收容人健保醫療制度與推行成效之探討

The Study on the Health Care System of National Health Insurance for Inmates and Its Implementation Effect

我國收容人健保醫療制度之設計，就國家責任、收容人醫療權、就醫選擇自由及診療環境等部分，均與新加坡等12個先進國家一致，然醫療提供機制我國則係最多元。固然收容人仍需依健保法規定繳納自行負擔費用，此一規定雖與一般民眾相同，但與其他國家採全部公費方式提供收容人醫療有所不同，惟依看診人次統計結果觀之，亦有避免浪費健保醫療資源之效果。收容人於2013年納保後，健保醫療順利引進矯正機關，並成為收容人醫療主要來源。分析2013年醫療利用資料發現，收容人於機關內診治人數大幅減少33.57%，但相較於2012年公醫診次，2013年健保診次共增加19.14%。每診平均就醫人次從2012年的50.08人次下降至2013年的28.63人次。2013年以後，機關內診治的門診科別雖仍以家醫科為主，但牙科、內科、外科、皮膚科、精神科及眼科等科別均增加，更符合收容人醫療需求。惟戒護外醫人數亦大幅成長，使得矯正機關戒護人力負擔沉重。經調查2013年10月24日2,926名全部之就醫收容人後發現，收容人對2013年健保醫療的滿意度，在診療環境、提帶看病流程、醫師專業能力、醫護人員服務態度、自費金額說明及整體醫療服務感受等6個項目，均顯著優於2012年的公醫，但在醫師說明病情、病情改善及外醫等候時間等3個項目，則維持2012年公醫時的水準。收容人納保後，其整體醫療品質確有提昇，但未來應再加強機關內診治之醫療設施與專科門診，或與醫療院所協調更有效率之外醫機制，俾利兼顧收容人醫療需求與矯正機關人力負擔。 The design of the health care system of National Health Insurance for inmates in our country is consistent with the designs of health care systems of 12 developed countries in terms of national responsibility, inmates' right to medical care, freedom of choice for medical care, and health care environment, and the provision of medical care in our country is the most diverse. The inmates still need to pay part of the medical fee according to the principle of user pay and the relevant regulations in National Health Insurance Act. Although this is the same with the citizens who utilize health care system in our country, it is different from the solution of other countries, in which the government pays all medical fees of inmates. We can also observe from the statistical result of the number of people who went to doctors and find out that our solution has the effect of preventing the waste of medical resources provided by National Health Insurance. After inmates joined National Health Insurance in 2013, National Health Insurance was thus successfully introduced into correction agencies, and it has become the main source of the fee of medical care for inmates. The data of medical care utilization of 2013 was analyzed, and the results show that the number of inmates who received medical care in the agencies significantly reduced by 33.57%. However, comparing the number of inmates who applied and received medical care in public medical sectors outside the correction agencies in 2013 with the number in 2012, the number increased by 19.14%. The average number of inmates who receive medical care in each sector dropped from 50.08 persons in 2012 to 28.63 persons in 2013. After the year of 2013, general practice has still been the main branch of the branches of medical care provided in the agencies, but the branches of dentistry, internal medicine, surgery, dermatology, psychiatry and ophthalmology have been increased to meet the medical needs of the inmates. Yet the number of inmates who applied to receive medical care outside the agencies with guards also significantly grew, forming the human resource burden of correction agencies. The satisfaction degrees of inmates toward health care system of National Health Insurance in 2013 were all higher than the satisfaction degrees toward public medical care in 2012 in the aspects of health care environment, the procedure of being drawn and taken to the doctors, professional skills of doctors, the service attitude of medical personnel, the description for self-pay fee and overall feeling for medical service received, but the satisfaction degrees toward description of disease, disease improvement and waiting time for receiving medical care outside the agencies in 2013 were about the same with the ones in 2012. After inmates joined National Health Insurance, the overall quality of health care for them has been actually improved. However, the medical facilities and sectors of specific branches of medicine in the agencies should be further enhanced in the future, or the agencies should coordinate with hospitals and clinics for a more efficient procedure for inmates to receive medical care outside the agencies in order to meet the needs of inmates for medical care and to relief the human resource burden of correction agencies.