醫院總額風險調整移撥款計畫介紹（以健保署東區業務組為例）

Introduction to the Total Hospital Risk Adjustment Transfer Funding Scheme (Taking Eastern District of National Health Insurance Administration as an Example)

李名玉(Min-Yu Lee)；羅亦珍(Yi-Chen Lo)；陳星助(Hsing-Chu Chen)；郭曉菁(Siao-Jing Guo)

醫療資源 ； 區域整合 ； 遠距健康照護 ； 健康不平等 ； 風險移撥款 ； Medical resources ； Integrated care ； Tele-healthcare ； Health inequalities ； Risk transfer funding allocated

醫學與健康期刊

10卷2期（2021 / 07 / 01）

125 - 134

繁體中文

全民健保為自助、互助及風險分攤的精神下建構社會安定基礎制度，目標為「提升民眾健康」、「健保永續經營」，而醫療體制因人口結構改變對醫療費用影響越來越大，歷年支出平均比收入高出8%，使收支不平衡，整體財務缺口持續擴大，東區所轄的衝擊尤為嚴峻。此外，花東地區平均餘命較全國低，也說明該區民眾相較其他五區之國人更早進入高醫療耗用需求階段；因此，東區運用風險移撥款推動區域整合，強化醫療體系間良好互動關係，且提供全面暨連續性照護模式，包含布建醫事人力支援區域聯盟、癌症個管共照網絡、建立急重症轉診之綠色通道，以降低醫療健康不平等，推動對病患具實質意義的「價值醫療」，此為全國健康照護體系應著重改革之挑戰，更是東區需超前部署之規劃。

The National Health Insurance program in Taiwan was social stability in the spirit of self-help, mutual assistance, and risk goals include ＂improving public health＂ and ＂health care sustainability.＂ Due to the change in population structure has had an, increasing impact on medical expenses, with over the years becoming on 8% higher on average than income, imbalance income and expenditure for the Bureau of National Health Insurance. Additionally, average life expectancy life in the Huadong area in the Eastern District is lower than the national average, indicating that the people in Huadong entered the stage of high medical consumption earlier than the people in other five areas. Eastern District used risk adjustment transfer funds to study promote medical regional integration. Results showed a need to better a Huadong cancer continuous care network, develop remote consultations, medical treatments, and remote wound consultations, and rationally allocate and medical resources in advance. In conclusion, it was foung the Eastern District (urgently) as well as the national healthcare system in general might want to incorporate ＂value medicine＂ to their plans for reform.

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