總額預算對台灣各層級醫療院所眼科醫療服務的影響

Abstract

目的：台灣於1995年實施全民健保，在2001年1月實施西醫基層總額預算，而在2001年7月實施醫院總額預算制度。我們研究台灣六大分局的各層級醫院及醫療診所的眼科，在實施總額預算前後的醫療服務變化。

方法：使用國家衛生研究院2000至2005年的資料來做敘述性分析。

結果：眼科健保醫師占所有健保西醫醫師的4.22~4.72%。然而，每年的眼科申請點數卻從2001年的3.26%降至2005年的2.7%。平均國人每年看眼科的診次為0.7~0.8次，每一位眼科醫師所要照顧的人口從2000年的22000人下降至2005年的17200人。各層級醫院及醫療院所的眼科，2005年的每月門診申請總額較2000年為低，其他如：每月門診人次、每月住院件數及每月白內障手術的服務量也都下降(東區分局除外)。

結論：各層級醫療院所的眼科，因為總額預算制度之後被壓縮。我們認為，另闢資源是眼科醫師進一步努力的方向

Purpose: Taiwan introduced National Health Insurance (NHI) Program in 1995 and further implemented Global Budgeting for Physician Clinics in 2001 -01 and for hospitals in 2001-07. We evaluate the services changes of Ophthalmology in medical centers (MC), metropolitan hospitals (MH), local community hospitals (LCH) and Physician Clinics (PC) at six different bureaus (Taipei, North Middle, South, Kao-Pin and East) in Taiwan.

Method: Using National Health Insurance Institutes data to perform descriptive analyses from 2000 to 2005.

Results: The ophthalmologists account for 4.22-4.72% of all the physicians; however, the yearly budget dropped continuously from 3.26% to 2.70% from 2001 to 2005. The number of ophthalmologic clinic visit per capita is 0.7-0.8 per year. Each ophthalmologist takes care of 22000 people in 2000, and the number decreased to 17200 people in 2005. The outpatient expenditure pre month was reduced in 2005 compared with that in 2000; so were the outpatient numbers pre month, inpatients per month, and the cataract operations per month at all medical institutions except at the East Bureau.

Conclusion: The ophthalmologic services at various medical institutes become much restricted after the implementation of global budgeting. We suggest the ophthalmologists to find the sources unrestricted by global budgeting.