我國民國八十三年實施全健康保險後,民眾的高滿意度已成為台灣地區最成功的施政項目之一。然而人口老化、醫療技術日新月異,醫療成本節節上升,保費收入增加有限下,使得健保財務陷入危機。因此,健保局參考了歐美的情形使用了『總額支付制度』,於是自八十年七月一日起,先行辦理牙醫門診總額支付制度,緊接著中醫門診總額支付制度、西醫基層總額支付制度、醫院總額亦陸續實施。我國總額支付制度是屬於支出上限制,因此總額支付制度實施後,健保局可以預知醫療費用的支出,從而做到財務上的控制。然而對於醫療機構來說,協商後的總額制度即是這一段時間的資源,而且總額內各醫療機構都有權利使用,而以醫院來說,九十三年七月實施了醫院卓越計劃,使得參與卓越計劃的醫院可以預知自己可運用的額度。未參與卓越計劃的醫院只能使用醫院總額內剩下之資源。因此未參與卓越計劃醫院是否會有競用資源的情形將在本論文中討論。?
Since National Health Insurance was put into practice in 1994, the high satisfaction of people has made National Health Insurance one of the most successful policies in Taiwan. Nevertheless, ageing of people, advancement of medical technologies, rising of medical cost and limited increase of premium has made financial condition of National Health Insurance in crisis. Referencing the “total amount settlement system” in advanced countries, Bureau of National Health Insurance initiated the total amount settlement system for outpatient dental service from 1 July 1998. The system for Chinese medicine outpatient service and basic western medicine followed. The system in Taiwan is expenditure maximum. Therefore, after establishment of the system, Bureau of National Health Insurance can predict medical expenditure for financial control. For medical institutions, the negotiated total amount settlement system is the resource of the period. As for hospitals, after the establishment of Excellence Project in July 2004, hospitals that participate in the project can understand the quota that they can use in advance while those that do not participate in the system can only use the resources left from the total amount of the hospitals. Consequently, whether the medical institutions that do not participate in the project will compete for the resources will be discussed in the article.