全民健保總額支付制度之研究

Abstract

台灣的健保制度始於1995年，到目前為止無論是制度、主管機關和財政各方面都可說是越來越完備，結合健保署、醫師、病患各方權益，造福全國人民，可作為全球各國的標竿。為管控健保制度下的醫療支出，健保局在2001年開始實施健保總額制度(global budget system)，目前適用於牙醫門診、中醫門診、西醫門診和醫院，有效期間為一年，且每年會依據前年執行效果、環境因素和醫療技術進行配額的調整。本研究透過統計方法研究過去幾年健保總額制度的公平性、二代健保的影響、經濟指標的影響和人口變項的影響，結果發現：

1. 四個部門中，醫院所獲得的總額明顯高於牙醫、中醫和西醫診所，但各類診所之間沒有顯著差異。 2. 二代健保對於各部門的總額並沒有顯著影響。 3. 歷年GDP、經濟成長率、平均國民所得與健保總額沒有顯著的關係，且牙醫總額和中醫總額分別與歷年GDP和歷年經濟成長率呈現負向關係。 4. 人口變項與健保總額沒有明顯的相關性，但牙醫總額與人口數呈現負相關。

Taiwan’s National Health Insurance system commenced in 1995, and the policies, governing authorities, and finances are becoming more and more structured over time, integrating the interests of the National Health Insurance Administration, doctors, and patients, bettering the lives of the general public, and serving as an example to countries all around the globe. In order to manage medical expenditures under the National Health Insurance system, the National Health Insurance Administration implemented the global budget system in 2001. The system is currently applied to dentist clinics, traditional Chinese medicine clinics, Western medicine clinics, and hospitals, and relevant figures are adjusted every year in accordance with implementation results, environmental factors, and medical advances. This study used statistical analysis to determine the fairness of the global budget system, effects of the Second Generation NHI policy, effects of economic indicators, and effects of demographic changes. Our results showed that:

1. Of the four departmental units involved in the global budget system, the percentage given to hospitals was significantly higher than that of dentist, traditional Chinese medicine, and Western medicine clinics, although there were no significant differences between the three types of clinics. 2. The Second Generation NHI policy had no significant effect on global budget figures. 3. Historical GDP, economic growth figures, and average income showed no significant correlation with global budget figures, although the percentages for dentist clinics and traditional Chinese medicine clinics, respectively, showed negative correlation with GDP and economic growth. 4. Demographic factors showed no significant correlation with global budget figures, although the percentages for dentist clinics showed negative correlation with total population.