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題名:不同醫療利用量者之費用影響因素與供需誘因機制控制成效
作者:黃玉珂
作者(外文):Yu-Ke Huang
校院名稱:國立高雄第一科技大學
系所名稱:管理研究所
指導教授:林兆欣
學位類別:博士
出版日期:2010
主題關鍵詞:總額預算支付制度部分負擔制度醫療利用量分量迴歸Co-payment SystemHealth Care UtilizationQuantile RegressionGlobal Budget System
原始連結:連回原系統網址new window
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由於台灣健保之醫療服務使用狀況具有明顯的偏斜性,因此本研究針對不同醫療利用量之保險對象進行費用影響因素分析。並將醫療服務利用的情況區分為使用頻率與使用幅度,分別以就診次數與門診費用來衡量部分負擔新制與西醫基層總額預算支付制度的實施成效。另外,本研究以分量迴歸探討不同醫療利用量者之就診次數與門診費用的影響因素。並且將醫療需求價格彈性較小之65歲以上人口,以及重大傷病患者設定為差異中之差異的控制組,65歲以下人口與非重大傷病患者為實驗組,以探討健保誘因制度之施行成效。
本研究之主要發現有:(1)供給面與需求面之誘因制度對於高醫療利用量者有顯著的控制成效。(2)就醫可近性的高低將影響保險對象之醫療需求,兩者呈現顯著正相關。(3)薪資收入與職務特性將影響保險對象之醫療利用量。薪資收入較少的保險對象其就診次數較少,而工作之危險性與勞動程度較高的保險對象則有較高的就診次數與門診費用。(4)不論是就診次數或是門診費用的使用,女性皆較男性為多。(5)健康狀況越差與年紀越大的保險對象,其就診次數與門診費用的使用也相對較多。
This study adopted quantile regression to investigate the determinants for the utilization of health care, using outpatient visits and ambulatory expenditure as the sample. In addition it examined the impact of the new co-payment system and the primary care global budget program. The study applied the difference-in-differences method to investigate the effect of cost control on both the supply-and demand-side incentive mechanisms. The control group includes patients over the age of 65 and patients of any age with a catastrophic illness.
The main findings indicated that first, both supply-and demand-side incentive mechanisms can effectively control the health care expenses of high utilizers. Second, we found there to be a positive relationship between accessibility of medical care and health care utilization. Third, a person’s socio-economic status may result in a different level or type of health care utilization. Outpatient visits were less for people with low income compared with those with a higher income. Ambulatory expenditures were lower for those with a dangerous type of job than for those with a safer type of job. Fourth, females were found to have a much higher rate of health care utilization than males. Finally, older people and those in ill health have a higher health care utilization.
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