由飲酒對醫療利用影響探究開徵酒品健康捐之正當性

本文目的在於分析飲酒過量是否確實導致醫療資源使用及支出的增加，評估政府開徵酒品健康捐是否存在正當性。本文嘗試回答兩個問題：一為飲酒過量是否增加醫療利用，二為飲酒過量所引發相關疾病及交通意外的整體就醫成本多寡，藉此評估政府是否應開徵酒品健康捐。本文利用2005年國民健康訪問調查（NHIS）資料串聯2005年全民健康保險研究資料庫（NHIRD）中的「門診處方及治療明細檔」（CD檔）及「住院醫療費用清單明細檔」（DD檔），並運用二部負二項分配模型（Two-Part NegBin）估計飲酒過度對醫療利用之影響；另以2006－2008年NHIRD的CD檔及DD檔，估算2006－2008年因飲酒所引發疾病及交通意外的就醫成本。估計結果顯示飲酒過度者門診就醫機率及次數顯著較低，但住院機率較無飲酒者高；飲酒所引發疾病及交通意外的整體醫療成本每年約70億元的支出，且金額有逐年上升趨勢，可見得飲酒過量不僅危害健康，且造成醫療費用龐大負擔。因此本文建議政府應審慎考量開徵酒品健康捐，除可挹注全民健保安全準備以健全健保財務，更可使外部成本內部化，並達減少飲酒過量行為以降低相關醫療成本之功效。
Appraise whether Taiwan should levy the alcohol health and welfare surcharge. This study first analyzes the relationship between alcohol-drinking and the related health care utilization, and then estimates the overall medical costs of alcohol- related illnesses and the traffic accidents. A two-part negative binomial regression model is employed to estimate the impact of excessive alcohol drinking on the health care utilization using 2005 National Health Interview Survey(NHIS) merging with 2005 outpatient (CD) and inpatient utilization (DD) files National Health Insurance Research Database (NHIRD). Furthermore, both of CD and DD files of NHIRD in 2006-2008 are used to estimate the incremental medical costs of alcohol-related illnesses and traffic incidents. Our results show that for patients consuming excessive alcohol, they have a higher chance of being hospitalized. It is estimated that the medical cost of alcohol-related illnesses and the traffic incidents is increased by around NT$ 7 billion, and this amount is increasing over years. It indicates that excessive alcohol consumption is not only harmful for a personal health; it causes a tremendous health care burden for a society as well. The authorities should consider levying the alcohol health and welfare surcharge prudently, since not only can it ease part of NHI financial burden, it can also lower the alcohol consumption, and then reduce the related medical costs.