結論與建議

第五章討論

第三節結論與建議

(一)運用全民健康保險對象醫療費用申報資料，可將保險對象之照護提供者建構為課責式照護組織，並可作為課責保險對象照護品質與費用之基礎。

(二)課責式照護組織照護人數規模增加，有助於減輕預算風險；運用論人計酬設定預算，採用預測力愈高之風險校正模式，有助於降低預算風險。

(三)績效風險應獨立於財務風險之外，並作為設算節餘分享基礎，以反應醫療提供者醫療照護成效，避免傳統論人計酬過度轉嫁預算風險之問題。

二、建議

(一)研究建議

1.未來應針對保險對象門診持續照護率之影響因素進行探討，由於門診持續照護率影響風險校正模式之預測力與課責式照護組織之財務風險，藉由研究探討可以更完整評估與控制該因素其課責式照護組織之影響。

2.績效風險評估方法，未來應進一步分析不同課責式照護基礎其特定疾病或處置照護醫療資源耗用之差異，藉由瞭解各照護組織間醫療服務量與醫療照護密度變異情形，建立更完整的績效風險評估架構，並作為提升醫療照護效率之參考。

3.本研究僅分析課責式照護組織 1 年之財務風險影響，考量課責式照護組織多採至少須加入 3 年以上之長期參與設計，未來應可進一步進行長期趨勢模擬分析，瞭解課責式照護組織支付模式對醫療提供者長期之財務風險影響情形，以提供更完整政策參考資訊。

(二)政策建議

1.本研究發展之課責式照護組織建構與病人歸屬方法，可提供政策決策者參考，作為發展評估保險對象照護品質與費用管理之分析單位，以及協

助醫療提供者建構課責式照護組織之基礎。

2.課責式照護組織規模應有最低照護人數之規定，且設定課責式照護組織之目標預算，應導入較能合理反映保險對象健康狀態差異之健康基礎風險校正模式，以降低醫療提供者之預算風險。

3.課責式照護組織若僅以忠誠病人(門診持續照護率達 50%以上)為照護對象，其目標預算設定公式應納入可反映保險對象健康狀態差異之風險校正因子，以改善目前僅採用性別年齡等人口因子設定預算，可能低估保險對象醫療費用需求導致醫療提供者預算風險增加之問題。

4.課責式照護組織支付模式，應將績效風險納入作為論質計酬監測給付指標或作為分配節餘之機制，以落實課責基礎支付鼓勵醫療提供者提升照護成效改善之目的，並降低醫療提供者財務風險之不確定性。

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在文檔中發展台灣全民健康保險課責基礎支付模式 (頁 107-122)

第五章 討論

第三節 結論與建議