台灣全民健保總額預算最適分配之探討

本研究以台灣總額四大部門的醫療費用為主體，針對平均每人部門醫療費用成長率以及平均每人各部門醫療費用佔平均每人GDP比率做探討，利用誤差修正模型探討當平均每人GDP成長率與平均每人各部門醫療費用成長率之間達均衡時之最適成長率以及不均衡時的調整過程。同時探究平均每人各部門費用佔平均每人GDP的最適比率應為何。實證結果為實施總額制度時的最適醫療費用成長率為4.6%，平均每人各部門醫療費用佔平均每人GDP的最適比率分別為西醫醫院是2.23%，西醫基層是0.66%，中醫是0.13%，牙醫是0.26%，總體部門（四大部門和）是3.28%。藉由實證結果可以推論實施總額制度對於平均每人各部門醫療費用佔平均每人GDP比率具有明顯的調整作用，且目前實際上各部門比率已經達到最適值；另一方面則可以觀察到總額制度對於平均每人總體部門醫療費用成長率能有效發揮強烈的抑制作用，達到降低醫療費用過度支出的目標。希望本研究實證結果可以提供政府決策單位進行總額協商過程的參考依據。

關鍵字

總額支付制度；醫療費用成長率；誤差修正模型

並列摘要

The study focus on the health expenditure growth rate and the shares of sectors to GDP under Taiwan’s Global Budget Payment System. We utilize the Error Corrected Model (ECM) to evaluate the optimal growth rate while the sectors and GDP growth rate are in equilibrium, and the adjusting process in un-equilibrium. Meanwhile we study the optimal share of sectors to GDP. Our empirical shows that the optimal growth rate is 4.6%, and the optimal shares with respect to Hospitals budget, Clinics budget, Chinese medicine budget, and Dentistry budget on GDP are 2.23%, 0.66%%, 0.13%, and 0.26%, respectively, so the total sector is 3.28%,under global budget payment system. Through the empirical result we could figure out that global budget payment system has obvious adjustment in the shares of sectors to GDP, and presently the shares have reached the optimal; the other is it also could effectively decrease the health expenditure growth rate to reach the goal of reducing health expenditure overuse. We hope the result could be a consultation for the government decision.