Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, Taiwan.
Health Policy. 2020 Nov;124(11):1192-1199. doi: 10.1016/j.healthpol.2020.03.013. Epub 2020 Jun 30.
This study investigates the welfare effect of copayment adjustments on emergency department (ED) visits in medical centers under the National Health Insurance (NHI) program in Taiwan. To this end, we first applied the smooth time-varying co-integration model to estimate the time-varying price and income elasticities of ED care demand in medical centers, and then welfare effects of various copayment adjustments were simulated. Our empirical results suggested that an upward adjustment in copayment neither cause a potential pricing-out effect nor generate a significant amount of welfare gain, despite there exists a negatively long-run relationship between copayment and ED care utilization in medical centers. Nevertheless, the share of non-urgent ED visits is positively correlated with both the negative time-varying price elasticities and welfare gain. These findings serve as important evidence to validate the application of the copayment as a strategic policy instrument to moderate both non-urgent ED care utilization and welfare loss due to moral hazard behavior under Taiwan's NHI program.
本研究考察了台湾全民健康保险（NHI）计划下医疗中心自付额调整对急诊就诊的福利效应。为此，我们首先应用平滑时变协整模型来估计医疗中心急诊护理需求的时变价格和收入弹性，然后模拟各种自付额调整的福利效应。我们的实证结果表明，自付额的上调既不会导致潜在的定价过高效应，也不会产生显著的福利收益，尽管医疗中心的自付额与急诊护理利用之间存在长期的负相关关系。然而，非紧急急诊就诊的比例与负时变价格弹性和福利收益呈正相关。这些发现为验证自付额作为一种战略政策工具的应用提供了重要证据，该工具可用于缓和台湾 NHI 计划下因道德风险行为导致的非紧急急诊护理利用和福利损失。
