醫院權屬別與醫療收費

Hospital Ownership and Medical Service Pricing

張樂心(Le-Hsin Chang) ； 鄭守夏(Shou-Hsia Cheng) ； 楊銘欽(Ming-Chin Yang) ； 江東亮(Tung-Liang Chiang)

《台灣公共衛生雜誌》 23卷2期 (2004/04) Pp. 130-140

https://doi.org/10.6288/TJPH2004-23-02-05

摘要

目標：我國私人醫院比例高於美國三倍以上，不同權屬別醫院收取醫療費用是否不同，本研究提供台灣實證資料。方法：以糖尿病、中風、剖腹產與闌尾切除四種常見疾病病人為研究對象，共4945名，分析不同權屬別醫院之醫療費用；包括醫院向病人收取之自付費用、向健保局申報之醫療費用，以及住院天數。並以同病再入院與術後傷口發炎率作為品質指標。結果：論病例計酬的剖腹產與闌尾切除病人，私人醫院的申報費用最低，但收取最高的自付費用與醫療總費用；論量計酬的糖尿病與中風患者，私人醫院的申報費用、自付費用與總費用皆顯著高於公立醫院。無論哪種支付方式，公立醫院的平均住院天數皆較長。結論：私人醫院論病例計酬的申報費用低於公立醫院，論量計酬類則較高，其因應健保支付制度之費用策略可能較公立醫院明顯。公立醫院可能因公務預算補助等因素，收取最低的自付費用，但住院天數偏長。

關鍵字

醫院權屬別 ； 醫療費用 ； 自付費用 ； 住院天數 ； 支付制度

並列摘要

Objective: The proportion of private hospitals in Taiwan is 3 times higher than that in the United States. This study addresses the question as to whether private hospitals charge higher prices by providing empirical evidence from Taiwan. Method: There were 4945 patients with one of common diagnoses/procedures of diabetes, stroke, Cesarean section, or appendicitis included in the analysis. The between-hospital comparisons were measured by patients’ out-of-pocket payment, NHI claimed expenses, and patients’ length of stay. We also adopted the readmission rate and post-operation infection rate as quality indicators for comparison. Results: Multiple regression models showed that private hospitals had the lowest level of claimed expenses, but higher out-of pocket and total expenses than their counterparts for procedures under the case payment method. Moreover, both their claimed reimbursements and out-of-pocket charges were both higher than that of public hospitals for diseases under the Fee-for-Service system. On average, public hospitals had the longest length of stay. Conclusion: Private hospitals seem more flexible in response to the NHI payment policy than public hospitals. Owing to the governmental subsidy, public hospitals charge lower out-of-pocket prices but have a longer length of stay.

並列關鍵字

Ownership ； medical expense ； out-of-pocket ； length of stay ； payment system

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