The Effects of NHI Capitation Payment System Investigate

• Main Authors: WANG, PAO-HUA, 王寶華
• Other Authors: Wei, Ching-Chun
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/42643954045222100348

碩士 === 靜宜大學 === 管理碩士在職專班 === 102 === Since 2011, Bureau of National Health Insurance has promoted the capitation pilot program. The income of medical institutions has been transformed into Capitation payment instead of fee for service. In this case, there have three kinds of pilot models and each of them has own executive medical teams. In this study, we use the case studies and comparative study that of medical institutions, the changes of executive and management model, in response to this change in the payment system.；And compare these three pilot models to find out which one is the optimum executive model. In the future, the optimum one can be the suggestion model in the capitation payment system. The results are list as below： The first is the high financial risk of the medical institutions capitation payment system in Taiwan does not restrict patients choose medical establishments they want and does not set a mechanism to exclude the extreme case. Although patients right is not be effect, but that will cause uncontrollable in medical sources and many unpredictable factors. The second is that in order to reduce medical use and increase efficiency of medical resource using, the medical institutions must be strengthened to build information systems, to enhance case management, to promote community health and make medical care team reach vertical and horizontal integration to achieve decreasing the medical resource repeat waste. The third, for short-term benefit viewpoint, it is easy for medical institutions to monitor the medical situations of insured and control the medical use via implementing the hospital of patient loyalty model. However, for long-term policy, it should be regional integration model via combining family responsibilities, MD. The aim is to decrease the medical cost by early detection and prevent diseases through the medical team go into communities to give promotion and health Education, such as the health life method, cancer prevention screening and preventive medicine.