醫院評鑑、健保合約與支付制度的糾葛【本期企劃】 試閱
Disputes on the Evaluation of Hospital, the Contract of National Health Insurance and the Payment System
醫療法中分別有醫院評鑑與教學醫院評鑑的規定。我國醫院評鑑則肇始於1978年教育部會同行政院衛生署主辦之「教學醫院」評鑑，但是遲至1986年版的醫療法才規定中央主管機關「得視需要」辦理「醫院評鑑」，衛生署則於1999年將醫院評鑑委託給「財團法人醫院評鑑暨醫療品質策進會」（簡稱醫策會）辦理。全民健康保險實施後，除在母法中規定「醫療服務給付項目及支付標準之訂定，應以相對點數反應各項服務成本及以同病、同品質同酬為原則」，更於「全民健康保險法施行細則」中明定所稱地區醫院、區域醫院及醫學中心，由「主管機關辦理醫院評鑑評定之」，從此不同層級醫院有不同「支付標準」的點數。除醫院形象品牌、招收醫師等外觀因素外，健保實質收入的多寡才是各家醫院爭取評鑑升級的重點。
Evaluating hospitals and teaching hospitals are regulated according to the Medical Care Act. The evaluation of hospitals could be traced back to the evaluation of the teaching hospital in 1978 which was held by Ministry of Education in cooperation with the Department of Health of Executive Yuan. However, it was not until the Medical Care Act in 1986, according to which the central competent authority was required to conduct hospital evaluation “as needed,” and in 1999, the Department of Health entrusted hospital evaluation to the Joint Commission of Taiwan. After the implementation of the National Health Insurance, in addition to stipulating in the general law that “the fee schedule and reference list of medical services described in the preceding paragraph shall follow the principle of ‘equal payment for same nature of illness’ and the relative points shall reflect the cost of each medical service.” The so-called district hospitals, regional hospitals and medical centers according to the Enforcement Rules of the National Health Insurance Act should be “evaluated and designated by hospital accreditation conducted by the competent authority”, so that hospitals of different tiers will have different points of the “standard of payment”. In addition to external factors such as hospital image and branding, and recruitment of physicians, the amount of actual revenue from health insurance is the focus of each hospital’s bid for accreditation and upgrading.
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