西醫基層總額支付制度實施前後費用趨勢之研究－以中部四縣市為例

The Study of Expenditure Trend for Western Medicine Clinics of Central Taiwan under Global Budget System

葉德豐(Te-Feng Yeh) ； 王俊文(Jiunn-Wen Wang)

《醫務管理期刊》 3卷4期 (2002/12) Pp. 11-29

https://doi.org/10.6174/JHM2002.3(4).11

摘要

在面對醫療費用高漲的壓力下，各國紛紛採取總額預算制度來控制其醫療費用的成長。我國全民健保於民國87年7月首先開辦牙醫總額支付制度，而西醫基層總額支付制度也於90年7月開始實施。本研究旨在探討基層總額支付制度實施前後一年之件數、醫療費用總點數、藥費點數及用藥天數等之比較，同時探討總額支付制度的實施對這些因素之影響。
研究結果顯示，總額支付制度實施後一年之件數、醫療費用總點數均低於實施前一年，但91年以後均呈現緩步成長，顯示基層醫師在實施總額支付制度半年後已逐漸能吸引病患之就診意願。總藥費點數則遠低於實施前一年，主要原因除了91年降低日劑藥費外，基層醫師也逐步降低藥品費在總費用所佔之比率。用藥天數較實施前高，尤其是慢性病的案件。從各類案件來看，屬於鼓勵項目的慢性病及預防保健，不論在件數與醫療費用總點數均有明顯的成長；但門診手術及論病例計酬案件則不如預期。經過多變量分析後發現，影響總額支付制度實施一年來費用趨勢最大的因素是90年6月及91年1月兩次醫師診察費的調整。顯示這一年來，由於尚未感受到明顯的費用成長壓力，因此中區基層醫師並未使用較為激烈的費用控管手段。未來隨著醫院總額的實施，醫療生態勢必會有極大的變化，未來費用趨勢的發展，值得密切地觀察與注意。

關鍵字

總額支付制度 ； 西醫診所 ； 醫療費用

並列摘要

Most nations always adapt global budget system to control the growth of medical expenditure when facing the pressure of inflation. Taiwan's National Health Insurance Bureau had initially started the dental global budget since July of 1998 and implemented this system on western medicine clinics from July of 2001. The purpose of this study is trying to compare those medical claims one year before and after the global budget system launching, and also to explore the extent of impacts that system brought on. The result shows that the number of medical visits and overall medical expenditure claims for central Taiwan are lower at the year after the system implementing. The claim of overall drug expenditure is much lower and length of medication is higher at the second year because of physician's reducing the proportion of cost on medication. Among all cases, the services provided related to the encouraged items and preventive medicine all had significant growing on number of visits and overall expenditure except cases of ambulatory surgery and case payment. After multi-variant analysis, the study finds that the adjustment of diagnosis fee implemented on June of 2001 and January of 2002 is the major factor causing the change of expenditure trend rather than the global budget system. Further attention should be taken on change of medical industry especially after the implementation of hospital global budget system.

並列關鍵字

Global budget system ； Western medicine clinic ； Medical expenditure

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