Policy Analysis of Global Budget Program for Taiwan’s National Health Insurance:System Planning, Implementation and Performance

• Main Authors: Yu-Hsuan Chang, 張鈺旋
• Other Authors: 鄭守夏
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/6mh5t3

碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 107 === It has been nearly 24 years since the implementation of Taiwan’s National Health Insurance (NHI) in 1995. The NHI financing is mainly based on premium collection and payment system adopts the third-party reimbursement mechanism. Issues such as insufficient financing resources, pressures of improving health care efficiency and effects often be discussed when mentioning about the health insurance reform. In order to control national health expenditures from the macro level, a target or capped global budget (GB) payment system is usually adopted to deal with the problems of limited medical care resources, efficiency of resource allocation as well as enhancement of health care quality. The aforementioned mechanisms also demonstrate an obvious performance in health care expenditure containment. Taiwan refers other countries’ experiences on the design and implementation of GB system and develops its own system. By adopting a fixed GB through health care provider peer restriction and collaborative management, health care expenditures can be controlled precisely, at the meantime, to guarantee the accessibility and equality to health care services for the general public. By implementing GB as a macro mechanism to control health care expenditures, several micro payment schemes such as fee-schedule reform, capitation or case payment etc. need to be adopted to encourage the behavior change of health care providers. Viewing from the macro perspective, the implementation of GB makes the utilization of medical resources be more reasonable and the total health care expenditures be contained under a manageable scope by purchasing value-based health care services. Viewing from the micro perspective, the key issue will be how to allocate the payment to health care providers through various payment schemes. Different aspects of performances need to be assessed after the implementation of GB, such as: 1. The impact of health care expenditure containment. 2. The impact to the health care providers’ operation. 3. The impact on the health care service quality and the satisfaction of the general public towards the health care system. Though the fraud and drawbacks of health care system cannot be eliminated by implementing a single strategy like GB, it stills demonstrate its positive value on establishing a good negotiation mechanism, perspective payment budget and fee-schedule review. Major conclusions of this study are as follows: 1. The target GB achieves the objective of containing total health care expenditures. 2. The promotion strategy of GB mainly is executed by the elite group, and different sectors GB negotiation and allocation are also achieved through medical professional groups. 3. Though different sectors of GB have their problems to be solved, the philosophy for operation is consistent. 4. GB system has accomplished its periodic achievement, however, the reform of reimbursement fee-schedule need to be continued. 5. The establishment of deliberative democracy mechanism has its price to pay. 6. The implementation of GB has no impact or has slightly improvement on the utilization of medical resources and health care quality. 7. When disputes occur for district budget allocation, negotiation or the intervention of political power are common ways to solve them. Taiwan is facing aged population and increased chronic diseases, the structural allocation of GB may be further reviewed of its propriety. In addition, the design of payment incentives can be further considered of driving the change of health care model and motivating the optimal health care model in order to have a brand new idea on the reconstruction of health care system. The aforementioned issues need to be further studied.