national policies, according, respectively, to Articles 155 and 157 of the Constitution and Article 10, Paragraph 5, of the Additional Articles of the Constitution. The Legislative Yuan may therefore promulgate relevant laws and regulations conforming to the aforesaid constitutional purposes. The design of a national insurance system belongs to the discretionary power of the legislative branch. The National Health Insurance Act, promulgated on August 9, 1994, and implemented on March 1, 1995, is for the realization of the aforesaid provisions of the Constitution. Provisions in Article 11-1, Paragraph 1, Article 69-1, Paragraph 1, and Article 87 of the Act regarding compulsory subscription of insurance are necessary to enable the State to include the whole population in health insurance coverage, so as to perform the responsibility to provide health care for the general public, and therefore conform to the constitutional purpose of promoting national health insurance. Provisions in Article 30 of the Act regarding overdue charges are for the purpose of obliging a group insurance applicant or the insured to submit monetary payment in accordance with public laws. This and the compulsory subscription of insurance are reasonable measures to realize the system of national health insurance. Hence, there is no overstepping of Article 23 of the Constitution. However, for those who cannot afford to pay premiums, the State shall give appropriate assistance and relief and shall not refuse to pay benefits, in order to fulfill the constitutional purposes of promoting national health insurance and protecting senior citizens, the infirm and the financially disadvantaged.     
      
    •         Those already covered, respectively, in accordance with the Public Functionaries Insurance Act, the Labor Insurance Act and the Farmers Health Insurance Act, by the insurance for government employees, labor insurance and the insurance for farmers, must still join the National Health Insurance program. This is for the purposes of integrating medical insurance payment under the respective insurance plans for government employees, laborers and farmers, and establishing a single and fair health insurance system, so as to facilitate reasonable distribution of medical resources and provide social insurance. The terms and conditions of this compulsory social insurance are prescribed by the laws for national implementation, and therefore this differs from an insurance policy selectively purchased by individuals. There is no resulting question of contradiction with trust and protection of interests where the legislative body, in consideration of the needs of social development, makes or amends the laws and changes various social insurance regulations so as to establish the social security system in conformance with constitutional purposes. Nonetheless, the authorities concerned shall, based on the provisions of Article 85 of the Act regarding presenting an improvement proposal within a prescribed time period and this J.Y. Interpretation No. 472, conduct at an appropriate time a full-scale evaluation and implement improvement measures in aspects of insurance operations (including diversification of the insurers), categories of the insured, the insured amount, premium rates, payment of medical insurance, austerity measures and the appropriateness of the temporary suspension of insurance benefits. With respect to the provisions regarding medical insurance as set forth in the Farmers Health Insurance Act, they have become inappropriate as a result of the implementation of the National Health Insurance Act, because the said provisions are temporary measures based on the letter issued by the Executive Yuan. Therefore, the authorities concerned shall pay special attention in this regard.
      
    • ______________________
      
    • * Translation and Note by Ching-Yuan HUANG
      
    • **Also available in Leading Cases of the Taiwan Constitutional Court, Vol. II (2019).       
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