臺灣「全民健保總額點值資料庫」之建置介紹

Translated title of the contribution: The Establishment and Application of National Health Insurance (NHI) Global Budget (GB) Point Value Database

Li-Jung Elizabeth Ku, 佳純 李, 翊涵 廖

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: This database gathered global budget system (GB) point values released by the National Health Insurance Administration (NHIA) to provide GB point value data that is closer to actual medical expenditures than GB medical points. The aim of this database is to accurately estimate the medical expenditures of the middle-aged and the elderly population, and allow future studies to compare growth trends of actual medical expenditures across year. Methods: According to the GB point value data released by the NHIA, there are five departments of GB points including Dentistry, Chinese medicine, Physician Clinics, Hospitals, and Dialysis. This database put together GB average point values and floating point values between 1998 and 2015, and also medical expenditures deduction rates were listed by year, quarter and by the five NHIA branches. To test for the difference between medical utilization (GB points) and medical expenses, we chose the middle-aged and elderly diabetics population in 2013 and persons with dementia from 2002 to 2012 as two study samples to conduct point values conversion. Results: In calculating medical expenses for middle-aged and elderly diabetics in 2013, it we did not adjust GB point values but used only GB points, outpatient expenditures will be NT$3000 higher (accounting for 3% of the medical points) and inpatient expenditures will be NT$8000 higher (accounting for 6% of the medical points). Differences were found between GB points and point value-adjusted expenditures by urbanization status of different areas. In calculating medical expenditures for persons with dementia from 2002 to 2012, the differences between GB points and point value-adjusted expenditures varied by years, and the range was from about NT$3000 to NT$11,000 (accounting for 5-12% of the medical points). Conclusion: This database can be used to convert GB medical points into point values, and it could estimate actual medical expenditures more accurately than using NHI medical point data. But it is not recommended to discuss medical expenditures in the unit of individual medical claim, as it is only suitable to apply average GB points to aggregated claims to calculate overall medical expenditures.
Translated title of the contributionThe Establishment and Application of National Health Insurance (NHI) Global Budget (GB) Point Value Database
Original languageChinese
Pages (from-to)24-32
Journal健康科技期刊 = The Journal of Health Sciences
Volume2018
Publication statusPublished - 2018 Dec 1

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