The Impact of Physician Supply on the Utilization of Ambulatory Care under the National Health Insurance

全民健保下醫師數增加對西醫門診醫療利用之影響

蔡文正(Wen-Chen Tsai) ； 龔佩珍(Pei-Tseng Kung) ； 廖凱平(Kai-Ping Liao)

《Mid-Taiwan Journal of Medicine》 9卷1期 (2004/03) Pp. 27-37

https://doi.org/10.6558/MTJM.2004.9(1).4

摘要

目的 台灣於1995年實施全民健保後，每年醫療費用不斷上漲，本研究主要探討西醫門診醫療利用之成長與西醫師數增加之關係。
方法 本研究以衛生署規劃之次醫療區為觀察單位，以民國85年至88年間之資料為研究期間，門診醫療費用取自全民健保費用申報檔，其他相關變項取自內政部每年相關年報。應用固定效果模型為複回歸統計分析模型，分析醫師供給對門診醫療利用之影響。
結果 每萬人口西醫師數成長顯著影響西醫門診醫療利用次數與費用。其中，每萬人口西醫師數增加一人，則每人每年西醫門診醫療利用次數將增加2.43﹪，而每人每年平均醫療費用將增加5.34﹪。西醫門診醫療利用之成長與西醫師數增加明顯相關，且民國85至88年西醫門診醫療費用成長中，有21.71﹪的成長費用導因於西醫師人數之增加。中醫師數與病床數並未顯著影響西醫門診醫療利用。
結論 全民健保實施後，以次醫療區而言西醫師數之成長顯著增加西醫門診醫療利用。

關鍵字

門診費用 ； 醫療費用 ； 醫師供給

並列摘要

Objectives. Taiwan's annual national ambulatory care expenditure increased dramatically after the implementation of the National Health Insurance program (NHI). This research aimed to examine how the supply of physicians affect the use of ambulatory services in Taiwan.
Methods. The study used the sub-regions in the health care network as the unit of observation from 1996 to 1999. Information about ambulatory care utilization was collected from the NHI medical claim database. Other related information was obtained from the Taiwan Demographic Fact Book published by the Ministry of the Interior. We applied multiple regression analysis with the fixed-effects model for the statistical analysis. The model examined how the supply of physicians influenced ambulatory service utilization after controlling for extraneous factors.
Results. The research clearly demonstrated that the supply of physicians increased demand in ambulatory care after controlling for other factors. The results showed that an increase of one physician per 10,000 people increased the number of physician visits per capita by 2.43%, and the ambulatory care expenditure by 5.34%. The increase in the physician-population ratio accounted for 21.71% of the rise in ambulatory service expenditures from 1996 to 1999. The number of Chinese medicine physicians and the number of hospital beds did not significantly influence utilization of ambulatory medical care.
Conclusions. After Taiwan implemented the National Health Insurance program, the increase in the number of physicians increased the utilization of ambulatory care at the sub-region in the health care network.

並列關鍵字

ambulatory care ； health care expenditure ； physician supply