台灣醫院市場競爭程度、地區付費能力與醫院收費水準

Association between hospital competition, patient ability to pay, and hospital charges

目標：本研究旨在探討醫院市場競爭程度、地區付費能力及個人所得與醫院收費之間的相關性。方法：本研究資料來源為2018-2019年健保署委託之「住院病人就醫經驗調查運作模式之先驅研究」計畫的「住院病人就醫經驗（PEHC）」調查結果，調查對象為20歲以上之出院病人，並使用序列羅吉特模型，估計醫院向住院病患收費金額多寡之決定因素。結果：研究結果顯示，當醫院所在地為高度競爭的環境時，其收費較高的機率是位於低度競爭市場之醫院的1.51倍。再者，若醫院所在地區付費能力高、病患家戶所得較高及中等者，醫院收取較高費用的機率亦較高。最後，病人特性（住院日數、病房類型、年齡、自覺疾病嚴重度）也與出院收費呈顯著正相關。結論：醫院收費與市場競爭、地區與個人付費能力呈正相關，通常醫院高收費隱含高品質，政府應正視過量品質可能衍生高成本的隱憂，以及與付費能力相關之醫療品質的城鄉差距，並採取相應措施，以促進醫療資源的有效利用，防範城鄉之間健康不均現象的惡化。

Objectives: This study investigated the association between hospital competition, patient ability to pay, and hospital charges. Methods: The data source was the results of the“Patient Experience of Hospital Care”survey, which were extracted from the research project“A Pioneering Study on the Operation Mode of the Inpatient Medical Experience Survey,”which Taiwan’s National Health Insurance Administration commissioned for completion in 2018–2019. Participants were discharged hospital patients over the age of 20 years. The determinants of hospital charges were estimated through the ordered logit model. Results: Hospitals in more competitive markets charge more than those in less competitive markets, with the corresponding odds ratio being 1.51. Moreover, hospital charges are higher if the patient is more capable of paying, as measured by township and mean household income. Patient characteristics—such as length of stay, ward type, age, and self-assessed disease severity—also significantly contribute to variation in hospital charges. Conclusions: Hospital charges are positively associated with market competition and patient ability to pay. The relevant authorities should be concerned about the nexus of cost, competition, and the urban–rural gap in quality related to patient ability to pay and take steps to promote the effective use of medical resources and prevent an increase in health inequality between urban and rural areas.