軍人納入健保對其醫療資源使用之影響－－以至某軍方地區教學醫院就醫之軍人為例

The Impacts of Military Personnel Enrolled in the National Health Insurance on Medical Utilization--The Case of a Military Teaching Hospital

背景：我國全民健康保險自1995 年3 月開始實施，首先涵括原有的農、 勞、公保等各項社會保險制度，使台灣的健康照護制度更往先進國家邁進一 大步。由於幾乎所有人民均被納為全民健康保險對象，而且絕大多數醫療院 所，包括軍醫院均成為全民健康保險的特約機構，使得全體國人都能充分享 有更便利、高選擇性與高品質的醫療服務。然而，大約四十萬國軍官兵的實 際醫療需求，加上整體社會及醫療團體的共識，政府本著「全民納保、平等 就醫」的健保基本原則，在盡力照顧國軍官兵並維繫軍隊戰力的考量下，於 2001 年2 月將所有軍人納入全民健康保險體系，讓軍人與全國人民共同享有同 品質的醫療服務。 方法：本研究是以實證方式分析比較軍人納保前後在醫療資源使用上是 否發生變化。採用回溯性的研究方式，取樣軍人納入台灣全民健康保險前後 各兩年的時間，即1999 年2 月至2003 年1 月合計4 年間，現役軍人身分的病患， 於台灣南部某一地區教學醫院門診就醫的財務資料，分析並比較軍人納入健 保前後的差別。研究方法包括描述性分析及平均數差異分析，探討實施前後 醫療資源利用之影響。 結果：軍人納入健保後，門診人次平均每月降幅為1 1. 49% 。檢查治療費 由平均每月升幅為62.83% 。藥費由平均每月降幅為3 1. 19% 。總醫療費用由平 均每月升幅為2.84% 。由統計資料發現，門診人次及總醫療費用，在軍人納入 健保前後並無明顯改變，而其他項目如檢查治療費、總藥費、每人次費用、 每人次藥費、每人次檢查治療費及藥費佔率則均具有顯著變化。 結論：研究發現在軍人納入健保後對醫療資源的使用確實發生了相當的 變化，同時對於軍醫院的經營管理也產生深遠的影響。對醫院管理階層及醫 療政策制定者而言，如何提升至該醫院就醫之軍人的醫療服務品質與就醫的 滿意度、改善就醫的可近性及就醫環境，如何掌控整體醫療費用，在有限的 費用中，作更有效率的分配利用，促進軍人的健康及醫療照護並兼顧醫院整 體營運的財務控管，使軍醫院在醫療市場的劇烈競爭下仍能穩健的經營，當 為經營管理者的重要課題。

Background: Since 1995 the National Health Insurance (NHI) was implemented in Taiwan, the military hospital have been incorporated into the system of NHI, which integrate Labor, Farmer and Government Employee Insurances, making Taiwan s insurance program a new era. However, about four hundred thousand military personnel are subsumed the scheme because of the practical medical needs, social requests and inner hope. Based on the principle of nationally insured; equally hospitalized , the government admitted military personnel in 2001 as insurants under NHI scheme allowing medical service and life dignity. Up to now, empirical studies on the effect of military personnel enrolled in NHI system in Taiwan are rare. Therefore the purpose of this study is to analyze the impacts of the event on medical utilization and to examine whether it has an apparent influence on the hospital. Methods: In Feb. 2001 the military personnel enrolled in the NHI. Researcher had collected 4 years data about the out-patient department in the military teaching hospital located in south area of Taiwan. Data were collected from Feb. 1999 to Jan. 2003, which included the average cost of total medical, drugs, laboratory and therapeutic procedure, and total out-patient visits per month. This study will evaluate the impacts and differences of before and after enrolling military personnel into NHI on medical utilization. Results: After enrolling military personnel into NHI, the out-patient visits had significantly decreased by 11.49% per month. Averaged total medical cost had increased by 2.84%. Cost of drugs had significantly decreased by 31.19% per month. Laboratory and therapeutic procedure cost had increased by 62.83%. Conclusions: We concluded the significant impacts of military personnel enrolled the NHI on medical utilization. It also does an obvious influence on the military hospital. For the health care providers, it is important to increase the financial management responsibility and the quality of health care; in addition, to meet the satisfaction of military personnel has become an important consideration for the management of hospitals. Hence, it suggests that the military hospital should enhance the service quality and improve the facility so as to be more competitive and be accessible to military personnel.