日本醫療費用控制方案

The Cost Containment of Medical Care in Japan

我國全民健康保險於八十四年三月實施迄今，在消除磺醫障礙，提供健康保障的政策目標上，已獲初步的成果。自健保開辦後，在保險費率不調整的前提下，收入面的成長有限，欲藉由開源以平衡財務收支，現階段有其困難存在。有鑑於此，衛生署及健保局無不致力於研擬各項醫療費用節制的對策，其中，即欲透過其他已開發國家的經驗提供我國借鏡。本文除了解日本有哪些管控醫療費用措施外，亦針對我國目前遭遇的問題如藥費成長等深入了解日本在此方面的管控。本文之目的即是要介紹日本如何在不影響國民的健康水準下亦能控制醫療費用成長，希望能作為我國制定醫療費用節制措施的參考。日本所採行的醫療費用控制方案包括支付標準／藥價基準調整、部分負擔制度設計、長期照護服務及保險、住院部分支付基準設計、高科技醫療及醫療資源控制等，採漸進式改革，亦即在現有論量計酬支付制度下作逐步調整，故近期內未有隨世界趨勢朝向總額支付制度之規劃。雖與我國規劃欲自2002年全面朝向總額支付制度之改革方向，其實不盡相同，但仍有可做為我國借鏡之事項，尤以藥價基準合理範圍及藥品分類群族支付、支付標準價格調控及長期照護保險設計。

The National Health Insurance Initiated in 1995 has removed the barriers to medical care for citizens and increased the total coverage rate. However, it is difficult for the Bureau of National Health（BNHI）to contain medical costs because it is politically unfeasible to raise the premium rates. Thus, the BNHI has struggled to find ways to contain costs while maintaining quality of care. The purposes of this paper are to introduce how the medical costs are controlled in Japan and to propose the possible suggestions for the BNHI to contain escalating medical costs. The mechanisms for cost containment adopted by Japan include payment standard/drug unit adjustment, co-payment, long-term care service and insurance, control of high technology and medical resources. The revolution of health delivery system is gradual on the basis of fee-for-service payment system in Japan. Although the direction of revolution in Japan is different from the National Health Insurance, which plans to implement the global budget system from the year of 2002, the BNHI can learn the mechanisms applied by Japan to control medical costs.