全 民 健 康 保 險 年 報
National Health Insurance In Taiwan
2013-2014
ANNUAL REPORT
依健保署監測情形，實施
Tw-DRGs
制
度，確實能提升住院醫療服務效率。
2012
年
DRGs
案件平均住院天數下降
0.26
天，提高
病床週轉率；平均每件實際醫療費用下降，
減少不必要手術、用藥及檢查等，並減少醫
療成本。
論人計酬支付制度採
3
種模式試辦，打
破傳統「醫院看的越多、領的越多」觀念，
提供更大誘因促使醫院投入健康促進服務，
以民眾健康為導向，只要把病人照顧得越好，
醫生和醫院的收益就越多，讓民眾獲得更周
全的醫療整合照護。目前計有
8
個試辦團隊，
照護對象
20
萬人，試辦期間
3
年。
此外，針對醫療費用大、罹病人數多、
照護模式有改善空間之疾病別，推動醫療給
付改善方案，採論質計酬－即論「品質」付
費的支付方式。醫院可依治療指引，使病患
獲得較佳之治療，並透過個案管理師針對病
患提供疾病管理追蹤，使病患得到完整且持
續之照護，讓疾病獲得良好控制，改善論服
務量計酬無法有誘因提升醫療品質之缺點，
且根據不同疾病之醫療照護特性設計支付誘
因，兼顧了醫療費用控管，也提升了醫療服
務的效率與品質，達成全民健保照顧全民健
康的使命。
The many Tw-DRGs that have been phased in over the
past few years have in fact demonstrated more efficient use of
medical resources used for inpatient care. In 2012, the average
hospital stay for patients in diagnosis related groups fell 0.26
days from a year earlier, freeing up hospital beds. Average
medical resources used per case also fell because of the
elimination of unnecessary operations, medications and tests,
resulting in lower health care costs.
At the same time, three different capitation system
models are being tested. The capitation payment system –
which essentially pays doctors a fixed amount per person –
is designed to break the traditional mindset that doctors will
make more if they see more patients or render more services.
It provides incentives for hospitals to invest in services that
promote good health, because the better patients are cared
for, the more doctors and their hospitals will benefit. The
patients also come out ahead, because they receive more
comprehensive and integrated care. There are currently eight
medical teams responsible for 200,000 people in Taiwan
working under the capitation payment system on a three-year
trial basis.