在全民健保開辦後,醫療費用的上漲,成為健保能否永續經營的關鍵。中外一致的研究結果,高科技醫療的使用為醫療費用的上升主要因素,而在我國電腦斷層攝影掃描儀(CT)及核磁共振掃描儀(MRI),為九項昂貴醫療儀器當中醫療使用次數及醫療費用佔最大宗之醫療項目,且其利用呈持續上漲趨勢。在論量計酬下,目前又無良好的管控方式,本研究試著找出影響電腦斷層攝影掃描儀及核磁共振掃描儀醫療利用之因素。 研究對象以衛生署規劃之17個醫療區為觀察單位,觀察時間自民國87年至民國90年,應用複迴歸分析方法。研究模式中控制人口結構變項、家庭經濟因素、醫院醫師人力資源變項,探討每百萬人口CT及MRI儀器數對醫療使用次數及醫療使用費用的影響。 研究結果發現,在統計模型中控制其他變項下,對平均每千人每年CT使用次數,一地區的CT儀器密度、醫院醫師數、女性人口比率、幼年人口比率及家庭經濟因素對其有顯著的影響。對平均每千人每年MRI使用次數,一地區的MRI儀器密度、醫院醫師數、女性人口比率及家庭經濟因素對其有顯著的影響。對平均每千人每年CT使用費用,一地區的CT儀器密度、醫院醫師數、女性人口比率及家庭經濟因素對其有顯著的影響。對平均每千人每年MRI使用費用,一地區的MRI儀器密度、醫院醫師數及女性人口比率對其有顯著的影響。此外,模式中老年人口比率對使用次數及使用費用無顯著的影響。 由本研究之結果得出CT及MRI儀器密度對於醫療利用次數及費用的關係呈顯著正相關,尤其醫療利用向來由供給面作主導,在各國皆面對醫療費用高漲的今日,如何做好醫療費用的控制為政府之一大課題,而我國目前針對高科技檢驗檢查寄予厚望的部分負擔,目前成效還看不出,且受到不少爭議,對於高科技醫療供給面的控制目前尚未有進一步的政策,因此國內相關衛生主管單位可盡早做好針對供給面管控的方式。
After National Health Insurance (NHI) was executed in Taiwan, the control of rising health care expenditure became a key issue for NHI. Many researches have found that high-tech medical instruments are one of the main factors for the rise of health care cost. In the nine items of expensive medical instruments, CT and MRI are the top two items with major cost and the highest frequent uses. This study would like to find out the relative factors that affect CT and MRI. This study used the medical care regions as the observation units from 1998 to 2001.Multiple regression analysis was applied as statistical method. After controlling for some variables such as demographic variables, income, hospital physicians, and hospital beds, this study wanted to find the density of CT and MRI that influence the utilization and health care expenditure. The result found that CT’s density and hospital physicians have a significant influence on CT utilization after controlling for income, the proportion of female and young population. MRI’s density and hospital physicians also have a significant influence on MRI utilization after controlling for other factors. In addition, CT’s density and hospital physicians have a significant influence on CT and MRI expenditure after controlling for income and female’s proportion. However, the proportion of aged population didn’t have a significant influence on CT or MRI utilization. Under the results of this study, the density of CT and MRI has a positive correlation with health care utilization. It’s important for government to establish the relative policy to control health care cost, especially for high-tech medical instruments.
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