醫療費用支付制度趨勢－論量計酬轉變為以價值為支付基礎

數十年來各國醫療費用持續不斷上漲，各國為了控制醫療費用的持續上漲，紛紛從醫療需求或供給端尋求政策介入。過去十年，美國逐步將支付照護的核心，從醫療服務的量(volume)往價值(value) 的方向前進，可負擔健保法案(Affordable Care Act, ACA) 強調以價值為基礎的照護模式，完全跳脫以服務量為基礎的支付制度，取而代之的是強調病患的照護品質(quality of care)、照護結果(outcome)、病患滿意度(patient satisfaction)、同時也包括成本(cost) 和效率(efficiency) 的考量。2015 年開始，醫療服務可及性與兒童健康保險項目再授權法案(the Medicare Access and CHIP (Child Health Insurance Program) Reauthorization Act, MACRA)廢除了醫療可維持增長率，重新啟動了醫師以價值為基礎的健康照護支付計畫，自此美國將開始逐步推動醫療支付方式的改變。臺灣自1995 年3 月1 日開始實施全民健康保險至今，支付制度對於醫療服務提供者的支付方式還是架構在論量計酬的基礎下，面對更快老化的臺灣社會，醫療界與社會大眾應該如何找到並認知屬於臺灣醫療文化的服務價值，值得所有醫療專業人員儘早達成共識後提供給健保署及相關支付單位參考，除了提供民眾高價值的醫療服務外，也能維持相對穩定的醫療保健支出，達到雙贏的局面。

關鍵字

醫療支付；服務量；價值；照護品質；照護結果；成本；效率

並列摘要

Many countries are facing the continue rising national health expenditure and searching for policy intervention from the aspects of medical needs and supplies to control the escalating health care costs. In recent years, the United States is moving gradually from volume-based payment system to quality- and value-based system. For example, the Affordable Care Act has included a specific focus on value-based models that emphasizes the quality of care, outcomes, patient satisfaction, and cost and efficiency. In 2015, the Medicare Access and Child Health Insurance Program Reauthorization Act repelled the Sustainable Growth Rate and initiated value-based payment programs for physicians. The National Health Insurance Taiwan was initiated in 1995 but still the payment is still based in volume. Facing the challenges of the growing elderly society and the progression of medical technology, health professionals in Taiwan should reach consensus on service value based on Taiwan culture as soon as possible and submit the recommendation to the National Health Insurance for their consideration. As such, the medical professionals shall continue to provide high value medical services while maintain stable medical expenditure, and reach a both-win status.

並列關鍵字

medical payment ； volume ； value ； quality of care ； outcome ； cost ； efficiency

被引用紀錄

蘇柏名、曾啟庭（2019）。居家藥事服務：高價值新思維－以服藥配合度為例。長期照護雜誌，23(2)，111-119。https://doi.org/10.6317/LTC.201910_23(2).0002

郭語蓁、譚家惠（2021）。低價值醫療：國際經驗與對台灣的啟示。台灣公共衛生雜誌，40(2)，151-165。https://doi.org/10.6288/TJPH.202104_40(2).109142

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醫療費用支付制度趨勢－論量計酬轉變為以價值為支付基礎

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