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研究生:黃偉堯
研究生(外文):Wei-Yao Huang
論文名稱:臺灣牙醫人力地理分布之分析
論文名稱(外文):Geographic Distribution of Dentists in Taiwan
指導教授:江東亮江東亮引用關係
指導教授(外文):Tung-liang Chiang
學位類別:博士
校院名稱:國立臺灣大學
系所名稱:衛生政策與管理研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:92
中文關鍵詞:牙醫師地理分布市場力量標準位置理論承載能力理論全民健康保險生活機能
外文關鍵詞:dentistgeographic distributionmarket forcesstandard location theorycarrying capacity theoryNational Health Insurancelife function
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目的:應用標準位置理論及承載能力理論,探討市場力量與臺灣牙醫人力地理分布變遷的關係,特別著重全民健康保險的作用與生活機能的影響。具體而言,要回答下列四個問題:
1. 1985 年至 1994 年之間,在牙醫人力總體供給快速成長下,是否產生牙醫人力地理分布擴散的現象?
2. 1985 年至 1994 年間,臨界市場規模附近的鄉鎮市區,其牙醫人力供給成長是否較快?
3. 1995 年全民健康保險實施之後,由於大幅誘發牙醫服務需求,牙醫人力地理分布是否出現擴散減緩的現象?
4. 生活機能好的鄉鎮市區,是否該地區的牙醫人力供給較多?也增加較快?
資料來源:牙醫人力資料取自臺灣大學公共衛生學院衛生政策研究中心之牙醫師人力資料庫、衛生署醫事人力資料庫、臺灣地區公私立醫療院所現況調查;三級產業人口資料來自臺閩地區工商及服務業普查;人口資料的來源為臺閩地區人口統計。
研究設計:以橫斷與縱斷的區位研究法,分析 1985 至 2000 年的牙醫人力地理分布。以鄉鎮市區人口數為市場規模的指標,三級產業人口密度為生活機能的指標。
研究對象:鄉鎮市區,臺灣地區計有 359 個。
主要結果測量:有牙醫師鄉鎮市區百分比、牙醫師人口比、牙醫師成長率、與牙醫師增加佔率。
研究結果:橫斷分析結果顯示,人口數愈大的鄉鎮市區人口數分組,其有牙醫師鄉鎮市區百分比愈大;三級產業人口密度愈大的鄉鎮市區,其牙醫師人口比愈大。縱斷分析結果顯示,在牙醫人力供給快速成長下,每個鄉鎮市區人口數分組的有牙醫師鄉鎮市區百分比都呈現成長的現象; 1985 至 1994 年間,在臨界市場規模附近的鄉鎮市區,人口數約 120,000 人,其牙醫師成長率最快;而三級產業人口密度愈高的鄉鎮市區,其牙醫師成長率愈大。最後,在全民健康保險實施後,鄉鎮市區的人口數愈大,其牙醫師增加佔率的差值愈大,因而延緩了牙醫人力地理分布的擴散。
結論:市場力量是臺灣牙醫人力地理分布的重要決定因素。
Objectives. This study applied the standard location theory and carrying capacity theory to examine the geographic distribution of dentists in Taiwan, with a focus on the effect of the National Health Insurance (NHI) and the effect of the life function of a township on the geographic diffusion of dentists. In specific, this study aims to answer the following 4 questions:
1. Along with the rapid growth of dental manpower supply between 1985 and 1994, has the geographic distribution of dentists in Taiwan been improved?
2. Has the supply of dental manpower in the townships with a critical market size increased the most rapidly between 1985 and 1994?
3. Has the extensive increase in dental demands as induced by the NHI reduced the diffusion process of geographic distribution of dentists in Taiwan?
4. Would a township with better life function have more dentists and a higher growth rate in the supply of dental manpower?
Data. Data on dental manpower were obtained from the Dental Manpower Database of the Center for Health Policy Research, College of Public Health, National Taiwan University, the Health Manpower Masterfile of Department of Health, and the National Hospital Survey. Data on life function came from the Industry, Commerce and Service Census of the Directorate-General of Budget Accounting and Statistics. Data on population were from the Taiwan-Fukien Demographic Fact Book.
Designs. Ecological cross-sectional and longitudinal study on the supply of dental manpower between 1985 and 2000. The population of a township was used to measure the size of market and the density of third industry population was used to measure the life function of a township.
Setting. All 359 townships.
Main outcome measures. Percentage of served townships, dentist-population ratio, growth rate of dentists, net growth proportional rate of dentists.
Results. Cross-sectional observations show that the larger township size groups tended to have a higher percentage of served townships in 1985 and in 1994, and that townships with a higher density of third industry population tended to have a higher dentist-population ratio in 1991 and 1996 ( P < 0.001 ). Longitudinal observations show that, for each township groups, the percentage of served townships increased during the study period as a result of increasing supply of dental manpower, and that a township with a critical population size of about 120,000 or a higher density of third industry population tended to have a higher growth rate of dentists. Further, following the implementation of the NHI, townships with a larger population size tended to have a higher net growth proportional rate of dentists, and that postponed the diffusion of geographic distribution of dentists.
Conclusions. Market forces play a major role in the geographic distribution of dentists in Taiwan.
第一章 前言 1
第一節 供給成長趨勢 1
第二節 地理分布不均 2
第三節 研究目的 3
第四節 論文結構 4
第二章 文獻探討 5
第一節 研究取向的演變 5
第二節 區位取向的理論與應用 7
一、 標準位置理論 7
二、 環境選擇說 10
第三節 實證研究發現 14
一、 標準位置理論的應用 14
二、 環境選擇說的應用 17
第四節 研究啟示 18
第三章 研究方法 20
第一節 研究架構與假說 20
第二節 資料來源與變項定義 22
一、 資料來源 23
二、 變項定義 24
第三節 分析方法 27
一、 研究年代與分析單位 27
二、 研究設計 29
三、 統計分析 33
第四章 研究結果 36
第一節 臺灣牙醫人力之人口特性、供給與地理分布 36
一、 牙醫人力人口特性 36
二、 牙醫人力供給 37
三、 牙醫人力地理分布 37
第二節 市場規模與牙醫人力地理分布的關係 38
一、 地理分布擴散分析:市場規模與有牙醫師鄉鎮市區百分比的關係 38
二、 臨界市場規模分析:臨界市場規模與牙醫人力供給的關係 39
三、 健保效應分析:全民健保實施前後,市場規模與牙醫人力供給成長的關係 41
第三節 生活機能對牙醫人力地理分布的影響 42
一、 地區生活機能與牙醫人力地理分布 42
二、 地區生活機能與牙醫人力供給成長 43
第四節 結果摘要 45
第五章 討論與結論 46
第一節 研究限制 46
假設的限制 46
分析單位 47
資料的限制 47
指標的限制 49
第二節 討論 50
市場規模與牙醫人力地理分布 50
生活機能與牙醫人力地理分布 52
市場規模、生活機能與牙醫人力地理分布 53
未來研究方向與政策啟示 54
第三節 結論 56
參考文獻 57
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