台灣健保醫療費用時間序列預測模型

Time Series Forecasting Model of Health Care Expenditure in Taiwan

10.30003/JRM.200511.0003

許碩芬(Shuo-Fen Hsu)；楊雅玲(Ya-Ling Yang)；范碧純(Bi-Chun Fan)

醫療費用支出 ； 時間序列預測模型 ； Health care expenditure ； Time series forecasting model

風險管理學報

7卷3期（2005 / 11 / 01）

279 - 300

繁體中文

本文探究影響醫療費用成長的重要因素，並探討台灣實施的三種抑制醫療費用成長措施，亦即牙醫總額支付制度、中醫總額支付制度及門診部份負擔新制對於醫療費用所造成的衝擊。結果發現：（一）在自變數的影響效果方面：前一、二期的醫療費用對總醫療費用成長率有顯著負的效應，平均投保薪資、人口老化指數和標準死亡比對總醫療費用成長率有顯著正的效應，而投保人數、特約醫療機構數和通貨膨脹率並無顯著影響。（二）在制度的衝擊方面：政府在資料期間實施的牙醫總額支付制度、中醫總額支付制度及門診部份負擔新制，對醫療費用成長率並無顯著影響。（三）預測精確度方面：本文模型所計算出之絕對相對誤差（absolute relative error）平均值較ARIMA模型計算所得之值為小。

In this paper, we explore the key factors for the growth of National Health Insurance expenditure and the impact of three most important expenditure containment policies that have been practiced during our data period. The results of empirical research were presented as follows: First, prior one and two month health care expenditure affected the rate of current health care expenditure negatively. On the other hand, average insured wage, ratio between population 65 years of age and over and population aged 15 to 64, and standard death rate had positive effect on the rate of health care expenditure. The amount of insured persons, contracted medical care institutions, and rate of inflation had no significant effect on it. Second, three supply-side incentive mechanism including the global budget policies on dental institutions and institutions practicing Chinese medicine, the new copayment system in ambulatory are of no significant impact on the health care expenditure. Third, the average of absolute relative error calculated by our model was smaller than that of ARIMA model.

1. Barros, P. P.(1998).The black-box of health care expenditure growth determinants.Health Economics,7,533-544.
2. Becker, G. S.(1965).Theory of the Allocation of Time.Economic Journal,75,493-517.
3. Cockx, B.,C. Brasseur(2003).The demand for physician services: Evidence from a natural experiment.Journal of Health Economics,22(6),881-913.
4. Culyer, A. J.(1988).Health expenditure in Canada: myth and reality; past and future.Canadian Tax Paper 82.
5. Cutler, D. M.,R. J. Zechkhauser,A. J. Cutter (eds.),J. P. Newhouse(eds.)(2000).Handbook of Health Economics.Amsterdam:Elsevier.
6. Ellis, R. P.,T. G. McGuire(1993).Supply-side and demand-side cost sharing in health care.Journal Economics Perspectives,7(4),135-151.
7. Ellis, R. P.,T. G. McGuire(1990).Optimal payment systems for health services.Journal of Health Economics,5,375-396.
8. Gbsemete, K.,U. -G. Gerdtham(1992).The determinants of health expenditure in Africa: a cross-sectional study.World Development,20,303-308.
9. Gerdtham, U. -G.(1992).Pooling international health expenditure data.Health Economics,1,217-231.
10. Gerdtham, U. -G.,B. Jönsson(1991).Health care expenditure in Sweden, an international comparisons.Health Policy,19,211-228.
11. Gerdtham, U. -G.,B. Jönsson(1994).Health care expenditure in Nordic countries.Health Policy,26,207-220.
12. Gerdtham, U. -G.,B. Jönsson,A. J. Culyer(eds.),Newhouse, J. P. (eds.)(2000).International comparisons of health expenditure: theory, data and economic analysis.Elsevier Science, North Holland, Handbook of Health Economics, 1A..
13. Gerdtham, U. -G.,B. Jönsson,M. MacFarlan,H. Oxley,P. Zweifel (ed.)(1998).Health, The Medical Profession and Regulation.Dordrecht:Kluwer Academic.
14. Gerdtham, U.-G.,J. Sögaard,B. Jönsson,F. Andersson,P. Zweifel (eds.),H. Frech, (eds.)(1992).Health Economics Worldwide.Dordrecht:Kluwer Academic.
15. Gerdtham, U.-G.,J. Sögaard,F. Andersson,B. Jönsson(1992).Econometric analysis of health expenditure: a cross-sectional study of the OECD countries.Journal of Health Economics,11,63-84.
16. Grossman, M.(1972).On the concept of health capital and the demand for health.Journal of Political Economy,80,223-255.
17. Hellinger, F. J.(1996).The impact of financial incentive on physician behavior in managed care plans: A review of the evidence.Medical care research and review,53(3),294-314.
18. Hitiris, T.,J. Posnett(1992).The determinants and effects of health expenditure in developed countries.Journal of Health Economics,11,173-181.
19. Hu, T. W,M. L. Sheu(2000).Patterns and regional variations of health care expenditure and utilization in Taiwan -a pooled time-series and crosssection data analysis.A Report of Bureau of National Health Insurance.
20. Jenkinson, C.,Coulter, A.,Wright(1993).Short form (SF36) health survey questionnaire: normative data for adults of working age.British Medical Journal,306,1437-1440.
21. Kleiman, E.,M. Perlman (ed.)(1974).The Economics of Health and Medical Care.London:Macmillan.
22. Leu, R. E.,A. J. Culyer(eds.),B. Jönsson, (eds.)(1986).Public and Private Health Services.Oxford:Basil Blackwell.
23. Lubitz, J.(1987).Health status adjustments for Medicare capitation.Inquiry,24,362-375.
24. Manning, W. G.,J. P. Newhouse,N. Duan(1987).Health insurance and the demand for medical care: evidence from a randomized experiment.American Economic Review,77(3),251-277.
25. Meara, E.,C. White,D. M. Cutler(2004).Trends in medical spending by age.Health Affairs,23(4),176-186.
26. Mendelson, D. N.,W. B. Schwartz(1993).Data watch: The effects of aging and population growth on health care costs.Health Affairs,12(1),119-130.
27. Miline, R.,H. Molana(1991).On the effect of income and relative price on demand for health care: EC evidence.Applied Economics,23,1221-1226.
28. Newhouse, J. P.(1977).Medical care expenditure: a cross-national survey.Journal of Human Resources,12,115-125.
29. OECD(1995).Factors affecting health spending: a cross-country econometric analysis.New directions in health care policies: improving cost control and effectiveness.
30. Parkin, D.,A. McGuire,B. Yule(1987).Aggregate health expenditures and national income: is health care a luxury good?.Journal of Health Economics,6,109-127.
31. Pfaff, M.(1990).Differences in health care spending across countries: statistical evidence.Journal of Politics and Law,15,1-67.
32. Rosset, R. N.,L. F. Huang(1973).The effect of Health Insurance on the demand for medical care.Journal of Political Economy,81,281-305.
33. Tolley, H. D.,K. G. Manton(1984).Assessing health care costs in the elderly.Transactions of the Society of Actuaries,36,579-603.
34. van De Ven, W.,R. Ellis,A.J. Culyer (Edited),J. P. Newhouse(2000).Risk adjustment in competitive health plan markets.Handbook of Health Economics.
35. Viscusi, W. K.(1994).Risk-risk analysis.Journal of Risk and Uncertainty,8,5-17.
36. Zweifed, P.,W. G. Manning,A. J. Cutter(eds.),J. P. Newhouse(eds.)(2000).Handbook of Health Economics.Amsterdam:Elsevier.
37. 中央健康保險局(2004)。2003年全民健康保險統計動向。
38. 中央健康保險局(2004)。2003全民健康保險統計年報。
39. 中央健康保險局(2003)。2002全民健康保險統計年報。
40. 中央健康保險局網站
41. 中華民國老人狀況調查報告（91年）
42. 行政院主計處網站
43. 中華民國九十二年衛生統計（二）生命統計年報
44. 行政院衛生署衛生統計資訊網

1. 黃玉珂、許碩芬、林兆欣(2007)。台灣健保醫療費用成長因素與供需誘因機制之費用控制成效。風險管理學報，9(3)，197-219。
2. 張嘉仁(2010)。降雨、農曆月份及作物收成對門診量影響－以中部某區域醫院眼科為例。弘光學報，60，1-8。