全民健康保險醫療費用協商制度之法規範評析

A Critique on Laws and Regulations Governing the Negotiation of Medical Costs under the National Health Insurance System

郝鳳嗚(Feng-Ming Hao)

《勞資關係論叢》 6期 (1997/06) Pp. 141-161

https://doi.org/10.29902/JCSTVS.199706.0003

摘要

我國全民健康保險擬以協商之模式，建立醫療費用總額支付制度，該制度之實施將嚴重影響健保財務、醫療品質、醫療生態與診療報酬，亦將使雇主、保險對象與醫療業者間之權利義務關係產生變動。然而，我國未曾採行醫療費用協商模式，前述關係人對於醫療費用協商制度之意義、內涵以及施行後之影響實難以確知，況且，我國協商制度之法規仍未臻健全，而有再予以修訂之必要。為此，本文從法制面釐清醫療費用協商之概念、簡介德法兩國之經驗、並評析相關法律規範。

並列摘要

The National Health Insurance System of the Republic of China is proposed to establish the global medical-cost budget system by negotiation among government authorities, the providers of medical services, and the employer and employee representatives. The budget system will create massive impacts on the financing, quality of service, as well as nature and income of medical service. It also changes the right-and-obligation legal relationship among the employers, the insured, the beneficiary, and the medical service providers. Therefore, it is essential to establish a best and acceptable budget system through negotiation among all concerned parties in the National Health Insurance System. However, as the above negotiation model has never been practiced in the ROC, its meaning, context, and impacts are difficult to envisage. On the other hand, the existing laws and regulations need to be amended in order to properly govern the negotiation model. This study thus intend to clarify the legal concept of negotiation and to examine the German and French experiences in order to propese relevant regulations governing negotiation for the ROC.