全民健保財務收支連動機制之研究：問題建構途徑

Linkage Mechanism of Financial Revenue and National Health Insurance Expenditure: A Problem Construction Approach

臺灣藉由支付制度的階段性改革與相關管控措施，賦予醫療提供者 越來越高的財務風險責任，加上日新月異的醫療科技衝擊著醫療體系的 供需面，而使健保給付範疇不斷擴大，面對有限的健保資源，健保政策 決策者、醫療服務提供者與全民均應重新省思整體健保資源的分配與優 先順序的必要性。在收支平衡概念下，二代健保在 2010 年1 月26 日通 過修法，將二代健保改革焦點中「收支連動」的機制，寫入《全民健康 保險法》中。本研究透過蒐集文獻資料、健保會的會議內容分析，並訪 談利害關係人，以問題建構途徑釐清未能建立收支連動機制之問題。研 究發現現階段運作的問題，主要包括：資訊不完整、收支資訊概念不一 致、收支資訊未同時出現在關鍵決策點等問題。

Taiwan has implemented phased reforms of its payment system and related control measures to give medical providers greater financial risk responsibilities. However, few studies have evaluated the appropriateness of health care payments and the associated decision-making processes. Particularly, the payments for universal health care have not been carefully reviewed. Rapidly advancing medical technology has had an impact on both the supply and demand sides of the medical system. Additionally, the scope of health care payments has been continuously expanding. Considering the limited number of health care resources, health care policy makers, and medical service providers, rethinking the need for allocation and prioritizing health care resources are warranted. The second-generation health insurance law passed on January 26,2010 was based on the concept of balance of payments and the linkage between revenue and expenditure to usher reforms in the health care system. Research has revealed that current problems mainly include incomplete information, inconsistent revenue and expenditure information, and revenue and expenditure information not appearing at key decision points.