影響自費醫療項目願付程度之因素-以骨折內固定為例

Willingness to pay for characteristics on fracture fixation devices of out-of-pocket in Taiwan

朱家宏(chu chia hung)

指導教授 ： 朱僑麗

亞洲大學/健康學院/健康管理研究所/碩士(2007年)

摘要

本研究主要為探討在健保制度底下曾經有過手術或醫療經驗是否會改變民眾及患者對自費醫療的願付金額。我們利用假設性的自費骨折固定醫材作為例子，探討各種變因對自費願付額的影響。
全民健保開辦以來，在近年逐漸有收支不平衡之勢，因此健保局提出總額給付甚至於醫院主管理的制度，以改善日漸惡化的財務體質，而自費醫療也就在這樣的環境下成為各個醫療院新的業務成長目標。為了不受限於健保的給付，許多新的醫療科技並不申請加入健保的給付範圍，醫療提供者即可自訂價格並擴張其適應症。但其成本效益就變成一個需要探討的課題。
我們利用願付法(Willingness-To-Pay)以支付卡(payment card)的方式，並使用假設市場法(Contingent Valuation Method CVM)設計四種場景分別代表新型骨折固定醫材的四種改良特性(減少傷口大小並美觀、減少術後疼痛程度、提早恢復功能時程、可吸收不需再拔除)，在中部某一大型區域教學醫院中立意取樣，以訪員面對面訪談，共回收349 份完整問卷。問卷包含自費醫療及手術經驗、自覺健康狀況(SF-36)、願付金額及基本資料。
研究結果顯示平均自費願付金額從疼痛減少的18,044 元到可吸收骨板的27,329 元。如果以50,000 元為目前市場上大多已出現或可能出現的高價骨折骨板價格，約只有10%(疼痛減少)到15%(可吸收骨板)民眾願付額超過現有價格。和願付金額正相關的變項包括有自費醫療經驗、家戶總收入、都市化程度。而有私人醫療保險則只和實用性場景(恢復快及不用再一次手術)的願付額有關。其他人口變項及健康狀態(SF-36 分數及慢性病有無)則無明顯相關。此外在健保制度下曾有手術經驗並不會使人更願付自費，且其滿意度對自費願付金額也無明顯相關。
本研究結論為台灣的健保制度提供了一個可接受的醫療服務品質，人們並不會因為曾受過手術痛苦的經驗就更願付健保以外的錢。而高價自費骨折固定醫材在現有的價格及制度下並沒有明顯很好的成本效益，不應納入健保給付範圍以免在有限的資源下排擠其他更有成本效益的項目。針對許多新的所謂高科技醫療技術，建議政府相關單位及健保局應建立適當的成本效益評估機制，支持醫療成本效益的研究，以期社會資源更合理有效率的分配及使用。

關鍵字

自費醫療, 願付法, 假設市場法, 骨折內固定, 全民健保

並列摘要

Rationale: New technology comes out with more advanced medical devices to improve the outcome of disease. However the higher and higher price of the devices brings out the heavy financial burden of the national health insurance (NHI). Therefore most of the new medical devices only exist in the market of out-of-pocket in Taiwan. The decision makers are often concerned if these devices ought to be covered by NHI and how do the common people think about it.
Objectives: The objective of this study is to understand the attitude of people to the advanced fracture fixation device of out-of-pocket under NHI.
Methodology: We design a contingent survey to measure the willingness-to- pay (WTP) of non-market fracture fixation devices respectively with four characteristics of advantage including less wound size, less pain, more rapid functional recovery and no need to take out after bone healing under the scenario of leg fracture. Since April to June 2006, 349 structured questionnaires were completed by face-to-face interview in out patient department of a general hospital in central Taiwan. Multiple linear regressions were used to perform multivariate analysis.
Results: The mean WTP for the advantage is respectively from $550 (less pain) to $833 (no need to take out, absorbable plate) that are far less than the true price of fracture devices of out-of-pocket on market. The willingness-to-pay is positive related to family income, experience of medical treatment of out-of-pocket and residency urbanization but not significantly related to health status (SF-36) and other demographic variant. The experience of previous operations doesn’t influence the WTP. Even if the people have suffered from surgeries would not pay more than those who did not have operations.
Conclusion: Under the NHI, Taiwanese patients had acceptable health care satisfaction and would rather not pay more even if they had suffered from the operations before. This WTP survey as a cost-benefit study also suggested that the advanced fracture fixation device on market with high price is not so worthwhile for Taiwanese.

並列關鍵字

Out-of-pocket ； Willingness to pay(WTP) ； Contingent valuation metod(CVM) ； Fracture fixation ； National health insurance(NHI)

參考文獻

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