臺灣博碩士論文加值系統

背景：2008年的經濟危機造成全球經濟的劇烈動盪，使人們的工作狀況、家戶收入及資產價值皆發生改變，政府的公共衛生、社會福利支出及服務也可能減少，人民的健康因此成為值得關注的議題。不同的福利國體制有著不同的福利種類及提供方式，在經濟危機時能有不同程度的保護作用。儘管過去已有許多2008年經濟危機對健康影響的研究，卻少有研究將對象著重於65歲以上的高齡族群。本研究欲探討2008年經濟危機對老年人的影響，是否會因為福利國體制的不同而有所差異。
方法：使用歐洲大型跨國縱貫性資料庫Survey of Health, Ageing and Retirement in Europe第二波和第四波的調查，作為經濟危機前後個人社經人口學、健康狀況及生活習慣的資料來源，並且以多層級分析中的隨機截距模式，分析研究期間各國GDP、吉尼係數、家戶收入及社會支出的改變，對於老年人自評健康及憂鬱狀況改變的影響，並檢視GDP改變與福利國體制之間是否存在交互作用。
結果：(一)四個福利體系中，不論是自評健康或是憂鬱，南歐體系的健康狀況在研究期間最明顯的變差，斯堪地那維亞體系健康變差的情形最小；(二)家戶可支配收入(β=-0.0456，p=0.0255)或社會支出(β=-0.0903，p=0.0009)增加幅度愈高的國家，人民的自評健康愈不會變差；(三)福利國體制與GDP改變在自評健康的分析中具交互作用，相較於斯堪地那維亞體系，南歐(β=0.9739，p=0.0161)和東歐體系(β=0.1911，p=0.0125)的自評健康比較容易因為經濟環境的改變而受到影響。
結論：四個福利體系當中福利國家色彩最鮮明的斯堪地那維亞體系，人民健康最不容易因為經濟環境的改變而受到影響，著重家庭功能的南歐體系則最容易受到經濟波動的影響。完善且制度化的社會福利制度有助於國家財政的穩定、社會安全網的健全，在經濟危機時期能減緩經濟波動對老年人健康的影響，在老年人口快速增長的時代，各國更應重視老年人的相關福利及保護措施。

Introduction: The 2008 economic crisis has had a far reaching impact on countries around the world. Welfare states provide a variety of social transfers as well as key services at a time of personal financial difficulty, so that individual health may not be negatively affected. While much work has been carried out to assess the effect of economic crisis on health and well-being of the general population, few studies have assessed its effect on the elderly population. This research focuses on the influence of economic recession on self-rated health and depression among the elderly, as well as the moderating effect of welfare regimes on the influence of economic recession on elderly health.
Method: Data used for this study comes from Survey of Health, Ageing and Retirement in Europe wave 2 (2007) and wave 4 (2011). To precisely access the health effect on the elderly during the recession, sample was restricted to individuals aged over 65 at the time of wave 2 and have complete data of the two waves. Changes in national GDP per capital, GINI index, household disposable income and social expenditure as a percentage of GDP between 2006 and 2010 were taken as indicators of the impact of the crisis. Multilevel random intercept models were used for statistical analysis.
Results: From 2006 to 2010, analyses showed that elderly in Scandinavian welfare regime had better health conditions in comparison with elderly in other welfare regimes; a decrease in social expenditure were associated with higher probability of poor self-rated health after economic recession; and Scandinavian welfare regime appeared to have more capacity to moderate the influence of economic recession compared to Southern and Eastern Europe welfare regimes.
Conclusions: This research provided some evidence that the elderly could also suffer negative effects from economic crisis, just like the working population. Moreover, it showed that welfare regimes did moderate the effects of economic recession on elderly health. Welfare states with greater magnitudes of social safety net might have better resilience to economic crisis.

第一章 前言 1
第二章 文獻探討 3
第一節 福利國家體制 3
第二節 經濟衰退對健康的影響 19
第三章 材料與方法 31
第一節 研究架構與假設 31
第二節 資料來源與樣本 34
第三節 研究變項 36
第四節 統計分析 43
第四章 研究結果 45
第一節 描述性分析 45
第二節 雙變項分析 57
第三節 多變項分析 66
第五章 討論 83
第一節 主要研究結果 83
第二節 福利國體制的健康差異 83
第三節 經濟指標與健康 86
第四節 福利國體制與GDP的交互作用 88
第五節 自評健康與憂鬱的差異 91
第六節 個人因子與健康 92
第七節 研究限制 96
第八節 結論與建議 97
參考文獻 99

英文文獻
Abdul Karim, S., T. A. Eikemo and C. Bambra (2010). "Welfare state regimes and population health: integrating the East Asian welfare states." Health Policy 94(1): 45-53.
Aguiar, M., E. Hurst and L. Karabarbounis (2013). "Time Use During the Great Recession." American Economic Review 103(5): 1664-1696.
Ahnquist, J., S. P. Wamala and M. Lindstrom (2012). "Social determinants of health--a question of social or economic capital? Interaction effects of socioeconomic factors on health outcomes." Soc Sci Med 74(6): 930-939.
Ailshire, J. A. (2012). "LINKED LIVES IN THE "GREAT RECESSION": PERSONAL AND FAMILY ECONOMIC STRESS AND OLDER ADULT HEALTH." Gerontologist 52: 503-503.
Asgeirsdottir, T. L., H. Corman, K. Noonan, T. Olafsdottir and N. E. Reichman (2014). "Was the economic crisis of 2008 good for Icelanders? Impact on health behaviors." Econ Hum Biol 13: 1-19.
Astell-Burt, T. and X. Feng (2013). "Health and the 2008 economic recession: evidence from the United Kingdom." PLoS One 8(2): e56674.
Börsch-Supan, A., A. Brugiavini, H. Jürges, J. Mackenbach, J. Siegrist and G. Weber (2005). "Health, ageing and retirement in Europe – First results from the Survey of Health, Ageing and Retirement in Europe." Starting the longitudinal dimension. Mannheim: MEA.
Bambra, C. (2006). "Health Status and the Worlds of Welfare." Social Policy and Society 5(01): 53.
Barmby, T. and M. Larguem (2009). "Coughs and sneezes spread diseases: an empirical study of absenteeism and infectious illness." Journal of Health Economics 28(5): 1012-1017.
Bartoll, X., L. Palencia, D. Malmusi, M. Suhrcke and C. Borrell (2014). "The evolution of mental health in Spain during the economic crisis." Eur J Public Health 24(3): 415-418.
Bontout, O. and T. Lokajickova (2013). Social protection budgets in the crisis in the EU, Citeseer.
Bosque-Prous, M., A. Espelt, L. Sordo, A. M. Guitart, M. T. Brugal and M. J. Bravo (2015). "Job Loss, Unemployment and the Incidence of Hazardous Drinking during the Late 2000s Recession in Europe among Adults Aged 50-64 Years." PLoS One 10(10): e0140017.
Bougerol, E. (2009). "Good news! Recession may make your healthier." BC Los-Angeles.
Brennenstuhl, S., A. Quesnel-Vallee and P. McDonough (2012). "Welfare regimes, population health and health inequalities: a research synthesis." J Epidemiol Community Health 66(5): 397-409.
Burgard, S. A., J. A. Ailshire and L. Kalousova (2013). "The Great Recession and Health People, Populations, and Disparities." The ANNALS of the American Academy of Political and Social Science 650(1): 194-213.
Burgard, S. A., J. E. Brand and J. S. House (2007). "Toward a better estimation of the effect of job loss on health." Journal of Health and Social Behavior 48(4): 369-384.
Burgard, S. A. and L. Kalousova (2015). "Effects of the Great Recession: Health and Well-Being." Annual Review of Sociology 41(1): 181-201.
Burgard, S. A., K. S. Seefeldt and S. Zelner (2012). "Housing instability and health: findings from the Michigan Recession and Recovery Study." Soc Sci Med 75(12): 2215-2224.
Cagney, K. A., C. R. Browning, J. Iveniuk and N. English (2014). "The onset of depression during the great recession: foreclosure and older adult mental health." Am J Public Health 104(3): 498-505.
Cannuscio, C. C., D. E. Alley, J. A. Pagan, B. Soldo, S. Krasny, M. Shardell, D. A. Asch and T. H. Lipman (2012). "Housing strain, mortgage foreclosure, and health." Nurs Outlook 60(3): 134-142, 142 e131.
Catalano, R., S. Goldman-Mellor, K. Saxton, C. Margerison-Zilko, M. Subbaraman, K. LeWinn and E. Anderson (2011). "The health effects of economic decline." Annu Rev Public Health 32: 431-450.
Chung, H. and C. Muntaner (2007). "Welfare state matters: a typological multilevel analysis of wealthy countries." Health Policy 80(2): 328-339.
Coburn, D. (2004). "Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities." Social Science & Medicine 58(1): 41-56.
Cohen, S., D. Janicki-Deverts and G. E. Miller (2007). "PSychological stress and disease." JAMA 298(14): 1685-1687.
Cowen, T. (2009). "Recession can change a way of life." New York Times 31.
Cullen, M. R. (2013). "A review of health consequences of recessions internationally and a synthesis of the US response during the Great Recession." Public Health Reviews 35(1): 1.
Cylus, J., P. Mladovsky and M. McKee (2012). "Is there a statistical relationship between economic crises and changes in government health expenditure growth? an analysis of twenty-four European countries." Health Serv Res 47(6): 2204-2224.
Dagher, R. K., J. Chen and S. B. Thomas (2015). "Gender Differences in Mental Health Outcomes before, during, and after the Great Recession." PLoS One 10(5): e0124103.
de la Fuente, V. S., M. A. C. Lopez, I. F. Gonzalez, O. J. G. Alcantara and D. O. Ritzel (2014). "The impact of the economic crisis on occupational injuries." Journal of Safety Research 48: 77-85.
Der, G., S. MacIntyre, G. Ford, K. Hunt and P. West (1999). "The relationship of household income to a range of health measures in three age cohorts from the West of Scotland." European Journal of Public Health 9(4): 271-277.
Economou, M., M. Madianos, L. E. Peppou, A. Patelakis and C. N. Stefanis (2013). "Major depression in the Era of economic crisis: A replication of a cross-sectional study across Greece." Journal of Affective Disorders 145(3): 308-314.
Eichhorst, W., M. Dolls, P. Marx and A. Peichl (2010). Report No. 31: The Role of Social Protection as an Economic Stabiliser: Lessons from the Current Crisis.
Eikemo, T. A., C. Bambra, K. Joyce and E. Dahl (2008c). "Welfare state regimes and income-related health inequalities: a comparison of 23 European countries." Eur J Public Health 18(6): 593-599.
Eikemo, T. A., C. Bambra, K. Judge and K. Ringdal (2008a). "Welfare state regimes and differences in self-perceived health in Europe: a multilevel analysis." Soc Sci Med 66(11): 2281-2295.
Eikemo, T. A., M. Huisman, C. Bambra and A. E. Kunst (2008b). "Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries." Sociol Health Illn 30(4): 565-582.
Esping-Andersen, G. (1990). The Three Worlds of Welfare Capitalism, Princeton University Press.
Esping-Andersen, G. (1999). Social Foundations of Postindustrial Economies, Oxford University Press.
Ettner, S. L. (1996). "New evidence on the relationship between income and health." Journal of Health Economics 15(1): 67-85.
Evans-Lacko, S., M. Knapp, P. McCrone, G. Thornicroft and R. Mojtabai (2013). "The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European countries." PLoS One 8(7): e69792.
Ferrera, M. (1996). "The ''Southern Model'' of Welfare in Social Europe." Journal of European Social Policy 6(1): 17-37.
Ferrie, J. E., P. Martikainen, M. J. Shipley and M. G. Marmot (2005). "Self-reported economic difficulties and coronary events in men: evidence from the Whitehall II study." Int J Epidemiol 34(3): 640-648.
Foubert, J., K. Levecque, R. Van Rossem and A. Romagnoli (2014). "Do welfare regimes influence the association between disability and self-perceived health? A multilevel analysis of 57 countries." Soc Sci Med 117: 10-17.
Gerdtham, U. G. and M. Johannesson (2003). "A note on the effect of unemployment on mortality." Journal of Health Economics 22(3): 505-518.
Gerdtham, U. G. and C. J. Ruhm (2006). "Deaths rise in good economic times: evidence from the OECD." Econ Hum Biol 4(3): 298-316.
Gili, M., M. Roca, S. Basu, M. McKee and D. Stuckler (2013). "The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010." Eur J Public Health 23(1): 103-108.
Hales, S., P. Howden-Chapman, C. Salmond, A. Woodward and J. Mackenbach (1999). "National infant mortality rates in relation to gross national product and distribution of income." Lancet 354(9195): 2047-2047.
Hauksdottir, A., C. McClure, S. H. Jonsson, O. Olafsson and U. A. Valdimarsdottir (2013). "Increased Stress Among Women Following an Economic Collapse-A Prospective Cohort Study." American Journal of Epidemiology 177(9): 979-988.
Hildebrand, V. and P. Van Kerm (2009). "Income inequality and self-rated health status: evidence from the European Community Household Panel." Demography 46(4): 805-825.
Houle, J. N. (2014). "Mental health in the foreclosure crisis." Soc Sci Med 118: 1-8.
Hurd, M. D. and S. Rohwedder (2010). "The effects of the economic crisis on the older population." Michigan Retirement Research Center Research Paper(2010-231).
Hyclak, T. J., C. D. Meyerhoefer and L. W. Taylor (2013). "Older Americans’ health and the Great Recession." Review of Economics of the Household 13(2): 413-436.
Hyclak, T. J., C. D. Meyerhoefer and L. W. Taylor (2015). "Older Americans’ health and the Great Recession." Review of Economics of the Household 13(2): 413-436.
Jylha, M., J. M. Guralnik, L. Ferrucci, J. Jokela and E. Heikkinen (1998). "Is self-rated health comparable across cultures and genders?" J Gerontol B Psychol Sci Soc Sci 53(3): S144-152.
Kalousova, L. and S. A. Burgard (2013). "Debt and Foregone Medical Care." Journal of Health and Social Behavior 54(2): 203-219.
Karanikolos, M., P. Mladovsky, J. Cylus, S. Thomson, S. Basu, D. Stuckler, J. P. Mackenbach and M. McKee (2013). "Financial crisis, austerity, and health in Europe." The Lancet 381(9874): 1323-1331.
Katikireddi, S. V., C. L. Niedzwiedz and F. Popham (2012). "Trends in population mental health before and after the 2008 recession: a repeat cross-sectional analysis of the 1991-2010 Health Surveys of England." BMJ Open 2(5).
Keegan, C., S. Thomas, C. Normand and C. Portela (2013). "Measuring recession severity and its impact on healthcare expenditure." International Journal of Health Care Finance & Economics 13(2): 139-155.
Kentikelenis, A., M. Karanikolos, A. Reeves, M. McKee and D. Stuckler (2014). "Greece''s health crisis: from austerity to denialism." Lancet 383(9918): 748-753.
Kovacs, J. M. (2002). "Approaching the EU and reaching the US? Rival narratives on transforming welfare regimes in East-Central Europe." West European Politics 25(2): 175-+.
Linn, M. W., R. Sandifer and S. Stein (1985). "Effects of unemployment on mental and physical health." Am J Public Health 75(5): 502-506.
Marmot, M. and R. Bell (2012). "Fair society, healthy lives." Public Health 126 Suppl 1: S4-10.
Mayer, A. and M. Foster (2015). "Understanding Recession and Self-Rated Health with the Partial Proportional Odds Model: An Analysis of 26 Countries." PLoS One 10(10): e0140724.
McInerney, M., J. M. Mellor and L. H. Nicholas (2013). "Recession depression: mental health effects of the 2008 stock market crash." J Health Econ 32(6): 1090-1104.
McLaughlin, K. A., A. Nandi, K. M. Keyes, M. Uddin, A. E. Aiello, S. Galea and K. C. Koenen (2012). "Home foreclosure and risk of psychiatric morbidity during the recent financial crisis." Psychol Med 42(7): 1441-1448.
Mladovsky, P., D. Srivastava, J. Cylus, M. Karanikolos, T. Evetovits, S. Thomson and M. McKee (2012). "Health policy responses to the financial crisis in Europe."
Modrek, S. and M. R. Cullen (2013). "Job insecurity during recessions: effects on survivors'' work stress." Bmc Public Health 13.
Mulsant, B. H., M. Ganguli and E. C. Seaberg (1997). "The relationship between self-rated health and depressive symptoms in an epidemiological sample of community-dwelling older adults." J Am Geriatr Soc 45(8): 954-958.
Navarro, V., C. Muntaner, C. Borrell, J. Benach, A. Quiroga, M. Rodriguez-Sanz, N. Verges and M. I. Pasarin (2006). "Politics and health outcomes." Lancet 368(9540): 1033-1037.
Norstrom, T. and H. Gronqvist (2015). "The Great Recession, unemployment and suicide." J Epidemiol Community Health 69(2): 110-116.
OECD (2014). National Accounts at a Glance 2014, OECD.
OECD. (2016). "OECD.Stat." from http://stats.oecd.org/.
OECD. Household disposable income, OECD Publishing.
Ogg, J. I. M. (2005). "Social exclusion and insecurity among older Europeans: the influence of welfare regimes." Ageing and Society 25(1): 69-90.
Olsen, K. M. and S. A. Dahl (2007). "Health differences between European countries." Soc Sci Med 64(8): 1665-1678.
Parry, J. and G. Humphreys (2009). "Health amid a financial crisis: a complex diagnosis." Bull World Health Organ 87(1): 4-5.
Pichler, F. and C. Wallace (2007). "Patterns of formal and informal social capital in Europe." European sociological review 23(4): 423-435.
Ploubidis, G. B., C. Dale and E. Grundy (2012). "Later life health in Europe: how important are country level influences?" European Journal of Ageing 9(1): 5-13.
Rathmann, K., V. Ottova, K. Hurrelmann, M. de Looze, K. Levin, M. Molcho, F. Elgar, S. N. Gabhainn, J. P. van Dijk and M. Richter (2015). "Macro-level determinants of young people''s subjective health and health inequalities: a multilevel analysis in 27 welfare states." Maturitas 80(4): 414-420.
Reeves, A., M. McKee and D. Stuckler (2014). "Economic suicides in the Great Recession in Europe and North America." Br J Psychiatry 205(3): 246-247.
Reile, R., S. Helakorpi, J. Klumbiene, M. Tekkel and M. Leinsalu (2014). "The recent economic recession and self-rated health in Estonia, Lithuania and Finland: a comparative cross-sectional study in 2004-2010." J Epidemiol Community Health 68(11): 1072-1079.
Richter, M., K. Rathman, S. Nic Gabhainn, A. Zambon, W. Boyce and K. Hurrelmann (2012). "Welfare state regimes, health and health inequalities in adolescence: a multilevel study in 32 countries." Sociol Health Illn 34(6): 858-879.
Rosengren, A., S. Hawken, S. Ounpuu, K. Sliwa, M. Zubaid, W. A. Almahmeed, K. N. Blackett, C. Sitthi-amorn, H. Sato, S. Yusuf and I. investigators (2004). "Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study." Lancet 364(9438): 953-962.
Rostila, M. (2007). "Social capital and health in European welfare regimes: a multilevel approach." Journal of European Social Policy 17(3): 223-239.
Rueda, S., L. Artazcoz and V. Navarro (2008). "Health inequalities among the elderly in western Europe." Journal of Epidemiology and Community Health 62(6): 492-498.
Ruhm, C. J. (1995). "Economic conditions and alcohol problems." J Health Econ 14(5): 583-603.
Ruhm, C. J. (2000). "Are recessions good for your health?" Quarterly Journal of Economics 115(2): 617-650.
Sargent-Cox, K., P. Butterworth and K. J. Anstey (2011). "The global financial crisis and psychological health in a sample of Australian older adults: a longitudinal study." Soc Sci Med 73(7): 1105-1112.
Starke, P., A. Kaasch and F. van Hooren (2012). Comparing social policy responses to global economic crises: Constrained partisanship in mature welfare states. Paper to be presented at ESPAnet annual conference, Edinburgh.
Stuckler, D., S. Basu and M. McKee (2010). "Budget crises, health, and social welfare programmes." BMJ 340: c3311.
Stuckler, D., S. Basu, M. Suhrcke, A. Coutts and M. McKee (2009). "The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis." Lancet 374(9686): 315-323.
Suhrcke, M. and D. Stuckler (2012). "Will the recession be bad for our health? It depends." Soc Sci Med 74(5): 647-653.
Suhrcke, M., D. Stuckler, J. E. Suk, M. Desai, M. Senek, M. McKee, S. Tsolova, S. Basu, I. Abubakar, P. Hunter, B. Rechel and J. C. Semenza (2011). "The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence." PLoS One 6(6): e20724.
Swift, R. (2011). "The Relationship between Health and Gdp in Oecd Countries in the Very Long Run." Health Economics 20(3): 306-322.
Taylor, A., E. Dal Grande, T. Gill, L. Fisher and R. Goldney (2007). "Detecting determinants of suicidal ideation: South Australian surveillance system results." Int J Public Health 52(3): 142-152.
Toffolutti, V. and M. Suhrcke (2014). "Assessing the short term health impact of the Great Recession in the European Union: a cross-country panel analysis." Prev Med 64: 54-62.
Tucker-Seeley, R. D., Y. Li, S. V. Subramanian and G. Sorensen (2009). "Financial Hardship and Mortality among Older Adults Using the 1996-2004 Health and Retirement Study." Annals of Epidemiology 19(12): 850-857.
Valencia-Martin, J. L., I. Galan and F. Rodriguez-Artalejo (2009). "Alcohol and self-rated health in a Mediterranean country: the role of average volume, drinking pattern, and alcohol dependence." Alcohol Clin Exp Res 33(2): 240-246.
Vandoros, S., P. Hessel, T. Leone and M. Avendano (2013). "Have health trends worsened in Greece as a result of the financial crisis? A quasi-experimental approach." Eur J Public Health 23(5): 727-731.
Wahlbeck, K. and D. McDaid (2012). "Actions to alleviate the mental health impact of the economic crisis." World Psychiatry 11(3): 139-145.
WHO (2011). Impact of economic crises on mental health. . Copenhagen: WHO Regional Office for Europe.
WorldBank. (2016). "World databank." from http://databank.worldbank.org/data/reports.aspx?source=2&country=&series=NY.GDP.MKTP.KD.ZG&period=#.
Yur''yev, A., A. Värnik, P. Värnik, M. Sisask and L. Leppik (2012). "Role of social welfare in European suicide prevention." International Journal of Social Welfare 21(1): 26-33.
Zavras, D., V. Tsiantou, E. Pavi, K. Mylona and J. Kyriopoulos (2013). "Impact of economic crisis and other demographic and socio-economic factors on self-rated health in Greece." Eur J Public Health 23(2): 206-210.
中文文獻
古允文、詹宜璋 (1998). "臺灣地區老人經濟安全與年金政策：社會排除觀點初探." 人文及社會科學集刊(10:2): 191-225.
古允文譯, G. E.-A. (2001). 福利資本主義的三個世界. 台北, 巨流圖書公司.
林萬億 (1994). 福利國家－歷史比較的分析. 台北, 巨流圖書有限公司.
香港管理專業發展中心 (2004). 管理人經濟學. 香港, 香港中文大學.
陳忠孝、歐欣亞 (2013). 財政學. 新北市, 千華數位文化.
董和銳 (2005). "台灣老年人口自評健康與功能障礙情形之轉變." 身心障礙研究季刊 3(2): 72-87.