全民健保總額制度執行架構之評估

Abstract

[研究目的] 本研究的目的有四： 1. 中央健康保險總局各總額支付委員會之組成與運作方式現況探討。 2. 各總額執行委員會及分區執行委員會之組成與運作方式現況探討（各總額執委會加上分區執委會標的過多，在分析時會尋找關鍵的個案做有意義的比較分析）。 3. 各總額支付委員會及執行委員會之運作方式的比較，以及優缺點分析。 4. 總額支付制度運作模式的建議。 [研究方法] 本研究為達到前述研究目的，在資料蒐集方面，擬採取現有文獻蒐集、菁英問卷調查、深度訪談、以及參與觀察法，透過相關二手與一手資料的蒐集，藉以瞭解各總額支付委員會與執行委員會的背景與問題，以及總額運作的政策需求與各方意見。在資料分析上，擬採用內容分析與量化的分析方式進行。 [預期結果] 本研究預計以兩階段為之，所欲達成的研究目標有以下兩點： 1. 瞭解各總額部門支付委員會及執行委員會之籌組過程及運作方式。 2. 就目前的醫療生態，提出各部門總額適當合理之運作模式。 關鍵詞： 總額支付制度、總額支付委員會、總額執行委員會、委員會治理、公有財產資源

[Research proposes] There are four proposes in this project: 1. An analysis of the implementation mechanism of the Global Budget Payment Committees in the National Health Insurance Bureau. 2. An analysis of the implementation mechanism of Global Budget Implementation Committees and Regional Global Budget Implementation Committees. 3. A comparative analysis of the different Global Budget Payment Committees and Global Budget Implementation Committees. 4. Providing policy recommendations for improvement of the implementation mechanism of the Global Budget Payment System. [Methodologies] Literature reviews, questionnaires, face-to-face interviews, participatory observation are four methods utilized in this research. First hand and secondary data will be collected to understand the institutional background and bring up questions to be discussed in this research. Furthermore, with the acquired data, content and statistical analysis through the softwares such as UNDIST and SPSS. [Expectation Results] The results of this research could make the following contributions: First, to understand how the Global Budget Payment Committees and Global Budget Implementation Committees be form and what the operational details are. Second, the results of this research could generate recommendations for reforming the Global Budget Payment System under the current difficult situation for the NHI’s finance. Keywords: Global Budget Payment Committee, Global Budget Implementation Committee, Global Budget Payment System, Committee Governance, Policy Implementation, Common Pool Resources (CPRs).