博碩士論文 93444009 詳細資訊




以作者查詢圖書館館藏 以作者查詢臺灣博碩士 以作者查詢全國書目 勘誤回報 、線上人數:14 、訪客IP:3.235.11.178
姓名 林宜靜(I-Ching Lin)  查詢紙本館藏   畢業系所 產業經濟研究所
論文名稱 牙醫師執業行為之經濟分析
(The Economics Analyses of Dentist Practice Patterns)
相關論文
★ 投資者之風險屬性與基金理財績效之實證研究★ 企業經營績效的影響分析-以台灣醫療器材產業為例
★ 銀行財富管理業務手續費收入影響因素之實證研究★ 母親的教育程度對兒童醫療利用行為之影響
★ 地區醫院的存亡與轉型★ 教育對健康的影響—臺灣地區老人之實證研究
★ 醫院購置高科技醫療儀器與市場結構的關聯★ 台灣地區醫院最適效率規模的估計-倖存者分析方法應用
★ 出口與生產力的關聯 —台灣電子業廠商之實證研究★ 社會資本與家庭結構對健康及醫療資源利用之影響 —台灣地區老人之實證研究
★ 醫療利用可近性—台灣老人之實證研究★ 父母健康知識與其子女健康狀況之關聯
★ 臺灣股市之效率檢定及多因素模型之探討—長期追蹤資料之計量分析★ 醫療資源與國人健康的關聯
★ 青少年菸害的健康風險認知與吸菸行為的關聯─台灣地區的實證研究★ 醫療資源可近性對個人醫療利用的影響 ――台灣地區的實證研究
檔案 [Endnote RIS 格式]    [Bibtex 格式]    [相關文章]   [文章引用]   [完整記錄]   [館藏目錄]   [檢視]  [下載]
  1. 本電子論文使用權限為同意立即開放。
  2. 已達開放權限電子全文僅授權使用者為學術研究之目的,進行個人非營利性質之檢索、閱讀、列印。
  3. 請遵守中華民國著作權法之相關規定,切勿任意重製、散佈、改作、轉貼、播送,以免觸法。

摘要(中) 牙科屬於基礎醫療照護專科,在維護國民健康方面扮演重要角色。然而,牙醫師執業型態以及牙醫診所之醫師組成型態與醫療結果之關聯性如何?牙醫總額支付制度對牙醫師執業的區位選擇是否有影響?本論文將以「牙醫師執業行為之經濟分析」為主軸,採用國家衛生研究院健保資料庫,分別以牙齒根管治療結果及醫師執業地點異動情形,進行探究三個相關之議題。研究結果分述如下:
議題一,研究焦點在牙醫群醫執業的醫療結果是否優於獨立執業型態?以病患牙位為觀察單位,設定order probit 模型分析診所執業型態與根管治療結果之關聯性,實證結果顯示在群醫診所接受根管治療的牙齒持續保存良好之機率高於獨立執業診所,而且此效果隨著群醫診所之規模而遞增。究其原因,乃群醫執業藉由合作學習、專業分工及發揮規模經濟效益等優勢,而提升醫療結果。
議題二,根據第一個議題群醫執業之醫療結果,將群醫診所之型態分為三種,研究焦點在探討醫師固定地點執業型診所、醫師流動地點執業型診所及混合型診所等三種型態之醫師的醫療結果是否存在差異?以牙醫師為觀察單位,設定診所固定效果的最小平方估計法,實證結果顯示:混合型之醫師兼具固定地點執業型醫師的品牌聲譽效應與流動地點執業型醫師的知識外溢效果,使得根管治療的牙齒保存良好機率較高。
議題三,由於群體執業之醫師未必固定在單ㄧ診所看診,在人力可自由流動的市場,瞭解醫師區位選擇的決策因素,有助於解決醫療人力不均的問題,因此本議題焦點在分析總額支付點值是否影響牙醫師之區位選擇?根據牙醫師執業的區域特性來分析造成牙醫師變更執業地點的誘因。實證結果顯示,牙醫師會因為支付點值較高而留在原地區執業,而支付點值越高的地區(醫療資源相對貧乏區)越能吸引31至40歲的牙醫師遷入。剛畢業的牙醫師首次區位選擇傾向在支付點值成長率高的地區,因此,牙醫總額支付制度對平衡牙醫師人力分布有正向效果。
摘要(英) Dental care definitely plays an essential role in maintaining general health. By employing the data extracted from the National Health Insurance Database, this study empirically examined the correlation between dentist practice and quality of dental care which is measured by the outcome of root canal treatment. Furthermore, this paper assesses the influence of dental global budgets on dentists’ location choices. The objective of this dissertation concerns three issues relating to dentist practice patterns.
In first issue, this study empirically investigated whether dentists practicing in group tend to have better performance than that of the solo counterparts. Order probit model showed that success rate of root canal treatment is significantly increasing with the group size. The better performance of dentist group practice may result from the effect of peer learning, peer competition, economies of scale and labor division within a workplace.
In the second issue of this study, we divided dental clinics into three types: (1) clinic with all mobile practicing dentists; (2) clinic with all immobile practicing dentists; and (3) clinic is mixed, containing both mobile and immobile practicing dentists (“mixed type” hereafter). Based on a physician-level data, this study investigates the treatment outcome disparity among different types of clinics via employing ordinal least squares with clinic fixed effects. Our results found that dentists of the mixed type were likely to have better performance. This improvement could be attributed to brand name and knowledge spillovers effect.
In the third issues, we investigate the effects of dental global budget on dentists relocated their practices. Markets with high point value of dental global budget did increase the probability of staying in the original markets for dentists. Dentists who aged 31-40 and relocated their practices were most likely to switch to a county where the point value was higher than their original markets. Further, higher growth rates of point value did affect the choice of initial practice location by new dentists. Hence, the result reveals that dental global budgeting could improve the equality of medical resources distribution.
關鍵字(中) ★ 群醫執業
★ 根管治療
★ 流動地點執業
★ 牙醫總額支付點值
關鍵字(英) ★ group practic
★ root canal treatment
★ mobile practicing dentists
★ global budget
論文目次 目 錄

中文摘要 i
英文摘要 ii
誌謝辭 iii
目錄 iv
圖目錄 vi
表目錄 vii
第一章 緒論 1
1.1 研究動機 .1
1.2 全文架構 2
第二章 牙醫師執業型態與醫療結果的關聯性 4
2.1 前言 4
2.2 台灣牙科診所群醫執業的發展概況 7
2.3 研究資料 11
2.4 實證模型 17
2.5 實證結果 19
2.6 實證結果穩健性檢視(Robustness check) 27
2.7 結論 30
第三章 牙醫診所之醫師組成型態與醫療結果的關聯性 31
3.1 前言 31
3.2 文獻回顧 34
3.3 台灣牙醫診所醫師組成型態概況 36
3.4 實證模型與研究資料 39
3.4.1 實證模型 39
3.4.2 研究資料 41
3.5實證結果 47
3.6 結論與研究限制 49
3.6.1 結論 49
3.6.2 研究限制 51
第四章 總額支付的點值影響牙醫師之區位選擇嗎? 52
4.1 前言 52
4.2 文獻探討 56
4.3 實證模型與研究資料 60
4.3.1 實證模型 60
4.3.2 研究資料 68
4.4 實證結果 74
4.5 結論與研究限制 81
4.5.1 結論 81
4.5.2 研究限制 83
第五章 結論 84
參考文獻 87


圖目錄

圖4.1 模型ㄧ牙醫師變更執業地點之選擇架構 63
圖4.2 模型二與模型三之牙醫師區位選擇架構 67
圖4.3 健保六分局牙醫總額支付點值趨勢圖 72

表目錄
表2.1 台灣地區牙醫診所家數及執業型態的概況 11
表2.2 變項名稱與敘述統計分析 15
表2.3 追縱根管治療5 年內之成效與診所規模之對照 17
表2.4 牙醫執業型態與醫療結果的關聯---兩階段最小平方法估計結果 23
表2.5 牙醫執業型態與醫療結果的關聯---order probit模型估計結果 25
表2.6 牙醫執業型態與醫療結果的關聯---邊際效果 26
表2.7 牙醫執業型態與醫療結果的關聯---醫師固定效果線性機率模型估計
結果 29
表3.1 台灣地區群體執業牙醫診所家數及診所之醫師組成型態的概況 37
表3.2 流動地點執業之醫師與固定地點執業之醫師在各健保分局的占率 38
表3.3 流動地點執業之醫師同一時期之執業場所數的占率 38
表3.4 實證模型之變項名稱、定義與敘述統計分析 44
表3.5 診所型態之牙醫師與醫療結果之關聯性--兩階段最小平方法估計結果 48
表3.6 診所型態之牙醫師與醫療結果之關聯性實證結果-診所固定效果模型 49
表4.1 牙醫師特性與區位選擇特性 71
表4.2 變數說明 73
表4.3 變數之描述性統計分析 74
表4.4 模型一牙醫師遷出原執業地點之決策因素 76
表4.5 模型二牙醫師遷入新執業地點之決策因素 79
表4.6 模型三剛畢業牙醫師首次區位選擇的決策因素 81
參考文獻 林恆慶、張伊萍、陳楚杰、王炳龍與董鈺琪 (2002),「開業醫師對聯合執業之參與意願與模式之質性研究」,醫務管理期刊,第3 期第3 卷,58-69。
李貞姮、藍守仁與謝天渝 (2002),全民健保對牙醫師人力及醫療照護費用之分布探討一以高屏地區為例,臺灣口腔醫學衛生科學雜誌,第18卷第1期,59-69。
林宜靜、李忠興與蔡偉德(2010),「群醫執業型態與醫療品質的關聯:以牙醫根管治療門診案件為例」,發表於第十一屆全國實證經濟學研討會,輔仁大學舉辦,民國99年5月22日。
陳楚杰、楊銘欽、林恆慶與黃昱瞳 (2002),「參與聯合執業基層醫師之特性及其較認同的聯合執業模式,醫護科技學刊,第4 期第4 卷,337-348。
黃昱瞳、楊長興與薛亞聖 (2002),「全民健保實施牙醫總額預算制度對醫療資源分布的影響評估」,臺灣公共衛生雜誌,第21卷第6期, 403 -410。
楊涵妃與文羽苹 (2007),「台灣西醫基層診所聯合執業的變化:1998 年與2003 年」, 臺灣公共衛生雜誌,第2 期第26 卷,161-168。
鄭守夏與何玉雪 (1997),「群體執業與單獨執業醫師之生產力比較」,中華公共衛生雜誌,第16 期第5 卷,428-434。
Arrow, k. (1962), “Economic welfare and the allocation of resources for invention,” The rate and direction of inventive Activity: economic and social factors, Princeton University Press, Princeton.906-926.
Aron, D. J. (1987), “Worker reputation and productivity incentives,” Journal of Labor Economics, 5(4), 87-106.
Benham, L., A. Maurizi and M. W. Reder (1968), “Migration, location and remuneration of medical personnel: physicians and dentists,” The Review of Economics and Statistics, 50(3), 332-347.
Brown, D. M. (1987), “Do physicians underutilize aides?,” The Journal of Human Resources, 23(3), 342-355.
Bradford, W. D. (1995), “Solo versus group practice in the medical profession: the influence of malpractice risk,” Health Economics, 4, 95-112.
Bolduc, D., B. Fortin and M. A. Fournier (1996), “The effect of incentive policies on the practice location of doctors: a multinomial probit analysis,” Journal of Labor Economics, 14(4), 703-732.
Bradford, W. D. and R. E. Martin (2000), “Partnerships, profit sharing, and quality competition in the medical profession,” Review of Industrial Organization, 17(2), 193-208.
Burke, F. M., C. D. Lynch, R. Niriordain and A. Hannigan (2009), “Technical quality of root canal fillings performed in a dental school and the associated retention of root-filled teeth: a clinical follow-up study over a 5-year period,” Journal of Oral Rehabilitation, 36,508-515.
Chamberlin, E. H. (1948), “Proportionality, divisibility and economies of scale,” The Quarterly Journal of Economics, 62(2), 229-262.
Cull, W. L., H. J. Mulvey, K. G. O’Connor, D. R. Sowell, C. D. Berkowitz and C. V. Britton (2002), “Pediatricians working part-time: past, present, and future,” Pediatrics, 109(6), 1015-1020.
Casalino, L. P., K. J. Devers, T. L. Lake, M. Reed and J. J. Stoddard (2003), “Benefits of and barriers to large medical group practice in the United States,” Archives of Internal Medicine, 163(16), 1958-1964.
Davis, M. M. (1919), “Group medicine,” American Journal of Public Health, 9(5), 358-363.
Defelice, L. and W. D. Bradford (1997), “Relative inefficiencies in production between solo and group practice physicians,” Health Economics, 6, 455-465.
Daido, K. (2006), “Peer pressure and incentives,” Bulletin of Economic Research, 58(1), 51–60.
Eisenberg, B. S. and J. R. Cantwell (1976), “Policies to influence the spatial distribution of physicians: a conceptual review of selected programs and empirical evidence,” Medical care, 14(6), 455-468.
Escarce, J. J., P. Daniel, D. W. Gregory, V. P. Mark and R. K. Phillip (1998), “Health Maintenance Organization penetration and the practice location choices of new physicians: a study of large metropolitan areas in the United States,” Medical Care, 36(11), 1555-1566.
Escarce, J. J., D. Polsky, G. D. Wozniak and P. R. Kletke (2000), “HMO growth and the geographical redistribution of generalist and specialist physicians, 1987-1997,” Health Service Research, 35(4), 825–848.
Evans, J., M. J. Goldacre and T. W. Lambert (2000), “Views of UK medical graduates about flexible and part-time working in medicine: a qualitative study,” Medical Education, 34(5), 355-362.
Easthaugh, S. R. (2001), “Hospital costs and specialization: benefits of trimming product lines,” Journal of Health Care Finance, 28(1), 61–71.
Freshnock, L. J. and L. J. Goodman (1980), “The organization of physician services in solo and group medical practice,” Medical Care, 18(1), 17-29.
Fein, L. T. and R. Garfield (1991), “Impact of physicians’ part-time status on inpatients’ use of medical care and their satisfaction with physicians in an academic group practice,” Academic Medicine, 66(11), 694-698.
Fairchild, D. G., K. S. McLoughlin, S. Gharib, J. Horsky, M. Portnow, J. Richter, N. Gagliano and D. W. Bates (2001), “Productivity, quality, and patient satisfaction, comparison of part-time and full-time primary care physicians,” Journal of General Internal Medicine, 16(10), 663–667.
Goodman, L. J., E. H. Bennett III and R. J. Odem (1977), “Current status of group medical practice in the United States,” Public Health Reports, 92(5), 430-443.
Getzen, T. E. (1984), “A brand name firm theory of medical group practice,” The Journal of Industrial Economics, 33(2), 199-215.
Gaynor, M. and M. V. Pauly (1990), “Compensation and productive efficiency in partnerships: evidence from medical group practice,” Journal of Political Economy, 98(3), 544–573.
Gaynor, M. (1989), “Competition within the firm: theory plus some evidence from medical group practice,” The Rand Journal of Economics, 20(1), 59–76.
Gaynor, M. and P. Gertler (1995), “Moral hazard and risk spreading in partnerships,” The Rand Journal of Economics, 26(4), 591-613.
Grytten, J. and D. M. Dalen (1997), “Too many for too few?efficiency among dentists working in private practice in Norway,” Journal of Health Economics, 16, 483-497.
Hotelling, H. (1929), “Stability in competition,” The Economic Journal, 39(153), 41-57.
Hurley, J. (1990), “Simulated effects of incomes-based policies on the distribution of physicians,” Medical Care, 28(3), 221-238.
Hosaka, T., T. Aoki, T. Watanabe, T. Okuyama and H. Kurosawa (1999), “General hospital psychiatry from the perspective of medical economics,” Psychiatry and Clinical Neurosciences, 53(4), 449–453.
Hsueh, Y. S., S. Y. Lee and Y. T. Huang (2004), “Effects of global budgeting on the distribution of dentists and use of dental care in Taiwan,” Health Services Research, 39(6), 2135-2153.
Heiligers, P. JM., J. D. Jong, P. P. Groenewegen, L. Hingstman, B. Völker and P. Spreeuwenberg (2008), “Is networking different with doctors working part-time? Differences in social networks of part-time and full-time doctors,” BMC Health Services Research, 8(204), 19pages.
Isabel, C. and V. Paula (2010), “Geographic distribution of physicians in Portugal,” The European Journal of Health Economics, 11(4), 383-393.
Jong, J. D., P. Heiligers, P. P. Groenewegen and L. Hingstman (2006a), “Why are some medical specialists working part-time, while others work full-time?,” Health Policy, 78, 235-248.
Jong, J. D., P. Heiligers, P. P. Groenewegen and L. Hingstman (2006b), “Part-time and full-time medical specialists, are there differences in allocation of time?,” BMC Health Services Research, 6(26), 8pages.
Kim, S. (1989), “Labor specialization and the extent of the market,” Journal of Political Economy, 97(3), 692–705.
Kandel, E. and E. P. Lazear (1992), “Peer pressure and partnerships,” Journal of Political Economy, 100(4), 801–817.
Lane, P. J. and M. Lubatkin (1998), “Relative absorptive capacity and interorganizational learning,” Strategic Management Journal, 19, 461–477.
Lankford, P. M. (1974), Ph”ysician location factors and public policy,” Economic Geography, 50(3), 244-255.
Langwell, K. (1980), “Real Returns to Career Decisions: The physician’s specialty and location choices,” Journal of Human Resources, 15(2), 278-286.
Leibowitz, A. and R. D. Tollison (1980), “Free riding, shirking, and team production in legal partnerships,” Economic Inquiry, 18(3), 380-394.
Leese, B. and N. Bosanquet (1996), “Changes in general practice organization: survey of general practitioners’ views on the 1990 contract and fund holding,” The British Journal of General Practice, 46(403): 95–99.
Lazear, E. P. (1998), “Turnover, Layoffs and buyouts,” chapter 7, Personnel Economics for Managers, 167-193, New York: Wiley.
Lee, M. C. and A. M. Jones (2004), “How did dentists respond to the introduction of global budgets in Taiwan: an evaluation using individual panel data,” International Journal of Health Care Finances and Economics, 4, 307-326.
Lee, M. C. and A. M. Jones (2006), “Heterogeneity in dentists’ activity in Taiwan: an application of quantile regression,” Empirical Economics, 31, 151-164.
Lugtenberg, M., P. J. Heiligers, J. D. Jong and L. Hingstman (2006), “Internal medicine specialists’ attitudes towards working part-time: a comparison between 1996 and 2004,” BMC Health Services Research, 6(126), 10pages.
Marshall, C. L., K. M. Hassanein and R. S. Hassanein (1971), “Principal components analysis of the distribution of physicians, dentists and osteopaths in a midwestern state,” American Journal of Public Health, 61(8), 1556-1654.
Murray, A., D. G. Safran, W. H. Rogers, T. Inui, H. Chang and J. E. Montgomery (2000), “Part-time physicians: physician workload and patient-based assessments of primary care performance,” Archives Family Medicine, 9(4), 327-332.
Mistretta, M. J.(2007), “Differential effects of economic factors on specialist and family physician distribution in illinois: a county‐level analysis,” The Journal of Rural Health, 23(3), 215–221.
Newhouse, J. P. (1973), “The economics of group practice,” The Journal of Human Resources, 8(1), 37-56.
Newhouse, J. P., A. P. Williams, B. W. Benneth, and W. B. Schwartz (1982), “Does the geographical distribution of physicians reflect market failure?,” Bell Journal of Economics, 13, 493-504.
Polsky, D., P. R. Kletke, G. D. Wozniak and J. J. Escarce (2000), “HMO penetration and the geographic mobility of practicing physicians,” Journal of Health Economics, 19, 793–809.
Parr, J.M. and A. R. T. Michael (2002), “Environments, processes, and mechanisms in peer learning,” International Journal of Educational Research, 37(5), 403-423.
Parkerton, P. H., E. H. Wagner, D. G. Smith and H. L. Straley (2003), “Effect of part-time practice on patient outcomes,” Journal of General Internal Medicine, 18(9), 717-724.
Reinhardt, U. (1972), “A production function for physician services,” Review of Economics and Statistics, 54 (1), 55-66.
Rhee, S. O. (1976), “Factors determining the quality of physician performance in patient care,” Medical Care, 14(9), 733-750.
Roos, M. P. (1980), “Impact of the organization of practice on quality of care and physician productivity,” Medical Care, 18(4), 347-359.
Richard J. W. (1991), “Practice mobility among young physicians,” Medical Care, 29(10), 977-988.
Rosenthal, M. B., A. Zaslavsky and J. P. Newhouse (2005), “The geographic distribution of physicians revisited,” Health Research and Educational Trust, 40(6), 1931-1952.
Ricketts, T. C. and R. Randolph (2007), “Urban-Rural flows of physicians,” The Journal of Rural Health, 23(4), 277–285.
Scheffler, R. M. (1975), “Further considerations on the economics of group practice: The Management Input,” The Journal of Human Resources, 10(2), 258-263.
Salop, S. C. (1979), “Monopolistic competition with outside goods,” The Bell Journal of Economics, 10(1), 141-156.
Shapiro, C. (1983), “Premiums for high quality products as returns to reputation,” The Quarterly Journal of Economics, 98(4), 659-680.
Smith, C. S., D. J. Setchell and F. J. Harty (1993), “Factors influencing the success of conventional root canal therapy- a five-year retrospective study,” International Endodontic Journal, 26(6), 321 - 333.
Sundqvist, G., D. Figdor, S. Persson and U. Sjögren (1998), “Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 85(1), 86-93.
Sintonen, H. and I. Linnosmaa (2000), “Economics of dental Service,” chapter 24 in Culyer, A. J. and J. P. Newhouse, (eds.), Handbook of health Economics, 1252-1296, New York : Elsevier press
Song, J., P. Almeida, and G. Wu (2003), “Learning-by-hiring: when is mobility more likely to facilitate interfirm knowledge transfer?,” Management Science, 49(4), 351-365.
Williams, A. P. and E. Vayda, M. H. Stevenson, M. Burke and K. D. Pierre (1990),”A typology of medical practice organization in Canada: data from a national survey of physicians,” Medical Care, 28(11), 995-1004.
Zimmerman, D. J. (2003), “Peer effects in academic outcomes: evidence from a natural experiment,” The Review of Economics and Statistics, 85(1), 9–23.
指導教授 蔡偉德(Wei-Der Tsai) 審核日期 2012-12-4
推文 facebook   plurk   twitter   funp   google   live   udn   HD   myshare   reddit   netvibes   friend   youpush   delicious   baidu   
網路書籤 Google bookmarks   del.icio.us   hemidemi   myshare   

若有論文相關問題,請聯絡國立中央大學圖書館推廣服務組 TEL:(03)422-7151轉57407,或E-mail聯絡  - 隱私權政策聲明