醫院評鑑結果與接續健保特約措施之行政行為定性【本期企劃】 試閱
The Legal Characterization of Administrative Actions Concerning Hospital Accreditation Results and Subsequent National Health Insurance Contract Measures
本文主要探討衛福部醫院評鑑結果之法律性質，及其與健保署依評鑑結果所為健保特約權利義務調整行為間之關聯。本文認為，醫院評鑑雖係衛福部基於排他且獨立之審查權限所為，然其對醫事服務機構於健保特約上之法律效果，尚待健保署後續處置之作成，應屬多階段行政處分之前階段行為。至於下稱健保署依評鑑結果所為之變更特約保險給付等級及終止特約，係直接變動醫事服務機構因健保特約所生之公法上權利義務，應定性為行政處分，而適用行政救濟程序。
This article examines the legal nature of the Ministry of Health and Welfare’s (MOHW) hospital accreditation results and the relationship between these results and the corresponding changes in the rights and obligations under the National Health Insurance (NHI) contract, as determined by the National Health Insurance Administration (NHIA). The article argues that while hospital accreditation is conducted by the MOHW based on its exclusive and independent review powers, its legal effect on NHI contracts does not materialize until the NHIA takes specific action. Therefore, the accreditation results cannot be considered administrative acts but are rather part of a multi-stage administrative process. In contrast, decisions made by the NHIA based on the accreditation results, such as changing the insurance payment level or terminating the contract, directly affect the public law rights and obligations of medical institutions and should be classified as administrative acts, subject to administrative remedy procedures.
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