民國84年全民健康保險實施至今已超過10年，醫療服務市場的規模不斷擴大，但
是醫療服務的產業結構卻產生很大的變化。本研究分析了84-94年健保實施期間，醫
療服務產業演化的原因與呈現的結果。健保實施至今，醫院總家數急速下降，而診所
家數穩定成長，醫療服務產業產生「大醫院與小診所」的兩極化發展。健保的價格機
制、醫院評鑑升級的誘因、消費者的偏好、與政府對財團法人醫院的租稅優惠，都是促使醫院趨向大型化的原因，然而儘管醫療資源因醫院的大型化而較集中，但醫療資
源也向偏遠地區擴散。其次，近來公立醫院逐漸整併或裁撤，對照於私立醫院(特別
是財團醫院)的擴建，醫療體系私有化的趨勢益加明顯;以及醫院為抗衡健保支付的
財務壓力，紛紛以水平或垂直整合上下游醫療機構，或投入自費醫療市場，這種醫療
服務企業化與市場化的趨勢，將對醫療費用的掌控、醫療資源的配置、與健保醫療服
務質量的確保產生嚴峻的挑戰。This paper investigates the evolution of Taiwams health care industry since the
institution of National Health Insurance (NHI) in 1995. The enactment of National Health
Insurance has boosted the general public)s utilization of health care services and, as a result,
enlarged the market size of the health care industry. However, the expansion of market
size has also led to a sharp decline in the number of small hospitals. By contrast, there is
an increase in the scale and number of large hospitals. Moreover, the number of clinics
grows stably as well. Thus, there is a polarization of the health care industry in Taiwan.
The growth in the scale of hospitals can be attributed to (a) the design of the NHI payment
and copayment systems, which financially favors large scale hospitals, (b) consumers)
preference for quality of service, and (c) the tax concession of capital investment by private
hospitals. On the other hand, the hospital market becomes more concentrated also due to the
exit of small hospitals. In addition, the consolidation of public hospitals and size expansion
of private hospitals has tilted Taiwams health care industry toward the private sector. To
improve their profit margins, hospitals have increasingly introduced services not covered
by NHI and expand vertically or horizontally by acquiring other medical organizations.
The trend of rising market share of private hospitals and marketization of health care bring
about new challenges to the NHl>s approach to cost containment, resource allocation, and
assurance the quantity and quality ofNHI health care.
