監所藥事服務費扣減案：健保藥事服務費——可以拆分來支付【學習式判解評析】 試閱
Deduction of Pharmaceutical Service Fee for Supervision Office: Medicine Service Fee of Health Insurance: Be Able to Split It up and Pay for It
全民健保醫療服務給付項目及支付標準所稱「給付項目」係針對保險對象，所稱「支付標準」係針對保險特約醫事服務機構，包括醫療機構及藥事機構（特約藥局）。支付標準中存在不少的「統包」項目，即一種支付內含多種項目，以藥事服務費（調劑）為例，其健保支付，包含處方確認、處方查核、藥品調配、核對及交付藥品、用藥指導、藥歷管理及藥品耗損、包裝、倉儲、管理等費用。再以醫師診察費為例，其健保支付，包含醫師診療、處方、護理人員服務、電子資料處理、污水及廢棄物處理及其他基本執業成本（如不計價藥材、建築與設備、醫療責任保險及水電等雜項支出）。以上藥事服務費、醫師診察費的「統包」項目繁多，究竟孰輕孰重（如藥品調配、交付藥品及用藥指導），難有一定的標準，今難得有最高行政法院依據「不完全給付」之法理作出判決，類推這些「統包」項目的權重基本相等，總算踏出第一步，期待將來有更多論述。
The “benefit items” referred to medical service payment items and payment standards in National Health Insurance Service refer to the insurance recipients, while the so-called “payment standards” refer to the insurance contracted medical service providers, including medical institutions and pharmaceutical organizations (contracted pharmacies). There are a number of “all-inclusive” items in the payment standards, that is, one payment includes a variety of items. Take the fee for pharmacy services (dispensing) as an example, its health insurance payment includes costs for prescription confirmation, prescription verification, drug dispensing, verification and delivery of drugs, medication counseling, medication history management, and costs for drug wear and tear, packaging, warehousing, and management. In the case of physician’s diagnosis fee, for example, Health Care Insurance pays for the physician’s office visits, prescriptions, nursing staff services, electronic data processing, sewage and waste disposal, and other basic practice costs (e.g., miscellaneous expenses such as non-valued pharmaceuticals, building and equipment, medical liability insurance, and utilities). There are many items in the above “turnkey” package of pharmacy service fees and physician consultation fees, and it is difficult to set a standard as to which item is more important or less (e.g., drug dispensing, delivery of drugs, and medication guidance). Today, it is rare that the Supreme Administrative Court has ruled on the basis of the legal doctrine of “incomplete performance”, and by analogizing the weights of these “turnkey” items as basically equal, which is finally the first step forward, and we look forward to more discussion in the future.
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