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題名：風險校正因子：論人計酬醫療費用預測之基礎
書刊名：臺灣公共衛生雜誌
作者：張睿詒／賴秋伶
作者(外文)：Chang, Ray-e／Lai, Chiu-ling
出版日期：2004
卷期：23:2
頁次：頁91-99
主題關鍵詞：風險校正因子；風險校正；論人計酬；健康保險；Risk adjuster；Risk adjustment；Capitation；Health insurance
原始連結：連回原系統網址new window
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  • 被引用次數被引用次數:期刊(5) 博士論文(0) 專書(0) 專書論文(0)
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  • 共同引用共同引用:15
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　　　　　為了有效控制醫療費用成長與強化社會公平，前瞻式預算支付設計已被許多先進國家的健康照護制度採用，在避免無效率及缺乏公平性存在於此預算額度的決定，近年來風險校正機制已逐漸導入。而多年來國際研究持續投入此一領域，提供許多政策制訂上之依據，其中發展風險校正因子，提升對未來醫療費用預測的研究，為數甚多。鑑於全民健康保險支付制度已全面採行前瞻式總額支付方式，而多項健保改革制度倡議均提及風險校正之必要性，而國內之風險校正相關研究仍處於萌芽階段，然初步結果顯示，我國風險校正因子預測力相較國際研究結果並不遜色，甚或有較佳之跡象。在檢視國內外文獻提出對臺灣風險計價發展之下列建議：(1)風險計價與校正因子的發展，應考量本土保險制度與社會習性，方可提供有效訊息予政策規劃使用；(2) 短期內，國內風險計價研究可利用完整診斷資訊，發展具預測力的風險因子並從事國際比較，中、長期而言，可藉由處方資訊的改善，發展用藥處方因子，全面與國際發展趨勢銜接。
　　　　　In order to contain the escalation in health care expenditure and strengthen social equity, most developed countries ,at least to a certain degree, have introduced prospective budget mechanism into their health care systems. To avoid the carrying over of inefficiencies and any resulting unfairness into the current system, in recent years the determination of the prospective budget has been calculated more cautiously by employing risk adjustment. Many studies have been dedicated to this area and have provided a sound basis for policy making. Among these studies, a large number are related to the development of risk adjusters to increase the predictability of risk assessment. Taiwan掇 NHI has fully implemented a prospective budget payment system, and many reform proposals have urged the necessity of risk adjustment. Although the research into risk adjustment is at an early stage, some risk assessment studies have reported promising results. After reviewing both Taiwan掇 and international risk assessment studies, we recommend: (1) to provide valuable information to policy makers, the development of a risk assessment model must take Taiwan掇 health care system and social characteristics into account; and (2) in the short term, a risk assessment model incorporating fully diagnostic information should be developed immediately, and in the long term, the prescription information in the claim data should be improved, which can be used in developing indigenous prescription drug adjusters. In this way, the research into risk assessment in Taiwan will be able to be used for cross-country comparisons and be compatible with the global trend.
期刊論文
1.Hornbrook, M. C.、Goodman, M. J.(1996)。Chronic Disease, Functional Health Status, and Demographics: A Multi-Dimensional Approach to Risk Adjustment。Health Services Research，31，283-307。  new window
2.Clark, D. O.、Von Korff, M.、Saunders, K.、Baluch, W. M.、Simon, G. E.(1995)。A chronic disease score with empirically derived weights。Medical Care，33(8)，783-795。  new window
3.Lubitz, J.(1987)。Health status adjustments for Medicare capitation。Inquiry，24，362-375。  new window
4.賴憲堂、楊志良、范碧玉(19980800)。全民健康保險下疾病分類編碼品質與相關影響因素研究。中華公共衛生雜誌，17(4)，337-348。new window  延伸查詢new window
5.Rice, N.、Smith, P. C.(2001)。Capitation and Risk Adjustment in Health Care Financing: An International Progress Report。Milbank Q，79，81-113。  new window
6.張睿詒、江東亮(1998)。風險校正：健康保險市場的效率與公平之關鍵。中華公共衛生雜誌，17，373-380。new window  延伸查詢new window
7.Epstein, A. M.、Cumella, E. J.(1988)。Capitation Payment: Using Predictors of Medical Utilization to Adjust Rates。Health Care Financing Review，10，51-69。  new window
8.Lamers, L. M.(2001)。Health-Based Risk Adjustment: Is Inpatient and Outpatient Diagnostic Information Sufficient。Inquiry，38，423-431。  new window
9.Newhouse, J. P.、Buntin, M. B.、Chapman, J. D.(1997)。Risk Adjustment and Medicare: Taking a Closer Look。Health Aff，16，26-43。  new window
10.蔡偉德、羅紀琼(2000)。「論人計酬」之支付標準探討。經濟論文，28(3)，231-261。new window  延伸查詢new window
11.張睿詒、林文德、謝其政、江東亮(2002)。臺灣全民健康保險下照護利用型態與風險校正。臺灣醫學會雜誌，101(1)，52-59。  延伸查詢new window
12.林文德、張睿詒、謝其政、楊志良、江東亮(2003)。建立臺灣主要住院診斷之風險校正論入計酬模式。臺灣醫學會雜誌，102(9)，637-643。  延伸查詢new window
13.Weiner, J. P.、Dobson, A.、Maxwell, S. L.(1996)。Risk-Adjusted Medicare Capitation Rates Using Ambulatory and Inpatient Diagnoses。Health Care Financing Review，17，77-99。  new window
14.Van Vliet, R. C. J. A.、Van De Ven, W. P. M. M.(1993)。Capitation Payments Based on Prior Hospitalizations。Health Econ，2，177-188。  new window
15.Ash, A. S.、Porell, F.、Gruenberg, L.(1989)。Adjusting Medicare Capitation Payments Using Prior Hospitalization Data。Health Care Financing Review，10(4)，17-29。  new window
16.Anderson, G. F.、Steinber, E.P.、Powe, N. R.(1990)。Setting Payment Rates for Capitated Systems: A Comparison of Various Alternatives。Inquiry，27，225-233。  new window
17.Weiner, J. P.、Tucker, A. M.、Collins, A. M.(1998)。The Development of Risk-Adjusted Capitation Payment System: The Maryland Medicaid Model。Ambul Care Manage，21，29-52。  new window
18.Ellis, R. P.、Pope, G. C.、Lezzoni, L. I.(1996)。Diagnosis-Based Risk Adjustment for Medicare Capitation Payments。Health Care Financing Review，17(3)，101-127。  new window
19.Pope, G. C.、Adamache, K. W.、Walsh, E. G.(1998)。Evaluating Alternative Risk Adjusters for Medicare。Health Care Financing Review，20，109-129。  new window
20.Kronick, R.、Dreyfus, T.、Lee, L.(1996)。Diagnostic Risk Adjustment for Medicaid: The Disability Payment System。Health Care Financing Review，17，7-33。  new window
21.Lamers, L. M.(1999)。Pharmacy Costs Groups: A Risk-Adjuster for Payments Based on the Use of Prescribed Drugs。Medical Care，37(8)，824-830。  new window
22.Fishman, P. A.、Goodman, M. J.、Hornbrook, M. C.(2003)。Risk Adjustment Using Automated Ambulatory Pharmacy Data。Med Care，41，84-99。  new window
23.Sales, D. E.、Liu, C. F.、Sloan, K. L.(2003)。Predicting Costs of Care Using a Pharmacy-Based Measure Risk Adjustment in a Vetern Population。Med Care，41，753-760。  new window
24.Chernichovsky, D.、Van De Ven, W. P.(2003)。Risk Adjustment in Europe。Health Policy，65，1-3。  new window
25.Zhao, Y.、Ellis, R. P.、Ash, A. S.(2001)。Measuring Population Health Risks Using Inpatient Diagnoses and Outpatient Pharmacy Data。Health Services Research，36，180-193。  new window
26.Lamers, L. M.、Van Vilet, R. C.(1996)。Multiyear Diagnostic Information from Prior Hospitalizations as a Risk-Adjuster for Capitation Payments。Med Care，34，549-561。  new window
27.Reid, R. J.、MacWilliam, L.、Verhulst, L.(2001)。Performance of the ACG Case-Mix System in Two Canadian Provinces。Med Care，39，86-99。  new window
28.Breyer, F.、Heineck, M.、Lorenz, N.(2003)。Determinants of Health Care Utilization by German Sickness Fund Members with Application to Risk Adjustment。Health Econ，12，367-376。  new window
29.Majeed, A.、Bindman, A. B.、Weiner, J. P.(2001)。Use of Risk Adjustment in Setting Budgets and Measuring Performance in Primary Care I: How It Works。British Medical Journal，323，604-607。  new window
30.Majeed, A.、Bindman, A. B.、Weiner, J. P.(2001)。Use of Risk Adjustment in Setting Budgets and Measuring Performance in Primary Care II: Advantages, Disadvantages, and Practicalities。British Medical Journal，323，607-610。  new window
31.Zhao, Y.、Ash, A. S.、Ellis, R. P.(2002)。Disease Burden Profile: An Emerging Tool for Managing Managed Care。Health Care Management Science，5，211-219。  new window
32.Van Barneveld, E. M.、Lamers, L. M.、Van Vilet, R. C. J. A.(2001)。Risk Sharing as a Supplement to Imperfect Capitation in Health Insurance: A Tradeoff between Selection and Efficiency。Journal of Health Economics，20，147-168。  new window
33.Van Barneveld, E. M.、Van Vliet, R. C. J. A.、Van De Ven, W. P. M. M.(2001)。Risk Sharing between Competing Health Plans and Sponsors。Health Aff，20，253-262。  new window
34.Shen, Y.、Ellis, R. P.(2002)。How Profitable is Risk Selection? A Comparison of Four Risk Adjustment Models。Health Econ，11，165-174。  new window
35.Lamers, L. M.、Van Vilet, R. C. J. A.、Van De Ven, W. P. M. M.(2003)。Risk Adjusted Premium Subsidies and Risk Sharing: Key Elements of the Competitive Sickness Fun Market in the Netherlands。Health Policy，65，49-62。  new window
會議論文
1.Chang, R. E.、Chiang, T. L.、Lin, W. D.(1999)。Development of Risk Assessment Model in Taiwan。Rotterdam, Netherlands。  new window
2.Lai, C. L.、Chang, R. E.、Chou, M. H.、Lin, W. D.(2001)。Development of a Diagnosis-Based Assessment Model in Taiwan。York, UK。  new window
3.Lai, C. L.、Chang, R. E.、Hou, Y. H.(2003)。The Development of Diagnosis-Based Risk Adjustment Model for Medical Saving Accounts (MSAs) in Taiwan。San Francisco, CA。  new window
學位論文
1.謝其政(1998)。利用全民健保資料建立風險計價模式之初探，0。  延伸查詢new window
2.賴秋伶(2000)。利用診斷資料建構風險計價模式，臺北。  延伸查詢new window
3.林文德(2003)。風險校正模型之預測力研究，0。  延伸查詢new window
4.周明慧(2003)。評估不同風險分攤型式之選擇與效率誘因，臺北。  延伸查詢new window
5.列嘉祺(1999)。健保多元體制下風險調整機制探討－臺灣全民健保資料的實證分析，嘉義。  延伸查詢new window
6.劉坤河(2000)。以類神經網路建構論人計酬之風險調整模型，高雄。  延伸查詢new window
7.呂欣潔(2001)。總額預算支付制度下區域分配之公平性及其最佳預算分配模式，高雄。  延伸查詢new window
8.張世芳(2001)。論人計酬支付制度下風險分類與風險調整模式之建構，高雄。  延伸查詢new window
9.李芳琪(2001)。以不同計費單位探討全民健保論人計酬之風險模型，臺北。  延伸查詢new window
10.林子郁(2002)。末期腎臟疾病患者於不同透析治療階段之醫療費用風險因子探討，高雄。  延伸查詢new window
11.張碧玉(2000)。影響末期腎臟疾病患者血液透析醫療費用之風險因子探討，高雄。  延伸查詢new window
圖書
1.Lee, C.、Rogal, D.(1997)。Risk Adjustment: A Key to Changing Incentives in the Health Insurance Market。Risk Adjustment: A Key to Changing Incentives in the Health Insurance Market。Washington。  new window
2.Medicare Payment Advisory Commission(2000)。Report to the Congress: Improveing Risk Adjustment in Medicare。Report to the Congress: Improveing Risk Adjustment in Medicare。Washington。  new window
其他
1.(Center for Medicare，Medicaid Service)(2003)。CMS Announces Preliminary Growth Estimates for Medicare+Choice for 2004，沒有紀錄。  new window
圖書論文
1.van de Ven, W. P. M. M.、Ellis, R. P.(2000)。Risk adjustment in competitive health plan markets。Handbook of Health Economics。Amsterdam：Elsevier。  new window
 
 
 
 
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