全民健保實施總額預算制度之後，原本濟世救人的醫療院所，逐漸產生醫療體制企業化、私有化與市場化的趨勢。因此，當台灣醫療的最後「道德」防線也被資本主義體制攻陷以後，它除了有利於資本家外，受害的卻是全社會，至少它阻礙了醫學的研究、進步與發展。在「一切向錢看」的醫療發展趨勢下，是否會讓醫師置身於外，抑或正在侵蝕人們對醫師所期待的道德要求，同時扭曲醫學院所教育的價值觀。
為了進一步了解台灣現行實施總額預算制度之醫療成本問題，是否確切將影響醫療資源合理分配及達社會公平及醫療行為與病患就醫權益。本文除了以文獻探討，分析諸多學者對於醫療成本控制影響醫師的公義、道德和社會責任心的正反評論，同時對於醫療醫病行為的差異，希望分別透過醫師及病患的深入訪談，檢視醫師及病患對於總額預算制度實施的看法，以及在此醫療成本控制機制之下，是否影響醫師的醫療行為與腐蝕了醫師傳統的醫學教育價值觀，以呼應學者對於醫療成本控制，引發醫師公義與道德層次的影響。更希望得知醫病心勝，期盼能促進醫療生態的平衡發展，以達到民眾健康權更有保障。
從本文的研究發現，總額預算制度實施後，釵h醫院由於醫療成本的考量，嚴重影響醫師開立高成本藥方的行為。住院部份的重症病患則成為醫療人球或是被迫提早出院，對於需要龐大醫療給付的重症醫療，已經面臨人才難覓的困擾，也野憎荅f患僅為了盲腸炎的手術治療，都因此而被迫延宕至數個月後執行。此外，由於在有限的醫療資源下；使得瓜分醫療資源大餅日趨不易，部份醫師為了配合醫院財務自主管理機制，產生有違公義的醫療行為。例如醫師建議病患自費接受高科技儀器的檢查與診斷，不但加重釵h社會貧病的弱勢族群與老人的經濟負擔外，更使這些族群無法再追加有益於自我健康的部份負擔用藥或醫療費用。然而這些貧窮線以下的弱勢族群，也釵b各國社會福利的政策下，尚可得到政府的補助，最窮困的則是中低收入家庭的弱勢老人，不但家庭經濟有限，自己也無法順利就業，更難以支應部份負擔的診療費用。
為避免民眾權益受損，健保當局是否應該先設法解決醫療支付合理化問題，現行健保制度下，醫療齊頭式平等的給付，的確影響醫師看診的行為。此外，是否建立「退場機制」，讓經營不善的醫療服務機構，排除其與績效較佳的醫療服務機構搶食健保經費，以讓醫療提供者可以專注於完善的醫療服務提供。

Since the Global Budget System of National Health Insurance, medical institute used to save life has gradually turned such medical system with the trend of becoming private and market-oriented enterprise. Therefore, the last frontier of “ethics” for medical treatment in Taiwan has been completed collapsed by capitalism, and it has rendered the entire community to suffer and hindered the research, development, and progress of medicine, aside from merely beneficial to capitalist. Under the trend that development of medical treatment “heads towards money,” one would wonder if such context would keep doctor aloof, or erode the moral standards as expected of people upon doctor and distort the sense of value that medical school inculcates upon them.
We should further appreciate the problem of medical treatment cost when Global Budget System was implemented in Taiwan, and if it would, indeed, affect rational distribution of medical treatment resources, social justice and medical treatment behavior, and patient’s right for medical consultation. This paper will, aside from literature investigation, analyze the pros and cons of criticism from many scholars as they discuss how the costs of medical treatment should affect the justice, ethics, and social responsibility of doctors. Meanwhile, it would resort to in-depth interview of doctor and patient to view respectively the difference of medical treatment and doctor-patient behavior so as to examine the views of doctor and patient regarding the implementation of total payment system. As such, we can see if the medical treatment behavior of doctor is affected and conventional sense of value for medical education eroded under this cost control mechanism of medical treatment so as to echo with scholars who are concerned that the control of medical treatment might have affected the justice and ethics of doctor. It is further hoped that treatment of soul is better than illness, and we do hope that balanced development of medical treatment ecology can be achieved to render rights of health of the mass with greater protection.
As found form the study, when the Global Budget System was implemented it has seriously affected the behavior of doctors to issue high-priced prescription because many hospitals have to consider the cost consideration of medical treatment. Critical patients staying at hospitals have either become human balls of medical treatment or have to be evicted early, and it has created the problem finding suitable of medical talents for the medical treatment of critical illness in need of massive medical expenses. As such, patient for appendicitis operation might have to wait for months with procrastination in the future. Besides, it has become more and more difficult to split a share of medical treatment resource under limited medical resources, and some doctors will, in coping with autonomous management mechanism of financial independence, render medical behavior in violation of justice. As a result, it will not only further burden the economic load of the underprivileged and the senior, but also turn these groups not to pursue with partial-payment medication or medical treatment that is beneficial to self-health. Nonetheless, these minority groups under the poverty line might, under social security policy of countries, obtain government subsidies. But the most impoverished group would be the minority senior from the middle and lower-income family as they are only financially limited but could not locate suitable work, not to mention that they can afford the partially –paid medical treatment expenses.
To avoid that the rights of the mass would be jeopardizes, the Health Insurance Bureau should, first, see to the problem of rational payment of medical treatment. As for current health instance system, equality payment of medical treatment would surely affect the behavior of doctor for consultation. Besides, we should reckon if “withdrawal mechanism” should be set up so that poorly managed medical service institute is excluded to strive for health insurance expenses with the better-performing medical service institute. As a result, the provider of medical treatment can be more focused on providing more comprehensive medical treatment service.