臺灣博碩士論文加值系統

探討在國軍醫院就醫之病患，就醫時具有優免身分者，是否因優免身分不同而改變其就醫行為，以及就醫次數及醫療費用之間的變化。主要研究對象為就醫時具有優免身分之軍人、軍人眷屬、福保以及無職榮民四類病人。
研究範圍從三軍總醫院基隆分院的資料庫中，隨機抽樣5%門診病人，自民國94至101年全部門診就診紀錄，分析方法包括描述性統計、t檢定，以及複迴歸分析。
實證結果顯示，具優免身分之病人，除了軍人之外，其餘身分之病人就診次數高於無優免身分者。當優免金額愈高，病人需負擔的就醫成本愈低，因此使用醫療資源頻率愈頻繁。

The purpose of this research is to investigate patients of armed forces hospital, whether the frequency of visiting outpatient service is correlated with their identity which has different preferential treatment. The main sort of patient include soldier, military dependent, Low-income household and veteran.
According to the database of Tri-Service General Hospital, Keelung branch, gets 5% of outpatient records by random sampling, from year 2005 to 2012, analytical methods including descriptive statistics, t-test, and multiple regression analysis.
Compare visiting number of outpatient service, excluding soldier, patients with preferential treatment is higher than non-preferential treatment patients. The result shows the lower medical cost patient paid, the higher frequency health care utilization be used.

目 錄
摘要 I
Abstract II
目錄 III
表目錄 IV
圖目錄 V
第 壹 章 緒論
第 一 節 研究背景與動機 1
第 二 節 研究目的 2
第 三 節 研究流程 4
第 貳 章 文獻探討
第 一 節 理論模型 5
第 二 節 實證研究 11
第 參 章 研究方法
第 一 節 研究範圍 14
第 二 節 研究架構 16
第 三 節 變數定義說明 19
第 四 節 模型與資料分析 20
第 肆 章 研究結果
第 一 節 樣本基本資料分析 22
第 二 節 資料檢定結果 33
第 三 節 小結 34
第 伍 章 結論與建議
第 一 節 結論 37
第 二 節 建議 38
第 三 節 未來研究方向 39
參考文獻 40
參考資料 47

盧瑞芬，謝啟瑞(2000)，醫療經濟學，P194-P202
陳肇男，林惠玲(1996)，全民健康保險對老人醫療需求之影響評估
蘇建榮(1999)，全民健康保險制度下門診醫療利用函數之估計，保險專刊，57，民88.09，P81-93
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，人文及社會科學集刊;87/3:1-32
謝啟瑞(1996)，健康經濟學，P41-58
石曜堂、葉金川、楊漢泉、羅紀瓊、張明正、吳正義(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1994；13(6)：473-83
吳肖琪(1991)，健康保險與醫療網區域資源對醫療利用之影響，國立台灣大學公共衛生研究所博士論文
許志成、季瑋珠(1996)，住院高度使用者之特性：以大溪鎮群醫中心住院病人為例，中華衛誌1996，15(1)：91-5。
楊長興(1995)，全民健保實施對於民眾醫療利用率影響之初期評估，長庚醫學院暨工程學院醫務管理系
楊志良(1986)，健康保險對醫療照護利用度之影響，社會保險年刊，11:61-71
賴芳足(1996)，全民健保實施後民眾醫療利用影響因素之研究，中國醫藥學院醫務管理研究所碩士論文。
張博論、藍忠孚、陳孝平、吳肖琪(1998)，醫療費用結構分析－兼論住院、住院分項保險之可能性，行政院衛生署委託研究計劃。
林兆欣、許碩芬、黃玉珂(2007)，台灣健保醫療費用成長因素與供需誘因機制之費用控制成效，風險管理學報2007，9(3)：193-216
楊昭恂(2005)，我國退伍軍人健保西醫醫療利用及其影響因素，碩士論文
曾郁文(2006)，台灣老年人門診醫療利用之長期分析:1997~2001，碩士論文
陳蓓綺(2005)，門診高診次醫療利用之相關因素探討，碩士論文
陳欽賢，劉彩卿，陳美吟(2005)，全民健康保險制度下之民眾就醫：感冒及慢性病，保險專刊21：2，113-143
蔡淑芬(1983)，烏腳病地區居民醫療行為研究，中華衛誌，2：95-113
鄭守夏、江東亮(1997)，全民健保對民眾醫療利用影響的追蹤調查，國科會研究計劃
陳肇男，林惠玲(1996)，全民健康保險對老人醫療需求之影響推估，人口變遷、國民健康與社會安全，楊文山、李美玲主編，中研院中山人文社會科學研究專書 37，63-88
李卓倫(1998)，仁愛鄉巡迴醫療保健計劃成果評估，行政院衛生署委託計劃
張鴻仁、黃信忠、蔣翠蘋(2002)，全民健保醫療利用集中狀況及高、低使用者特性之探討，台灣衛誌21，207-213
蔡文正、陳綾穗、龔佩珍(2001)，外籍勞工是否延誤就醫及其相關因素之研究，公共衛生，28(2)：109-122
龔佩珍、蔡文正、王悅馨(2010)，經濟弱勢者醫療利用及其健康狀態分析，行政院衛生署99年度委託研究計畫
趙睦男(1985)，台灣地區成人之醫療疾病傷殘狀況調查研究報告，公共衛生，11:27-240
施仁興(1995)，醫療利用行為之研究：花蓮地區族群、城鄉及醫療資源差異比較，陽明大學公共衛生研究所碩士論文。
鄭保成、胡玉蕙(1997)，台灣家庭醫療需求的實證分析，台北銀行月刊，27(5)71-88
林芸芸(1992)，社會保險醫療給付、就醫交通時間和中西醫醫療利用-以新店居民為例，中華家醫誌，2(3):115-129
陳欽賢、劉彩卿、陳美吟(2005)，全民健康保險制度下之民眾就醫：感冒及慢性病，保險專刊，21(2):113-143
Anderson, A. S., & Laake P.,1983,”A causal model for physician utilization: Analysis of Norwegian”, Medical Care, 21(3):266-278
Anderson, R.A., & Aday, L. A.,1978,”Access to medical care in the U.S.-realized and potential”, Medical Care, 16:533
Anthony C.K. and William W.E.,1998, “ Absence of social networks Social Support and health services utilization”, Psychol Med, 28(6):1301-1310
Bolduc D., G. Lacroix, and C. Muller, 1996, “The Choice of Medical Providers in Rural Benin: A Comparison of Discrete Choice Models.”, Journal of Health Economics, 15:477-498
Cheng S.H. and Chiag T.L.,1998, “Disparity of medical care utilization among different health insurance schemes in Taiwan”, Social Science & Medicine, 47(5):613-620
Cockx, B. and C. Brasseur, 2003, The demand for physician services: Evidence from a natural experiment, Journal of Health Economics 22(6): 881-913.
Cox, C.,1986, “Physician utilization by three groups of ethnic elderly”, Medical Care, 24(8):667-676
Cunningham PJ, Altman BM：The use of ambulatory health care services by American Indians with disabilities. Medical Care 1993；31(7)：600-16.
Eastaugh, S.R., 2000, “National Healthcare Spending and Fiscal Control: Comparisons among 15 Countries.” Hospital Topics, 78: 9-13.
Fernandez-Olano C., Lopez-Torres Hidalgo J.D., Cerda-Diazb R., Requena-Gallego M., Sahchez-Castano C., Urbistondo-Cascales L., and Otero-Puime A., 2006, “Factors associated with health care utilization by the elderly in public health care system”, Health Policy, 75(2):131-139
Fredric D.W., & Robert J.J., 1991, “The use of health services by older adults”, The Journal of Gerontology, 47(1):S8-16
Garfinkel SA, Riley GF, Iannacchione VG. “High-cost users of medical care”, Health Care Finance Rev 1998;9:41-52
Gertler P., L. Locay and W. Sanderson, 1987, “Are User Fees Regressive? The welfare Implications of Health Care Financing Proposals in Peru”, Journal of Econometrics 36:67-88
Green, C. A., & Pope C. R.,1999,”Gender, psychosocial factors and the use of medical services: a longitudinal analysis”, Social Science & Medicine, 48(10):1363-1372
Greenberg JLLG, Gorina Y, Wartzman L, Gibson D, 2001,“Three decades of health are use by the elderly, 1965-1998”. Health Aff 2001;(Mar-Apr):19-32
Grossman, M., 1972, “On the concept of health capital and the demand for health”, Journal of Political Economy 80: 223-255.
Hellinger, F. J., 1996, “The impact of financial incentive on physician behavior in managed care plans: A review of the evidence”, Medical care research and review 53(3): 294-314.
Henderson G., Akin J., Zhiming L., Jin S., MA H., and Ge K.,1994, “Equity and the utilization of health services: Report of an eight-province survey in China”, Social Science & Medicine, 39(5):687-699
Hibbard, J.H., & Pope C.R.1986,”Age difference in the use of medical care in the HMO”, Medical Care, 4:52-66
Katz S.J., Hofor T.P.,1994, “Socioeconomic Disparities in Preventive Care Persist Despite Universal Coverage. Breast and Cervical Cancer Screening in Oatario and the United States”, JAMA, 17,272(7):530-534
Leu, Robert E.,1986,”The public-private Mix and International Health Care Costs”, in Culyer A. J. and B. Jonsson eds., Public and Private Health Services：Complementaries and Conflicts, Oxford：Basic Blackwell.
Levkoff SE, Cleary PD, Wetlet：Difference in determinants of physician use between aged and middle-aged persons. Medical Care 1987；25(12)：1148-59.
Louis TY, Dee WE, Pamela W. Corporate medical claim cost distributions and factors associated with high-cost status. J Occup Med 1994;36:505-15
Manning, W. G., J. P. Newhouse and N. Duan, 1987, “Health insurance and the demand for medical care: evidence from a randomized experiment”, American Economic Review 77(3): 251-277
Markides, K. S., Levin J. S., & Ray L. A., 1985, ”Determinants of physician utilization among Mexican-Americans, a three-generation”, Medical Care, 23(3):236-246
Monheit AC, Nichols LM, Seldem TM. “How are net health insurance benefits distributed in the employment-related insurance market?”, Inquiry 1995-96(winter);32:379-91
Newhouse, J. P., 1992, “Medical Care Costs：How Much Welfare Loss?”, The Journal of Economic Perspectives 6: 3-21.
Pauly, Mark V.,1968,”The Economics of Moral Hazard”, American Economic review, 58:3, 531-537
Rosett, R. N. and L. F. Huang, 1973, “The effect of Health Insurance on the demand for medical care”, The Journal of Political Economy 81: 81-305.
Rosen P., and Anell A.,1999, “Patient Views on Choice and Participation in Primary Health Care”, Health Policy, 55:121-128
Rosner, T. T., Namazi K. H., & Wykle, M. L., 1988,”Physician use among the old-old: factors affecting variability.” Medical Care, 26(10):982-991
Saag, K. G., Doebbeling, B. N., Rohrer, J. E., Kolluri, S., Peterson, R., Hermann, M. E., & Wallace, R. B.,1998, ”Variation in tertiary prevention and health service utilization among the elderly.”, Medical Care, 36(7):965-976
Salzman P., 1996, “Integrating community services for prevention: Northeast Health Systems may be taking the ultimate moneysaving measure” (Cover story), Behavioral Health Management, 16(4):9-13
Shortell S. M., ”Factors associated with the use of health service.” Edited by Williams, S.J., & Torrens P.R., Introduction to Health Service. 2:49-88
Zadoroznyj, M. & Svarstad, B. L.,1990, “Gender, employment and medication use”, Social Science & Medicine,31(9):971-978
Woolhandler, S.,& Himmelstein, D. U.,1988, “Reverse targeting of preventive care due to lack of health insurance”, JAMA, 259：2872-2874