基層醫療經濟指數之建立

Establishment of a Medical Economic Index for Clinics

目標：本研究之目的在建立西醫診所醫療經濟指數，以利總額支付制度協商總額預算時之參考，並作為未來繼續修改國內其他類型醫療經濟指數之基礎。方法：本研究以拉氏指數為基礎，首先以郵寄問卷調查全民健保實施後西醫診所之各項執業成本占總成本之比率（包括人事費用、藥品費用、材料費用、建築物租金、設備折舊、其他費用及雜項支出），以作為指數計算之權重。其次，本研究針對西醫診所各執業成本項目，就政府統計單位公佈之各項經濟指數中，選擇較能反映各西醫診所成本項目之指數，並以該項成本所佔比率當做權數進行加權平均，以建立西醫診所醫療經濟指數。結果：醫師成本（占42.96%）為西醫診所營運成本比重最大的項目，其次是人事費用（占17.37%）及藥品費（占16.75%）。以民國85年為基期，台灣地區86至89年西醫診所醫療經濟總指數分別為103.66、107.62、109.12及110.34，年增率分別為3.66%、3.82%、1.39%及1.13%。以執業地區分類指數而言，89年各執業地區之分類指數以中區及北區較高，分別為109.95及109.59。結論：西醫診所醫療經濟指數之建立及持續修正，有利於西醫基層總額支付制度協商年度預算時，共識之建立。鑑於總額預算制度已由牙醫推廣至中醫、西醫診所，醫院亦將納入，衛生署應持續推動並檢討各種相關醫療經濟指數之建立與應用。

Objective: This study established a Medical Economic Index for Clinics to facilitate the implementation of the global budget payment system of the National Health Insurance. Methods: Clinics were surveyed to determine their cost structure, as measured by the percentage of personnel, medicine, materials, office rent, and equipment. Then, the cost structure was matched by appropriate price indexes to construct the Medical Economic Index for Clinics. Results: We found that physicians’cost was the main cost item of clinics (42.96.%), followed by other personnel expenses (17.37%) and medicine expenses (16.75%). Using 1996 as base year, the 1997 to 2000 indexes were 103.66, 107.62, 109.12 and 110.34, representing an annual increase rate of 3.66%, 3.82%, 1.39% and 1.13%. Conclusion: The establishment and continuous refinement of the Medical Economic Index for Clinics is crucial to the implementation of global budget payment system for clinics. The methodology discussed in this paper can be used to establish similar indexes for other types of clinics and hospitals.