全民健保部分負擔政策對醫院復健科門診醫療使用的影響

The Impact of NHI Co-payment Policy on the Utilization Pattern of Hospital Outpatient Rehabilitation Services

陳皇仲(Huang-Chung Chen) ； 張斐綾(Fei-Lin Chang) ； 盧瑞芬(Jui-Fen Rachel Lu) ； 朱岳喬(Ngok-Kiu Chu) ； 蔡文鐘(Wen-Chung Tsai) ； 石琳娜(Lin-Na Shih) ； 劉耀宗(Yiu-Chung Lau) ； 鄧復旦(Fuk-Tan Tang)

《台灣復健醫學雜誌》 34卷2期 (2006/06) Pp. 73-80

https://doi.org/10.6315/2006.34(2)02

摘要

全民健保自開辦以來，醫療費用持續上漲，中央健保局為因應財務壓力，實施多項開源節流方案。於需求面採行部份負擔的主要目的，在於透過被保險人成本分攤的觀念，進而抑制醫療資源的濫用，民國88年8月實施的門診復健部份負擔就是其中之一。本研究針對復健部份負擔實施前後，於醫療利用和醫療費用之差異情形及趨勢進行探討。資料來源以五家研究醫院提供之門診物理治療件數為個案研究進行分析。部分負擔新制實施後一年的研究結果顯示：醫療利用和醫療費用皆比88年8月部份負擔新制實施初期有減少的情形；然而，於實施五個月之後隨時間逐漸減緩。此外本研究也發現，於復健部分負擔實施後，簡單和中度治療項目申報件數減少，但複雜治療項目申報有隨之增加的趨勢，顯現診療項目間有轉移複雜等級申報的情形。綜而言之，於實施初期五個月可看出復健部份負擔新制對於控制醫療利用和醫療費用上的短期效應，但因追蹤的時間不夠長，因此，復健部份負擔的長期效應有待未來持續研究。

關鍵字

全民健保 ； 部分負擔 ； 物理治療 ； 醫療利用 ； 醫療費用

並列摘要

In response to pressing financial distress as a result of escalating health care expenditures, Bureau of National Health Insurance (NHI) has adopted various deliberate policy interventions to increase the sources of incomes and meanwhile enhance cost containment. Co-payment policy is one measure often taken when focusing on demand-side mechanism, which aims to reduce the potential misuse of medical resources by the insured through cost sharing. The co-payment policy for outpatient rehabilitation services implemented since August, 1999 is one good example.
The purpose of this study is to assess the impact of the co-payment policy on the utilization pattern of hospital outpatient rehabilitation services. The analytical sample is composed of the detailed visit records for physical therapy from five selected hospitals. Examining the visit records before and after the co-payment policy was introduced, we have found that both the utilization rates and expenditures have decreased after the co-payment policy was initially implemented, although the rate of decrease stagnated after the first five months. In addition, a shift before treatment items of different levels of complexity was detected; cases of treatment items of simple and moderate complexity decreased while those of most sophisticated complexity were on the rise. In conclusion, a short-term effect on the control of utilization rates and expenditures due to the introduction of co-payment policy has been observed in the initial five months. Future research should focus on investigating the long-term effect of the policy by extending the length of the follow-up period.

並列關鍵字

national health insurance ； co-payment policy ； physical therapy ； medical utilization ； medical expenditure