2005年全民健保部分負擔調整政策效果分析

游家昂

doi:10.6840/cycu201100273

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2005年全民健保部分负担调整政策效果分析

The Adjustment Effect of NHI Co-payment Policy in 2005

游家昂 , 硕士　　导师：陈计良　　

繁体中文 DOI： 10.6840/cycu201100273

转诊制度；部分负担；全民健康保险；就医次数； referring system ； Co-payment ； number of medical visits ； Nation Health Insurance

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摘要 │ 参考文献 (52) │ 国际计量

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ABSTRACT

The Nation Health Insurance system（NHI）of Taiwan has been operating around 15 years. The most important issue is the growing deficit problem. In order to control deficit and ensure survival of NHI, the Bereau of Nation Health Insurance (BNHI) has executed many adjustment policies. co-payment policy is one of the common use policies to restrain medical demand of people and to implement referring system. For the past 15 years, co-payment policy had been adjusted 8 times, the latest adjustment was made in 2005. The purpose of my research is to understand the adjustment effect of NHI co-payment policy in 2005, especially in restraining medical demand of people and the validity of referring system.

The sample in my research uses “National Health Insurance Research Database”, which was produced by National health Research Institutes. There are  110,129 people who had medical record during July 15, 2004 to October 14, 2006 （before and after the co-payment policy was implemented）. I adopt random effect model to analyze the adjustment effect of NHI co-payment policy in 2005. In order to make research results more robust, I select the people who were defined as frequent visitors of outpatient services, then testing whether the adjustment of co-payment policy in 2005 could control their medical utilization. In addition, I select the people who have a preference for high-level hospital for medical treatment and have diseases suited to all-level medical institutions for medical treatment and have diseases suited to advanced hospital for medical treatment, then testing whether the adjustment of co-payment policy in 2005 could improve referring system.

According to the empirical result, the adjustment of co-payment policy in 2005 not only could control medical demand of people effectively, but also inhibited frequent visitors of outpatient services effectively. In addition, the adjustment of co-payment policy in 2005 drove people to implement referring system, and push people who have a preference for advanced hospitals for medical treatment to low-level hospitals. Finally, I distinguish the sample by specific disease type. After testing, it is clearer to understand that the adjustment of co-payment policy in 2005 can improve referring system and does not affect people who have medical demands for advanced hospitals for medical treatment.

参考文献 ( 52 ) 〈TOP〉

中央健保局，2007，全民健保与您牵手12年 : 成长与蜕变。
连结：
郭碧云，2006，健保部分负担调整对糖尿病人门诊医疗利用之影响，高雄医学大学医务管理学研究所硕士在职专班硕士论文。
连结：
陈听安、徐伟初、周丽芳，1998，我国全民健康保险医疗费部份负担经济效果分析与与制度改进之研究，行政院卫生署全民健康保险监理委员会八十六年度委托研究计画研究报告，计画编号：DOH86-HS-001。
连结：
黄惠萍，2007，全民健保新制部分负担对民众就医层级选择之影响，国立台湾大学卫生政策与管理研究所硕士论文。
连结：
刘美君，2006，加重部分负担与家庭医师制度对转诊病患医疗资源耗用差异之研究，元智大学管理研究所硕士论文。
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