藥品部分負擔政策之成效及對不同特性病患之影響

The Impacts of Drug Copayment Policy on Patients with Different Characteristics

陳忠廷(Chung-Ting Chen)

指導教授 ： 陳欽賢

共同指導教授 ： 賴惠子

國立臺北大學/社會科學學院/經濟學系/碩士(2008年)

摘要

我國自民國84年3月開辦全民健保以來，各項醫療服務利用率及費用均逐年快速上升，近年來健保局已陷入虧損。為了改善財務狀況並抑制民眾浮濫用藥的行為，健保局於民國88年8月1日實施「藥品部分負擔」等三項新措施，藉以抑制藥費金額並以新增的部分負擔金額增加收入。

本研究藉由民國88年1月至3月及民國89年1月至3月全民健保承保檔資料，以差異中之差異法(difference in difference)對樣本進行分析，並以藥費金額、就診次數及部分負擔金額等項目為研究標的，探討藥品部分負擔政策之成效，並探討不同特性(尤其是不同所得)民眾的就診用藥行為是否因政策實施而產生差異。

我們得到的結論是，藥品部分負擔政策實施後，必須支付部分負擔的病患藥費金額顯著下降45元，所以我們認為該政策可有效抑制藥費金額；必須支付部分負擔病患的就診次數顯著下降0.29次，所以我們認為該政策會抑制病患就診行為。

此外，各所得級距病患(需支付部分負擔者)的藥費降幅並無顯著差異。中間所得病患(需支付部分負擔者)的就診次數降幅是顯著大於最低所得病患的，而其它各所得級距病患的降幅則無顯著差異。低所得病患(需支付部分負擔者)的部分負擔金額佔其所得比例大致是高於高所得病患的，尤其政策實施後，低所得病患的比例值增幅更大，可見低所得病患應會感到較沉重的經濟壓力。需支付部分負擔病患的部分負擔金額顯著上升63元，所以我們認為藥品部分負擔政策可增加健保局的收入。

除了以上的結論，我們也發現，年齡是影響藥費金額和部分負擔金額的重要因素，病患的年齡越大，藥費金額便越高，部分負擔金額也越高。南區分局病患的部分負擔金額最高。各所得級距病患的藥費金額和部分負擔並沒有顯著差異，但就診次數卻是顯著有差異。男性病患的藥費比女性高。

關鍵字

藥品部分負擔

並列摘要

After the implementation of National Health Insurance (NHI), medical utilizations and expenditures increased rapidly. The Bureau of National Health Insurance faced financial deficit as a result. In order to improve the deficit and to reduce the utilization of drugs by patients, Drug Copayment Policy was implemented on August 1, 1999.
The aim of this study is to access the effecitiveness of the policy and to analyze the impact of this policy on patients with different characteristics, especially on the ones with different incomes.
Data used in this study were drawn from the January 1999 through March 1999 and the January 2000 through March 2000 National Health Insurance database. The method of difference in difference and the multiple regression model were used to analyze patients’ drug expenditure, outpatient visits, and drug copayment.
Our major findings are the followins: (1) For each patient who needed to pay the copayment, the drug expenditure significantly decreased by 45 NT dollars. (2) For each patient who needed to pay the copayment, the outpatient visits significantly decreased by 0.29 times. (3) The drug copayment for each patient increased significantly by 63 NT dollars. (4) The impacts of Drug Copayment Policy on patients with different incomes were not different significantly. (5) Comparing to the patients with higher incomes, patients with lower incomes bear much more burden after the implementation of Drug Copayment Policy. (6) The drug expenditure for the elderly patients and for the male patients was higher than their counterparts.

並列關鍵字

drug copayment

參考文獻

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