| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 88 === Facing to deficit of National Health Insurance (NHI), a tentative study of reinsuring high medical expense cases for National Health Insurance is conducted.
This study divided into two parts, the first part was about the expense structure of hospital inpatient patients included overall cases and specific diseases, e.g. dialysis and ventricular septal defect (VSD) repair surgery; the second part was about tentative calculation of reinsurance and additional insurance rates of above mentioned three kinds of patients ─ general high expense, dialysis and VSD repair surgery.
The database was retrieved from sampled file of general claimed database and catastrophic diseases database offered by National Health Insurance Bureau of 1997. The study results showed that the reinsurance fee of the high hospital inpatient patients using “Excess of loss reinsurance” manner was $12,199,433,080 , about 15.65% of annual inpatient medical expense. The study results also revealed that the additional insurance fee of the high hospital inpatient medical expense calculated by different limits and co-payment were ranged from $484.7 to 1825.1 per person per year. The additional insurance fee of specific disease, dialysis and VSD repair surgery, were $29.6 and $9.8 per person per year respectively.
The NHI budget is under deficit currently and couldn’t afford any further reinsurance fee, so it is unsuitable to set up any additional insurance program either. The future researches can be directed to payment system reform, and use simulation technique to estimate scale, magnitude and extent of hazard of the insured.
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