醫療消費者及醫療提供者對全民健保新制門診藥品部分負擔的認知；態度及行為之研究

The Perception, Attitude, and Behavior of Health Services Consumers and Providers Under National Health Insurance Outpatient Prescription Drug Co-Payment Program in Taiwan

林惠雯(Hui-Wen Lin) ； 薛亞聖(Ya-Seng Hsueh)

《台灣公共衛生雜誌》 22卷1期 (2003/02) Pp. 33-42

https://doi.org/10.6288/TJPH2003-22-01-05

摘要

目標：瞭解民國88年實施新制門診藥品部分負擔之後，民眾及醫師對此制度之認知、態度及行為，並比較民眾與醫師兩者意見之差異。方法：分別以台灣地區就醫民眾及有執業之西醫師(不含牙醫)為研究對象，經隨機抽樣分別進行電訪及郵寄問卷調查。就醫民眾電訪完成有效問卷946份，醫師部分隨機抽取4,113位醫師為樣本，最後得有效問卷688份(回收率16.7%)。經適合度檢定，就醫民眾問卷與健保局投保人口分佈無顯著差異，樣本具代表性。結果：就醫民眾調查結果，新制部份負擔實施近1年半，尚部分負擔；約七成的就醫民眾可以接受看門診拿藥要付藥品的民眾只有4.6%。醫師調查結果，多數醫師(85.5%)對門診藥品部分負擔表示支持的能度；有89.4%認為藥品浪費嚴重；61.1%醫師會受門診藥品部分負擔的影響而建議病人減少用藥。結論：就醫民眾普遍認為藥品浪費嚴重，並能接受新制藥品項部分負擔制度。雖然就醫民眾在認知、態度上支持新制部分負擔，但是對減少就醫、拿藥的效果卻不高，反而是醫師自認愛影響的比率較高，可見部分負擔雖然是作用在民眾身上，但是影響較深的卻是醫師。

關鍵字

門診藥品,部分負擔,健康保險,使用者付費

並列摘要

Objectives: The purpose of this research is to understand the perception, attitude and behavior of patients and health care providers under the new Outpatient Prescription Drugs Co-payment policy of the National Health Insurance (NHI) Program. Methods: This research uses two sources of data. One is a nation-wide random sampling telephone interview with CA TI (Computer aided telephone interview) system for the patients. The other set of data is from a random sampling survey with self-administered questionnaire. We got 946 valid respondents by telephone interview. The response rate is 16.7% for the physicians. Results: There is still one-fifth of patients who don't know this new policy. There are about 70% of patients who can accept this policy. 60%patients consider that waste of drug is serious. Only 4.56% patients have asked physicians to prescribe fewer drugs, and 11.57% reported they have made fewer visits to the doctors. Regarding whether physicians will change prescriptions pattern because of the new outpatient prescription co-payment policy, 61.1 % physicians reported they tended to suggest fewer drugs. Conclusion: Most patients can accept this policy but few of them will reduce visiting doctors and buy less drugs. Therefore, outpatient prescription co-payment policy influences physicians more than patients.

並列關鍵字

outpatient prescription drugs, co-payment, health insurance, user charge

參考文獻

Johnson, R. E.(1997).The Effect of Increased Prescription Drug Cost-Sharing on Medical Care Utilization and Expenses of Elderly Health Maintenance Organization Members.Medical Care.35(11)

Johnson, R. E., Goodman, M. J., Hornbrook, M. C., Eldredge, M. B.(1997).The Impact of Increasing Patient Prescription Drug Cost Sharing on Therapeutic Classes of Drugs Received and on the Health Status of Elderly HMO Members.Health Services Research.32(1)

Manning, W. G., Newhouse, J. P., Duan, N., Keeler, E. B., Leibowitz, A., Marquis, M. S.(1987).Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment.The American Economic Review.77(3)

Scitovsky, A. A., McCall, N.(1977).Coinsurance and the Demand for Physician Services: Four Years Later.Social Security Bulletin.40(5)

Scitovsky, A. A., Synder, N. M.(1972).Effect of Coinsurance on Use of Physician Services.Social Security Bulletin.35(6)