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總額預算制度是一種讓醫療院所替代健保局來承擔財務風險,以舒緩健保財務壓力的制度設計。 總額預算制度的成敗與醫療院所衝量風氣強弱息息相關,同儕制約精神被不少學界、醫界人士認為是抑 制衝量風氣而使總額預算制度發揮良好功能的一項重要機制。這篇文章設計一個可表現出同儕制約精神 的總額預算制度模型來初步探討衝量行為。本文指出同儕制約中「愈多(愈少)醫療院所衝量、衝量時同儕 壓力愈小(愈大)」的從眾心理特性,透過自我強化的過程可能造成兩種截然不同的後果。首先,在「衝量 醫療院所很少、衝量時同儕壓力很大」的情況下,會有效抑制衝量風氣,導致衝量風氣不興盛的穩定均 衡,這有強化總額預算制度永續經營的功能。其次,相反的,在另一種「衝量醫療院所很多、衝量時同 儕壓力很小」的情況下,就不能有效壓抑衝量風氣,導致衝量風氣很興盛的穩定均衡,這反而帶來一股 破壞總額預算制度有永續經營的力量,這也是一般強調同儕制約成效人士所忽略的觀點。另外,此模型 將指出總額預算制度中點值浮動的特性,會產生當衝量醫療院所增加(減少),點值下降(提高),而降低(提 升)醫療院衝量誘因的效果。總額預算制度因此展現「愈多(愈少)醫療院所衝量,接著會促使衝量的醫療 院所減少(增加)」的自我回歸風格,顯示總額預算制度有時會呈現出一種內建的「內在自動穩定機能」。

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Paper provided by Institute of Economics, Academia Sinica, Taipei, Taiwan in its series IEAS Working Paper : academic research with number 12-A008.

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Length: 34 pages
Date of creation: Sep 2012
Handle: RePEc:sin:wpaper:12-a008
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