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    题名: 健保部分負擔制度改革與財務模擬研析
    Exploring Taiwan`s Copayment System Reform and Financial Impact Experiment
    作者: 張育瑄
    Chang, Yu-Hsuan
    贡献者: 連賢明
    周德宇
    Lien, Hsien-Ming
    Chou, Te-Yu
    張育瑄
    Chang, Yu-Hsuan
    关键词: 部分負擔
    門診
    醫療利用
    健康保險
    Copayment
    Outpatient
    Health care utilization
    Health insurance
    日期: 2022
    上传时间: 2022-09-02 15:30:29 (UTC+8)
    摘要: 本研究主要針對門診方面，提出四種部分負擔模擬制度，並藉由試算，估計各新制實施後，對於政府、醫療院所、民眾之影響。研究使用健保資料庫2020年門診數據，針對四種部分負擔制度設定調整比率後，利用含有價格彈性之試算公式，估計政策對於政府健保收入、醫療院所點值、民眾就醫次數及財務負擔等造成之變化。
    此外研究亦進一步嘗試使用其他設定，如加入上限措施與改變調整數值，並重複上述步驟進行估計，並獲得多種試算結果，將能從中進行比對與分析，釐清各項模擬制度於不同面向之優缺點，為日後門診部分負擔調整提供預測與建議。
    結果顯示，政府收入於不同制度間差距甚大，政府制定政策時應謹慎評估政策有效性，同時亦應兼顧公平性。而醫療院所方面，假設總額與住院費用不變之情形下，當醫院與診所均調整時，診所之點值增幅將高於醫院。最後，於民眾方面，部分負擔調升將對高齡者、所得較低者與高醫療利用者造成較嚴重之財務衝擊。另外，若以定率收費卻未設定上限，將使民眾，尤其高醫療利用者產生過高經濟負擔。
    This study has focused on outpatient care, proposed four copayment simulation systems, and calculated the impact on the government, medical institutions, and the general public after implementing new system. We used the outpatient data in 2020 from the National Health Insurance Research Database (NHIRD). After adjusting the ratios for the four copayment systems, the trial calculation formula with price elasticity has been used to estimate the impact of the policy on government health insurance revenue, the point value of medical institutions, the number of people undergoing medical treatments, and financial burden.
    Besides, the study would add additional cap limit measures and use different adjustment values, repeating the preceding steps to estimate and obtain multiple trial calculation results that could be used to compare, analyze, and clarify the advantages and disadvantages of different simulation systems.
    Results have indicated that there is a significant disparity in government revenue between various systems. When formulating policies, the government should carefully considering their effectiveness and fairness. As for medical institutions, when both the adjustment ratio of hospital and the clinic are changed, the clinic will experience a greater increase in point value than the hospital. Eventually, on the side of the people, the study has discovered that the new system has a greater financial impact on the elderly, those with lower incomes, and those who utilize medical services more frequently. Furthermore, the results have revealed that if there is no cap on the coinsurance charge scheme, it will place a disproportionate financial burden on consumers, particularly those with significant medical utilization.
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    描述: 碩士
    國立政治大學
    財政學系
    109255022
    資料來源: http://thesis.lib.nccu.edu.tw/record/#G0109255022
    数据类型: thesis
    DOI: 10.6814/NCCU202201338
    显示于类别:[財政學系] 學位論文

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