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eCounsel group

A boutique firm with unparalleled expertise in business and technology. We have good command of industrial ecology and legal practice, and have undertaken highly regarded cases. Because the small business scope, we pay more emphasis on effectiveness and efficiency, and choose clients with deliberation. The managing partner not only has extensive experiences in various legal issues more over than 20 years, but invests and manages several technology companies. In addition, he always checks each case rigorously. Clients’ business objectives are our primary focus. To achieve the same in the most cost-effective fashion trumps all seemingly sophisticated legal discussions.

The Core Problem of Taiwan's National Health Insurance

2015 - 09 - 03

Our health insurance is a public insurance. It should not operate like a private one. The reimbursements should only cover generic drugs not brand-name drugs.

新聞眼/加錢可選原廠藥 醫療階級化

「……國人就醫用藥將有重大變革。衛福部指示健保署試辦「藥品差額負擔試辦計畫」,明年一月一日起,比照人工水晶體、心血管支架等醫材,針對部分健保未給付的原廠藥,以學名藥價給付,民眾若負擔價差,就能使用原廠藥…」

「……民眾對於藥品常處於資訊弱勢,差額負擔會讓民眾誤以為藥品療效有差異;若是必要使用的藥品,就應健保給付,何必要民眾自行負擔?若訂定差額負擔,民眾就醫會被依財力來分等級,甚至可能引發醫院誘導患者選擇自費藥品,恐造成有錢買生,沒錢買死…」

http://ppt.cc/z90o8

綜觀本篇新聞報導內容,撰稿者顯未探究健保作為「社會保險」的本質為何。

對於政府的作為,我很少表達肯定。對於我自己、對我自己所創立的各個事業,更是這樣。不自我鞭策,哪來的進步?

但衛福部的這一步,我則認為,是終於找到正確的方向了。

我在四年前受亞洲藥學會 (FAPA) 的邀請,在第一屆學名藥研討會中發表了 “To the rescue of Taiwan NHI”(拯救台灣全民健保)的演說。http://www.eCounsel.net/?p=738

依目前門診藥品健保支付之規定,均由病人按處方箋載總藥費作級距式且有最高上限 (NT$200) 的定額負擔。如此一來,如果醫師要為病人開原廠藥,但同時明明其專利已過期且有同成分同劑量同劑型並且也同療效(理論上)之學名藥時,健保將被迫為了該病人支出遠較學名藥為高的原廠藥費。

因此,我在那次演說中就提到「我們肯定衛生署的用心,讓民眾定額負擔較法定比率為低的藥費;但這應該僅止於學名藥。如果原開發廠的藥已有市面上核准的學名藥可以替代,而醫師或病人指定非用原廠藥不可的話,請改依健保法43條第1項,要求其依Coinsurance的作法作全額比率負擔,這才是社會的公平!倘若衛生署一意孤行(行政程序法第6條禁止無正當理由為差別待遇),那麼健保局的藥品核價模式,已欠缺正當理由圖利外國原開發藥廠,依貪污治罪條例第6條,圖利他人的主管官員應處5年以上有期徒刑…」

為什麼?

「全民健保是社會保險,但運作起來卻像私人保險,除了給人民基本的照護之外,還要管到大家心裡舒不舒服;這純粹是討好選民之舉動。社會保險,捍衛的是人民的基本生活水平,以藥費支付為例,在同成分、劑型、劑量之條件下,健保局僅須支付學名藥費而非昂貴的原廠藥費,全民健保即可被認為是成功的制度;畢竟根據藥品查驗登記審查準則之規定,學名藥一旦核准,就已表示其療效與原開發廠藥相同。既如此,健保局怎麼可以慷國民之慨,對實質相同的東西,卻支付更高的價格給外國藥廠?」

一樣米養百樣人。普通病房能住,健保給到那裡就好。有的愛住特等病房,你讓他自費住,理所當然。學名藥一樣能治病,健保也就應該付到那裡為止。

我在這份報告中,講述的,不過就是:社會保險的基本觀念應如何落實於健保藥費之保險補償中

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