臺灣地區醫療財源籌措的問題與對策

Health Care Financing in Taiwan: Issues and Directions

江東亮(Tung-Liang Chiang)

《中華民國公共衛生學會雜誌》 11卷1期 (1992/03) Pp. 20-31

https://doi.org/10.6288/JNPHARC1992-11-01-03

摘要

目前，臺灣地區尚有55%的人口沒有健康保險。為了進一步保障人人有公平就醫的機會，政府已經決定在1994年完成實施全民健康保險。但是，在低保險費率政策與醫療費用節節上升之下，所有現行健康保險都已面臨嚴重財務他絀的危機。低保險費率政策主要源於過度強調社會保險的福利層面、與政治利益及降低生産成本的考量；而醫療費用的節節上升則與物價上漲、醫療需求的增加、醫學進步、事後論量計酬制度，以及醫療資源的配置不當等息息相關。為了健全全民健康保險制度，本文建議未來使康保險不但應單獨設置會計制度，按精算結果釐訂保險費率，而且應實施部分負擔，管制高科技醫療給付，採取總額預算制度，以及配合醫療行政改善醫療資源總體配置效率。本文最後呼籲應建立社會連帶責任的共識，期能在醫療資源有限的時代，化衝突為建設力量。

並列摘要

At this moment approximately 55% of the total population in Taiwan are uninsured. In order to futher protect the right of citizen to health care the Government has decided to fully implement the National Health Insurance (NHI) program by 1994. However, as a result of their low premium policy and the rapid rising of health care costs all existing health insurance programs are facing serious financial deficits. The low premium policy was mainly due to an overemphasis upon the welfare dimension of social insurance, concerns for political interest and for the cost of production. The rising of health care costs was attributed to price inflation, the increase of demand for health care, the medical advancement, retrospective fee-for- service payment system, the inefficent macro-allocation of health care resources, and so on. To assure the soundness of the NHI program, I suggest that health insurance programs should not only establish their independent accounting system and adopt actuarial premium rates, but also implement cost sharing, regulate the benefit of advanced medical technology, adopt a global budgeting system, and integrate with the public administration of medical affairs to improve the efficiency of allocating health care resources. Finally, in an era of limited resources I should call for building a consensus of social solidarity so that the interest conflict be resolved into constructive power.

並列關鍵字

Health Insurance ； Health Policy