政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/59107
English  |  正體中文  |  简体中文  |  Post-Print筆數 : 27 |  全文筆數/總筆數 : 113318/144297 (79%)
造訪人次 : 50961677      線上人數 : 883
RC Version 6.0 © Powered By DSPACE, MIT. Enhanced by NTU Library IR team.
搜尋範圍 查詢小技巧：
  • 您可在西文檢索詞彙前後加上"雙引號"，以獲取較精準的檢索結果
  • 若欲以作者姓名搜尋，建議至進階搜尋限定作者欄位，可獲得較完整資料
    •  進階搜尋


    請使用永久網址來引用或連結此文件: https://nccur.lib.nccu.edu.tw/handle/140.119/59107


    題名: 部分負擔調整對醫療利用的衝擊:以2005年政策調整為例
    作者: 許績天;韓幸紋;連賢明;羅光達
    Sheu,Ji-Tian;Han,Hsing-Wen;Lien,Hsien-Ming;Lo,Kuang-Ta
    貢獻者: 政大財政系
    關鍵詞: 部分負擔;醫療利用;容量限制
    payment;health care utilization;capacity constraints
    日期: 2011-08
    上傳時間: 2013-08-26 11:39:16 (UTC+8)
    摘要: 目標：本文探討2005年健保局調高部分負擔對民眾醫療利用和就醫選擇影響。方法：本文使用2005年健保百萬歸人檔中的西醫門診資料來分析政策效果。由於2005年部分負擔調高僅侷限於醫院，政策效果理應依民眾所屬鄉鎮使用診所高低而有差別。本文因而將病患經常就醫鄉鎮按平均診所就醫比例區分三組：低於65%（分組Ⅰ），65%-75%（分組Ⅱ），高於75%（分組Ⅲ），採障礙模型(Hurdle model)估計部分負擔調高後對各組就醫機率與次數影響。結果：部分負擔調整顯著減少就醫機率及門診次數。整體而言，調漲後半年門診次數減少0.34次（或6.1%），其中醫院次數為0.07次，高層級醫院為0.01次。更重要的是，各分組間政策效果存在相當差異。處於使用醫院最高比例鄉鎮（分組Ⅰ）民眾，降低醫院（和高層級醫院）利用；相反的，處於使用醫院比例最低鄉鎮（分組Ⅲ）民眾，增加醫院（和高層級醫院）利用。這估計結果即使將樣本時間延長至政策前後一年仍相同。結論：部分負擔調高的確減少就診次數，降低民眾醫療利用。另外，政策效果會依民眾經常就醫地點而有顯著差異。一個可能解釋為醫院服務的容量限制(capacity constraint)。因醫院存在容量限制，使得鄰近醫院的分組Ⅰ民眾較易接受醫院服務，但是當部分負擔調漲使得分組Ⅰ民眾降低醫院就醫，此時就醫距離較遠鄉鎮民眾（分組Ⅲ）填補原先醫院門診空缺，使得分組Ⅲ民眾醫院利用反而在部分負擔調高後有所增加。
    Objectives: The aim of this study was to evaluate the impact of the increase in NHI copayments in 2005 on the choice and use of health care. Methods: We analyzed the outpatient utilization of one million NHI enrollees between 2004 and 2006. Because the policy increased only the copayment for hospital visits, it was plausible to expect that the effect would be smaller for individuals residing or working in towns with a lower propensity for visiting hospitals. Therefore, based on the average percentage of clinical care in the town of residence, the sample was separated into three groups: less than 65% (group Ⅰ), between 65 and 75% (groupⅡ), and more than 75% (group Ⅲ). We then used the Hurdle regression model to examine the effect of the new policy on the probability of health care utilization, and the number of outpatient visits for each group. Results: Our results showed that the increase in copayment significantly reduced the probability and the number of outpatient visits. We estimated that outpatient use six months after the policy change decreased by 0.34 visits (or 6.1%), of which 0.07 were visits to hospitals, and 0.01 were visits to regional hospitals or above. More importantly, the effect differed substantially across groups. Individuals residing or working in towns with a higher propensity to visit hospitals (group Ⅰ) reduced their visits to hospitals after the policy change. On the other hand, individuals residing or working in towns with a lower chance of visiting hospitals (group 3) increased their visits. These findings were robust even after extending the sample period from six to 12 months. Conclusions: Our results confirmed that a copayment increase in 2005 reduced the use of outpatient services. Nonetheless, the effect differed substantially across groups with various propensities to make hospital visits. One explanation might be that there is a capacity constraint that limits outpatient services offered by hospitals. While individuals residing or working in towns near hospitals reduced their hospital visits due to the price hike, those residing or working in more distant towns increased their hosp
    關聯:  臺灣公共衛生雜誌, 30(4), 326 -336
    資料類型: article
    顯示於類別:[財政學系] 期刊論文

    文件中的檔案:

    檔案 描述 大小格式瀏覽次數
    326336.pdf2033KbAdobe PDF21081檢視/開啟


    在政大典藏中所有的資料項目都受到原著作權保護.


    社群 sharing

    著作權政策宣告 Copyright Announcement
    1.本網站之數位內容為國立政治大學所收錄之機構典藏，無償提供學術研究與公眾教育等公益性使用，惟仍請適度，合理使用本網站之內容，以尊重著作權人之權益。商業上之利用，則請先取得著作權人之授權。
    The digital content of this website is part of National Chengchi University Institutional Repository. It provides free access to academic research and public education for non-commercial use. Please utilize it in a proper and reasonable manner and respect the rights of copyright owners. For commercial use, please obtain authorization from the copyright owner in advance.

    2.本網站之製作，已盡力防止侵害著作權人之權益，如仍發現本網站之數位內容有侵害著作權人權益情事者，請權利人通知本網站維護人員(nccur@nccu.edu.tw)，維護人員將立即採取移除該數位著作等補救措施。
    NCCU Institutional Repository is made to protect the interests of copyright owners. If you believe that any material on the website infringes copyright, please contact our staff(nccur@nccu.edu.tw). We will remove the work from the repository and investigate your claim.
    DSpace Software Copyright © 2002-2004  MIT &  Hewlett-Packard  /   Enhanced by   NTU Library IR team Copyright ©   - 回饋