本研究之目的在於瞭解臺灣地區有關醫療需求與利用之行為，並進而藉其

研究結果來推估部分負擔之實施成效。針對「八十年家庭收支記帳調查」

之 1,327戶家庭之資料，本研究分別以多元迴歸之線性模型與指數模型來

從事分析，並獲致下列之重要結果及發現： 1.門診價格偏彈性為 -0.27

至 -0.28 之間；住院價格偏彈性為 -0.06之間。可見兩者均欠缺彈性，

且住院較門診的彈性值更小。 2.門診之住院交叉彈性為 0.0015 至

0.0016 之間，顯示門診與住院之間有些替代效果存在。 3.門診之所得偏

彈性係數為 0.19至 0.22之間，表示門診是種正常品，且其彈性值並不大

。 4.部分負擔在門診上所節省之保險給付，若以負擔率為 10%來看，約

佔保費收入之 6.6%至 10.2%；醫療給付之 8.2%至 24.9%。但若提高部分

負擔至 25%時，則上述各數值約增加為兩倍。可見部分負擔對於保險財務

之補充，實具有相當功效。 5.以 10% 至 25% 的門診部分負擔率來估算

，一般家庭於一年內須自付之門診費用，約佔家庭消費支出之 0.3%至

1.3%，佔儲蓄金額之0.7%至 3.0%，佔可支配所得之 0.2% 至 0.9%。其比

率並不算高，應不至於對一般家庭形成過重之經濟壓力。但若常使用醫療

資源的話，負擔將會更加提高且不容忽視。

---

This research attempts to estimate the financial effects of

cost-sharing system in Taiwan's health insurance. According to

book-keeping data of 1,327 families, the study uses the linear

& exponential model of the multiple regression to analyze the

demand of the medical resources in Taiwan. The major results

are as following: 1. The partial price elasticity of the

outpatient care is esti- mated between -0.27 and -0.28, while

the partial price elasti- city of the inpatient care is -0.06.

Both are inelastic, but the inpatient care is ever more

inelastic than the outpatient care. 2. The cross elasticity of

the outpatient visits demanded with respect to inpatient price

is between 0.0015 and 0.0016. It shows that there are some

substitutions between two kinds of medical care. 3. The partial

income elasticity of the outpatient care is esti- mated between

0.19 and 0.22, which reveals that the outpatient care is a

normal good though the elasticity is small. 4. As to the

potential effect of cost-sharing system on saving outpatient

benefit, if the cost-sharing ratio were 10%, the reduced

payment as the share of the premium is expected from 6.6% to

10.2% and as the share of the medical benefit from 8.2% to

24.9% depending on varying assumptions. If the ratio were

raised to 25% , the reduced payment is projected to be twice as

above. It implies that the cost-sharing system could be

effective to improve the insurance finance. 5. It is further

estimated that, when the cost-sharing ratio of the outpatient

care were 25%, the cost-sharing burden for an average family is

1.3% with respect to the consumption expend- iture, 3.0% with

respect to the savings and 0.9% with respect to disposable

income. These ratios are not too high and an av- erage family

can afford it. However, for those using medical services more

heavily, their burden could be much higher and should be

seriously considered.

1. 中央研究院經濟研究所(1993)，「全民健保給付與財源方案之比較」，臺灣經濟預測與政策，第二四卷第一期，頁二二七至三三四。
2. 內政部(1985)，「勞工保險醫療費用部分負擔制度之研究」，臺北：內政部社會保險叢書。
3. 王家銓(1985)，各國醫療保險制度的研究，臺北：茂昌圖書有限公司。
4. 方曉娟(1992)，「台北市兒童醫療需求的實證研究」，政治大學經濟學研究所碩士論文。
5. 白培英(1993)，「我國社會保險之財政負擔」，保險專刊，第三二輯，頁一至十。
6. 行政院經濟建設委員會全民健康保險規劃小組(1990)，「國人對部分負擔之負擔能力及負擔意願」，全民健康保險規劃小組中間報告之二。
7. 吳肖琪(1991)，「健康保險與醫療網區域資源對醫療利用之影響」，臺大公共衛生學研究所博士論文。
8. 吳國士(1990)，「健康保險對民眾醫療消費行為影響之研究」，中原大學企業管理研究所碩士論文。
9. 吳凱勳(1992)，健康保險概論，臺北：中國社會保險學會。
10. 林小嫻(1993),臺灣地區國民醫療保健支出及其財源與配置，中央研究院經濟研究所。
11. 林芸芸(1992),「新店民眾部分負擔意願及能力」，公共衛生，第一九卷第一期，頁二五至三七。
12. 林淑萱、陳幼華、鄭清峰、蕭麗卿譯(1990),「醫療費用部分負擔制度的研究」,臺北：臺閩地區勞工保險局。
13. 周麗芳(1987),「老年人口醫療需求與醫療資源利用之研究」,陽明醫學院公共衛生學研究所碩士論文。
14. 柯木興(1992),社會保險，臺北：中國社會保險學會。
15. 郎慧珠(1989),「台北都會區民眾對健康保險部分負擔付費意願之探討」,楊明醫學院公共衛生學研究所碩士論文。
16. 紀艷瓊、甯素珠、蔡淑鈴(1989),「公務人員保險實施醫療費用部分負擔制度之研究」,中央信託局。
17. 翁世傑(1985),「社會保險醫療費用部分負擔之研究」,逢甲大學保險學研究所碩士論文。
18. 黃玄騰(1986),「我國公保支出的經濟分析」，逢甲大學經濟學研究所碩士論文。
19. 黃玄騰(1987),「從經濟學觀點談保險政策對醫療資源浪費與解決途徑」,第一二五期，頁二九至三六。
20. 黃世鑫、余漢儀、吳炎成、鄭文輝、蔡爵霙(1992),「我國全民社會醫療保險制度之研究」，臺北：業強出版社。
21. 陳炫碩(1990),「臺灣地區全民健康保險部分負擔制度之研究」,中原大學企業管理研究所碩士論文。
22. 張慶輝(1984),「勞保醫療費用增加問題調查研究」，臺灣省政府研考會。
23. 張馥芳(1992),「我國全民健康保險制度財源籌措策略之研究」,政治大學保險研究所碩士論文。
24. 曹嬿恆(1992,「醫療需求理論與臺灣的的實證研究」,政治大學經濟學研究所碩士論文。
25. 陳聽安、張慶輝、鄭文輝、梁正德、蘇建榮(1993),「我國全民建ㄤ保險財務規劃之研究」，財團法人保險事業發展中心。
26. 楊志良(1985),「社會保險醫療費用上漲原因及對策之探討－兼析醫療費用部分負擔制之效果」，社會保險年刊，第十期，頁一○二至一一○。
27. 楊志良(1989),「國人對全民健康保險部分負擔之意見調查」,中華衛誌，第九卷第四號，頁一八四至一九六。
28. 楊志良(1993),健康保險，臺北：巨流圖書公司。
29. 蔡宏毅(1992),「全民健康保險醫療給付部分負擔制之福利分析」,逢甲答學經濟學研究所碩士論文。
30. 藍忠孚(1989),「有效建立勞工保險醫療轉診及部分負擔制度」,勞工行政，第十七期，頁一○至二○。
31. 藍忠孚(1993),「健康保險部分負擔制的論證」，防止浪費醫療資源實施部分負擔制度座談會引言報告。
32. 藍忠孚、鄭惠珠(1991),「健康保險部分負擔制的理論與論證」，公共衛生,第一八卷第一期，頁一至一八。
33. 藍忠孚、鄭惠珠、郎慧珠(1991),「健康保險部分負擔付費意願之研究」，臺灣醫誌,第九一卷附冊二，頁S99-S108。
34. 謝秀宜(1993),「我國全民健康保險醫療費用部分負擔制度之研究」,逢甲大學保險學研究所碩士論文。
35. 簡宣博(1989),「臺灣農民紀康保險醫療給付之研究」,財團法人保險事業發展中心。
36. 蕭文(1992),健康保險概論，臺北：三民書局。
羅紀瓊(1991)，「人口老化對醫療支出的影響：台灣的實證研究」，經濟論文，第一九卷第一期，頁一○七至一三三。
二、西文部份
1.Andersen R. & Newman J.F. (1973), "Societal and
Individual Determinants ofMedic-al Care Utilization in
the United States", MilbankMemorial Fund Quarterly:
51,95-124.
2.AndersenG. M., Broo-k R. & William-s A. -(1991), "AComparison
of Cost-Sharing Versus Free Care in Children:
Effects. on the Demand -for Office-Based Medical
Care", Me.dical Care, 29(9), 890-898.
3 .Arnold, S. S. (1983), "The Rand Health Insurance Study
Is Cost Sharing •Dangerous to Your Health ?", New
England J ournalo.f Medicine, J09: 1453.
4.Arrow, K. J. (1963), "Uncertainty and the Welfare Economics
of Medical Care", American Economics Review:
53(5),941-973.
5. Bec.k, R . G. (1974), "The Effects of Co-payment on the
Poor", J 0 urn a I of Hu man Res 0 ur c e s, 9 ( 1) , 129-142.
6.Beck, R. G. & Horne, J. M. (1980), "Utilization of
PubIicly Insured Health Services in Saskatchewan B~fore,
During and After-Copayment", Medical Care, j 8
(8), 787-806.
7.Bro-yles, R. W_. & Rosko, M. D. (1988), "The Demand
for Health Insurance and Health Care: A Review of the
Empirical Literature", Medical Care Review ,45(2}
291-33-8.
8.Campbell, R. R. (1980), The Economics and Politics of
Health, New York: McGraw-Hi11-, 18-19.
9.Chou, Li--Fang (1993), "Selbsbeteiligun-g bei Arzneimitteln
aus ordnugspolitis-cher Sicht: das Beispiel der
B undesrepublik Deutschland", (Finanzwissenschaftliche
schriften, Bd. 55), Frankfurt am Main, Berlin;
Bern.
10.Colle A. D. & Grossman M-. (1978), "Determinants of
Pediatric Care Utilization", The Journal o,{ Human
Resources, 13, Supplement, 117-158.
11.Culyer, A. J . (1989), "Cost Containment in Europe
Health Care Financing Review,Annual Supplement
Supplement,2 1-32.
12.Davis K. & Russell L. B. (1972), "The Substitution of
Hospital Outpatient Care for Inpatient Care", The
Review 0.[ Economics and Statistics, 54(2), 109-120
13.Donaldson C. & Gerard K. (1989), "Countering Moral
M-oral Hazard in Public and Private Health Care Systems:
A Review of Recent Evidence", Journal of
Social Policy, 18, Part II, 235-251.
14.Ellis, R. P. & McGuire, T. G. (1986), "Cost Sharing
and Patterns of Mental Health Care Utilization"The
Journal o.[Human Resources, 21(3),359-379.
1S.Ellis, R. P. & McGuire~ T. G. (1986), "Provider
Behavior Under Prospective Reimburesment: Cost
Sharing and Supply", Journal 0.[ Health Economics:
5, 129-151.
16.Fein R.(1981), " Effects of Cost-Sharing in Health
Insurance--A Call for Caution", New Engfand Journal
of Medicine, 305 (25),1526-1528.
17.F-eldstein., M. (1977)," Quality Chance and the Demand
for Hospital Care ", Econometrica, 45(7), 1681-
1702.
18. Feldstein, M. S. (1971), "Hospital Cost Inflation: A
Study of Nonprofit Price Dynamics", The American
Ecnomic Revie,w, 61 (3), Part I, 853-872,
19.Feldstein, M. S. (1973), "The Welfare Loss of Excess
Health Insurance", Journal of Political Economy
Part I, 251-280,
20.'Feldstein, P. J. (1988), Health Care Economics, New
York: John Wiley and Sons, 129.
21.Fran k, R. G. & McGuire, T. G. (1986),"A Review of
Studie-s of the Impact of Insurance on the Demand
and Utilization of Specialty Mental Health Services
", Health Services Research, 21 (2), 241-265, '
22.Foxman, B., Valdez, R. B., et aL (1987), "The Effect
of Cost Sharin-g on the Use of Antibiotics in Ambu-
latory Care: Results From a Population--Based Randomized
Controlled Trial" , Journal of Chronic Diseases,
40( 5), 429-437.
23.Goldman F. & -Grossman, M. (1978), "The Demand
for Pediatric Care: An Hedonic Approach", Journal
0.[ Political Economy, 86(2), Part I, 259-280.
24-.Gree.ne, S . . B. & Gunselman, D. L. (1986), "Cost
Sharing and Its Effects on Hospital Utilization: The
Blue Cro•ss and Blue Shield of North Carolina Experience",
Medical Care, 24(8),711-720.
25.Grembowski , D., et al. (1986), "Coinsurance Effects
on Dental Prices", Social Science and Medicine.
23(11),1131-1138.
26.•Hankin, J. R., Steinwachs, D. M. & Eikes, C. (1980)
"The Impact on Utilization of a Copayment Insurance
Increase for Ambulatory Psychiatric Care"
Medical Care, 18(8), 807-815.
27.Leibowite, A., Manning, W. G., et •al. (1985), "Effect
of Cost-Sharing on the Use of Medical Services by
Children: Interim Results from a Randomized Controlled
Trial", Pediatrics, 75(5), 942-951.
28.Lurie, N., Manning, -We G.,- et al. (1987), "Preventive
C.are: Do We- Practice Want We Preach", Amercian
Journal of Public He-alth, 77(7),801-804.
29.Manning, G. M., Kenneth, B. W., et al. (1984)," Cost
Sharing and the Use of Ambulatory Mental Health
Services", American Psychologist, 39(10), 1077-
1089.
3 0 . Mann i n g, W. G., New h 0 use, J. P., eta l. ( 19 87), "
Health Insurance ,and -the Demand for Medical Care
Evidence from a Randomized Experiment" ~ American
Economic Review~ 77(3)~ 251-277.
3-1.Moffet, D. (1979)~ "The Risk-Sharing Problem, Essays
in-the Economics", Theoryo,fRisk and Insurance~ 1-2.
32.Myers, B. A. (1982), "Cost-Sharing Effects-- Revisited-"
~ Medical Care, 20( 12), 1166-1167.
33.Nelson, A. A~, Reeder, C. E. & Dickson', W. M.
(1984), "The Effect of Medicaid Drug Copayment
Program on the Utilization and Cost of Prescription
Service", Medical Care, 22(8), 724-736.
34.Newhouse, J . P. (1978), "Insurance Benefits, 'Out-of Pocket
Payments~ and the Demand for Medical Care
A Review of the Literature", Health Medical Care
Services Revielv, 13-15.
35'.Newhouse, J. P ., Manning, W. G., et al. (1981), "
Some Interim Results from a Controlled Trial of
Cost Sharing in Health Insurance", New England
Journal-ofMedicine, 305 (25), 1501-1507.
36.Newhouse, J. -P., Manning, W. G., et a-I. (1987):
"The Findings of the Rand Health Insurance Experiment:
,A Response to Welch et al.", Medical
Care, 25(2), 157-179.
37.Newhouse, J. 'P., Ro]ph, J. E., et al. (1980), "The
Effect of Deductibles on the Demand for Medical
Care Services", Journal of-the AcousticalSociety oj
American, 75(371), 525-537.
38.0ECD (1987), Finqncing and D.elivering Health Care.
Social Policy Studies NO.4,Paris,France.
39.0-'Grady, K. F., Manning, W. G., et ~I. (1985), 1'The
Impact- of Cost Sharing on Emergency Department
Use", New England Journal 0.[ Medicine, 313(8).
484-490.
40.Paff, M., Schneider, M. & Stumpf, M. (1980), "Objectives
and Forms of Cost-Sharing", In: Brandt, A ..
Horisber..ger, B. Von Wartburg, W. P. eds, Cost-Sharing
in Health Care, New York: Spring-Verlag, 117-129.
41.Peel, E. & Scharff, F. (1973), "Impact of Cost-Sharing
on Use of Ambulatory Services Under Medicare, 1969
1969", Social Security Bulletin, 36(10), 3-24.
42. P helps, C. E. & Newhouse, J . P. (1972), "Effect of Coinsurance:
A Multivariate Analysis", Social Security
Bull e tin, 3 5 ( 6 ), 20 -28 .
4-3.P_helps, C. E. & Newhouse, J. P. (1974), "Coinsurance,
the Price of Time, and the Demand for Medical
Services", Review o.[Economics and Statistics ,
56, 334-342.
44.Piland, N. F. (1979), "Cost-Sharing in Health. Insurance
Its Effects on Health Service Utilization", P .h. D. Dissertation,
University of California, Los Angeles.
45.Reinhart, U. E. (1989), "The U. S. Health Care Financing
and Delivery System: Its Experience and Lesson
for Other Nations", InternationalSymposium on
Health Care Systems, Taipei,Taiwan, R.O.C ..
46.Roddy, P. C., Wallen, J-. & Meyer-s, S. M. (1986), "Cost
Sharing and Use .ofH-ealth Service: The United Wine
. Workers of American Health Plan", Medical Care.
24(9), 873-877.
47.Roemer, M•. I., Hopkins, C. E., .et al. (1915), "Copayments
for Ambulatory Care: Penney-Wise and PoundFoolish",
Medical Care, 13(6),457-466.
48 .Scbeffer, R. M. (1984), "The United Mine Workers'
Health Plan: An Analysis of the Cost-Sharing
P-rogram", Medical Care, 22(3), 247-254.
49.Scitor-sky, A. A., McCall, N. (1977), "Coinsurance and
the ,Demand for Physician Services: F our Year Latter ".
Social Security Bulletin, 40(5), 19-27.
50.Scitorsky, A.• A. & Snyder, N. M. (1972), "Effect of
Coinsurance on Use of Physician Services", Social
Security Bulletin, 3 5( 6), 3-19.
51.Seidman L. S. (1991-), "Health Insurance Reform Consumer
Cost-Sharing", Current, March-April, No. 33 L17-22.
52. Shapiro, M. F., Ware, J. E., & Sherbourne, C. D.
(1986), "Effect of Cost Sharing on Seeking Care for
Serious and Minor Symptoms: Results of a Randomized
Controlled Trial", Annals a/Internal Medi"Cine:
104(2), 246-251.
53.Simic, S., Doknic-Stefanovjc, D., et al. (1988), "Assessment
of the Effects of Cost-Sharing in Yugoslavia",
Medical Care, 26(2),148-158.
54. Sin, A. L., Sonnenberg, F. A., et al. (1985), "Does
Cost Sharing .Reduce Inappropriate Hospital Use":
Clinical Research, 33(2), 525A.
55.Sorkin, A. L. (1984), "The Demand for Health Services",
Health Economics: An Introduction, D.C.
Health and Company, 25-44 .
56.Valdez, R. B. (19-85), "The Effects of Cost Sharing on
the Health of Children", Ph.D. Dissertation, University
of Michigan.
57.Va ldez, R. B., Brook, R. H.-, et a1. (1985), "Consequences
of Cost Sharing for Children's Health".
Pediatrics, 75(5),952-961.
58.Wagner, E. H. & Bledsoe T. (1990), "The Rand Healtth
Insurance Experiment and HMOs, Medical Care:
28(3), 191-200.
59.Wagstaff A. (1986), "The Demand for Health: Theory
and Applications", Journal 0.[ Epidemiology and
Community Health, 40, 1-11.
-60.WalIen,J., Roddy, P. C. & Meyers, S. M. (1986), "
Difference in Mantal H-ealt-h Visits Under CostSharing",
Health Services Research, 21 (2), part-II:341-350.
61.Weber 8., & Wiesmeth, H. (1990), "On the Theory of
Cost Sharing", Jourrml o,fEconom-ics, 52(1) ,71-82.
62.Wolfson, J. ,Kapadia, A. S., et al. (1982), "Effect of
Cost-Sharing on Users -of a State's Hea-Ith Service
Program", Medical Care, 20(12),1178-1187.