家庭医师整合型服务及其医保支付制度：台湾地区的经验与启示  

Family physician integrated health care plan and payment system in Taiwan Province

作　　者：匡莉[1] 曾益新[2] 张露文[1] 马天龙[2] 

机构地区：[1]中山大学公共卫生学院,广东广州510080 [2]中国医学科学院、北京协和医学院,北京100730

出　　处：《中国卫生政策研究》2015年第7期26-35,共10页Chinese Journal of Health Policy

基　　金：广州市医药卫生科技项目(20141A031003);CMB基金(11-075)

摘　　要：台湾地区的全民健保紧密围绕基层诊所和家庭医师核心功能,探索实践了家庭医师整合型照护计划,其以医保带动医疗服务体系整合的经验值得借鉴。本文首先从卫生筹资、医保支付制度、服务体系结构与市场化制度安排等方面,简要概括了台湾地区医疗卫生体制和基层医疗卫生服务体系概况。其次,对台湾地区"家庭医师整合型照护计划"的政策目标、组织结构、运行机制、服务模式、医保支付制度等方面进行全面介绍,对其经验进行归纳总结。最后提出,在我国卫生服务整合实践中,应以全科医生核心功能服务作为出发点和落脚点,系统设计整合服务计划,力争医疗与医保部门政策协同,提供资金资源和政策资源支撑,保障家庭医生制度和整合的卫生服务深入持续开展。Under National Health Insurance system （NHI）, Taiwan implemented ＂Family Physician Integrat- ed Health care Plan＂ by focusing on the key functions of primary medical institutions and family physicians. This plan had continuously strengthened the family physician system and the quality of integrated health care provision. Taiwan＇s achievements and experiences were valuable for China's Mainland. This paper first introduced the health sys- tem and health care provision system of primary medical institutions in Taiwan from the aspects of financing, pay- ment, health care delivery system structure, and market-capture institutions. Then, we made a comprehensive intro- duction on the policy objectives, organization structures, operation system, service schemes and health insurance pay- ment system of this plan. Finally we proposed the suggestion for integrated health care provision system in China's Mainland. It is of vital importance that government should design the integrated service provision system by focusing on the key functions of family physicians. It is also of equal significance that the health administrative departments should cooperate with health insurance administrative departments to gain sufficient policy and funding resources for the plan＇s successful implementation.

关 键 词：家庭医师 整合型服务 医疗卫生体制 支付制度 

分 类 号：R197[医药卫生—卫生事业管理]