健保重複用藥與費用核扣問題【本期企劃】 試閱
Disputes on Health Insurance Payment Deduction for Medication Duplication
重複用藥問題不僅影響病人安全,也同時造成健保資源的浪費,健保署為此於2011年起定期統計「用藥重疊率指標」,以便醫療院所進行自我管理;於2013年再開發「健保雲端藥歷系統」,供醫事人員即時掌握病人完整用藥資訊;至2015年7月起則開啟分階段實施門診特定藥品重複用藥之「費用核扣」與「費用管理」等方案。然而,健保署近十餘年來,藉由該等方案實施費用管理及核扣健保給付藥品,其所為業已超越藥品管理主管機關的權限,究竟有何依據及影響,是為本文討論主題。
Drug Duplication affects patients’ safety and leads to a waste of health insurance resources. National Health Insurance (NHI) has regularly compiled the “Rate Indicator for Drug Duplication” since 2011 to ensure that medical institutions can manage resources by themselves; NHI has also developed the “Medication Record System for Healthcare Cloud” in 2013 to enable medical staff to immediately grasp the complete information of patient’s using of medication. Since July 2015, NHI has begun implementing some programs like “fee deduction” and “fee management” for duplicate use of specific drugs in outpatient clinics in phases. By implementing those programs above for the past decade, NHI nonetheless has exceeded the authority of the drug administration authorities. This essay’s topics are the legal basis NHI has to implement those programs, and which effect those executed programs lead.
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