摘 要 在整個的醫療過程中,資訊不完整或不對稱(Information Asymmetry)的起因在於,醫療提供者擁有被保險人及負責醫療給付的中央健保局所沒有的資訊,亦即被保險人所需之醫療服務。此一資訊不對稱的情形,提供醫療供應者一個投機的空間:在中央健保局無從證實的情況下,醫療機構可以以較高或較多的醫療提供給被保險人,以獲取健保局較高的醫療給付。甚至在被保險人無從分辨醫療的執行內容的情形下,醫療提供者以次佳的醫療內容或治療提供給被保險人,而以較昂貴的醫療內容向健保局申領給付,進而產生市場失靈的現象。這是代理理論(Agency Theory)中,典型的道德危險(Moral Hazard)問題。 每種支付制度各有其優缺點,不同的支付制度會給予醫療院所提供不同的誘因,影響醫師的醫療行為,形成不同的代理問題。因此,本研究的目的有三: (一)、本研究主要以代理理論的角度,來探討全民健保支付制度下,所產生的不同代理問題,這些代理問題對於醫療體系所產生的影響為何。 (二)、在醫療市場上,因資訊的不對稱所造成的道德危險等情形,是否因健保支付制度的改變能有所改善,亦或產生其他市場失靈的現象,影響整體醫療體系與生態。 (三)、希望藉此研究的分析與探討,促使健保支付制度臻於完善,修正市場失靈之現象,減少不必要之交易成本。
Abstract Information asymmetry often arises in medical insurance system between the medical treatment providers and the insured as well as the HIB who is responsible for the co-payment. This asymmetry renders in the opportunities of opportunistic behavior for the medical treatment providers. That is, because of the difficulties of monitoring by the HIB, the provider may not provide the right treatments that the patients would need for higher reimbursements. The case may be even worse in which the patients received inferior therapies for the lack of verification competences. Consequently, it results in market failure (also referred as “Moral Hazard”), a typical agency problem in the viewpoint of Agency Theory. The objectives of the present study are: (1)To explore the various agency problems and their impacts on the medical system in the light of the Agency Theory; (2)To explore the changes that may be induced by the introduction of different medical payments systems, that is, how would the moral hazard problem be improved or would other problems arise to the changes; (3)To search for a solution in payment system to reduce the market failure as well as the transaction cost occurred. Our study shows that each of the proposed or adopted payments has its own advantages and deficiencies in the viewpoint of Agency Theory. Providers behave to the incentives that the payments proposed.