第 二 篇 經 營 成 效 與 品 質 提 升
Chapter 2 Achievements &Quality Assurance Initiatives
89
電子申報系統提升整體效率
自全民健保開辦以來，健保署即鼓勵
特約醫事服務機構採用網際網路、媒體、
VPN
等方式申報費用，有效節省書面申報
之人工及郵遞成本，提升申報作業效率，且
可縮短費用暫、核付時程。統計資料顯示，
特約醫事服務機構採醫療費用電子申報之
比率已近
100
％。
2004
年
1
月
1
日健保卡全面上線後，
健保署建置健保資訊網（
VPN
）
作為與特
約醫事服務機構雙向溝通之專用網路，特
約醫事服務機構除了可透過
VPN
進行健
保卡連線、認證、更新、上傳作業以外，
更可進行費用申報、試辦計畫等網路申
報服務，提供更有效率之連線服務管道。
2012
年
12
月份平均每日健保卡就醫上傳
檢核成功之清單明細約
158
萬筆、醫令約
556
萬筆資料。
另為因應近年來醫療院所
e
化的腳步
逐漸加速，健保署於
2006
年
9
月建置完成
並啟用「電子化專業審查
PACS
（
Picture-
Archiving and Communication System
）
系統」，建立了醫療費用專業審查（含文
字及影像資料）作業
e
化環境，以期協助
醫療院所進行醫療專業審查電子化申請或
申報；同時串接健保署內部之醫療給付相
關系統，使整個審核流程更加自動化，並
提升原有人工審查作業的效率，降低行政
作業成本。
Enhanching Efficiency with Electronic Claims
System
Since the inception of the NHI program, the NHIA
has encouraged contracted medical institutions to file their
reimbursement claims electronically via the Internet, electronic
media or the Virtual Private Network, which has improved
claims efficiency and lowered the administrative costs of
processes that were once handled manually. The system also
shortens the time it takes to approve or deny expense claims.
Nearly all contracted medical institutions now file their claims
electronically.
The Virtual Private Network in particular was set up to
provide a dedicated two-way communication channel with
medical institutions, which now use it to verify and update
IC cards during patient visits, file their expense claims and
claim costs for pilot plans. In December 2012, an average of
1.58
million patient visit summaries containing 5.56 million
medical service orders (also known as physician orders) were
uploaded and verified daily through the system.
The NHIA has set up other online systems to
accommodate the growing efforts of medical institutions
to digitize their operations and strengthen the overall
e-government environment. In September 2006, a picture-
archiving and communication system (PACS) to audit expense
claims (including text and imaging information) was launched
to help medical institutions report their expenses electronically.
At the same time, the systemwas linked to the NHIA’s internal
payment systems, automating the auditing systemeven further.
Ultimately, the increased reliance on electronic systems has
improved efficiency and cut administrative costs.