1991年11月

對經建會「全民健康保除制度規劃」的評估
An Assessment on the NHI Plan Proposed by CEPD, Executive Yuan

研究論文 Research Article

覃怡輝
Tom Yee-huei Chin

137-196

「全民健康保險」是我國目前在醫療政策上，正在推行的一項重大改革，其良窳得失，將直接關係著全體國民的福祉，深爲大家所關切。基本上，政府可透過救助、保險和津貼等三種基本方式，而介入醫療服務的提供。這三種方式各有所長，亦各有所短，因此不可能只採行其中的某種方式，就能完滿解決全部的問題。規劃報告雖宣稱只採行「保險制」的政策，但在實際上，其中還是要加入了救助和津貼的成分，以解決低收入戶和榮民的問題。接著，即使在已決定採行保險政策的前提下，爲實現國家醫療政策的目標，經建會針對保險對象、保險給付、部分負搪丶保險財務丶支付制度丶保險體制、醫療機構的特約和體系等項目，都提出了原則性的規劃，筆者都一一提出其可能遭遇的問題，並儘量提出因應的對策，以防範問題於未然。

The implementation of National Health Insurance (NHI) is a major reform in the health policy in the Republic of China on Taiwan. The performance of this reform will directly and greatly influence the well­being of the people. In principle, the public provision of health services may be made through the forms of social assistance, social insurance and universal allowance. There are different merits and shortcomings for dif­ferent provisions, so it is impossible to apply a single provision to solve all problems of health services. Though only the policy of social insurance is adopted by the NHI Plan, actually the methods of social assistance and universal allowance are also applied to remove the financial barrier of low income families and veterans. In order to achieve the long run aims of national health policy through the provision of social insurance, CEPD pursues this plan with the aspects of insurance cover, insurance benefits, cost-sharing, insurance financing, payment system, insurance system, and the contracting and system of medical institutions. The au­thor points out all possible problems and raises the coresponding policy to tackle these problems in advance.

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