健保制度與健保改革

1、2022/2/211健保制度與健保改革健保制度與健保改革二代健保的展望二代健保的展望2022/2/212全民健保制度與社會公義全民健保制度與社會公義民眾面民眾面2022/2/213全民健保制度與社會公義全民健保制度與社會公義宏觀面宏觀面2022/2/214二代健保規(guī)劃二代健保規(guī)劃2022/2/215二代健保規(guī)劃二代健保規(guī)劃從可近性到可靠性從可近性到可靠性 2022/2/216量能付費的公平性量能付費的公平性保險費籌措及財務(wù)平衡保險費籌措及財務(wù)平衡 2022/2/217政府分擔(dān)部分政府分擔(dān)部分 2022/2/218僱用單位分擔(dān)部分僱用單位分擔(dān)部分 2022/2/219保險對象分擔(dān)部分保險對象分擔(dān)

2、部分 2022/2/2110EnrolleesBeforePresentReformOccupation-based health insurance program（58 of total population）Non insured population（42）1234.13Finance PoolingEmployer organizationGovernmentIIIVIVIIIVIFixed Financial ResponsibilityEmployer organizationGovernment 37% 30%33%NHI implementationPayroll-based

3、 & flat rate premium6 categories enrollees（98 of total population）Family Income - based premium33% 30%Finance pooling2022/2/2111資源配置的原則與操作資源配置的原則與操作2022/2/2112健保目前給付項目收載及調(diào)整健保目前給付項目收載及調(diào)整制度尚未健全制度尚未健全2022/2/2113協(xié)商討論2022/2/2114國外有關(guān)資源配置的經(jīng)驗國外有關(guān)資源配置的經(jīng)驗 2022/2/2115Political ProcessPublicParticipationAut

4、horizedOrganizationTechnological processExplicit RationingTransparence of decision makingKeep with social transitionMultiple channelsEnpowermentPoint of valuesMacro-levelconsensusMicro-levelconsensusCategorized service -Survey-WTP (willingness to pay) -SolidarityMethodology -DALY -QALY-Public View + Professionals suggestionSubjective preference + Objective science2022/2/2116醫(yī)療資源配置機(jī)制醫(yī)療資源配置機(jī)制2022/2/2117確保醫(yī)療可靠性（Accountability）的品質(zhì)制度2022/2/2118四大執(zhí)行策略四大執(zhí)行策略 2022/2/2119FinancingAccountabilityServicesPremium2022/2/2120PurchasingAccountabilityqualitypayment202