薛亞聖臺灣大學：醫療機構管理研究所陳厚任Chen, Hou-JenHou-JenChen2007-11-282018-06-292007-11-282018-06-292004http://ntur.lib.ntu.edu.tw//handle/246246/60056　我國自民國88年8月1日起，實施藥品部分負擔政策，用以抑制不斷 增加之門診費用及藥品利用，本研究目的則在於探討藥品部分負擔政 策之效應；資料來源為民國87年、88年、89年與90年「健保資料庫」 資料及民國88年之「財稅資料核定檔」資料，並運用差異中之差異的 統計方法進行分析。 　研究中以癲癇病人為對象，分析政策實施前後癲癇病人於短期（實 施後一年）與長期上（實施後二年），醫療利用與健康狀況的改變； 並藉此探討健保資料庫中「特定治療項目代號」欄位之正確性。 本研究主要研究結果如下： ㄧ、政策實施後，對癲癇病人醫療利用之影響： 　1. 藥品費用：在總藥品費用與抗癲癇藥品費用上，於長短期均無 　　　　　　　 顯著改變。 　2. 給藥天數：在總藥品天數與抗癲癇藥品天數上，於長短期均有 　　　　　　　 顯著減少。 　3. 門診次數：在總門診次數與癲癇門診次數方面，於長短期均有 　　　　　　　 顯著減少。 二、以住院與急診為指標，政策實施後對癲癇病人健康狀況之影響： 　1. 住院天數：在總住院天數方面，於長短期均無顯著改變；在癲 　　　　　　　癇住院天數方面，於長短期均有顯著減少趨勢。 　2. 急診次數：在總急診次數與癲癇急診次數方面，於長短期均無 　　　　　　　顯著改變。 三、在以癲癇病人為研究對象下，發現健保資料庫中「特定治療項目 　　代號」欄位缺漏甚多；且該欄位有無資料者在多項醫療利用上， 　　均有顯著之差異。 綜上所述，本研究建議如下： ㄧ、藥品部分負擔政策宜繼續實施。 二、政府應提高醫師開立慢性病連續處方箋之誘因，且鼓勵病人和醫　　師討論是否適合持慢性病連續處方箋領藥；以減輕真正有就醫需 　　求之慢性病人的負擔。 三、健保局應對該欄位存在之必要性進行評估，以避免造成後續研究 　　者之困擾。Bureau of National Health Insurance (NHI) implemented drug copayment policy on August 1, 1999. This new policy was designed to reduce the growth of ambulatory care expenditure and prescription utilization. This study aimed to evaluate the impact of drug copayment policy, and it used NHI claim data from 1998 to 2001 and tax report information with difference-in-difference methodology to analyze. This study observed epilepsy patients’ medical utilization and health status for both short-term (i.e., one year after the policy) and long-term (i.e., two year after the policy) periods. Besides, it evaluated correction of “cure item” column in the NHI claim data by analyzing epilepsy patients. The main findings were concluded as below: 1.The impacts of epilepsy patients’ medical utilization and expenditure: (1) Prescription expenditure: There were no significant effects on total prescription expenditure and antiepileptics expenditure for both short- term and long-term periods. (2) Prescription days: There was a significant decrease on total prescription days and antiepileptics days for both short-term and long- term periods. (3) Ambulatory care visits: There was a significant decrease on total ambulatory care visits and epilepsy-related ambulatory care visits for both short-term and long-term periods. 2.Using length of stay and emergency care visits as health status indicator, the impact of epilepsy patients' health status: (1) Length of stay: There was no significant effect on total length of stay for both short-term and long-term periods, and there was a significant decrease on epilepsy- related length of stay. (2) Emergency care visits: There was no significant effect on total emergency care visits and epilepsy-related emergency care visits for both short-term and long-term periods. 3.By analyzing epilepsy patients’ medical utilization and expenditure, this study found there were lots of data missing in “cure item” column in NHI claim data. Besides, there were lots of significant differences from medical utilization and expenditure between patients who had records in the column and those who did not have records. Based on above findings, this study suggests: 1.It is appropriate to maintain the current drug copayment policy. 2.In order to release the financial burden for those chronic patients who really need medical cares,govern- ment should motivate doctors to prescribe more longer duration of medicine for chronic diseases as incentive. Meanwhile, government should encourage chronic patients to discuss with doctors to know whether they should take longer duration of medicine for chronic diseases or not. 3.In order to avoid more researchers will have been confused by NHI claim data in the future, Bureau of NHI should evaluate the existence of “cure item” column.摘要 i Abstract ii 目錄 iv 第一章　緒論 1 　第一節　研究背景 1 　 第二節　研究動機 3 　 第三節　研究目的 7 第二章　文獻探討 8 　 第一節　部分負擔政策之介紹 8 　 第二節　我國門診部分負擔政策之介紹 15 　 第三節　部分負擔政策對醫療利用的影響 20 　 第四節　部分負擔政策對健康的影響 26 　 第五節　癲癇之概述 28 第三章　研究方法 34 　 第一節　研究設計 34 　 第二節　研究假說 37 　 第三節　統計分析 38 　 第四節　研究材料 44 　 第五節　研究限制 47 第四章　研究結果 48 　 第一節　人口學特性分析 48 　 第二節　醫療利用分析 53 　 第三節　多變項分析 65 　 第四節　特定治療項目代號欄位正確性分析 70 　 第五節　研究結果小結 74 第五章　討論 76 　 第一節　醫療利用之變化 76 　 第二節　健康狀況與相關議題之探討 82 　 第三節　研究方法之探討 84 　 第四節　特定治療項目代號欄位之正確性 88 第六章　結論與建議 89 　第一節　結論 89 　第二節　建議 91 參考文獻 94 　 英文部分 94 　 中文部分 98 附件一　抗癲癇藥物品名及其相對應之代號 101 附件二　特定治療項目代號對照表 103610087 bytesapplication/pdfen-US特定治療項目代號抗癲癇藥物醫療費用醫療利用癲癇健康狀況健康保險必要性藥品部分負擔健保資料庫差異中之差異CopaymentNHI claim dataMedical UtilizationDifference-in-differenceEssential drugsHealth statusAntiepilepticsMedical ExpenditureEpilepsyCure itemHealth insurancethesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/60056/1/ntu-93-R91843006-1.pdf