實行全民健保不應以醫學中心為犧牲

Should the Establishment of a Stratified Patient Care System be at the Cost of Graduate Medical Education？A Review on Some Aspects of the National Health insurance plan

立法院最近通過之全民健康保險法以”分級轉診”，”越級就醫加重自行負擔”，及”同工同酬”來規範病人就醫行為，但未同時設計使教學醫院維持正常教學，保障繼續提供優良醫師及醫事人員之制度，使全國教學醫院，尤其是做為火車頭帶動醫療進步之醫學中心醫院陷入與一般醫院從事市井競爭，全力招攬病人才能生之境地，對於社會整體福祉恐有妨礙。醫學中心有其固有任務，其財政應由保險機構及政府合理安排，使其適度地免於與不同性質的醫院作市場競爭，才是全民之福。保險給予醫院之教研費用應根據醫院教學功能儒成效定其差距，像勞工保險行之數年，不分醫院大小，一律給予3％”一刀切”式的償付辦法絕非妥善。

The lately enacted national health insurance plan by the Legislation Yuan imposes a de facto compulsory patient transfer scheme, or a stratiffied patient care system on the Nation’s health care market.　Walking－in patients at the medical center Hospitals will be obliged to shoulder an extra 50％ self－payment rate which is one and a half higher than they go to a clinic （20％）. The medical center will possibly be forced to go to the mall to compet with the medium or small size hospitals just for surviving. The Insurance Plan as well as the government neglected to arrange a compatiable module at the same time to immunize the centers from those competition so that their teaching functions can be maintained. The imappropriate 3% reimbursement rate system of the labor’s insurance plan (will soon passthrough into national health insurance plan agency) gives an example that the authorities have long ignored the sophistication of the graduate medical education in the era of national health insurance.