健保制度與重症醫療體系之關聯探討及問題解決之興革方向

Abstract

八仙塵爆這樣的「極端災難」這次靠全體醫護人員熱血挺過，但救命不能只靠熱血。自1995年健保實施以來，至2011年醫師人數成長68％，但每日門診、急診等人次成長近109％，每日手術人次成長約114％，每千人配1.7名醫師，且醫療費用占台灣GDP（國內生產毛額）的比重只有7％，遠低於英國10％、美國17％。這篇論文，我們利用SWOT分析、民眾問卷、醫護問卷、回顧文獻與其他國家經驗來更清楚了解健保政策對重症醫療的衝擊。並歸納台灣重症醫師三項內憂、台灣醫療院所兩項外患，十二項改革重點、一個結構問題、一個根本問題。健保20週年，希望台灣能抓住這次機會，開始打造可長可久、合理公平的醫療體制。

Taiwan Formosa Water Park explosion such "extreme disaster" this time was survive by the enthusiasm of medical staff, but health care system can not rely on enthusiasm. Since 1995, the implementation of National Health Insurance System, to 2011 the number of physicians grow to 68%, but the daily outpatient, emergency patients grow nearly 109%, day surgery patients grow about 114%, with 1.7 doctors per thousand people, and the medical costs accounted for Taiwan's GDP (gross domestic product) accounted for only 7%, well below the 10% of UK, 17% in the United States. In this paper, we use SWOT analysis, public questionnaires, medical questionnaire, review of the literatures and the experience of other countries to understand and more clearly the impact of the health care policy to critical care system. We summary three internal problems to Taiwan critical physicians, two foreign aggression problems to Taiwan medical hospital, twelve focus problems of Taiwan National Health Insurance System, a structural problem, and a fundamental problem. Taiwan National Health Insurance System 20 anniversary, hopes the politician of Taiwan can grasp this opportunity, begin to build a permanent, reasonable and equitable health care system.