The Evolution and Future Directions for Provider Payment in Taiwan

台灣醫療支付制度沿革與未來改革方向

葉壽山(Shou-Shan Yeh) ； 楊志良(Chih-Lian Yaung)

《醫護科技學刊》 2卷1期 (2000/01) Pp. 65-81

https://doi.org/10.6563/TJHS.2000.2(1).5

摘要

本文主要描述台灣的醫療支付制度變遷及不同支付制度下醫療市場的改變及因應，1995年全民健保實施，降低就醫財務障礙，民眾在就醫可近性大幅提昇後，衍生醫療費用上漲。
探究目前支付制度仍沿襲勞保時代論量計酬之支付標準，致使在資訊不對等下給予醫療提供者創造收入需求的空間整體醫療費用支出亦產生結構上的扭曲，不僅門診住院醫療費用支出差距過大且造成科別發展失衡。
因此未來若能擴大實施論病例計酬或採論人計酬及總額預算的支付方式，將可加強醫療提供者財務管理責任及促進醫療資訊透明化使醫療支付標準更加合理化，而醫療品質亦能獲得適當提昇。

關鍵字

支付制度 ； 論量計酬 ； 全民健保 ； 論人計酬

並列摘要

This paper deals primarily with the changes in Taiwan's health care in response to changes in the medical reimbursement programs in three different periods. Initially, the inauguration of National Health Insurance (NHI) reduced the waiting list for medical services. Although medical accessibility has been improved to a great extent, there will be an increase of medical expenses. The current reimbursement program continues to employ the fee-for-service program, which was adopted for Laborer's Insurance, thus created health care providers opportunities for increasing their earnings under the conditions of unequal information flow. Medical expenses in Taiwan do not reflect the actual costs of medical services, and there is a great discrepancy between expenses for outpatient and inpatient services. There is also an imbalance in the development of medical departments. Therefore、if it is possible to extend the coverage of the case payment program or adopt reimbursement programs such as capitation payment or total global budget in the future, it may increase the financial management responsibility of health care providers and promote the transparency of medical information, In this way, it will be possible to improve the quality of health care while increasing their financial responsibility.

並列關鍵字

provider payment ； Fee-for service ； National health insurance ； Capitation