牙醫門診總額支付制度實施後牙醫健保醫療資源使用狀況分析－以高屏區為例

A Provider Profile Analysis after the Dental Global Budget System─Example in Kaohsiung、Ping Tung Area

鍾尚衡(Shang-Heng Zhong)

指導教授 ： 黃純德

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2002年)

摘要

本研究主要目的在探討高屏區牙醫門診總額支付制度實施後，牙醫健保醫療資源使用狀況，就各縣市、各年度、城鄉別、各區域做探討。以1999年1月至2001年12月間，高屏分局轄內申報醫療費用之牙醫師及費用以及高屏分局轄內四縣市之人口為研究對象，主要資料來自中央健康保險局高屏分局1999年1月至2001年12月之「門診申報費用檔」及「醫事機構管理檔」利用描述性統計、變異數分析、相關性、迴歸分析研究，結果發現：
(1) 高屏分局轄內四縣市就牙醫佔率與人口佔率兩相比較發現高雄市
牙醫師佔率遠高於人口佔率，而屏東縣的牙醫師佔率則遠低於人口佔率；而澎湖縣與高雄縣牙醫師佔率也低於人口佔率。(2)高屏分局轄內每十萬人口牙醫師數，高雄市最高46.97~49.25，屏東縣最低17.27~19.79，兩者相差近30，高雄市為屏東縣的2.5倍。就行政區作比較，則前金區最高206.87，而有16個無牙醫鄉行政區最小0。(3)就四縣市比較人口佔率與申報點數佔率，高雄縣、屏東縣申報點數佔率小於人口佔率；而高雄市與澎湖縣申報點數佔率大於人口數佔率。(4)就城鄉別來比較人口佔率與申報點數佔率，則城市化位階高的「區」申報點數佔率遠超過人口佔率，「鄉」則反之。(5)在1999年及2000年每就醫病患使用點數澎湖縣最高，高雄市次之，高雄縣再次之，屏東縣最低；2001年高雄市最高，澎湖縣次之，高雄縣第三，屏東縣最低。(6)以牙醫師每月看診日數來比較，整體上2000年(22.47日)及2001年(22.46日)的看診日數無顯著性差異。但在縣轄市的牙醫師，則無顯著性差異。(7)以牙醫師每月病患數比較有逐年減少的趨勢，而牙醫師每月所蓋健保卡格數也逐年減少；總額支付制度抑制了量的成長。(8)而牙醫每一病人申請點數、每一健保卡申請點數，則不論城鄉別均呈現逐年昇高。(9)而牙醫師每一日申請點數整體而言呈逐年昇高，但在鄉的牙醫師則不呈現顯著性差異。(10)申請點數中以復形點數佔最多，而四縣市比較則高雄市最高。(11)牙體復形重補率以城鄉別作比較，區顯著的比較高，縣市別則也有顯著的差異，其中澎湖縣在恆牙他家重補率、乳牙他人重補率都顯得較高。(12)就迴歸分析結果每十萬人牙醫師數與人口密度呈正相關。
　　依據以上結果，建議中央健康保險局採行家庭牙醫師制(論人計酬)，以利牙醫健保醫療資源分佈平均。建請全民健康保險醫療費用協定委員會視牙醫界表現給予鼓勵，以利牙醫門診總額支付制度朝論人計酬發展。並建議牙醫門診總額支付高屏分區委員會執行檔案分析，加強實地訪查。

關鍵字

總額支付制度 ； 論文計酬 ； 牙醫醫療資源

並列摘要

The main purpose of this research is to look deeper into the current
situation of how the resources of dental health insurance work in Kaohsiung
and Ping-tung Area(KPA) after the Global budget payment system was
carried out.This research is done and targeted at the differences among cities
and counties in KPA in accordance with area distinctions
On the process of doing the research, I concentrated my attention on the
time span starting from January, 1999 to December, 2001. The information I
gathered derives from the medical expense at dental clinics in KPA. The
statistics, which are related to KPA Police Station, comes mainly from
Kaohsiung Branch, National Health Insurance Bureau.(KBNHIB) and they
are accomplished through descriptive analysis correlation analysis, analysis of
variance, and analysis of regression. My findings are as follows:
A. The percentage of the number of dentists in Kaohsiung City is much
higher than that in Kaohsiung County, Ping-tung County, and
Peng-hu County. In addition, the percentage of dentist in Peng-hu
County is far lower than that of the population in Ping-tung. The
percentage in Ping-tung County and Kaohsiung County is also lower
than that of their population.
B. As for the number of dentists among every hundred thousand people,
the highest one goes to Kaohsiung City. It’s 46.97~49.25. On the
contrary, the lowest one goes to Ping-tung County. It’s 17.27~19.79.
The former one is two and half times as large as the latter. If we take
the administrative area into consideration, we’ll find that the highest
one goes to Cheng-Chin District. It’s 206.87; however, there are 16
towns without any dentists in KPA.
C. If we focus on the relationship between the population rate and
application rate, we’ll find that the application rate in Kaohsiung
County and Ping-tung County is lower than the rate of population.
And yet, the application rate in Kaohsiung City and Peng-hu County
is higher than the rate of population.
D. If we compare the population rate with application rate on the basis
of the differences between countries and cities, we’ll find that the
districts where citizens have higher standard of living have higher
application than the population rate. On the other hand, towns where
people don’t enjoy high living standard have lower application rate.
E. During the time span, the most frequent use rate of health insurance
goes to Peng-hu County, followed by Kaohsiung City and then
Kaohsiung County and Ping-tung County.
F. Concerning the total days the dentists spent on, the number in
1999(23.01days) is greater than that in 2000(22.47days) and
2001(22.46days). Nevertheless, there is no significant difference
arising in dentists who practice medicine in county-ruled cities.
G. When we turn to the number of patients, we find that there are fewer
and fewer patients, which means patients don’t use the National
Health Insurance Cards(NHIC) so often as before. Consequently, the
Global budget payment system curtails the growth of counties.
H. Ironically, the dentists in KPA, be they in countries and cities, apply
more and more NHIC dental cost from the government.
I. What’s more, the dentists apply more and more daily medical cost
chronically, the dentists in the countries excluded.
J. Among all the cost applied by the dentists, operative dentistry is the
most common.In comparison to the other counties, dentists in
Kaohsiung City are most widely seen to use operative dentistry to
apply money from the government.
K. Viewing the rate of dental recovery or refilling, the districts in
Kaohsiung are higher than that in the countryside. Patients in Peng-hu
have the highest refilling rate, inclusive of .deciduous tooth
L. In terms of the analysis of regression, the density of population is in
proportion to the number of dentists in every hundred thousand
people.
According to what is mentioned above, I strongly suggest that
National Health Insurance Bureau practice the Individual Dentist
Payment Enrollment System so that the distribution of dental Healthy
resources of national health insurance will be fair. I propose that
Payment Agreement Committee expands Global budget payment
system so as to guide Global budget payment system to individual
payment system. Meanwhile I recommend Global budget payment
system pay the bill concerning the analysis of files, which is carried
out by Kaohsiung Branch, so that officials can strengthen local
investigation.

並列關鍵字

Global budget system ； capitation ； dental healthy resources

參考文獻

1.涂醒哲。全民健康保險V.S衛生醫療政策。全民健保二週年特

刊1997；218。

2.Mei-Su Lai ROC. Current status of National Health Insurance Program in Taiwan and the Experience of Outpatient Dental Care. In:New frontiers of multidisci plinary dettistry for the 21st century. The 23rd asia Pacific Dental Congress Organizing Committee. ROC: Taipei ;2001 P36-38.

3.李玉春、梁淑政。牙醫總額支付制度試辦計劃簡介。衛生報導1996；6(10)11-17。

4.研議全民健康保險總額支付制度牙科部門試辦計畫會議。牙醫界1996；15(1、2)：70-72。