由德英荷三國之經驗剖析我國健保醫院總額之採行

　　醫院總額已於民國91年7月1日實施，其推動原則為(1)預先規劃；(2)簡單上路；(3)漸進改革；醫院總額實施之初，其「遊戲規則」相當不明確，可預見醫院總額上路之後，將會有一段「黑暗期」，之後勢必須逐步將規範訂定的更明確，故本文希望藉由探討先進國家之經驗，做為我國未來改革之參考。本文建議：1.應確實區別醫院及診所的主要功能及目的；2.訂定醫院總額時，宜適度考量投入因素；3.訂定醫院總額時，應考量醫院間的差異性；4.醫院總額宜採支付上限制；5.醫院總額應同時將營運成本及資本成本納入；6.未來醫院總額可考慮以分層預算之方式分配醫院總額。

關鍵字：總額支付制度、醫院總額、全民健保〕
Analysis of the Global Budget Payment System in Taiwans Hospitals Based on Experiences in Germanly, England,and Holland
Abstract　　　　　　　　　　　　　　　　　　　　　　　　　　　　
The Global Budget Payment System in hospitals was brought into force on July 1, 2002. The principles are to (1) plan in advance, (2) emphasize simplicity, and (3) reform gradually. This study aims to review the Global Budget Payment System in developed countries and identify the advantages and disadvantages of these systems. Based on this analysis, we propose that regulators should: (1) distinguish the main functions of hospitals and clinics, (2) evaluate input factors when making budgeting decisions, (3) consider differences among hospitals when determining budgets, (4) limit hospital expenditures, (5) take into account operating costs and capital costs, and (6) consider integrating hospital accreditation in the future.

Keywords: global budget, global budget payment system in hospitals, national health insurance