「論人計酬」之支付標準探討

CAPITATION PAYMENT SYSTEM-RISK FACTORS ESTIMATION

蔡偉德(Wei-Der Tsai) ； 羅紀(Joan Lo)

《經濟論文》 28卷3期 (2000/09) Pp. 231-261

摘要

為了更有效地控制醫療支出，行政院衛生署擬藉修法將單一保險人改為多元保險人，同時將「論量計酬」的支付制度改為「論人計酬」。亦即按各個保險人承保人數的多寡及其風險，給付定額醫療費用。本研究探討風險計價之下個人醫療支出變異的預測，以作為「論人計酬」制度下個人風險計價的支付標準。我們的實證研究結合「民國八十五年台灣地區全民健康保險滿意度調查」資料及中央健康保險局的個人醫療費用申報檔案資料，並應用Duan et al. (1983)之四部分模型(four-part model)來估計風險校正之個人醫療支出變化。最後，我們利用所估算出來的風險調整參數驗證其對實際醫療支出的預測能力，並計算依風險計價之支付費率。

關鍵字

風險校正,論人計酬支付制度,四部分模型,個人醫療支出

並列摘要

For the purpose of containing the financial burden arising from the National Health Insurance (NHI) system, the Department of Health of the Executive Yuan is considering opening up the NHI market for private insurance companies to participate. At the same time, a capitation-based payment system is being considered to replace the current fee-for-service system. Under a capitation system, an insurance agent is paid according to the number insured, adjusted by their health risks. Our empirical work is based on data from the “Survey of Degree of Satisfaction toward the NHI” as well as the NHI claim data. The four-part model of Duan et al. (1983) is employed to estimate parameters of individuals’ medical expenditure function. The parameter estimates are used as risk adjustment factors. To examine the accuracy of the empirical results, we look at the predictive performance of our empirical model.

並列關鍵字

Risk-adjusted capitation payment system,Four-part model,Individual medical expenditure

參考文獻

Beebe, J. C.(1992).An Outlier Pool for Medicare HMO Payments.Health Care Financing Review.14(1)

Bulter, S. J., Burkhauser, Richard V., Mitchell, Jean M., Pincus, Theodore P.(1987).Measurement Error in Self-Reported Health Variables.Review of Economics and Statistics.69(4)

Duan, N., Manning, Jr. Willard G., Morris, C. N., Newhouse, J. P.(1983).A Comparison of Alternative Models for the Demand for Medical Care.Journal of Business and Economic Statistics.1(2)

Duan, N., Manning, Jr. Willard G., Morris, C. N., Newhouse, J. P.(1984).Choosing between the Sample-Selection Model and the Multi-Part Model.Journal of Business and Economic Statistics.2(3)

Hornbrook, M. C.(1989).Adjusted the AAPCC for Selectivity and Selection Bias under Medicare Risk Contracts.Advance in Health Economics and Health Services Research.10