Page 39 - 2018-19全民健康保險年報

給付完整 就醫便利
Comprehensive Benefits and Convenient Access
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the NHI launched its Taiwan Diagnosis Related Groups(Tw-DRGs)program on January 1, 2010, followed by a second stage of the program, which has been in effect since July 2014.
Global Budget Payment System
The NHIA has phased in global budget payment for dental care, traditional Chinese medicine, primary-level Western medicine, and hospital care since 1998, and implemented a full- scale global budget payment system in 2002, which effectively curbed the growth rate of medical expenses to within 5%. See Chart 3-1 for the NHI medical expenditure growth rates since 2009.
Starting 2010, the global budget departments’ medical expenditure agreement growth rates are as shown in Table 3-4.
To ensure that the quality and scope of the care provided by medical service organizations is not affected by the implementation of the global budget payment system, while negotiating global medical expense budgets, NHIA also drafts quality assurance programs. These quality assurance programs for global budget sectors include medical services quality satisfaction surveys, complaints and reported case handling mechanisms, insured care accessibility monitoring. NHIA has also determined clinical services guidelines for professional treatment
圖3-2 Chart 3-2
年度醫療給付費用總 額，由主管機關於年度 開始6個月前擬訂其範 圍，經諮詢健保會後， 報行政院核定
Health authorities figure out general parameters for the overall global budget six months before fiscal year begins. After consulting with the NHI Committee, health authorities send the proposed global budget parameters to the Executive Yuan for approval.
年度開始6個月前 Six months before fiscal year begins
健保會於年度開始3個月 前，在行政院核定總額 範圍內，協議訂定醫療 給付總額及其分配方式
Once Executive Yuan approves the global budget parameters, the NHI Committee discusses and sets the final global budget and how it will be allocated three months before fiscal year begins.
年度開始3個月前 Three months before the fiscal year
保險人於健保會協議 訂定醫療給付總額後1 個月，將保險費率提 請審議
Within one month after the NHI Committee completes its review, the NHIA must set the health insurance premium rate and submit it for approval.
年度開始2個月前 Two months before fiscal year begins
健保會應於年度開始1個 費率公告實施 月前依協議訂定之醫療給 Premium 付總額，完成該年度應計 rateimplemented 之收支平衡費率之審議
全民健保醫療費用總額收支連動機制
Total NHI Medical Income and Expenditure Linkage Mechanism
The NHI Committee must complete full review of premium rate needed to balance revenues and expenditures under global budget system at least one month before fiscal year begins.
年度開始1個月前 One month before fiscal year begins
不 能 於 期 限 內 完 成 審 議 時，由主管機關逕行報 行政院核定後公告
If review cannot be completed by the deadline, the MOHW send the premium
rate proposal to the Executive Yuan for approval and implementation.
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Chapter