| 摘要註: |
全民健康保險全面實施上限制總額支付制度屆滿十年,其框架和實質內容經過多次修改,2013年正式進入二代健保,除了落實總額制度為控制健保支出的框架外,導入Tw-DRGs制度以期改善論量計酬造成的醫療費用逐年攀升。總額制度應屬保險人與醫療供給者,就特定範圍的醫療服務項目預先協商醫療費用總額度,質變成被保險人與醫療供給者協商醫療費用總支出,保險人成為兩者間之仲裁者。本文以醫事人員的角度,將總額支付制度、支付及審查標準訂定和計酬制度,衍生出影響醫療供給者與被保險人基於自身地位所產生的權利義務問題,以及憲法賦予健保法所須貫徹的健康權保障目的,逐一討論。第一章緖論,將健保總額支付制度如何影響醫療產業,進一步探討衍生的問題可能對人民健康權造成如何侵害,為核心議題之研究設定。第二章癌症放射治療的類型與應有的醫療行為,將癌症的定義、期別、治療方式、治療目的與醫療行為間的各自獨立和相互關連,先作論述前的說明。第三章總額支付制度,首先介紹總額制度的概念與內容,並以我國全民健康保險法所規範之診斷關聯群支付標準及病例審查辦法,將總額支付制度與癌症治療給付間的關係作現況的描述。第四章總額支付制度對醫師醫療行為之影響,將總額預算造成的醫療行為扭曲,以臨床實例佐證目前的醫療困境。第五章人民權利因醫療行為取捨之影響,以重症病患為主軸,論述健康權在憲法及法律應受保障之目的,在總額制度下醫療給付項目與人民對滿足健康保障之期待,已難取得平衡。第六章結論。 The National Health Insurance (NHL) of Taiwan implement the expenditure cap global budget system almost ten years, also its framework and substance got modified many times during the term. In order to improve the increase with years on medical fees by Fee-For-Service, here comes the 2nd Generation NHI policy formally in 2013, the Controlling Organization execute the Tw-DRGs system into it to hope that Global Budget System can control the extraneous expenses on NHL. Actually, the Global Budget System has evolved into a complicated circumstances, so this research is based on a radiologist of Radiation Oncology's point of view to discuss how the influence of this policy on the total amount medical fees among National Health Insurance Administration, medical treatment provider and the public. Chapter 1, Introduction will be the stock issues about how the influence of the Global Budget System to medical services and also infringed the right to health of the public. Chapter 2, as the radiation therapist, will discuss the types of cancer and treatment ways of Radiation Therapy. Chapter 3, will introduce the Global Budget System here then describe the situation from Dignosis Related Groups and medical chart review by NHI, especially influence on Radiation Therapy. Chapter 4, to be more precisely, put real clinical cases to discuss the twisted circumstances due to the Global Budget System. Chapter 5, nowadays, is getting hard to get balance on the right to health for people especially the critically ill patients because of the Global Budget System. In fact, these sections contravene the constitution. Chapter 6, conclusion. |