國內的現況，最有可能成為全民健保民營保險人的，應屬由大型醫療機構為主導所形成的似HMOs的機構（或稱「醫療組合」）。因此，本文即以大型醫療機構的管理階層為對象，進行焦點團體座談，探索以大型醫療機構髼為全民健保改革動力的可行性。在座談中，請受邀之大型醫療結構之代表，從全民健保實施之後對醫界的影響、醫療給付範圍之更張、對「醫療組合」的看法以及對全民健保採公辦民營體制的整體看法表示意見。醫界普遍認為現刪健保的論量計酬制既扭曲醫療生態，又造成大量之浪費，對於支付標準與醫療使用之審核亦迭有抱怨，但若轉型成醫療組合，則又對無法掌握風險因素深有戒心；雖嚮往整合，但對是否能夠整合成功，卻又缺乏信心。對於公辦民營模式，醫界也質疑其對醫療品質、醫療可進性與醫學教育的影響。但醫界歡迎醫療儲蓄帳戶制度，也建議可考慮試行開放式醫院制度。

Large Medical Institutions are the most hopeful candidates to become something like Health Maintenance Organizations (HMOs), should the National Health Insurance reform take a privatization route. As an effort to identify if major medical institutions can serve as an agent for the NHI reform, we invited CEOs from those medical institutions and organized then into three focus groups to discuss the related issues. The discussants expounded how the NHI program, particularly the benefit package and the payment system thereof, had affected the delivery system in Taiwan, argued for and against the desirability as well as feasibility of the possible policy of privatization. They believed that, the current fee-for-service (FFS) payment system had distorted medical priorities as well as engendered a great measure of waste. They complained on the reimbursement levels and the utilization review process; the CEOs in general, however, were less than confident that their institutions might be able to handle the elusive issues of risk selection on the patient’s side, and therefore were concerned the likelihood of success should their institutions transformed into an HMO. The discussants called in to questions of the privatization policy, for the policy might render lower quality and hinder medical education. They preferred a system of medical savings accounts, and anticipated a half-open delivery system might bring about better coordination among medical facilities of different levels.