The Study of Administrative Contract Focus on the Relationship Between Clinics and National Health Insurance

• Main Authors: Feng-ying, Chu, 儲鳳英
• Other Authors: Yang Jen
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/54257011798616777719

碩士 === 東吳大學 === 法律學系 === 102 === The Article X of the Additional Articles of the Constitution provides that the State should implement national health insurance, clearly using the constitutional commission to make it Republic of China's basic national policy. The national health insurance has established since its 1 March 1995 implementation, it becomes an important foundation of the national security to protect the social health safety of the Taiwan people. Taiwan becomes barrier-free environment for medical treatment and its health care system has become the envy of the world and the system of international praise. During this system's operation, NHI as the single insurer signed the National Health Insurance Medical Care Institutions contract with the country's about 98% of the medical care institutions. This National Health Insurance Medical Care Institutions contract defines special legal relationship in between, is signed in special contract type using predefined standard contract, most of the contents are required by law, and also because the unique nature of the healthcare industry, all these factors leading to a qualitative uneasy type of contract. Despite the Grand Justices interpretation No. 533 reasoning characterized it as administrative contracts, but special contracted institutions' and insurer's obligations and rights remain controversial. Therefore, this article will take an administrative contract with the legal system related characteristics collate, analyze, and compare with the practical operation of the National Health Insurance in order to explore subsequent administrative remedies, administrative self-censorship, the nature of first appeal procedures, administrative litigation procedures, and practices discussed in respect of such in order to propose specific proposals to construct mechanisms and legal relations in line with the needs of society, keep the sustainable management to maintain durable health insurance system. Conclusion recommendations: 1, although this article agree with a limited permit of administrative sanctions, but it is recommended that health care systems should be based on characteristics of administrative contracts, adopted in line with norms of their way to adjust the contract, reducing using both of the administrative sanctions and administrative contract situation with the administrative disposition. 2, the administration should be appropriate to simplify the process of self- examination of objection, review, etc., special contracted institutes and insurer shall conduct only one self-review process, then the dispute can go to appeal or review process, remove the needless duplication of Contend Commission and Appeal Board by merging the organizations. 3, the existing administrative contractual relationship, given the discrepancies and in order to avoid disputes and meet and practice needs, we shall rethink practices of the contract signing system, change it to "administrative sanctions to be applied". For the qualified ones, one time application can make long-term continuous use, while avoiding health practices and administrative contract of conflicting tune.