目標：本研究旨在探討醫院總額預算對費用單價與服務量的影響。方法：以趨勢分析來觀察全體醫院在總額實施前後費用單價與服務量的變化；以涵蓋醫院別固定效果的迴歸分析來探討總額實施前後層級、權屬及分局等特性對費用單價與服務量的影響。資料為健保局提供的各醫院各月的門、住診申報費用、人次及住院人日，涵蓋期間為1996年1月至2005年6月。分析軟體為Stata 9.0。結果：住院次數、每日費用及門診次數長期來說皆有上升趨勢，總額實施前後並沒有顯著新增差異。每次住院平均日數有減少趨勢，然而總額實施使其顯著增加。每次門診平均費用有上升趨勢，總額實施後有顯著新增差異。總額的實施對不同層級、權屬與分局別醫院有不同程度的影響。醫學中心、財團法人醫院，台北、中區及高屏分局醫院申報的費用顯著增加；地區，公立、私立，東部與南部分局醫院申報的費用顯著減少。結論：總額實施後醫療費用更往都市、大型及財團法人醫院集中，主管機關應正視此問題。

Objectives: To investigate the effect of hospital global budgeting on the distribution of payments. Methods: We conducted a trend analysis to study the effect of hospital global budgeting on health expenditures and services. We also used a panel data model with hospital specific fixed effects to investigate payment distributions among hospitals of different levels, ownership, and locations. The statistical analysis was based on monthly hospital claims from January 1996 to June 2005 provided by the Bureau of National Health Insurance. Results: Global budgeting had no significant effect on the number of outpatient and inpatient visits. Mean expenditures per inpatient day rose over time, as did the length of stay decreased over time, though this downward trend reversed after global budgeting. After the global budgeting period, we observe a significant positive effect on mean expenditures per outpatient visit. Regarding payment distribution, medical centers, not-for-profit hospitals, and hospitals in northern and central areas all gained resources. By contrast, district, public, and private hospitals, as well as hospitals in eastern and southern areas, received fewer resources. Conclusions: After global budgeting was implemented, payments were distributed toward urban, large, and not-for-profit hospitals. The Department of Health should pay attention to this problem.

醫院總額 ； 總額預算 ； 醫療費用分配

hospital global budget, global budgeting, payment distribution