以德菲法建構中醫地區總額預算分配之考量因素研究

Delphi Method to Construct Chinese Medicine Global Budget Distributive Formula Region Total Budget Allocation Considerations

洪錦墩(Chin-Tun Hung) ； 賴怡婷(Chin-Tun Hung) ； 李淑芬(Shu -Fen Li) ； 黃昱瞳(Yu-Tung Huang) ； 黃光華(Kuang-Hua Huang) ； 李卓倫(Jwo-Leun Lee)

《臺灣中醫科學雜誌》 6卷2期 (2012/12) Pp. 1-16

https://doi.org/10.29810/SJTTCM.201212.0001

摘要

中醫醫療服務為全民健康保險一部分，但中醫醫療資源的分布仍相當不平均，且集中於臺灣西部及都會區。本研究目我國全民健康保險自1995年3月1日起開辦，為抑制醫療費用快速成長，並讓醫療費用有期合理之成長空間，於是健保開始實施總額預算制度，而中醫門診總額預算制度也自2000年7月1日起實施，依健保局行政分區6區為基準預算分配；於2006年1月1日起改為東區、西區2區分配總額其主要在瞭解中醫實施總額預算後，其地區總額分配模式變動對中醫醫療資源分布之影響，並針對分配模式加以評估及提出建議。本研究以政策德菲法進行研究，共邀請26位專家，透過德菲問卷填答，瞭解學者專家對於中醫總額制度分配公式之意見整合，嘗試提出總額公式的修正建議，提供未來中醫門診總額地區預算分配更適切模式及建議。結果發現經兩輪專家德菲問卷結果，發現中醫地區總額分配公式有幾個項目是專家學者有較高共識建議優先納入，包括有戶籍人口佔率、中醫利用人口佔率、人口風險因子、區域執業成本、中醫診所數量及無中醫師服務鄉鎮人口數等因素是專家學者建議中醫地區總額分配公式可優先考量的因素。中醫總額分配的目的，除控制費用與資源分配外也希望能達成區域資源均衡。由於中醫醫療資源嚴重分布失衡問題，乃屬歷史發展所造成之問題，需要時間來進行改善，政府公權力介入將是最迅速有效的解決方式。在有預算專款致力於改善中醫師地理分布的前提下可以考慮以中醫醫療利用人口為分配基準，以簡化目前復雜的分配公式。待逐年資源分布及民眾使用率達到某一程度後，再轉為以人口健康風險評估後之區域預算分配為宜。

關鍵字

中醫 ； 總額預算 ； 德菲法

並列摘要

Chinese medical service is part of National Health Insurance, but the distribution of resources of Chinese medical service is quite unequal, mostly focusing on western Taiwan and Metropolitan areas. The National Health Insurance (NHI) in Taiwan has since 1995. In order to restrain the increasing speed of the medical expenditure and to give the total expense a reasonable growing space, the Bureau of NHI (BNHI) commenced the Global Budget system and therefore traditional Chinese medicine was brought into the system from July 1, 2000 .The global budget is distributed by six administrative districts in initial stage, i.e. Taipei, northern, central, southern, Kaoping and eastern regions. The former 5 districts was combined as the western district since Jan 1,2006. In this study, the policy Delphi method was utilized by inviting 26 experts to answer the questionnaires to understand and integrate these specialists' opinions toward the Chinese medicine global budget distributive formula. Moreover, this study also tried to propose improved suggestions to make the distribution of Chinese medicine global budget more moderate in the future.The Chinese medicine global budget distributive formula based on Delphi Method suggested that the priority of distributive formula included proportion of household, proportion of utilization of Chinese medical service, risk factor, regional practice cost, number of Chinese medical service clinic, and number of population which has no Chinese medical service in the township. Besides cost control and resource allocation, the distribution of Chinese medicine global budget aims to balance regional resources. The problem of severe imbalance in Chinese medical resources is caused by historical development, and it takes time to improve. Before utilization and resource distribution of Chinese medical service are improved, the authorities may give priority to insured rights for medical treatment in the short-term. Under government's budget for special fund improving geographic unbalanced distribution of Chinese medical service, distributive formula of Chinese medical service global budget can be simplified. Both the number of population and area population who use Chinese medical service can be regarded as distributive basis. It is appropriate for using regional budget distribution of population health risk assessment after increasing utilization of Chinese medical service.

並列關鍵字

Chinese medicine ； Global budget ； Delphi technique