| 研究生: |
梁敬婕 Ching-Chieh Liang |
|---|---|
| 論文名稱: |
2005年健保部分負擔調漲對不同人口特性族群就醫層級選擇之影響 |
| 指導教授: | 蔡偉德 |
| 口試委員: | |
| 學位類別: |
碩士 Master |
| 系所名稱: |
管理學院 - 產業經濟研究所 Graduate Institute of Industrial Economics |
| 論文出版年: | 2019 |
| 畢業學年度: | 107 |
| 語文別: | 中文 |
| 論文頁數: | 102 |
| 中文關鍵詞: | 部分負擔 、就醫選擇 、政策效果 、所得效果 |
| 外文關鍵詞: | copayment, medical care choice, policy effect, income effect |
| 相關次數: | 點閱:12 下載:0 |
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全民健保實施至今已二十餘年,如何抑制醫療成本持續膨脹,減少醫療資源浪費是政府一直所重視的,因此部分負擔是全民健保制度設計之重要一環。本研究旨在探討2005年健保門診部分負擔大幅度調漲後,不同疾病(上呼吸道感染、糖尿病)患者中不同族群(所得、年齡)的醫療利用變化。本研究利用健保門診部分負擔調漲政策實施的前後一年(2004/07/15-2006/07/14)的看診資料來觀察上呼吸道感染與糖尿病病患中不同族群的醫療利用情形,並依照不同所得與不同年齡層作為分組依據來進行分析。我們使用序列logit迴歸模型(ordered logit regression model)來當作實證研究模型,並利用政策邊際效果與所得邊際效果來衡量此次政策的成果。
本研究的實證結果顯示,政策效果方面,上呼吸道感染患者的就醫層級選擇對部分負擔調漲政策有顯著影響;糖尿病患者中僅有低所得組、地區人口與農民受政策影響。所得效果方面,高所得族群較不受政策影響,對他們而言只要所得提高,就越有可能往高層級醫院就醫的誘因存在,但效果很小。
Since the implementation of National Health Insurance (NHI) on Taiwan for more than 20 years, it is important for the government to control the expansion of medical costs and reduce waste of medical resource. Therefore, copayment is a significant part of the design of the NHI system. The purpose of this study is to exam the changes in medical use of different patient groups (income, age) with different diseases (upper respiratory tract infection, diabetes) after a substantial increase in the outpatient copayment in 2005. This study used the observation data of the one-year (2004/07/15-2006/07/14) implementation of the NHI outpatient copayment increase policy to observe the medical utilization of different groups in upper respiratory tract infection and diabetes patients, and the analysis is based on different incomes and different age groups. We use the ordered logit regression model as an empirical research model, computing the marginal effects of the policy and the marginal effects of income to measure this copayment policy.
The results of this study show that in terms of policy effects, the choice of hospital level for patients with upper respiratory tract infection has a significant impact on the copayment increase policy; while the diabetes patients, only the low-income group, the regional population and farmers are affected by the policy. On the other hand, in the terms of income effects, the high-income groups are less affected by the policy. For those people, as long as the income increases, the more likely they are to go to a high-level hospital for medical treatment, but this effect is small.
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二、 中文文獻
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3. 紀慧珊(2011),「兒童醫療補助計畫是否改善弱勢兒童醫療利用的可近性?」,國立中央大學產業經濟研究所,碩士論文。
4. 陳昕(2007),「利用健保部分負擔調漲估算醫院門診價格彈性:一個自然實驗法的觀察分析」,臺灣大學衛生政策與管理研究所,碩士論文。
5. 陳欽賢、劉彩卿、陳美吟(2005),「全民健康保險制度下之民眾就醫:感冒及慢性病」,《保險專刊》,21(2),113-143頁
6. 連賢明(2011),「如何使用健保資料推估社經變數」,《人文及社會科學集刊》,23(3),371-398頁。
7. 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」,《台灣公共衛生雜誌》,30(4),326-336頁
8. 黃昱瞳(2008),「全民健保部分負擔制度對幼童、年長者及慢性病患健康之影響」,國立陽明大學,博士論文。
9. 劉見祥、葉玲玲、黃雅君、黃宇君(2010),「部分負擔新制對不符低收入戶資格邊緣戶醫療利用之影響」,《健康保險期刊》,6(1),21-33頁
10. 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(4),589-623頁
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