The Effects of Global Budget on the Operating Efficiency of Dental Care in Taiwan

摘要 本文以民國85年7月至民國89年6月國家衛生研究院全民健保資料庫中關於牙醫醫事服務之相關資料，探討我國牙醫總額支付制度之實施，是否達到醫療費用成長率抑減及提昇效率之預期目標。研究結果顯示，以總額支付制度前後二年牙醫價量變化觀之，平均申報件數下降4.05％，而其申報金額之成長率為3.9％，低於協商之醫療費用成長率8％。而資料包絡分析之研究結果發現，總額支付制度實施後，全體醫院之平均純產出距離函數與全體平均產出距離函數均有攀升之現象，表示總額支付制度之實施，對於牙醫醫療院所產出效率之提升有正面之助益。本研究欲分析牙醫醫療院所生產力之變動是否與總額支付制度之實施相關，故利用前述DEA模型求得之純產出距離函數平均值與整體產出距離函數平均值，進行Tobit迴歸模型分析。實證結果顯示，總額支付制度別之迴歸係數為正，表示該制度實施後，牙醫醫療院所之生產力優於實施前，故總額支付制度之實施，對於牙醫之生產力改善有正面助益。而實證結果亦顯示，醫事機構之權屬別、評鑑等級別及健保分局別的不同，亦會造成其生產力之差異。Abstract Using dental services data from July 1996 to June 2000 in NHI, this study examines the effects of Global Budget on the operating efficiency of dental care. The results of this study indicate that after the implementation of the Global Budget system, the claimed number of cases of dental services reduced by 4.05％, and the claimed charges of dental services increased by 3.9％, below the allowed expense increase ratio. And the results of Data Envelopment Analysis (DEA) show that both CRS and VRS increased after the implementation of the Global Budget system, indicating that implementation of the Global Budget system improves the efficiency of dental care. This study also uses Tobit regression model to examine whether the improvements in the efficiency of dental care are related to the implementation of the Global Budget system. The results indicate that after implementation of the Global Budget system, the efficiency of dental care became better. This study also found several hospital characteristics are associated with the efficiency of dental care