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    題名: 管理式醫療的網絡效應
    其他題名: The Network Effect in Managed Care
    作者: 連賢明
    關鍵詞: 合作網絡;醫療成本;醫療品質;管理式醫療
    Network;Health Cost;Health Quality;Managed Care
    日期: 2003
    上傳時間: 2007-04-18 18:25:39 (UTC+8)
    出版者: 臺北市：國立政治大學財政系
    摘要: 管理式醫療的一大特徵是建立合作網絡---健康保險機構選擇性和醫療供給者合作來 提供醫療服務。然而，文獻上對合作網絡為何建立以及合作網絡如何運作並沒有一個清楚 的解答。本文假設健康保險機構透過兩項機制管理合作網絡：排除（僅允許被保人使用進 入網路內醫療供給者） ，導引（將被保人轉移至較優良醫療供給者） ，這兩項機制來提高品 質和降低成本。由於無法清楚觀察到各供給者的治療品質和成本，保險機構利用『相對』 成本和品質來決定機制的使用。因此，本文推論過去的治療成本和品質和現在醫院是否納 入合作網絡和現有治療病患數存在相當關係。 透過 1995 至 1999 年間的麻省各主要保險機構受保婦女的懷孕住院資料，我們利用資 料驗證這兩項機制在網絡中扮演的角色。我們以孕婦的剖腹產比例當作品質的指標，以醫 院生產服務（常規性）定價和生產中非常規性和常規性費用比例作為成本指標。我們發現 排除這項機制在實際上很少被使用。其次，我們發現當過去醫療品質較差，或是成本較高 時，醫院從該保險機構獲得的現有病患數目下降；這些證據說明導引機制被較廣泛使用。
    One of the most prevailing practices in managed care is the creation of network---a managed plan selectively contracts with health providers to supply medical services. Yet, it is still unclear why and how the network is operated. This paper hypothesizes that the network is operated through two mechanisms: "exclusion", enrollees are restricted to providers within the network, and "redirection", enrollees are directed to favored providers in the network, to contain the health cost and improve the quality of care. Because a plan imperfectly observes the cost and quality of care, a plan utilizes these two mechanisms by comparing the cost and quality of a specific provider with that of the average. As a result, a link exists between the previous periods` treatment performances and the exclusion and the patient flow of a provider at this period. Using discharge records of baby deliveries in acute hospitals between 1995 and 1999, we empirical test the presence of the two mechanisms in the hospital networks of several large managed plans in Massachusetts. We measure the quality of care by the cesarean rate, and the hospital cost by the hospital charge on non-routine delivery as well as the ratio of routine over non-routine charges. We found that "exclusion" mechanism is rarely used in practice: very few hospitals are excluded from a plan`s network over the sample years. We also found that patients are directed away from hospitals with higher costs or lower quality, the evidence in support of "redirecting" mechanism.
    描述: 核定金額：504400元
    資料類型: report
    顯示於類別:[財政學系] 國科會研究計畫

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