1、演講大綱 全民健康是崇高的理想，但達到此理想並非靠經濟發展或國民生產毛額的提高 ，而是靠完善的制度與組織，與全民 (尤其醫務人員 ) 的支持 : 比較美國與台灣的醫療照護 從倫理面思考如何幫助健保永續 :健保光靠總額預算制度，雖可暫時生存，但是卻會因醫務品質差異而發生健康不平等 發展並全面推動合乎成本效果 (cost-effectiveness)之臨床指引為健保必走之路 計量健康 (長壽又生活品質好 )之方法簡介及對基督徒醫療從業與經營者之 建言1美國醫療照護的困境 根據 2008年 2月 7日新英格蘭醫學雜誌所載，美國每年 花 2.1兆美元在健康照護 上，平均每年 每人約 7000美元 ，約
2、佔其國內生產毛額 (GDP)的 16%，但是還是有 4千 7百萬人無健康保險 ，其中多數是經濟上弱勢的族群，他們往往是最需要醫療照護者。 可見光是 GDP成長起來，有充足的醫療照護人力、設備及財力還是不夠提昇 全民 的健康。 2PAYING FOR HEALTHCARETAIWAN VS USA Two SystemsAre there lessons to be learned?National Taiwan University HospitalCollege of Medicine September 28 2006RN Pierson Jr. ABMAC Foundation and
3、Columbia University 3Paying for HealthcareUSA For-Profit systemCapitalism ACCESS Varies widely Highly insured Sometimes insured Uninsured QUALITY CARE Varies widely SYSTEMS multiple REGULATION Advisory PROFESSIONAL RoleSpecialty SocietiesTAIWAN Not-for Profit system ACCESS UniversalAll are “insured”
4、QUALITY CAREVaries by geographySYSTEMS ?REGULATION ?PROFESSIONAL Role?41980 1985 1990 1995 2000454035302520Source: U.S. Census Bureau( Millions )Number of Uninsured Americans5COST SHIFTING: NO END IN SIGHTThe “Insurance Death Spiral”Get CareDeficit!Cost shiftHigher premiums Fixed costs not metBills
5、not paidMoreUn, Under-insured6The costs of health care in AmericaUtilization: Who decides?Over? Under? Mis?Hospitals 40% Physicians 14%Pharmaceuticals 17% Administration 31%DistributionThe very sick are very expensive Radically Improving, Expensive, Technology End-of-life costs of care Insurance pro
6、fits & Overheads increase costs7How We Got Here For Profit : The American Way ! The Great Conversion: 1990-2005 “Competition begets efficiency” 520+ Insurers compete Health Care was Not-for-Profit Blue Cross 1935 Kaiser Permanente, WW II Military Medicine: DOD, VA, Fed. Employees MediCare / MediCaid
7、 19658The Elements1990-2005: the “for-profit” era Healthcare Costs: the Sources Fixed costs: Hospitals (40%) Administration: overhead! (31%) Malpractice (3%) Fraud Utilization: Under, Over, Mis-93.1%MedicareNon-profit BluesCommercial CarriersSource: Schramm. Blue Cross Conversion. Abel Foundation. CMS. Investor-owned Blues16.3% 19.9% 26.5%Private insurers high overhead10
