由美國的經驗檢視我國實施自負额制度之可行方向

Deductible in Taiwan? An Experience from the United States

陳欽賢(Chin-Shyan Chen) ； 劉彩卿(Tsai-Ching Liu)

《醫務管理期刊》 2卷4期 (2001/12) Pp. 1-17

https://doi.org/10.6174/JHM2001.2(4).1

摘要

全民健康保險法第34條规定：本法實施後連續兩年如全國平均每人每年門診次数超過十二次，即應採行自负额制度。而根據中央健保局的统計資料顯示，我國民每人每年的門診次数在八十四年爲12.9次，在八十五年则爲13.8次，八十六年逹到14.5次，近年來更超過15次。因此本文的目的首先在於介绍自负额制度，其次则是鈘述美國自负额制度的實施经驗，因爲美國是實施此制的主要國家，不管是公營或私營的健康保險都採行，舉凡住院、門診的醫療服務，甚至藥劑、输血都沒有自負额，一方面從需求面抑制醫療需求的上升，同時也可以减少行政费用的支出。如果我國现行的制度仍無法長期地控制民衆不的醫療使用量，而欲實施自负额制度，则自负额的設計應慎重，可以著手先於門診實施，並區分爲一般西醫、中醫、牙醫三大類试辦以收成效，抑制不必要的門診使用。

關鍵字

自負额 ； 全民健康保險

並列摘要

According to the National Health Insurance Act Article 34: if the national average ambulatory visit exceeds twelve times per person per year for two consecutive years, the deductible system shall be adopted immediately. Indeed, data from the Bureau of National Health Insurance show that per capita ambulatory visit is above 12 in the first three years, which is 12.9, 13.8, and 14.5 in 1995-1997, resptive1y. Therefore, the purpose of this paper is to introduce the deductible system first and then to attempt to learn some experiences from the United States. We find that the United States adopts the deductible system in ambulatory visit, inpatient visit, and even prescription drugs and blood service in both public and private health insurance. If we want to adopt this system in Taiwan, we could carefully apply it to ambulatory visit first. In addition, in order to reduce unnecessary ambulatory visit more effectively, we need to apply this system to western medicine, Chinese medicine, and dental care separately.

並列關鍵字

Deductible ； National Health Insurance