全世界的保險付費者(payer)正逐漸改變過往以論量計酬(Fee-for-service)為主要付費方式，提出各種替代性支付模式(alternative payment models)，給予醫療提供者(providers)經濟誘因，並使醫療提供者負擔更多財務責任。而隨著人口老化，慢性病人口增多，支付制度改革已經是台灣健康體系關鍵的一環。參考各國照護模式及支付制度，利用包裹式支付(Bundled Payments)提高醫療提供者的責任，在提升照護結果的同時，降低過度醫療與避免片段照護，是可能方向之一。本文將簡述各國實施包裹式支付制度的背景、制度模型、相關實證研究之成效結果，並討論包裹式支付制度可提供我國醫療與健康照護模式精進的借鏡之處。

Insurance payers around the world are gradually shifting from historical fee-for-service reimbursement toward alternative payment arrangements. These new alternative payment models aim to provide economic incentives and increase financial accountability among healthcare providers. With an aging population and increasing prevalence of chronic conditions, payment reform has become a crucial component of Taiwanese healthcare system. Drawing from international care models and payment systems, bundled payments could be a potential approach for increasing healthcare provider accountability and enhancing care outcomes while reducing excessive medical interventions and fragmented care. This study outlines the background, institutional models, and the outcomes from implementation of bundled payment models in various countries. This study also discusses how bundled payments can provide insights for improving Taiwanese healthcare and medical care models.

支付制度；健康照護模式；包裹式支付；支付制度改革

payment system, healthcare model, bundled payments, payment reform