我國藥品部分負擔經濟效果衡量模型之建立

Abstract

我國全民健康保險制度在規劃之初，便極為重視部分負擔，舊制部分負擔的課徵範圍包括門診與住院，課徵標準則係總括式，尤其是在門診醫療方面，容易造成非醫師診療的項目（例如檢驗、藥品等）費用增加。全民健保實施四年多來，藥品支出佔總支出的比例有增加的趨勢，因而於民國八十八年八月一日起，新增藥品費用部分負擔；保險對象就醫時，不僅需針對舊制部分負擔繳費，亦需額外繳納藥品費用部分負擔。本文即是針對此項議題，進行經濟效果分析。本文嘗試建立我國門診藥品費用部分負擔經濟效果的衡量模型，並將部分負擔的經濟效果分解為醫療需求抑制效果、保險財務挹注效果及社會福利損失縮減效果。

The cost sharing is an essential instrument of controlling health care cost within the health insurance system.An undifferentiated collection of co-payments, either as a lump sum or at a percentage, is possibly associated with over-proportional increase of non-physician insurance benefits, e.g. the prescribed pharmaceuticals. Thus, a scheme of drug co-payments has been introduced into the National Health Insurance (NHI) in Taiwan on August 1st,1999. This paper is aimed at this issue to conduct an economic analysis. A model is constructed to analyze three economic effects of drug co-payments:containing the demand for medical care, financing the health insurance and reducing the welfare loss.