淡江大學機構典藏:Item 987654321/93944
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    题名: 總額支付制度實施前後對醫療使用量之影響
    其它题名: Impact of global budget system on the medical utilization
    作者: 陳韋汝;Chen, Wei-ru
    贡献者: 淡江大學保險學系保險經營碩士班
    許文彥;田峻吉;Hsu, Wen-Yen;Tien, Jyun-Ji
    关键词: 全民健保;醫療使用量;醫療品質;跨欄模型;總額支付制度;national health insurance;Global Budget System;medical utilization;medical quality;Hurdle Regression
    日期: 2013
    上传时间: 2014-01-23 13:42:49 (UTC+8)
    摘要: 本研究旨在探討全民健保總額支付制度實施對醫療服務使用量的影響。採用主計處家庭收支調查資料為研究來源，研究總額支付制度實施前(1998-1999年)及總額支付制度實施後(2003-2004年)的就診機率及使用情形。研究方法以跨欄迴歸模型分別以邏輯斯迴歸分析家戶第一次就診機率及負二項迴歸分析家戶就診次數。研究敘述性統計結果發現，總額實施後住院天數增加了1.83天，門診次數增加了5.68次，可看出總額實施後就診機率及次數都有增加的趨勢；但經由迴歸分析結果顯示，在加入年齡、收入等控制變數後，住診機率及使用量有減少的情況。整體而言，總額支付制度實施後醫療使用量顯著減少，經由本研究證實總額支付制度的實施的確會影響民眾對醫療服務的使用量，且研究結果多為顯著相關。
    This study examines the impact of Global Budget System on the medical utilization proxied by inpatient days and outpatient visits. I use hurdle regression to model the two-stage decision process occurred in medical utilization. In particular, a Logistic Regression analyzes patient’s initial visit, and Negative binomial Regression analyzes the magnitude of utilization. The sources of data used in this study were the Directorate-General of Budget, Accounting and Statistics. The summary statistics indicate that after the implementation of the Global Budget System the inpatient days increase by 1.83 days and outpatient visits increase by 5.68 times. However, after controlling household income and trend effect, the empirical results from our hurdle model indicate that the probability of incurring inpatient days decreases and the frequency of outpatient visits decreases conditional on positive use. Overall, the empirical results show that the medical utilization decreases after the implementation of the Global Budget System.
    It can be seen after the implementation of the probability and frequency of visits has increased over time. It showed that the probability of visit and medical utilization has reduce, when the addition of age, income and other control variables. Overall, after Global Budget System implemented, the medical utilization had been reduced, and affect medical utilization. And the results were mostly significant.
    显示于类别:[風險管理與保險學系] 學位論文

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