政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/154580

政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/154580

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政大典藏 > College of Social Science > Department of Public Finance > Theses > Item 140.119/154580

Please use this identifier to cite or link to this item: https://nccur.lib.nccu.edu.tw/handle/140.119/154580

Title:	醫療補助政策影響-以台北市兒童醫療補助為例 Impact of Subsidy Program on Medical Care-Evidence from the Medical Subsidy Program for children in Taipei City
Authors:	黃心楹 Huang, Xin-Ying
Contributors:	連賢明 Lien, Hsien-Ming 黃心楹 Huang, Xin-Ying
Keywords:	醫療補助部分負擔兒童醫療替代效果 Medical Subsidy Copayments Children 's health care Substitution effect
Date:	2024
Issue Date:	2024-12-02 11:25:54 (UTC+8)
Abstract:	我國於1995 年開辦健保，且在納保率將近100%全民納保的情況下，健保的政策與國民的生活間息息相關，其中對於嬰幼兒及孩童的健康關注度在各國之間高度受到關注。為此，臺北市於1995 年領先其他縣市首推出兒童醫療補助計畫，對於符合相關規定之三歲以下兒童給予門診、急診及住診部分負擔補助優惠，在1998 年10 月將醫療補助政策擴大於符合相關規定之六歲以下兒童皆可享有補助優惠。後續內政部於2002 年3 月開辦全國性之三以下兒童醫療補助，臺北市為配合國家政策而先於2001 年2 月取消該市的補助政策，自然形成政策空窗期得以進行補助政策轉換影響之研究。研究目的為得知門診補助政策取消後對於六歲以下兒童在其他醫療使用上有何轉變，故對該族群在門診、急診以及住診做分析，更近一步至醫院層級以及兒童個人相關訊息是否會對醫療使用產生影響。採用差異中的差異研究法(Difference-in-Difference，DID)進行初步以及後續較為深入的分析，研究期間為2000 月2 月至2002 月1 月底止，政策轉變時間點為2001 年1 月31 日。研究結果中發現在取消部分負擔補助政策後六歲以下兒童的門診就診次數有顯著下降的狀況，由於急診與住診補助未取消而未受到影響，並未受到補助取消影響而有差異差距擴大的現象。進一步以差異中的差異研究法針對臺北市的數據分析住診與門診之間有無替代效果，發現在三歲以下族群中兩者並未有替代效果外，整體在門診與住診的醫療使用上是下降趨勢而在四至六歲組群中可能因為年紀而健康狀況較為穩定而有延誤就醫或是忽略症狀而導致惡化需要使用住診服務。 In 1995, Taiwan introduced its National Health Insurance program, achieving nearly 100% enrollment and making health insurance policies deeply integrated into citizens' lives. There has been a strong emphasis on children's health, a priority shared internationally. To address this, Taipei City was the first among local governments to launch a children's medical subsidy program in 1995, providing partial subsidies for outpatient, emergency, and inpatient care for children under three who met eligibility criteria. In October 1998, the subsidy program was expanded to include eligible children under six. Later, in March 2002, the Ministry of the Interior launched a nationwide subsidy for children under three, and in anticipation of this national policy, Taipei City canceled its local subsidy in February 2001. This created a policy gap, allowing an opportunity to study the effects of the policy change on healthcare utilization. The purpose of this study is to assess changes in healthcare utilization among children under six following the cancellation of the outpatient subsidy, with analyses focusing on outpatient, emergency, and inpatient services. Further analysis also considers whether hospital-specific or individual factors related to children impact healthcare use. The study adopts the Difference-in-Difference (DID) method for both preliminary and more in-depth analysis, covering the period from February 2000 to the end of January 2002, with the policy change occurring on January 31, 2001. The results reveal a significant decrease in outpatient visits among children under six after the subsidy policy was canceled, while emergency and inpatient visits remained unaffected since their subsidies were still in place, indicating no widening of utilization gaps due to subsidy removal. A further DID analysis of Taipei City data found no substitution effect between inpatient and outpatient services for children under three. Overall, both outpatient and inpatient service utilization showed a declining trend, while among children aged four to six, possibly due to better health stability, delayed care or symptom neglect may have led to worsened conditions requiring inpatient services.
Reference:	許績天、韓幸紋、連賢明、羅光達，(2011)。部分負擔調整對醫療利用的衝擊: 以2005 年政策調整為例。台灣衛誌，Vol.30，NO.4，326-336。許君強、林澤余、沈希哲、張嘉莉、湯澡薰，(2006)。醫療補助政策對醫療利用之影響─以臺北市兒童醫療補助計畫為例。北市醫學雜誌，3(3)。黃昱瞳、李玉春、楊銘欽，(2009)。兒童醫療補助計畫實施對幼童健康之影響。兒童及少年福利期刊，第15 期，101-124。韓幸紋、連賢明，(2008)。降低部分負擔對幼兒醫療利用的影響:以北市兒童補助計畫為例。經濟論文叢刊，36，589-623。蔡偉德、蔡偉德、陳芝嘉、余清祥，(2014)。老人醫療利用的價格效果:以921 震災的自然實驗為例。經濟論文，卷期42:4，599-645 謝啓瑞、林建甫、游慧光，(1998)。台灣醫療保健支出成長原因的探討。人文及社會科學集刊，卷期10:1，1-32 簡偉研、方海，(2015)。門診服務對住院服務替代效應的實證分析。北京大學學報，47，459-463。 Iizuka, T. & Shigeoka, H. (2018)。Free for children? Patient cost-sharing and healthcare utilization. CEI Working Paper Series, 2019-5 Miyawaki, A., Noguchi, H., & Kobayashi, H. (2017). Impact of medical subsidy disqualification on children‘s healthcare utilization : A difference-in- difference analysis from Japan. JournalSocial Science and Medicine, Vol.191，89-98 Kang, C., Kawamura, A., & Noguchi, H. (2019). Does Free Healthcare Affect Children’s Healthcare Use and Outcomes? Journal of Economic Behavior and Organization, Vol.202, 372-406 Kato, H., & Goto, R. (2017). Effect of reducing cost sharing for outpatient care on 33 children’s inpatient services in Japan. Health Economics Review, Vol.7, issue 1, 1-10 Zweifel, P. & Manning, M.G. (2000). Moral Hazard and consumer incentives in health care. Handbook of Health Economics ,Vol.1 ,409-459 Getzen, T. (2000). Health Care is an Individual Necessity and a National Luxury: Applying Multilevel Decision Models to the Analysis of Health Care Expenditures. Journal of Health Economics, Vol.19, No.2 人口統計資料，中華民國內政部戶政司全球資訊網 https://www.ris.gov.tw/app/portal/346 臺北市兒童醫療補助計畫辦法沿革，臺北市法規查詢系統 https://www.laws.taipei.gov.tw/Law/LawSearch/LawArticleContent/FL013743?date= 19991221 全民健康保險實質納保率-按性別年齡別分，行政院性別平等會 https://www.gender.ey.gov.tw/gecdb/Stat_Statistics_Field.aspx 全民健保保險統計動向，衛生福利部中央健康保險署 https://www.nhi.gov.tw/ch/lp-3022-1.html
Description:	碩士國立政治大學財政學系 107255024
Source URI:	http://thesis.lib.nccu.edu.tw/record/#G0107255024
Data Type:	thesis
Appears in Collections:	[Department of Public Finance] Theses

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