全 民 健 康 保 險 年 報
National Health Insurance In Taiwan
2013-2014
ANNUAL REPORT
多元支付制度
自
2002
年
7
月起，全民健保全面實施
醫療費用總額預算支付制度。醫療費用總額
預算支付制度為一種前瞻性、宏觀調控醫療
費用之方法
;
同時透過支付工具等微觀策略，
如論病例計酬、論質計酬等改革方案，以達
到改變診療行為，有效使用醫療資源之目的。
全民健保的醫療費用支付方式，在各部
門總額之下，仍以「論服務量計酬」為主，
並逐步推動「論病例計酬」及「論質計酬」，
以提升醫療服務品質、促進國民健康。另為
提升醫療服務效率、使民眾獲得更完整之全
人照護，自
2010
年
1
月起實施全民健康保
險住院診斷關聯群（
Taiwanese Diagnosis
Related Groups
，
簡稱
Tw-DRGs
）
支付制度；
並自
2011
年
7
月起試辦論人計酬支付制度。
支付制度
Diversified Reimbursement Plans
In the early years of the NHI system, Taiwan’s health care
providers were paid based on a “fee-for-service” basis, which
gave an incentive to hospitals to increase the “volume” of care
at the expense of quality and cost control. That changed in July
2002,
when a global budget system was implemented, setting
broad limits for total health care spending in different medical
sectors to control medical expenditures. Within this system,
however, payment strategies are still needed at the “micro”
level, such as “case payment” and “pay-for-performance”
schemes, to rein in supplier-induced demand and effectively
use availablemedical resources.
Reimbursement System