25西医医院门住诊总额各季点值.ppt

醫院門診藥費（點值） 藥價調整 健保藥價調查對藥費成長趨勢影響 112,129 109,449 94,542 90,594 84,735 82,935 80,426 72,271 64,002 6,269 6,522 7,814 9,110 12,748 13,330 19,451 20,381 22,899 70,271 78,793 88,239 92,045 97,483 103,924 113,993 129,830 135,028 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 86 87 88 89 90 91 92 93 94 健保藥費 藥價調查影響金額 推估藥費 單位:百萬元 年度 1.資料來源:全民健康保險資料倉儲系統 2.藥價調查影響金額:各年度各品項藥品使用量*(各品項首次收載單價-該年度12.1藥價) 3.推估藥費=健保藥費+藥價調查影響金額 但醫療費用和藥價均隨時間成長，比較醫院總額前後可能會有偏誤 不同醫療項目使用藥的可能性不同，僅比較藥價比例並不合理 改採DID方式估計，但受到藥價調整影響，這個方式會低估供給者使用藥費來保照所得的效果 估計模型 DID model 估計模型 未來研究方向 醫療供給者在面對不確定價格下，是否會增加服務量，即俗稱的「衝量」？ 醫療供給者在面對不確定價格下，是否會降低醫療品質？ 醫療供給者在面對不確定價格下，是否會聯合起來穩定支付價格？ eventually reduce the common resources available to everyone Game theory predicts that in the case of Strong Symmetric Nash Equilibrium (SSNE), physicians of the same type will form coalition and voluntarily restraint the service volume to maximize total profit of the group. The sense of competition made all subjects provided more service and all made less profit. * Local clinics are dropped in part because they are not affected by hospital GB, but also because a substantial of their drug expenditure are reimbursed in lump sum payment (three days NT75), which is likely to inflate the actual drug expenditure. We drop zero co-payment claims to avoid the possible bias. We drop dialysis treatment because they are quite expensive and routine services that are likely to affect the average payment of each hospital. We drop surgeries because their expenditures are quite high which are likely to affect the average payment substantially.. No needs to explain why Chinese medicine or dental services are dropped. * How do hospitals respond to Global Budget? Evidence from Outpatient Prescription Drug Expenditures in Taiwan 連賢明 政大財政 大綱 前言 總額制度介紹 總額制度在台灣 健保資料 估計模型 實證結果 未來可能方向 總額制度（global budget system ） 所謂總額制度是指付費者與醫事服務提供者，尌特定範圍的醫療服務（如牙醫門診、中醫門診，西醫門診或住院服務）等，預先以協商方式，訂定未來一段期間（通常為1年）內健康保險醫療服務總支出（預算總額），藉以控制醫療費用於預算範圍內的一種制度。 總額制度介紹 支