| Development of Taiwan’s national health insurance system,from the social insurance system to establish a health care system in a generation,from generation to second-generation health care reform,the formation of the current second-generation health care system.During the second generation of health care reform starts from 2000 to 2011 to complete,after the reforms were stalled during the DPP and the KMT has changed during the original intention of the reform is completed,the process can be described as hard-line difficulties,the results are not as expected.Therefore,after January 1,2013 the formal implementation of the second generation of health care soon,the Ministry of Health and Welfare announced that three generations of Taiwanese health care reform started,continue to push the period since the DPP had made "total household income" for the purpose of health care reform.Accordingly,this article historical institutionalism theory of institutional change research path,the path dependence of the current national health insurance system was set as the starting point of the social insurance system in Taiwan,to long-term time horizon of a comprehensive review and study of Taiwan’s national health insurance system development process,taking historical narrative method,counterfactual analysis,document analysis and case studies from the institutional system,the concept of power and three dimensions,explore the following questions:a universal health care system in each stage of development in the existing system how system(political system environment and health care system itself traits)that affect the formation and changes in national health insurance system,what system changes and changes in the power mode of each stage is thus constructed can effectively explain the true picture of Taiwan’s national health insurance system in the development process.2.The health care system to explore various actors on cognitive health care system and preferences,the main controversy,as well as the critical moment of power between the actors interact with each stage of development,how the results of the National Health Insurance system has led to change.3.Analysis of the development of Taiwan’s National Health Insurance system and reform the existing problems,analyze the specific cause of universal health care system reform troubled Taiwan,and to explore the direction of reform health care system for the future of Taiwan.4.Based on the foregoing findings,from the system,the concept of power and the interaction between these three angles,reflect historical institutionalism path on research methods and institutional change.After the analysis about establishment of the political process as well as the second generation of health care system reform this paper draws the following conclusions:First,the origin of the system of universal health insurance system in Taiwan is the social insurance system in 1995 before the formation of the current national health insurance system,has experienced from the social insurance system to establish a health care system in a generation,as well as the period from the DPP generation health care health care reform to a standstill second generation system,health care system and the formation of the second generation of the KMT era,the three stages of institutional change.Taiwan’s national health insurance system in the development of these three phases,respectively,show the following system changes modes:replace&conversion->drift->layering.Overall view,the development of Taiwan’s national health insurance system presents a gradual institutional change mode.Second,the reform of the national health insurance system in Taiwan,it is fair in terms of medical payments,due to the establishment of a single payment system and have greater equity,which is the satisfaction of the people of Taiwan’s national health insurance system in the main cause of long-term high;health insurance premiums in the charging system,the result of inherited social insurance system initially charging system separate and there is a significant unfair premiums and supplementary premiums generally track system of the second generation of health care reform in the charging system design,stricken wider criticism and lead people to avoid the payment of premiums behavior,secondary health care reform is seen as the failure of reform;and,the charging system under this legacy of path dependence,health care has become the biggest problem the second generation and the future of health care reform.Third,the resulting second-generation health care system factors in the reform of the plight of the charging system,there are three factors:the impact of macro-institutional factors.First,the institutional legacy of the charging system,and electoral politics.Second,the various actors on the health care system reform and preferences of different concepts of cognitive factors.Third,micro factors preference various actors under the authority of the interaction effects.Fourth,the future of health care reform in Taiwan three generations Discussion and suggestions.First,the "total household income" for fee-based reform program to improve the fairness and increase the financial stability of health care,and reduce administrative costs,etc.,are better than the current second-generation health insurance system is the direction of the three generations of health care reform.Second,in planning for the future of health care reform program,developed especially to consider links,should be the essence of the right to expand public participation initiatives,so that policy makers can more fully reflect public opinion,and the digestion process of health care reform to some extent,the "party struggles.".Third,the policy planning and formulation stage,should take a variety of marketing strategies to strengthen policies,actively and effectively communicate with all social groups and people,strengthening the pursuit of social justice,health care reform and equity concept,widely recognized for the people and support,which will help make health care reform.Fifth,under the system path dependence legacy of inherited or immobilization studies,historical institutionalism need to factor in the social system of philosophy and cognitive preferences,the depth to explore the concept of influence factors of institutional change.Sixth,on institutional factors,the health care reform from the mainland to Taiwan inspiration to get health care development has two main points:first,the integration of the basic medical insurance system for existing discrete,establish a single fee and payment system designed for the health care system,and the establishment of a unified management,efficient health care management organization.Second,accelerate the reform of property rights in public hospitals,health care services market gradually opening to form a wide range of private and public hospitals,health care services market,and strengthen the supervision of medical and pharmaceutical markets... |
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