醫院與衛生所承辦巡迴醫療的經濟評估

Cost-effectiveness and cost-benefit Analysis of Mobile Healthcare of Community Hospital and Health Center in Taiwan

楊惠娟(Hui-Chuan Yang) ； 李卓倫(Jwo-Leun Lee)

《台灣公共衛生雜誌》 26卷2期 (2007/04) Pp. 110-117

https://doi.org/10.6288/TJPH2007-26-02-03

摘要

目標：本研究目的在計算健保局巡迴醫療政策的成本、效果與效益，並比較醫院與衛生所執行巡迴醫療在社會成本及結果面的差異。方法：問卷調查以付費卡方式測量台東縣延平鄉民眾的付費意願作為效益面資料，效益面包括一般門診、專科門診(眼科、婦產科)、成人預防保健、婦女子宮頸和乳癌檢查、衛生教育、慢性病防治服務，蒐集醫院與衛生所投入巡迴醫療相關的成本資料，及巡迴醫療相關的效果面資料，效果面包括利用率指標、滿意度指標及可近性指標，以進行成本效果與成本效益分析，評估之依據主要為益本差與益本比。結果：延平鄉巡迴醫療的整體社會效益為每月390,871元，大於延平鄉整體社會成本每月363,351元，益本比為1.076。其中醫院投入延平鄉巡迴醫療的總成本為每月232,123元，效益為每月228,145元，益本比為0.983。而衛生所投入延平鄉巡迴醫療的成本為每月131,229元，效益為每月162,725元，益本比為1.240。結論：整體而言，延平鄉巡迴醫療的整體社會效益大於整體社會成本，因此巡迴醫療是一項值得繼續推行的醫療政策。此外衛生所提供巡迴醫療服務的項目較為單純但提供效率較高，醫院提供巡迴醫療服務的項目較多元，總體社會效益較高但成本也較高，造成提供效率上的損失，因此在政策上有較多改進的空間。

關鍵字

巡迴醫療 ； 成本效果分析 ； 成本效益分析

並列摘要

Objectives: This study aims to analyze and compare the cost-effectiveness and cost-benefit ratio of mobile healthcare provided by a hospital and a community health center in rural Taiwan. Methods: Data were collected in Yan-Ping Township, Tai-Tung County by questionnaire survey, which adopted a payment-card technique to measure subjects' willingness to pay for general and specialized ambulatory care, general prevention and Pap smear, health education, etc. Administrative data of the hospital and community health center were also collected to analyze the cost-effectiveness of mobile healthcare. Results: Effectiveness data indicate that mobile healthcare increases accessibility. Subjects' satisfaction with mobile healthcare is higher than with other general medical care, and its utilization is higher as well. Total cost-benefit per month of mobile healthcare is NTD 232,123 and 228,145 for the hospital; and NTD 131,229 and 162,726 for the community health center. Cost-benefit ratio is 0.983 for the hospital and 1.240 for the community health center, with mobile healthcare delivered by community health center more efficient than that of the hospital. Total net benefit and total cost-benefit ratio for mobile healthcare is NTD 27,519 and 1.076 per month. Conclusions: The mobile healthcare policy for rural areas in Taiwan is justified in terms of efficiency. The Taiwan government should seriously think about allocating more resources to mobile healthcare delivered by community health centers or other primary care clinics rather than by community hospitals.

並列關鍵字

Mobile healthcare ； cost-effectiveness analysis ； cost-benefit analysis

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