全民健康保險下民眾自付醫療費用之評估; Out of Pocket Medical Care Payments under National Health Insurance

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题名:	全民健康保險下民眾自付醫療費用之評估;Out of Pocket Medical Care Payments under National Health Insurance
作者:	何姍珊;Shan-Shan Ho
贡献者:	中國醫藥大學醫務管理研究所
关键词:	自付費用;部分負擔;全民健保;out-of-pocket;cost-sharing;National Health Insurance
日期:	1993
上传时间:	2009-12-24 10:56:15 (UTC+8)
摘要:	健保局無法得知民眾的自付醫療費用，故本研究之產生動機為，對於全民健保制度下，民眾自付醫療費用多寡的關切。本研究最主要為評估民眾自付醫療費用之金額，以及民眾自付醫療費用中屬於「隱性部分負擔」的金額。同時建立未來瞭解民眾自付醫療費用的例行調查方法，並進一步執行統計檢定，探討影響民眾自付醫療費用之因素。本研究母群體為中央健保局中區分局轄區內四縣市(台中市、台中縣、彰化縣及南投縣)之1,500位保險對象。研究方法採家戶訪問調查，並輔以兩個月期間的就醫記錄。根據前述蒐集所得資料，將民眾自付醫療費用粗略的區分為，主要由醫療供給者所決定的醫療服務之相關費用；及主要由民眾自願選擇並決定的醫療服務之相關費用。其中醫療供給者所決定的醫療服務之相關費用為本研究的重點，並將其定義為「隱性部分負擔」。研究結果顯示，兩個月期間，所有自付醫療費用之總金額為192,287元以及民眾自付醫療費用中屬於「隱性部分負擔」的總金額為30,850元。且就醫次數愈多者以及商業健保附加險之保費愈高者，自付費用愈高，達到統計學上顯著相關（p<0.01）。就醫比率為32.2％、平均就醫次數為2.68次，以及平均自付醫療費用為951.16元。平均每位保險對象之隱性部分負擔額為29.05元，以及實質部分負擔額為83.24元。而本研究所蒐集或計算之「民眾自付醫療費用」項目，並不包含住院部分，只討論門診部分。; Given that there is no way for the Bureau of National Health Insurance to know the out-of-pocket payment for medical care, the motive of this research is originated from the concern for the money that out-of-pocket payment for medical care under National Health Insurance system. The major task of this research is to evaluate the absolute of out-of-pocket payment, and to assess the absolute of hidden cost-sharing; meanwhile, we also seek to establish the mechanism and method for routine collection and analysis of out-of-pocket payment in the future; and also to conduct further statistic examination, so as to analyze and discuss factors that might effect this out-of-pocket payment. This research method is a combination of face-to-face interview survey and diary. This method will study sample population from the jurisdiction of Central Regional Bureau of BNHI, which include Taichung City, Taichung County, Changhwa County, and Nantou County, from which a sample of 1,500 individuals will be interviewed and supplemented with diary record. From the data we collected, all out-of-pocket payments for medical care will be classified into two categories. The first category is for all out-of-pocket payments that were predominantly determined by providers; the second category is those out-of-pocket payments that were largely determined by the insured. Among these two categories, the first one is also defined as hidden cost-sharing, and is the focus of this research. Research result indicates that, within two months, the total sum of this absolute of out-of-pocket payment is 192,287 dollars, and that of the “hidden cost-sharing” is 30,850 dollars. Besides, the more frequent a patient receive medical treatment, and the higher the premium for the accessory risk part in the commercial health insurance; the higher “out-of-pocket payment” one will have to pay; this agrees to the “significant co-relation” in Statistics.（p<0.01） The rate for receiving medical treatment is 32.2%; the average times for hospital-going is 2.68, and the average “out-of-pocket payment” is 951.16 dollars. The average “hidden cost-sharing” for each insured is 29.05 dollars, and the substantial cost-sharing is 83.24 dollars. The “out-of-pocket payment” discussed and analyzed in this research does not include inpatient fee, but only the ambulatory (outpatient) service.
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