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研究生:黃其穎
研究生(外文):Huang, Chi-Ying
論文名稱:台灣全民健保制度下自費人工水晶體之利用
論文名稱(外文):Out-of-pocket Intraocular Lens Utilisation Under National Health Insurance in Taiwan
指導教授:蒲正筠蒲正筠引用關係
指導教授(外文):Pu, Christy
口試日期:2023-07-18
學位類別:碩士
校院名稱:國立陽明交通大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2023
畢業學年度:111
語文別:英文
論文頁數:51
中文關鍵詞:自費醫療醫材人工水晶體白內障手術
外文關鍵詞:Out-of-pocketMedical devicesIntraocular lensCataract surgery
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背景
人工水晶體在台灣的健保差額給付醫材中是使用量最多的品項,為了保護有可能的價格不平等,健保局公布了一項針對差額給付醫材的費用收費上限。然各醫療院所內針對使用自費醫材的政策不盡相同。政策應考量自費醫材的使用是否會對民眾的經濟造成負擔。另外,自費醫材的使用也可能會影響到醫療保健體系的公平性。政府需要監督和管理自費醫材的使用,確保民眾及醫療保健體系的權益和福祉,因此政策上應分析病患和醫療院所特性與選擇不同價格之人工水晶體之關聯。

目的
分析使用不同種類人工水晶體的患者及醫療院所特性。

方法
本研究使用2016年至2020年衛生福利部資料科學中心之全民健康保險資料檔,針對人工水晶體處方的病人及醫院特性分析。將人工水晶體分為全額給付及四個部分給付組別,分別使用邏輯斯迴歸及邊際效應描述使用特性。

結果
本研究結果發現五年來的人工水晶體使用量持續增加,特別是在自費人工水晶體。三個主要發現為:1) 年輕病人使用較多部分給付人工水晶體,尤其是多功能又自費較高的類型、2) 使用部分給付的病人有較多為收入高的病人、3) 診所的部分給付人工水晶體處方比其他層級或權屬別的醫療院所都要多。

結論
自費人工水晶體持續增加的使用量可能代表台灣醫療自費市場的成長,經濟上可以負擔的病人比較會選擇使用自費人工水晶體。診所與醫學中心對於人工水晶體的處方差異可能是因為兩者的報酬方式不同。政策制定時需要考量到不同醫療機構的處方及病患特性的差異。
Background
The artificial intraocular lens (IOL) is one of the most implemented balance-billing items under the National Health Insurance (NHI) in Taiwan. A restriction on the prices of IOLs is set to protect potentially inequitable pricing. However, the management policies for providing an out-of-pocket (OOP) healthcare service differ between institutions. The financial burden brought by utilising OOP medical items should be considered in policymaking. Additionally, medical OOP item utilisation may also influence equity in the healthcare system. Government should supervise and manage the utilisation of OOP medical items to ensure the rights and welfare of the public within the healthcare system. Therefore, we should analyse the relationship between patient and healthcare institution characteristics in adopting IOLs with different prices.

Objectives
This study aimed to analyse patient and hospital characteristics of intraocular lens prescription in Taiwan.

Methods
Examining the NHI claims data from 2016 to 2020, intraocular lens prescriptions and the associated patients and hospital characteristics were analysed. Dividing IOLs into fully-reimbursed, and four groups of OOP-covered IOLs, we applied logistic regression and marginal effects to compare the differences.

Results
We found an increasing adoption of IOLs in the five years, especially for OOP IOLs. There are three main findings: 1) patients with younger age adopted more partially-covered IOLs than older patients, especially IOLs which have more function and are more expensive. 2) patients with higher income adopted more partially-covered IOLs with more functions. 3) there are more prescriptions of partially-covered IOLs at clinics than at healthcare institutions in other accreditation levels or ownerships.
Conclusion
The increasing adoption of IOLs with more functions may be a sign of enlarging OOP markets in Taiwan. Patients adopted OOP IOLs because they are financially affordable. Differences in prescribing observed between clinics and medical centers may contribute to differences in physician incentives. Considering the institutional differences and patient traits in IOL prescription is important for policymaking.
誌謝 i
中文摘要 ii
Abstract iii
List of Tables v
List of Figures v
1.Introduction 1
1.1 Background 1
1.2 Cataract surgery and intraocular lenses 2
1.3 Types of intraocular lens 2
1.4 Price difference of IOLs 4
2. Literature Review 5
2.1 Factors influencing the choice OOP healthcare services. 5
2.2 Different management strategies for adopting OOP products. 6
2.3 OOP healthcare costs and the consequent financial burden. 7
3. Objectives 9
4. Methods 10
4.1 Data and study samples 10
4.2 Study variables 11
4.3 Analytical methods 14
5. Results 16
6.Discussion 33
6.1 Recommendations 37
6.2 Research limitations 38
6.3 Conclusion 40
7. References 41
8. Appendices 45
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