臺灣博碩士論文加值系統

醫療體制改革重點在於提昇醫療體系效率、品質改善及反應保險對象需求，醫療照護提供方面以市場競爭為原則，財務上大多用採論人計酬支付方式。競爭的健康保險市場若未能善加規模，很容易導致保險對象就醫權益受損的結果。於是先進國家採用風險校正策略，以解決兼顧醫療照護之公平與效率的難題。
本研究以某地區整總醫療費用為分析單位，資料係採89年至91年三年完整的次級資料，依人口因子、先前利用因子、重大傷病等影響醫療費用之變數，建立不同的風險校正計價模式加以比較，以尋求能真實反映該地區醫療費用的最佳預算分配模式。
研究結果顯示，風險計價模式之預測力以僅採用人口因子之模式一預測力嚴重偏低，R2為5.69%、Adj-R2為5.65%。再納入重大傷病因子後之模式預測力有明顯的增加，R2為11.71%、Adj-R2為11.67%。再加入先前利用因子後有較高的預測力，加入一年先前利用因子與二年先前利用因子間的預測力相近，其預測值R2為43.14%、45.57%、Adj-R2為43.11%、45.54%。

The major objectives of health policy reform include efficiency, equity, quality improvement and need of insurer’s health services . For those goal ,the capitation payment is used .
The result of insurer’s privilege may be victimized if the competitive health insurance market has not any norm, So some nations have already introduced risk adjustment to their health care reform, because risk adjustment may achieve both goal of equity and efficiency .
This study is using 3 years medical expenditure of a isolated area as analysis unit, data duration from 2000 to 2003. the purpose of study intends to develop a risk-adjusted capitation rates using demographic 、catastrophic factor and prior utilization factors.
The results show the model with only age and gender factor has R2 5.69%、Adj-R2 5.65%. On the other hand, the model accommodating catastrophic factor has R2 11.71%、Adj-R2 11.67%，the model accommodating 1~2 year prior utilization has R2 43.14%、45.57%、Adj-R243.11%、45.54%。

目錄
中文摘要………………………………………………………………..i
英文摘要……………………………………………………………….ii
目錄………………………………………………………………………I
圖目錄………………………………………………………………..III
表目錄………………………………………………………………...IV
第一章 緒論
第一節 研究動機…………………………………………………….1
第二節 研究目的…………………………………………………….3
第二章 文獻探討
第一節 各國及國內之醫療體制改革趨勢………………………….4
第二節 論人計酬支付制度………………………………………….5
第三節 風險校正模型的探討……………………………………….6
第三章 研究方法
第一節 研究架構……………………………………………………34
第二節 資料來源……………………………………………………35
第三節 資料處理與分析
一、 資料處理程序……………………………………………….36
二、 資料分析…………………………………………………….36
第四節 研究變數
一、 變項說明…………………………………………………….39
二、 變項操作型定義…………………………………………….40
第四章 實證結果與分析
第一節 描述性統計分析....………………………………………41
第二節 模型建立……………..…………………..………………55
第二節 模型預測能力比較………..………………………………57
第五章 結論與建議
第一節 研究結論……………………………………………………66
第二節 研究建議……………………………………………………67

參考文獻………………………………………………………………110
中文部分……………………………………………………………110
英文部分……………………………………………………………110






圖目錄
圖3 風險計價模式研究架構……….……………………………….34

















表目錄
表 4.1 2000年研究樣本人口數-依年齡與性別分…………………68
表 4.2 領有重大傷病卡保險對象人數－按年齡性別分……….…69
表 4.3 保險對象人數－按投保類目分…………………….………70
表 4.4 保險金額－按年齡分……………………………………….71
表 4.5 投保金額統計表-依性別,類目分………………………….72
表 4.6 2000年醫療服務使用情形………………………………….73
表 4.7 2001年醫療服務使用情形………………………………….74
表 4.8 2002年醫療服務使用情形………………………………….75
表 4.9 2000年醫療服務使用情形-依年齡分……………………..76
表 4.10 2001年醫療服務使用情形-依年齡分…………………...78
表 4.11 2002年醫療服務使用情形-依年齡分……………………..80
表 4.12 2000年醫療服務使用情形-依年齡、性別分…………….82
表 4.13 2001年醫療服務使用情形-依年齡、性別分…………...83
表 4.14 2002年醫療服務使用情形-依年齡、性別分…………….84
表 4.15 重大傷病名及代號對照表………………………………..85
表 4.16 2000年重大傷病醫療服務使用情形-依年齡、性別分….89
表 4.17 2001年重大傷病醫療服務使用情形-依年齡、性別分….90
表 4.18 2002年重大傷病醫療服務使用情形-依年齡、性別分….91
表 4.19 2000年重大傷病醫療服務使用情形-依重大傷病別…….92
表 4.20 2001年重大傷病醫療服務使用情形-依依重大傷病別….94
表 4.21 2002年重大傷病醫療服務使用情形-依依重大傷病別….98
表 4.22 2000年年醫療服務使用情形-依投保類目分…………..100
表 4.23 2001年年醫療服務使用情形-依投保類目分…………..101
表 4.24 2002年年醫療服務使用情形-依投保類目分……………102
表 4.25 2000年年醫療服務使用情形-跨區就醫情形……………103
表 4.26 2001年年醫療服務使用情形-跨區就醫情形…………..104
表 4.27 2002年年醫療服務使用情形-跨區就醫情形……………105
表 4.28 跨區域住院使用情形 ………………………………….106
表 4.29 風險計價模式預測力分析………………………………..107
表 4.30 風險計價模式預測力分析………………………………..108
表 4.31 風險計價模式預測比……………………………………..109

[參考文獻]
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3.張睿詒、江東亮、楊志良等：以風險校正模型探討控制全民健康保險醫療費用之研究。行政院衛生署中央健康保險局八十七年度委託研究計畫，1999。
4.蔡偉德等：風險校正-論人計酬的支付制度。行政院衛行署全民健康保險醫療費用協定委員會八十七年度委託研究計劃，1999。
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