第 一 篇 全 民 健 保 組 織 與 制 度
Chapter 1 NHI Administrative Framework
31
The Benefit Package
The NHI system offers a comprehensive and uniform
benefits package to all those covered by the program. With
a valid health insurance IC card, the insured have access to
more than 20,000 contracted medical care facilities (hospitals,
clinics, pharmacies and medical laboratories) around the
country that offer inpatient and ambulatory care, dental
services, traditional Chinese medicine therapies, child delivery
services, physical rehabilitation, home care, and chronicmental
illness care, among others. The system covers most forms of
treatment, including general diagnoses and treatment, medical
consultations and operations, and related expenses such as
examinations, laboratory tests, prescription medications,
supplies, nursing care, hospital rooms, and certainOTC drugs.
Co-payments and ‘Pay-as-you-go’ System
The co-payments for outpatient and emergency care
were adjustedmultiple times during the system’s first 10 years.
But in July 2005, the NHIA inaugurated a new co-payment
fee schedule and referral system to encourage patients to
seek treatment for basic ailments at local clinics and then
get referrals to regional hospitals or medical centers if more
advanced treatment or tests are necessary. The system, which
keeps co-payments lower for people with referrals, has led to
the more efficient use of medical resources by leaving regional
hospitals and medical centers free to focus on patients with
more pressing needs.
醫療給付範圍
參加全民健保的保險對象，經繳交保
險費並領取健保卡後，凡發生疾病、傷害
事故或生育，皆可憑健保卡至醫院、診所、
特約藥局及醫事檢驗機構等特約醫事服務
機構接受醫療服務。全民健保所提供的醫療
服務包括：門診、住院、中醫、牙科、分娩、
復健、居家照護、慢性精神病復健等項目。
治療照護的範圍則包括：診療、檢查、檢
驗、會診、手術、藥劑、材料、處置治療、
護理及保險病房等。
部分負擔使用者付費
全民健保開辦至
2005
年
6
月底，門、
急診之部分負擔已經調整多次。為鼓勵民
眾小病到當地診所就醫，需要進一步檢查
或治療時再轉診到區域醫院、醫學中心等
大醫院，自
2005
年
7
月
15
日起推出若配
合轉診則不加重部分負擔之設計，增進全
民健保資源的有效運用，門診基本部分負