市場競爭對於醫材利用與醫療品質的影響—以冠狀動脈支架植入術病患為例

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何翊安(Yi-An He) 查詢紙本館藏

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論文名稱

市場競爭對於醫材利用與醫療品質的影響—以冠狀動脈支架植入術病患為例
(The Impact of Market Competition on Utilization of Out-of-Pocket Medical Devices and Quality of Care - Cases of the Patients who had Received Percutaneous Coronary Intervention)

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摘要(中)

本論文旨在探討市場競爭對於自付差額之醫材利用與醫療品質的影響，並利用2007至2017年間接受經皮冠裝動脈介入性治療並植入支架的病患為研究標的進行研究。本文首先以市場競爭和醫師偏好為解釋變數，探討病患治療中是否選擇利用塗藥支架；接著以市場競爭與使用支架類型為解釋變數，觀察病患的醫療成效，並評估對醫療品質的影響；最後，利用結構方程模型進行中介分析，以使用塗藥支架為中介因子、市場競爭為重要解釋變數，評估競爭對於醫療品質的直接效果及透過塗藥支架產生的間接效果，以探討市場品質的提升主要來源。

根據實證結果，本研究發現市場競爭和醫師偏好皆與塗藥支架的利用呈現正相關，且醫師偏好的影響高於其他解釋變數。此外，本文也發現市場競爭的確會造成醫療成效的提升，顯示市場存在品質競爭的現象，且同時競爭也帶動提升塗藥支架的利用率，與醫療競武現象相符。然而，從中介分析中可知，在中度集中市場上，品質提升主要是來自間接效果(利用塗藥支架)的推動。

綜上所述，儘管競爭確實帶來醫療品質的提升，但同時也會為市場帶來醫材利用的改變和醫療競武現象，將有可能對於社會弱勢者產生不利的影響。然而，本研究仍存在一些限制，希冀未來研究能使用更完善的研究方法，深入了解醫療市場競爭對於醫材利用與醫療品質的影響。

摘要(英)

This research explores the impact of market competition on the utilization of out-of-pocket medical devices and quality of care. This study focuses on patients who received percutaneous coronary intervention (PCI) and had at least one coronary stent inserted from 2007 to 2017. Firstly, this research examines the influence of market competition and physicians’ preference on whether patients will use drug-eluting stents (DES) in therapy. Subsequently, using market competition in healthcare as an explanatory variable, this study observes its impact on patients’ medical outcomes, which can be regarded as a proxy variable for the quality of care. Lastly, the mediation analysis in the structural equation model will be used to evaluate the composition of the impact of market competition on quality of care, including the direct and indirect effects mediated through DES usage, thereby exploring the primary source of quality improvement in the market.

Based on the empirical results, this study finds a positive correlation between market competition, physicians’ preference, and the utilization of DES, with physicians’ preference exerting a stronger influence than other explanatory variables. Additionally, the model shows that the market competition will contribute to a better quality of care, indicating the presence of quality competition in the recent market and increasing the usage of DES, aligning with the phenomenon of the medical arms race (MAR). However, the mediation analysis shows that the indirect effect drives quality enhancement in a moderately competitive market via DES utilization.

As discussed above, although market competition can enhance the quality of care, it also brings out the changes in the utilization of medical devices and the phenomenon of MAR simultaneously, which might not benefit vulnerable groups. Whereas, there are still some limitations in this research, and future studies are encouraged to adopt more sophisticated methods and models for a deeper understanding of the effects of healthcare market competition on the utilization of out-of-pocket payment medical devices and quality of care.

關鍵字(中)

★ 市場競爭
★ 醫療品質
★ 塗藥支架
★ 醫療競武

關鍵字(英)

★ Market competition
★ Quality of care
★ Drug-eluting stent
★ Medical arms race

論文目次

中文摘要 I
ABSTRACT II
致謝 IV
目錄 V
圖目錄 VII
表目錄 VIII
第一章緒論 1
第一節研究背景與動機 1
第二節冠狀動脈心臟疾病簡介與我國現況 4
第三節研究目的 8
第二章文獻回顧 10
第一節冠狀動脈支架治療成效 10
第二節其他影響醫療成效的因素 15
第三節探討病患選擇醫療器材因素之研究 18
第四節市場競爭對於醫療市場的影響 21
第三章研究方法 24
第一節研究架構與實證模型 24
第二節羅吉斯迴歸和效果羅吉斯迴歸模型 26
第三節 COX比例與非比例危險模型 27
第四節中介因子分析 30
第四章資料來源與變數說明 32
第一節資料來源 32
第二節資料處理與建構過程 32
第三節變數選用及說明 35
第四節敘述統計 43
第五章實證分析結果 49
第一節羅吉斯迴歸與混和效果羅吉斯迴歸 49
第二節 COX比例與非比例模型分析 52
第三節中介分析 56
第六章結論與研究限制 62
第一節結論與建議 62
第二節研究限制與未來研究建議 63
參考文獻 65

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指導教授

蔡偉德(Wei-Der Tsai)

審核日期

2023-7-17

推文