- 學位論文
指定醫師費幫助處理醫界內外婦兒四大皆空的探討
Using Balance Billing to help to solve the lacking of internal medicine, surgery, obstetrics/gynaecology, and pediatrics physicians
摘要
本研究的目的在探討我國全民健保制度，檢討現行醫療政策與醫療環境對國民健康之影響。台灣醫療馳名國際，但因醫療糾紛等醫療環境不佳以及健保給付分配的不合理，醫師從事醫療行為所負擔的責任風險與所獲得的報酬不對稱，造成目前台灣遭受到內外婦兒四大科醫師嚴重缺乏之危急處境。本文分析台灣實施全民健保後，台灣醫療環境包括對四大科給付分配不合理以及內外婦兒的醫療糾紛過多等困境，並探討國外先進國家實行差別取價及指定醫師費之現況以資借鏡。我們引入經濟學差別取價以及風險溢酬之概念，在理論上說明指定醫師費的合理性。在實務上，我們以醫師拆帳制度及VIP門診來類比指定醫師費，來說明指定醫師費之可行性。我們建議內外婦兒四大科採行指定醫師費制度後，以施行一個合理的指定醫師費制度，有助於處理醫界四大皆空的問題。
並列摘要
The purpose of this study is to investigate our national health insurance system and to investigate the health effects on citizens of current health policy and health environment. Taiwan’s medicine is famous worldwide, but the medical lawsuit with worse health environment, the unfairness of health insurance payment, and the unsymmetry of physicians’ rewards and his risk on duty cause the current dangerous situation of lacking internal medicine, surgery, obstetrics/gynaecology, and pediatrics physicians in Taiwan. This article analyzes the unreasonable payment and excessive medical lawsuits of internal medicine, surgery, obstetrics/gynaecology, and pediatrics physicians in current Taiwan medical environment, and investigate and learn the balance billing system of foreign developed counties. We introduce the economic theories of price discrimination and risk premium to explain the reasoning of balance billing. In practical, we use PPF and VIP OPD systems to mimic balance billing to explain the feasibility of balance billing. We suggest to let the four major medical department to accept balance billing system, and to solve the lacking of the four major department physician problem by the reasonable balance billing system.