台湾医保启示(大陆中国中药协会20131012t)概要1.ppt

? 1995年全民健康保险开办时采「论量计酬」支付制度。 　1997年起，选取部分较为简单且易标准化的手术项目改 　采「论病例计酬」方式支付，为进一步控管医疗费用成 　长，自1998年起到2002年，全面导入「总额预算支付制 　度」。此外，为提升医疗照护质量，以全人照护为核心 自2001年开始试办「论质计酬」支付方式。 ? 为了让医疗服务的支付标准化，健保局在2004年导入了 以医疗资源耗用愈多，则支付点数愈多的相对值表制度 ，而在住院支付方式上，预定于2010年开始实施台湾版 的「住院诊断关联群」，以不断改进健保支付制度的合 理性。 * * * Most prescription drugs are covered under Taiwan’s NHI. And one may ask who makes the decisions on drug coverage? Well, A drug review committee established under the BNHI makes decisions on: Types of drugs to be covered. Reimbursement prices for new drugs. Setting restrictions in drug indications when necessary. * * The uttermost factor to be considered for covering new drugs is the relative effectiveness. To review the relative effectiveness, we require the drug company to report on which existing drug is the new drug comparing, then our pharmaceutical experts will review them. It is better to have the clinical test of the head to head comparison between the new drug and the second-best item. But since it is rather difficult to obtain head to head comparison, indirect comparison is also accepted. * The BNHI also takes into account the financial impact if a new drug is included. We usually ask the drug company to submit sales projection for 3 years. And we will analyze internally the effect on the drug expenditures and overall medical expenditures. If it will have a major impact on the NHI finance, then we would ask the drug company to reduce their prices or set limit to the indications. * * * * * * * * * * * ? 台湾实施全民健康保险的成果可以归纳为：全民纳保、 　就医方便、负担得起费用、民众满意度高，同时医疗 　质量达一定的水平。 ? 全民健康的核心价值在于透过社会互助、以「社会保 险」的形式，来分担每一个保险对象的疾病医疗与财 务风险。 ? 以全国每人平均医疗费用为比较基准，低收入户每人 平均的医疗费用为全国每人平均值的2倍，65岁以上 者的费用则为3倍，癌症、洗肾、及血友病等之平均 医疗费用则分别为6.2倍到114.3倍不等，充分发挥了 社会保险的功能。 * * * * * * * * * * * * 台湾医保中药报销项目与价格 1.囊锭式中药均列入报销目录 2.饮片式中药均病患自费 3.中药报销采每日定额药费 　 　 　 　 　 　 　 　 　 　 　 NTD $100 Millions 　 　 　 　 　 　 　 　 　 　 　 　 　 Expenditures 99 00 01 02 03 04 05 06 07 08 09 10 Meical claim