https://scholars.lib.ntu.edu.tw/handle/123456789/109505
標題: | 全民健保牙科總額預算制度及以資源為基礎相對價值尺度對牙科醫療服務之影響 | 作者: | 薛亞聖 | 關鍵字: | 全民健康保險;總額預算;資源成本相對價值尺度;牙科醫療服務;National health insurance;Dental global budget payment;RBRVS;Dental service | 公開日期: | 31-七月-2000 | 出版社: | 臺北市:國立臺灣大學公共衛生學院醫療機構管理研究所 | 摘要: | 由西方國家實施總額預算經驗及牙醫門診費 用及人次於全民健保開辦後其增加之現象,衛生署 自1998 年7 月1 日起實施牙科總額預算試辦制, 期望總額預算可以使總體支付金額受到控制,而且 透過牙醫師團體協商之理性互動及協商模式可以 發揮團體自律及同儕制約之效果,進而有效抑制醫 療費用之高漲,,為了了解總額預算是否能有效達 到上述目的,評估總額預算前後牙科服務量之改變 是相當重要的。 除了考慮總額預算可以降低牙科服務量外,仍 有其他值得考量之問題尚待解決,首先,在總額預 算下,其給付不再根據全額,而是計算其相對點 數,一般相對點數仍然是根據經常性、經驗性及合 理性(Usual, customary and reasonable,簡稱UCR) 之方法, 而非根據資源成本相對價值尺度 (Resource-Based Relative Value Scale,簡稱RBRVS) 中之複雜度、風險及實際工作時間,其合理性會受 到質疑,因此比較使用UCR 及相對價值尺度所計 算相對點數是相當值得的。而若要使社會每個人其 醫療服務量達到一個最小服務量,則在總額支付 下,其不同年齡層、性別及教育程度可能會有不 同,因此探討全民健保其不同特徵族群總額預算制 度如何影響牙科服務量是相當值得的。另一方面, 在總額預算下,為防止少數人分享太多牙醫師資 源,因此有必要針對全民健保總額實施前後之比較 了解其各診所或醫院在實施前後其總體服務量及 各項服務量改變以提供建立上述上限支付之標 準。最後,在總額預算是否醫療品質會受到影響也 是值得探討的問題。 The experience of global budget system from western countries and uprising dental expenditure and dental visits after the introduction of national health insurance in Taiwan prevail on Department of Health (DOH) to consider implementing dental global budget payment in order to contain dental expenditure via peer discipline and self-control among dentists. It is timely to evaluate whether dental global budget 3 payment system can be effective in achieving this purpose. In addition to this, several issues should be also considered under global budget payment system. Firstly, the rating score of global budget payment system is usually based on usual, customary, and reasonable, UCR) rather than resource-based relative value scale (RBRVS), which takes working time, complexity, effort and skill into account. This may still lead to unreasonable payment from the viewpoint of RBRVS. It is worthwhile to make a comparison between UCR and RBRVS under global budget payment system. Previous studies showed that the impact of dental global budget payment on different subgroups defined by basic demographic characteristics such as age sex, education and occupation may be different. In order to avoid the phenomenon that certain dental clinics still monopolize resource it seems to set up ceiling payment by different geographical areas and level of dental care delivery. Whether global budget payment system has influence on quality of dental care is also worthy of being investigated. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/29727 | 其他識別: | 892416H002029SSS | Rights: | 國立臺灣大學公共衛生學院醫療機構管理研究所 |
顯示於: | 健康政策與管理研究所 |
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892416H002029SSS.pdf | 41.17 kB | Adobe PDF | 檢視/開啟 |
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