台灣二代健保與中國醫療制度改革

Health Insurance Reform in Taiwan and Health Care Reform in China

張淳茜(Chun-Chien Chang) ； 何瑛(Ying Ho) ； 連守揚(Shoou-Yang Lian) ； 胡淑寶(Shu-Bauh Hu) ； 柯成國(Chen-Guo Ker) ； 阮仲炯(Chung-Chiung Juan) ； 阮仲鏗(Chung-Keng Juna) ； 阮仲洲(Chung-Chou Juan)

《福爾摩莎醫務管理雜誌》 1卷2期 (2005/12) Pp. 115-123

https://doi.org/10.6771/FJHA.200512.0115

摘要

台灣目前推動二代健保的改革，中國大陸則進行醫療制度改革，兩岸在醫療保險制度上共同面臨財務收支不平衡的問題，本文旨在探討我國的二代健保執行方向，並與中國目前之醫療制度改革進行比較。在台灣的二代健保改革，以「平衡財務」、「提升品質」、「擴大參與」為三大規劃目標，而大陸醫療制度改革著重於「打破城鄉、所有制等各種界限，建立覆蓋全民的、一體化醫療衛生體制」、「劃分醫療衛生服務的層次和範圍，實行不同的保障方式」、「建構與目標體制相適應的醫療衛生服務體系」、「全面推行醫藥分業」、「建立完善籌資與組織管理體制」。兩岸目前面臨到相同的問題是，人民對醫療衛生的需求是無止境的，而社會所能提供的醫療衛生資源則是有限的，錯誤的制度誘因設計，在台灣因論量計酬造成醫療提供者不斷的衝量，在中國則因醫院擴建而走入醫院商業化，過度競爭的結果，造成醫療資源分配不均，醫療費用高漲，且存在醫療資源浪費等問題。期望台灣的健康保險透過二代健保改革案中得到改善，在開源和節流方面有進展且顧及公平和效率。

關鍵字

二代健保 ； 醫療改革

並列摘要

The financial im-balances of health insurance is a common issue both in Taiwan and mainland. To sustain the development of the National Health Insurance system, 2(superscript nd) generation National Health Insurance (NHI) Program in Taiwan and Health Care Reform in mainland were being untaken. The purpose of this article is to investigate the implementation of 2(superscript nd) generation NHI Program in Taiwan and the comparison with Health Care Reform in mainland.
The three main goals of Taiwan's 2(superscript nd) generation NHI program are financial balances, improving healthcare quality, and expansion of medical involvement. Mainland focused the Health Care Reform on healthcare system with no boundaries between urban and suburban zones, facilitate the entry of individuals into healthcare system; establishment of healthcare system with nation-wide coverage rate and unity program, differentiate the levels and scales and implement series of health care insurances, fulfillment of separation of prescription and dispensing, and establishment of a financial recruitment and organizational management system.
The endless-satisfying needs in health care and the limited resources of health insurance are the same problems faced in two sides. Resulting from the mistaken design, the fee for service program in Taiwan seduced health care provision of redundant health care; incentive regulations in mainland have seduced hospital commercialized and in extreme competition, it ends up in unfair distribution of healthcare resources and unaffordable high cost of medical care and also problems of medical resources waste. We look forward to reshaping financing mechanisms of healthcare system fairly and efficiently to upgrade health care insurance through National Health Insurance Program in China and Taiwan.

並列關鍵字

2(superscript nd) generation National Health Insurance Program ； Health Care Reform