全民健保實施總額預算制度之初步影響評估：以牙醫與西醫基層為例

The Impact of Global Budgeting of National Health Insurance: A Preliminary Study on Dental and Primary Care Facilities

10.6288/TJPH2006-25-02-08

張育嘉(Yu-Chia Chang)；黎伊帆(Yi-Fan Li)；汪芳國(Fang-Kuo Wang)；鄭守夏(Shou-Hsia Cheng)

全民健保 ； 總額預算 ； 就醫可近性 ； 醫療支出 ； 醫療品質 ； National Health Insurance ； global budgeting ； accessibility ； health expenditure ； quality of care

台灣公共衛生雜誌

25卷2期（2006 / 04 / 01）

152 - 162

繁體中文

目標：本研究初步探討全民健保牙醫及西醫基層總額預算制度實施後，對民眾醫療可近性、醫療支出及醫療品質的影響。方法：本研究採用1997年至2003年全民健康保險學術研究資料庫、內政部台閩地區人口統計，以及衛生署國民醫療保健支出統計等不同資料來源進行分析，分別觀察牙醫及西醫基層院所週末看診、國民醫療保健支出、牙醫拔牙次數、牙醫根管治療次數，以及西醫門診國產藥與原廠藥佔率等趨勢分佈。結果：在可近性方面，牙醫診所週末／非週末看診次數比值在總額後仍持續下降。在醫療支出方面，牙醫之全民健保費用受到控制，但自付費用仍持續上漲。在醫療品質方面，每萬人口拔牙與根管治療次數的趨勢相仿，隱含民眾的牙齒照護品質無明顯變化；但西醫基層院所使用國產藥比例顯著增加，民眾用藥品質可能受到影響。結論：總額預算制度實施後，由於自付費用持續成長，使得控制整體醫療費用的成效有限；且若牙醫診所週末看診的比率再持續下降，民眾就醫可近性將有下降的疑慮；但在醫療品質方面，初步並未發現明顯的負面影響。本研究限於資料取得困難，只能做初步探討，總額的影響評估值得衛生部門持續關切。

Objectives: The study aims to evaluate the effects of the Dental and Primary Care Global Budgeting (Global Budgeting) policies on people's access to care, health care expenditure, and quality of care. Methods: Three major sources of data used in this study were the National Health Insurance Research Database, Taiwan An-Fukien Demographic Fact Book, and Statistics of Health Expenditure, from 1997 to 2003. The study analyzed the distribution and trends in weekend visits to dentist and physician offices, national health expenditure, numbers of tooth extractions and root canal treatments per 10,000 individuals, and market shares of domestic versus imported medicines used in ambulatory care. Results: After the introduction of the Global Budgeting, in terms of access to care, the ratio of weekend to weekday visits sustained decreased in dental clinics. Regarding health care expenditure, the out-of-pocket expenses kept increasing although the Global Budgeting policy had curbed the dental expenditure growth. In terms of quality of care, the numbers of tooth-extractions and root canal treatments per 10,000 shared similar trends, which suggested that quality of dental care remained stable. On the other hand, the ratio of domestic to imported medicines increased significantly among community clinics, which might impair the quality of care. Conclusions: The implementation of the Global Budgeting policy has a limited impact on containing total health care expenditure because of the increasing out-of-pocket expenses. And if the ratio of weekend to weekday visits keeps declining in dental clinics, it is possible that the accessibility will become worse. However, these preliminary analyses did not find significant evidence concerning quality of care. Due to the limitation of acquiring data for analysis, this study can only provide preliminary findings. Health authorities should pay more attention to the impact evaluation of the Global Budgeting policy of the National Health Insurance.

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