| Summary: | 碩士 === 國立臺灣海洋大學 === 海洋法律研究所 === 98 === Abstract
The design of thrust of the national health insurance（NHI）system should be under medical care for any people to care, is not so "ill not seek medical treatment," "sick without medical resources", can not lead to "sick and poor, and died," because if so, then , a violation of the broad constitutional "right to life."
In the absence of health insurance for my age, no medical insurance, the family, often the envy of the civil insurance of the family. If they are sick, especially the major diseases, rare diseases, cancer, etc., are often huge medical expenses, drag the whole family and life, the havoc caused by the disadvantaged; However, in the health care system, major injuries and the major diseases, most of can be resolved by the health care treatment, while making vulnerable have their vitality.
But health care has its benefits, but of financial balance of payments problems, how to maintain balance, the effective use of such issues, the incidents at a loss O'clock, while Pi Zhiyi poor implementation, if we up health insurance, they Mianlinfandui, For Shou , support conditions, to the Executive Yuan approved the report, the Department of Health can not lead, but to the Health Department.
Tracking back the source of this, health care finance system is not independent of "financial" prevail, involving "political reality side", of course, command the Department of Health National Health Insurance regulations, "developing" or "approved", but must be presented again at the Executive Yuan, while the is not an independent body. Therefore, the health insurance problem is not purely financial issues.
In fact, we have the responsibility to health insurance loss, the effectiveness and monitoring related to the density issues, such as lack of validity, just like a waste; lack of supervision, the leading health care economic crime has its breeding ground. In the current system, health insurance fee income in part due to the occupation as the standard error can be described as system design, its manufacture so that people can pay less premium premium (such as paid subsistence allowances). The NHI Bureau know it would be unfair and even criminal cases, Jingbu thought immediately change the law, not positive to the inspection, due to the competent units of omission, the seriousness of the problem, become increasingly significant.
As for the medical expenses expense, but also serious problems, if a person visits, take Quanjia of drugs, or the existence of doctors,-institutional wasting medical resources (that is, the cooperation of doctors Bing, you can order a la carte agents, such as to require inspection, surgery, etc.), or physicians, medical institutions and drug companies, equipment providers and other seemingly legal, but improper partition of the common medical resources.
"Black hole" shall mean "inappropriate drug price difference", this is to make health care one of the main loss, which may be as high as tens of billions of NT dollars. As for the "reasonable drug price difference", the non-black hole, the Department of NHI Law and NHI Bureau for cause. However, in a reasonable price difference, there are also unknown the "technical", this, how to begin to comply with "reasonable", yet to amend the law through the timely and the NHI Bureau in a professional, positive for the inspection, before they can improve. The improper drug spread (such as A drug for B drug, discount price switch to donate), NHI Bureau are not perceptible, it relates to the professional pharmaceutical market, as prosecutors and police may not be aware of tone, and to cause serious loss of health insurance.
In addition, health care fraud, to make health insurance loss is one of the main. As the health care system and the laws command is not an effective defense against, and derivative crimes. Therefore, it is necessary to modify the health insurance law changed to a pragmatic treatment of disease of the "standard" in order to calculate the number of points away from impractical to control crime Health Insurance Bureau of weapons, combined with public power, on the fraudulent claims to health insurance to the person to be deterrence and prevention.
This paper is going to propose some policies and suggestion of reforms for the prevention of the economic crime on NHI from the following four aspects:
1. The aspect of morality: (medical ethics, the rule of law concept of the medical community, Self-constraint of medical system)
2. The aspect of system: (administrative cooperation, improve the inspection system, report)
3. The aspect of legality (elevate fines and penalties, add special provisions or articles in related laws or regulations, set up special investigation and the trial court)
4. The aspect of implementation: (medical records in electronic form and inter-connected, increase rigorous review of operating level, review of medical institutions and individuals with higher rate of medical usage or criminal records)
Even the implementation of the second generation of health insurance, health insurance and may face financial and criminal problems. In this regard, the future long-term care system should include: nursing care without medical care, do not need aggressive treatment of cancer, hospice (care environment), etc., Ershi health care spending can have significant distinction in the field.
This paper, dealing with the health care system is derived and the types of economic crimes, perhaps through the study of this thesis, and make health care-related economic crime has nothing to escape its shape transparency features to help those who care about national health care system can further explore the health care system and to reduce economic crime of opportunity, to make health insurance even more robust financial and thus improve the quality of our health care and medication.
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