醫院總額支付制度之協商機制－新制度主義觀點

Negotiation Mechanism under Global Budgeting-A New Institutionalism Perspective

陳建立(Chien-Li Chen)

《醫務管理期刊》 6卷1期 (2005/03) Pp. 94-110

https://doi.org/10.6174/JHM2005.6(1).94

摘要

總額支付制度為健保法所明訂實施的前瞻性支付制度，我國自民國84年3月實施全民健保，如何制訂公平與有效率的醫院總額分配機制，以促進醫療費用總額與分配之合理化，提升專業自主性及尊嚴，是保險人與醫療服務提供者追求的目標。晚近新制度主義興起，使學者致力於探究在制度的限制下，制度對行動者及行動者間的互動影響。本研究採用新制度經濟學的研究途徑，探討總額支付制度實施以來，有關總額簡單上路、漸進改革的推動策略，制度變遷依循著路徑依賴的軌跡，在支付基準與支付標準基本架構並未改變下，總額協商機制開啟了政策之窗，讓醫療團體能夠共同參與遊戲規則的制定，新制度經濟學強調的交易成本、代理理論以及資訊權力等，則用來解釋總額支付制度的某些現象及現行協商制度運作上的限制，並藉新制度主義之理論觀點提出建議，讓未來的總額支付制度，能更加的順遂推行，共同研議可行的制度，以維護國民的健康。

關鍵字

總額支付制度 ； 新制度主義 ； 交易成本 ； 代理理論

並列摘要

Hospital global budget system is a perspective payment system promulgated by the National Health Insurance Act. How to enact an allocation mechanism with equity and efficiency to improve total healthcare expenditure and medical payment coordinated and allocated reasonably as well as to advance both professional autonomy and esteem are what the insurers and healthcare providers pursue for. The recently burgeoning school of the new institutionalism enables researchers to investigate the effect of interaction between actors under the constraint of institutions. This study adopted the new institutionalism economics approach to investigate the performance of global budget system, particularly regarding the issues of the practicing of simplified global budget system, incremental revolution of implementing strategy and the path dependence of the institutional change. Without any change of the basic framework of payment system and fee schedule for medical services, the setting up of negotiation mechanism opens the policy windows which permit the healthcare groups involving themselves in the formulation of the rules of the game. We apply some notable theories of the new institutionalism economics such as transaction costs analysis, agency theory and theory of information power to explain some of the phenomenon of global budget system and examine the operating constraint of the present negotiation mechanism. Finally, from the new institutionalism perspective, we propose some possible ways to improve the global budget system, which eventually a more established system will hopefully be achieved and therefore be more capable of taking care of the health of the general public.

並列關鍵字

Hospital Global Budget System ； New Institutionalism ； Transaction Costs Analysis ； Agency Theory

參考文獻

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