| Abstract: | 我國自民國八十四年施行全民健康保險，由當初倉促上路迭有怨言，至今普獲民眾肯定，實在難能可貴。然而，給付項目與醫療服務利用逐年俱增，財務壓力伴隨而來。民國八十七年起健保首見赤字，隔年赤字並高達210億元。在入不敷出的情況下，政府於92年度首度調高保費，引發各界對健保財務的檢討聲浪。健保財務穩定的首要前提在於醫療支出的準確推估。正確推估醫療支出不但是計算保費的基礎，也是了解醫療資源是否有效運用的重點。本研究試圖以健保資料的住院費用申請總表主檔（DT）和門診費用申請總表主檔（CT），再校正過各醫院的核減率後，計算歷年健保費用的趨勢變化。此外，為了瞭解醫療費用的影響因子，我們進一步使用承保抽樣歸人檔四組（每組5萬），共20萬人的健保抽樣資料，分析個人特性（年齡、性別、年齡使用率，和個人過去醫療支出）和國內特有因素（昂貴儀器使用、醫院層級的提升、和總額制度）對醫療支付的影響。希望透過這些因素的探討，來準確預估健保費用，供政策決策和保費制訂的依據。 Taiwan implemented National Health Insurance (NHI) in 1995. Though NHI had a hasty start, it has steadily gained the support of the majority of Taiwan residents. As coverage expands and usage increases, however, the financial stability of NHI is under great challenge: the financial deficit first saw red in 1998 and widened to NT 2.1 billions in the following year. Due to the financial pressure, the government increased the premium in 2003, causing the concerns on the financial stability of NHI. The premise of financial stability is the precise prediction of health expenditure. Predicting health expenditure is not only a basis of setting premium, but also the ground of understanding resource efficiency. Using the hospital inpatient files and outpatient data from National Health Research Institute (NHRI), after adjusting the verifying ratios, we calculate the trends of NHI expenditures over years. Furthermore, to understand the factors affecting the NHI expenditure, we use four groups of NHIS sample files (50,000 per group, 200,000 in total) to analyze personal factors (age, sex, age utilizations, and the health expenditure in the past year), as well as the specific NHI factors (utilization of expensive medical equipments, change of accreditation of hospitals, and global budgeting). Through the study of these factors, we hope to predict the NHI expenditure more accurately, and provide a basis for policy discussions and premium setting. |
