全民健保實施至今已二十餘年，醫院市場的產業結構發生重大改變，醫院紛紛朝向大型化發展。本研究旨在探討醫院大型化分別對重症病患醫療結果，與重症及輕症之醫療花費的影響。我們所選用的疾病分別為屬於重症的急性心肌梗塞、出血性中風與阻塞性中風，以及類屬輕症的單側腹股溝疝氣手術與痔瘡切除術。本研究使用1998至2007年「全民健康保險資料庫」，以及1996至2013年「2000年百萬人次抽樣資料」，我們以急性心肌梗塞、出血性中風及阻塞性中風病患出院後30天內死亡作為衡量病患的醫療救治結果；以重症與輕症之住院的總醫療花費來衡量病患之醫療利用，並利用醫院病床數作為大型化趨勢的指標，來探討醫院的大型化是否讓醫療結果變好，以及如何反映到醫療花費上。 本研究的實證結果顯示，醫院大型化使得重症疾病如急性心肌梗塞與出血性中風之醫療結果變好，然而在醫療利用指標上，大型化使得重症與輕症的醫療花費增加。此外，我們由殘差趨勢圖發現，醫院大型化並非主要影響醫療結果與醫療花費的原因，重症死亡率下降可能與醫療科技的進步等因素有關；而醫療花費的高升則是與健保之給付較相關。 ;National Health Insurance has been implemented for more than twenty years, the structure of hospital industry has experienced a dramatic change, the hospitals’ scale gradually become larger. This study aims to investigate the effect of the enlargement of hospital industry to patients’ treatment outcome and medical expenditures. The treatments we choose for acute disease are Acute Myocardial Infarction, Hemorrhagic Stroke and Occlusion Stroke, Unilateral Inguinal Hernia surgery and Hemorrhoids surgery which are chronic disease. This study use the 1998-2007 data extracted from the National Health Insurance database, and 1996-2013 sampling data from the National Health Insurance database. We conduct the patients’ treatment outcome measured by 30-day mortality and evaluate expenditure during admission for patients’ medical expenditure. Moreover, we utilize the beds of hospital as the indicator of the enlargement of hospital industry. Using forgoing data, we investigate whether the enlargement of hospital industry makes better treatment outcome, and how it mirrors to medical expenditures.
The empirical results show that the enlargement of hospital industry makes the patients’ treatment outcome of Acute Myocardial Infarction and Hemorrhagic Stroke become better. However, patients’ medical expenditures are increasing in all kinds of medical service we examined. Besides, the residual plots demonstrate that the enlargement of hospital industry is not the main reason leading to the change of patients’ treatment outcome and medical expenditures. The decreasing of mortality may be correlated to the advance in medical technology, whereas the rising of medical expenditures is derived from the NHI payment system.
