全民健保長期被視為台灣最自豪的制度之一，但只要真的離開台灣生活過一段時間，再回頭看這套制度，很多規定其實經不起推敲，甚至充滿矛盾。問題不在於健保該不該存在，而在於：這套制度在實際運作上，是否已經偏離了公平與合理的基本原則。
最讓人難以理解的，就是對「人在國外」這件事的雙重標準。制度一方面不希望國人平時不繳保費，等回台灣才來使用健保，於是設計了「入境即強制復保、不得停保」的規定。表面理由是防止制度被濫用，但實際效果卻是：不管你回台灣是不是為了工作、探親、辦事，只要入境，就必須立刻繳保費，而且之後出國也不能隨意停保。
問題來了。如果健保這麼介意國人「只在需要時才使用」，那為什麼又同時允許另一套看似補償性的制度存在？例如，國人在國外就醫後，可以回台申請部分醫療費用核退，但卻設下嚴格的申請期限與繁複條件。這兩套邏輯放在一起，其實是互相衝突的。
因為現實是，大多數人在國外會去看醫生，幾乎都是因為「不得不」。在多數國家，看門診並不像台灣這麼方便，不是臨時掛號就能解決的事。如果不是急症、明顯不舒服，很多人根本會選擇忍一忍，等回台灣再看。也就是說，真正發生在國外的醫療行為，幾乎都接近急診性質。
既然如此，那麼回台後還要限制申請期限、要求各種證明，甚至讓人實際上很難成功申請核退，這樣的制度設計到底是在補償誰？如果制度預設「國外就醫是例外狀況」，那就不該一邊強迫復保，一邊又假裝提供一條幾乎走不通的補償管道。
更矛盾的是，健保制度在這裡展現出一種很奇怪的態度：要收錢時，不管人在哪裡、回來做什麼，一律算你責任在身；但要給保障時，就開始強調時間限制、程序正義與行政規定。結果變成一種結構性的傾斜——義務是即時且強制的，權利卻是有條件、可被否決的。
這也讓人不免懷疑，所謂「國外就醫可申請核退」，是否更多只是制度上的裝飾，而不是一個真正期待被使用的保障機制。如果大多數案例在實務上都很難成功，那它存在的意義是什麼？是為了讓制度看起來比較公平，還是真的有打算讓國人用得到？
當然，制度設計不可能完美，也不可能完全防止濫用。但問題是，現在的健保制度，似乎選擇了最簡單的一條路：用強制手段確保收入，用行政門檻降低支出。這樣的做法，也許在財務上有效，卻很難說在制度正義上站得住腳。
真正合理的制度，應該是邏輯一致的。如果認定人在國外期間不應享有健保，那就應該允許清楚、合理的停保與復保機制；如果認定國外就醫是必要且不可避免的，那就應該提供真正可行的補償方式，而不是形式上的窗口。
健保不是不能檢討，也不是不能改革。真正的問題，是當一套制度只允許被歌頌，卻不允許被質疑時，它就很容易從保障，慢慢變成一種理所當然的收費機器。討論這些矛盾，不是為了否定全民健保，而是希望它至少能對得起「全民」這兩個字。
When the Logic of National Health Insurance Contradicts Itself, Can It Still Be Called “Protection”?
Taiwan’s National Health Insurance (NHI) system has long been portrayed as one of the country’s proudest achievements. But for people who have actually lived abroad for a period of time and then returned to Taiwan, many of the rules within this system start to feel deeply inconsistent. The issue is not whether NHI should exist, but whether its current design still follows basic principles of fairness and logic.
One of the most confusing aspects is how the system treats citizens who are overseas. On one hand, the government clearly does not want people to avoid paying premiums and then return to Taiwan only when they need medical care. To prevent this, it enforces mandatory re-enrollment upon entry into Taiwan and restricts the ability to suspend coverage again afterward. Regardless of the purpose of your return—work, family, paperwork—you are immediately required to pay premiums.
However, at the same time, the system claims to offer a mechanism for reimbursing medical expenses incurred overseas. In reality, this reimbursement process is bound by strict deadlines and complicated administrative requirements, making it extremely difficult to use. These two logics contradict each other.
In practice, most people seek medical care abroad only when it is unavoidable. In many countries, accessing outpatient services is not as easy or affordable as it is in Taiwan. If the situation is not urgent, people often choose to wait and see a doctor after returning to Taiwan. Therefore, overseas medical treatment is usually closer to emergency care rather than routine visits.
If that is the reality, then why impose tight reimbursement deadlines and procedural barriers that effectively discourage applications? If overseas medical care is treated as an exceptional and unavoidable circumstance, the reimbursement system should be designed to genuinely support it—not exist merely on paper.
What we see instead is an imbalance in responsibility and rights. Premium payments are enforced immediately and unconditionally, regardless of where you live or why you return. But when it comes to receiving benefits, the system suddenly emphasizes administrative rules, deadlines, and discretion. Obligations are absolute; protections are conditional.
This raises a fundamental question: Is the overseas reimbursement policy truly meant to be used, or is it simply there to make the system appear more reasonable? If most real cases fail in practice, its function becomes symbolic rather than protective.
No system is perfect, and no system can completely eliminate abuse. But Taiwan’s NHI seems to have chosen the simplest path: ensure revenue through strict enforcement while limiting payouts through procedural barriers. This approach may be financially effective, but it is difficult to justify as fair or coherent.
A truly reasonable system should be internally consistent. If people abroad are not meant to be covered, there should be a clear and fair suspension mechanism. If overseas medical care is recognized as necessary, then reimbursement should be accessible in practice, not just in theory.
Questioning these contradictions is not about denying the value of NHI. It is about asking whether a system that claims to serve “everyone” still lives up to that promise.
全民健康保険の制度が自己矛盾しているなら、それは本当に「保障」と言えるのか
台湾の全民健康保険制度は、長年にわたり国の誇りとして語られてきた。しかし、実際に海外で生活し、その後台湾に戻った経験がある人にとっては、この制度の多くの規定が非常に不合理に感じられる。問題は制度の存在そのものではなく、その運用が公平性と論理性を保っているかどうかである。
特に理解しがたいのが、海外にいる国民への扱いだ。制度は、保険料を払わずに必要な時だけ帰国して利用する行為を防ぐため、入国と同時に強制的に復保させ、再度の停保を認めない仕組みを取っている。帰国理由が仕事でも家族でも手続きでも関係なく、即座に保険料の支払い義務が発生する。
一方で、海外で医療を受けた場合、帰国後に医療費の一部を申請できる制度も存在する。しかし実際には、厳しい期限や複雑な書類要件があり、現実的に利用しづらい。この二つの制度は、根本的に矛盾している。
現実には、多くの人が海外で医療を受けるのは「やむを得ない場合」だけだ。多くの国では、台湾のように気軽に外来診療を受けられない。緊急でなければ、帰国してから診察を受ける人がほとんどである。つまり、海外での医療行為は実質的に救急医療に近い。
それにもかかわらず、厳しい申請期限や行政的障壁を設ける理由は何なのか。海外医療を例外的な必要行為と認識しているなら、制度は実際に使える形で設計されるべきである。
現在の制度は、義務と権利のバランスが著しく崩れている。支払い義務は即時かつ無条件だが、保障を受ける権利は条件付きで制限されている。
このような制度が本当に「全民」を対象とした保障と言えるのか、冷静に再考する必要がある。
국민건강보험의 제도 논리가 스스로 모순된다면, 그것을 과연 ‘보장’이라 부를 수 있을까
대만의 국민건강보험 제도는 오랫동안 국가적 자부심으로 여겨져 왔다. 그러나 실제로 해외에서 일정 기간 생활한 뒤 대만으로 돌아온 사람들에게 이 제도의 여러 규정은 논리적으로 맞지 않는 부분이 많다. 문제는 제도의 존재가 아니라, 그 운영 방식이 공정하고 일관된 논리를 가지고 있는지에 있다.
가장 이해하기 어려운 부분은 해외 체류 국민에 대한 이중적 태도다. 정부는 보험료를 내지 않다가 필요할 때만 귀국해 의료 혜택을 이용하는 것을 원치 않기 때문에, 입국과 동시에 강제적으로 보험을 복구시키고 이후 다시 중단하는 것도 제한한다. 귀국 목적과 상관없이 보험료 납부는 즉시 의무가 된다.
그러나 동시에 해외에서 진료를 받은 경우 일정 조건 하에 의료비 환급이 가능하다고 말한다. 실제로는 엄격한 신청 기한과 복잡한 절차 때문에 실질적으로 이용하기 어렵다. 이 두 가지 제도는 서로 충돌한다.
현실적으로 해외에서 병원을 찾는 경우는 대부분 불가피한 상황이다. 많은 나라에서는 외래 진료가 대만처럼 쉽지 않다. 급하지 않다면 귀국 후 진료를 받는 것이 일반적이다. 즉, 해외 진료는 대부분 응급 상황에 가깝다.
그럼에도 불구하고 환급 제도를 사실상 사용하기 어렵게 만든 이유는 무엇인가. 해외 의료가 불가피하다는 점을 인정한다면, 환급 제도 역시 실제로 작동해야 한다.
현재의 제도는 의무는 즉각적이고 강제적인 반면, 권리는 조건부이며 제한적이다. 이러한 구조가 과연 ‘국민 전체’를 위한 보장이라고 할 수 있는지 다시 생각해 볼 필요가 있다.