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題 名 | 荷蘭健康照護民營化的省思=Lessons Learned from Netherlands's Privatization of Health Care System |
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作 者 | 林芸芸; | 書刊名 | 公共衛生 |
卷 期 | 25:3 1998.10[民87.10] |
頁 次 | 頁141-152 |
分類號 | 412.56 |
關鍵詞 | 民營化; 規範競爭; 疾病基金會; Privatization; Regulated competition; Sickness funds; |
語 文 | 中文(Chinese) |
中文摘要 | 荷蘭健康照護體系的特質為:1.民營導向、2.不准設立營利醫院及3.由政 府控制醫療費用。 實施強制的全民健康保險與規範式競爭( regulated competition ), 為其改革的特色。1980 年代 Plan-Dekker 的改革重點在於強調:市場、誘因與競爭;1990 年代 Plan-Simons 則強調:消費者選擇、責任分擔及分權化, 改革的原則為:1.統合社 會福利與健康照護;2.減少政府干預,增加市場力量,激發醫療供給者間、與疾病基金會 間的競爭;3.維護醫療公平性。 疾病基金會在改革過程中扮演著主角的地位。第一期:開放健康保險市場,商業保險公司得 以自由進入;可於全國各地廣招會員;更允許自行協商較低的醫療價格或自行開設醫療機構 。第二期:各疾病基金會可選擇與較優良的醫療供給者特約,因此,基金會間以服務種類、 品質、聲望及特約醫療供給者等加劇競爭行為。使疾病基金會由「行政導向」轉型為「市場 導向」;由「高級決策者」轉變為「企業管理者」。 荷蘭健康照護改革之借鏡:1.政府需扮演「再規範( re-regulation )」, 而非「去規 範( de-regulation )」的角色。 並營造適合健康市場競爭的環境:普及全國的強制健康 保險、制訂風險調整的論人計酬制、傳播醫療資訊、控制醫療品質、設計反聯合、反壟斷等 策略、及以政府補助保障社會公平等。2.風險調整論人計酬制是調整保費、發揮市場競爭 功能的必要條件,需及早致力於資料收集、研究、與設立行政組織等。3.避免保險人的風 險套利行為。4.避免競爭的健康保險市場產生的不良影響,如:(1)醫療弱勢者或慢性 及重大傷病病人的缺乏醫療可近性,或導致的醫療不公平性;(2)劣幣逐良幣;(3)成 本轉嫁。總而言之,健康照護之民營化須循序漸進,長期持續實施;而在過渡期間,必須解 決民營化所涉及的複雜技術與政治問題。 |
英文摘要 | The characteristics of health care system in the Netherlands's are: (1) private-sector orientated. (2) no permission for the setting of for-profit hospitals. (3)government's control of medical cost. The two key elements of the health care reforms are national compulsory health Insurance and regulated competition. In 1980s, Plan-Dekker emphasized: market, incentive and competition. In 1990s, Plan-Simons emphasized: consumer's free choice, sharing of responsibility, and decentralization. The principles of health care reform are as follows: (1) Intergrating social welfare with health care. (2) Decreasing government's intervention, increasing market power, and stimulating the competition between the medical providers as well as the insurance companies. (3) Protecting the equity of medical care. Sickness funds played the key role during health care reforms. At stage one, the major reforms included: (1) Opening the free entry to the private companise of health insurance. (2) Permitting the recruitment of the insured from nation-wide. (3) Permitting the negotiation for lower medical price. (4) Allowing the self-setting of hospitals. At stage two, allow sickness funds to make selective contracting with medical providers, thereby induce dramatic competition between sickness funds by its multi-patterns of services, quality, physicians, hospitals and reputation. The role of sickness funds was changing from the "administration-orientated" to "market-orientated", from the "high-level decision-maker" to "enterprise manager". Lessons learned from the privatization of health care system in Netherlands are as follows: (1) The government should play the role of reregulation instead of deregulation. (2) The government should create the competitive environment for health insurance market, including: the insurance coverage of national health insurance, the development of risk-adjusted capitation rate, the broadcasting of health information, the quality control of medical care, the development of anti-cartel or anti-trust policies, and the guarantee of equity of medical care through government subsidy. (3) It's very important to avoid cream-skimming behavior of the health insurance companies. (4) It's critical to avoid the undesired effects of privatization such as: the inequality of medical care to the disadvantaged groups, the cost transfer, and prevent the inefficient medical providers to force-out the better ones. In sum, privatization of health care system needs a long time to proceed gradually with transitional stages to solve the relevant technical and political problems. |
本系統中英文摘要資訊取自各篇刊載內容。