Factors That Influence Medical Hierarchy Selection - A Case Study of Patients That Had Ever Suspended and Resumed NHI Coverage

• Main Authors: Chiaw-Wei Lee, 李喬偉
• Other Authors: 張勝凱
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/rrr2kc

碩士 === 國立臺灣大學 === 經濟學研究所 === 105 === Since National Health Insurance (NHI) implement, the government curb people upgrading in seeking outpatient service by co-payment and a variety of systems. This study aims to explore whether there are other factors that affect people''s choice of medical hierarchy besides the price mechanism. We use the group of Taiwan beneficiary that had ever suspended coverage from 2010 to 2015 as samples of the research in order to analyze the factors that affect people how to choose a doctor, and the research variables how to affect the choice of the medical hierarchy before and after the implementation of “second-generation NHI” by Probit probability model and so on and its marginal effect analysis. Further, we explore the considerations of the medical hierarchy selection between the working and non-working people. The study found that after the implementation of the “second-generation NHI”, the probability of district hospitals for medical treatment significantly reduces. Area hospitals and clinics for medical treatment significantly increases. Women have higher probability of medical use, but men choose a higher level of healthcare than women do. After the implementation of “second-generation NHI”, the probability of male patients seeking to higher levels of hospital treatment declines. The farther away from the northern region, the lower the probability of medical treatment in each of medical hierarchy; and further, the probability of higher levels of medical institutions for medical treatment is lower than the probability of basic level medical institutions. The government employees compared to non-government employees, farther away from the north, still choose medical research center for medical treatment. Government officials or employees in private sectors subscribe to this insurance longer, the probability of the medical treatment in the basic level medical institutions is higher; non-working people subscribe to this insurance with the Township (City) Office longer, the probability of the medical treatment in the higher level medical institutions is higher. The probability of the patients of urology, emergency medicine, gastroenterology and cardiovascular seeking healthcare in area hospitals is higher than the probability in medical research center. After the implementation of “second-generation NHI”, the situation has eased slightly. The more premium arrears working people owe in a year, the more significantly the probability of them seeking healthcare in medical research center, area hospitals, and clinics reduces. The more premium arrears non-working people owe in a year, the more significantly the probability of them seeking healthcare in medical research center and area hospitals increases. The medical utilization rate of chronic disease and acute severe outpatient in the district level and above hospitals is higher. The primary care hospitals mainly treat mild disease, such as ENT (ears, nose, and throat), dermatology, dentistry, and Chinese medicine. The distribution of disease categories varies among different levels of medical care facilities. It shows that most people have some degree of medical treatment literacy. Nevertheless, there are still significantly different choice behavior between working and non-working people. Non-working people seek healthcare in the high-level medical institutions with higher medical utilization, because of their lower opportunity cost (they are willing to wait for a long time in large hospitals). Besides, the implementation of “second-generation NHI” is also contributed to the change of the public''s choice behavior of medical treatment. We should strengthen the examination of repeated and improper use of medical resources; simultaneously, advocate national health and preventive care to reduce the medical resource consumption in each of the medical hierarchy. Only in this way can we defend the rights of people who really need medical care.