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題名 | 美國健康保健組織和按件計酬健保計畫競爭結果之理論分析=The Competition Outcome in a FFS-HMO Mixed Medical System-Theoretical Perspective |
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作者 | 李隆生; | 書刊名 | 長榮學報 |
卷期 | 1:1 1997.11[民86.11] |
頁次 | 頁15-27 |
分類號 | 412.56 |
關鍵詞 | 健康保健組織; 健康維持組織; HMO; Health Maintenance Organization; |
語文 | 英文(English) |
中文摘要 | 本論文以理論模型探討美國 FFS-HMO 兩種保險制度競爭的結果。有下列重要假設 :第一、家戶對於醫療財( medical goods )和非醫療財( non-medical goods )的偏好 以李昂替夫效用函數( Leontief utility function )表示; 第二、家戶所得平均地分布 於 0 和 Y 之間;第三、家戶可選擇 FFS 健保計畫、HMO 健保計畫、及不投保;第四、FFS ( fee-for-service )計畫提供較 HMO ( Health maintenance organization )為多的 醫療財,而選擇不投保的家戶其醫療財消費為零;第五、這兩種計畫的單位利潤為正值常數 。最後,我們發現家戶會根據其所得水準和醫療財與非醫療財的相對價格選擇醫療保險,因 此 FFS 和 HMO 會因競爭中收入所得戶而迫使 FFS 計畫提供者降低其醫療財提供的數量和 保費。另外當醫療財的價格上升時,HMO 的市場佔有率亦上升。 |
英文摘要 | The outcome of FFS-HMO competition is explored here using a theoretical model. A simple Leontief utility function to represent household's preference between medical goods and non-medical goods is employed. Household's income is distributed uniformly from 0 to Y. In addition, households choose their health insurance from among the FFS plan (m□ utiliztion provided), the HMO (m�d utilization provided), or no insurance (zero utilization provided) to maximize their utility levels (m□>m�d by assumption). Last, each of the two health provider industries has a constant rate of profit and thus maximize its profit by choosing m□ or m�d. Endogenous variables are thereby assumed to adjust in the long-run to satisfy these fixed profit margins. I find, in the Nash equilibrium, that households, if insured, have higher utilization in the traditional system, where FFS is the sole provider, than in the mixed system if the medical price level is sufficiently high. This is the result of strategic interaction between the FFS sector and the HMO. In addition, the HMO will attract more members as medical prices rises faster than general prices in the economy. |
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