全民健保醫療服務使用公平性之探討

Equity of Health Care Delivery of National Health Insurance in Taiwan

湯澡薰(Chao-Hsiun Tang) ； 郭乃文(Nai-Wen Kuo) ； 張維容(Wei-Jung Chang)

《醫護科技學刊》 4卷4期 (2002/10) Pp. 291-304

https://doi.org/10.6563/TJHS.2002.4(4).2

摘要

本研究目的在檢視健保醫療服務使用的公平性。為了能將公平性的程度具體化，以便進行跨年度或跨國性的比較，本研究使用醫療服務使用水平不公平性指標以衡量健保醫療服務的水平公平性。本研究的資料來自二方面，一為民國85年衛生署全民健保滿意度調查，二為民國87年健保醫療費用申報檔。本研究的結果發現，以自覺健康狀況定義醫療需要的程度時，健保醫療服務的使用存在有對窮人不利的水平不公平性。不論 就使用頻率或費用方面，三項門診服務，即西醫、中醫、牙醫門診，皆存在有對窮人不利之不公平性。其中，尤其是中醫與牙醫兩項服務之使用頻率與費用之分佈皆集中於富人而非窮人身上，使得中醫與牙醫兩項門診服務之不公平性最大，其中又以牙醫服務之不公平性大於中醫服務。相反地，住院服務不論在使用次數、使用日數與費用之分佈都集中於窮人身上，且其程度大於疾病集中在窮人身上的幅度。因此，住院服務不論在頻率與費用方面都不存在有對窮人之不公平性。最後，加總各項醫療費用所得到的醫療總費用之水平不公平性指標為0.022，顯示整體而言，台灣健保醫療服務之分佈存在有對窮人不公平的現象。在健保醫療服務使用分配之國際性比較上，民國87年台灣全民健保醫療服務使用分配呈現不利於窮人之水平不公平性現象，與其他OECD國家醫療服務使用之分配相比較，我國健保醫療服務使用之水平不公平性指標相對較高，水平不公平住相對較差。因此，未來健保改革的方向，應加強公平性之提昇，以弭平社經地位不同族群間醫療服務使用的不公平。

關鍵字

全民健保 ； 公平性 ； 醫療服務使用

並列摘要

One of the major objectives of Taiwan's National Health Insurance (NHI) program, which has been put into effect in March 1995, is to link utilization of medical care to medical needs but divorce ability to pay from the receipt of medical services. The purpose of this research is to examine whether this goal has been met or whether the extent of inequIty has been reducing since the implementation of NHI.
The concentration coefficient method is employed to investigate whether inequity exists in the delivery of NHI. The equitable principle employed in this research is horizontal equity, which means that medical services should be distributed according to medical needs. The data used for the analysis are from the 1996 Survey of Satisfaction on NHI and the 1998 NHI claims.
Results show that the NHI program is less equitable in terms of the delivery of health care services according to level of need. In particular, indices of equity on Chinese medicine and dental services suggest inequity favoring the better-off. Overall, the horizontal inequity index is 0.022 for Taiwan's NHI program compared to that of a low of -0.10 in Denmark and a high of about 0.06 in Australia.

並列關鍵字

National Health Insurance ； Equity ； Health Care Delivery

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