第 二 篇 經 營 成 效 與 品 質 提 升
Chapter 2 Achievements &Quality Assurance Initiatives
69
可選擇使用新醫療特材
部分新醫療材料係改善現有品項之某
些功能，惟價格較原全民健保給付類似產品
之價格昂貴。為減輕保險對象的負擔及增
加民眾使用新醫療材料的選擇權，自
2006
年
12
月
1
日起陸續將塗藥及特殊塗層血管
支架、陶瓷人工髖關節、特殊功能人工水
晶體及金屬對金屬介面人工髖關節等
4
項
列入自付差額項目（表
12
）。
凡符合健保
現行類似品項之使用規範，而自願選用較
為昂貴品項，全民健保按現行類似品項之
支付標準給付，超過費用由民眾自行負擔。
為保障民眾權益，健保署規定醫療院
所應於手術或處置前，充分告知病患或家
屬使用原因、應注意事項及須自行負擔金
額等，並完整填寫規定之同意書。
另醫療院所也應將現行全民健保給付
同類項目及自付差額項目之廠牌及產品性
質（含副作用、禁忌症及應注意事項等），
提供民眾參考。並且將所進用的部分給付
品項之廠牌、收費標準等相關資訊置於各
醫院之網際網路、明顯易見之公告欄或相
關科別診室門口，以供民眾查詢。健保署
也已將各醫療院所之民眾自付價格，彙總
公布於健保署全球資訊網（
http://www.nhi.
gov.tw
），
民眾可上網查詢。
Providing More Medical Device Choice
Many new, technologically advanced medical devices
that provide better health benefits are far more expensive than
the devices they have been designed to replace. To ease the
financial burden of patients who stand to benefit from such
advanced devices and give them greater choice, the NHIA
phased in coverage of drug-eluting and bio-active coronary
stents, artificial ceramic hip joints, artificial intraocular lenses,
andmetal-on-metal artificial hip joints beginning onDecember
1, 2006 (
Table 12). For patients who choose these and other
more expensive devices and materials, the NHI system covers
the standard amount it would reimburse for similar more
conventional devices and has patients cover the additional cost.
To safeguard the rights of the insured, the NHIArequires
that physicians clearly inform patients or their families prior
to the procedure why a more advanced device is needed and
the additional amount they will be asked to pay and then have
themfill out the required authorization agreement.
Medical institutions are also required to provide a
comparison of devices or materials that are fully covered under
the NHI system and those for which the patient would have
to pay extra, detailing their brands and specific characteristics
(
including potential side effects, contraindications, and other
issues to be aware of). They must also post descriptions of
items and the items’suppliers that have been used recently and
the price charged on their websites, on easily spotted hospital
bulletin boards or outside outpatient clinics as a reference for
patients. The NHIA also posts information on its Chinese-
language website showing the amounts local hospitals charge
for items covered under this “balance billing” scheme.