抄録

　アメリカの医療保障システムは,他の先進諸国と共通に医療費の膨張という問題を抱える一方で,他の先進諸国とは違って国民全体を対象とした医療保険制度がなく,21世紀に入ってからの無保険者数の急増,また医療保障の不安定層の拡大という問題も抱えている.システムの中核的役割を担ってきた雇用主提供医療保険を通じた医療保障が問題視される背景には,アメリカの産業・雇用構造の変化がある.すなわちもともと医療給付の提供率が低い,あるいは不十分な業種・職種が雇用の受け皿として拡大し,そのことが医療保障の不安定層の拡大につながっている.パートタイム雇用を含めた非正規雇用は,雇用を通じて医療保険に加入する資格が得られにくく,さらにウォルマートのように医療給付制度があっても被用者の保険料負担や高額な免責金額の設定から,必ずしも医療保険に加入できないあるいは不十分な医療保障しか受けられない被用者になりやすいといえる.

abstract

While the American health care security system has a problem of expansion of medical expenses in common with other advanced nations, it also have a problem of rapid increase in number of the uninsured or underinsured after entering in the 21st century. Employer-sponsored health insurance has played a hard-core role of the system, but is regarded as questionable; because there is change of U.S. industry and employment structure (workers in service or retail/wholesale industries and service or sales occupations that could be offered health benefits rarely or insufficiently by their employers). Contingent workers or part-time workers are hard to join own employer-sponsored health insurance. Wal-Mart Stores sponsors health insurance for their employees, but they could receive insufficient health security because their burden of premium payment or high deductible of health plans.