就業形態の多様化と個人参加の社会保険 : 医療保険改革のあり方

概要

論文の詳細を見る
Social insurance originally started as a system for the protection of the employed and gradually expanded to include the self-employed and rural population. In Japan a nation-wide coverage of medical care and pension insurance for all was attained in 1961. Since then, social insurance schemes have grown as more and more people have become employees throughout the period of economic growth. But lately the tendency has reversed and many female adults came to join the labour market as low-paid part-timer workers. As they try to maintain the status of dependant of their husbands' insurance schemes by managing their income below the threshold, they do not contribute to the cost of social insurance. The aim of this paper is to show that a standard contribution principle can be applied to employee schemes, as well as self-employed schemes and to present a fair mechanism for allocating resources to all the schemes, according to the standard benefit cost of each. The proposed system of total risk adjustment for health insurance schemes can be an alternative to the much debated health insurance reforms for the elderly.