全民健保停保及復保政策對門診牙醫醫療使用之影響

Abstract

全民健康保險雖然經歷多次改革，但全民健保財政問題仍未解決且新聞媒體報導多起長期旅居境外國民在身體發生病痛時，短暫返國申請復保利用健保資源之案例，引起部分民眾質疑全民健保中停保及復保政策執行的公平性。本研究針對特定健保政策所區隔出的特殊群體其醫療資源使用情況，以及針對全民健保停保、復保政策影響的進行觀察。以衛福部及相關報導中統計曾申請復保者常利用的牙醫醫療服務作為觀察的依據，並以多元回歸等統計方法檢曾停保者與長期在保者在門診牙醫醫療使用的差異。另以差異中之差異法（difference-in-differences）進一步觀察，在2013年二代健保改革，增加復保三個月後使得再次停保之限制後，曾停保者的門診牙醫醫療服務的使用狀況（包含在保期間每月平均次數、在保期間每月申請點數及在保期間每月申請之部分負擔點數等）變動之情形。 研究顯示，曾停保者與長期在保者的人口特質有所不同，曾停保者為男性的比例較長期在保者低，且其年齡集中於20至39歲，另曾停保者之投保單位類別以無職業的地區人口為主，投保地區之分布集中於臺北區。 針對門診牙醫醫療使用部分，曾停保者與長期在保者在門診牙醫醫療資源的使用上確實存在差異。曾停保者於在保期間內每月平均使用次數、每月平均申請點數及每月平均部分負擔點數皆較長期在保者高。而在2013年二代健保改革增加三個月等待期後，曾停保者於在保期間使用門診牙醫醫療服務的每月平均次數較增加三個月等待期前之平均每月平均使用次數低、且於在保期間內每月平均申請點數增加，另每月平均申請部分負擔點數亦增加。顯示二代健保改革增加復保後三個月始得再次停保之制度，確實抑制曾停保者使用門診牙醫醫療服務之情形。

Despite undergoing multiple reforms, Taiwan’s National Health Insurance (NHI) system continues to face financial challenges. In recent years, media coverage of overseas Taiwanese nationals temporarily returning to Taiwan to reinstate their NHI coverage for medical treatment has sparked public concerns regarding the fairness of the suspension and reinstatement policy. This study investigates the healthcare utilization behavior of a specific group defined by this policy—individuals who previously suspended their coverage—and evaluates the impact of the NHI suspension and reinstatement policy. Focusing on outpatient dental services, which are frequently used by those reinstating NHI coverage according to statistics from the Ministry of Health and Welfare and related reports, this study employs multiple regression analyses to compare the utilization patterns between previously suspended individuals and those continuously insured. Additionally, a difference-in-differences (DID) approach is used to examine changes in outcome variables before and after the 2013 second-generation NHI reform, which introduced a three-month restriction period during which reinstated individuals could not suspend their coverage again. The outcomes of interest include insured-period monthly averages of dental visit frequency, claimed points, and out-of-pocket copayment points. Results indicate that previously suspended individuals differ demographically from continuously insured individuals, with lower proportions of males, a concentration in the 20–39 age group, a higher likelihood of being unemployed, and a geographic concentration in the Taipei region. In terms of healthcare utilization, previously suspended individuals had higher monthly averages in dental visits, claimed points, and copayment points during insured periods. After the 2013 policy reform, their average number of monthly visits decreased, while claimed points and copayment points increased. These findings suggest that the reform's restriction on repeated suspension effectively moderated healthcare usage behavior among this group, contributing to a fairer distribution of financial responsibility within the NHI system.