- 學位論文
醫院健保門診部分負擔上升對病人選擇就醫場所之影響─論不同疾病之差異
The effect of NHI copayment policy on hospital selection- The variation of patients with different diseases
摘要
於1995年3月台灣開始針對全體國民的全民健康保險，使台灣社會進入全民保險的新世代。全民健康保險是一項重要的社會安全與福利措施，全台灣地區有96％以上的人口均受到它的保護。但同時，全民健保也耗用了社會龐大的資源，從1998年到2000年時的醫療支出就已高達全年新台幣三千億的費用。由於社會資源有限，必須做最有效率的使用，故醫療資源利用的適當性，值得吾人重視。 故本論文旨在探討全民健保於2005年7月15日調整部分負擔制度後，對於部分負擔之上升是否會影響民眾選擇就醫場所地點的行為。研究資料是以全民健保資料庫作為我們的樣本來源，研究期間為2004年7月15日至2006年9月14日，主要研究針對一般門診之利用情形進行分析，研究疾病為：肝炎、糖尿病無併發症、白內障、退化性關節炎、扭傷或拉傷及表面傷或挫創傷，再以這六種疾病別來分析政策前後民眾就醫行為是否有改變。實證結果指出，綜合這六種疾病來看在調整部分負擔制度後，民眾到大醫院就診的機率確實有顯著減少，表示政府實施部分負擔制度是有它的功效，其功效能讓患者先衡量自己的病情是否需要到大醫院進行診治，也間接達到政府實施另一個分層就醫制度的觀念，一來可降低民眾對醫療資源的浪費，二來也可減輕全民健保於1998年至2005年財務赤字問題。若以各個疾病別來分析，糖尿病無併發症、白內障、退化性關節炎、扭傷或拉傷及表面傷或挫創傷等這五種疾病，在調漲部分負擔政策實施後，確實會影響民眾就醫場所的選擇逐漸轉向小醫院就醫，因為這五種疾病皆屬於輕傷，診所的醫生只需針對患者症狀醫治，無須替患者做更深入的檢查或是使用高科技醫療器具來看診，所以屬於這類疾病患者在小診所就診即可。肝炎疾病患者在部分負擔制度實施後，對於去大醫院就診機率是沒有什麼影響，可能是因為肝炎疾病患者經常要回醫院複診，但如果去小診所就診的話沒有良好的設備檢查反而會影響民眾病情，因此不太可能去小醫院就診，故肝炎患者不受此制度之影響。
並列摘要
In March 1995, Taiwan began to target the entire population of the National Health Insurance, is a new generation of universal coverage in Taiwan society. National Health Insurance is an important social security and welfare measures, all in Taiwan for more than 96% of the population are under its protection. At the same time, national health insurance also consumes vast resources of society, from 1998 to 2000 had been the medical expenses of up to NT $ billions in annual costs. As the limited social resources, to do the most efficient use, so the appropriateness of the use of medical resources, it is worth I attention. The purpose of this is to examine the relationship between affect the location of places people choose medical act and after the national health insurance on July 15, 2005 to adjust their copayment upwards some of the burden of the system, for some of the burden of the increase will We use years data of National Health Insurance in the period from July 15, 2004 to September 14, 2006, primarily aimed at the general out-patient study of the use case analysis to study the disease: hepatitis, diabetes without complications, cataracts, degenerative arthritis, sprain or strain injury or setback and surface wounds, then to analyze the six disease-specific policies before the people seeking behavior have changed. To conduct this study, that the combination of these six diseases of view some of the burden of the adjustment system, to a large public hospital does have a significant reduction in the probability that the government is implementing some of the burden of system has its effect, its effectiveness before allowing patients to measure their own whether the condition to a hospital for treatment, but also indirectly to the Government to implement the concept of another tiered medical system, one to reduce the waste of public resources for health care, and secondly to reduce the national health insurance in the 1998-2005 financial deficit problem. In terms of the various disease-specific analysis, diabetes without complications, cataracts, degenerative arthritis, sprains or strains, and surface injury or trauma such as these five diseases setback, rises in some of the burden in the implementation of the policy, medical treatment does affect the public gradually to a small selection of places to hospital, because these five diseases are the property of minor injuries, the clinic doctors treat only symptoms for patients, not for more in-depth examination of patients with high-tech medical equipment or diagnostic point of view, it is Such diseases can be in a small clinic. Hepatitis diseases in parts of the burden of system implementation, for to a large hospital probability is no impact, possibly because of hepatitis disease patients often have to return to the hospital referral, but if you go to small clinics, then there is no good equipment checks but will affect the public condition therefore unlikely to small hospital, so patients with hepatitis from the impact of this system.