超額醫療費用對家戶必要消費之衝擊：以飲食支出為例

Impacts of Catastrophic Health Expenditures on Household Basic Consumptions: An Analysis on Food Spending

超額醫療費用（catastrophic health expenditures, CHE）可能迫使家戶減少必要消費或落入貧窮，是評估健康照護系統對家庭財務保護效果的重要指標。本研究採橫斷性研究設計，使用《華人家庭動態資料庫》2004年調查資料檢證CHE和家戶飲食支出的關係，以多元填補、邏輯斯迴歸和傾向分數配對等方法進行統計分析。結果發現閾值設定在10%時，CHE家戶佔16.85%，其年均等飲食支出較非CHE家戶少了18.69%，顯示家戶可能透過縮減飲食花費來支應醫療費用。CHE組所得最低的20%家戶，有95.24%未曾獲得政府醫療補助，原因可能是CHE家戶醫療支出不符合法令規定須「超過2至5萬元」。建議政府定期追蹤CHE家戶盛行率，並將具有「超額」醫療費用家庭的需要納入考量，重新檢討醫療補助費用之閾值和政策執行效能，俾能將資源確實輸送予有需求的家庭。

Catastrophic health expenditures (CHE) may force households to reduce consumption or fall into poverty, thus is an important indicator to evaluate the performance of health care system regarding the protective effect on household financial safety. This is a cross-sectional study using data from Taiwan ＂Panel Study of Family Dynamics 2004＂, to explore the relationship between CHE and household food spending. Multiple imputation, logistic regression and propensity score matching methods were used for data analysis. With a threshold set at 10%, the results showed that CHE household, accounting for 16.85% households, had average annual food spending less than the control group by 18.69%, indicating that households may reduce food spending to cope with medical expenditures. Among CHE household with lowest quintile income, 95.24% of them hadn't received any government medical subsidy. That may due to the fact that their medic al expenses mayor may not meet the threshold ($20,000-50,000) to receive medical subsidy from government. We suggests that government should monitor the prevalence of CRE households regularly and take the special need of CHE household into consideration in setting the medical subsidy threshold and in delivering resources to those most in need.