論質計酬計畫是否節省醫療成本-以糖尿病試辦計畫為例;

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题名:	論質計酬計畫是否節省醫療成本-以糖尿病試辦計畫為例
作者:	胡哲議;Hu,Je-yi
贡献者:	產業經濟研究所
关键词:	論質計酬;傾向分數配對;差異中的差異;difference-in-difference;pay-for-performance;propensity score matching
日期:	2012-09-21
上传时间:	2012-11-12 14:31:25 (UTC+8)
出版者:	國立中央大學
摘要:	本文旨在探討「糖尿病論質計酬試辦計畫」之政策效果，資料來源為全民健保資料庫的2000 年承保抽樣歸人檔，從2002-2003 年挑選第一次加入糖尿病試辦計畫且往後三年皆參與此計畫的病患作為實驗組，而對照組即為未參與此計畫的病患，但因為比較過程中存在樣本選擇問題，因此利用傾向分數配對法(Propensity Score Matching，PSM)，從對照組中配對出像似於實驗組特性的配對組，以消除基礎點的差異，並利用差異中的差異(Difference-in-Difference，DD)法說明政策效，評估目前的論質計酬制度下，糖尿病試辦計畫實施後能否有效減緩糖尿病的醫療費用。研究實證結果顯示，糖尿病人持續加入論質計酬試辦計畫三年後，門診利用次數顯著減少，住院利用亦顯著減少；醫療費用部分，糖尿病人在加入計畫第一年，總醫療費用顯著增加，而第二年及第三年的總醫療費用皆顯著減少，但若以累計糖尿病總醫療費用可發現，實驗組持續就醫三年總醫療費用顯著減少，住院費用也顯著減少，顯示完整照護計畫以及持續且固定回診是照護成效的重要關鍵。This article aims to explore the policy effect of “diabetes on the pay-for-performance program” using the data of National Health Insurance from National Health Research Institute. I construct two sample groups: the experimental group includes the patients enrolled this program for first time during 2002-2003 and continued for the further three years while the control group includes the patients that are out of this program. To avoid potential sample selection problem, I use the propensity score matching method (PSM) and arrange the samples from two groups into comparable pairs. At last, we want to assess whether this program effectively reduce the medical expenses in diabetes or not.The empirical results show that patients enrolled three years in the pay-for-performance program had a significantly lower number of diabetes-related physician visits, and also is the diabetes-related hospitalizations. Patients in the experimental group spend significantly more than the matched group in the first year；the continual enrollees spent significantly less than their counterparts in the subsequent years. Patients enrolled three years in the diabetes program spend significantly lower the matched group, and also is the hospitalizations costs. Therefore, the key point of care plan is continuous clinic care.
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