由英國經驗探討台灣的醫療資源配給

The Rationing of Healthcare Resources in the UK and Its Implications on Taiwan

本文擬由英國的經驗來探討台灣的醫療資源配給問題，期能藉此對台灣現階段的資源配給議題提出具體的建議。本文所指的英國經驗，包括英國政府或民間所實施的實務經驗，以及英國本土學者所進行的理念論戰，因為實務與理論對於台灣的具體政策建議具有同等重要性。本文分為四個段落，第一個段落先就名詞作界定，並陳述資源配給的層級與型式，以作為討論的基礎。第二段探討資源配給的若干原則，包括以需要為基礎的效率、公平和可行性三個原則的取捨，區分決策層級的配給原則，以及說明配給過程中應由資訊亦或機構取得優先地位的爭論。第三段介紹英國在過去與近年來的醫療資源配給經驗，以及英國對於醫療資源地理分布的策略內容。第四段則陳述本文對英國在理念論戰與實務經驗兩方面對台灣全民健保的啟示。

This article aims to explore the experience of rationing of healthcare resources in the UK, and its implications for the healthcare system reform in Taiwan. The UK experience of rationing mentioned in this article includes the practical policy or clinical issues faced by the UK government, as well as the theoretical or conceptual debates among researchers in the UK. It is revealed that the practical and theoretical issues have equivalent impact on the policy implications for healthcare rationing in Taiwan. Four sections are presented. The first describes the definition of rationing, and its levels and types, as the basis of further discussion in this study. The second takes some of the more well-known rationing principles and assesses their merits using three basic criteria: equity, efficiency and practicality. It is also mentioned of how rationing may take place at different levels, and the argument about the priorities of information and institutions. The third section introduces the practical policy experience of rationing in the UK, and the weighted capitation formula for geographical areas. The last section reveals the policy implication for the healthcare reform in Taiwan.