National Health Insurance Act Article 42
The Fee Schedule and Reference List for Medical Services described in the preceding paragraph shall follow the principle of “equal payment for the same nature of illness,” and the relative points shall reflect the cost of each medical service. It shall be drafted taking into account volume, cases, quality, individuals, and number of days.The Insurer may first conduct a medical technology evaluation before drafting the Fee Schedule and Reference List for Medical Services in the preceding paragraph, and then consider human health, medical ethics, the cost-effectiveness of the treatment, and the finances of the Insurance. The same applies to the drafting of the drug dispensing items and fee schedule.Medical services and drugs are expensive and pose great danger to inappropriate users, which must be presented to the Insurer for review and approval before use, except in emergencies.The review items before use, as well as the definition and review of emergencies, standards, and other relevant Fee Schedule and Reference List for Medical Services, shall be drafted for the medical service items and fee schedule as well as the drug dispensing items and fee schedule. 14
中文原文 全民健康保險法第42條
醫療服務給付項目及支付標準之訂定，應以相對點數反應各項服務成本及以同病、同品質同酬為原則，並得以論量、論病例、論品質、論人或論日等方式訂定之。
前項醫療服務給付項目及支付標準之訂定，保險人得先辦理醫療科技評估，並應考量人體健康、醫療倫理、醫療成本效益及本保險財務；藥物給付項目及支付標準之訂定，亦同。
醫療服務及藥物屬高危險、昂貴或有不當使用之虞者，應於使用前報經保險人審查同意。
但情況緊急者，不在此限。
前項應於使用前審查之項目、情況緊急之認定與審查方式、基準及其他相關事項，應於醫療服務給付項目及支付標準、藥物給付項目及支付標準中定之。
前項醫療服務給付項目及支付標準之訂定，保險人得先辦理醫療科技評估，並應考量人體健康、醫療倫理、醫療成本效益及本保險財務；藥物給付項目及支付標準之訂定，亦同。
醫療服務及藥物屬高危險、昂貴或有不當使用之虞者，應於使用前報經保險人審查同意。
但情況緊急者，不在此限。
前項應於使用前審查之項目、情況緊急之認定與審查方式、基準及其他相關事項，應於醫療服務給付項目及支付標準、藥物給付項目及支付標準中定之。