| 摘要: | 本研究之目的希望能完成中醫住院納入健保給付之相關問題如下：1. 擬定中醫住院醫療費用支付項目及各項目支付標準，作為全民健保醫療費用協定參據。2. 瞭解目前中醫醫院設施與醫事服務人力現況與中醫醫院之地理分佈。3. 研究建立中醫住院醫療服務品質控管機制。4. 針對一般民眾進行中醫住院之成本效益分析。5. 建議中醫住院費用之財務機制與擬定總額之評估。本研究擬從民眾對中醫住院之醫療體系供給面、民眾需求面、與專家政策面，三方面進行中醫住院醫療費用支付項目及各項目支付標準之評估。其中供給面的探討除了傳統研究中針對醫療體系進行各種性質的量化描述之外，也包括進行中醫住院業務的成本估算。需求面的研究則主要針對中醫住院的民眾效益進行估算。透過這樣的方式進行中醫住院的成本效益分析，並以此作為依據來進行專家會議與提出政策建議。在醫療體系供給面部分，以問卷調查目前台灣地區中醫醫療院所的相關設施，以醫院之醫師人力、醫療設施、服務科別等結構面指標，嘗試區分不同之醫院等級以評估支付標準是否分級之可能，同時也參照中醫醫院評鑑指標與評估方式。另也針對以醫學院或設有中醫部門之區域醫院級以上教學醫院之結構面指標進行分析，評估其與其他醫療機構之差異。本研究在探討供給面的另一項重點，為擬計算中醫住院的成本，意即針對所可能建議的中醫住院政策內容進行成本計算。民眾的效益面評估可以幫助決定中醫住院財務總額，也可以依此與成本面進行比較。理論上全民願意為中醫住院醫療支付的總額，應該作為中醫住院財務總額的上限，然後再與實際執行的成本面進行比較分析。在經濟評估的範圍中，成本效益分析為評估一個計畫是否值得推動的方法，社會效益的計算基礎為個別消費者的最高付費意願，即為福利經濟學計算消費者剩餘的主要依據，而橫跨消費者之間對消費者剩餘的加總即為成本效益分析的基礎 。專家政策面擬以德菲方式進行，由國內中醫界與學術界針對中醫住院各項給付項目與支付標準進行專家意見之調查，並於最後召開專家會議尋得共識，提出中醫住院之相關建議。
The purpose of this study is to solve the related problem about subsuming the inpatient of Chinese medicine in national health insurance. There are five problems？G？]1？^framing the expenditure payment items and payment criterion of Chinese medicine hospitalization , in terms of NHI expenditure agreement？F？]2？^understanding the facilities , the medical manpower and the geographical distribution of Chinese medicine hospital？F？]3？^ establishing the medical quality control mechanism of Chinese medicine hospitalization？F？]4？^using cost-benefit analysis on Chinese medicine hospitalization aiming at the public people ？F？]5？^suggesting the financial mechanism of Chinese medicine hospitalization expenditure and the evaluation of global budget. This research from three dimensions to evaluate Chinese medicine hospitalization expenditure payment items and payment criterion, including medical system supply side, public demand side and expert policy side. Supply side includes estimation of Chinese medicine hospitalization cost, in addition to quantity description of Chinese medical system. Demand side mainly aims at estimation benefit of Chinese medicine hospitalization. Proceeding cost-benefit analysis on Chinese medicine hospitalization through this way, we hold expert conference and pose policy suggestion according to the CBA result. Supply side of medical system, using questionnaire investigates the structure index of Chinese medicine hospital such as medical manpower, medical equipment and medical specialist, trying distinguish different level hospital the possibility of different payment criterion, referring to the accreditation standard and evaluation method at the same time. Another point of the study to research supply side is to calculate the cost of Chinese medicine hospitalization and to count the cost of all possible Chinese medicine hospitalization policy. The benefit of public people can aid the determination of Chinese medicine hospitalization financial global budget, also can compare with cost. In theory, people are willing to pay for the global budget of Chinese medicine hospitalization as the upper limit, then compare with cost of implement. In economic evaluation, cost-benefit analysis is a method to assess if the program is worthwhile or not, the computing basis of social benefit is individual consumer maximum willingness-to-pay？]WTP？^, is also the basis of welfare economics computing consumer surplus, is the aggregation of this consumer surplus across individuals which forms the basis of the cost-benefit analysis. The expert policy side is proceeding through Delphi Method, investigating expert opinion of Chinese medicine hospitalization each items and payment criterion form Chinese Medicine and academia in Taiwan. Finally, we will hold the expert conference and pose related suggestion about Chinese medicine hospitalization. |
