掙脫全民健保總額制度枷鎖 ── 醫院自費市場選擇

Struggle Against Global Budget System Restrictions of National Health Insurance—Hospital Choice of Self-Pays for Healthcare Market

王亮堯

指導教授 ： 黎正中

國立清華大學/科技管理學院/經營管理碩士在職專班/碩士(2014年)

https://doi.org/10.6843/NTHU.2014.00464

摘要

本研究為探索台灣自民國84年全民健康保險制度實施至今，中央健康保險署為控制逐年上升的醫療總支出，實施一連串的管控制度。目前採用的是總額管控制度，亦即醫院年度醫療總費用若超出中央健康保險署所給予的額度，需自行吸收超出部分，導致醫院執行了部分醫療服務，卻無法申請費用，面臨獲利率下降的危機。
在開源的考量下，近年來醫療院所朝開發高級健康檢查與醫學美容等自費醫療市場。而醫療自費市場的客群有限，因屬非必要之醫療，易受景氣影響。
目前政府逐漸重視社會邁入高齡化的現實，體認到老年人口的照護是社會關注、重視的議題。分階段推出政策，最終將實施長期照護保險法，採全體國民強制納保之方式，以實現老有所終之理想境界。
醫院擁有的醫療照護專業，可向下延伸至長期照護階段，以突破全民健保管控制度目前造成的困境，再開發自費市場，提高獲益、改善經營體質，並讓護理之家住民獲得有醫院專業之醫療人員所提供之整合照護醫療服務。

關鍵字

總額制度 ； 自費市場 ； 長期照顧保險法 ； 一般護理之家

並列摘要

National health insurance took effect since 1995 in Taiwan and the medicine expense increased year by year. This study is to discover a series of manage strategies under controlling overall national medicine expense by national health insurance administration. Global budget system is the only one to put into practice, and that means hospitals may face the crisis of profits descending because hospitals might not gain enough government subsidy if hospitals’ yearly medicine expense exceed the quota which is made from national health insurance administration.
Hence, self-pays services of high-quality health check and aesthetic medicine are developed and considered in the most hospitals. However, medical self-pays services is not necessary and it depends on limited market and economy status.
Taiwan government highly respected on aging society in the present, and comprehended about caring of aging population is a valuable issue. With policies in the different stages, long-term healthcare insurance will be presented ideally in the end.
Hospital is a professional organization with medicine/nurse care with exploring self-pays market, rising profits, and developing manage strategies, long-term healthcare is a considerable strategy to struggle against global budget system restrictions of national health insurance.

並列關鍵字

global budget system ； healthcare self-pays market ； long-term healthcare insurance ； elderly nusing care

參考文獻

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