全民健保已於民國83年3月1日起正式開辦，其為社會保險的一種，和以往公、勞保等的社會保險，最大的不同處有二：一是將全民皆納入保險的體系中。以往的社會保險只針對特定群體承保，如公務員的公保、勞工的勞保。二是採行部分負擔制度。以往的社會保險除了掛號費外，被保險人幾乎不用再繳交其他的費用。因此，本篇論文即針對這兩個主要的不同處，做一番理論性的探討與實證上的研究。 　　在理論探討方面，是說明政府為何要介入全民健保，其與道德危險的關係如何。所採用的模型為Rothchild與Stiglitz在1976年所提出之競爭性市場下保險配置的模型，並由代表性個人擴充到兩類高低風險不同的被保險人。在實證研究方面，所利用的數據，主要是來自公、勞保的醫療費用支出的數據，再輔以必要的資料，如人口總數，各年齡層的人口分佈及醫療費用的比例，而資料為最近十年間的數據。其方法為先利用公、勞保醫療費用支出的金額，計算出平均一個人可能的醫療費用支出，再透過各年齡層對醫療資源需求不同的程度與人口數，估算出可能的總醫療費用支出，然後再利用先前估算出的數字，求出政府方面所可能節省的醫療費用支出，以及社會福利損失所可能減少的金額。 　　本論文的結論認為，全民健保中的部分負擔制度，確實能發揮抑制道德危險的效果，不論是在政府的醫療費用支出方面，或是整個社會支出的變動方面，都可以看得出有不錯的改善情形。但在長期趨勢預估方面，值得注意的是，醫療費用支出的成長會大於保費收入的增加，若不提早因應與改善規劃，全民健保也有可能會出現入不敷出的情形。因此，全民健保仍有努力與改善的必要。

由於我國在社會、經濟、政治方面快速發展，人民普遍要求實施全民健康保險。在長達七年的規劃之下，終於在八十三年七月實施。全民健康保險法可說是我國有史以來最重要的民生法案，其不僅具有具體的福利效益和保障國民免於疾病的威脅的功能，而且更具有已邁向福利社會的具體意義。 　　隨著各國民主政治的發展，人民參與政治過程的機會和方式愈來愈多，我國全民健康保險法草案合法化過程中由於爭議極多，例如保險費負擔比例、保險機構的體制、分級轉診的部分負擔等，各個利益團體也不斷介入其中，使得全民健康保險法草案合法化過程更為熱鬧非凡，同時，也充滿了政治性和妥協性。 　　全民健康保險制度的實施，其成敗關鍵在於現制缺失的徹底消除，醫療體系的健全與效率，以及全體國民的共識與維護。任何制度的實施都會有一段陣痛期，唯有多方面加以配合，才能使全民健康保險成為可長可久的制度。

<p>In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the&nbsp / human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR&nbsp / odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and&nbsp / proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas) / researchers / academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government&rsquo / s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category&nbsp / has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical&nbsp / health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system.</p>

本論文以台灣1995年3月實施全民健康保險為分水嶺，1985-2010年的醫療環境為脈絡、同時間的《聯合報》為研究樣本，檢視醫生的實際勞動過程與勞動條件，相較新聞傳媒論述的落差。 因年代演進、健保前後的報紙再現確實不同，新聞與投書最大的迥異之處出現於財團化，醫病關係與醫療糾紛，醫療極限與去專業化，情緒勞動，因健保更為負面的醫德，及健保體制爭議等的分析類目上，呈現醫師的媒體形象隨時間遞嬗變動。無論是否包含個案，從報導數目來看，可以發現中期、後期醫病關係惡化，醫療糾紛增加，醫學知識去專業化與有限性；健保下的負面形象初實施便有、後期卻越形明顯，可謂與財團化同步。新聞數量、論述，與消費主義社會、醫療環境、政策之演變高度正相關。不過，媒體長期以來多忽略體制變革牽涉個體醫師的「勞動過程與勞動條件」問題，醫師團體凝聚的勞動意識則直至最近才逐漸被喚醒與展現在媒體上。 媒體在醫療議題中扮演的角色，確有出現變化，然，不是晚一步，就是極少報導。在歷時性或個案新聞中，台灣媒體對於醫師身體勞動、情緒勞動之變遷，商品化醫療服務與健康權利有所衝突，以及結構、資本主義之變因與影響，均再現與詮釋不甚全面。 / This thesis investigates how the United Daily News(UDN) represented the doctor’s labor process in Taiwan between 1985 and 2010, taking 1995 as the watershed when the National Health Insurance (NHI) was implemented, prior to and after which the working conditions of medical people have experienced substantial changes. As such, the UDN did register differences in its treatment of related events accordingly. The current study has focused upon issues related to conglomeration, doctor-patient relationship and medical malpractice, limits of medicine and deprofessionalization, emotional labor, negative medical ethics, as well as health care system debates etc.. Images and discourses of doctors in the media have changed across two period of time. It becomes clear that since 1995 the doctor-patient relationship has been getting worse, while medical negligence increased and deprofessionalization of medicine multiplied. In addition, with the introduction of NHI, there were more medical ethics violation and capitalists have made more gains with medicalconglomeration. Another factor contributing to the increase of medical news is the arrival of a consumerist society, and simultaneous changes of medical environment and policy. Although there is such a transformation of Taiwan’s health system, the media has however failed to represent adequately the doctor’s changing labor process and conditions. The UDN has not covered such topic until very recently in the wake of several protests arising out of worsening medical environment. In conclusion, Taiwan’s media has paid insufficient attentions to various significant issues, doctors’ physical labor and their emotional labor, commodified medical services and its conflicts with universal rights of health are among the most eye-catching.

National Health Insurance (NHI) can be said to play the most significant role among all the other social securing systems. People pay great attention to its policy and institution. NHI is an obligatory social insurance, protecting all the citizens in Taiwan. The insured is required to enroll into the NHI only by their employers¡V be it a school, a business company, an institution, an organization, private business employer or any other work unit. When the insured are underwritten by or withdrawing from the system, all the changes must be made through the employers who refer to and enroll their employees with the NHI. The Bureau of National Health Insurance, operating in coordination with the e-government policy that aims to provide much more convenience to the Taiwanese people and to improve government efficiency, as well as for the sake of energy conservation and carbon reduction, has been encouraging people to use on-line applications for the NHI affairs. As much effort as they have put on promoting such policy to the employers who are responsible to insure their employees with the NHI, currently, the popularity of using on-line applications for NHI affairs is barely satisfactory, as a matter of fact. Many parties are involved in the procedure of processing on-line applications for NHI affairs; therefore, this dissertation uses Nominal Group Technique (NGT) and Interpretive Structural Modeling (ISM) from Interactive Management (IM) theories conducting the research. All participating parties will have conversations with one another; therefore, there will be a workshop. The purpose and subject for this workshop is to explore practical strategies that would effectively promote the usage of on-line applications with the NHI affairs. Through such an interactive dialogue collecting diverse viewpoints, there are thirteen strategies concluded to be effectively helpful achieving the aim: The NHI sectors responsible for on-line applications should (1) provide favorable incentives for on-line applicants, (2) simplify the net identification procedure and the NHI operational network and (3) the logging-in system, (4) increase the network bandwidth, (5) resolve NHI insurers¡¦ qualms of network security using online-applications. Also, they may need to redesign the network platform and (6) simplify procedure for users, and (7) more frequently promote the advantages using on-line applications and expand contents of their service, so that (8) the web search function for the NHI will be able to provide wider, faster, more efficient service. (9) the relative NHI sectors should really receive guidance and assistance carrying out this project, and (10) negotiate the assigned policy with their superior supervisory sectors to give clear order to their subordinate sectors using on-line applications and (11) set up trainings for instructors to establish future training resource, and (12) hold workshops to give more information and verification on the scene permitting the participants of the workshops to use on-line applications, and (13) finally achieve the aim that to have applications for NHI affairs completely done on-line. Among them all, strategy 3, ¡¥simplifying logging-in system¡¦, ranks 11 using NGT sequencing (strategy 11, 12, 13 all get the same points in the vote). However, in the enhancement structure, strategy 3 ranks number 1, has net score points 10. Therefore, strategy 3 should be given as much priority as to and carried out with strategy 1 ¡¥providing favorable incentives for online applicants¡¦ that gets the most points, in the NGT sequencing process. This research has given the participants questionnaires at two stages during the interactive workshop. The participants¡¦ concern, or understanding of using on-line applications for NHI affairs, appears to have risen after the workshop. There is unexpected, significant satisfaction over the promising conclusions from the workshop, which proves the workshop to be non-redundant and have reached consentient results. Also, the research, primarily using ISM program, has reduced the voting numbers when comparing two strategies from 156 times to 58. This has saved great amount of the time from the voting procedure in discussion, so that the workshops was able to finish in one day and hence did not exhaust the participants¡¦ enthusiasm. ISM is therefore proved to be efficient in saving time and assures that not losing the participants in different stages of the workshop.

全民健保的實施改變了傳統的藥品通路，使得藥品市場逐漸集中於醫院，而醫療院所為因應總額支付的政策，降低營運成本，因而有逐漸結盟經營的趨勢。為滿足市場導向的藥品供應鏈需求，本研究探討自全民健保1995年實施後，藥品通路的變革對藥品供應鏈所造成的影響，並藉由個案探討以及理論分析，探討藥品供應鏈e化之趨勢，以歸納出一個藥品供應鏈e化可行模式，供政府機關、醫療院所、藥商及物流商在藥品供應鏈之流程中作為參考。 本研究認為藥品供應鏈應從分散管理改為集中管理，並藉由具有公信力的中央健保局，配合資訊科技協助藥品供應鏈e化，以讓藥品資訊可以有效的流通被利用。透過以以中央健保局為中心的藥品供應鏈模式，可以讓各個產業專業分工的成效更明顯，其具有下列益處： 一、以量制價統一配銷 二、降低醫療院所藥品存貨 三、簡化健保給付流程 四、藥品資訊有效利用 五、幫助醫藥分類落實 　　此外，本研究亦針對此模式下之藥品供應鏈提出初步實施規劃如下： 一、從公立體系醫院興辦 二、選擇量大且較常使用的健保給付藥品 三、彈性的配送頻率 四、資訊流與金流的整合 五、由中央健保局協助資訊商建立藥品供應鏈e化平台 透過本研究所提出之藥品供應鏈之e化模式及流程，本研究期望能加速藥品供應鏈集中管理之機制形成，以幫助醫藥產業降低藥品流通的成本並落實醫藥分業。 / This paper examines the condition of Taiwanese National Health Insurance (NHI) and brings up the idea of the centralizd management. Since Taiwan put the NHI into practice, Drug Price Black-Hole of the NHI has estimated about 20 billion every year under the fee-for-service payment system (FFS) and pricing drug with brand. Therefore, we collect the papers and some cases to discuss the situation of the Drug Supply Chain in Taiwan. We would like to understand how to descrease the drug cost in purchasing and distributing by this paper. This paper makes use of Value Chain, Diamond Theory, New Value Curve to analyze the Drug Supply Chain in Taiwan and proposes the model and process to direct the industry how to developing the Drug Supply Chain by certralized management. The Drug Supply Chain of certralized management can provide some benefit as following: 1. Purchase jointly to reach economies of scale 2. Simplify the reporting process 3. Effectively use the information of the drugs 4. Utilize the distributed process by jointly delivery 5. Help the separation profession of pharmacy from medicine to implement Besides, this paper proposes the initial plan about the Drug Supply Chain of certralized management as following: 1.Begin with governmental hospitals. 2. Select large amount of the drugs of NHI. 3. Provide flexible frequency of distribution. 4. Intergrate the information flow and cash flow. 5. Bureau of National Health Insurance (BNHI) supports the Internet Servie provider (ISP) to build the platform of the Drug Supply Chain. Our main goal is to adapt this kind of model to help NHI overcome financial crisis by jointly purchasing and distributing, simplifying the process of reporting and help the separation profession of pharmacy from medicine.

<p>In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the&nbsp / human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR&nbsp / odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and&nbsp / proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas) / researchers / academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government&rsquo / s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category&nbsp / has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical&nbsp / health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system.</p>

Background: The government of South Africa has focused on Primary Health Care and implementation of the National Health Insurance (NHI) as part of the plan to reform the South African health care system. This is based on the principle of the right to healthcare and the right to access health care facilities. Aim: The aim of this study was to analyse the Nurse Managers’ interpretation of the National Health Insurance Policy and, its implications for implementation on their roles and responsibilities in health care facilities. Methodology: The sequential mixed method approach was conducted. There was direct interaction (semi structured interviews) with the Nurse Managers as well as a survey (questionnaires) for both qualitative and quantitative phases. Qualitative data was collected and analysed first, and an instrument was developed based on the analysed data from the qualitative phase to collect quantitative data. Setting: EThekwini district comprising of two district hospitals, three Community Health Centres (CHC) and four Private healthcare facilities were selected. Participants: Nurse Managers in the public Primary Health Care facilities and private hospitals in the EThekwini district. These were Nurse Managers (top middle and lower levels) from the public healthcare facilities (district hospitals, Community Health Centres, primary health clinics) middle and lower levels in the private facilities. Data Analysis: A thematic analysis was used in the qualitative phase. Descriptive statistic was used in the quantitative phase to describe and synthesize data (Polit and Beck 2004) as well as inferential numeric analysis (Creswell 2009). Findings: The findings in both the qualitative and quantitative data revealed that the participants demonstrated a general impression on the NHI rather than specific understanding; hence the researcher believes that there was more general than specific knowledge and interpretation of the NHI policy. The participants’ display of lack of knowledge and understanding of the concept NHI and the implementation process was an indication that there was lack of personal development in relation to expectations from the nurse managers concerning NHI though there is a lot of publicity in this respect from the government and media. There are national policies and guidelines for all citizens to access. Recommendations: The recommendations were made for sharing with the policy makers and seniors in the healthcare facilities in order to improve nursing management, nursing education and nursing research. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2012.

Universiẗat, Diss., 2006--Frankfurt (Main).

Magister Public Health - MPH / In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas); researchers; academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government’s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system. / South Africa