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題名 健保部分負擔制度改革與財務模擬研析
Exploring Taiwan`s Copayment System Reform and Financial Impact Experiment
作者 張育瑄
Chang, Yu-Hsuan
貢獻者 連賢明<br>周德宇
Lien, Hsien-Ming<br>Chou, Te-Yu
張育瑄
Chang, Yu-Hsuan
關鍵詞 部分負擔
門診
醫療利用
健康保險
Copayment
Outpatient
Health care utilization
Health insurance
日期 2022
上傳時間 2-Sep-2022 15:30:29 (UTC+8)
摘要 本研究主要針對門診方面，提出四種部分負擔模擬制度，並藉由試算，估計各新制實施後，對於政府、醫療院所、民眾之影響。研究使用健保資料庫2020年門診數據，針對四種部分負擔制度設定調整比率後，利用含有價格彈性之試算公式，估計政策對於政府健保收入、醫療院所點值、民眾就醫次數及財務負擔等造成之變化。
此外研究亦進一步嘗試使用其他設定，如加入上限措施與改變調整數值，並重複上述步驟進行估計，並獲得多種試算結果，將能從中進行比對與分析，釐清各項模擬制度於不同面向之優缺點，為日後門診部分負擔調整提供預測與建議。
結果顯示，政府收入於不同制度間差距甚大，政府制定政策時應謹慎評估政策有效性，同時亦應兼顧公平性。而醫療院所方面，假設總額與住院費用不變之情形下，當醫院與診所均調整時，診所之點值增幅將高於醫院。最後，於民眾方面，部分負擔調升將對高齡者、所得較低者與高醫療利用者造成較嚴重之財務衝擊。另外，若以定率收費卻未設定上限，將使民眾，尤其高醫療利用者產生過高經濟負擔。
This study has focused on outpatient care, proposed four copayment simulation systems, and calculated the impact on the government, medical institutions, and the general public after implementing new system. We used the outpatient data in 2020 from the National Health Insurance Research Database (NHIRD). After adjusting the ratios for the four copayment systems, the trial calculation formula with price elasticity has been used to estimate the impact of the policy on government health insurance revenue, the point value of medical institutions, the number of people undergoing medical treatments, and financial burden.
Besides, the study would add additional cap limit measures and use different adjustment values, repeating the preceding steps to estimate and obtain multiple trial calculation results that could be used to compare, analyze, and clarify the advantages and disadvantages of different simulation systems.
Results have indicated that there is a significant disparity in government revenue between various systems. When formulating policies, the government should carefully considering their effectiveness and fairness. As for medical institutions, when both the adjustment ratio of hospital and the clinic are changed, the clinic will experience a greater increase in point value than the hospital. Eventually, on the side of the people, the study has discovered that the new system has a greater financial impact on the elderly, those with lower incomes, and those who utilize medical services more frequently. Furthermore, the results have revealed that if there is no cap on the coinsurance charge scheme, it will place a disproportionate financial burden on consumers, particularly those with significant medical utilization.
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描述 碩士
國立政治大學
財政學系
109255022
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0109255022
資料類型 thesis
dc.contributor.advisor 連賢明<br>周德宇zh_TW
dc.contributor.advisor Lien, Hsien-Ming<br>Chou, Te-Yuen_US
dc.contributor.author (Authors) 張育瑄zh_TW
dc.contributor.author (Authors) Chang, Yu-Hsuanen_US
dc.creator (作者) 張育瑄zh_TW
dc.creator (作者) Chang, Yu-Hsuanen_US
dc.date (日期) 2022en_US
dc.date.accessioned 2-Sep-2022 15:30:29 (UTC+8)-
dc.date.available 2-Sep-2022 15:30:29 (UTC+8)-
dc.date.issued (上傳時間) 2-Sep-2022 15:30:29 (UTC+8)-
dc.identifier (Other Identifiers) G0109255022en_US
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/141760-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 財政學系zh_TW
dc.description (描述) 109255022zh_TW
dc.description.abstract (摘要) 本研究主要針對門診方面，提出四種部分負擔模擬制度，並藉由試算，估計各新制實施後，對於政府、醫療院所、民眾之影響。研究使用健保資料庫2020年門診數據，針對四種部分負擔制度設定調整比率後，利用含有價格彈性之試算公式，估計政策對於政府健保收入、醫療院所點值、民眾就醫次數及財務負擔等造成之變化。
此外研究亦進一步嘗試使用其他設定，如加入上限措施與改變調整數值，並重複上述步驟進行估計，並獲得多種試算結果，將能從中進行比對與分析，釐清各項模擬制度於不同面向之優缺點，為日後門診部分負擔調整提供預測與建議。
結果顯示，政府收入於不同制度間差距甚大，政府制定政策時應謹慎評估政策有效性，同時亦應兼顧公平性。而醫療院所方面，假設總額與住院費用不變之情形下，當醫院與診所均調整時，診所之點值增幅將高於醫院。最後，於民眾方面，部分負擔調升將對高齡者、所得較低者與高醫療利用者造成較嚴重之財務衝擊。另外，若以定率收費卻未設定上限，將使民眾，尤其高醫療利用者產生過高經濟負擔。		zh_TW
dc.description.abstract (摘要) This study has focused on outpatient care, proposed four copayment simulation systems, and calculated the impact on the government, medical institutions, and the general public after implementing new system. We used the outpatient data in 2020 from the National Health Insurance Research Database (NHIRD). After adjusting the ratios for the four copayment systems, the trial calculation formula with price elasticity has been used to estimate the impact of the policy on government health insurance revenue, the point value of medical institutions, the number of people undergoing medical treatments, and financial burden.
Besides, the study would add additional cap limit measures and use different adjustment values, repeating the preceding steps to estimate and obtain multiple trial calculation results that could be used to compare, analyze, and clarify the advantages and disadvantages of different simulation systems.
Results have indicated that there is a significant disparity in government revenue between various systems. When formulating policies, the government should carefully considering their effectiveness and fairness. As for medical institutions, when both the adjustment ratio of hospital and the clinic are changed, the clinic will experience a greater increase in point value than the hospital. Eventually, on the side of the people, the study has discovered that the new system has a greater financial impact on the elderly, those with lower incomes, and those who utilize medical services more frequently. Furthermore, the results have revealed that if there is no cap on the coinsurance charge scheme, it will place a disproportionate financial burden on consumers, particularly those with significant medical utilization.		en_US
dc.description.tableofcontents 第一章 緒論 1
第一節 研究動機與目的 1
第二節 研究範圍與流程 4
第二章 部分負擔制度介紹 6
第一節 部分負擔定義與類型 6
第二節 各國部分負擔制度介紹 7
第三節 各國制度比較與統整 25
第三章 文獻探討與政策方向 26
第一節 部分負擔政策效果實證研究 26
第二節 醫療需求價格彈性研究 35
第三節 各界對部分負擔制度之看法與建議 46
第四章 估計方法與敘述統計 52
第一節 估計方法 52
第二節 敘述統計 60
第五章 試算結果分析 74
第一節 平均每次部分負擔變動 75
第二節 對政府之影響 76
第三節 對醫療院所之影響 77
第四節 對民眾之影響 78
第六章 其他設定試算：加入上限 86
第一節 上限設定說明 86
第二節 試算結果分析：設定統一上限 88
第三節 試算結果分析：考量所得設定上限 96
第七章 其他設定試算：改變數值 105
第一節 數值設定說明 105
第二節 試算結果分析：方案二 107
第三節 試算結果分析：方案三 126
第八章 結論與建議 148
第一節 結論 148
第二節 限制與建議 152
參考文獻 154		zh_TW
dc.format.extent 6962889 bytes-
dc.format.mimetype application/pdf-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0109255022en_US
dc.subject (關鍵詞) 部分負擔zh_TW
dc.subject (關鍵詞) 門診zh_TW
dc.subject (關鍵詞) 醫療利用zh_TW
dc.subject (關鍵詞) 健康保險zh_TW
dc.subject (關鍵詞) Copaymenten_US
dc.subject (關鍵詞) Outpatienten_US
dc.subject (關鍵詞) Health care utilizationen_US
dc.subject (關鍵詞) Health insuranceen_US
dc.title (題名) 健保部分負擔制度改革與財務模擬研析zh_TW
dc.title (題名) Exploring Taiwan`s Copayment System Reform and Financial Impact Experimenten_US
dc.type (資料類型) thesisen_US
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dc.identifier.doi (DOI) 10.6814/NCCU202201338en_US