| 摘要: | 全民健康保險實施以後，國內醫療保險普及率高昇，使得醫療費用迅速上漲。近年來在各型醫療機構不斷擴充門診服務量下，加上目前主要採取論量計酬（fee for service）的支付方式，使得年度門診醫療的總支出約佔全國總醫療費用的三分之二。因此本研究針對西醫門診醫療費用的上漲，在排除經濟成長等因素外，探討是否存在醫療供給造成醫療需求增加的情形。亦即本研究主要探討西醫門診中是否存在醫師供給誘導需求（Supplier-induced Demand）的現象。 本研究採用次醫療區為觀察單位，觀察期間為民國八十五年至民國八十八年，共有二百五十二個觀察值。採用「全民健康保險學術研究資料庫」、「臺閩地區人口統計」、「衛生統計」、「家庭收支調查報告」等資料。以計量經濟學中之固定效果模型（Fixed-effects Model）做為統計分析模型。模型中控制了人口結構變數、家庭經濟能力因素、時間參數與地區參數，探討醫療供給（每萬人口醫師數、每萬人口病床數）對於平均每人每年西醫門診醫療費用與使用次數之間的關係。 研究結果證實了在國內西醫門診醫療中，醫師確實有誘發醫療需求的現象。並發現模型中之人口結構變數、家庭經濟能力因素與每萬人口病床數，並非影響西醫門診醫療費用升高的顯著因素。 由固定效果模式（Fixed-effects Model）計算出一地區平均每萬人口增加一位醫師會使得該地區每人每年平均西醫門診醫療費用增加1.01268倍；平均每人每年西醫門診就診次數將增加1.01279次。最後本研究推算出民國八十五年至八十八年西醫門診醫療費用的成長中有9.18%的部分，可能是因每萬人口醫師數增加所造成西醫門診醫療費用的增加。; The implementation of National Health Insurance greatly universalizes our medical insurance so that our medical expenses are rapidly up-climbing. In recent years, all kinds of medical organizations have been increasing their medical services, and the reimbursement is a fee-for-service payment method. Consequently, our annual outpatient care expenditure largely go up and equals to nearly two thirds of national medical expenses. After, excluding the influence of economic growth and other factors, we do have good reason to doubt if the rising outpatient care expenses reflect that medical supply induces medical demand. Therefore, this research aims to study whether "supplier-induced demand" exists in today''s western-medicine outpatient services. This research observes sub-region in health care service network over the period from 1996 to 1999, and contains 252 observations in total. The data sources include "National Health Insurance Research Database," "Taiwan-Fukien Demographic Fact Book," "Health and Vital Statistics," "Report on the Survey of Family Income and Expenditure In Taiwan Area of Republic of China." Meanwhile, this study applied "Fixed-effects Model," used in econometrics, as means of analysis and statistics. The model examined how, given the income, demographics, and population, medical supply (i.e. the number of physicians and hospital beds) influences individual expenses and frequency for outpatient services per year in a specific area over a period of time. The research results clearly prove that physician do induce medical demand in our western-medicine outpatient services. Also, we can find that in the model, the family income, variation in population structure, and number of hospital beds per ten thousand population are not significant factors on the increase of outpatient care expenses. Furthermore, according to the Fixed-effects Model, the study showed that increasing one physician per ten thousand population will raise 1.01268 times outpatient care expenditure per capital, and 1.01279 times frequency of physician visits given an area. Finally, this research computes the increasing number of physicians for every ten thousand people may have taken responsibility for 9.18 percent of the increased outpatient care expenditures during 1996 to 1999 in Taiwan. |
