全 民 健 康 保 險 年 報
National Health Insurance In Taiwan
2013-2014
ANNUAL REPORT
品質確保措施
在協定醫療費用總額時，同時訂定品
質確保方案，以確保醫事服務機構提供的
照護品質及範圍，不致因總額支付制度的
實施，而衍生負面的影響。
各總額部門所訂定之「品質確保方案」
內容包括：
一、保險對象就醫權益的確保：
含醫療服務品質滿意度調查、申訴及
檢舉案件處理機制、保險對象就醫可
近性監測。
二、專業醫療服務品質的確保
（
一）訂定臨床診療指引、專業審查、
病歷紀錄等專業規範。
（
二）建立持續性醫療服務品質改善方案：
1.
監測診療型態及服務品質
2.
建立醫療院所輔導系統
3.
建立醫療服務品質指標，並將
品質資訊透明化，公開於健保
署全球資訊網（
http
：
//
www.
nhi.gov.tw
），
作為醫療院所
持續提升醫療品質的參考。
Ensuring Quality under Global Budget System
As global budgets are being negotiated and approved,
other measures are taken to ensure that the global budget
payment systemwill not force medical sectors or institutions
to cut back the quality or scope of care because of budget
constraints.
The quality assurance programs agreed to with Taiwan's
medical sectors contain the following provisions:
I. Safeguarding the insured’s right to health care
The right to care is guaranteed through satisfaction
surveys on health care quality, mechanisms to handle
appeals and complaints, and the monitoring of
accessibility to health care.
II. Ensuring quality of specialized health care services
A. Professional guidelines established for clinical practices,
peer reviews andmedical records
B. Ongoing programs developed to improve health care
quality by:
1.
Monitoring clinical profiles and service quality;
2.
Establishing a guidance system for medical
institutions
3.
Establishing health care quality indicators and
posting quality information on the NHIA website
(
http://www.nhi.gov.tw
) as a reference for medical
institutions to help them continue improving the
quality of their care.