台湾地区二代健保改革对大陆医保基金公平性及可持续性的启示  

Revelation of the second-generation national health care reform in Taiwan Region on the equity and sustainability of the medicare fund in China's Mainland

作　　者：陈致远[1] 蒋蓉[1] 邵蓉[1] CHEN Zhi-yuan JIANG Rong SHAO Rong(School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing Jiangsu 211198, China)

机构地区：[1]中国药科大学国际医药商学院,江苏南京211198

出　　处：《中国卫生政策研究》2017年第2期50-56,共7页Chinese Journal of Health Policy

摘　　要：本文对我国台湾地区二代全民健保的改革背景、筹资和支付机制方面的改革措施进行分析。结果发现,二代健保通过调整费率,增收补充保费,扩充筹资来源,采用多元支付方式和辅助手段控制医药费用的增长,明确给付项目及标准,新增卫生技术评估作为决策依据等手段,极大缓解了财务赤字,目前已重新实现财务平衡。其多元的筹资方式、总额控费和按病种付费相结合的支付制度和为医疗质量和医保报销项目制定的评价标准等都值得大陆地区借鉴。This paper analyzes the reform backgrounds,mechanisms and measures of financing and payment taken in the second-generation national health insurance（ NHI） in Taiwan. The results indicate that in 2ndNHI,the rate was adjusted more flexibly,supplementary insurance premium was charged to enlarge the financial source by implicating additional subsidies and expanding the sources of financing,multiple payment methods and auxiliary assistive means were used to control the growth of medical expenses,social insurance payments are specified in terms of category or clear payment projects and standards,new health technology assessments are used as new basis for decision making,etc. by greatly alleviating the financial deficit,which helped achieve the financial balance again. Many features of the 2ndNHI in Taiwan,especially like its diversified financial resources and financing methods,global budget of control fees and DRGs payment systems,making evaluation criteria for medical quality control and health insurance reimbursement project development and so on,are worth learning for the China's Mainland.

关 键 词：二代健保 量能付费 总额预付制 按病种付费 卫生技术评估 

分 类 号：R197[医药卫生—卫生事业管理]