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    題名: 總額支付制度對不同特性醫療院所用藥行為之影響 : 以高血壓藥品為例
    其他題名: The impact of the global budget on hospital prescription decision in Taiwan : an empirical study on hypertensive patients
    作者: 邱鈺珊;Chiu, Yu-Shan
    貢獻者: 淡江大學會計學系碩士班
    韓幸紋;Han, Hsing-Wen
    關鍵詞: 總額支付制度;供給誘發需求理論;用藥行為;Global Budget;Supplier Induced Demand;Prescription Decision
    日期: 2012
    上傳時間: 2013-04-13 11:30:18 (UTC+8)
    摘要: 為了合理控制醫療費用成長,我國實施總額支付制度,此制度對藥品及藥事費用採取預先自總額中扣除的方式,意即其給付保障點值,但其他醫療行為點值卻日益下降。在供給誘發需求理論下,當醫院因給付方式改變而面對所得損失時,為了維護自身利益,利用其醫療資訊優勢,可能改變其病患的用藥行為。故本文以高血壓藥品為例,檢驗醫院是否會因總額支付制度造成所得減低,誘發其用藥行為改變,且此所得效果會因不同特性醫療院所有所差異。
    研究結果顯示隨著總額支付制實施期間經過,不同特性醫療院所所得效果誘發需求對用藥行為的影響越趨於一致,且影響程度越大。另外,不論觀察期間為長期或短期,私立醫院對所得效果反應於用藥行為皆為顯著負相關,此結果於過去研究指出私立醫院具較強烈財務動機看法一致。
    To control the medical expenses and prevent health insurance deficit expanded continually, the Bureau of National Health Insurance implement the Global Budget (GB) on July 1, 1998 and the Hospital-Based GB on July 1, 2002. Additionally, in economics, supplier induced demand (SID) may occur when asymmetric information exists between supplier and consumer. The theory is particularly important in health economic whereby doctors may encourage patients th demand healthcare they do not necessarily need.
    The purpose of the study is to explore the impact of GB and SID on pharmaceutical behaviors in hospital on antihypertensive drugs and we use Taiwan National Health Insurance Data from 2000 to 2004. We use a first difference approach to control for unobserved characteristics of provider.
    The result shows that the relationship between the income effect of the for-profit hospitals and the prescription decision is significantly negative as GB was applied. This result reveals that the for-profit hospitals have stronger financial incentives, which is consistent with prior studies.
    顯示於類別:[會計學系暨研究所] 學位論文

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