The Influence of Health Reform on Medical Expenditure---The Case of Thailand

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許瑀彤(Yu-tung Hsu) 查詢紙本館藏

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論文名稱

(The Influence of Health Reform on Medical Expenditure---The Case of Thailand)

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摘要(中)

泰國在2001年初推動的全國性醫療改革(Universal Coverage Scheme, UCS)旨在減輕民眾的財務負擔及促進醫療公平性，但探討該政策成效的研究甚少。本文目的在於探討UCS的實施對於民眾醫療支出的影響，及UCS對於不同所得層級及區域間民眾醫療支出的改變是否有不同影響。本研究使用兩年「泰國社會經濟調查」之橫斷面資料，並利用差異中差異方法進行估計。由於資料中未涵蓋健康狀況之資訊可能導致模型中存在自我選擇問題，在後面的章節中亦採取Heckman二階段估計法修正。實證結果顯示，整體而言，門診、住院以及藥物三個部分的醫療支出在政策實施之後皆有明顯的下降，其中，低所得水準者在醫療支出的下降幅度最大，且效果隨著所得水準的上升而減弱。在地區的部分則發現各地區之間的支出差異在健保後反而呈現微幅增加的現象，顯示泰國健保改革在降低醫療支出的目標上雖取得卓越的成果，但在平衡區域發展方面則未獲顯著改善。此外，本文亦採用醫療支出占消費的比例作為應變數進行估計，結果顯示健保實施前所得水準最低者負擔較高比例的醫療費用，高所得族群反而負擔的較少，但此一現象在健保後則有逆轉的情況。

摘要(英)

A nationwide health reform which attempted to release the financial burden on health and promote the equity of seeking treatment was implemented in Thailand in 2001. However, there are limited studies that provide a comprehensive analysis on this issue. This paper tried to evaluate the effects of policy and go further discussion across different income level and region. Data use in this paper is Social Economic Survey 2000 and 2004. We pool the data and adopt the difference-in-difference approach to estimate. Considering lack of sufficient information of health status may cause self-selection, we continue to modify by Heckman-two-stage model in later part. The empirical results show that UCS dramatically decreased outpatient, inpatient and medical health expenditure, particular in the poorest quintile. Besides, the decreasing magnitude became weaker with income increasing. Although UCS made an impressive stride toward reducing health payments, the phenomenon of widening disparity among regions indicated that the policy did not achieve the goal of balancing regional development. An attempt differ from other health reform research is that this paper did another estimate by replacing the out-of-pocket health expenditure by percentage of a household’s total consumption serve as the dependent variable. The results show that the poverty households bear relatively more health burden but the situation was inversed after the UCS.

關鍵字(中)

★ 醫療支出
★ 差異中差異法
★ 醫療改革
★ 泰國

關鍵字(英)

★ out-of-pocket health expenditure
★ difference-in- difference
★ universal coverage
★ Thailand

論文目次

Chinese Abstract i
English Abstract ii
Acknowledgement iii
Table of Contents iv
List of Tables v
Chapter 1 Introduction 1
Chapter 2 Overview of Thailand’s Medical System 3
Chapter 3 Literature Review 6
3.1 The health reform in other countries 6
3.2 The health reform in Thailand 8
Chapter 4 Data and Empirical Specification 10
4.1 Data source 10
4.2 Empirical specification 11
4.2.1 Year effect approach 11
4.2.2 Difference in Difference Approach 15
Chapter 5 Results and Discussions 16
5.1 Main Results 16
5.2 Robustness check 19
Chapter 6 Conclusion 40
References 42
Appendix 47

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指導教授

楊志海(Chih-hai Yang)

審核日期

2013-7-22

推文