從民眾觀點建構健保評量指標

Abstract

全民健保實施已逾十年，政府除致力維持相較於世界先進國家偏低的健保費率外，醫療費用占國民生產毛額(GDP)的比重，亦明顯低於世界先進國家。此外，我國的醫療服務指標亦曾被英國經濟學人雜誌評定為全球第二名，而健保局委託研究亦發現台灣在許多醫療品質指標與先進國家相似或更好。同時在歷年的健保民眾滿意度調查中，民眾對健保的滿意度，常常高達80%。惟近年面對健保財務的虧損日趨嚴重，為期永續經營，健保局除透過調整保費、部分負擔及多元微調給付措施，亦規劃透過制度的大幅度變革，提高健保政策品質與經營績效，但卻受到民眾對於健保政策執行績效的質疑，無法獲得民眾對於健保改革的認同。 為此，本研究將從廣義的「民眾」觀點(包括「關注民眾」觀點與「一般民眾」觀點)建構周延與具有公信力的健保政策績效的系統架構、評量指標與方式，以提升民眾對健保的支持，並成為日後提升醫療品質、服務品質、調整保費和其他健保改革的重要參考。 為達成上述目標，本研究主要工作項目與方法如下：文獻與次級資料分析：彙整與分析國內外有關健保政策指標相關理論及個案，作為本研究的理論架構。政策德菲法：邀集健保政策的「關注民眾」(即政策菁英)二十五位進行二個回合的腦力激盪與「紙上會議」對話，將其提出的指標，作為電話調查的問題依據。電話調查法：以全國二十歲以上民眾為母體，以隨機撥號的電話調查全國1,100位以上之民眾，詢問其對於健保政策執行績效指標的認知與意見，以及相關具體建議。根據以上研究發現，撰寫期末報告，針對從廣義民眾觀點建構健保評估指標意涵、內容、評估方式與優先順序，提出具體建議，進而提供未來健保改革的重要參考。 The implementation of Taiwan National Health Insurance has been for more than 10 years. The government has committed to maintaining the world`s advanced countries in comparison to the low health insurance rates. Also, the medical costs account for the gross national product (GNP) and the proportion is significantly lower than the world`s advanced countries. In addition, the British Economist magazine rated medical services indicators of National Health Insurance as the second best one in the world. Also, Bureau of National Health Insurance has commissioned several studies to prove medical quality of National Health Insurance to be better than many advanced countries. The public opinion survey found that 80 percent of people were satisfied with the program. However, the government faced strong opposition from the general public in attempting to raise rates. This study will be a broad \"public\" point of view (including \"policy elites\" views and \"the general public\" viewpoint) to evaluate the policy performance and present evaluation indicators. The survey methods include secondary data collection and literature review to analyze the relevant policy evaluation theory and case-related indicators as the theoretical framework of this study. Also, the research applies policy Delphi method, telephone survey, and focus group discussion to empirical study. Finally, the research will present research findings and policy suggestions about evaluation indicators.