民眾對於健保藥品費用部分負擔方式之意見調查

為了紓解全民健保財務壓力，2021年保險費率從4.69%調漲至5.17%，補充保費費率也連動調整，從1.91%漲至2.11%；此外，健保署也提出部分負擔改革構想，希望能挹注健保財源，其中也包括藥品部分負擔之改革，唯尚未調查民眾對這些改革之之意見。因此本計畫利用自擬結構式問卷，探討一般民眾對於健保藥品費用部份負擔方式之意見。資料蒐集方法為透過網路社群平台發送邀請，請20歲以上民眾上網填答此一匿名問卷，再利用統計軟體進行描述性統計、二變項分析、及複迴歸分析等方法，檢定自變項(包括社會人口學特徵與與民眾健康相關因素)與依變項(包括對藥品費用分攤方式接受度、部分負擔意願與部分負擔上限額度設定)之相關性。研究結果顯示，民眾社會人口學特徵與與健康相關因素對於藥品部分負擔認同程度、藥品部分負擔付費意願與自費上限額度設定方式具相關性。在藥品部分負擔認同程度之調查上，發現原本就了解健保藥品部分負擔計算方式的台灣民眾僅有21.59%；逾五成民眾完全可以接受目前的健保的門診藥費部分負擔與健保門診藥費部分負擔每次需付200元的上限金額規定；有66.37%的民眾贊成與非常贊成提高目前健保門診藥費部分負擔的最高上限金額，其中又以較年輕、學歷較高、職業為醫療保健相關者、沒有慢性疾病與沒有領慢性疾病連續處方箋者較為支持。此外，超過半數民眾完全支持提高健保門診藥費負擔金額上限的目的是在於「讓民眾有成本意識，多拿藥就要多負擔，減少藥品浪費」及「讓新藥可以早一點納入健保」；顯示台灣民眾對於健保藥品部分負擔認同度高，且大多也接受未來健保藥品部分負擔相關政策改革。

關鍵字

全民健保；藥品部分負擔；自費上限

並列摘要

In order to relieve the national health insurance financial pressure, the premium rate increased from 4.69% to 5.17% and supplementary premium also increased from 1.91% to 2.11% in 2021. Moreover, the National Health Insurance Administration (NHIA) is planning for a set of co-pay policy reform strategies aimed at increasing capital infusion. The policy reform concept includes the cost sharing for medicines. However, the attitude of the general public toward these reform strategies has not yet been investigated. Thus, the objective of this study is to explore the opinion of the public toward the models of cost sharing for medicines under the national health insurance via online survey. We invited people who were over the age of 20 and send the link of anonymous questionnaires via the internet. Descriptive statistics, bivariate analysis, and multiple regression analysis were performed using statistic software to test the association between the independent variables (incuding social-demographic and health related variables) and dependent variables (including acceptance of different medicine co-pay model, the willingness of medicine co-pay and co-pay maximum limits setting). The results show that there were significant associations between social-demographic characteristics and health-related factors regarding the degree of recognition of part of prescription co-payment, willingness to pay for prescription drug, and the setting method of the co-payment upper limit. Only 21.59% of respondents knew the prescription co-payment policy. More than 50% of the respondents fully accepted the current National Health Insurance’s co-payment of prescription drug fees and the maximum limit of NTD 200 each time. Among them, those who are young, have a higher education, have a health care related career person, do not have chronic diseases, and do not receive refillable chronic prescriptions are more supportive. In addition, 66.37% of the people agreed and strongly agreed to increase the current maximum amount of prescription drug co-payment and the purpose is to "make the people cost-conscious, you need to pay more if you take more medicines, and reduce drug waste" and "make new drugs be reimbursed earlier"; it shows that Taiwanese people have a high degree of recognition of the prescription drug co-payment, and most of them also accept future policies reform.