全 民 健 康 保 險 年 報
National Health Insurance In Taiwan
2013-2014
ANNUAL REPORT
增修支付標準
為平衡醫療發展，自全民健保開辦起，
即積極改善醫界普遍認為支付偏低而較不
願投入或發展的項目，例如住院、急診、
重症醫療、婦產科、小兒外科、一般外科
等，並配合新醫療科技發展及實際臨床需
要，持續新增診療項目，以提供民眾與時
並進之醫療技術。截至
2012
年，支付標準
共計
4,281
項診療項目，經統計
2004
年至
2012
年
12
月底，共計有
63
次公告調整支
付標準；其中以
2004
年
6
月公告及
2005
年
12
月公告增修診療項目為最多，共修訂
1,382
項診療項目的支付標準點數。
為鼓勵醫院重視臨床護理照護人力，
促使醫療院所配合增設護理人力，
2009
年
起辦理「全民健康保險提升住院護理照護
品質方案」，截至
2013
年挹注經費累計達
63.325
億元，用以鼓勵醫院增聘護理人力、
提高夜班費及補貼超時加班費，增加護理
人員留任的意願。
多元支付 提升品質
Diversifying Payment Systems
for Better Outcomes
Adjusting Reimbursement Standards
Since the inception of Taiwan’s National Health
Insurance system, the NHIA has steadily increased the
number of services and procedures covered to keep up with
technological advances and clinical needs and provide the
insuredwith access to new technologies.As of the end of 2012,
the system had standard reimbursement rates for 4,281 items.
At the same time, the NHIAhas worked to change the medical
community’s perception that a number of medical fields, such
as emergency and inpatient care, critical care/intensive care,
obstetrics/gynecology, pediatrics surgery and general surgery,
were not worth pursuing because their reimbursement rates
are too low. Between 2004 and the end of December 2012,
the NHIA adjusted reimbursement rates 63 times, with the
biggest overhauls of the fee schedule coming in June 2004 and
December 2005, when the relative point values of 1,382 items
and services were revised.
The NHIA has also given hospitals incentives to focus
more closely on their clinical care manpower and strengthen
their nursing staffs. A program to improve the quality of
nursing care was initiated in 2009, and more than NT$6.33
billion had been poured into it as of 2013. The funding
has been directed at hiring more nurses, increasing pay for
overnight shifts, and subsidizing extra overtime, making nurses
more willing to stay on the job.