醫師服務量對精神分裂症患者醫療利用之影響-分量迴歸

The Influence of Physician Volume on Utilization of Medical Services for Schizophrenia Patients by Quantile Regression

陳建翔(CHIEN-HSIANG CHEN)

指導教授 ： 劉彩卿

國立臺北大學/公共事務學院/財政學系/碩士(2008年)

摘要

世界衛生組織估計全球約有五千萬精神分裂症患者，亞洲地區位居第二高。我國於1995年實施全民健康保險，雖將精神分裂症納入重大傷病，以減低患者的負擔，但精神分裂症乃需長期治療，所耗費的醫療費用一直居高不下，故如何有效利用此一方面的醫療資源，值得深入研究。本文主旨在於探討精神分裂症患者門診醫療利用與醫師醫療經驗間之關聯性及其他相關因素分析，俾期提供相關政策建議。
本研究是使用2006年「全民健保資料庫」作為樣本依據，篩選出有精神分裂症患者作為研究樣本。研究樣本共有3696人。研究方法上採用普通最小平方法及分量迴歸法，比較不同疾病嚴重程度對醫療利用影響的因素是否有所不同。
實證研究發現：醫師年紀及服務量於門診使用量具顯著相關性，高服務量及年紀大醫師，在醫療費用上比較少，此一論點充分支持本研究的預期假設，即經驗越足夠越能準確診斷病情且給予適當的治療，故經濟效益較佳。另外，精神分裂症患者大都到醫院層級就診，但疾病嚴重程度較重者易到公立醫院及位於省轄市醫療院所進行治療，年輕患者及有一種以上其它疾病在醫療費用上支出比高。
本文建議，未來在健保制度的設計上，宜將患者是否有其它疾病納入整體考量，尤其在長期照護上所支付的點數有所偏低，故應對支付點數進行調整，以提供完整的醫療復健。對於嚴重精神病患應適度轉介資深醫師加以處理較具效率。

關鍵字

醫師服務量，醫療利用

並列摘要

World Health Organization (WHO) reports that there are fifty million schizophrenia patients in the world, and the region of Asian ranks the second high. Taiwan implemented the National Health Insurance in 1995, which included schizophrenia as one of the catastrophic illnesses to decrease patients’ financial crisis. However schizophrenia needs long-term treatment and induces huge medical expenditures. How to control the cost in term of this illness becomes a hot issue and raises many concerns. The main purpose of this paper was to examine the relationship between the outpatient care use for schizophrenia patients and physician experience in order to provide evidence for policy implications.
Samples used in this study were taken from the Year 2006 National Health Insurance database. We select patients who used medical care for Schizophrenia. Total samples were 3696. We used Ordinary Linear Regression and Quantile Regression to compare the impact of doctor experience on medical care utilization among different groups of patients.
We found that schizophrenia patients who are more serious are more likely to visit public and urban hospital. Patients who are younger and have other illness tend to expend higher cost of medical services. Higher volume physician or older doctors tended to have lower outpatient visits, implying that experienced physician may treat such an illness more effective.
Our finding suggests that high volume physicians tend to teat their patients with less medical resources per patient. Payment adjustment imposed on these experienced physicians need to be carefully estimated to avoid the misallocation of resources.
Keywords: physician volume, utilization of medical services

並列關鍵字

physician volume, utilization of medical services

參考文獻

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