篇名

《全民健康保險法》下的Tw-DRGs支付制度   免費試閱

並列篇名

Under the National Health Insurance Act: Tw-DRG Payment System

作者
中文摘要

診斷關聯群是保險支付方式之一,臺灣健保制度自2010年1月1日起實施第一階段共164項DRGs,2014年7月1日起再導入237項DRGs,合計401項目。預計2016年3月1日起,除早產兒等53項暫緩實施外,第三階段將再實施1262項DRGs,連同原已實施之401項,總計1716項,不料被新科朝野立法委員聯手擋下,全部暫緩實施,顯見中央健康保險署與保險醫事服務機構就此保險支付方式尚未達成共識。究竟《全民健康保險法》對於這種保險支付方式的規定為何?是否有疊床架屋、不合情理之處?但是無論法律規定如何,醫療終極目的是治療病人,並非治療病情!

英文摘要

The DRGs (Diagnosis Related Groups) system is an insurance payment method. The first phase of Taiwan DRGs (Tw-DRGs) was implemented on January 1, 2010 with 164 groups, followed by the second phase on July 1, 2014 with an additional 237 groups (total: 401 groups). The third phase had been scheduled to add 1262 more DRGs on March 1, 2016, aside from 53 groups postponed (including the group of premature babies), making an expansion to 1,716 groups. However, newly elected members of the Legislative Yuan among different political parties teamed up to stop it. This showed obviously that the NHIA and its contracted medical care institutions haven’t reached a consensus. What exactly are the rules of this payment system under National Health Insurance Act? Are they reasonable? No matter how the law sets all the rules, we should still keep in mind that the ultimate goal of medical care is to treat the patient, not the disease.

起訖頁

072-080

出版單位
DOI

10.3966/241553062016070000005  複製DOI  DOI查詢

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