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研究生:呂欣潔
研究生(外文):Hsin-Chieh Lu
論文名稱:總額預算支付制度下區域分配之公平性及其最佳預算分配模式
論文名稱(外文):The Fairness of Regional Budget Allocation in National Health Insurance and Optimal Risk Adjustment Model
指導教授:許碩芬許碩芬引用關係
指導教授(外文):Shou-Fen Hsu
學位類別:碩士
校院名稱:國立高雄第一科技大學
系所名稱:風險管理與保險所
學門:商業及管理學門
學類:風險管理學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:77
中文關鍵詞:總額預算區域分配醫療費用風險校正全民健保
外文關鍵詞:National Health InsuranceRisk AdjustmentGlobal BudgetingMedical ExpenditureHealth Resource Allocation.
相關次數:
  • 被引用被引用:6
  • 點閱點閱:286
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:5
總額預算支付制度為全民健康保險法明定應實施的制度,該制度透過前瞻性的協定分配預算,達到控制醫療費用上漲與平衡醫療資源分布的目的。目前全民健保總額預算制度已在牙醫(民國87年7月)與中醫(民國89年7月)門診部門分別實施,而西醫部分之總額預算支付制度則由衛生署就西醫基層與醫院兩部分邀請醫事團體代表分別規劃研議,基層診所與醫院部門預計分別於民國90年7月與91年1月實施。本研究主要探討西醫基層總額預算制度下,健保各分局資源合理分配的最佳模式,及其相關風險校正因子的適當性。
本文以全民健保各分局各月西醫門診總醫療費用為分析單位,依人口統計因子、疾病診斷資料、先前利用資料、區域醫療資源及自我評量五大分類,選取影響醫療費用之變數,建立不同的風險校正模型加以比較,以尋求能真實反映各區醫療費用的最佳預算分配模式。具體而言,本研究主要目的為:
1.建構區域群體風險校正模型,探討西醫基層總額預算支付制度下區域資源分配之公平性。
2.探討西醫基層總額預算制度所採取風險校正因子之適當性。
3.探討西醫基層總額預算制度下最佳預算分配模式。
4.探討目前西醫基層總額預算制度各分局預算分配是否合理。
Global budgeting is the statutory payment system of National Health Insurance Act in Taiwan. The payment system is prospective to control medical expenditure to some extent and improve the health resource allocation. In Taiwan, global budget has been applied on dental service and Chinese ambulatory care. Continuously the primary care clinics (HCC) and the Hospitals will be applied soon.
This study uses medical care data of Bureau of National Health Insurance (BNHI) in Taiwan from July 1999 to June 2000. We choose several risk-adjusters that are determinants of the growth of medical expenditure to construct different regional risk adjustment model. The risk-adjusters are classify by demographics, diagnose, prior year expenditures, health resource and self-reported health. According to those describe above, we look into optimal risk adjustment model for budget allocation.
The purposes of this study are as follows:
1.To construct regional risk adjustment model that improve the fairness of regional medical expenditure allocation for global budgeting in National Health Insurance.
2.To look into optimal risk adjustment model for budget allocation.
3.According to optimal risk adjustment model to estimate the expected medical expenditures of BNHI.
目錄
中文摘要I
英文摘要II
誌謝III
目錄IV
表目錄VI
圖目錄VII
壹、緒論1
一、研究背景與動機1
二、研究目的2
三、研究方法與進行步驟3
貳、文獻回顧5
一、有關總額預算支付制度之文獻5
(一)、總額預算支付制度5
(二)、各國總額預算支付制度11
(三)、全民健保西醫基層總額預算制度14
二、有關風險校正之文獻20
(一)、總體醫療費用的風險校正因子及其相關文獻21
(二)、標準死亡比之探討24
三、迴歸模式之探討27
(一)、不同資料層級之迴歸模式27
(二)、模式之適當性探討28
(三)、使用不同資料層級對於我國總額預算分配估計的影響29
參、實證模型建構31
一、變數選取探討31
(一)、人口統計因子31
(二)、疾病診斷資料34
(三)、先前利用資料34
(四)、區域醫療資源35
(五)、自我健康評量36
二、選取變數的資料來源與計算方式38
(一)、資料來源38
(二)、計算方式38
三、統計模型建構43
肆、實證結果分析44
一、研究範圍44
二、描述性統計分析44
(一)、醫療服務使用45
(二)、人口結構49
(三)、平均投保金額52
(四)、每人西醫診所數52
(五)、標準死亡比54
三、最佳預算分配模式分析55
(一)、模式一55
(二)、模式二59
四、西醫基層總額預算支付制度與本文預算分配模式之比較65
伍、結論與建議68
一、結論與建議68
二、後續研究之建議69
陸、參考文獻71
一、英文部分71
二、中文部分76

表目錄
表 2-1 各年度醫療支出情形15
表 2-2 西醫基層總額預算制度之協商及非協商因素19
表 2-3 西醫基層總額預算支付制度各部門之支付模式20
表 2-4 相關文獻預測總體或個人醫療費用所使用之風險校正因子26
表 3-1 各年齡別每人年之平均費用33
表 3-2 老年及幼年重大疾病人口佔全部重大疾病人口數之比例35
表 3-3 本文及西醫基層總額預算支付制度所選取之變數37
表 3-4 本文選取變數之詳細資料來源及資料期間。39
表 4-1 各分局醫療費用之月平均值、標準差及變異係數45
表 4-2 各月份之各分局平均醫療費用46
表 4-3 各分局總醫療費用之差異檢定47
表 4-4 各分局跨區費用之月平均值、標準差及變異係數47
表 4-5 各分局跨區比例之月平均值、標準差及變異係數48
表 4-6 各分局每人西醫診所數之月平均值、標準差及變異係數53
表 4-7 各分局標準死亡比之月平均值、標準差及變異係數54
表 4-8 各月標準死亡比之區平均值、標準差及變異係數54
表 4-9 模式一及模式二所選取之變數56
表 4-10 模式一之誤差常態性檢定結果58
表 4-11 模式一取半對數標準化之迴歸結果59
表 4-12 模式二之誤差常態性檢定結果61
表 4-13 模式二取半對數標準化之迴歸結果62
表 4-14 本文及西醫基層總額預估各分局之預算及其比例67








圖目錄
圖 1-1 研究步驟與架構4
圖 2-1 風險校正模型的由來21
圖 4-1 各分局月平均醫療費用45
圖 4-2 各分局月平均跨區醫療費用48
圖 4-3 各分局月平均跨區費用佔總費用之比例49
圖 4-4 各分局月平均投保人口數50
圖 4-5 各分局月平均投保人口數佔全國投保人口數之比例50
圖 4-6 各分局月平均老年人口數及幼年人口數51
圖 4-7 各分局月平均幼年人口數佔投保人口數之比例51
圖 4-8 各分局月平均老年人口數佔投保人口數之比例52
圖 4-9 各分局各月平均投保金額53
圖 4-10 各分局月平均每人西醫診所數53
圖 4-11 模式一原始之殘差圖57
圖 4-12 模式一全對數之殘差圖57
圖 4-13 模式一半對數之殘差圖57
圖 4-14 模式一原始之殘差常態機率圖57
圖 4-15 模式一全對數之殘差常態機率圖57
圖 4-16 模式一半對數之殘差常態機率圖57
圖 4-17 模式一取半對數標準化58
圖 4-18 模式一取半對數標準化之殘差常態機率圖58
圖 4-19 模式二原始之殘差圖60
圖 4-20 模式二全半對數之殘差圖60
圖 4-21 模式二半對數之殘差圖60
圖 4-22 模式二原始之殘差常態機率圖60
圖 4-23 模式二全對數之殘差常態機率圖60
圖 4-24 模式二半對數之殘差常態機率圖60
圖 4-25 模式二取半對數標準化之殘差圖61
圖 4-26 模式一取半對數標準化之殘差常態機率圖61
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