我國實施全民健康保險對醫療服務使用量的影響

The Impact of National Health Insurance on the Utilization of Medical Services: Empirical Evidence from a Taiwan Natural Experiment

許文彥(Wen-Yen Hsu)

《風險管理學報》 15卷2期 (2013/12) Pp. 125-147

摘要

本文檢驗我國於1995年實施全民健康保險對醫療服務使用量的影響。由於在全民健保前，有許多民眾沒有健康保險，我們比較實施全民健保前後，這些原本沒有健康保險的民眾在門診次數及住院天數的變化，而為控制同時發生但與全民健保無關的因素，我們以公保為控制組使用'difference-in-differences'、採用二部模型（two-part model）以檢驗醫療服務使用的變化是存在於民眾的看診決策、醫生的治療決策，或二者同時存在。實證結果顯示全民健保實施後，醫療服務使用量大幅增加。具體而言，民眾在健保實施後，住院及門診的可能性均顯著增加，對有住院、門診紀錄的民眾而言，平均住院天數增加、但平均門診次數減少。換言之，實施全民健保後，原先沒有保險的民眾無論是住院可能性及住院天數均顯著增加；但雖然門診的機率增加，平均門診次數卻減少，顯示健保增加許多使用少量門診次數的病患。

關鍵字

全民健保 ； 醫療使用量

並列摘要

This paper investigates the impact on medical consumption (hospitalization days and physician visits) of the 1995 introduction of Taiwan's National Health Insurance (NHI). Using the 'difference-in-differences' approach to control for unobservable effects, we examine the post-NHI rise in medical consumption among the previously uninsured. Our two-part model enables us to determine whether this increase occurred because of a rise in first-time consumption, a rise in treatment intensity, or both. We present empirical evidence that NHI led to a substantial increase in consumption. The likelihood of first-time hospitalization and physician visits increased post-NHI. Conditional on nonzero consumption, the number of hospitalization days increased, but the number of physician visits decreased. Post- NHI, a larger proportion of consumers visited physicians infrequently. Therefore, NHI seems to have had an ambiguous effect on average consumption.

並列關鍵字

national health insurance ； medical services utilization

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