Study of Regional Global Budget with Referral System–A New Solution for Taiwan National Health Insurance Policy
Date Issued
2007
Date
2007
Author(s)
Chen, Ta-Liang
DOI
zh-TW
Abstract
Background：The National Health Insurance System（NHIS）in Taiwan has been established since 1995. The high satisfaction ratio of the publicity pushes the government to the endless financial demand in medical care. The initial financial planning and internal regulation for budgeting was based on the basic principle of matching the need from the supply-side（hospitals and physicians vs. patients）of the medical market. However, the constant development for the new hospitals and medical innovations provoked the irreversible increases in the budget demand in the NHIS. In order to restrain the budget, the struggling between the private medical systems with the government seems to be inevitable.
Methods: In order to design a budgeting system, matching with the demand-side of the publicity instead of the supply-side of the medical group, prevention-based instead of therapy-based, we suggest a new model of operation providing the possibility of financial balance of government with acceptable quality of medical service. First, we search the journals and analyzed the major restraints and present difficulties of NHIS facing the hospital global budget system in Taiwan and compared with the world-wide NHIS applied in other western developed countries. Secondly, according to the data bank from BNHI（Bureau of National Health Insurance）for the disease entities of patients in different levels of hospitals, the regional characteristics of the patient source of the medical centers, we proposed the possibility of the regional global budgeting system to replace the present individualized hospital global budget system.
Results: The regional global budget system with the referral system would direct the future integration of regional medical system of different levels and function together. The major alterations of the health system would be: 1) The efficient profit-pursuing financial model for the future hospital development would change from the horizontal into the vertical integration; 2) The policy of financial distribution in this new system would convert the market from the supply-side（amount-centered）of medical service（physician-oriented）to the demand side（patient-centered）of general population（individual-oriented); 3）The health policy would shift from the therapeutic medicine（hospital-based）to the preventive medicine（public health-based）.
Discussion: There are several key successful factors in order to have a smooth operation, including: 1) To have vertical integration among the regional hospital and attending physicians, the availability and the accessibility of personal medical records from different health providers would be essential and important to avoid unnecessary repetition of medical consumption; 2) Community-based referral system with family physicians provides the background support for the completion of regional responsibility of medical care. However, the outlier’s free choice out of the regulation for special treatment is allowed but with extra-payment; 3) The independent auditing and negotiation system for the finance and quality evaluation between the contractors and the regional hospitals is needed as long as with the mutual transparency of information to secure the equity of the health system and the human right for the general population.
Subjects
全民健保
中央健保局
供給與需求
區域總額制
轉診制度
財務
National Health Insurance System
Bureau of National Health Insurance
supply vs. demand
regional global budget
referral system
finance
SDGs
Type
other
File(s)![Thumbnail Image]()
Loading...
Name
ntu-96-P93748029-1.pdf
Size
23.31 KB
Format
Adobe PDF
Checksum
(MD5):44ef82703b3f166b58179c881acb663f