本稿では, わが国の医療保険と介護保険において, 保険機能と所得再分配機能に着目して, 税と保険料の負担のあるべき姿を提示した。この観点から, 保険原理に基づく保険料水準の設定と, 所得再分配を意識して保険料負担が困難な個人に税財源を用いた保険料減免を, さらに明確に行うことが求められる。しかし, 現行制度では, 税と保険料の明確な機能分化はなされてこなかった。そこで, この機能分化を意識して, 2009年度の社会保障給付費統計を用いた分析では, 保険原理を貫徹した場合, 医療保険では加入者1人当たり平均の年間保険料は約26.4万円, 介護保険では第1号被保険者1人当たり平均の年間保険料は約25.0万円であると推計される。また, これに比べて, 実際に賦課している被保険者1人当たり平均の年間保険料は, 医療保険では46.3%引き, 介護保険では59.3%引きとなっていることが示された。
This paper focuses on the insurance principle and income redistribution functions in public insurance of health care and long-term care, and investigate how the burden of taxes and insurance premiums should be set in Japan.
Benefits of health care and log-term care insurance are financed by taxes and premiums.
However, differentiating functions between taxes and insurance premiums in the current system is not established clearly.
From this perspective, the establishment of premium levels based on the insurance principle and the reduction of insurance premiums using individuals as tax revenue resources, who can ill afford to bear the burden of insurance premiums, require further elucidation.
Given this functional difference, an analysis, used "The Cost of Social Security in Japan" in fiscal year 2009, estimates that if the insurance principle fully prevails, the average annual premium in health care insurance per subscriber is approximately JPY 264,000, whereas in long-term care insurance, the average annual premium per Category I insured persons who are 65 years old or over is approximately JPY 250,000. In comparison, this study indicates that the discounts on average annual premiums per insured person actually levied are 46.3% for health care insurance discounts and 59.3% for long-term care insurance.
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