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題 名 | 從管理式競爭到管理式合作--英國的「內部市場」對臺灣全民健康保險公辦民營的鑑戒=From Managed Competition to Managed Cooperation--Lessons Learned from the Internal Market in U.K. |
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作 者 | 林芸芸; | 書刊名 | 公共衛生 |
卷 期 | 26:1 1999.04[民88.04] |
頁 次 | 頁1-12 |
分類號 | 412.56 |
關鍵詞 | 內部市場; 管理式競爭; 管理式合作; Managed competition; Managed cooperation; Internal market; |
語 文 | 中文(Chinese) |
中文摘要 | 英國保守黨實施的「內部市場」具「管理式競爭」的特色;披著市場競爭的外 衣,卻具中央官僚的混亂本質。減少政治干預原是其改革目標,但決定實施管理式競爭卻 是政治運作的結果;存在既期望產生競爭的結構與行為,又不希望產生太多競爭結果的矛 盾。「內部市場」造成的衝擊包括:導致成本先增後降;產生新的無效率;縮減醫療給付 ,使社會醫療雪上加霜;風險套利、圖利私人,國民保健服務(NHS)仍需為醫療弱勢者 的最後保障;購買者缺乏充份資訊,仍處購買弱勢;大醫院較佔優勢,GPFH則處相對務勢 ;資源分配公式(RAWP)終歸失敗,醫療改革效果不佳。 今英工黨當政後,提出「管理式合作」的主張:由原強調醫療供給者與購買者分開, 走向合作;由以供給者強勢引導,轉向增加購買者的選擇權;從原「官僚行政關係」變成 「契約關係」、「夥伴關係」;由一年一訂的簽約方式走向長期契約;並整合初級、次級 的醫療照護、及社會醫療,建立國民保健服務(NHS)、醫療供給者、醫療消費者三贏的 局勢。基本上,英國之健康照護改革反應了政黨輪替的現象。 由英國之鑑戒:臺灣的全民健康保險宜漸進改革,審慎評析「管理式競爭」與「管理 式合作」的目標達成可能性。不是「解體」現存的全民健保組織;而是「再架構」(res ructure)一個更符合全民健康保險意識型態的健康保險組織和醫療型態;絕非「完全鬆 綁」(deregulation),而是「再規範」(reregulation),加強政府的監控能力;政府是全 民健保最後的「保險人」。不僅強調分工,更強調整合;不僅強調競爭,更強調合作;不 僅追求效率,更追求品質和公平性。 |
英文摘要 | Internal market, asserted by the Conservative Party in U.K. has the characteristics of managed competition. The impact of internal market is as follows:(1) the medical cost increases at beginning then decreases, but only decreases in some specialties of lowcost. (2) Inducing new inefficiency. (3) The reduction of insurance coverage causes the more severe shortage of social services. (4) Due to cream-skimming and profitmaking of the private insurance companies, NHS has to become the last protector for the medical- disadvantaged group. (5) Lack of full information causes consumers to become disadvantaged buyers of medical care. Larger hospitals take advantage of economic scale; but GP fundholders stay relatively disadvantaged. Resource Allocation Formula failed, and health care reform was claimed ineffective in U.K. In sum, internal market, though coated by market competition, is confusedly characterized by centralized bureaucracy. The original objective of health care reform in U.K. is to reduce the political interference, but results in more politicized. The Labor Party of U.K. claims "moving from managed competition to managed cooperation": transferring form the split of providers and consumers to mutual cooperation; from provider-orientated to consumer-targeted; from bureaucratic relationship to contract partnership; from one-year contract to long-term contract. In order to make NHS, medical providers and consumers all together to be winners, managed cooperation also needs to integrate primary, secondary medical care with social services. Lessons learned from U.K. are as follows: (1) The reform of National Health nsurance (NHI) in Taiwan should be made step by step with discreet evaluation regarding the effectiveness of managed competition and managed cooperation. (2) The contents of NHI reform should include: 1. restructuring an organization which will match the ideology of NHI and cope with the existing medical care system. 2. emphasizing reregulation instead of deregulation, and increasing the governments' regulatory power. 3. decentralization and integration should be emphasized. 4. government acting as the last insurer of NHI. |
本系統中英文摘要資訊取自各篇刊載內容。