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    Please use this identifier to cite or link to this item: http://tkuir.lib.tku.edu.tw:8080/dspace/handle/987654321/33971

    Title: 全民健康保險系統代理問題之研究
    Other Titles: The agency problems in the system of national health insurance
    Authors: 尹志峰;Yin, Chih-feng
    Contributors: 淡江大學公共行政學系公共政策碩士班
    韓釗;Han, Charles Chao
    Keywords: 全民健康保險;總額支付;代理理論;代理成本;投機行為;有限理性;紮根理論;National Health Insurance (NHI);Global Budget Payment System;Agency Theory;Agency Cost;Opportunistic Behavior;Bounded Rationality;Grounded Theory
    Date: 2007
    Issue Date: 2010-01-11 04:43:54 (UTC+8)
    Abstract: 本研究之焦點係針對全民健康保險系統的財務問題,依據代理理論所提出的代理成本模型為架構,探討健保局與特約醫療院所間所形成之代理關係,並基於以行為為基礎的契約與以結果為基礎的契約,分析代理結構中監督成本、約束成本與剩餘損失之間的互動,提出以下四項主要發現及相關策略建議。


    This research focused its efforts on probing the financial problems of the National Health Insurance (NHI) System. In accordance with the agency cost model proposed by agency theorists, this research investigated the agency relationship between the Bureau of National Health Insurance (BNHI) and the contracted medical care institutions. Moreover, this research analyzed the interactive effects among monitoring cost, bonding cost, and residual loss resulted from behavior-based contract and outcome-based contract, respectively. Based on the analyses of this research, four major findings and related strategies are stated as follows:

    First, the incentive structure embedded in the financial system of NHI may be one of the major causes that result in financial deficits. The incentive structure tends to motivate overgrazing behaviors in the medical system that in turn, lead to the growth of medical care expenditures. Second, in light of current agency relationships, the more the incentive structure is aligned to the interest of BNHI, the less is the reliance of BNHI on its information system. Third, BNHI should provide correct and proper incentive links to encourage the agents’ bonding behaviors. Finally, before BNHI can correctly measure the behaviors of medical institutions by means of behavior-based contract, it may consider managing the agency relationships by using outcome-based contract instead, and replacing with behavior-based contract later when it has the ability to collect more information for monitoring the behaviors of the contracted medical care institutions.

    Based on the research findings stated above, this research proposed the following three strategies for coping with the financial problems existed in the National Health Insurance System. First, BNHI may establish a set of “contravention standards”, and the budget for the medical institutions below those standards will include the negotiated amount plus the reserve. Second, BNHI may provide a certain proportion of service amount to reward those medical institutions which report fraudulent upcoding so as to encourage peer monitoring. Finally, BNHI may consider regulating the service outcome at present, and shift to behavior regulation after accumulating enough information for designing appropriate index that are able to accurately measure medical service behaviors.
    Appears in Collections:[Graduate Institute & Department of Public Administration] Thesis

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