1993年12月

健康保險與老人自付醫療費用之探討
An Investigation on Health Insurance and Out-of-Pocket Medical Expenditure by the Elderly in Taiwan

研究論文 Research Article

謝啓瑞, 陳肇男
Chee-ruey Hsieh, Chaonan Chen

163-203

本文利用 Heckman 的樣本選擇模型，實証估計影響老人自付醫療費用的因素。實証資料來自行政院主計處在民國78年12月所舉辦的「老人狀況調查」，共有 5,121 個樣本。本文的實証發現，具有公、勞、農保資格及享有軍榮民就醫優待的老人，其平均自付門診住院費用約爲無健康保險者的二至三成。此一結果顯示，現行健康保險雖尙未普遍採行部份負擔制度 ( 名目部份負擔率爲0 )，但老人在實際就醫時，卻要自己負擔約 20％ 到 30％ 的醫藥費 ( 此相當於平均實質部份負擔率在 0.2 至 0.3 之間 ) 。因此，現行健康保險制度之給付條件與支付制度，實有檢討之必要。

This paper used Heckman's sample selection model to estimate the determinants of the out-of-pocket medical expenditure by the elderly in Taiwan. The primary source of data was from the Old Status Survey in 1989, which was conducted by the Directorate-General of Budget, Accounting, and Statistics, Executive Yuan, Republic of China. The data base contained 5,121 cases aged 65 and above. The analytical results showed that the out-of-pocket medical expen­diture paid by insured elderly was equivalent to 20 to 30 percent of the medical expenditure of the uninsured elderly. This result indicates that the real coinsurance rate is 0.2 to 0.3, although the nominal coinsurance rate is nearly zero under the current health insurance system. Thus, to reform the current reimbursement system is urgently needed.

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