The determinants of health care expenditure and the control effects of incentive mechanisms in Taiwan

[[abstract]]健保醫療支出的成長因素，除前期醫療費用之外，亦受醫療服務之需求與供給兩面的影響。在需求面，主要為被保險人的實際健康風險因素而衍生的醫療需求，及其隱含之道德風險所導致的醫療費用增加。在供給面，特約醫療機構家數的增加不僅可能增加被保險人的就醫可近性，降低就醫時間成本，從而增加醫療服務需求，另一方面亦可能產生醫療提供者的誘發性需求，進而影響醫療支出成長。由於醫療費用成長受到供需雙方因素影響，何者為因何者為果不易釐清，故本文採用 VAR 模型分別探討供需兩方之控制機制，亦即部分負擔及總額預算支付制度的施行效果。 本文實證結果發現：(1)台灣健保部分負擔制度能有效控制醫療費用成長。(2)台灣健保所實施的西醫基層及醫院總額預算支付制度，能有效減少非必要之門診，進而控制醫療費用的成長。(3)醫療費用與特約醫療機構數間具回饋關係，亦即前期/當期醫療費用與當期/前期醫療機構數間彼此互相影響。(4)影響醫療費用的主要顯著因子有前期之醫療費用與特約醫療機構數、65 歲以上人口比例、每人實質 GDP、部分負擔新制。(5)影響特約醫療機構家數之顯著因素則為前期醫療費用與醫療機構數、標準死亡比、以及西醫基層與醫院總額支付制度。[[abstract]]This study intends to investigate the major factors affecting the growth of health expenditures in Taiwan. In particular, we examine the impacts of both supply-and demand-side incentive mechanisms, i.e., the new co-payment system, the primary care global budget payment system, and the hospital global budget payment system, on health expenditures. The main results are as follows. First, the new co-payment system could control the growth of health expenditures. Second, the primary care global budget payment system and the hospital global budget payment system could reduce the non-necessarily outpatient services and control the growth of health expenditures. Third, there were a feedback relationship between health expenditures and contracted medical care institutions. Fourth, prior health care expenditure, the percentage of population over 65, real GDP per capita, and the new co-payment system had significant effect on the current health care expenditure. Finally, prior health care expenditure, prior contracted medical care institutions, standard mortality ration, the primary care global budget payment system, and the hospital global budget payment system had significant effect on current contracted medical care institutions