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題名：建構以健康需要為基礎的地區總額預算分配模式-以門診為例
作者：王秀英
作者(外文)：Wang, Shiow-Ing
校院名稱：亞洲大學
系所名稱：健康產業管理學系健康管理組
指導教授：楊志良
學位類別：博士
出版日期：2012
主題關鍵詞：資源配置；健康需要；總額預算地區分配；resource allocation；health needs；regional ambulatory global budget
原始連結：連回原系統網址new window
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「資源有限，欲望無窮」，由於資源與欲望間的不平衡，決定投注多少資源、如何分配健康照護資源以及訂定優先次序一直是衛生政策關注的議題。依據健康需要來分配資源的原則得到普遍的認同，因此，本研究擬建構一個以民眾健康需要為取向的總額預算地區分配模式，研究結果可供衛生主管機構參酌，藉以修正現行總額預算分配模式，以達到合理、公正地分配健康照護資源的目的。
本研究定義「健康需要」係從專業人員的角度著眼，藉以區隔個體從主觀角度認定的「健康需求」。我們分別從預防保健及疾病治療來定義所謂的健康需要。首先，依據現行全民健康保險所提供的九項預防保健服務項目，及其規定的服務對象及檢查期程及支付點數，乘上六大醫療區符合規定的服務對象人數，得到各醫療區的預防保健健康需要點數，再將此預估點數與實際發生點數進行比較，以得知各區在預防保健是否有健康需要未滿足或過度使用資源的狀況。
其次，利用2009年全民健保門急診處方及治療明細檔及全民健保承保檔，計算出全國各疾病別在不同性別及年齡層的平均治療年費用，以此為基準，乘上六大醫療區各性別年齡層的實際罹病人數，估算各區預期的疾病治療健康需要點數，再將此預估點數與實際發生點數進行比較，以得知各區在疾病治療是否有健康需要未滿足或過度使用資源的狀況。另外，依據六區各疾病的罹病率與全國各疾病罹病率的偏差程度，提出各區應優先處理的問題及對象。
研究結果顯示在預防保健方面，實際值佔率高於預估值佔率的依次為北區、台北區及東區；實際值佔率低於預估值佔率的依次為高屏區、中區及南區。在疾病治療方面，呈現與預防保健相近的結果。實際值佔率高於預估值佔率的依次為北區、台北區及東區；實際值佔率低於預估值佔率的依次為高屏區、中區及南區。將預防保健及疾病治療彙整一起檢視，本研究方法所預估2010年六區的健康需要點數分配佔率與實際申報點數分配比例相差分別為：台北區- 4.35 %、北區- 9.13%、中區4.00 %、南區2.01 %、高屏區9.18 % 及東區-1.17 %。研究估算的分配比例與實際申報或中央健康保險局公告的現行預算分配比例有所不同，顯示目前的門診總額預算分配並未達到依據健康需要來分配。
六區有不同的健康需要及應優先處理的健康問題。相較於台北區同性別同年齡層的群體，北區民眾有較高的背部病變及風濕症的健康需要；中區則有較高的食道胃及十二指腸疾病、其他泌尿系統疾病、血液及造血器官疾病的健康需要；南區在腎炎、腎徵候群及腎病罹、其他內分泌腺疾病、生殖泌尿器官惡性腫瘤等疾病有較高的需要；高屏區亦有較高的腎炎、腎徵候群及腎病、其他內分泌腺疾病等健康需要；東區民眾是在高血壓疾病、其他精神病、精神官能症有較高的健康需要。
現行全民健保總額預算地區分配公式的選取有其時空背景考量，但公式的內容應該隨著時間不斷地加以檢驗或修正。各地區民眾由於生活型態及環境的不同，有其特定的健康問題，需要不同的資源來處理。擬訂符合當地民眾需要的衛生政策，配置當地民眾所需要的資源，才有可能達到讓所有民眾都能享有最高的健康水平之目標。
Scarcity is the mother of allocation. Therefore, allocating healthcare resources to satisfy need is always a persistent challenge for health policy planners. The principle of distribution according to need has gained generally recognition in the health care field. The purpose of present study is to construct a needs-based formula to allocate regional ambulatory budget of National Health Insurance in Taiwan. The results can provide some evidences to modify the existing allocating mechanism for the best interest.
We defined health need from preventive and treatment dimensions. According to the subjects and frequency of preventive services currently covered by National Health Insurance, we calculated preventive health need based on the geographic popularity in six medical regions. Using National Health Insurance claim data, we present regional morbidity rates and national average expenditures by diseases, gender-age groups to demonstrate the treatment health need of popularity in six regions.
The study results showed that people in six medical regions have different health needs with unique health problems. Needs-based allocations and the actual declared expenditures were significantly different. Needs-based allocations ranged from 9.18% higher than actual expenditures in Kaoping Division to 9.13% lower in Northern Division. It reveals that current mechanism to allocate ambulatory global budget under the national health insurance system does not reflect the rational situation based on health needs.
The contents of the resource allocation formula should be tested or amend over time. Establishing health policies to meet the needs of the local people, and rationing resource according to health needs would improve equity in the distribution of healthcare services and result in an achievement of goals that everyone can enjoy the highest level of health.
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