論美國之醫療改革與醫療財務政策

Healthcare reform and healthcare financing policy in the United States

美國總統歐巴馬先生於2010年的3月簽署了病患保護及可負擔醫療法案（Patient Protection and Affordable Care Act，PPACA），此重要改革改寫了美國的醫療保險歷史，使得數千萬尚無醫療保險的民眾也能擁有可負擔之醫療保障。本研究的主要目的在於介紹美國醫療保險改革歷史、說明病患保護及可負擔醫療法案的內容，討論美國醫療改革相關財務政策及其產生之衝擊。參考美國此次結構性的醫療改革經驗，我們認為政府可以考慮評估降低醫療支出的租稅政策、將更多的資源投注在家庭醫學科與疾病管理、推展健康生活型態，並結合支付制度改革鼓勵提升醫療品質的醫療服務。此外，我們建議未來進行醫療改革討論時，政府應詳盡評估目前二代健保相關政策的影響，在強調收支平衡的同時，也重視財務改革政策對勞動市場、經濟行為與醫療品質各層面可能產生的衝擊。

The President of the United States, Barack Obama, signed the Patient Protection and Affordable Care Act (PPACA) in March 2010. Passage of the PPACA has enabled the uninsured to purchase affordable healthcare insurance and access medical services. The main purpose of this paper was to introduce the history of American healthcare reform, explore PPACA, discuss relevant healthcare financing policies, and investigate the impact of PPACA. Learning from the USA experience, the government may consider using tax policies to curb healthcare expenditures. In addition, we suggest that the government devote more resources to primary care, disease management, and policies promoting a healthy lifestyle. Furthermore, the government can reform payment systems to pay providers based on health outcomes. Finally, we suggest that the government evaluate second-generation National Health Insurance policies thoroughly when formulating further healthcare reform proposals. In addition to achieving a balanced budget, the government should focus on the impact of healthcare financing policies on the labor market, economic behavior, and the quality of medical services.