全民健保醫療價格指數的分析與建構－－MEI與IPI之效率性研究

THEMEDICAL PRICE INDEX IN THE NATIONAL HEALTH INSURANCE OF TAIWAN: A COMPARATIVE STUDY OFMEI AND IPI BASED ON ECONOMIC EFFICIENCY

本研究的主要目的有二： 一是建立「無窮多期」（infinite horizon） 的生產選擇模型，探討美國「醫療經濟指數」（Medicare Economic Index，MEI）因採用「非農業部門受僱人員薪資指數」的編製方式所可能造成的福利成本； 二是藉由問卷調查、業界訪談、及健保資料分析等方式，重新建構我國中、西、牙醫診所的成本結構及其醫療價格指數。研究結果顯示， 根據「要素投入價格指數」或「生產因素價格指數」（Input Price Index， IPI）的編製方式，以各類醫事人員的實際薪資成長率衡量中、西、牙醫診所對應受僱人員的薪資波動，所計算出來的醫療價格成長率雖然較高，但卻不會扭曲診所有關醫療資源的配置行為。若按MEI醫療價格指數的編製方式，改採與「非農業部門受僱人員薪資指數」同性質的「工業及服務業受僱員工薪資指數」概括衡量所有醫師薪資及其他人事費用的價格波動， 在短期間內或許比IPI 較具有抑制醫療價格水準的作用，但長期間將誘使醫療院所使用相對上較多昂貴的醫療儀器設備，並減少醫師勞動力的使用，從而造成「無謂的」（deadweight）福利成本，且恐會帶動整體醫療費用及醫療價格的上漲。

We have written this paper with two purposes foremost inmind. First, we built up an infinite-horizon production choicemodel to examine theMedicare Economic Indices (MEI) where the nonagricultural employees’ earnings index is used as ameasure for the fluctuation of earnings in the medical sector. Second, we reinvestigate the cost structures and hence themedical price indexes of the Chinesemedical,westernmedical, and dental clinics in Taiwan. As part of this, we distributed questionnaires to all the clinics in Taiwan to gather the corresponding data set. Contrary to the MEI , in this paper we follow the Input Price Index (IPI) and hence use the actual growth rate of earnings in the medical sector to construct the medical price indices. On the basis of our analysis, we found that, as compared to MEI, the medical price indices computed based on the actual growth rate of earnings in the medical sector, although greater, would not create distortions in the allocation ofmedical resources and thereby would yield lower welfare costs.