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題名：民眾對全民健保給付合理論責機制之態度調查
書刊名：臺灣公共衛生雜誌
作者：吳全峰／董鈺琪
作者(外文)：Wu, Chuan-feng／Tung, Yu-chi
出版日期：2018
卷期：37:2
頁次：頁166-181
主題關鍵詞：合理論責機制；全民健康保險；給付決策流程；分配正義；Accountability for reasonableness；A4R；National health insurance；NHI；Treatment/drug reimbursement decision-making process；Distributive justice
原始連結：連回原系統網址new window
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  • 被引用次數被引用次數:期刊(1) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:0
  • 共同引用共同引用:112
  • 點閱點閱:8
合理論責機制（accountability for reasonableness, A4R）為健康照護分配正義評估提供完整連貫之理論架構，本研究目的便係瞭解民眾（作為重要利害關係人）對於將A4R要件納入全民健保給付決策機制之態度與認知，並探討可歸因性之相關因素。方法：研究對象為20歲以上全國民眾，採隨機抽樣並輔以電話訪問，樣本數為1,140位，以多項式邏輯斯迴歸探討可歸因性與民眾特性、公開性、參與性及可修正性之關聯性。結果：多數受訪者認為可歸因性、公開性、參與性與可修正性為健保給付決策機制之重要要素，但僅少數受訪者認識相關機制。就健保給付決定因素分析，重視藥物/醫療服務價格勝於治療效果者，與年齡、教育程度、收入、醫療利用、公開性及參與性有關；重視疾病負擔勝於治療效果者，與年齡、收入、慢性病及參與性有關。結論：民眾普遍認為健保給付決策機制納入A4R要件有其重要性，但認知與態度存在差距；且可歸因性與民眾特性、公開性、參與性有關。
Objectives: Accountability for reasonableness (A4R) provides a coherent theoretical framework to evaluate healthcare distributive justice as part of healthcare policy. This study aimed to analyze people’s knowledge about and attitudes toward employing A4R (including relevance of decisions, transparency, involvement of stakeholders, and revisability) in the National Health Insurance (NHI) treatment/drug reimbursement decision-making process, and to explore factors associated with the relevance of such decisions. Methods: A total of 1,140 adults aged 20 and over were randomly sampled from a nationwide population and interviewed by telephone. Multinomial logistic regression was used to examine the associations of individual characteristics, transparency, involvement of stakeholders, and revisability with the relevance of decisions. Results: Most respondents regarded A4R as essential to the NHI reimbursement decision-making process, but only few recognized how A4R was implemented. Additionally, with regard to considerations about setting healthcare priorities - (medical efficacy, disease burden, treatment/drug price), respondents' concerns about price were associated with age, education, income, medical utilization, and their subjective perspectives about transparency and the involvement of stakeholders. Their concerns about disease burden were associated with age, income, chronic disease status, and subjective perspective about the involvement of stakeholders. Conclusions: Even though most people agree on employing A4R to support fair priority-setting in NHI's reimbursement decision-making, a gap exists between their attitudes and knowledge. Additionally, public attitudes about the relevance of decisions are associated with socio-economic characteristics and concerns about transparency and the involvement of stakeholders.
期刊論文
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5.van Exel, J.、Baker, R.、Mason, H.、Donaldson, C.、Brouwer, W.、Team, EuroVaQ(2015)。Public views on principles for health care priority setting: findings of a European cross-country study using Q methodology。Soc Sci Med，126，128-137。  new window
6.Daniels, Norman(2008)。Just health: meeting health needs fairly。Bulletin of the World Health Organization，86(8)，653。  new window
7.Kapiriri, L.、Norheim, O. F.(2004)。Criteria for priority-setting in health care in Uganda: exploration of stakeholders' values。Bull World Health Organ，82，172-179。  new window
8.Gibson, J. L.、Martin, D. K.、Singer, P. A.(2005)。Priority setting in hospitals: fairness, inclusiveness, and the problem of institutional power differences。Soc Sci Med，61，2355-2362。  new window
9.Kapiriri, L.、Norheim, O. F.、Martin, D. K.(2009)。Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making?。Soc Sci Med，68，766-773。  new window
10.Goetghebeur, M.、Castro-Jaramillo, H.、Baltussen, R.、Daniels, N.(2017)。The art of priority setting。Lancet，389，2368-2369。  new window
11.Martin, D. K.、Abelson, J.、Singer, P. A.(2002)。Participation in health care priority-setting through the eyes of the participants。J Health Serv Res Policy，7，222-229。  new window
12.Gibson, J. L.、Martin, D. K.、Singer, P. A.(2004)。Setting priorities in health care organizations: criteria, processes, and parameters of success。BMC Health Serv Res，4，25。  new window
13.Kapiriri, L.、Norheim, O. F.、Martin, D. K.(2007)。Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda。Health Policy，82，78-94。  new window
14.Byskov, J.、Bloch, P.、Blystad, A.(2009)。Accountable priority setting for trust in health systems--the need for research into a new approach for strengthening sustainable health action in developing countries。Health Res Policy Syst，7，23。  new window
15.Maluka, S.、Kamuzora, P.、Sansebastian, M.(2011)。Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation。Implement Sci，6，11。  new window
16.陳珮青、李玉春(20150400)。以德菲法建構醫療資源配置：政策利害關係人觀點。臺灣公共衛生雜誌，34(2)，193-203。new window  延伸查詢new window
17.Daniels, N.(1999)。Decisions about access to health care and accountability for reasonableness。J Urban Health，76，176-191。  new window
18.Daniels, N.、van der Wilt, G. J.(2016)。Health technology assessment, deliberative process, and ethically contested issues。Int J Technol Assess Health Care，32，10-15。  new window
19.Abelson, J.、Giacomini, M.、Lehoux, P.、Gauvin, F. P.(2007)。Bringing 'the public' into health technology assessment and coverage policy decisions: from principles to practice。Health Policy，82，37-50。  new window
20.Mantel, J.(2010)。Setting national coverage standards for health plans under healthcare reform。UCLA Law Rev，58，221-279。  new window
21.Kingham, R.、Wheeler, J.(2009)。Government regulation of pricing and reimbursement of prescription medicines: results of a recent multi-country review。Food Drug Law J，64，101-114。  new window
22.Weide, U.(2001)。Coverage and medical necessity determinations: US managed care treatment decisions versus German administrative rulemaking。ILSA J Int'l & Comp L，8，507。  new window
23.Lopert, R.(2009)。Evidence-based decision-making within Australia's pharmaceutical benefits scheme。Issue Brief，60，1-13。  new window
24.Barnieh, L.、Manns, B.、Harris, A.(2014)。A synthesis of drug reimbursement decision-making processes in Organisation for Economic Co-operation and Development countries。Value Health，17，98-108。  new window
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30.林國明、陳東升(20031200)。公民會議與審議民主：全民健保的公民參與經驗。臺灣社會學，6，61-118。new window  延伸查詢new window
圖書
1.Daniels, N.、Sabin, James E.(2002)。Setting Limits Fairly-Can We Learn to Share Medical Resources?。New York：Oxford University Press。  new window
2.Groves, Robert Martin、Fowler, Floyd Jackson Jr.、Couper, Mick P.、Lepkowski, James M.、Singer, Eleanor、Tourangeau, Roger(2004)。Survey Methodology。John Wiley & Sons, Inc.。  new window
3.WHO(2008)。Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health。Geneva：WHO。  new window
4.WHO(2006)。Equity and Fair Process in Scaling Up Antiretroviral Treatment: Potentials and Challenges in the United Republic of Tanzania。Geneva：WHO。  new window
5.WHO(2014)。Making Fair Choices on the Path to Universal Health Coverage: Final Report of the WHO Consultative Group on Equity and Universal Health Coverage。Geneva：WHO。  new window
6.Syrett, K.(2007)。Law, Legitimacy, and the Rationing of Healthcare: A Contextual and Comparative Perspective。New York, NY：Cambridge University Press。  new window
7.Davies, C.、Wetherell, M.、Barnett, E.(2006)。Citizens at the Centre: Deliberative Participation in Healthcare Decisions。Bristol, UK：Policy Press。  new window
8.陳義彥、黃紀、洪永泰(2016)。民意調查研究。臺北：五南。  延伸查詢new window
9.Calabresi, Guido、Bobbitt, Philip(1978)。Tragic Choices。New York, NY：Norton。  new window
10.Davies, C.、Wetherell, M.、Barnett, E.(2006)。Citizens at the centre: Deliberative participation in healthcare decisions。The Policy Press。  new window
11.Department of Health(2000)。The NHS Plan - A plan for investment, A plan for reform。London：Department of Health (DoH)。  new window
其他
1.NICE。Get involved，https://www.nice.org.uk/get-involved。  new window
2.NICE。NICE guidance，https://www.nice.org.uk/guidance。  new window
圖書論文
1.吳全峰(2009)。健康照護資源分配之界線--兼論醫療科技發展下健康照護資源分配之變與不變。2009科技發展與法律規範雙年刊。臺北：中央研究院法律學研究所籌備處。  延伸查詢new window
2.雷文玫(2011)。司法審查健保給付決策的正當性及其界限？--全民健保高科技診療項目判決分析。2010行政管制與行政爭訟。臺北：中央研究院法律學研究所。new window  延伸查詢new window
3.雷文玫、鄧宗業(2004)。建構權責相符的醫療服務支付制度。二代健保規劃叢書--全民健保醫療資源配置合理使用。臺北：衛生福利部。  延伸查詢new window
4.陳東升(2004)。全民健保的公民參與。公民參與︰審議民主的實現與全民健康保險政策。臺北：衛生福利部。  延伸查詢new window
5.Rättilä, T.(2000)。Deliberation as public use of reason-or, what public? whose reason?。Democratic Innovation: Deliberation, Representation and Association。London：Routledge。  new window
 
 
 
 
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