| 摘要: | 本研究計畫之產生動機，在於對全民健保制度下，民眾自付之醫療費用所佔比率及成長的關切。這些民眾自付醫療費用之多寡及其成長，就全民健保制度來看，以及對中央健保局而言，是非常重要的資訊，其理由有三個。第一個理由，作為唯一公營的全民健保制度，以及執行此制度的中央健保局，所應關心的醫療費用，除了全民健保的醫療總支出外，也應關切全國的醫療總支出。第二個理由則是為了評估總額預算支付制度實施的成果和影響。如未對保險對象自付醫療費用成長加以監督管制，則雖然全民健保的醫療支出得以有效節制，但卻讓民眾自付醫療費用快速成長。這樣的結果，可能導致整個全民健保制度存續的危機。第三個理由，是在全民健保制度下，若任憑民眾自付醫療費用成長，將會逐漸促使民眾批判全民健保制度存在的合理性，進而懷疑其與合法性。本研究計畫之目的有三個：第一個目的為評估全民健保制度下，民眾自付的醫療費用之金額，以及該金額相對於全民健保的醫療支出的大小。第二個目的為評估民眾自付醫療費用中屬於「隱性部分負擔」的總金額，以及該金額相對於全民健保的醫療支出的大小。第三個目的為建立未來中央健保局瞭解民眾自付醫療費用的例行調查方法。本研究計畫所採用的方法有兩個：第一個方法：家戶訪問調查及每日記錄本研究將以系統隨機抽樣法，以戶為單位，在中央健保局中區分局轄區的四個縣市(台中市、台中縣、彰化縣及南投縣)居民中抽取600戶，對全戶人口作家戶訪問調查，並輔以30天期間的每日記錄，來收集受訪對象的自付醫療費用。第二個方法：行政檔案分析為了確保就醫資料及民眾就醫時的自付費用之正確，本研究將就中央健保局中區分局的保險對象就醫檔案來和上述家戶訪問調查的資料比對勾稽。根據上述收集所得資料，本研究將民眾自付醫療費用粗略的區分為二類：(1)主要由醫療供給者所決定的醫療服務之相關費用；及(2)主要由民眾自願選擇並決定的醫療服務之相關費用。其中第一類為本研究的重點，並將其定義為「隱性部分負擔」。藉著本研究，一方面瞭解隱性部分負擔的變動，同時也協助中央健保局建立未來例行收集與分析隱性部分負擔資料的機制與方法。
The motivation for this research project is the concern about how out-of-pocket payment for medical care is growing under Taiwan？H？Hs National Health Insurance system. Such concern is important for both the system and the Bureau of National Health Insurance (BNHI) for 3 reasons. First, as a single public health insurance system, BNHI being the agency overseeing this system, it should care about not only the system？H？Hs medical expenditure, but also how the national health expenditure grows. The second reason is to evaluate the newly implemented Global Budget system and its impact. If the Global Budget system successfully controls the growth of NHI？H？Hs medical expenditure at the expense of growing of out-of-pocket payment for medical care, such success may jeopardize the survival of the NHI system. Finally, under a national health insurance system, if the system allows unrestraint growth of out-of-pocket payment, such growth could lead to legitimacy crisis for the NHI system. The purposes of this project are threefold. First is to evaluate the absolute and relative sizes of out-of-pocket payment under Taiwan？H？Hs NHI system. The second purpose is to assess the absolute and relative sizes of hidden cost-sharing in Taiwan？H？Hs NHI system. The third purpose is to help BNHI to establish the mechanism and method for routine collection and analysis of out-of-pocket payment in the future. To achieve those purposes, this project applies two methods of research. The first 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 600 households will be drawn and 1,700 individuals will be interviewed and supplemented with diary record. The second method is to use administrative record analysis, which is to match our sample subjects with BNHI？H？Hs claim data to analyze and ascertain their out-of-pocket payment. 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 project. Through this project, it will help BNHI to understand the growth of hidden cost-sharing, and the mechanism for its collection and analysis in the future. |
