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    請使用永久網址來引用或連結此文件: https://nccur.lib.nccu.edu.tw/handle/140.119/156888


    題名: 健保自墊境外就醫費用核退制度之問題建構：混合方法途徑
    Problem Structuring of the NHI Reimbursement System of Self-advanced Medical Expenses Incurred Overseas: A Mixed-Method Approach
    作者: 陳敦源;劉宜君;賴怡樺;王光旭;林昭吟
    貢獻者: 公行系
    關鍵詞: 問題建構;全民健康保險;境外醫療;輿情分析;混合方法
    Problem structuring;Mixed methods;National health insurance;Out-of-country medical care;Big data analysis
    日期: 2022-11
    上傳時間: 2025-05-09 11:05:06 (UTC+8)
    摘要: 依據全民健康保險法規定，民眾在國外發生不可預期的緊急傷病，必須在當地醫療機構立即就醫時，可以在門、急診治療當日或出院日六個月內，向健保署申請核退自墊醫療費用。由於境外核退訂有金額上限，與相關查驗文件要求，申請民眾反映核退金額與實際就醫支出差距過大，因此，申請民眾期待與政府機構的政策美意之間存在落差。有鑑於問題建構是政策分析的首要步驟，本研究從混合方法與多元資料來源，先由網路輿情分析等管道瞭解境外自墊醫療費用制度的現況與問題，再透過訪談相關人員與學者專家釐清健保境外自墊醫療費用制度的問題。研究發現健保境外就醫核退制度的主要問題包括核退申請作業的便利性與可行性、核退條件與標準認定的合適性與公平性、資訊不對稱與道德風險等。研究建議加強宣導健保境外自墊醫療費用制度（尤其針對核退的條件、標準與限制）及出國購買商業保險的必要性；建議除了制式的官方新聞內容，可以多增加些情境式的Q&A，除了能讓民眾增加印象外，也能夠同時得到正確的政策知識。
    Problem structuring is a very important initial step in policy analysis. This study attempts to construct policy problems by using a mixed method of big data analysis and qualitative interviews, taking as an example the issue of out-of-pocket payments for emergency medical treatments occurred outside of Taiwan. According to Articles 55 and 56 of the National Health Insurance Act, if an insured person has an "unexpected emergency illness or injury" outside Taiwan and must seek immediate medical treatment at a "local medical service organization," they may apply to the insurer for the reimbursement of their medical expenses within six months from the day of outpatient or emergency treatment or the date of discharge from the hospital. In the past, however, there have been complaints about the significant gap between the reimbursement amount and the actual medical expenses, which has led to the arguments that the maximum reimbursement amount should be raised to a more reasonable level and that the number of cases should be categorized. The public is not very supportive of the idea of limiting the scope of benefits or abolishing the system, given that the number of people who go abroad for work and travel is increasing and the demand for overseas reimbursement has not decreased. This study intends to use mixed methods and multiple data sources to understand the current status of and opinions about this reimbursement system. Using big data analysis and Internet public opinion analysis, this study aims to explore the relevant discussions among netizens on the issue, with the goal to clarify and better grasp the directions of public opinions. This study also discusses the applicability and limitations of mixed methods in problem structuring.
    關聯: 空大行政學報, No.36, pp.25-57
    資料類型: article
    顯示於類別:[公共行政學系] 期刊論文

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