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美國參議院單一保險制度聽證口頭證詞
2014/11/04 12:15
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Taiwan’s NHI program

Taiwan established universal national health insurance in 1995.

台灣在1995年開始實施全民健保。

Currently, 99.6% of the population, about 23 million people, is enrolled in the NHI program.

目前,有99.6%人口, 大約兩千三百萬,參加全民健保。

Taiwan’s NHI program is a single-payer system, and has a large single risk pool, cross-subsidization among diverse groups with not only different socioeconomic status but also different health status.

台灣全民健保是單一支付體制,有很大的疾病風險分擔效果,讓不同社經地位和不同健康狀況族群,可以相互補助。

Studies show that the premium contribution compared to the health resources utilized are favorable to the low and middle-low income classes.

研究發現,從保費的負擔和醫療資源使用來比較,這制度是對低和中低收入階層是較為有利的。

Single-payer system

Having a single-payer system is the main reason for our efficient services and also the low prices for health care we can achieve. Private delivery and highly competitive providers enable us to have efficient health services.

單一支付制度是我們有效率醫療服務和低價格的主因,私部門為主的醫療服務體系和高度競爭的醫療提供者是效率的機制。

The NHI Administration’s contract with 100% of the hospitals and 93.5% of the private practitioners enable the insured to have an easy and equal access to health services.

全民健保署和100%的醫院及93.5%開業醫師簽約,因此被保險人可以得到方便和公平的醫療服務。

A single insurance administration also has the benefit of a very low administrative cost, which was only 1.15 percent of total NHI spending in 2012.

單一保險行政也有低保險行政成本的好處,在2012年,它只占健保支出的1.15%。

Although there is no choice of insurers, people enjoy complete free choice of providers. Providers in Taiwan must be mindful of patients’ demands to stay competitive.

雖然民眾沒法選擇不同健保,但是人民享有就醫場所的完全自由選擇權。

The NHI Administration set a uniform national fee schedule for all the providers. Price competition is limited to those services not covered by the NHI program. It is quality competition in nature, not price competition; but it certainly is competition.

健保署制定全國一致的支付標準,價格競爭只限健保不給付的項目。本質上,健保是品質競爭,不是價格競爭,但是存在競爭是無庸置疑的。

Furthermore, the administration of the single-payer system is simple, as there is only one set of claim forms, clinical protocols, quality indicators, fee schedule, etc. The administration costs of hospitals are also much lower than those of a multi-insurer system.

此外,單一體制的行政作業相對單純,只需一套費用申請、臨床標準、品質指標、支付標準等,對醫院的行政成本來說,也比多元保險人制度少很多。

Public satisfaction

The NHI is the most successful public policy in Taiwan.

健保是台灣最成功的公共政策。

The general public has been very satisfied with the NHI. One reason for the high satisfaction is that premium and co-payment rates are low.

民眾對健保的滿意度非常高。原因之一是低保險費和低部分負擔。

Easy accessibility is another reason. Free choice of providers is the key to the easy and equal access of health care.

就醫方便是另一個原因。自由選擇就醫地點是方便和公平的關鍵。

Basically, there are no waiting list at all except for a few well-known medical centers and well-known doctors.

基本上,除了少數醫學中心和名醫,病人不需要長期等候就醫。

We solve the problems of rationing by provider competition and efficient services.

我們用競爭和效率來解決分配醫療資源的種種困難。

Health performance

Our health performance, e.g. life expectancy, infant mortality and maternal mortality, are better than U.S., although we spent only one-quarter of USD (PPP) in health expenditure.

雖然我們只用了美國四分之一的費用(經物價調整),但是我們的健康成果,像平均壽命、嬰兒死亡率、產婦死亡率等,都比美國要好。

Before NHI, life expectancy increased 1.8 years from 1986 to 1996, and after NHI, it improved 2.9 years from 1996 to 2006. Studies show that life expectancy improved more for low-ranked health classes.

健保實施前十年,全體國民平均壽命增加1.8歲,而實施健保之後十年,國人平均壽命增加2.9歲。研究指出,健康狀況較差的人平均壽命增加較多(對生病的人較為有利)。

Health IT

All providers submit claims electronically based on the patient records they keep, we can do very detailed profiling of both patients and providers.

所有醫療機構都用電子數據申報醫療費用,我們可以非常仔細的分析病人和醫療院所的資料。

We are on the way to develop cross-system EMRs, and expect to accomplish a complete life-time e-record system within a few years.

我們正在發展全國性的電子化病歷(醫院都有個別不同程度的電子化病歷),也期望未來幾年內能完成國人終生電子病歷。

Thank you!

謝謝!

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