全民健保支付制度對醫療機構財務績效影響之研究-以A醫院為例

Research on the Effect of Taiwan National Health Insurance Payment System on the Medical Institutions Financial Performance–Taking A Hospital as an example

曾瀞瑤(Tseng Ching-Yao)

指導教授 ： 詹文男 ； 馮震宇

國立政治大學/商學院/經營管理碩士學程(EMBA)/碩士(2021年)

https://doi.org/10.6814/NCCU202100549

摘要

人口老化與醫療科技進步，醫療費用成長為全球性議題，非僅是台灣所面臨問題，為何醫療費用逐年成長，但反映在醫療機構的營運上確是醫務收入虧損，是醫療機構營運問題，抑或是支付制度是否也有所影響。
健康保險自1995年開辦以來26年，其中經歷了幾次宏觀的改革，健保制度的政策一直牽引著整體醫療產業的發展，進入了總額支付制度，醫療提供者在固定總額內須同時滿足民眾又兼顧醫療服務端的專業與品質，實則是巧婦難為無米之炊，要讓健保永續經營，醫療提供者也要能永續經營，才能承擔增進國民健康的任務，除了調漲健保費我們是否還有其他需要思考的，是研究主要動機。
採個案研究法，透過健保署公開資料及搜尋相關文獻等次級資料之彙整並輔與面談，期望尋找對民眾對醫院以及醫療支付者都獲利的方向。
健保支付制度與財務績效影響，在個案研究上，醫務餘絀的虧損在財務績效上反應在經營能力、獲利能力以及財務安定性都有所影響，影響財務績效還有其他非支付制度因素是醫院經營管理可再強化，但與此同時，高齡化社會，慢性病以及癌症病人增多、新科技與醫療項目擴大範圍納入健保，支出大增是必然，但在現行總額加點值控管下，健保署請客醫療機構買單的支付制度下，醫療機構經營更形困難是可預期。
建議可參考國外經驗推行論人計酬或論價值計酬，讓醫療機構自發提供有效率醫療服務，繼而降低醫療費用成長，病人也可以參與其中，民眾或病人端也應有共同承擔，降低不必要的醫療花費，將醫療財物支出風險由原本的醫療機構承擔，轉而由醫病共同承擔，提高誘因讓民眾對自己的健康負責，改變不健康的生活型態，因此減少就醫頻率與需求。
支付制度對醫療費用、醫療服務效率、醫療品質、醫療資源之分布及行政效率皆有很大的影響。好的支付制度不但能控制費用成長於合理之範圍，更可進一步影響醫療服務提供者之服務效率。

關鍵字

總額支付制度 ； 財務績效

並列摘要

With the aging population and the advancement of medical technology, the growth of medical expenses has become a global issue. It is not only a problem faced by Taiwan. Why does medical expenses grow getting increase, but it is not reflect on the medical institutions profit. Is it a medical institution operation problem? or Is the payment system also affected.
Since 1995,health insurance has undergone several macro reforms. The policies of the health insurance system have been leading the development of the overall medical industry. It has entered a Global Budget payment system. Medical providers must satisfy the patients with high quality service and the government within a fixed budget.in fact, it is difficult.
Medical providers must also be able to sustainably operate in order to undertake the task of improving national health. Besides raising the health insurance fee, do we have anything else? What needs to be considered is the main motivation for the study.
Adopting a case study method, through the secondary information such as the public information of the National Health Insurance Agency and searching related documents, and supplemented with interviews, we hope to find a direction that will benefit the people, the hospital and the medical payers.
The health insurance payment system and the impact of financial performance. In the case study, medical profit loss in financial performance reflects the impact of operating ability, profitability and financial stability. There are other non-payment system factors that affect financial performance. Hospital operation and management can be strengthened, but at the same time, with an aging society, chronic diseases and cancer patients are increasing, new technologies and medical items are expanded to include health insurance, a large increase in expenditure is inevitable, but the National Health Insurance Agency treats medical institutions with a value added to the current total. Under the pay-for-payment system, it is expected that medical institutions will become more difficult to operate.
It is recommended to refer to foreign experience to implement remuneration based on people or remuneration based on value, so that medical institutions can spontaneously provide efficient medical services, and then reduce the growth of medical expenses. Patients can also participate in it, and the public or patients should also share the burden to reduce unnecessary The cost of medical expenses, the risk of medical property expenditure is borne by the original medical institution, and the medical and disease are shared, increasing the incentives to make the public take responsibility for their health, changing the unhealthy lifestyle, and reducing the frequency and demand for medical treatment
The payment system has a great impact on medical expenses, medical service efficiency, medical quality, distribution of medical resources, and administrative efficiency. A good payment system can not only control the growth of expenses within a reasonable range, but also further affect the service efficiency of medical service providers.

並列關鍵字

Global Budget payment system ； Financial performance

參考文獻

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