價格對老年慢性病患就醫行為之影響

Abstract

人口老化與健康情形衰退是現今許多先進國家面臨到的問題，因為這使得醫療服務的需求增加，也使得各國醫療費用的快速提高。本研究主在探討慢性病病患部分負擔增加前後就醫行為的變化。研究資料來自於健保局申報資料檔，資料分析結果呈現隨著醫學中心與區域醫院的部分負擔費用增加，也使得病患就醫醫院選擇改變，但改變在實務上的意義並不明顯。而病患就醫次數則有顯著的減少，各項醫療費用也有顯著增加。另針對不同年齡群組之個案進行比較，結果呈現醫院層級選擇、就醫頻率、用藥天數、診療費與部分負擔在新制實施前後均有顯著差異。並對部分負擔增加對於老年人的影響進一步討論，以做為政策制訂者之參考。

Aging and declining health are intrinsically related and are resulting in increasing healthcare spending in many countries. Control of healthcare spending and patient usage behavior are linked. This study examines the healthcare usage behavior of chronically ill elderly patients in Taiwan following an increase in co-payments. The differences in usage behavior are interpreted by comparing the frequency of hospital visits and the types of hospitals chosen by patients before and after the implementation of the new co-payment policy. Analysis results indicate that choice of hospital type by the elderly is affected by an increase in co-payment, but that difference of the hospital-type choice before and after the co-payment increase is too small to be practically significant. However, the frequency of visits decreased significantly after the implementation of the new co-payment policy. Medical care costs per visit for individual patients and for the National Health Insurance system both increased significantly. Visit frequency and hospital-type choice, as well as diagnosis and treatment cost and co-payment, all show significant differences among different age groups of the elderly. The effects of co-payment increases are also discussed from the viewpoint of patients and of governmental policy.