西醫基層分科總額對點值提升效果的評估

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题名:	西醫基層分科總額對點值提升效果的評估 The Impact of the Departmental Clinics Global Budget Program on the Payment Point Value
作者:	蔡佳蓉;Chia-Jung Tsai
贡献者:	公共衛生學院環境醫學研究所碩士班
关键词:	基層總額分科管理計畫;總額預算;差異中取差異法;介入時間數列分析;Departmental Clinics Global Budget Program;Global Budgeting;Difference-in-Differences;Intervention Time Series Analysis
日期:	2010
上传时间:	2010-09-29 12:03:15 (UTC+8)
摘要:	目的本研究主要探討中區健保局實施「西醫基層總額分科管理計畫」對於中區點值的影響，並與其他未實施此政策的健保五個分局作比較，藉以評估此政策對醫基層總額點值提升的成效及對民眾醫療利用的影響。方法資料來源為健保局自2001年第三季至2009年第二季健保六區分局所發佈之西醫基層總額各季點值及全民健保資料庫，本研究使用差異中取差異法(Difference- in-Differences Method) 與介入時間數列模型(Intervention Time Series Analysis)來檢視西醫基層總額分科政策對西醫基層總額點值及醫療服務量的影響力。結果本研究實證結果顯示，各區健保分局在總額分科管理政策介入後的點值均較政策介入前來的高。在差異中取差異迴歸模型中，政策介入與中區分局交乘項之估計係數值未達顯著水準，再以介入時間數列分析結果顯示，總額分科管理政策介入後中區的點值仍呈現顯著下降的情形，以上兩項實證資料無法支持分科總額管理政策對提升點值的實質效果。另外，在醫療醫療服務量方面，政策介入後中區總醫療費用呈現顯著上升，但在開藥日數、藥費、部分負擔費用皆無顯著影響，推估是就醫人次上升導致。 Objective This study evaluated the impact of implementing the Departmental Clinics Global Budget (DCGB) on the Payment Point Value (PV) and the health care uses among the insured population affiliated with the Taichung branch of the Bureau of the National Health Insurance (BNHI). Methods The quarterly based RBRVS data in six sub-branches of the BNHI were obtained from Department of Health in Taiwan.We used the difference-in-differences regression model and intervention time Series analyses to evaluate the PV and medical service impact of the DCGB policy. The Resource-Based Relative Value Scale (RBRVS) in this area was compard with that of other five areas, in which the DCGB has not been enacted. Results Our empirical results showed that the RBRVS in all sub-branches of the BNHI were increased after the implementation of DCGB policy. The estimates of the difference-in-differences regression model did not support effectiveness of the DCGB policy to increase PV in the Taichung branch of BNHI. Moreover, the results of intervention time series analysis indicated that the PV decreased over time after RBRVS. Additionally, medical services increased in the Taichung branch after the implement ation of DCGB policy. However, there were no statistical differences in prescription days, drugs cost, and patient partial expenses.
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