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題名 | 英國國民健康服務的發展(1948-1996)--臺灣全民健康保險的借鏡與啟示=The Development of Britain's National Health Service 1948-1996-Lessons and Implications for Taiwan's National Health Insurance |
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作者姓名(中文) | 黃源協; | 書刊名 | 社會政策與社會工作學刊 |
卷期 | 1:1=1 1997.06[民86.06] |
頁次 | 頁99-132 |
分類號 | 412.56 |
關鍵詞 | 國民健康服務; 總體經營; 內部市場; National health service; General management; Internal market; |
語文 | 中文(Chinese) |
中文摘要 | NHS開辦後,第一次財政危機便接踵而來,五○年代年初期,兩大政黨皆曾採取 部分負擔及總額預算方式應付之, 保守黨政府更企圖要再折國到 NHI 的體系,唯因民眾對 NHS 的依賴與期待及社會主義團體的強烈反對,而使得此企圖未能得逞。受惠於戰後經濟的 復甦與繁榮,六○年代及七○年代中期前,NHS 皆能在穩定中成長與發展。七○年代中期的 石油危機,使得 NHS 面臨第二次的財政困境, 保守黨於一九七九年執政後,經營效率的改 善便被視為是舒緩財政壓力的主要策略,「總體經營」及「內部市場」的實施,即為實現此 策略的具體措施。唯因前者缺乏市場的誘因及無法擺脫政治的影響,後者需大量的行政費用 及 NHS 所強調的公平性遭受侵犯,而使得改革蒙上陰影。 英國健康照護體系的發展,可提 供臺灣全民健保多項重要的借鏡或啟示。就健康政策的制定而言,建康照護議題本是政治議 題,讓「政治歸政治、醫療歸醫療」的理想,必難以達成,因而政策的制定應將政治現實視 為重要變項。就財源籌措而言,健康照護財務自主的理想雖不易實現,但若能適時且斷然的 採取有效策略加以防範,則健康照護的財務支出不必然會是個無底洞。就服務的經營而言, 「公辦民營」雖可提昇效率,但若認為它能完全解決健康服務爭端及免除政府的責任,必是 一廂情願的想法。 |
英文摘要 | Shortly after the implementation of the NHS in 1948, to cope with its first financial crisis, various charges and global budget were introduced by both main parties. Furthermore, the Conservatives ever tried to convert the taxation-based health care system to a contributory one. The ambitious programme was finally abandoned as a result of its unpopularity and fierce opposition from the Labour Party. Benefited from the econonmic prosperity in the 1960s and early 1970s, the NHS's resources were increased steadily. However, the oil crisis of the mid-1970s brought the NHS into its second financial crisis. For coping with the difficulties, promoting efficiency has been regarded as one of main solutions by the Conservatives. `General management `and `internal market' have therefore been introduced and carried out. The former has not achieved its goals as expected partly due to absence of incentive and inability to get rid of political intervention, and the latter has suffered from serious condemnation as a result of the increase in management cost and the creation of a `two tier health service' There have been several lessons or implications for Taiwan's NHI First of all any health policy-makings should take political institutions in which they take place into consideration because health issues essentially are political issues. Secondly, health care expenditure does not necessarily mean a bottomless pit if proper measures could be implemented timely. Finally, even though privatisation is good for promoting efficiency, it does not mean or guarantee that government could be entirely exempted from the responsibility ofr health financing. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。