臺灣衛(wèi)生系統(tǒng)陳述報告-組織結構融資渠道以及案例研究（英文版）

StructurePerformanceComparisonPrioritiesProblemsTaiwanHealthSystem--Structure,performanceandreformissuesPresenters:JenniferCorralesLisaGaynonEmmaYifanDengOctober12,2021OverviewandtimelineStructure,financinganddelivery-----------------4min--------------------------------------------------------------Performance,horizontalcomparison---------------------------------------8min----------------------------------------Healthreformpriorities,resultsandproblems----------------------------------------------------------12min-------------------Q&A----------------------------------------------------------------------------15minStructurePerformanceComparisonPrioritiesProblemsOrganizationalStructureOrganizationPerformanceComparisonPrioritiesProblemsTheExecutiveYuanMunicipalityGovernmentsDepartmentofHealth(2)DistricthealthcenterDepartmentofHealthCounty/citygovernmentsHealthBureau(23)TownshiphealthstationHealthroomDirectlyaffiliatedBusinessassociationSource:TaiwanDepartmentofHealth,PublicHealthReport2021,April2021FrameworkofMedicalCareSystemsDeliveryPerformanceComparisonPrioritiesProblemsSource:TaiwanDepartmentofHealth,PublicHealthReport2021,April2021Delivery:No.ofMedicalCarePersonnelDeliveryPerformanceComparisonPrioritiesProblemsSource:TaiwanDepartmentofHealth,PublicHealthReport2021,April2021Physiciansper1,000populationDentistsper1,000populationDeliveryPerformanceComparisonPrioritiesProblemsSource:NationalHealthInsuranceGlobalBudgetingGuidebook,2021No.ofhospitalsvs.No.ofClinicsDeliveryPerformanceComparisonPrioritiesProblemsSource:TaiwanDepartmentofHealth,PublicHealthReport2021,April2021Acutecarebedper1,000populationDeliveryPerformanceComparisonPrioritiesProblemsSource:NationalHealthInsuranceGlobalBudgetingGuidebook,2021Financing:NationalHealthInsuranceBNHIProvidersInsured/Employers/GovernmentOtherrevenuesLotteryrevenuesTobaccoexcisetaxPremiumspaymentscopaymentFinancingPerformanceComparisonPrioritiesProblems

Financing:Healthexpenditure/GDPFinancingPerformanceComparisonPrioritiesProblemsSource:NationalHealthInsuranceGlobalBudgetingGuidebook,2021RoleofgovernmentRoleofGov.PerformanceComparisonPrioritiesProblemsDemographicTrends:

CrudeBirthRate,CrudeDeathRate,andNaturalIncreaseRateofPopulationbyYearStructurePerformanceComparisonPrioritiesProblemsSource:TaiwanDepartmentofHealth,PublicHealthReport2021,April2021DemographicTrends:

Neonatal,InfantandMaternalMortalityRatesbyYearStructurePerformanceComparisonPrioritiesProblemsSource:TaiwanDepartmentofHealth,PublicHealthReport2021,April2021DemographicTrends:

ChangesinLeadingCausesofDeathStructurePerformanceComparisonPrioritiesProblemsSource:TaiwanDepartmentofHealth,PublicHealthReport2021,April2021LifeExpectancy:

IncreasestomorecloselyresembleOECDcountryprofileStructurePerformanceComparisonPrioritiesProblemsSource:TaiwanDepartmentofHealth,PublicHealthReport2021,April2021LifeExpectancy:

IncreasestomorecloselyresembleOECDcountryprofileStructurePerformanceComparisonPrioritiesProblemsSource:TaiwanDepartmentofHealth,PublicHealthReport2021,April2021LifeExpectancy:

IncreasestomorecloselyresembleOECDcountryprofileStructurePerformanceComparisonPrioritiesProblemsSource:TaiwanDepartmentofHealth,PublicHealthReport2021,April2021KeyHealthIndicators:

TaiwanandRegionalCountriesin2002StructurePerformanceComparisonPrioritiesProblemsSource:AdaptedfromR.Gauldetal./HealthPolicy79(2006)325-336KeyHealthIndicators:

TaiwanandRegionalCountriesin2002StructurePerformanceComparisonPrioritiesProblemsSource:AdaptedfromR.Gauldetal./HealthPolicy79(2006)325-336TrendsinOut-of-PocketSpendingonHealthcareStructurePerformanceComparisonPrioritiesProblemsSource:Wagstaff,A.WorldBankPolicyResearchWorkingPaper3790,December2005RegionalSystemComparisonsStructurePerformanceComparisonPrioritiesProblemsSource:AdaptedfromR.Gauldetal./HealthPolicy79(2006)325-336JapanSouthKoreaTaiwanRegulationMinistryofHealth,LaborandWelfareMinistryofHealthDepartmentofHealthandSubordinatesFundingSocialinsurancewithco-pays;3-tieredsocialinsurancewithmultipleproviders;commonpaymentscheduleSocialinsurancewithhighpatientco-pays;singlesocialinsurer;MedicaidschemeandprivateinsuranceSocialinsurancewithco-pays;singlesocialinsurer;directgovernmentfinancingProvisionMixofpublicandprivate;emphasisonoutpatientcarePrivatesectordominatesallservicedeliveryexceptpublichealth;highprovidercompetitionPrivatesectordominatesallservicedeliveryexceptpublichealth;highprovidercompetitionHealthFinancingComparisonsStructurePerformanceComparisonPrioritiesProblemsSource:Wagstaff,A.WorldBankPolicyResearchWorkingPaper3790,December2005.PercentofPopulationoverage65StructurePerformanceComparisonPrioritiesProblemsSource:NationalHealthInsuranceGlobalBudgetingGuidebook,2021MaternalMortalityRate(Per10,000)StructurePerformanceComparisonPrioritiesProblemsSource:NationalHealthInsuranceGlobalBudgetingGuidebook,2021InfantMortalityRate(per1,000livebirths)StructurePerformanceComparisonPrioritiesProblemsSource:NationalHealthInsuranceGlobalBudgetingGuidebook,2021CompareandContrast:JapanStructurePerformanceComparisonPrioritiesProblemsInsurancerequired-canchoosefromeitheremployer-basedornationalinsuranceGovernmentsubsidizespremiumsforthosewhocan’taffordthemCopayments:30percentofthecostofaprocedure,totalamountcappedbasedonincomeMOHsetspricesforeachprocedureMajorityofhealthcareprovidersintheprivatesectorCompareandContrast:TaiwanandJapanSimilaritiesSingle,governmentmanagedfeescheduleNoinsurancecompetitionHospitalservicesalmostentirelyprovidedbytheprivatesectorDifferences

SocialinsuranceschemeinplaceinJapansince1961GDPexpenditureonhealth:JapanismuchhigherAging:Japanhastwiceasmanypeople>65yearsoldasTaiwan(18%Japan,9%Taiwan)StructurePerformanceComparisonPrioritiesProblemsIsJapanafuturepictureofTaiwan?Quality“fastfoodmedicalservices〞,“threeminutesdiagnosis〞Cost-effectivenessTragedyofCommonGoodsResourcedistributionmountainareasandoff-shoreislandsPrioritiesStructurePerformanceComparisonPrioritiesProblemsUpgradeAdvancedaffiliationTheNationalHealthInsuranceIntegratedDeliverySystem(IDS)SubsidyIndigenouspeopleTransportationcostsInformationSystemTele-MedicalCareHISPACS(PictureArchivingandCommunicationSystem)StructurePerformanceComparisonPrioritiesProblemsFrameworkonHealthInformationNetwork

Source:P85,TaiwanPublicHealthAnnualReport,2021StructurePerformanceComparisonPrioritiesProblemsProblemsofNationalHealthInsurance(NHI)FinancialstatusUnbalancedinsuranceexpenditureBeneficiarypartiesPaymentbenchmarkStructurePerformanceComparisonPrioritiesProblemsBeforeNHI:Beneficiariesin1992Source:HealthSystemReformintheRepublicofChina—FormulatingPolicyinaMarket-basedHealthSystem,HealthAffairsStructurePerformanceComparisonPrioritiesProblems1950s1980sHighcostsMaldistributionofservices1987VotedtocreateandimplementNationalHealthInsuranceProgramJuly19,1994NHIpassedbythelegislatureJan,1995EstablishedBureauofNationalHealthInsurance(BNHI)March,1995BegantooperateNHI2002GlobalBudgetingG2NHIMilestonesofNHIStructurePerformanceComparisonPrioritiesProblems12345678901289/12/31B123456789楊志良NHIFinancingBNHIProvidersInsured/Employers/GovernmentOtherrevenuesLotteryrevenuesTobaccoexcisetaxPremiumspaymentscopaymentStructurePerformanceComparisonPrioritiesProblemsProblem1:FinancialStatusSource:DOH,ExecutiveYuan,TaiwanNote:thevalueof2021isestimated1USD=33NTDStructurePerformanceComparisonPrioritiesProblemsDeficitSource:DOH,ExecutiveYuan,TaiwanNote:thevalueof2021isestimatedStructurePerformanceComparisonPrioritiesProblemsProblem2:UnbalancedNHIExpenditureStructurePerformanceComparisonPrioritiesProblemsProblem2:UnbalancedNHIExpenditure:hemodialysis0.2%NHIinsured25.9%majorillnessorinjuryexpenditure>7%NHIresourcesSource:APolicyPlanningStudyforNationalChronicKidneyDiseaseProgramStructurePerformanceComparisonPrioritiesProblemsNumber1prevalenceandincidenceofdialysis:TaiwanTheprevalenceofdialysisTheincidenceofdialysisSource:UnitedStatesRenalDataSystemPermillionpopulationStructurePerformanceComparisonPrioritiesProblemsProblem3:Whoisthebiggestbeneficiary?StructurePerformanceComparisonPrioritiesProblemsBNHIProvidersInsured/Employers/GovernmentOtherrevenuesLotteryrevenuesTobaccoexcisetaxPremiumspaymentscopaymentWhoisthebiggestbeneficiaryparty?StructurePerformanceComparisonPrioritiesProblemsTremendouswasteofNHIbudgetNT$9,500perbagDiscardeddrugsStructurePerformanceComparisonPrioritiesProblemsStructurePerformanceComparisonPrioritiesProblemsPrioritiesvsproblemsQuality

Cost-effectiveness

Resourcedistribution

FinancialstatusUnbalancedinsuranceexpenditureBeneficiarypartiesPaymentbenchmarkAppendix1:HistoricalInsuranceSchemes

1950s1980s19501959196519801982LaborInsuranceGovernmentemployeesRetiredgovernmentEmployeesPrivateschoolstaffDependentsofgovernmentemployeesLate1980s1985198519901990RetiredPrivateschoolstaffSpousesofretiredschoolstaffFarmer’sHealthInsuranceDependentsofprivateschoolstaffLow-IncomeHouseholdInsuranceStructurePerformanceComparisonPrioritiesProblemsAppendix2:CharacteristicsofNHICoverageCompulsoryenrollmentforallcitizensandlegalresidentsAdministrationSingle-payersystemrunbygovernmentFinancingPayroll-basedpremiumGovernmentandemployerssharecontributionfortheinsuredandtheirdependentsBenefitsUniformedpackage,copaymentrequiredProvidersContrastbased92%ofproviderscontractedwithNHIPaymentUniformedfeescheduleundertheglobalbudgetPrivilegesPremiumandcopaymentsubsidiesforthedisadvantagesStructurePerformanceComparisonPrioritiesProblems

Appendix3:PremiumCalculationMethod

SalaryearnersTheinsuredInsurableincomexPremiumratexContributionratex(1+No.ofdependents)EmployerInsurableincomexPremiumratexContributionrateorgovernmentx(1+AverageNo.ofdependents)GovernmentInsurableincomexPremiumratexContributionratex(1+AverageNo.ofdependents)Regionalpopulation(Withoutsalaryorwages)TheinsuredMeanpremiumxContributionrate

(Withoutsalaryorwages)x(1+No.ofdependents)GovernmentMeanpremiumxContributionratexActualNo.oftheinsuredPremiumrate:4.55%sinceSept.2002

StructurePerformanceComparisonPrioritiesProblemsCategoryGovernmentEmployerInsured1stPrivate-sectorEmployees106030GovernmentEmployees__7030Self-e