初探我國健康照護改革方案—
以促進國民健康與重視被保險人個人責任為策略

李明謙

doi:10.6342/NTU201702634

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初探我国健康照护改革方案— 以促进国民健康与重视被保险人个人责任为策略

The Preliminary Study of Taiwan National Health Care Reform— Implementing the Strategies of Health Promotion and Regarding Personal Responsibility

李明谦 , 硕士　　导师：洪一薰　　

繁体中文 DOI： 10.6342/NTU201702634

健康照护改革；健康促进；个人责任；部分负担；医疗储蓄帐户；个人健康资讯帐户； health care reform ； health promotion ； personal responsibility ； co-payment ； medical savings accounts ； personal health information accounts

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摘要 │ 参考文献 (104) │ 国际计量

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Since 1995, our country has implemented the National Health Insurance as the health care system. Over the past 20 years, the system has success in the almost fully insurance coverage with high satisfaction rate, and has become a role model of other countries owing to the good performance on overall care effect at a relative low premium rate. Nevertheless, we have also gradually faced the shortages and the pitfalls of the system that needs to be reformed urgently, including the lack of sustainable financial plan and the medical resources wasting problems, the lack of health promotion strategies, and the unsuccessful referral system. Even though people enjoy the relatively cheap and convenient medical service, a group of people live in an unhealthy way, and does not meet the standard healthy life defined by the World Health Organization (WHO). A comprehensive reform of our national health care system is another urgent issue while the government make efforts on long-term care policies.
  After exploring the possible key factors that affect people’s health and reviewing the literatures with health care reform policies of other developed countries and the associated theories with human behavioral theory, this thesis suggests implementing the strategies regarding health promotion and personal responsibility to ensure sustainable management of the National Health Insurance System. This research also makes efforts on proposing the matching programs as the short, medium and long-term reforming policies. The short-term program is a comprehensive review of the existing co-payment system, which puts more emphasis on the personal responsibility and is supposed to effectively prevent medical resources from being wasted. The medium-term program is the implementation of the personal medical savings account system to encourage the healthy behavior of the insured, which is also compatible with the principle of user-pays and saving for the future expense. The long-term program is to establish personal health information account system supervised by both doctors and patients. Under the principles of personal consent and information security, different health information is proactively communicated to health care providers and insurance managers to offer the more precise treatment, the health improvement methods and the more efficient resource-managed policies, which will also carry out the integrated patient-centered care system through the multiple feedback mechanisms. It is expected that these preliminary programs will serve as a reference for the country to formulate relevant policies and contribute to the health promotion of insured people in the national health insurance program.

参考文献 ( 104 ) 〈TOP〉

Baker, A. M. and Hunt, L. M. (2016). Counterproductive Consequences of a Conservative Ideology:Medicaid Expansion and Personal Responsibility Requirements. American Journal of Public Health, 106, pp.1181–1187.
连结：
Barber, R. M., et al. (2017). Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015. The Lancet, 390(10091), pp. 231–266.
连结：
Blendon, R. J., Benson J. M. and Hero, J. O. (2014). Public Trust in Physicians-U.S. Medicine in International Perspective. The New England Journal of Medicine, 371, pp. 1570-1572.
连结：
Coombs, J. G. (2005) The rise and fall of HMOs: an American health care revolution. Madison,Wisconsin, University of Wisconsin Press, 430 pages, p. 277.
连结：
Deber, R. B. (2003). Health Care Reform: Lessons From Canada. American Journal of Public Health, 93(1), pp. 20-24.
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引用含有DOI的文献

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。 如想对DOI的使用与概念有进一步了解，请参考 （ ） 。

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。如想对DOI的使用与概念有进一步了解，请参考（）。