全民健保總額支付對醫院醫療競武的影響

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姓名

張雅惠(Ya-Hui Chang) 查詢紙本館藏

畢業系所

產業經濟研究所

論文名稱

全民健保總額支付對醫院醫療競武的影響
(The Effect of NHI Global Budget on Hospital Medical Arms Race.)

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摘要(中)

本篇論文是探討全民健保實施後，支付制度從論量計酬至總額支付制度，醫院市場高科技醫療儀器之數量與市場競爭程度的關聯。本研究利用「民國84至93年底台灣地區公私立醫院昂貴或具危險性醫療儀器使用台數」裡提供的電腦斷層掃描器、放射性同位素設備(放射性同位素治療和放射性同位素診斷設備的加總)、高能粒子治療設備、核磁共振斷層掃瞄器與高震波腎臟碎石機的使用數量為被解釋變數，另以三大變數「市場競爭變數」、「總額支付制度之時間虛擬變數」、「市場供需變數」作為解釋變數，以醫院為觀察單位進行固定效果負二項分配迴歸分析。
本研究的實證結果發現全民健保總額支付制度實施後，高能粒子治療設備和高震波腎臟碎石機的數量隨著市場越競爭而減少，即這兩種儀器在總額支付制度實施後，醫療競武的影響有所減緩並達到我們的預期。不過仍有三種儀器的數量並未因為總額支付制度的實施，和市場競爭程度呈現顯著性的正相關。由於本研究所採用總額支付制度實施後的觀察年度才兩年半，樣本數不足夠反映出總額支付制度市場集中度的變化和高科技醫療儀器的變化的關聯性，以致只有部份儀器的實證結果顯示醫療競武之影響有所減緩。於此，我們預期隨著總額支付制度實施的期間越長，對醫療競武的影響將會越顯著。

摘要(英)

This paper is to empirically examine the effects of global budgeting on medical arms race phenomena and its relationship with the market structure. More specifically, with the implementation of global budget, we test the possibility whether the more competitive the hospital’s market, the greater degree to which it has had to lower the acquisition of hi-tech medical equipment. Using a fixed effects negative binomial regression model based on a panel of hospitals in Taiwan for the period 1995-2004, we find that the number of two kinds of hi-tech medical equipment that a hospital has after global budgeting was initiated is negatively in relation to the degree of market competition and these results attain our expectation. However the number of the rest three kinds of hi-tech medical equipment is not. These results also suggest that we can expect along with the longer period of implementation of global budget, medical arms race phenomena will be lowered further.

關鍵字(中)

★ 高科技醫療儀器
★ 醫療競武
★ 總額支付制度

關鍵字(英)

★ hi-tech equipment
★ Global Budget
★ MAR

論文目次

第一章緒論　 1
　第一節研究動機 1
　第二節研究目的 7
第二章文獻回顧　　
　第一節醫院的品質競爭行為 8
　第二節保險支付制度對醫院行為的影響 10
　第三節國內文獻 12
第三章實證模型介紹　　
　第一節實證模型架構 14
　第二節固定效果負二項分配模型 15
第四章資料來源及變數設定　　
　第一節資料來源 18
　第二節重要變數說明及基本統計分析 19
第五章實證結果分析　 28
第六章結論與建議　 33

參考文獻

參考文獻
一、中文部份(按作者的姓氏筆畫排序) ︰
[1]朱僑麗 (1998)，「台灣高科技醫療儀器採用情形與國際之比較」，《醫院》，31，17-22。
[2] 洪思雯、蔡志宏與黃金山 (2005)，「醫院卓越計畫下醫院衝擊與因應之探討」《醫院》，48，65-68。
[3]蔡偉德與李一鑫 (2002)，「醫院非價格競爭與市場結構的關聯—醫院購置高科技醫療儀器之實證研究」，《經濟論文》，30，57-78。
[4]蔡文正、龔佩珍、楊志良與江怡如(2005)，「臺灣高科技醫療儀器之利用趨勢，1998-2001」，《醫務管理期刊》，6 ，446-460。
[5]盧瑞芬與謝啟瑞 (2003)，「臺灣醫院產業的市場結構與發展趨勢分析」，《經濟論文》，31，107-153。
[6] 韓幸紋 (2002)，「由德英荷三國之經驗剖析我國健保醫院總額之採行」，《保險實務與制度》，2，83-98。
二、英文部分(按作者姓的第一個字母排序) ︰
[1]Baker, Laurence C. (2001), “Managed Care and Technology Adoption in Health Care：Evidence from Magnetic Resonance Imaging,” Journal of Health Economics, 20, 395-421.
[2]Bamezai, A., Zwanziger, J., Melnick, G. A. and Mann, J. M., (1999), “Price Competition and Hospital Cost Growth in the United States (1989-1994),” Health Economics, 8, 233-243.
[3]Bazzoli, G. J., Dynan, L., Burns, L. R. and Lindrooth, R., (2000) “Is Provider Capitation Working? Effects on Physician-hospital Integration and Costs of Care,” Medical Care, 38, 311-32.
[4]Barnum, H. Kutzin, J. and Saxenian, H. (1995), “Incentives and provider payment methods,” The International Journal of Health Planning and Management, 10, 23-45.
[5]Clancy, C. M. and Hillner, B. E., (1989), “Physicians as gatekeepers. The impact of financial incentives,” Archives of Internal Medicine, 149, 917-20.
[6]Dranove, D., Shanley, M. and Simon, C., (1992), “Is Hospital Competition Wasteful?”Rand Journal of Economics, 23, 247-262.
[7]Dranove, D., and White, W. D. (1994), “Recent Theory and Evidence on Competition in Hospital Markets,”Journal of Economics and Management Strategy 3, 169-209.
[8]Greene, W. H. (2003), Econometric Analysis, Prentice Hall, NJ07458.
[9]Hamilton, B. H., and Ho Vivian, (2000), “Hospital mergers and acquisitions: Does market consolidation harm patients,” Journal of Health Economics, 19, 767-792.
[10]Hausman, J. and Griliches Z. (1984), “Econometric Models for Count Data with an Application to the Patents-R&D Relationship,” Econometrica, 52, 909-938.
[11]Hsiao, W. C., and Dunn, D. L. (1987), “The Impact of DRG Payment on New Jersey Hospitals,” Inquiry, 24, 212-20.
[12]Joskow, Paul L. (1980), “The Effects of Competition and Regulation on Hospital Bed Supply and the Reservation Quality of the Hospital,” The Bell Journal of Economics, 421-447.
[13]Kessler D. P, and McClellan M. B. (2000), “Is hospital competition socially wasteful?” Quarterly Journal of Economics, 577-615.
[14]Luft et al. (1986), “The Role of Specialized Clinical Services in Competition among Hospital,” Inquiry, 23, 83-94.
[15]Noether, M. (1988), “Competition among Hospitals,” Journal of Health Economics, 7, 259-284.
[16]Nazmi Sari. (2002), “Is Hospital Competition Socially Wasteful?” Health Economics, 11, 571-584.
[17]Oleske, D. M, Branca, M. L., Schmidt, J. B., Ferguson, R. and Linn, E. S. (1998), “A Comparison of Capitated and Fee-for-service Medicaid Reimbursement Methods on Pregnancy Outcomes,” Health Services Research, 33, 55-73.
[18]Robinson, J. C. and Luft, H. S. (1985), “The Impact of Hospital Market Structure on Patient Volume, Average Length of Stay, and the Cost of Care, “Journal of Health Economics, 4, 333-356.
[19]Robinson, J. C., Luft, H. S., McPhee, S. J. and Hunt, S. S. (1988), “Hospital competition and surgical length of stay, “Journal of The American Medical Association, 259, 696-700.
[20]Romeo, A. A., Wagner, J. L. and Lee, R. H. (1984), “Prospective Reimbursement and the Diffusion of New Technologies in Hospitals,” Journal of Health Economics, 3, 1-24.
[21]Shen Yu-Chu (2003), “The Effect of Financial Pressure on the Quality of Care in Hospitals,” Journal of Health Economics, 22, 243-269.
[22]Shortell, S. M. and Hughes, E. (1988), “The Effects of Regulation, Competition, and Ownership on Mortality Rates among Hospital Inpatients,” New England Journal of Medicine, 318, 1100-1207.
[23]Shortell, S. M., Grillies, R. R, and Anderson D. A. (1994), “New World of Managed Care：Creating Organized Delivery Systems,” Health Affairs, 13, 46-64.
[24]Town, R. and Vistnes, G. (2001), “Hospital Competition in HMO Network,” Journal of Health Economics, 20, 733-753.
[25]Wilson, G. and Jadlow, J. (1982), “Competition, Profit, Incentives, and Technical Efficiency in the Provision,” The Bell Journal of Economics, 13, 472-482.
[26]Zwanziger, J. M. and Melnick, G. (1988), “The Effects of Hospital Competition and the Medicare PPS Program on Hospital Cost Behavior in California,” Journal of Health Economics, 7, 457-464.

指導教授

蔡偉德(WEI-DER TSAI)

審核日期

2006-7-5

推文