查詢結果分析
來源資料
頁籤選單縮合
題名 | 全民健保對層級別院所門診給付影響初探=The Impact of NHI on Outpatient Services among Different Types of Medical Institutions: A Preliminary Exploration |
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作者 | 石淦生; 羅紀琼; Shih, Kan-shan; Lo, Joan C.; |
期刊 | 公共衛生 |
出版日期 | 19970700 |
卷期 | 24:2 1997.07[民86.07] |
頁次 | 頁97-108 |
分類號 | 412.56 |
語文 | chi |
關鍵詞 | 全民健保; 門診給付; 市場佔率; NHI; Outpatient services; Market share; |
中文摘要 | 我國社會保險中醫療給付,長期以來獨厚大醫院的作法,一直為學者所詬病。將 原有分歧的各類保險整合而成的全民健康保險,嘗試藉著部分負擔的差異,達到分級醫療的 目的。由於原本行之有年的、幾乎沒有部分負擔、以及院所選擇極端自由的勞農保就醫辦法 ,無法快速過渡到全民健保極具限制性的就醫規定,以致健保開辦後短短二個月內,部分負 擔制度已做了相當的調整。 全民健保制度是否一如勞農保,未讓基層有足夠的發展空間,而任其日漸萎縮﹖提高醫院的 部分負擔金額是否確能達到鼓勵基層發展的目標﹖本研究依據健保實施前後的月別資料分析 發現,全民健保對門診利用次數有顯著的抑制效果,高額部分負擔的抑制效果更為顯著,同 時診所的相對優勢得以提升。然而簡化的二級部分負擔,特別是調降了負擔金額的辦法,已 使全民健保的抑制效應逐漸淡化。整體而,健保開辦後各層級院所間醫學中心有最強的相對 優勢,地區醫院及基層診所不相伯仲,區域醫院為最弱勢。 |
英文摘要 | The favorable payment schedule for hospitals' outpatient services has resulted in an unusual growth of the outpatient share of the medical expenditures eversince the establishment of the social health insurance. The newly-implemented NHI intends to reduce the outpatient service volume rendered by hospitals through a heavier copayment. Since NHI is integration of various insurance schemes, the previous nearlyzeroed copayment as well as free choice among medical institutions made the system design of the NHI very difficult. The copayment program changed three times between March 1,1995 and May 1,1995. Whether primary care institutions are still being treated unfavorably in the NHI as they were in the old system ﹖ Will heavier copayment reduce hospitals' share of outpatient services ﹖By collecting data of the monthly payment from different types of medical institutions, we are able to provide a preliminary analysis. Our findings are as follows: NHI does have a discouraging effect on the health care utilization, and a heavier copayment for visits without referral has even more distinct impact, which is an advantage for the primary care institutions. However, the simplified version of the copayment, especially lower copayment for visits in hospitals, has weakened its effect to suppress both the utilization and hospitals' advantageous position. |
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