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題 名 | 美軍醫療體系民營化之經驗與啟示=Implications of Privatization in the U.S. Military Health Care System |
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作 者 | 陳育忠; 高森永; | 書刊名 | 國防醫學 |
卷 期 | 25:5 1997.11[民86.11] |
頁 次 | 頁479-489 |
專 輯 | 國軍醫療體系之前瞻 |
分類號 | 594.93 |
關鍵詞 | 現役軍人; 軍方特約醫院計畫; 軍方醫療體系; 全民健康保險; 軍方特約診所計畫; Active duty military personnel; CHAMPUS; Military health care System; National health insurance; NHI; PRIMUS; |
語 文 | 中文(Chinese) |
中文摘要 | 由於全民健保險的全面推展,以及國軍眷屬與編制內聘雇人員眷屬相繼納入全民 健保,而凸顯國軍官兵就醫可近性的問題。有鑒於近來軍中的人權問題逐漸成為各方關注的 焦點,也不時傳出要求加入全民健保的聲浪;民意代表亦曾強烈質疑批評軍醫體系,並要求 國防部規劃將軍人納入全民健保體系內,以及在媒體推波助瀾之下,使得整個國軍醫療體系 的處境更加艱辛,也因此正面著空前的經營危機以及存廢衝擊。由於軍人加入全民健保與否 ,是一個相當複雜而且牽涉極廣的問題,對於此關係體制變革的重大政策之律訂,實有必要 多方蒐集資料,並加以審慎研究評估以期周密。 美國軍方醫療體箹因為無法消化日益增加的病人而採取類似民營化(privatization)的 概念與民間醫療院所簽約。檢視兩個主要的軍民合約計畫,結果發現並未能達到預期的成 效:其中最主要的因素是這類的計畫均需耗用龐大的成本,雖然所有改革方案的重點仍在 設法使其更符成本績效(cost-effective),但是除此之外應有其他的替代方案可供參考,諸 如擴編軍方醫療體系以及降低病人不當地利用醫療服務等。 美國軍方醫療體系為減輕軍醫院病人超載的壓力而藉助民間醫療資源;透過與民間醫療 院所簽約的方式,由民間醫院提供軍方病人所需的醫療照護。本文擬簡介其實施過程、評估 其所獲成效、及其所遭遇到的問題。希望從美軍醫療體系這種利用軍民合約的醫療計畫之實 施經驗與成效,可以供我國軍方醫療體系在思考「現役軍人應否納入全民健保?應如何納入 全民健保? 應如何保障官兵就醫權益?」等問題時,可獲取些許啟示以為擬定相關政策之參 考。 |
英文摘要 | After the implementing of the National Health Insurance(NHI), military dependents in Taiwan have been insured under the Program that introduced the issue of accessibility to medical care for active duty members. Many active duty military personnel show their willingness to enroll the NHI througth any possible channels. The military health care system in Taiwan has been forced to deal with such a complex problem and look for feasible solutions. The US military health care system was facing a critical overload of patients in 1980s. To resolve the overload problem, military care planners and policy makers employed the approach of shifting workload to the civilian providers. This article explores the two most well-known and widely used contract programs: The Civilian Health And Medical Program of the Uniformed Services(CHAMPUS) and Primary Medical Care for the Uniformed Services (PRIMUS). In general neither of the military's two major health care contracting efforts can be deemed a total success due to the high costs associated with each program. It is the authors' belief that discussion and recommendations presented in this article can help us understanding the feasibility of introducing the US models of privatization into our military health care system. |
本系統中英文摘要資訊取自各篇刊載內容。