https://scholars.lib.ntu.edu.tw/handle/123456789/109495
Title: | 探討台灣風險計價模式之選擇與效率誘因及其最適化之分析 | Authors: | 張睿詒 | Keywords: | 健康保險;風險校正;風險分攤;風險選擇;health insurance;risk adjustment;risk sharing;risk selection | Issue Date: | 31-Jul-2003 | Publisher: | 臺北市:國立臺灣大學公共衛生學院醫療機構管理研究所 | Abstract: | 本研究評估多元保險機制下不同風 險分攤機制之實施,在平準基金與保險人 分別採不同風險計價模式下,對保險人選 擇誘因抑制與效率誘因維持情形,藉以分 析適當之風險分攤模式。 研究資料為中央健康保險局保險對 象2%隨機抽樣共371,620 人之1996 年及 1997 年相關檔案。平準基金採用之風險計 價模式為人口統計模式與診斷基礎模 式,保險人則採先前利用模式、診斷基礎 模式與全部資訊模式;風險分攤模式分別 為1996 年醫療費用前1%至5%的高風險 者風險分攤、1997 年醫療費用前1%至5% 的高費用者風險分攤、1997 年醫療費用 60,000 元至100,000 元為分攤臨界值之極 端值風險分攤,以及1997 年醫療費用30% 至70%的比例式風險分攤;此外,選擇誘 因衡量指標為平均預測絕對值與不利風 險期望損失,而效率誘因衡量指標為保險 對象以風險分攤支付比率與保險人所能 保有之獲利比率。 研究結果顯示四種風險分攤模式 中,若以維持效率誘因為重點,高風險者 風險分攤為較合適模式;若抑制保險人選 擇誘因為重點則以高費用者風險分攤效 果較佳;但若在兩者兼顧下可能採高比率 之高風險者風險分攤或低比率之高費用 者風險分攤較為適當。 This study intends to evaluate the impacts of various risk sharing forms on the selection and efficiency incentives of health plans in a competitive health insurance market. Different risk-adjusted models employed by the equalization fund and health plans are to be analyzed to understand the robustness of these risk share forms. A total of 371,620 beneficiaries, eligible for the National Health Insurance (NHI) from January 1, 1996 to January 1, 1997 were randomly selected from the enrollment file of NHI. The risk-adjusted models employed by the equalization fund were the demographic and diagnostic-based models. On the other hand, health plans employed the prior utilization, diagnostic-based, and all information models. Risk sharing forms analyzed were 1% to 5% high-risk sharing, 1% to 5% high-cost sharing, 60,000 NT$ to 100,000NT$ excess loss, 2 and 30% to 70% partial capitation. The measures of the selection incentive were mean absolute predicted result and unfavorable expected loss. The measures of the efficiency incentive were the proportion shared expenditures by a risk sharing mechanism and insurer portion of the efficiency gain. The results showed that among four risk sharing forms high-risk sharing could provide better efficiency incentive than the others. On the other hand, high-cost sharing could contain selection incentive better than the others. In order to maintain both the incentives, large percentage of high-risk sharing and small percentage of high-cost sharing would be appropriate choices. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/5028 | Other Identifiers: | 912416H002038 | Rights: | 國立臺灣大學公共衛生學院醫療機構管理研究所 |
Appears in Collections: | 健康政策與管理研究所 |
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912416H002038.pdf | 152.31 kB | Adobe PDF | View/Open |
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