none

Since National Health Insurance (NHI) was practiced in 1995,its public satisfaction was nearly 70% in the first year while the financial status got worse and worse years by years (15.3 billion of deficit in 1999,27.8 B deficits in Y2000, and around 37.7 B in Y2001). Therefore, Bureau of National Health Insurance (BNHI) had to not only care about cost saving, social fairness but also maintain medical care quality. In order to balance the worse finance, BNHI enforced many strategies, such as case payment (1997), outpatient and inpatient co-payment, high rejection rate of requested medical cases, global budget (Dental clinic in 1998, Chinese ambulatory in 2000, primary-cared clinics in 2001/07, hospital in 2002/07), drug price reduction from November of 1996 to December of 2002 to save about 14.65 billion, rationalization of OPD service, increase insurer fee (2002/09)….etc.
Those implemented strategies incurred the impacts on patients, medical provider, pharmaceutical industry, and government. Therefore, the aims of this study is to explore balancing strategic variables for finding out optimal solutions among heavy financial loading from insurers, profit loss and arguments of so-called “Drug price Black-Hole” from pharmaceutical industry, and quality of medical care from hospitals.
This study was through the ways of two-phase interview. The first one phase is to have in-depth interview with legislators, MNHI ministers, hospital administratives, scholars who are specialized at public health, and managers of consumer society; this phase was aimed at validity for all variables that were identified from the study. Until the second phase, we would focus on validated variables from phase one to design questionnaires for telephone interviewing with all stakeholders such as common people, phsicians from hospitals, managers from pharmaceutical industry, officials from BNHI.
The study will try to reveal the strategic variables from different dimensions to find out concrete balancing strategies and suggestions to stakeholders in order for coping with the inevitable impacts under system thinkings in the future.

Chapter one: Introduction
1. Research motives…………………………………………. 1
2. Study problems…………………………………………… 1
3. Study objectives……………………………………………8
4. Annotation………………………………………………... 9
5. Expecting contributions…………………………………...11
6. Conceptual framework……………………………………12
Chapter Two: Theory Discussion
1. Supporting theories of government dimension
-Social welfare development……………………………………….13
2. Theory discussion of pharmaceutical industry
-Competitive strategies……………………………………………..19
3. Theory discussion of hospital and patient dimension
-Strategic alliance, co-payment, patient satisfaction……………….38

Chapter Three: Research Methodology

1. Researching process………………………………………..46
2. Study Design……………………………………………….47
3. Study Implementation……………………………………...48
4. Data Analysis………………………………………………48
5. Study Outcome…………………………………………….48
6.Variable Definition and Identification
● Variables defined for government dimension…………48
● Variables defined for pharmaceutical firms…………...48
● Variables defined for hospitals and patient……………49
Chapter Four: Government Dimension
1. Retrospective history of National Health Insurance ……51
2. Comparisons of health insurance in the world…………..55
3. Major existed problems in Government dimension ….…63
4. Optimal variables for successful policy………………. ..64
Chapter Five: Pharmaceutical Dimension
1. Industrial Analysis……………………………………… 65
2. Comparisons of pharmaceutical industry in global and in Taiwan……………………………………………………76
3. Major existed problems in pharmaceutical dimension…..86
4. Future development trends of pharmaceutical industry in Taiwan……………………………………………………86
5. The identified problems for competitive advantages in industry…………………………………………………..89
Chapter Six: Hospital and Patient Dimension
1. Hospital ecology in Taiwan…………………………….…92
2. Patient satisfaction after NHI…………………………….103
3. Major problems of hospital dimension……………….….112
4. Major problems of patient dimension……………………113
5. Problems between medical-cared providers and patients
……………………………………………………………114
Chapter Seven: Data Analysis Results
1. Validation result of in-depth interview…………………...114
2. Quantitative survey report:
2.1. Theory base and study intention……………………………..125
2.2. Brief outline………………………………………………….128
2.3. Item analysis…………………………………………………128
Chapter Eight: Discussion & Conclusion
1. Key influential indicators among stakeholders…………..194
2. Correlation among “Variables”…………………………..209
3. Strategic model among evaluated “Variables”…………...235
Chapter Nine: Suggestions
1. Suggestions for optimal strategies………………………..250
2. Suggestions to the future researchers…………………….260

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English Version

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