台灣健康照護制度改革的理論面探討：代理人與效率

A Theoretical Discourse on Healthcare Reform in Taiwan: Agency Theory and Efficiency

李卓倫(Jwo-Leun Lee)

《台灣公共衛生雜誌》 25卷5期 (2006/10) Pp. 340-350

https://doi.org/10.6288/TJPH2006-25-05-03

摘要

本文的主旨在探討臺灣健康照護體系改革如何達成效率的理論基礎和制度設計，以論述及文獻回顧把制度設計建立在理論的合理性之上，並強調社會制度與人類行為動機假設兩者的緊密聯結。本文首先討論健康照護的本質，包括其基本特質、從屬特質及其政策意涵。第二節討論醫療體系設計的人類行為動機假設，第三節與第四節討論效率的人性面定義與制度面設計，其中人性面定義是為質量與價格的權衡，接著再討論何種制度設計可以引發這種有效率的行為。第五節為本文推論對台灣總額預算制度所提出的建議與結論。本文的討論指出以消費者或病患為出發點來設計醫療體系的思考邏輯，有必要轉變為以代理人關係作為制度設計的基礎。有效率的選擇來自於花費與品質數量之間的權衡，好的代理人制度應該可以確保由醫師來代理病患作這樣的權衡，亦即有效率的選擇來自醫師在既想節省費用又想提高品質數量兩者的衝突下所做的權衡。

關鍵字

健康照護體系改革 ； 效率 ； 代理人關係

並列摘要

Herein we have described the theoretical background regarding efficiency and healthcare reform. Literature review and discourse are used, with a specific focus on the connection between healthcare system design and assumptions pertaining to human traits and behavior motivation. Five sections are presented: 1) the intrinsic characteristics of healthcare, 2) the consumers' utility, 3) the definition of efficiency from a psychosocial perspective, 4) the agency relationship, and 5) suggestions for Taiwan's healthcare reform. Three intrinsic characteristics are described, the fundamental triad from which all other listed characteristics can be derived, either as variants or as resulting social responses. Healthcare, as that set of goods and services which patients use solely or primarily because of the anticipated impact on their health status, is then defined. In so doing, the concept of efficiency as a trade-off between quality/quantity and expenditures, which would be the most relevant perspective for designing and reforming a healthcare system, is delineated. Finally, the agency theory is discussed and suggested for healthcare reform in Taiwan. The national cap system and the primary healthcare fund holder, paid by a capitation base, are also discussed in the final section.

並列關鍵字

Health Care Reform ； Efficiency ； Agency Relationship