民眾對塗藥支架差額負擔的接受度－以台中某區域級教學醫院為例

Patient’s Acceptability on Balance Billing of Drug-Eluting Stent—A Pilot Study on Regional Hospital in Taichung

李佳俞(Jia-Yu Li)

指導教授 ： 劉見祥

亞洲大學/健康學院/健康管理研究所/碩士(2009年)

摘要

台灣於1995年3月開辦全民健康保險，民眾就醫習慣改變，1999年8月開始實行藥價差額負擔，許多昂貴的醫材及藥品，民眾必須自掏腰包購買。現行健保法規定給付範圍內，醫療院所不能要求民眾自費或付差額，健保提供基本給付外，若要求更好的服務，超過部分可自付差額。2006年12月塗藥血管支架納入差額負擔給付項目，此高額價差非一般民眾可接受，民眾接受度是一個政策推動的參考。
以問卷調查法進行研究，主要以Andersen求醫模式中的傾向因素、能力因素與需求因素是否影響民眾接受塗藥支架高差額負擔，並進一步探討差額負擔政策對民眾意願與接受度是否相關。
研究發現職業為其他、家庭收入在七萬以上及有私人健康醫療保險病患，較容易接受塗藥支架差額負擔。健康信念中等者(43-54分)相較於健康信念低者(31-42分)，較不願意接受塗藥支架差額負擔，具有統計差異；表示這些因素在塗藥支架差額負擔上為其影響因子。
全民健保屬社會保險，有強制納保的特性，針對健保給付的不足，龐大的醫療費用仍影響民眾就醫障礙，一般私人保險也推出「補充性的健康保險」，強調健保限制給付與不給付的醫療費用，減少民眾就醫時龐大的財務負擔，使民眾就醫更無障礙。

關鍵字

差額負擔 ； 塗藥支架 ； Andersen求醫模式

並列摘要

Since March 1995 when National Health Insurance was enacted, the way people receive medical treatment has changed. After the balance billing system initiated in August 1999, people had to pay for expensive medical devices and medications at their cost. Under the coverage of current National Health Insurance Law, hospitals cannot charge patients the full cost or the price differentials. The National Health Insurance provides the basic coverage beyond which the patients will have to pay the price differentials for better services. In December 2006, the drug eluting stents was included in one of the balance billing items. General population cannot afford the expensive price differentials. Public acceptance can serve as a reference for policy promotion.

The study was conducted utilizing questionnaire survey with the primary objective to study whether the predisposition factor, capacity factor and demand factor in the Andersen model would affect people’s acceptance of high balance billing of drug eluting stents. It also investigates whether balance billing policy is associated with the willingness and acceptance of the population.

Research results show that people with occupation from the other category, family income over 70,000 dollars and covered by private health and medical insurance are more open to balance billing of drug eluting stents. People with medium health beliefs (43-54 points) are less willing to accept the balance billing of drug eluting stents than those with low health beliefs (31-42 points). The result was statistically significant, indicating that these factors do affect the balance billing of drug eluting stents.

The National Health Insurance falls under social insurance, and is compulsory. Due to the insufficient insurance fund, the enormous medical costs shadow the medical behaviour of the general public. Private insurance has also launched “supplementary health insurance” which stresses on the medical costs with limited coverage or not covered by National Health Insurance and reduces the enormous financial burden for medical treatment. This will also make medical services more accessible for the public.

並列關鍵字

Balance billing ； drug eluting stents ； Andersen model

參考文獻

中央健保局網站（2006）

行政院衛生署網站（2006）。

行政院衛生署網站，九十六年度衛生統計。

張鴻仁、黃信忠、蔣翠蘋（2002）全民健保醫療利用集中狀況及高、低使用者之探討，臺灣衛誌；21（3）：207-213。

蔡文正、龔佩珍、楊志良、江怡如（2005），CT及MRI醫療利用與影響費用因素，台灣衛誌，24（6）：529-538。