國家健康保險總額預算制度之比較費用控制成效

The Effect of Global Budgets on Health Insurance Care Expenditures

何瑛(Ying Ho) ； 陳家容(Chia-Jone Chen) ； 柯成國(Chen-Guo Ker) ； 阮仲烱(Chung-Chiung Juan) ； 阮仲洲(Chung-Chou Juan) ； 黃偉堯(Wei-Yao Huang)

《福爾摩莎醫務管理雜誌》 1卷1期 (2005/06) Pp. 15-31

https://doi.org/10.6771/FJHA.200506.0015

摘要

1960年至1970年歐美各國醫療費用支出成長快速，為控制醫療費用，各國陸續進行醫療照護系統的改革，其中以總額預算制度為主要的控制手段。本文旨在探討總額預算制度的類型以及醫療照護系統的特色，並據以說明歐美主要國家醫療費用控制的成效。研究資料來自於經濟合作暨發展組織國家(OECD)網站2001年醫療統計資料。我們選擇英、法、德、荷、加等五個實施總額預算制度的國家，並以總額預算制度的五個面向，包括實施部門、政府角色、協商方式、支付型態及支付基準，與醫療照護系統的五個面向，包括醫療照護體制、醫療照護服務提供者、保險人角色、醫療照護財源以及支付制度，藉由醫療費用佔GDP的百分比與總醫療費用的增加率兩個指標來探討實施總額預算制度後醫療費用的成長趨勢。結果顯示：(1)此五個國家在實施總額預算制度後，醫療費用佔GDP的百分比呈現成長緩慢的現象；(2)此五個國家在實施總額預算制度後，總醫療費用的增加率呈現下降的趨勢。因此，施行總額預算制度可控制醫療費用的成長速度。然而，不同的醫療照護系統，總額預算制度實施的成效亦不同，醫療照護系統中具良好的轉診制度、費用來源穩定、政府適度介入，其費用控制效果較佳。然而，醫療費用的控制需從供給與需求雙管齊下，費用合理控制下需顧及民眾可近性與醫療品質。制度改革並非在短期內就可看到成效，這是需要政府、醫界以及民眾相互地配合以及不斷地改善制度缺失，才能使總額預算制度發揮最佳的效果。

關鍵字

總額預算制度 ； 醫療照護系統 ； 醫療費用 ； 支付制度

並列摘要

Faced with the growing rapidly health care expenditures during 1960-1970, most of countries used global budgets to control their health care expenditures. The aim of this study was to evaluate the effect of controlling health care expenditures of global budgets according global budget types and health care system characteristics. The data are derived from OECD Internet address-health data, 2001. In this article, we chose five countries using global budgets, including Germany, Canada, Netherlands, France and United Kingdom. We described global budget types according sector budget, government role, budget process, payment type and payment unit; health care system characteristics according health care organization, health care provider, insurer role, financing source and payment. In addition to, we used two criterions, percentage of total health expenditure/GDP and increasing rate of total health expenditure, to analyze the effect of controlling health care expenditures of global budgets. The results showed that: 1) percentages of total health expenditure/GDP of five countries grew slowly after practicing global budget; 2) increasing rates of total health expenditure of five countries declined after practicing global budgets. Therefore, global budgets may ease the growing of health care expenditure down. We found that the effect of global budgets on health care insurance care expenditures was better in the health care system with referral system, stable financing source and moderate government intervention. However, we should control health care expenditure in the aspects of supply and demand, and attend to access and quality. Reforming system is a difficult task, when government, health providers and people work together, it may be best in the effect of global budgets on health insurance care expenditures.

並列關鍵字

global budget ； health care system ； health care expenditure ； payment