- 期刊
德國健康照護制度改革的經驗回顧
The Review of Germany Health Care Delivery System Reform
摘要
本文的目的在回顧德國健康照護制度的發展與重要改革措施，進而提出對台灣全民健康保險制度改革的建議。 回顧發現，德國健康照護體系的主要參與者為1.聯邦政府；2.州政府；3.疾病永金會聯合會（購買者）及4.保險醫師聯合會（提供者）。聯邦政府主要的任務在制定法律（社會法典），建立財務架構與規則，以確保國民健康照護的公平性，提供綜合性的健康照護；州政府主要的任務為醫院硬體設備的投資及大學的醫學教育；疾病永金會聯合會與保險醫師聯合會則透過合約提供被保險人醫療服務。另發現實施「總額預算制度」是其能控制總體醫療費用在合理範圍內的主要原因。 回顧德國健康照護制度的改革經驗可知，「競爭機制的引進及強化」是其改革重點，然其亦提醒我們健康照護制度改革是一個持續的、長期的、漸進的過程，因此，個人建議台灣全民健康保險制度的改革，現階段「支付制度改革」應優先於「健保體制改革」，引進「醫療服務供給者問的競爭機制」應優先於「保險人問的競爭機制」。
並列摘要
This article attempts to review recent development and important reforms concerning the health care delivery system in Germany. This review could provide valuable suggestions for future improvement in the operation of the National Health Insurance in Taiwan. The central (federal) government, 16 member state governments, sickness funds (purchasers of health care), and physicians' associations (providers of health care are the key actors in the German health care delivery system. The central government is responsible to set rules and frame for financing health services, and maintain comprehensiveness and equity of the system. Those state governments are responsible for hospital building, undergraduate medical education, and the supervision of physicians' associations and offices, Sickness funds have the obligation to contract with physicians' associations in providing care that meets the health needs of the population. Additionally, cost containment is found to be quite successful in the German health care system due to the implementation of global budgeting resulting from the passage of the Health Care Structure Act of 1993. Based on this review, one can find out that the mechanism of competition enhances the innovations and reforms of an existing system, on one hand; innovations and reforms of a health care delivery systems are evolved through an incremental, long-run, and continuous process, on the other. My suggestions regarding future reforms for the National Health Insurance are twofold: First, reform concerning the reimbursement would be precedent to any proposal that aimed to change current structure of the NHI. Second, building a competitive mechanism among health providers is more important than building that mechanisms among insurers.