| 摘要: | 健保財務收支攸關醫院生存的關鍵，而健保支付制度的設計合理性影響醫院的經營甚鉅，健保署為了控制健保財務以及降低不必要的醫療花費，實施總額制度、門診量逐年遞減及藥價調整等政策對於醫院經營多所影響。
目前大多數的研究僅針對總額預算制度之實施成效、醫院對於總額預算實施後對於醫療院所經營的影響或採取之因應進行研究，且較多著重於地區醫院的研究，但對於區域教學醫院且對於因應總額預算制度之經營策略者著墨較少；希望藉由本研究可以提供區域醫院經營者最適經營模式之參考，在健保的架構下能醫療機構得以擺脫財務困境、健全發展並永續經營。
個案醫院面臨健保總額限制醫院業務的成長、健保點值嚴重被稀釋給付過低、藥品利潤空間被每年的藥價差調整壓縮以致無利可圖等共通性的困境，以及個別性的困境諸如稅賦負擔沉重、健保給付斷頭而連續虧損及租金成本高昂等；個案醫院經營受限種種健保制度桎梏及經營困境，從面臨經營危機，經過不斷的業務分析與調整，找到最適的經營模式:(一)降低門診量改善健保給付斷頭的問題 （二）增加自費收入（三）管控醫師用藥（四）健保額度科別重分配（五）租金漲幅調降協商。個案醫院找到最適化等則醫院財務收支為最佳的經營模式，為醫院帶來穩定的獲利，也替醫院管理交出一張漂亮的成績單。
未來建議政府應精算成本重新檢討健保費率，檢討重大傷病部分負擔不再完全給付，提高病患的部分負擔及對旅外國人回復健保身分的政策予以檢討，藉以降低健保資源的浪費，讓健保財務健全而得以用續經營。;The financial revenue and expenditure of health insurance is the key to the survival of the hospital, and the rationality of the design of the health insurance payment system has a huge impact on the operation of the hospital. Policies such as price adjustment have many impacts on hospital operation.
At present, most of the studies only focus on the implementation effect of the total budget system, the impact of hospitals on the operation of medical institutions after the implementation of the total budget, or the responses taken, and more emphasis is placed on the research on regional hospitals, but for regional teaching hospitals and Less attention is paid to the business strategy of the total budget system; it is hoped that this study can provide a reference for the most suitable business model for regional hospital operators, and under the framework of health insurance, medical institutions can get rid of financial difficulties, develop soundly and operate sustainably.
The individual hospitals face common dilemmas such as the total amount of health insurance restricting the growth of hospital business, the serious dilution of health insurance point value and the low payment, the profit margin of drugs being adjusted and compressed by the annual drug price difference, making it unprofitable, etc., as well as individual dilemmas such as taxation. Heavy burden, continuous loss of health insurance benefits and high rental costs, etc.; the operation of the individual hospital is limited by various health insurance system shackles and operational difficulties, from the face of business crisis, through continuous business analysis and adjustment, find the most suitable business model:( 1) Reduce the number of outpatient visits and improve the problem of decapitation in health insurance benefits (2) Increase self-pay income (3) Control physicians’ medication (4) Redistribution of health insurance quotas by department (5) Negotiations on rent increases and reductions. The case hospital finds the optimal business model, such as the hospital′s financial revenue and expenditure, which brings stable profits to the hospital and also handed over a beautiful report card for the hospital management.
In the future, it is suggested that the government should review the health insurance rates at actuarial costs, review the partial burden of major injuries and illnesses that are no longer fully paid, increase the partial burden of patients, and review the policy of returning foreigners to health insurance status, so as to reduce the waste of health care resources and make health insurance more affordable. Financially sound and able to continue operating. |
