請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/9659
標題: | 透析總額制度對腎臟專科醫師執業行為的影響 The Impacts of Outpatient Dialysis Global Budgets on Nephrologist Behavior |
作者: | Chia-Ying Wu 吳佳穎 |
指導教授: | 張睿詒(Ray-E Chang) |
關鍵字: | 西醫基層總額預算制度,門診透析服務,醫師行為, global budget,dialysis services,physician behavior, |
出版年 : | 2008 |
學位: | 碩士 |
摘要: | 健保局於民國90年7月實施西醫基層總額預算制度,期望藉由預先設定總額預算的方式,並藉由同儕制約促進合理醫療服務價量的提供,以有效控制醫療費用。支付制度的介入及改變會影響醫療提供者的醫療行為,進而影響醫療資源耗用的情形。而透析服務屬高服務量及高單價之醫療服務項目,且成長快速,並於各總額預算的分配架構中被獨立編列預算,故本研究旨在探討西醫基層總額預算制度下,門診透析總額對基層院所腎臟專科醫師執業行為的影響。
本研究為一自然實驗(natural experiment),以1999年7月至2002年6月間,具腎臟專科執照且曾執行透析服務醫師為研究對象,將以專屬於基層院所醫師為實驗組,地區醫院醫師為對照組,採用差異中之差異法與GEE估計迴歸模型之統計方法,運用全民健康保險研究資料庫進行分析,以釐清西醫基層總額預算制度對基層院所腎臟專科醫師行為的影響。 本研究主要研究結論如下: (1) 西醫基層總額預算制度實施前,相較於地區醫院,基層院所腎臟專科醫師可能存在預期心理,提前增加門診透析服務的醫療費用點數且顯著成長,顯示總額預期效應確實存在。 (2) 相較於地區醫院,西醫基層總額預算制度實施後,總額效應對基層診所腎臟專科醫師透析服務,有正向的影響,但不顯著,可能受限於研究上的限制,導致無法確認此效應。 綜合上述,本研究建議衛生主管機關在新政策實施前後,需考量醫療提供者對政策介入的預期心理,及政策實施後醫師行為的改變,可預先擬定管理策略,俾使確保政策目標有效達成,並降低其他不欲見之次效應。 Background:National Health Insurance implemented the global budget for primary care since July 2001. With expectations of the pre-set amount of budget caps and the mechanism of peer review to promote the reasonable price of medical services provided, and effective control medical costs. It is widely accepted that payment will affect how physicians practice medicine, thereby affecting consumption of medical resources. Dialysis care is a high-volume, high-priced medical service, and the number of patient requiring dialysis increase rapidly. Besides, the budget allocation framework of the provision was an independent budget. Objective:The purpose of this study is to investigate the impacts of outpatient dialysis global budgets on nephrologist behavior. Methods:This research is a natural experiment. The study subjects are licensed nephrologists who had practiced dialysis services from July 1999 to June 2002. Using National Health Insurance Research database for research, the nephrologists practicing in clinics are the experimental group, and the nephrologists in district hospitals are the control group. Adopting the differences-in-differences method and generalized estimation equation approach, the impacts of outpatient dialysis global budgets on nephrologist behavior were analyzed. Findings: 1. Compared to the nephrologists of district hospitals, prior to the implementation of outpatient dialysis global budgets, the nephrologists of clinics may have anticipations effect and therefore increase outpatient dialysis services in advance. Medical expenses also increase significantly. 2. Compared to the nephrologists of district hospitals, after the implementation of outpatient dialysis global budgets, the global budgets of dialysis services have positively affected the services provided by nephrologists. The results suggested that the health administration should develop management strategies in advance in order to reduce expectation effects and adverse policy effects before a policy is implemented. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/9659 |
全文授權: | 同意授權(全球公開) |
顯示於系所單位: | 健康政策與管理研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-97-1.pdf | 1.07 MB | Adobe PDF | 檢視/開啟 |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。