桃園縣觀音鄉鄉民就醫形態與醫療支出之研究分析

Medical Service and Expenditure in Kuan-Yin Town, Tao-Uang County

侯勝茂(Sheng-Mou Hou) ； 林雨靜(Yu-Chin Lin) ； 謝博生(Bor-Shen Hsieh) ； 林晉(Jinn Lin)

《醫護科技學刊》 3卷1期 (2001/01) Pp. 111-121

https://doi.org/10.6563/TJHS.2001.3(1).7

摘要

我國目前之醫療體系現況，除了醫療資源分配不均外，醫療品質低落以及費用的增加，亦是非常嚴重的問題。尤其，我民國年實施全民健康保險以來，論量計酬的給付方式更加助長了醫療提供者藉由不斷增加醫療服務量以獲得更高利潤，而導致健保支出不斷上漲，在品質方面卻沒有相對提高。整合性健康照護體系（Integrated Health Care Delivery System簡稱IDS）是一種能提供各種不同及連續性醫療照護的健康照護系統。除了能整合醫療院所的資源、提升服務品質外，也能吸引被保險人參與，達到預防醫學以及降低整體醫療費用的成效。本研究利用民國87年上半年度，觀音鄉所有全民健保被保險人之健保資料，以及全民健保被保險人醫療費用資料做分析比較，討論觀音鄉鄉民之就醫形態與醫療支出，並探討在該區實施IDS模式的方法以及必須克服的困難。本研究發現即使觀音鄉老年人口偏高，但個人平均健保使用率或花費金額不管是門診或住院均低於全國。可是觀音鄉民之門診花費偏高，佔所有醫療費之72%比全國之68%還要高，且每次門診費用比全國平均高一點。同時，觀音鄉民之鄉外就醫率極高，所有之住院全是鄉外。門診方面，鄉外就醫次數幾乎是鄉內就醫之三倍。同時醫學中心之就醫率仍高於區域醫院之就醫率。由此可知，在觀音鄉實施之IDS急迫性，以提升健保醫療水平並杜絕醫療浪費。醫療人力增援，轉診醫院之建立，民眾之宣導，轉診制度之確立以及醫療資訊的整合是落實IDS之必要措施。

關鍵字

醫療品質 ； 論量計酬 ； 整合性健康照護體系

並列摘要

The National Health Insurance Plan in Taiwan started in 1995. The Fee-for-Service payment system provides incentives to health care providers to profit by increasing the number of visits made by patients. Accordingly, medical expenditure increased rapidly without corresponding improvement in the quality of health care.
The construction of a community-oriented integrated health care delivery system (IDS) can decrease medical expenditure and improve preventative care by providing comprehensive health care services, reinforcing the quality of health care and promoting mutual health insurance service, this study tries to elucidate the possibility and problems of implementing IDS in Kuan-Yin county.
While the proportion of elderly in Kuan-Yin was higher than that in Taiwan overall, the average of personal medical expenditure in Kuan-Yin was lower than that for Taiwan. Outpatient services are more used in Kuan-Yin (72%) than throughout Taiwan (68%). Medical centers are visited more often that regional hospitals.
The importance and urgency of establishing the IDS in Kuan-Yin is clarified. Increasing medical manpower, establishing referral and medical information systems are crucial to implementing IDS.

並列關鍵字

medical quality ； Fee-for-Service payment system ； Integrated health care delivery system (IDS)