2010-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646862摘要：全民健保總額預算制度至2002 年全面實施後，對醫療服務提供者應有直接的影響，間接的也會影響病人的就醫可近性及醫療照護結果。本研究希望多元角度評估總額預算制度對醫療體系的影響，並將從醫療服務提供者及保險對象的角度評估。第一年的計畫將以全民健保1997 至2007 之100 萬人抽樣歸人檔及門診申報總表，以GEE 分析總額對基層診所申報之點數與點值的影響。其次，也將利用2000 至2007 的醫療院所現況檔、醫院服務量檔，探討地區醫院停/歇業之情形。為瞭解停/歇業地區醫院的地理分佈情形，呈現視覺化的結果，將嘗試以空間分析中的Anselin’s Local Moran’s I (LISA)描述停/歇醫院是否有空間群聚的現象。第三，為探討醫院總額預算制度實施後對醫院停/歇業可能造成的影響，本研究將以不同的區域劃分，進行時間序列資料分析。第二年的計畫以保險對象為主，將先以2001 及2005 年國民健康訪問調查資料，分析民眾自覺就醫可近性的變化。其次將以臺灣地區居民死亡資料檔分析「可避免死亡」的變化，第三將以健保1997 至2007 之100 萬人抽樣歸人檔分析「可避免住院」變化情形。透過二年廣泛的評估，本計畫預期結果為瞭解該制度在控制醫療費用成長時，是否對供給者與保險對象造成不良的影響，進而尋找可能的政策改善策略。<br> Abstract: After the full implementation in 2002, the global budget payment system (GBPS)of the national health insurance (NHI) would have direct effects on the health caresystem. It can also have indirect effects on the accessibility and care outcome of theinsured. The purposes of this study are to evaluate the effects of GBPS on healthcare system from plural perspectives. Specifically, it will be conducted from theperspective of health care providers and the insured.In the first year, we will use the GEE to analyze the one-million sample claimsfile of 1997-2007 to evaluate the impact of GBPS on the point value of primaryclinics. Second, we will use the hospital status report file of 2000-2007 to evaluatethe closure of district hospitals. To show the extent of spatial clustering, we will useAnselin’s Local Moran’s I (LISA) to generate spatial figures. Third, we will use thetime series analysis to evaluate the same data to identify related factors of hospitalclosure.In the second year, we will use the National Health Interview Survey of2001-2005 to analyze self-reported accessibility. Second, we will use the deathregistry to analyze avoidable death over time. And the third, we will use the100-million claims data of 1997-2007 analyze the change of avoidablehospitalizations.With the comprehensive evaluation, this study is expected to find out whether theGBPS caused negative effects to the providers and insured while containing theexpenditure. We also hope that possible strategies of improvement can be identified.