健康保險是國家保障人民就醫可近性的方式之一，台灣在1995年開辦全民健康保險，此後全民健康保險長期面臨入不敷出的財務難題，於是健保體系下的支付制度歷經一連串的變革，本文按時間歷程分階段整理1995年至今主要支付制度的變革，並探討對於醫療供給者、保險人以及被保險人的誘因與影響效果。
1995-1998年的論量計酬，到1998-2010年期間的總額預算，再到2010至迄今的論病例計酬，有此變革一定其改變的原因，因此本文從支付制度的介紹，到全民健康保險的歷史演變，再來透過多方的文獻分成費用、品質及醫院與醫事人力探討支付制度帶來的影響，最後針對健保體系中不可或缺的藥品支付制度詳細的補充。
多方研究結果顯示，總額預算與論病例計酬確實比最初實施的論量計酬在費用方面得到有效的控制，品質也不會因為制度的改變而有所打折。藥品支付制度方面，透過每一到兩年的藥價調查，以及逐年刪減指示用藥的給付，藥品費用的支出也得到有效的控制。
Health insurance is one of the ways the country guarantees people's access to medical treatment. Taiwan introduced universal health insurance in 1995. Since then, universal health insurance has faced financial difficulties for a long time, so the payment system under the health insurance system has undergone a series of changes. The course reviews the changes in the main payment system in stages from 1995 to the present, and explores the incentives and effects on medical providers, insurers, and insureds.
Discussed compensation from 1995 to 1998, total budget from 1998 to 2010, and cased compensation from 2010 to the present, there must be reasons for this change. Therefore, this article starts from the introduction of the payment system to universal health insurance. The historical evolution of the second, through the multi-party literature into costs, quality and hospital and medical manpower to explore the impact of the payment system, and finally a detailed supplement to the indispensable drug payment system in the health insurance system.
The results of various studies have shown that the total budget and the case-based compensation are indeed more effective in controlling costs than the initially-implemented theories based compensation, and the quality will not be discounted by changes in the system. Regarding the drug payment system, through the drug price survey every one to two years, and the annual reduction of the payment of the indicated medications, the expenditure on drug costs has also been effectively controlled.
