本文利用Heckman的樣本選擇模型，實証估計影響老人自付醫療費用的因素。實証
資料來自行政院主計處在民國 78 年 12 月所舉辦的「老人狀況調查」， 共有 5,121 個樣
本。本文的實証發現，具有公、勞、農保資格及享有軍榮民就醫優待的老人，其平均自付門
診住院費用約為無健康保險者的二至三成。此一結果顯示，現行健康保險雖尚未普遍採行部
份負擔制度（名目部份負擔率為０）， 但老人在實際就醫時，卻要自己負擔約 20% 到 30%
的醫藥費（此相當於平均實質部份負擔率在 0.2 至 0.3 之間）。因此，現行健康保險制度
之給付條件與支付制度，實有檢討之必要。

This paper used Heckman's sample selection model to estimate the
determinants of the out-of-pocket medical expenditure by the elderly in Taiwan.
The primary source of data was from the Old Status Survey in 1989, which was
conducted by the Directorate-General of Budget, Accounting, and Statistics,
Executive Yuan, Republic of China. The data base contained 5,121 cases aged 65
and above.
The analytical results showed that the out-of-pocket medical expenditure paid by
insured elderly was equivalent to 20 to 30 percent of the medical expenditure of
the uninsured elderly. This result indicates that the real coinsurance rate is
0.2 to 0.3, although the nominal coinsurance rate is nearly zero under the
current health insurance system. Thus, to reform the current reimbursement
system is urgently needed.