查詢結果分析
來源資料
頁籤選單縮合
題名 | 全民健保重大傷病政策評估=Evaluation of the Policy of Catastrophic Illness of National Health Insurance |
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作者 | 張鴻仁; 謝啟瑞; 蔣翠蘋; 黃信忠; | 書刊名 | 經社法制論叢 |
卷期 | 33 2004.01[民93.01] |
頁次 | 頁27-75 |
分類號 | 412.56 |
關鍵詞 | 全民健保; 重大傷病; 部分負擔; 醫療支出; National health insurance; Catastrophic illness; Copayment; Medical expenditure; |
語文 | 中文(Chinese) |
中文摘要 | 全民健康保險法第三十六條規定,保險對象有重大傷病情形者免自行部分負擔。本文的主要目的,即是分析這項重大傷病制度所面臨的結構性問題及其長期影響結果。運用民國85年到90年的健保申報資料,我們的研究有下列三項主要發現。第一、現行重大傷病的認定範圍雖包含三十一大類疾病,但就醫人數與醫療費用的分布皆呈現高度集中,90%的人數與費用集中在前十大傷病類別。第二、重大傷病制度平均使每一就醫的病人,一年節省13,391元的部分負擔支出,而中央健康保險局因這項制度所增加的財務支出,一年約65億元。第三、重大傷病制度實施的目的,雖為減緩部分負擔制度所造成的財務負擔不公平現象,但實施的結果,卻造成另一種形式的不公平:有為數相當多的「高醫療費用者」,其醫療支出水準超過重大傷病者的平均值,但因其所罹患的疾病不在重大傷病的認定範圍,並無法享受免部分負擔之優惠。為了解決現行制度所面臨的困境,本文亦評估改以「醫療支出」作為免部分負擔認定的依據所可能造成的影響。研究結果顯示:改採醫療支出作為免部分負擔認定的標準,可增進健保制度的公平性,但會面臨現制受益人的利益重分配問題,免部分負擔的支出標準若訂得愈低,改革所遭遇的阻力會愈小,但健保局所多增加的財務成本會愈高。 |
英文摘要 | In Taiwan, the National Health Insurance (NHI) law exempts patients with defined catastrophic illness from copayment requirement. The purpose of this paper is to empirically investigate the structure of this policy and its long-term consequences on cost and equity. Based on the NHI claim data between 1996 and 2001, our analysis leads to the following three major conclusions. First, we find that the frequency (in germs of number of patients) and severity (in terms of medical expenditure) of the catastrophic illness are highly concentrated. The 10 leading catastrophic diseases account for 90 percent of medical expenditure, as well as 90 percent of the number of patients of the NHI-defined catastrophic illness. Second, on average, each patient with NHI-defined catastrophic illness saved NT$13,391 from the copayment exemption in 2001, and this copayment exemption in turn, increases the expenditure of Bureau of National Health Insurance by NT$6.5 billion annually. Third, the empirical evidence indicates that the catastrophic illness policy violates the equity principle because non-catastrophic illness patients incur medical expenditure as high as catastrophic illness patients but are not qualified for copayment exemption. As a result, we further explore the potential effect of the reform that copayment exemption is-based on annual medical expenditures. Our results suggest that there is a trade-off between the financial costs of copayment exemption and the degree of difficulty on policy reform. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。