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題 名 | 邁向一個有限多元合作而開放的自治管理體系--德國疾病保險體系組織改革之方向及給我們之借鑒=Forming a Mandatory Self-Regulated Administration for National Health Insurance System: The Reforming Experience of the German Health Care Organization |
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作 者 | 林志鴻; | 書刊名 | 經社法制論叢 |
卷 期 | 21 1998.01[民87.01] |
頁 次 | 頁273-310 |
分類號 | 563.74 |
關鍵詞 | 德國; 疾病保險制度組織; |
語 文 | 中文(Chinese) |
中文摘要 | 德國疾病保險制度組織體制上之主要特點乃是在國家監督下之向治管理原 則。歷來學者之研究分析皆強調其多元分立之面向。本文則認為此一多分立面 向已漸由有限多元,合作且開放之原則取代。這一發展趨勢尤其以1992年後之 改革發展顯露其制度運作特徵。有限多元乃指一方面保險人具公法人特性,必須 經由許可程序方可成立,同時國家仍舊扮演監督與檢查之任務;另方面已往由分 立之基層管理會為自治管理運作中心,逐漸轉而由邦及聯邦協會為運作重心之對 內的共同自治管理,以及跨類協會間之對外的共同自治管理體系。是故,國家監 督與許可之特色仍舊維持,以各類疾病管理協會為運作單元之特色逐漸明顯。而 對外(面對醫事團體)合作,相互之間則成開放競爭(由被保險人選擇)之應 勢。如此之發展趨勢,既非維持已往之多元分立且封閉之經營狀態,也非往單一 中央集中化發展(如我國1995後中央健保局之建制),更非私有化(免除國家 監督責任)一詞所可含括,故認為其乃為有限多合作而開放的自治管理體系。 在此國家乃需加強其監督與檢查之功能與作為。以合法性,合目的性監督,配合 競爭性自治管理之運作,提升整體制度運作效能。 本文探討的重點為藉由德國疾病保險體制在1992年後組織體制改革之方向 的探討,希望能掌握該體制之發展趨勢與制度結構之本質,做為檢討我國現行全 民健保的保險人組織與體系結構之參考。 |
英文摘要 | The organization of the German Health care Insurance System is characterized by it's Mandatory Self-regulating Principle. However, the current researcher efforts have emphasized on its pluralism dimension. The aim of this paper is focus on analyzing the organization reform since 1992. Particularly. I shall focus on its manager aspect. I characterize as follows: first, the German still maintain its mandatory selfregulating principle but has made some modifies; second, it has transformed the system into cooperative but emphasize the opening selections for the insurant. The German's experiences can be an exemple for the organizational reform of our National Health Insurance system. This lesson could made some modifications of which to cooperated into our current system. Obviously, it is neither imply to privatize our system nor centralize as it is; but rather the German experience is a mixture of these two extremes. Thus, what we could learn is that, with the primciple of mandatory insurance that the government can apply a more free and competition regulation under which provide the insurant more choices, and at the same time promot their quality of health services. Certainly, the government should adjust its role to more indirectly as monitor of the system that would make it efficiency than before. |
本系統中英文摘要資訊取自各篇刊載內容。