| 摘要: |
| 医疗保险在成为医疗服务的最主要付费者后，为避免医务工作者因道德风险产生过度医疗，确保医疗服务的必要性与合理性，建立了医疗服务审查制度，以达到费用控制和质量保障两大作用。但成本降低和质量提高是一对矛盾体，加上审查标准不一致、相关规范不全面、审核过程不够透明等问题使得台湾医疗服务审查制度饱受医疗机构的不满和诟病，尽管如此台湾在此方面还是积累了比较丰富的经验。了解台湾地区医疗服务审查制的历史、现状及存在问题对于大陆相应制度的制订有一定的启示和借鉴意义。 |
| 关键词: 医疗服务 审查制度 医疗保险 |
| DOI： |
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| 基金项目: |
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| Research on Medical Services Audit System in Taiwan in China |
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| Abstract: |
| Medical insurance, as the major payers of health care services, establishes a medical audit system to prevent abuse medical treatment because of moral risk to ensure the necessity and reasonableness of medical services and to achieve the effect of cost control and quality assurance in medical audit.But cost reduction and quality improvement is a paradox.The health care providers in Taiwan argue and criticize that the relevant review standards are not inconsistent and comprehensive, internal regulations change too much and lack of transparency in the review process. Even though, Taiwan accumulates rich experience in this field.History，status quo and problems of medical service audit system are researched to make some enlightenment and references for Chinese mainland. |
| Key words: medical service, audit system, medical insurance |
