A Study on the Legal Relationship Between the BNHI and the Contracted Medical Care Institutions under the National Health Insurance Act

• Main Authors: Chun-yuan Huang, 黃俊元
• Other Authors: Ming-shiou Cherng
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/j4xau8

碩士 === 東吳大學 === 法律學系 === 96 === Because of the increasing insurance coverage, not finely calculated premium, and unbalanced premium revenues and medical expenditures, in addition to payment system changed from fee-for-service to global budget and financial responsibility shifted to the contracted medical care institutions, there are many disputes between the Bureau of National Health Insurance (BNHI) and the contracted medical care institutions, which endanger Taiwan’s National Health Insurance implemented since March 1995. The reasons why analyzing the legal relationship between the BNHI and the contracted medical care institutions under the National Health Insurance Act is important are as follows: 1.The medical expenditures were nearly NT$ 442 billion in 2007 (US$ 13.3 billion), 3.55％ of the GDP. 2.The health insurance covered 22.3 million people (99% of the population) in 2007. 3.There were 18,540 healthcare providers (92% of all providers) contracted with the BNHI in 2007. 4.There have been five Constitutional Interpretations about the National Health Insurance Act since the beginning of the health insurance. The purpose of the study is to investigate the legal relationship between the BNHI and the contracted medical care institutions under the National Health Insurance Act. In this study, the researcher analyzes the following issues between the BNHI and the contracted medical care institutions under the National Health Insurance Act, Regulations, Directions and contract: 1.the basic legal relationship and nature; 2. the right and obligation; 3.disputes including global budget expenditures, payment scope of health insurance, fee schedule for medical services and reference list for drugs, the examination of the medical service, the regulations governing contract and management matters in respect of the insurance medical care institutions; and 4. the remedies and lawsuit ways of those disputes. The researcher tries to construct the new cooperation model between the BNHI and the contracted medical care institutions to enhance the sound development of the medical service system, to maintain the sustainability of the National Heath Insurance, and to promote the health of all nationals. The conclusions and suggestions of the investigation are as follows: 1.To establish a health insurance organization with equilibrium of authority and responsibility. 2.To accurately calculate the national health insurance financial status. 3.To clearly define the payment scope of the health insurance. 4.To open up a new policy that the insured may pay for new medical technology parts. 5.To fairly share the responsibilities for the national health insurance finance between the BNHI and the contracted medical care institutions. 6.To set up definite examination principles of medical service. 7.To fulfill the principle of legal reservation in the healthcare provider management. 8.To strengthen communication and negotiation between the BNHI and the contracted medical care institutions.