| 研究生: |
楊立維 Yang, Li-Wei |
|---|---|
| 論文名稱: |
全民健保制度下部份負擔調整與醫療需求之關係 The Relationship of Co-payment Adjustment with Medical Demand of NHI in Taiwan |
| 指導教授: |
康信鴻
Kang, Hsin-Hong |
| 學位類別: |
碩士 Master |
| 系所名稱: |
管理學院 - 高階管理碩士在職專班(EMBA) Executive Master of Business Administration (EMBA) |
| 論文出版年: | 2007 |
| 畢業學年度: | 95 |
| 語文別: | 中文 |
| 論文頁數: | 89 |
| 中文關鍵詞: | 門診醫療需求 、部份負擔 、政策因素 、多元迴歸分析 、聯立方程式 |
| 外文關鍵詞: | medical demand in outpatient department, copayment, policy, simultaneous equations, multiple regression |
| 相關次數: | 點閱:122 下載:2 |
| 分享至: |
| 查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
摘 要
本文之目的為試圖找出影響門診醫療需求之因素及部份負擔調整政策對醫療需求之影響最後針對部份負擔與醫療需求的關係提出解釋及分析。
本文以2002年1月至2006年12月健保局統計各醫療院所申報之門診金額為研究對象,藉由計量經濟學的方式,透過e-view軟體進行實證分析.就各別主題建立各別單一方程式模型討論之。
根據迴歸分析發現,影響醫療需求因素中,部份負擔、醫療院所數、健保保險人數、政策因素,對醫療需求有顯著正相關之影響。影響部份負擔金額之因素中,醫療需求有顯著正相關之影響。
透過聯立方程式以部份負擔為外生變數以門診醫療需求為內生變數,實證顯示部份負擔與醫療需求間有顯著正相關,因此;本研究顯示部份負擔金額的變動調整弧度愈大對台灣門診需求量的影響也愈大,且二者關係呈現顯著性。
Abstract
This thesis aims at investigating the factors with respect to outpatient medical demand and the relationship between adjusted copayment policy and medical demand, and further proposing the interpretation analysis.
Our survey objects are the total medical expenditure at outpatient departments claimed to National Health Insurance Bureau from January 2002 to December 2006. We construct a single regression model in terms of individual topics via econometrics and conduct our empirical analysis by the software package “e-view”.
The results of our regression models show that there are positive relationships among copayment, the number of hospitals, the number of National Health Insurants, policy.in terms of the factors with respect to outpatient medical demand. In terms of the factors with respect to copayment, there is positive relationship with medical demand.
Through simultaneous equations, we further treat copayment as an exogenous variable and medical demand in outpatient department as an endogenous variable. Our empirical result shows that copayment is significantly and positively related to medical demands. Hence, our study argues that the greater the radiance of adjusted copyament, the more medical demand in outpatient department; the relationship between them is significant and positive.
一、中文文獻
石曜堂、葉金川、楊漢泉、羅紀瓊、張明正、吳正儀,1994,台灣地區國民自付醫療費用調查:1992年國民醫療保健支出調查之初步發現,中華衛誌,13:6,P473-484.
江均毅(2002)•大醫院或小診所?影響民眾選擇就醫層級因素之研究•國立台北大學,碩士論文•
江東亮(2001).醫療保健政策—台灣經驗﹐巨流圖書。
李淵真、阮仲垠(1989).勞保醫療費用部分負擔制度之探討,醫院1989;22(1):pp.17-21.
李季黛(2003)•醫院員對總額支付制度之滿意度研究---以南部某醫學中心為例•義守大學,碩士論文•
李隆安、藍忠孚、吳肖琪(1999)‧人口老化對全民健康保險醫療利用與費用影響之評估研究,行政院衛生署八十七年度委託研究計劃.
林慧修(2002)•部分負擔對不同種類醫療服務之影響分析•國立陽明大學,碩士論文•
林惠雯、薛亞聖(2003).醫療消費者及醫療提供者對全民健保新制門診藥品部分負擔的認知、態度及行為之研究.台灣衛誌2003.Vol.22.No1.
林小鳳(2002),全民健康保險醫療費用影響的因素,中國醫藥學院醫務管理研究所碩士論文。
吳佩璟(2000)•全民健保實施下影響門診病患選擇就醫層級因素之探討---以在北市小兒科就診的門診病患為例•國立台北大學,碩士論文•
紀駿輝(1999)•部份負擔的深度探討•全民健康保險,21,P10-14•
周麗芳(1998)•我國健康保險醫療費用部份負擔經濟效果分析與制度改進•全民健康保險監理委員會DOH86-HS-001研究計劃•
研考會(1986).區域醫療保健体系之研究﹐研考會委員會。
陳楚杰(1994).醫療組織與管理﹐宏翰文化。
陳禮穆(1998),個人醫療支出變化的解釋—風險因子的探討,中央大學產業經濟研究所碩士論文.
陳世能、邱雅苓(2003),醫療保健支出成長因素之探討—時間序列分析與門檻模型的應用,經濟研究,39(2),P197-240。
許志成、季瑋珠(1996),門診高度使用者之特性,中華衛誌,15:1,P91-95.
游慧光、王漢民、鄭新慶(2005).台灣醫療支出成長因素與其相互關係之研析.財稅研究,第37卷第1期P81-97.
黃泰郎(2006)•臺灣鋁擠型市場的需求影響因素及趨勢預測•國立成功大學,EMBA碩士論文•
塗宜均(2003)全民健保部分負擔調整對民眾門診醫療利用的影響—以門診高利用者為物件‧國立台灣大學,衛生政策與管理研究所碩士論文‧
楊志良、林雨靜(2002)•健保費率以部份負擔調漲之適當性評析•國家政策論壇季刊•創刊號P273—279•
楊銘欽、李姣姿、邱尚志(2004)•供需成本節制對健保醫療費用影響之時間序列分析•台灣衛誌2004;23(5):P377-387•
楊志良、張育嘉(2005).全民健康保險的問題與改革﹐財團法人國家政策研究基金會。
劉琪(2000)探討88年8月1日門診藥品部份負擔後,對全民健保醫療利用與醫療支出之影響。國立台灣大學會計研究所碩士論文•
劉採卿、陳欽賢、周添成(1999)‧影響台北都會區民眾就醫因素之探討,第四屆經濟發展研討會論文.
廖繼鋐(1997),我國中老年醫療使用及對全民健保費用影響之探討,中正大學社會福利系碩士論文.
錢梅芳(1997).影響民眾選擇西醫門診就醫層級之因素探討;台大公衛所碩士論文.
謝啟瑞、林建甫、游慧光(1998)台灣醫療保健支出成長原因的探討,人文社會學集刊,10(1),P1-32。
謝啟瑞(1996),健康經濟學,五南圖書出版公司。
羅英瑛(2001)•門診部分負擔制度對醫療費用及服務量之影響•國立中山大學﹐碩士論文‧
二、英文文獻
Arrow,KJ (1973). Optimal insurance and generalized deductibles,Santu Monica,CA:Rand Co.
Barros,P.P.(1998).“The black-box of health care expenditure growth determinants”,Health Economics 7,P533-544.
Beck,R.G and J.M.Hovue(1980).Utilization of public insurance health serice in sakatcheman before during and after copayment,Medical Care,18:8,P787-806•
Becker, G.S.(1965).”Theory of the Alloction of Time”Economic Journal 75:P493-517.
Broyles ,R.W.& Rosko,M.D(1988).The demand for health insurance and healthcare:A review of the empirical literature medical care review.45(2).P291-338•
Chang, FR(1996).Uncertainty and investment in health. Journal of Health Economic.15:P369-376.
Cherkin,D.C.Grothaus,L.&Wanger,E.H(1990).The effect of office visit copayents on preventive care service in an HMO,Inquiry.27(1),P24-38•
Cheng,s.h;Chiang,T.L.(1997).The effect of universal health insurance on health care utilization in Taiwan:results from a natural experiment. Journal of American Medical Association, 278,(2)P89-93.
Cockx,b.and c.Brasseur,2003.The demand for physician services:Evidence from a natural experiment,Journal of Health Economics 22(6):P881-913.
Cropper,ML. Health investment in health and occupational choice.Journal of Political Economy.85:P1273-1294.
Damodar,N.Gujarati(2006).Essentials of Econometrics.
Feldstein, MS. (1973). The welfare loss of excess health insurance.Journal of political Economy.81(1):P251-280.
Feldstein,PJ and Carr,J(1964).The effect of income on medical care spending.Proceedings of the Social Statistics Scetion of American Statistical Association.
Foldstein,Ms(1973).the welfare loss of excess health unsurance. Journal of political economy81(1),P251-280•
Folland,So.Goodman,A.C&Stano,M(1997).Consumer choice and d emand .The econmics of health and health care (2nded) New Jersey: Prentice-Hall.
Gerdtham,U.J.Sogaard,F.Andersson and B.Jonsson(1992).“An Econometric Analysis of Health Care Expenditure:A Cross-Section Study of the OECD Countries”.Journal of Health Economics,11,P63-84.
Getzen,T.E.(1990).“Macro Forecasting of National Health Expenditures”in Richard M.Scheffler and Louis F,Rossiter eds.Advances in Health Economics and Health Services Research,11,Greenwich,Conn:JAI Press.
Grossman,M.(1972).“On the Concept of Health Capital and the Demand for Health”.Journal of Political Economy,80(2),P223-255.
Hu,The-wei and Mei-ling Sheu,2000.“Patterns and Regional Variations of Health Care Expenditure and Utilization in Taiwan-A Pooled Time-series and Cross-section Data Analysis ”.A Report of Bureau of National Health Insurance.
James,R.McGuigan,R.Charles Moyer,Frederick,H.deB.Harris,2002“Managerial Economics”.
Leu,R.E.,1986.”The public-private mix and international health care costs”.in:A.J.Culyer and B.Jonsson,eds.,Public and Private Health Services:Complementaries and Conflicts,Oxford:Basic Blackwell.
Miline,R.and H.Molana,1991.”On the effect of income and relative price on demand for health care:EC evidence”.Applied Economics 23:P1221-1226.
Murthy,N.R.V.Ukpolo(1994).“Aggregate Health Care Expenditure in the United States:Evidence from Cointegration Tests”Applied Economics,26,P797-802.
Newhouse ,JP.Phelps,CE(1976). New estimates of price and income elasticities for medical service. In R.N.Rosett. The role of health insurance in health service sector. New York, National bureau of Economic Research Inc.
Newhouse,J.P.1997.”Medical care expenditure:a cross-national survey”.Journal of Human Resources12:P115-125.
Parkin,D.,A.McGuire andB.Yule(1987).“Aggregate Health Care Expenditures and National Income:Is Health Care A Luxury Good?”Journal of Health Economics,6,P109-127.
Rei watanab yasushi ohkusa(2000).An analysis o f the price elasticity of health-care demand for diabetes mellitus in Japan,The review of economic studies(49),P533-549•
Selby,J.V,Fireman,B.H,Swain,B.E(1996).Effect of copayment on use of emergency deportment in a health maintenance organization,New England Journal of Medicine 34(10),P635-641•
Solanki,G.Schauffler,H.H(1999).cost-sharing and utilization of preventive services,American Journal of Preventive Medician.17(2),P127-133•
Statmann, T(1999).What do medical service buy? Effect of doctor visits on work day loss. Eastern Economics Journal.25:P1-26.
Stoller,S.D Willis,R&Zhou,Y.(1996).Effects of copayment on office visits in a large group model HMO.AHSR&FHSR Annual Meeting Abstract Book,13,90•
Viscusi,W.K.1994a.“Risk-risk analysis”.Journal of Risk and Uncertainty 8,P5-17.
Viscusi,W.K.,1994b.“Mortality effects of regulatory costs and policy evaluation criteria”.Rand Journal of Economics 25,pp.94-109.
Woodside, A.G Frey L.L Dalyr.T(1989)."Linking service quality customer satisfaction and behavioral inteation" Journal of health care marketing 9:P5-17•
Wagstaff,A(1986).The demand for health:Some new empirical evidence.Journal of Health Economics.5:P195-223.
Wagstaff,A(1993).The demand for health:an empirical reformulation of the Grossman model.Health Conomics.2:P189-198.
Zeckhauser,R(1970).Medical insurance: a care study of the trade-off between risk spreading and appropriate in centives . Journal of economic theory 2(1),P10-26•