人口結構變動對醫學中心急診部分負擔政策有效性之影響

Effect of demographic structural change on copayment policy effectiveness for emergency department visits

目標：本研究旨在探討台灣地區人口結構變動對醫學中心急診部分負擔政策有效性的影響效果。方法：我們使用時間變動向量自我迴歸以及向量誤差修正模型建構人口結構變動對醫學中心急診部分負擔政策有效性的關聯。結果：部分負擔對急診與非緊急急診醫療利用12個月期間的衝擊反應數值均為負值，增加部分負擔能降低醫學中心急診醫療利用。長期而言，人口老化將降低醫學中心急診部分負擔對所有急診醫療利用負向影響，但是對醫學中心急診部分負擔對非緊急急診醫療利用的關聯性沒有顯著的影響。結論：若以減少整體醫學中心急診利用為政策目標時，高齡化社會所要調高的部分負擔將必須遠高於目前設定的水準。考量急診利用降載的政策工具眾多，未來政府在制定急診利用政策時，除考量人口老化對部份負擔政策的鈍化效果外，仍須搭配其他分級醫療的政策工具，藉以達成緩解醫學中心急診利用的政策目標。

Objectives: This study investigated the effect of demographic structural change on emergency department (ED) visits in medical centers in Taiwan. Methods: Time-varying parameter vector autoregressive and vector error correction models were adopted to establish the association between demographic structural change and ED visits in medical centers. Results: Our empirical results revealed negative cumulative responses over 12 months of copayments for ED visits and nonurgent ED visits. The negative relationship between copayments and ED visits was reduced in the aging population, but no significant relationship was found between copayments and nonurgent ED visits in this population. Conclusions: Higher copayment adjustment for ED visits should be made for achieving the policy goal of a lower number of total ED visits for the aging society. Various policy instruments other than the copayment policy have been established to reduce the number of ED visits. Considering the ineffectiveness of the copayment policy for ED visit reduction in the aging society, the government should adopt other policy instruments of the hierarchy of medical care together with the copayment policy to achieve the policy goal of total ED visit reduction.