西醫基層診所實施總額預算前後之價量變化以臺灣北部地區西醫基層診所為例

The Effect of the Global Budget on the Western Medicine Clinics Price and Utilization - Case of Western Medicine Clinics in the Northern Taiwan

10.6288/TJPH2002-21-05-06

張益誠(Yi-Cheng Chang)；廖宏恩(Hung-En Liao)

總額支付制度 ； 保險申報 ； 基層醫療 ； 全民健康保險。 ； Global Budget Scheme ； Medical Claims ； Primary Care ； National Health Insurance.

台灣公共衛生雜誌

21卷5期（2002 / 10 / 01）

363 - 372

繁體中文

目標：本研究主要目的在探討西醫基層總額支付制度實施前後對其醫療費用之初期影響。方法：利用健保局台北分局轄區台北縣市、基隆市、宜蘭縣基層西醫診所一門診醫療費用申報檔」，比較其在89及90年下半年申報費用與件數的變化。結果：總額制度實施半年之後；一、西醫基層診所申請件數顯著下降，單位價格顯著增加。二、預防保健及慢性病等鼓勵部門申請件數和點數顯著增加，上限制部門申請件數及點數顯著減少。三、複迴歸分析顯示，縣市別、城鄉別及權屬別是影響基層診所醫療費用變化的因素。結論：基層總額支付制度實施初期的確對基層西醫診所申請醫費用的行為產生一定程度之影響，但由於總額實施時間未久，本研究僅能分析短期變化情形。在推行醫院總額支付制度前，建議衛生主管機關應持續追蹤監測，並建立點值速算機制，和評估基層診所與醫院合作模式，以瞭解醫師醫療行為或醫院管理模式的改變，是否會影響到民眾就醫的可近性與醫療服務的適當性及品質。

Objective: The aim of this research is to explore the initial impacts of the Global Budget Scheme on the medical claims among primary Western physician clinics. Methods: Outpatient Medical Expenditure Data file is employed to compare the changes in medical claims among primary Western physician clinics in the same half year before (i.e., 2000/07) and after (i.e., 2001/ 07) the Global Budget Scheme was inaugurated. Results: I. Six months after launching the Global Budget Scheme, the number of cases claimed from primary Western physician clinics dropped sharply with a significant increase in unit price. 2. The number of medical claims categorized in encouraged groups such as preventive health services and chronic diseases increased dramatically, while that in the other categories with expenditure cap appeared to decrease. 3. Our regression model showed that the type of cities, type of townships, and the type of clinics ownerships are significant factors influencing the results of decreasing medical claims and an increasing unit price index. Conclusions: The behaviors of clinical physicians reflecting on the changes of Medical Claims were indeed influenced by the implementation of the Global Budget Scheme. Since our findings were confined to the initial impacts of the Global Budget Scheme, it is suggested that the authority continues to monitor the trend to analyze the extent to which patient's accessibility and medical quality would be influenced in the long run. In addition, before implementing the Global Budget Scheme on hospitals, the authority should establish an automatic unit-price response mechanism. For the health industry, it is suggested that the health administration should re-think the appropriate cooperative model between hospitals and primary clinics.

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