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台灣公共衛生雜誌 ScopusTSSCI

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篇名 醫院權屬別與醫療收費
卷期 23:2、23:2
並列篇名 Hospital Ownership and Medical Service Pricing
作者 張樂心鄭守夏楊銘欽江東亮
頁次 130-140
關鍵字 醫院權屬別醫療費用自付費用住院天數支付制度OwnershipMedical expenseOut-of-pocketLength of stayPayment systemScopusTSSCI
出刊日期 200404

中文摘要

     目標:我國私人醫院比例高於美國三倍以上,不同權屬別醫院收取醫療費用是否不同,本研究提供臺灣實證資料。方法:以糖尿病、中風、剖腹產與闌尾切除四種常見疾病病人為研究對象,共4945名,分析不同權屬別醫院之醫療費用;包括醫院向病人收取之自付費用、向健保局申報之醫療費用,以及住院天數。並以同病再入院與術後傷口發炎率作為品質指標。結果:論病例計酬的剖腹產與闌尾切除病人,私人醫院的申報費用最低,但收取最高的自付費用與醫療總費用;論量計酬的糖尿病與中風患者,私人醫院的申報費用、自付費用與總費用皆顯著高於公立醫院。無論那種支付方式,公立醫院的平均住院天數皆較長。結論:私人醫院論病例計酬的申報費用低於公立醫院,論量計酬類則較高,其因應健保支付制度之費用策略可能較公立醫院明顯。公立醫院可能因公務預算補助等因素,收取最低的自付費用,但住院天數偏長。

英文摘要

     Objective: The proportion of private hospitals in Taiwan is 3 times higher than that in the United States. This study addresses the question as to whether private hospitals charge higher prices by providing empirical evidence from Taiwan. Method: There were 4945 patients with one of the common diagnoses/procedures of diabetes, stroke, Cesarean section, or appendicitis included in the analysis. The between-hospital comparisons were measured by patients?out-of-pocket payment, NHI claimed expenses, and patients?length of stay. We also adopted the readmission rate and post-operation infection rate as quality indicators for comparison. Results: Multiple regression models showed that private hospitals had the lowest level of claimed expenses, but higher out-of pocket and total expenses than their counterparts for procedures under the case payment method. Moreover, both their claimed reimbursements and out-of-pocket charges were both higher than that of public hospitals for diseases under the Fee-for-Service system. On average, public hospitals had the longest length of stay. Conclusion: Private hospitals seem more flexible in response to the NHI payment policy than public hospitals. Owing to the governmental subsidy, public hospitals charge lower out-of-pocket prices but have a longer length of stay.

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