醫療補貼政策對門急診與住院利用之影響-以台北市兒童醫療補助計畫為例

兒童是國家未來的棟樑，呵護兒童的健康就是創造社會人口未來的健康；而社會人口的健康代表的就是一國的國力。台北市政府衛生局於民國84年12月25日起首度辦理「台北市兒童醫療補助計畫」，期望能減少兒童就醫之經濟障礙。。台北市政府實施兒童醫療補助計畫期間政策內容的改變，可能造成兒童醫療利用行為的改變，恰好提供一個自然實驗的機會供研究者進行探討。本研究探討台北市0至6歲兒童於民國90年2月1日門診醫療補助改變前後一年期間，其門診、急診與住院利用情形之變化，以研究因醫療補助政策的調整使得門診、急診補貼條件不同，其所引發的門急診醫療相對價格變動，是否會造成門、急診間的替代效果；換言之，兒童父母是否選擇以自付價格較低之急診取代自付價格較高之門診，而此舉是否有利於兒童之健康結果。本研究之結果發現，相對於全國除台北市以外之其他縣市的兒童而言，台北市0-6歲兒童於民國90年2月1日至91年1月31日一年期間較89年2月1日至90年1月31日一年期間之門診利用次數有顯著的降低，檢傷分類一、二級急診利用次數無顯著差異，檢傷分類三、四級急診利用次數有顯著的增加，而住院利用次數及住院人日數則無顯著差異。研究結果證實了此醫療補助政策內容的改變會誘導父母以急診替代門診，造成急診檢傷分類中較不緊急的三、四級案件使用頻率增加，不但浪費緊急醫療的資源，辜負了衛生局濟貧濟急的美意，也可能分散與排擠了急重症患者的照護，間接影響了整體急診醫療的照護品質。而本研究進一步以後續住院利用來檢視增加的急診利用對於兒童健康結果之影響，發現並沒有因為提供候診時間較短且價格較低的及時性急診醫療照護，而使得兒童病情在急診受到適當控制，並降低後續住院之使用。因此本研究建議衛生主管機關能重新研議補助內容，以提供更適切之補助。

關鍵字

兒童；醫療補助；醫療利用；替代

並列摘要

Children are the future of a country; therefore, taking good care of children is to create good health of the future population, which in a sense is to build up the strength of a nation. The authority of Taiwanese government has been paying attention to this issue. The Department of Health of Taipei City started to carry out the Medical Care Subsidy Program for Children on December 25th, 1995. The changes of policy provided a natural experiment for this study to investigate the effect of the program on children’s health care utilization. The purpose of this study is to examine the changes of outpatient care utilization, emergency care utilization and inpatient care utilization for the children aged 1 to 6 before and after February 1st, 2001 when the subsidy of outpatient care services has been removed. Specifically, this study sought to provide answers to the following two questions: First, was there substitution effect resulting from changes in relative price of outpatient services and emergency services? Second, were children’s inpatient services been affected by changes in policy? Results from this study indicate that, comparing to other counties and cities in Taiwan, children aged 1-6 in Taipei had lower frequency of outpatient care utilization in the post-policy-change period, comparing to the pre-policy -change period. At the same time, they also consumed more of the third and forth level of emergency care. This result suggests that parents might substitute emergency care for outpatient services due to the changes in relative price. Finally, there was no significantly difference in the utilization of inpatient care found in this study. The findings from this study suggest that parents were sensitive to the decreases in relative price of emergency care due to the policy change and substituted away from outpatient care toward emergency care. This might not only a waste of the emergency medical resources, but also has adverse effects on the quality of emergency care. Moreover, there were no significant reduction of hospitalization and actual benefit of children’s health outcome. Results from this study suggest a further evaluation of government subsidy program is warranted in order to facilitate more efficient use of resources.

並列關鍵字

Children ； substitute effect ； Medical care utilization ； Medical care subsidy

參考文獻

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Baker, David W., Stevens, Carl D., Brook, Robert H. (1995)Determinants of emergency department use by ambulatory patients at an urban public hospital. Annals of Emergency Medicine, 25(3), 311-316.

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醫療補貼政策對門急診與住院利用之影響-以台北市兒童醫療補助計畫為例

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