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Taiwan, the fairness of health-care system: a preliminary analysis


All
Rui, Institute of Philosophy, National Central University, director of

Key words: R-02 Document code: A Article ID :1002 -0772 (2007) 12-0028-04
Everyone can not help but illness and death, and every aspect of this process is closely related with the health problems, it can be said with the well-being of each individual's life can not be separated. Therefore, health care (healthcare) is the most important in modern society a kind of social security. In Western society, this social security not only for years, and from time to time there are new requirements and new reflection, new reforms, almost no full stops. Because of new medical technology, new medical products, new emerging health care goals, to the continuous development of society, economy, living environment, people's needs are changing, and each person usually closely related to health care in the social and natural political agenda,[link widoczny dla zalogowanych], the reform continued to advance with the times or consequential, or society that is great turmoil. In recent years, Western countries have not only been the voice of a health care reform and programs for the more urgent in developing countries, the allocation of medical resources to generate more controversy. Because, from the relatively poor and backward country into the initial system of strong, primary health care system, usually in a relatively backward and insufficient to keep up with society's new demands. But how to transition and onto the road of healthy development, not something natural and smooth. This example is currently China's rapid economic and social transformation, which faces the allocation of medical resources, how to reform the health care system to meet the current medical technology, economic structure, social patterns, the state financial resources needs of the people, and so the new status and condition, can be said to be a huge social project between gains and losses on the country and the people influence, self-evident.
dispute is the most important health care needs for care is unlimited, and social resources are always limited, how to achieve equitable distribution of health nail in the coffin so that everyone regrets, not an easy task. Many health care reform often due to financial factors, social and economic setting, often can not help but to accommodate the reality of social reform and the results are not necessarily those most in need the best interest of the development of the country as a whole is not always the most healthy. Poor health care system or policy development, can lead to social bankruptcy, even more unfair distribution of resources. Health care reform for social and economic system, and ethical norms for. On the one hand, a good health care system must be fair, otherwise it means that some people are subject to improper treatment, their personal and family have a serious injury. On the other hand, the system must also be in line with public expectations and feasible, or even to continue, otherwise the end will lead to social bankruptcy, everyone suffers. How to combine these two factors, is a large health care system can be a long time a necessary condition.
Taiwan society in the 20th century as the seventies and eighties economy has preliminary results, 80 that is actively planning new health care system, to promote new health care reform. Finally passed in 1994, the new National Health Insurance Act, starting the first wave of health insurance mechanisms. While this system the people of Taiwan to promote medical standards, but it can not lead students to avoid many serious problems, especially financial balance of the deficit problem. After a decade of development, the drawbacks of the various aspects of growing, the public health care in the various problems have been questioned and called for reform, which in recent years, the parties have advocated the birth of the second generation of health care, it seems that the first generation of health care as a whole has been overburdened,[link widoczny dla zalogowanych], to comprehensive reform of the update. But how to reform the parties are not exactly the same diagnosis and prescription, or even diametrically opposite situation is not compatible phase. As it involves the most vital interests of every citizen, government officials are not frivolous, but to keep consulting further consultation, study and then study whether the birth of the second generation of health care, still warm controversy.
showed a lot of controversy directly the allocation of medical resources, how to share the financial expenses, such as quality of health care is reasonable, but is actually involved in the issue of fairness. Because the burden of health care resources and medical costs of the distribution of natural wealth re-distribution of social behavior, the most fundamental problem of equitable distribution of resources naturally. And positive for a clear analysis of health care fairness to Taiwan's national health insurance is still rare academic study, therefore, this allocation of medical resources is intended to focus on fairness to view the current National Health Insurance in Taiwan possession of some of the core contained ethical principles. Meanwhile, in order to more clearly some of them into the prime of this article with Daniels (NormanDaniels) established by the health care reform the basic fairness of the ten markers (benchmarkoffairness) as a starting point for ethical analysis to demonstrate the fairness of the Taiwan National Health Insurance standards as a basis for further reform.
1 of the fairness of Medicare health care tag
Daniels justice theory is basically a play Rawls (John
Rawls) justice to the health care of the results. In short, Daniels to maintain and achieve fair and equitable opportunities (fairequalityofopportunity) the basic principles for health care, health care system is the guardian of the mechanisms of social justice, and justice to be achieved goal is to enable every citizen Under normal species function as open and fair, that under a fair chance to compete for social resources. Therefore, all the medical policies and facilities can use this principle as a basis for judging. His health care justice theory of the increasing influence of reason, not only because he is based on the Western mainstream justice theory, but also because he can effectively extend his health care justice theory with a lot of experience in research, to this theory to show the rich theoretical consequences. Medicine, such as he can with the knowledge and development, the establishment of social justice and the gene medicine technology, the relationship between equality and health care, etc. [2-3], more importantly, justice, health care he extended to more substantive theory of medicine rational allocation of resources, and then analyzes a variety of medical reform plan, has an important role in guiding national policy.
90 in the 20th century the United States government and health care reform has been heated debate, the government and private have put forward different proposals, Daniels further the concept of fairness based on a number of important and representative of the program, make a comparison analysis to evaluation of the fairness of different options. Here are his other two scholars to the U.S. health care reform proposed by the fairness of marking the ten (benchmarkoffairness):
(1) universal access to use - coverage and participation (Universalaccess-CoverageandParticipation)
(2) universal access to use - to minimize non-financial barriers (Universalaccess-MinimizingNonfinancialBarriers)
(3) the breadth of care, including sexual and interests of uniformity (ComprehensivenessandUniformBenefit)
(4) the fairness of the financial - set by the community Premium rate (EquitableFinancing-Community-RatedContributions)
(5) the fairness of the financial - set by ability to pay premiums (EquitableFinancing-ByAbilitytoPay)
(6) the value obtained funds - medical efficiency (ValueforMoney-ClinicalEfficacy)
(7) the value obtained funds - financial efficiency (ValueforMoney-FinancialEfficiency)
( to the people responsible (PublicAccountability)
(9) and Comparison of other expenses (Comparability)
(10) patients with a degree of choice (DegreeofConsumerChoice).
This principle is based on ten marks Daniels justice of the health care out of the interpretation of specific indicators to check a health care reform and fairness. The following abbreviated description of these ten markers expressed by the meaning of fairness.
Daniels that everyone has the right to basic health care [5], therefore,[link widoczny dla zalogowanych], a health care system is that it can provide fair and should be whether the health care for all citizens to maintain the healthy normal function of species conditions. Although Daniels is a liberal, but that is fair, in health care, the need to adopt universal compulsory insurance system to the number of correction comes from the social inequalities Cai to meet the social system should respond to the most vulnerable, the most favorable justice requirements. Because, if not for mandatory public participation arrangements, inevitably some people do not know to protect their long-term health needs,[link widoczny dla zalogowanych], they only immediate, since the prime of good health without medical care investment; or because of insufficient income, can not afford health insurance costs without participation, especially in low-income and elderly people, and these people are also usually the class most in need of medical services; or social well-off people to select only those most in need of their services, the health care community as a whole do not want to make altruistic and mutually beneficial contribution. If the pure free market for trading in the distribution of medical services, not only has obvious social injustice, the rich have the most medical services, and the poor even the most basic and most urgent life-saving medical care are not buy, the final result is inevitable society can not afford public burdens, or not an individual subjected to an intolerable deal to combat the disease and life, led to human tragedy. Therefore, Daniels that forced the national minimum health care is the best implement the overall pattern of social justice, health care reform must also as to how to achieve the widest possible participation, elimination of due care for people other than financial factors, such as income, wealth, education, geography and other factors,[link widoczny dla zalogowanych], but not access to basic medical services. Holistic health care is a social insurance system, insurance costs can not because of personal health status while the individual is poor, can not receive a single fee across the board, but it can pay according to their individual ability to pay. In other words, high income, are required to pay more, while the poor were almost deprived of accommodation can be free in order to maintain
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