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| 題 名 | 「西醫基層總額分科計畫」實施前後門診醫療利用差異之研究=Differences in Healthcare Utilization before and after Implementation of the Departmental Clinics Global Budget Program |
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| 作 者 | 陳文意; 李卓倫; 林玉惠; | 書刊名 | 臺灣公共衛生雜誌 |
| 卷 期 | 31:4 2012.08[民101.08] |
| 頁 次 | 頁347-360 |
| 分類號 | 419.45 |
| 關鍵詞 | 總額預算; 醫師行為; 差異中取差異; Global budgeting; Physician's behavior; Difference-in-differences; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 目標:本研究的主要目的在於評估中區健保分局實施「西醫基層總額分科計畫」前後門診醫療利用的差異,藉以探討基層醫師因應此項醫療政策的行為。方法:本研究的資料來源為全民健康保險研究資料庫的2005年承保抽樣歸人檔,為了釐清「西醫基層總額分科計畫」對醫療利用的影響,我們將樣本分為普通個案與高價個案兩個族群。我們使用差異中取差異法,針對「西醫基層總額分科計畫」實施前後的醫療利用差異進分析。結果:實證結果顯示「西醫基層總額分科計畫」僅對高價個案的每次門診給藥日數有顯著的抑制效果,但對於普通個案的各項醫療利用(每次門診申請金額、藥費、部分負擔以及給藥日數)的影響卻不降反升。結論:「西醫基層總額分科計畫」由不同專科別醫師的同儕制約力量,藉以控制醫療費用的效果應屬有限。健保局應針對某些特定指標(包括病患當月就診次數、給藥日數、藥費、部分負擔)進行監控,藉以抑制基層醫師回應支付制度改變的醫療行為。 |
| 英文摘要 | Objectives: To evaluate the differences in healthcare utilization before and after implementation of the Departmental Clinics Global Budget Program (DCGBP), and to investigate physicians' behavior in response to the DCGBP. Methods: Data were obtained from the 2005 Longitudinal Health Insurance Database. In order to determine the impact of DCGBP on healthcare utilization, the samples were separated into two groups, a high utilization group and a low utilization group. We used the difference-in- differences method to analyze the difference in healthcare utilization before and after implementation of the DCGBP. Results: Our empirical results showed that the DCGBP decreased drug days per visit in the high utilization group, but it impacted healthcare utilization (such as claimed expenditure, drug expenditure, co-payment, and drug days) positively in the low utilization group. Conclusions: The Bureau of National Health Insurance should monitor specific indices such as the numbers of outpatient visits per month, drug days, drug expenditure, and co-payment per visit to determine if physicians' behaviors change in response to change in the payment system. |
本系統中英文摘要資訊取自各篇刊載內容。