The Fairness of Regional Budget Allocation in National Health Insurance and Optimal Risk Adjustment Model

• Main Authors: Hsin-Chieh Lu, 呂欣潔
• Other Authors: Shou-Fen Hsu
• Format: Others
• Language: zh-TW
• Published: 2002
• Online Access: http://ndltd.ncl.edu.tw/handle/79477466884888969311

碩士 === 國立高雄第一科技大學 === 風險管理與保險所 === 90 === Global budgeting is the statutory payment system of National Health Insurance Act in Taiwan. The payment system is prospective to control medical expenditure to some extent and improve the health resource allocation. In Taiwan, global budget has been applied on dental service and Chinese ambulatory care. Continuously the primary care clinics (HCC) and the Hospitals will be applied soon. This study uses medical care data of Bureau of National Health Insurance (BNHI) in Taiwan from July 1999 to June 2000. We choose several risk-adjusters that are determinants of the growth of medical expenditure to construct different regional risk adjustment model. The risk-adjusters are classify by demographics, diagnose, prior year expenditures, health resource and self-reported health. According to those describe above, we look into optimal risk adjustment model for budget allocation. The purposes of this study are as follows: 1.To construct regional risk adjustment model that improve the fairness of regional medical expenditure allocation for global budgeting in National Health Insurance. 2.To look into optimal risk adjustment model for budget allocation. 3.According to optimal risk adjustment model to estimate the expected medical expenditures of BNHI.