差別取價在健保機制下的效益實證

Abstract

全民健保開辦前，我國有870餘萬的老、弱、婦、孺仍須獨自承擔醫療風險的重擔，造成社會的不平等。全民健保開辦10年後，全體2300萬國民全部納入保險範圍，民眾滿意度年年升高，但財務問題卻使全民健保瀕臨虧損破產。 台灣的醫療產業夾雜在一個多面化的複雜環境之中，從醫療專業技術的考量到選舉文化下的政治考量，在社會保險系統與社會福利政策中徘徊，或是應該扮演創造效益的經濟產業。健保的財務問題並不是問題，而是許多問題未適當解決所產生的後果。 從消費者剩餘理論的架構推論民眾的醫療消費行為，本研究發現消費者剩餘造成民眾超值消費的心理，民眾自然會毫無懼憚的擴大醫療消費。從賽局理論之囚犯困境模擬，發現在有限資源爭奪的情境下，醫院間會以擴大業績的策略進行競爭，使醫療資源耗費更形加劇。而第三者付費引發代理關係，也加深道德風險的誘因。當需求面因素造成民眾過度消費，供給面因素因為總額預算引發業績競爭，產業結構在代理關係下擴大交易成本，健保的財務虧損當然日益擴大。在財務壓力壓擠醫療給付後，造成醫師人力的分配失衡，連帶的影響整體醫療品質。 利用差別取價個案分析，本研究證實差別取價可以透過新價值的傳遞，將消費者剩餘轉換成實質效益，使民眾可以透過自己的價值選擇，產生適當的付費意願。從新光醫院的個案分析與問卷結果發現，特殊化設計的門診服務能滿足特定族群的重點需求。病患的人口特性隨科別變化，對服務的反應強度也各有不同。供給因素的品質會因為差別取價的競爭影響而提昇。民眾的醫療需求是多面向且重視強度因人而異。當特殊需求被適當滿足，民眾會依據價值決定付費意願。 本研究認為差別取價的自費醫療能夠成為另一股財務支柱。在政府的政策支持與法源依據下，利用創造消費者需求的價值，提昇消費者滿意度，並藉此換取消費者付費來產生新的效益。才能在不調漲整體保費下完全改善現有健保財務的窘境，以維繫醫療環境的健全體質，逐步的邁向自給自足的理想境界。

Before the National Health Insurance (NHI) is officially launch in Taiwan, more than 8.7 millions of elder, housewife and children are not included in any insurance scheme which force them to take medical risk by their own. This problem has cause injustice among social system. After 10 years of NHI, total 23 million populations is covered under insurance reimbursement program. Although the satisfactory rate of NHI is higher by years, but financial dispute have push the system to the edge of bankruptcy. The role of Taiwan medical industry is situated in a multi- dimensional and very complicated environment. From the professional consideration of medical view to the political consideration for public election; wondering between social insurance system and social welfare benefit; or an industry that provide health care service to people and create economic value as other industries does. The research findings are as follows: 1. Consumer surplus in NHI system will encourage the public to enlarge their spending in medical care; consumption will increase due to low costing. 2. In the Game theory—The Prisoner's Dilemma scenarios, hospitals will adopt expanding strategic and completing heavily on sales to fight for limited global budget. Medical resources will waste severely under the global budget. 3. Third party payer creates multi-layer agency relationship in NHI system. The moral hazard and agency cost will expand due to such structure. 4. NHI payment scheme have change the distribution of physician to unbalance. In long term the medical service quality will be impair unless the financial balance get improved. In the case study of out-patient service from Shin Kong Hospital we found that price discrimination will convert consumer surplus into true revenue if new value can be delivered to patient. Patient of different needs will choice the service according to option and generate wellness to pay for higher charge service. From the out-patient survey we found also that patient’s demographic character and specific requirement on medical service is different by department. According to this study, patient’s medical service requirement is multi-dimensional and demand intensity is different by demographic. When specific requirement has meet, patient is willing to pay extra charge for service that suit for themselves. Price discrimination act as another resource of financial support for NHI is highly possible according to this study. With the government supporting on policy and legislation, price discrimination can create new income for medical service and enhance satisfactory of patient by the delivery of new service value. Thus, without the needs in increasing NHI premium, new financial support will inject into medical industry. When financial quandary of NHI is improved and reaches self-contained and self-sufficient financially, which is the only way that NHI can be maintain and develop in healthy environment.