「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

陳文意(Wen-Yi Chen) ； 李卓倫(Jow-Leun Lee) ； 林玉惠(Yu-Hui Lin)

《台灣公共衛生雜誌》 31卷4期 (2012/08) Pp. 347-360

https://doi.org/10.6288/TJPH2012-31-04-06

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。

關鍵字

總額預算 ； 醫師行為 ； 差異中取差異

並列摘要

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.

並列關鍵字

Global Budgeting ； Physician's Behavior ； Difference-in-differences

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