以德菲法建構醫療資源配置：政策利害關係人觀點

Using the Delphi Method to Set Priorities for Health Insurance Benefit Schemes in Taiwan: A Policy Stakeholder Perspective

目標：本研究目的為從政策利害關係人觀點來建構醫療資源配置之原則與標準。方法：藉由德菲法以郵寄問卷方式，針對曾參與健保給付或支付、資源分配規劃或諮詢經驗之政府官員、醫療服務提供者、付費者代表、健保相關學者等共62專家，收集其對於醫療資源配置之看法。結果：兩回合德菲法回收44樣本，回收率70.97％，樣本68.2％為男性，年齡平均值為54.1歲，48.8％具有博士學歷，40.0％具有20年以上工作資歷。對醫療資源配置有以下5點共識：1、資源分配給「加權健康改善程度」最多的一群人，降低族群健康的不平等。2、對資源配置需考量「醫療成本效益」、「保險財務影響」、「有效性」、「公平性」、「人體健康影響」等標準。3、贊成對弱勢族群（除臨終病人及婦女外）給付加重考量。4、醫療資源配置標準重要性依序為「成本效益」、「有效性」、「公平性」及「個人負擔」。5、建立客觀可接受經濟評估閾值。結論：醫療資源配置應訂定原則與標準，及建立客觀可接受成本效益閾值，並考量弱勢族群給付加重。本研究結果可提供衛生福利部在進行醫療資源配置或給付優先順序決策之參考。

Objectives: The aim of this study was to develop the principles of and criteria for healthcare resource allocation in Taiwan from the perspective of policy stakeholders. Methods: Sixty-two experts including government officials, health professionals, healthcare providers, and public/lay representatives were selected to participate via purposive sampling. The Delphi method was used for the collection of data. Two rounds of mailed questionnaires included questions aimed at identifying the criteria used by experts to establish priorities for healthcare insurance benefits. Results: Forty-four respondents completed two rounds of the Delphi exercise for a response rate of 70.97%. Most experts recommended the following: (1) Resources should be allocated according to their effectiveness in maximizing health services and eliminating health inequalities under fixed resources. (2) The criteria for resource allocation, such as cost-effectiveness, insurance financial impact, effectiveness, fairness, and human health outcome should be considered. (3) Disadvantaged groups should be assigned greater weights. (4) The relative importance of the priorities should be cost-effectiveness, effectiveness, fairness, and personal burden. (5) There is a need to establish an objective and acceptable economic assessment threshold. Conclusions: This study provides a valuable resource to guide the allocation of resources and identify the criteria used by governments in the establishment of priorities for the provision of healthcare insurance benefits.