全民健保財務收支連動機制之研究：問題建構途徑

臺灣藉由支付制度的階段性改革與相關管控措施，賦予醫療提供者越來越高的財務風險責任，加上日新月異的醫療科技衝擊著醫療體系的供需面，而使健保給付範疇不斷擴大，面對有限的健保資源，健保政策決策者、醫療服務提供者與全民均應重新省思整體健保資源的分配與優先順序的必要性。在收支平衡概念下，二代健保在2010年1月26日通過修法，將二代健保改革焦點中「收支連動」的機制，寫入《全民健康保險法》中。本研究透過蒐集文獻資料、健保會的會議內容分析，並訪談利害關係人，以問題建構途徑釐清未能建立收支連動機制之問題。研究發現現階段運作的問題，主要包括：資訊不完整、收支資訊概念不一致、收支資訊未同時出現在關鍵決策點等問題。

關鍵字

全民健康保險政策；財務收支連動；問題建構

並列摘要

Taiwan has implemented phased reforms of its payment system and related control measures to give medical providers greater financial risk responsibilities. However, few studies have evaluated the appropriateness of health care payments and the associated decision-making processes. Particularly, the payments for universal health care have not been carefully reviewed. Rapidly advancing medical technology has had an impact on both the supply and demand sides of the medical system. Additionally, the scope of health care payments has been continuously expanding. Considering the limited number of health care resources, health care policy makers, and medical service providers, rethinking the need for allocation and prioritizing health care resources are warranted. The second-generation health insurance law passed on January 26,2010 was based on the concept of balance of payments and the linkage between revenue and expenditure to usher reforms in the health care system. Research has revealed that current problems mainly include incomplete information, inconsistent revenue and expenditure information, and revenue and expenditure information not appearing at key decision points.

並列關鍵字

National Health Insurance Policy ； Payment System and Related Control Measures ； Problem Construction Approach

參考文獻

立法院社會福利及衛生環境委員會（2013）。《我國健保醫療體系造福病患，卻造成醫護人員「五大皆空」窘境，健保在供給面與需求面該如何尋求平衡點？」公聽會》。資料檢索日期：2019 年5 月13 日。網址： https://www.slideshare.net/ROC-MOHW/20131113-46877871。