健保永續發展藍圖──健保會的運作與改革【本期企劃】 試閱
The Sustainable Development Blueprint of The National Health Insurance: The Operation and Reform of the National Health Insurance Committee
全民健康保險屬於行政院衛生福利部主管的業務，是行政權的一部分，但在組織架構上也是採取某種程度上的三權分立，由全民健康保險會（下稱健保會）負責監理，雖體現公民參與之精神，但因健保政策具有專業知識及資訊的門檻，並非所有人皆可立即掌握政策內容，故存在著專業不對稱、會議效率不彰等問題。本文係以衛生福利部108年度「從各國健康保險發展脈絡看我國全民健康保險體制與法規改革之方向及挑戰」（M08E8271）研究計畫的成果作為基礎，探討為了讓健保永續發展，健保會之運作與改革的可能藍圖。本文透過國內外相關制度的比較，並進行專家德菲法提出三種可能方案：一、維持現狀；二、擴大健保會的權責，將健保署現行負責的共擬會議併入健保會；三、健保會任務編組之修改。
National Health Insurance (NHI) is part of the executive power of the Ministry of Health and Welfare (MOHW). But it is structured according to the principle of separation of power to a certain extent. The National Health Insurance Committee (NHIC) as the legislative branch is in charge of governance. Although the NHIC embodies the spirit of citizen participation, due to the high professional threshold of the knowledge and information of health insurance policies, not everyone can fully comprehend the policy content right away. As a result, there are problems of professional asymmetry and meeting inefficiency. This article is based on the results of the research project, “The direction and challenges of the reform of Taiwan National Health Insurance’s system and laws from the perspectives of the development of the health insurances of other countries” (M08E8271), funded by the MOHW in 2019. The objective of the article is to explore the future blue prints for the innovation of the NHIC in order to facilitate the sustainable development of NHI. Through domestic and international comparative studies and the implementation of Delphi technique, the research proposes three potential paths: 1. Maintain status quo; 2. Expand the functions of NHIC to include the negotiation of reimbursement schedules of medical services and pharmaceuticals; 3. Modify the missions of the NHIC.
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