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題名：風險校正：健康保險市場的效率與公平之關鍵
書刊名：中華公共衛生雜誌
作者：張睿詒／江東亮
作者(外文)：Chang, Ray-e／Chiang, Tung-liang
出版日期：1998
卷期：17:5
頁次：頁373-380
主題關鍵詞：風險校正；健康保險市場；健康保險改革；Risk adjustment；Health insurance market；Health care reforms
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(4) 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:3
  • 共同引用共同引用:0
  • 點閱點閱:66
　　　　　在傳統的健康保險市場，醫療效率與就醫公平是二個相互衝突的目標，多年來學者與政策制定者均致力於研究如何設計兼顧公平與效率的健康照護制度。近期在解決此一難題的發展，是建立於風險校正的設計。理論上，風險校正藉由風險平準基金的機制使保險人得收取風險計價之保費，而被保險人則是依其財務能力繳交保費。目前，一些西方國家已將風險校正應用於其市場導向之醫療改革上；台灣值此全民健保朝多元化保險人體制發展之際，實有必要對風險校正加以深入探討。在檢視風險校正理論以及國際實施風險校正經驗之後建議：(1)經修正後之荷蘭風險校正模式或可適 合台灣全民健保體制改革之需要，以及(2)台灣應立即加強風險校正相關議題之本土研究，以為制訂醫療改革政策之參考。
　　　　　Efficiency and equity are conflicting objectives under the traditional health insurance market, and for many years researchers and policy makers have striven to achieve both goals at the same time. Recent developments to resolve this dichotomy have been based on risk adjustment. In principle, risk adjustment works through the mechanism of equalization fund so that health plans are able to collect risk-adjusted premiums while the contribution of the insured is in accordance with their abilities to pay. S ome Western nations have already introduced risk adjustment to their market-oriented health care reforms. In Taiwan, where market-oriented health insurance proposals are under consideration by the government, it is timely to open the debate on the issue of risk adjustment prior to being implemented. After reviewing the theory of risk adjustment and international experiences on the application of risk adjustment, we recommend: (1) Netherlands' model may be modifiable and adapted to meet the need of Taiwan 's health care reform, and (2) more indigenous efforts should be immediately undertaken to study issues related to the introduction of risk adjustment in Taiwan.
期刊論文
1.van de Ven, W. P. P. M.(1996)。Market-oriented health care reforms: trends and future options。Soc. Sci. Med.，43，655-666。  new window
2.van Vliet, R. C. J. A.、van de Ven, W. P. P. M.(1992)。Toward a capitation formula for competing health insurers: an empirical analysis。Soc. Sci. Med.，34，1035-1048。  new window
3.Newhouse, J. P.、Manning, W. G.、Keeler, E. B.(1989)。Adjusting capitation rates using objective health measures and prior utilization。Health Care Financ Rev.，10(3)，41-54。  new window
4.Newhouse, J. P.、Buntin, M. B.、Chapman, J. D.(1997)。Risk adjustment and medicare: taking a closing look。Health Aff，16(5)，26-43。  new window
5.Light, D. W.(1992)。The practice and ethics of riskrated health insurance。JAMA，267，2503-2508。  new window
6.Newhouse, J. P.(1986)。Rate adjusters for medicare under capitation。Health Care Financ Rev.，6(supple)，41-54。  new window
7.Robinson, J. C.、Luft, H. S.、Gardner, L. B.(1991)。A method for risk-adjusting employer contributions to competing health insurance plans。Inquiry，28，107-116。  new window
8.Cave, D. G.、Schweitzer, S. O.、Lachenbruch, P. A.(1989)。Adjusting employer group capitation premiums by community rating by class factors。Med Care，27，887-899。  new window
9.van Barneveld, E. M.、van Vliet, R. C. J. A.、van de Ven, W. P. P. M.(1996)。Mandatory high-risk pooling: an approach to reduce incentives for cream skimming。Inquiry，33，133-143。  new window
10.Beebe, J. C.(1992)。An outlier pool for medicare HMO payments。Health Care Financ Rev.，14(1)，59-63。  new window
11.Gosfield, A. G.(1997)。Who is holding whom accountable for quality?。Health Aff，16(3)，26-40。  new window
12.Enthoven, A. C.、Vorhaus, C. B.(1997)。A vision of quality in health care delivery。Health Aff，16(3)，44-57。  new window
13.Grimaldi, P. L.(1997)。HEDIS is bigger and better。Nurs Manage，28(1)，17+21-22。  new window
圖書
1.行政院衛生署(1997)。全民健康保險實施二年評估報告。台北：行政院衛生署。  延伸查詢new window
2.van de Ven, W. P. P. M.。Risk-adjustment: the achilles heel of market-oriented health care reform。  new window
3.OECD(1995)。Direction in health care policy。Paris：OECD。  new window
4.McCarthy, T.、Davies, K.、Gaisford, J.(1995)。Risk-adjustment and its implications for efficiency and equity in health care systems。Basel：Pharmaceutical Partner for Better Healthcare。  new window
其他
1.中央健康保險局(1997)。八十五年一至十二月保險對象各年齡層平均每人西醫門、住診醫療利用狀況，臺北：中央健康保險局。  延伸查詢new window
 
 
 
 
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