總額支付制度對中醫醫療市場競爭之影響

文羽苹
長庚大學
總額支付制度對中醫醫療市場競爭之影響總額支付制度主要的經濟誘因在於限制費用的總額，從而導致醫療行為的變化：就正面效果而言，總額預算可能減少醫療資源的浪費，提高醫療品質。但是，總額支付制度亦可能引起負面效果，例如誘發需求，拒絕無利可圖的病人，使得健保以高額支出買到低品質的醫療。就長遠影響而言，總額支付制度可能改變醫療生態，使醫療行為、醫療品質、就醫可近性受到影響。中醫健保自民國89年即實施總額支付，在臺灣的單一保險人與私立為主的醫療提供系統之下，總額預算對會中醫健保產生何種影響？本研究擬根據醫療市場競爭理論，以中醫門診為例，討論不同市場架構下，總額支付制度對中醫門診市場競爭程度與服務量的短期、長期影響。並以國家衛生研究院「全民健康保險學術資料庫」的門診（CT）、醫事人力檔（PER），以ANOVA與迴歸方法，分析總額支付制度前、後，地區中醫門診市場競爭程度的改變與偏遠地區中醫師人力分布的改變，作為政策參考的依據。
關鍵字：總額支付,市場競爭,醫師人力分布

The Effects of Global Budget System on Local Traditional Medical Markets

Wen, Yu-Ping
Chang Gung University
The Effects of Global Budget System on Local Traditional Medical Markets A major incentive of global budget lies in the cap it places on total medical expenditures. Consequently, health care provision and behavior may change. On one hand, global budget may result in waste reduction and quality improvement. On the other hand, it may cause severe side effects such as inducing demand and patient-dumping. Health insurers may pay higher costs only to get lower quality. In the long run, global bedgeting system may change the medical market structure and effectively change medical practive, quality of care, and accessibility of care. Under the single-payer and market-oriented health care systems in Taiwan, how will global budget change the health care provision and behavior of traditional medicine? Based on health market competition theories, this study aims to analyze the effects of global budget under different market structures in the short run and in the long run. We analyze NHRI Nation
關鍵字：global budget,market competition,physician manpower