对台湾地区全民健保总额控制下相对值表制度介绍及思考

Introduction and Thinking about the Resource-Based Relative Value Scales under the Control of Global Budgets of Taiwan’s National Health Insurance

总额预算支付制度限制了健保费用的总支出,相对值表制度确定了医疗服务项目的支付标准,两种制度的配合使用为台湾建立了公平合理的健保支付框架,对健保的良好运行和持久经营功不可没。本文通过对台湾地区此两种制度在健保支付方面的具体应用情况的介绍,并结合大陆地区试点城市类似模式的实施情况,对此模式提出思考与评价。

The total expenditures of the heahh insurance costs are limited by the global budgets, and the payment standard of medical services is determined by the Resource-Based Relative Value Seales. The successful joint implementation of two systems is results in the establishment of a fair and reasonable payment framework of Taiwan＇s national health insnrance, and also makes it continuous and steady. The two systems are introduced in details, and the effects with pilot projects of mainhmd China are compared to get some thinking and evaluation.