全民健保實施前後健康效益評估之比較

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林隆全(Lung-Chuan Lin) 查詢紙本館藏

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產業經濟研究所

論文名稱

全民健保實施前後健康效益評估之比較

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摘要(中)

本研究主要是探討制度的差異是否會影響民眾對於健康改善的願付金額。我們以全民健保實施前後為例，探討民眾對於健康改善的願付金額是否有所改變。
由於國內對於健康改善的願付金額之相關研究，在研究主題、問卷設計、調查時間與調查地區都有所不同，所以經過篩選之後，研究主題設定為感冒；在個案選擇方面，分別為劉錦添、王榮德與劉錦龍（1996）之「空氣品質改善對學童健康效益評估」以及蕭代基與蕭新煌（2003）之「電力設施社會經濟影響研究」。
實證模型採用Alberini et al.（1996）的方法。我們將函數設定成半對數型的函數形式，以配合存活分析（survival analysis）中的位置尺度模型（location scale model）。
研究結果顯示，全民健保實施前後，民眾對於健康改善的願付金額分別為938和462元。我們將這兩份問卷合併估計，加入了一個劃分年份的虛擬變數，估計結果顯示，全民健保實施後的受訪者，其願付金額為實施前受訪者的58%。
理論上，一個人對於避免疾病的願付金額應該包含三個部份：生病時的負效用之價值、生病時的時間損失之價值以及減輕身體不適的醫療費用（Harrington and Portney, 1987）。醫療費用又包含買成藥以及看醫生的費用。
過去大部分為自費的年代，透過CVM所得到的願付金額可以充分反映這三項成本。然而，全民健保實施後，民眾就醫的現金支出大幅減少，經過這七年的適應期，民眾認為一場感冒所應支付的醫療費用已經與先前大不相同。
因此，全民健保實施後，透過CVM衡量受訪者避免感冒的願付金額，會低估健康改善的經濟效益，需要透過中央健康保險局的資料加以調整，才能評估真正的健康效益。

關鍵字(中)

★ 條件評價法
★ 願付金額
★ 存活分析
★ 位置尺度模型
★ 特徵價格模型
★ 健康效益
★ 全民健保

關鍵字(英)

★ location scale model
★ survival analysis
★ WTP
★ CVM
★ hedonic model
★ National Health Insurance
★ health benefit

論文目次

第一章緒論 1
第一節研究背景 1
第二節研究動機與研究目的 5
第三節研究方法與論文架構 6
第二章文獻回顧 7
第一節條件評價法的相關文獻 8
第二節條件評價法應用在健康效益評估的相關文獻 13
第三章人類健康風險降低效益模型 20
第四章資料來源與資料說明 26
第一節資料來源 26
第二節資料說明 27
第五章實證模型與變數說明 36
第一節實證模型 36
第二節變數說明 38
第六章實證結果 45
第一節全民健保實施前 45
第二節全民健保實施後 49
第三節綜合比較 53
第七章結論 60
第一節研究結論 60
第二節研究限制 62
參考文獻 63
附錄一 1995年問卷節錄 68
附錄二 2002年問卷節錄 76

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指導教授

劉錦龍(Jin-Long Liu)

審核日期

2004-7-15

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