心臟血管疾病門診醫療需求及其預防效益之評估——納入異質性病患與就醫相關時間成本

Evaluation of Outpatient Medication Demand and Prevention Benefit of Cardiovascular Disease: The Effect of Differential Deductible Outpatients and Related Time Cost of Medication

本文利用旅行成本法設算包含就醫時間與交通成本之醫療價格，並建構一個旅行成本門診醫療需求函數，用以分析具不同健保優惠身份心血管疾病患者之門診就醫行為，同時評估高血壓改善之經濟效益。研究顯示：醫療價格與門診就醫需求呈反向關係，但基本費與藥費負擔之減免卻可能使得二者呈現正向的關係；而不同之時間成本設算方式亦將影響價格彈性之大小。文中我們亦比較經濟觀點與醫療管理觀點下之心血管疾病預防總效益，兩者之主要差異在前者多包含了個人效益值。研究結果發現：在基本費或藥費負擔減免下，前者會高於後者；此外，當設算時間成本所使用之工資率愈高時，兩者之差異會愈大。

This paper employs the travel cost method to impute the medication cost which covers costs of time and travel for medication. We also construct a travel cost outpatient medication demand function for analyzing heterogeneous outpatient demand of those patients with different types of medication cost exemptions, and for evaluating the economic benefit of cardiovascular diseases prevention. The results indicate a negative relationship between outpatient medication demand and the imputed medication price. Such relationship however becomes positive for those patients with the highest cost exemption from baseline treatment and medicine payment. The price elasticity of outpatient medication demand is also found to be affected by ways of wage ratios used in imputing time cost. Furthermore, we compare the estimated benefits of cardiovascular diseases prevention from economic and medical management viewpoints, which the difference represents the individual benefit. The results have shown that the economic benefit outweighs the pure medical benefit for those patients with medication cost exemptions from baseline treatment or medicine payment. Such benefit discrepancy would also be larger as the wage ratio used for cost imputation becomes higher.