市場競爭程度對醫院開發自費醫療服務之影響

Background and Purpose: After implementation of the National Health Insurance (NHI) in Taiwan in 1995, the medical environment was dramatically changed. Furthermore, the NHI of Taiwan adopted a global budget payment system for hospital reimbursement in 2001. This enforced many hospitals began to invest on new services, which were out of patients' own pockets, to increase their revenues in addition to reimbursement from the NHI. This study examined the relationship between market competition and number of ”out-of-pocket” services developed by hospitals. Methods: A questionnaire was sent to 128 hospitals, which were accredited as the level of district teaching hospitals or above, to collect data related to the ”out-of- pocket” services. Finally, 60 valid questionnaire (a response rate of 46.88%) were obtained. Additional data was drawn from the Hospital Survey from the Department of Health, the Executive Yuan. The definition of hospital market used in this study is the 63 sub-medical regions in Taiwan area. This study used the Herfindahl index to measure competitions among hospitals. Two-way ANOVA, Pearson correlation, and multiple regressions were employed to analyze the relationship between competition and number of ”out-of-pocket” services in hospital. Results: 1. Before the implementation of the NHI, hospital ownership and hospital accreditation levels had signigicant influence on number of ”out-of-pocket” services provided by hospitals in 1994; 2. After the implementation of the NHI, market competition and hospital accreditation levels had signigicant influence on number of ”out-of-pocket” services provided by hospitals in 2000; 3. After the implementation of the global budget payment system in 2002, hospital accreditation levels and household disposable income had signigicant influence on number of ”out-of-pocket” services provided by hospitals. Conclusion: The results showed that hospitals in higher competition environment tend to adopt more ”out-of-pocket” services. However, this may cause waste of medical resources. Therefore, we suggest that policy-makers should pay more attention on possible side-effects of any health policy.