| Abstract: | 全民健保實施後，高科技醫療被視為是造成醫療費用上漲的重要因素，在歐、美各國也都有相同的問題，健保局為解決此問題，近年來不斷推行一系列政策方案，例如：總額支付制度、自主管理、卓越計畫與點值穩定方案等，想藉由政策的介入來降低高科技醫療儀器之利用率。過去有關高科技醫療儀器利用之研究，主要多以單一地區或單一醫院為研究分析之對象，因此本研究利用1997 年至2005年之全國健保資料庫進行分析，以衛生署所定義之五項高科技醫療檢查儀器(電腦斷層攝影掃描儀(CT)、核磁共振斷層掃描儀(MRI)、放射線同位素檢查設備(RT)、心導管檢查設備與周邊血管檢查設備)為對象，深入探討自主管理相關政策(包含自主管理、卓越計畫與點值穩定方案)實施前後高科技醫療檢查儀器使用之變化情形。
本研究分析1997 年至2005 年間申報的健保資料，以全國醫院及有使用五項高科技醫療檢查儀器設備之民眾為研究對象，分析九年間台灣地區高科技醫療檢查儀器利用情形，並分別分析17 個醫療區、健保六區、不同醫院層級及屬性、不同疾病型態、不同儀器密集度等方面，五種高科技醫療檢查儀器於自主管理相關政策實施前後，其利用次數之變化情形。另外，以全國24 家醫學中心之門急診民眾為對象，由複迴歸分析(Multiple Regression Analysis)找出影響門急診電腦斷層攝影掃描儀(CT)與核磁共振斷層掃描儀(MRI)兩項高科技醫療檢查儀器利用之影響因素，以供衛生主管機關推行衛生政策參考之依據。
After the implementation of National Health Insurance (NHI), high-tech medical instruments are regarded as the major factor for the rise of health care cost. The same problem happens in Europe and America. In order to solve this problem, Bureau of National Health Insurance (BNHI) consistently implemented related policies, such as global budget system, self-management hospital budget, excellent hospitals project, and stable reimbursement project to decrease the utilization rate of high-tech medical instruments. Previous studies mainly investigated one certain area or one hospital. This study will analyze the national dataset of utilization of high-tech diagnosis medical instruments from 1997 to 2005, including 5 high-tech medical instruments, defined by Department of Health, such as computerized tomography (CT), magnetic resonance imaging (MRI), radioisotope diagnosis (RT), cardiac catheterization, and perivasculary. This study will investigate the changes of utilization of high-tech medical instruments after the implementation of hospital-based budget (including self-management hospital budget, excellent hospitals project, and stable reimbursement project).
The nationwide hospitals and the patients who have used these five high-tech diagnosis medical instruments will be the studied samples. This study will use nationwide claimed data obtained from BNHI from 1997 to 2005 to examine the utilization of high-tech medical instruments. Furthermore, this study will examine the utilization changes of five high-tech diagnosis medical instruments after the implementation of hospital-based budget in terms of 17 medical regions, 6 branch offices of BNHI, different hospital levels, different ownerships, type of diseases, and the areas with different ratio of high-tech medical instruments to population. Additionally, the multiple regression analysis will be used to find out the associated factors affecting the utilization of CT and MRI on outpatient and emergency care from 24 medical centers to provide public health offices with references for future health policy. |
