初探我國健康照護改革方案— 以促進國民健康與重視被保險人個人責任為策略

Abstract

我國實施全民健康保險制度至今已二十餘年，已有高納保率與民眾高滿意度的成果，並以低費率達成一定的國民健康照護成效而成為世界稱奇與研究的對象。可是我國的健保制度卻因醫療資源浪費嚴重加上缺乏長遠財務收支計劃以致難以永續，且制度下的國民健康照護問題更存在極大之隱憂，如慢性病盛行與使用藥物過度嚴重危害國人健康、分級醫療功能不彰以致急重症醫療瀕臨崩壞等。由此可見我全體國民雖然享有廉價又方便的健保與世界公認優良的醫療技術，但許多民眾卻處於不健康或亞健康狀態。有鑑於此，徹底改革國家健康照護制度是政府在致力推展長期照護政策之外另一個刻不容緩的議題。 本論文以探討影響我國國民健康的關鍵因素為出發點，再以文獻回顧其他先進國家之健康照護改革以及人類行為改變之相關研究理論，積極提出以促進國民健康與重視個人責任為健保永續經營之新策略，並以配套措施所需時間之不同分別訂出近、中、遠程的改革建議方案。近程方案是全面檢討現行部分負擔制度，以重視個人基本責任為經濟誘因加以有效抑制醫療浪費。中程方案是實施醫療儲蓄帳戶制度，以經濟學上使用者付費與鼓勵儲蓄之精神以改變健保為共有物悲劇的困境。遠程方案是建立醫病共管的個人健康資訊帳戶，在兼顧個人同意權與確保資訊傳遞安全原則下，各種個人健康資訊得以主動傳遞給醫療提供者與保險管理者，前者做為精準治療與進一步回饋強化民眾自我健康管理之依據，後者得以實施更有效益的資源管理措施，達成以病人為中心的整合性健康照護系統。期待以上這些初探方案能作為國家制定相關政策的參考，為國民健康盡一份心力。

Since 1995, our country has implemented the National Health Insurance as the health care system. Over the past 20 years, the system has success in the almost fully insurance coverage with high satisfaction rate, and has become a role model of other countries owing to the good performance on overall care effect at a relative low premium rate. Nevertheless, we have also gradually faced the shortages and the pitfalls of the system that needs to be reformed urgently, including the lack of sustainable financial plan and the medical resources wasting problems, the lack of health promotion strategies, and the unsuccessful referral system. Even though people enjoy the relatively cheap and convenient medical service, a group of people live in an unhealthy way, and does not meet the standard healthy life defined by the World Health Organization (WHO). A comprehensive reform of our national health care system is another urgent issue while the government make efforts on long-term care policies. After exploring the possible key factors that affect people’s health and reviewing the literatures with health care reform policies of other developed countries and the associated theories with human behavioral theory, this thesis suggests implementing the strategies regarding health promotion and personal responsibility to ensure sustainable management of the National Health Insurance System. This research also makes efforts on proposing the matching programs as the short, medium and long-term reforming policies. The short-term program is a comprehensive review of the existing co-payment system, which puts more emphasis on the personal responsibility and is supposed to effectively prevent medical resources from being wasted. The medium-term program is the implementation of the personal medical savings account system to encourage the healthy behavior of the insured, which is also compatible with the principle of user-pays and saving for the future expense. The long-term program is to establish personal health information account system supervised by both doctors and patients. Under the principles of personal consent and information security, different health information is proactively communicated to health care providers and insurance managers to offer the more precise treatment, the health improvement methods and the more efficient resource-managed policies, which will also carry out the integrated patient-centered care system through the multiple feedback mechanisms. It is expected that these preliminary programs will serve as a reference for the country to formulate relevant policies and contribute to the health promotion of insured people in the national health insurance program.