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題名：調高健保給付對醫療品質之影響：以2005年自然產給付調高為例
書刊名：經濟論文叢刊
作者：連賢明 引用關係／韓幸紋
作者(外文)：Lien, Hsien-ming／Han, Hsing-wen
出版日期：2019
卷期：47:4
頁次：頁621-664
主題關鍵詞：剖腹產；誘發性需求；醫療品質；Cesarean section；Induced demand；Healthcare quality
原始連結：連回原系統網址new window
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  • 共同引用共同引用:16
  • 點閱點閱:6
2005年5月健保局將自然產給付加倍，調整至與剖腹產給付一致，期望透過自然產給付增加，來降低剖腹產率並改善醫療品質。這自然產給付增加提供了一個檢視給付提高對醫療品質改善機會。本文使用2004與2006年生產案件，以健保給付當作醫師所得的替代變數，醫療品質則以剖腹產率、住院天數、再住院率進行觀察，分析醫師所得增加和醫療品質間因果關係。爲控制醫療時無法觀察因子，估計時選用初產產婦，並採用「一階差分」方式來排除內生性偏誤。結果顯示給付增加對剖腹產率沒有顯著關係，但原先自然產比例較高醫師剖腹產率卻有降低；另外，自然產再住院率也顯著下降。我們進一步針對幾個解釋剖腹產偏低效果進行檢驗，發現產婦個人偏好剖腹產是一個可能原因。最後，我們發現這給付調整效果並未外溢到同醫院的婦科、兒科治療。
In May 2005, Bureau of National Health Insurance doubled the reimbursement for vaginal delivery to the same rate as paid for cesarean section (c-section) in order to reduce the c-section rate and improve the quality of care. This reimbursement adjustment provides an excellent opportunity to examine whether such a payment increase can improve healthcare quality. Using obstetric cases of firstborns in 2004 and 2006 from National Health Insurance Data, this study examines if there was a negative relation between quality indicators (e.g. c-section, re-admission, and length of stay) and doctor's income, measured in terms of payments paid by NHI for baby delivery. To control for the endogenous bias, the study employs ＂first-difference＂ methods to attenuate the bias arising from unobserved factors, and restricts the sample to firstborn babies. Our results indicate that the doctor's income and c-section rate is statistically uncorrelated on the whole, but negatively related for doctors who previously had a lower percentage of c-sections. Additionally, we found the payment reduces both the 14 and 30 days re-admission after vaginal delivery. Furthermore, the analysis indicates that one explanation- a c-section is preferred by women for the sake of personal reasons- is largely consistent with our empirical findings. Finally, we found the effect of the payment increase did not spill over to gynecology or pediatric services in the same hospital.
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會議論文
1.楊哲銘(2000)。TQIP區域性資料報告。財團法人醫院評鑑暨醫療品質策進會台灣醫療品質指標計劃週年研討會，(會議日期: 2000年10月18日)。  延伸查詢new window
研究報告
1.樊家忠(2014)。龍年與鬼月對家庭生育決定的影響及其後果。  延伸查詢new window
2.Kessler, Daniel P.、McClellan, Mark(1996)。Do Doctors Practice Defensive Medicine?。  new window
學位論文
1.林阿明(2006)。健保調高自然產給付對剖腹產率之影響研究(碩士論文)。國立陽明大學。  延伸查詢new window
2.陳春木(2006)。影響初次剖腹產因素之分析及其醫療資源耗用適當性之探討--以2003年健保資料庫為例(碩士論文)。高雄醫學大學。  延伸查詢new window
3.江靜楓(2001)。公私立醫院醫師薪資制度設計與醫院醫師生產力的研究(碩士論文)。國立臺灣大學。  延伸查詢new window
4.汪育如(2006)。免不了的一刀--台灣產婦的社會建構(碩士論文)。東吳大學。  延伸查詢new window
圖書
1.陳建仁(1999)。流行病學：原理與方法。臺北：聯經出版社。  延伸查詢new window
2.OECD(2006)。OECD Health DATA。OECD。  new window
3.Lee, Myoung-Jae(2005)。Micro-Econometrics for Policy, Program, and Treatment Effects。Oxford University Press。  new window
4.方瑞雯、白映俞、吳佳璇(2012)。醫療崩壞!沒有醫生救命的時代。台北：貓頭鷹。  延伸查詢new window
5.全民健康保險醫療費用協定委員會(2005)。全民健康保險醫療費用總額支付制度問答輯。全民健康保險醫療費用協定委員會。  延伸查詢new window
6.行政院衛生署(2011)。醫療機構現況，健保支出及醫院醫療服務量統計。台北：行政院衛生署。  延伸查詢new window
7.李明濱(2012)。醫者心--跨越與創新。台北：中華民國醫師公會全國聯合會。  延伸查詢new window
其他
1.王昶閔，魏怡嘉(2012)。台灣婦產科快崩盤 過勞超時糾紛多 新血卻步，http://www.libertytimes.com.tw/2012/new/aug/13/today-life4.htm。  延伸查詢new window
2.邱宜君(2010)。調高醫師診察費能解決內外婦兒科醫師「四大皆空」的問題嗎?，http://issue.thrf.org.tw/Page_Show.asp?Page_ID=1293。  延伸查詢new window
3.莊其穆(20040525)。如何降低剖腹產率?--從提高第一胎自然生產給付做起。  延伸查詢new window
4.劉梅君，朱顯光(20110920)。健保補助艱困科醫師的錢進誰口袋?，http://www.thrf.org.tw/Page%7B%5C_%7DShow.asp?Page%7B%5C_%7DID=1438。  延伸查詢new window
5.衛生福利部全民健康保險會(2014)。103年度第11次委員會議議事錄。  延伸查詢new window
6.顏若瑾，曾韋禎(2010)。剖腹產率高遭糾正婦產科抗議，http://www.libertytimes.com.tw/2010/new/jul/13/today-life15.htm。  延伸查詢new window
圖書論文
1.Evans, Robert G.(1974)。Supplier-Induced Demand: Some Empirical Evidence and Implications。The Economics of Health and Medical Care。London：Macmillan。  new window
2.吳嘉苓(2000)。產科醫生遇上迷信婦女？台灣高剖腹產率論述的性別、知識與權力。性別政治與主體形構。台北。  延伸查詢new window
3.McGuire, Thomas G.(2003)。Physician Agency。Handbook of Health Economics。Amsterdam：Elsever, North Holland。  new window
 
 
 
 
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