第 一 篇 全 民 健 保 組 織 與 制 度
Chapter 1 NHI Administrative Framework
11
衛生福利部中央健康保險署前身為中
央健康保險局。為明確定位組織，於
2010
年
1
月
1
日由金融保險事業機構改制為行
政機關（行政院衛生署中央健康保險局）。
因配合行政院衛生署於
2013
年
7
月
23
日
改制為「衛生福利部」，亦同步更名為「衛
生利福部中央健康保險署」。
全民健康保險為政府辦理之社會保險，
以衛生福利部為主管機關。衛生福利部設
有全民健康保險會，以協助規劃全民健保
政策及監督辦理保險事務之執行，並設有全
民健康保險爭議審議委員會，處理健保相
關爭議事項。衛生福利部中央健康保險署
（
以下稱健保署）為保險人，負責健保業
務執行、醫療品質與資訊管理、研究發展、
人力培訓等業務；健保署所需之行政經費
由中央政府編列預算支應。
為有效推動全民健保各項服務，健保
署除依業務專業性質設置專業組室，規劃
各項業務措施之推動，在各地設有
6
個分
區業務組（圖
1
），
直接辦理承保作業、保
險費收繳、醫療費用審查核付及特約醫事
服務機構管理等服務，同時設置
21
個聯絡
辦公室，服務在地民眾。人員編制至
2013
年
6
月
30
日，共有
2,923
名。
全民健康保險組織
NHI Organization
To more clearly define its statutory status, the Bureau
of National Health Insurance (the NHIA’s predecessor) was
changed from a “financial and insurance public enterprise”
to an “administrative agency” on January 1, 2010. When
the Department of Health was reinstituted to become the
Ministry of Health and Welfare on July 23, 2013, the BNHI
was also changed to become the National Health Insurance
Administration.
Taiwan’s NHI system is a social insurance program
organized by the government under the jurisdiction of
the Ministry of Health and Welfare. The ministry’s NHI
Supervisory Committee helps plan and monitor NHI-related
tasks, and the NHI Dispute Mediation Committee, also
under the Ministry of Health and Welfare, deals with NHI-
related disputes. The NHIA is responsible for managing
health insurance affairs, medical quality, information on
the health care system, research and development, and
manpower training. Its operations are funded out of the central
government budget.
In addition to specialized groups and offices to plan and
promote various health insurance measures, the NHIA has
six regional divisions across Taiwan (Chart 1) that handle
insurance applications, premium collections, utilization review
and reimbursement, and the management of contracted
medical institutions. Twenty-one liaison offices have been set
up around the country to serve the public.As of June 30, 2013,
the NHIAhad 2,923 employees.