試辦區域論人計酬健保方案金門等醫師公會反對

The "General Conference of the President, Executive Supervisor, and Secretary-general of Medical Associations" (which included 15 counties across the northeastern and central parts of Taiwan), was held on November 21st in Kinmen. Members of medical associations from Taipei, Taizhong, Yilan, Miaoli, Taoyuan, and Kinmen counties all expressed their concern or opposition to the "Healthcare Capitation (1) System".
　 「北、東、中部十五縣市醫師公會理事長、常務理監事暨總幹事聯誼會」11月21日在金門舉行，台北縣、台中縣、宜蘭縣、苗栗縣、桃園縣、金門縣等醫師公會都對「論人計酬」表示懷疑或反對。

Many of the 15 Medical associations members who attended this conference have shown strong suspicion over the "Healthcare Capitation System", which was proposed by the Department of Health (DOH) and will be set for a trial run (2) in the DOH hospitals in Kinmen, Zhanghua, Bingdong etc. next April. One of their concerns is that the government seems to have decided to bring out (3) this new system in a rush and that it might still be in the experimental stage; also, the government has failed to fully communicate with both the public (the payers) and the physicians (4) (the healthcare providers), and has yet to propose any supporting measures to facilitate the system. These have all contributed to an increasing instability. Specifically in the Kinmen region, the lack of medical resources and healthcare, the difficulties of referral (5) treatment, and many "out-of-town" (6) registered residents have all added more risk factors to the new system. It is likely that the result will be far from the expected outcome if the new system is implemented abruptly (7) without careful planning. So in the end, it will become a "no-win" situation for the public, the healthcare providers, and the government.
　 21日在金門聚會的十五個縣市醫師公會中，很多公會對衛生署計畫於明年四月起在金門、彰化、屏東等署立醫院試辦「論人計酬」計畫表示了強烈的質疑。他們認為官方政策倉促推出，有著實驗性質，未充分與民眾（付費者）及醫師（醫療提供者）溝通，也未提出完整配套措施，不確定性仍高，特別是金門地區因先天醫療資源缺乏，醫療照護及轉診的便利性皆遠不如台灣地區，加上金門縣有許多設籍人口並未實際居住金門，這項新制度若貿然實施，效果可能不如預期；屆時恐怕會造成民眾、醫療機構及政府三輸的局面！

Director of the Kinmen Health Bureau, Chen, Tien-Shuan (陳天順), thinks that the following three conditions are required if the "Regional Healthcare Capitation Plan" is to be conducted in Kinmen: the overall satisfaction with the healthcare system should be above 80%; referral treatment rate should be lower than 50%; and finally, it should gain support from over half of the healthcare providers in Kinmen.
　 金門縣衛生局長陳天順認為，金門如果要實施「區域論人計酬健保方案」，應該先具備以下三個條件：醫療滿意度應超過百分之八十；境外就醫應低於百分之五十；要有二分之一以上的金門醫療院所支持！

On the other hand, the Superintendent (8) of the Kinmen Hospital, Ou, Tian-Yuan (歐天元), described the current dilemma (9) faced by National Health Insurance, "The system must go on, the service cannot stop. The public is unwilling to pay the bill, and the debt cannot be reduced." However, Ou mentioned that the DOH demanded that the trial run be carried out, and that the Kinmen Hospital should still sketch (10) out the regional plan according to DOH's direction.
　 署立金門醫院院長歐天元則表示，目前健保制度的困境是：「健保不能倒，服務不能少，全民不買單，債務不能少」；而衛生署的指令則是「勢在必行」。他將依據衛生署的指令提出金門的區域計畫。

【註解】
●1. capitation-(n)按人頭計算；人頭稅；均攤。
●2. trial run-試辦；試驗；試車、試航。
●3. bring out-推出；出產；出品。
●4. physician-(n)醫師；內科醫師。
●5. referral-(n)推薦、介紹；被推薦者；此處指被推薦、轉診之病患。referral treatment即轉診。
●6. out-of-town-(adj.)外埠的，從其他城市來的。
●7. abruptly-(adv.)唐突的；魯莽的；突然的。
●8. superintendent-(n)負責人；監督者；此處指署立醫院的院長。
●9. dilemma-(n)進退兩難的困境。
●10. sketch-(vt.)草擬。

本文摘譯、改寫自《金門日報》2010年11月22日報導