全 民 健 康 保 險 年 報
National Health Insurance in Taiwan
2013-2014
ANNUAL REPORT
總額支付制度
為落實財務責任，同時避免在論量計
酬支付制度下，引發醫療費用快速成長，全
民健保醫療費用支付之設計，採用醫療費用
總額支付制度。醫療費用總額支付制度實施
之程序，是在每一年度開始前，由醫界與
付費者就醫療服務內容，先協商次年適當
的健保醫療費用總額。在此協定的額度下，
若服務量過多，就可能導致每點點值降低；
反之，若醫界間同儕合作，減少不必要醫
療、加強預防保健措施有成，則因服務量
可以有效控制，有可能提高每點點值。
醫療費用總額預算支付制度自
1998
年
7
月起由牙醫門診先開始實施，其後分別於
2000
年
7
月陸續推動實施中醫門診總額預
算支付制度，
2001
年
7
月實施西醫基層總
額預算支付制度，至
2002
年
7
月實施醫院
總額預算支付制度，完成全面實施醫療費用
總額預算支付制度。總額預算支付制度全面
實施後，有效將醫療費用成長率控制在
5%
以下。自
2006
年起之醫療費用成長率如圖
3
。
為確保民眾就醫權益不因總額支付制度
實施而有所變更，健保署與醫療團體共同
執行醫療品質確保方案，以監督醫療院所，
提供更高品質的健康服務。醫療費用總額
研擬程序如圖
4
。
2006
年起各總額部門醫
療費用協定成長率如（表
14
）。
Global Budget Payment System
The global budget payment system was adopted to
constrain the rapid growth in costs under the fee-for-service
model and institute a system of financial accountability. Under
the system, medical providers and payers negotiate overcall
caps on total medical payments with the NHI system prior
to the beginning of a fiscal year based on a fixed volume and
range of medical services. The process is illustrated in Chart
3.
The negotiated growth rates for each medical sector’s total
expenditures since 2006 are shown inTable 14.
If the total amount claimed for reimbursement by a
sector exceeds the pre-set ceiling, point values for that sector’s
services may drop. If, on the other hand, a particular sector
works together to reduce unnecessary treatment and strengthen
preventive caremeasures, effectively controlling the volume of
services provided, point values for its services may increase.
The global budget system was phased in between 1998 and
2002,
capping overall expenditures in Taiwan’s four broad
medical sectors — dental (implemented in July 1998),
traditional Chinese medicine (July 2000), western medicine
clinics (July 2001) and hospitals (July 2002). Since the
system was fully implemented in 2002, it has successfully
controlled the growth of medical expenditures at below 5%
a year. Chart 4 shows medical expenditure growth since
2006.
To ensure that patients’ rights to care are not affected by the
constraints of the global budget payment system, the NHIA
and medical associations have adopted measures to jointly
supervise hospitals and clinics that operate under the system
and ensure that they are providing high quality care.