- 期刊
醫療保險市場－道德風險下管理型醫療費用控制之研究
Medical Insurance Market-A Study of Managed Care Medical Expenses Control under Moral Harzard
摘要
控制醫療費用上漲是維持一個國家醫療保障體系平穩進行的重要事項，也是各國所面臨的共同課題。如何在一個有效的機制下管理醫療成本、提供充足的就醫機會與維持良好的醫療服務品質，是所有國家目前醫療體制的考驗。在醫療保險市場中由於醫療服務的高度專業與第三方支付的特性，道德風險成為醫療費用節節上升的因素之一。美國的管理型醫療保險(Managed Care)則是一種結合醫療服務的籌資與提供的獨特方式，管理型醫療組織對醫療服務的提供方運用多種費用控制的機制，對控制醫療費用獲得實際成果。本文探討醫療市場的道德風險，認為控制醫療費用需從供需雙方著手，並介紹管理型醫療模式對醫院與醫生支付費用的方法，同時運用博奕模型說明管理型醫療與醫院的費用談判時的最大利益。
並列摘要
Controlling the rising medical expenses is am important matter to maintain the stability of a country's medical protection system. It is also a common task faced by all nations. How to manage the medical costs, provide adequate access to medical treatment and maintain good quality of medical services under an effective mechanism is challenge to the existing medical systems of all nations. In the health insurance market, because of highly specialized medical services and the nature of third party payment, moral hazard has become one of the factors causing the rising medical costs. Managed Care, origined from the US, is a unique system which combines the financing and delivery of health care. Managed care organizations utilize multiple mechanism to manage the expenses of providers of medical services and was proven to be effective. This article explores the moral hazard of health care market and found it is necessary to control medical costs from both the supply and demand sides. At same time we introduce managed care payment methodologies for hospital and physicians, also apply the game model to explore the maximum benefits during negotiation between hospital and managed care organization.