- 學位論文
台灣及OECD國家醫療體系治理、經濟發展、醫療支出、醫療資源、醫療利用與健康之比較分析
Comparison among OECD countries and Taiwan on Health Care Governance,Economic Development, Health Expenditure, Health Resources, Health Care Utilization and Health Status
摘要
幾乎所有國家都為醫療費用上漲所苦，財源籌措越來越困難，原因很多，例如：所得增加、平均壽命延長、人口老化、醫療科技的進步、醫療照護供給增加；然而醫療費用增加、人員及醫療設施增加，醫療利用率是否必然增加？醫療利用率增加，國民健康是否隨之增進？ 醫療體系的最終目的之一是提升民眾健康(WHO,2000)。影響健康的因素很多，醫療只是其中一項。探討醫療費用支出佔GDP比率相關文獻甚多，但很少探討例如GDP對醫療資源之影響；更少涉及GDP與醫療資源如何影響醫療利用；更缺乏醫療費用、醫療資源與醫療利用對健康之影響。 OECD共有三十個會員國，OECD對相關資料的收集及整理有一致的規範及正確性，台灣雖非會員國，但全民健保的實施及衛生署醫療保健支出統計(National Health expenditure, NHE)也與國際接軌，已達OECD國家的水準，故可一同納入，而從體制面、經濟、人力、設施、醫療利用率等方面與民眾健康，探討其間相關性，並比較實際值與期望值間的差距。 結果發現，公部門健康支出佔總健康支出比率顯著影響醫療支出(Per capita HE及HE佔GDP比率)、醫療資源(每千人口醫師數及病床數)、醫療利用(每千人口出院次數)。 依本研究模式，以OECD國家的資料比較分析之，則台灣相對耗用較少的GDP於健康照護，卻得到更多的醫療服務(住院及門診)，且國民享有較佳的健康水準。
並列摘要
Nearly all countries suffer from the rise of the health expenditure . There are a lot of reasons, for example: the increase of income, the extension of lifespan, the aging of population, the progress of medical science and technology, and the increase of health care service provision. However, with the increase of health expenditure, the personnel and the health facilities, whether the healthcare utilization inevitably increases or not? And whether the national health status improved or not along with the increase of health care utilization? One of the final goals in the health care system is to promote the populace health (WHO, 2000). There are a lot of factors to influence health, and the medical service is only one of them. The related literature discussing the percentage of health expenditure in GDP are many, but few of them discusses the influence of GDP to health resource, even fewer involves how GDP and the health resources affect the health care utilization, and they are even in lack of the influence of the health expenditure, health resources and health care utilization to the health status. OECD altogether has 30 member nations. OECD has the consistent standard and accuracy of the related data collection and coordination. Although Taiwan is the non-member nation, the implementation of its National Health Insurance and the statistics of its health disbursement in the Department of Health (National Health expenditure, NHE) also connect to the international rail, and it has reached the OECD nation’s standard. Therefore, Taiwan may count as one of the member nations. We can discuss their correlations and compare their disparity between the actual value and expected value, from the aspects of systems, economics, manpower, facilities, health care utilization and populace health as well. The result showed that the ratio of the health expenditure in government institutes to the total health expenditure notably influences the medical expenditure (Per capita HE and percentage of HE to GDP), the medical resources (the number of doctors and beds per thousand population), and the health care utilization (the number of patients checking out the hospital per thousand population). According to this research pattern, compared with the analysis of the OECD countries materials, Taiwan relatively consumes less GDP on health care, but obtains more health care service (hospitalized and outpatient service), and the nation enjoys a better health status.