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題 名 | 美國外包精神醫療管理式照護之介紹及其在臺灣實施的可行性探討=The Introduction of Mental Health Carve Outs in USA and the Feasibility of Applying to Mental Health Care Reform in Taiwan |
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作 者 | 張娟娟; 胡德偉; | 書刊名 | 公共衛生 |
卷 期 | 26:3 1999.10[民88.10] |
頁 次 | 頁193-206 |
分類號 | 419.57 |
關鍵詞 | 精神醫療; 外包管理式照護; 醫療管理; 醫療效率; Mental health care; Carve-out managed care; Health care management; Health care efficiency; |
語 文 | 中文(Chinese) |
中文摘要 | 臺灣公辦公營單一經營的健康保險理念,與美國商業式多元化的競爭機制迥然不 同。一九八○年代美國精神醫療照護,由於政府法令的優惠鼓勵,醫療設施的供給增加,導致精 神醫療費用持績急速上漲。外包精神醫療管理式照護於一九九三年在美國實施的主要動機, 就是基於有效控制醫療費用成長的經濟考量;至1996年為止,美國已有一億人口涵蓋在此外 包醫療管理式照護(如精神疾病、癌症、愛滋病、末期腎病等)的保險制度下。目前臺灣在第 三期精神醫療網計劃的規劃下,面臨七千張精神醫療病床即將加入醫療市場的衝擊,其在精神 醫療品質與費用成長的平衡點上,面臨嚴重考驗。雖然美國醫療照護體制,在經濟、政治、社 會及文化背景不同的情況下,對醫療可近性、醫療費用、品質的醫療策略與目標與我國差異頗 大;然而經由綜觀外包醫療管理式照護在美國醫療市場實施的潛在優點及缺點,藉此精神醫療 管理方式的改革,其增加醫療體系運作的效率,來達到抑制費用急遽成長、確保醫療品質與提 供適切精神醫療照護的目標,希望能對未來臺灣規劃精神醫療市場有所啟示。 |
英文摘要 | Taiwan has achieved universal health insurane coverage through the establishment of the National Health Insurance Program in 1995. The formulation of health insurance policy compared with that of USA with competitive strategy is far from straightforward. The supply of mental health care facilities were increased by the encouragement of US government's mental health policy in 1980s, but the cost of mental health care has increased rapidly since then. This so-called Mental Health Carve-out has led to a new "managed behavioral health care" industry consisting of management firms specializing in this service. Carve-out approach to mental health reform is hypothesized to contain care expenditures and resources devoted to mental health care at the beginning of 1993 in USA. It has been estimated that in 1996 more than 100 million Americans were enrolled in one of these carve outs including mental disease, AIDS, cancer, renal disease, et al. Under the third stage of mental health planning program developed by government in Taiwan, there will be approximate seven thousands more hospital beds to be supplied to the mental health care by year 2000. The impact of facing the dilemma to find an optimum balance among access, costs and quality on the mental health care will be a great challenge. Although each health care system places its relative emphases in goals of access, costs, or quality depending on its economic, political, social, and cultural background, drawing inspiration from the potential advantages and disadvantages by the experiences of mental health carve outs in USA will provide more provocative approaches in cost containment and quality improvement for the reform of mental health care in Taiwan. |
本系統中英文摘要資訊取自各篇刊載內容。