管理式醫療介紹

Introduction of Managed Care

林恆慶(Herng-Ching Lin) ； 黃子芬(Zhi-Fan Huang) ； 李照軒(Zhao-Shen Lee)

《台灣公共衛生雜誌》 20卷5期 (2001/10) Pp. 331-336

https://doi.org/10.6288/TJPH2001-20-05-01

摘要

在過去二十年中，美國在健康維護組織的納保人口已從1980年時的九百萬增加到1999年時的八千一百萬，管理式醫療機構不但重新塑造了美國健康照護體系，管理式醫療也被公認為是最能控制醫療費用及確保醫療品質的利器，本文的主要目的即是要藉由管理式醫療的介紹讓醫療專業者能對其他國家的健康照護體系有更進一步的瞭解。管理式醫療不僅支配了二十世紀末期的美國健康照護體系，其原理精神也成為世界各衛生政策製定者群起傚仿之對像，例如亞洲國家中的韓國、日本、香港、及新加玻都已將管理式醫療的部份精神融入他們的衛生體系中，而臺灣目前在澎湖、蘭嶼、綠島等離島及對洗腎病患所實行的論人計酬制度也是來自管理式醫療機構用來支付醫療提供者的付費機制，管理式醫療已被許多國家做為控制醫療費用及確保醫療品質的工具。本文敘述了管理式醫療的定義、起源、及發展過程，並且探討了促進傳統保險過渡到管理式醫療的主要因素及管理式醫療對健康照護體系之影響。

關鍵字

健康維護組織 ； 管理式醫療 ； 群醫執業

並列摘要

Managed care has dominated the U.S. health delivery system since the end of 20th century.
The umber of those enrolled in Health Maintenance Organizations jumped from 9 million in 1980 to 81 million in 1999. Managed care not only reshape the health care delivery system of the United States, but is also considered as the best mechanism to contain costs and to assure quality of medical care. The purpose of this paper is to help health professionals expand their understandings of other countries’ health delivery system through the introduction of managed care. The essence of managed care has been applied by many Asian countries such as Korea, Japan, Hong Kong , and Singapore into their own health delivery systems. The Bureau of Taiwan National Health Insurance also uses the capitation payment method, one kind of managed care payment mechanism, to pay for the health care service in outlying islands, such as Penghu, Lanyu, and Green Island. The adoption of managed care has become a popular strategy for the health industry to contain costs and to assure quality of medical care. This article states the definitions, origins, and developments of managed care. It also explores the major factors which facilitate the transition from traditional fee-far-service insurance to managed care and discusses the influences of managed care on the health care delivery system.

並列關鍵字

managed care ； Health Maintenance Organizations ； group practice.