兒童醫療補助計畫是否改善弱勢兒童醫療利用的可近性?

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Title:	兒童醫療補助計畫是否改善弱勢兒童醫療利用的可近性?
Authors:	紀慧珊;Hui-shan Chi
Contributors:	產業經濟研究所
Keywords:	差異中的差異;政策效果;可近性;difference-in-difference;policy effect;accessibility
Date:	2011-06-29
Issue Date:	2012-01-05 15:07:45 (UTC+8)
Abstract:	本篇論文旨在驗證2002年3月1日實施的「全國三歲以下兒童醫療補助計畫」之政策效果，並利用全民健保資料庫中的2005年承保抽樣歸人檔，觀察2000年3月1日-2001年3月1日出生的兒童在計畫前後各一年的醫療利用情形；本研究比較實驗組(高、中、低所得、地區人口組)與控制組(原本即享有免部分負擔優惠)兒童在政策實施前後醫療利用的差異，利用差異中的差異difference-in-difference (DD)方法，搭配負二項、羅吉斯及Tobit迴歸模型驗證政策效果；並將重點放在計畫實施後是否能使得低所得家庭兒童可以跨越就醫的財務障礙增加醫療利用，並改善計畫前後不同醫療院所層級間的可近性。本研究實證結果顯示，在門診部門方面，低所得與地區人口兒童在計畫後相較於控制組兒童顯著的提升門診次數，其中至中大型醫院(醫學中心、區域醫院)的門診就醫次數更有明顯的增加，代表「全國三歲以下兒童醫療補助計畫」確實有效拉近經濟弱勢兒童的醫療可近性；但是不論兒童家庭所得階級為何，兒童醫療補助計畫對兒童急診及住院的醫療利用效果則並不明顯，我們推論急診與住院之醫療利用較為特殊，屬於較緊急的醫療，並不會因為部分負擔的醫療補助而增加急診及住院之利用。 This paper is for the purpose of examining the policy effect on “the medical service subsidy plan for children below three years old” using the data of National Health Insurance from National Health Research Institute. We observe the medical using situations for children who were born on 2000 March 1st - 2001 March 1st around the subsidy plan each one year, comparing the treatment group (high, middle, low-income and local population group) and the control group(children who originally exempt from paying copayments) for the differences of medical uses around the policy implementation, namely using difference-in-difference(DD) method matching negative binomial, Logistic and Tobit regression model to examine the policy effect. Moreover, we emphasis on whether the low-income children may surmount the financial barrier and increase the medical uses and improve the medical accessibility. The results show that the low-income and local population children remarkably promote the times of using outpatient services, especially to the large-scale hospitals (medicine center, region hospital). In conclusion, “the medical service subsidy plan for child below three years old” pull closer the low-income children's medical accessibility truly effectively； but no matter what kind of income level, the effects of emergency and inpatient care are not significant, and we deduce that they are more special and belonging to the urgent medical services which will not induce more uses due to the copayment subsidy plan.
Appears in Collections:	[Graduate Institute of Industrial Economics] Electronic Thesis & Dissertation

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