近年來由於全民健康保險的實施及醫療技術的提升，造成醫療費用快速上漲，而使健保財務失衡，為抑制醫療費用持續上升，全民健康保險局採用總額預算支付制度，其藉由浮動點值的設計，藉以抑制醫療院所提供過多醫療服務的意願。本研究旨在探討醫療業經營績效與中央健康保險局給付點值波動之間相關性，希望透過各醫療院所的經營績效與健保局每季設定該區域的點值數進行比較分析，以提供醫療院所設置地點決策時之參考。本研究方法使用多元迴歸(Multiple regression)，以台灣北區健保局轄內之桃、竹、苗地區之醫療院所為對象，並收集健保局1999 年至2008 年的點值波動資料加以分析討論，以醫院績效變化與健保局每季點值波動1，對區域分配2是否有不均之情況加以研究。本研究結果顯示：1.中央健康保險局在總額支付下，點值波動於不同層級之醫療機構有顯著之差異，醫學中心3則影響較小。2.區域醫院4及地區醫院5的設置地點，會因健保局給付點數之波動而有所影響。本文建議門診點值有必要回復固定點值，以保障民眾的就醫權利。 Due to the implementation of National Health Insurance (NHI) and the improvement of the medical technology, the health expenditures increase sharply and lead to financial crisis of NHI consequentially. The application of global budget payment system was intended to suppress the inclination of clinics to offer excess medical services by implementing a floating points design where the points would change quarterly. It is an interesting issue to investigate how such kind of system affects the performance of medical care institutions. The aim if this research to investigate the relationship between the performance of medical care institutions and the floating points given by Bureau of National Health Insurance (BNHI). The outcome may present a policy reference for the allocation of clinics by analyzing their performances and the points given to that area. Multiple regression model is applied to analyze the data compiled from the clinics in Taoyuan, Hsinchu and Miaoli. The BNHI data of floating points from 1999 to 2008 were analyzed to figure out whether there was any influence of the performances of clinics to the given floating points. This research indicates that: 1) significant variations caused by floating points present in different levels of medical care institutions under the global budget payment system. There is smaller influence on the medical center; and 2) the allocations of area clinics and district clinics are affected by the points and a point ratio of 1:1 would give an even distribution of medical resources.
