1995年實施全民健保是我國社會保險發展的重要里程碑。本文評估全民健保實施六年來在公平性、費用管控與品質提昇的成效，進而探討現階段面臨的問題及未來的發展方向。 根據過去六年來執行成效評估，在擴大納保對象，減少民眾就醫財務障礙與提昇醫療可近性等方面已有具體成果，有助於達成提供國民適當醫療服務的政策目標。至於控制合理的醫療費用，在過去六年間整體醫療保健支出占GDP的比重，維持在5.27-5.44%之間，且全民健保醫療費用成長在2000年也低於經濟成長率。 以下為三項應重視的改革方向： （一） 在公平性方面應加強的是，對經濟困難者繳納保費的協助，以及對偏遠地區醫療資源的充實與提昇。 （二） 在費用管控方面，首先應探討的是整體醫療保健支出占GDP的適當比重，以及全民健保支出在總醫療保健支出的比率應為多少的問題。次則就確定的醫療支出來檢討全民健保的給付項目和給付水準。最後則應落實財務調整機制，以維持財務收支長期平衡。 （三） 在醫療品質提昇方面，必須在總額預算的大架構下，擴大實施論病例計酬與論人計酬，合理調整支付標準，重視醫療品質的審查，加強醫事團體的專業自主性與分擔財務責任。

　　　　　Implementing the National Health Insurance (NHI) in 1995 is a milestone for the social insurance development in Taiwan. This paper assesses the outcome of the equity, cost containment, and quality improvement aspects of the implementation of the NHI in the past six years; then discusses the critical issues faced by now; and explores the future development of the NHI. Sccording to the outcome evaluation in the past six years, expanding the enrollment coverage, reducing financial barriers for the citizens in seeking medical services, and improving medical accessibility have showed concrete achievements, which helped reaching the policy goal of providing proper medical services to all citizens. As for cost containment, the total medical expenditure as percentage of the GDP for the past six years kept is between 5.27%-5.44% and the NHI medical expenditure grew at a slower rate than the economic growth in 2000. The areas that need improvement the most are the efficient use of medical resources and the improvement of care quality, which are still in the starting phase and need more efforts. There are three major reform directions: (1) For the equity issue, reinforcing he assistance to people with financial difficulties in premium contribution and promoting medical resources in the remoted areas should be emphasized. (2) For cost containment, the first thing to be addressed is the appropriate ratio of national health expenditure to the GDP and the ratio of NHI expenditure to the national health expenditure. Secondly is to review the NHI benefit items and payment schedules in the context of a fixed medical expenditure. Finally is to carry out the autonomous financial readjustment mechanism for the long-run financial balance. (3) For medical quality improvement, it should expand case payment and capitation payment widely under the infrastructure of the global budget, adjust the payment schedules reasonably, emphasize medical quality review, reinforce the professional autonomy and financial responsibility of the medical providers.