臺灣博碩士論文加值系統

醫療供給是否會誘發需求？若得到這個問題的答案即可以決定醫療資源的分配與控制，究竟是應該由供給面還是需求面下手比較有效。而醫療服務市場中是否供給者因自利而誘發需求，造成市場失靈（Market failure）的議題，古今中外有許多的學者以各種方式嘗試驗證。但時至今日卻仍有些學理與實證上的難題與爭議存在，這樣的爭議存在實證研究中統計分析時所產生的認定問題（Identification）。本研究擬由另一個全新的角度，亦即以民眾付費意願（Willingness to pay；WTP）所推導而得的需求線，來驗證醫療供給的增加，是否會引導需求線的右移現象。
本研究之母群體為台灣地區18歲以上居民，以機率隨樣本大小成比例（Probability proportionate to size; PPS）的方式抽出代表性樣本，以面訪進行資料蒐集。研究分析則採計量經濟中對於聯立方程組模型（Simultaneous Equations Models）之聯立性檢定（Hausman test）觀察變項之內生問題，藉以判斷是否以兩階段最小平方法（Two-stage least square；2SLS）求解。
研究結果發現，在控制了人口學特徵、時間成本及健康狀況等相關變項後，在研究所調查之三種疾病中，即流行性感冒、急性闌尾炎及高血壓的付費意願仍與醫師人口比變項成顯著的正向影響，亦即醫師的供給量增加發現民眾對於醫療需求也隨之增加，藉此發現了供給誘發需求的間接證據。以此研究結果提出政策建議之擬定方向不應以價格管制為限，而須同時對供給面予以控制，才能有效率的節制醫療費用的上升。

Does medical supply induce demand? The answer to this question will inform the national health policy of resources allocation and cost containment. Numerous studies have been exploring this question since1970s. However, it remains problems and arguments both in the theoretical and empirical studies especially for the identification problems in the statistic analyses of empirical studies. This study uses the concept of consumers’ willingness to pay, trying to draw the demand curve conceptually, and to test the hypothesis of supply induces demand.
A national sample of 1500 general population were interviewed from the population in Taiwan who was elder than or equal to 18 years. The probability proportion to size（PPS）sampling method was used. Data was analyzed by simultaneous equations models, and Hausman’s specification test was applied to test the endogenity.
Study results show that after controlling time cost, health status and other relative variables, willingness to pay for the three diseases, influenza, acute appendicitis and hypertension, are significantly and positively influenced by physician-population ratios. That is, the more physician supply given, the more medical demand consumers request. This is the indirect evidence of supply inducing demand. The policy implication of the study result is that cost containment policy should not confine to price control only. The supply of physician should also be one of the important strategies.

（目錄）
第一章 緒論.........................................1
第一節 研究背景.....................................1
第二節 問題陳述.....................................3
第三節 研究目的及貢獻...............................6
第四節 研究大綱及架構...............................7
第二章 文獻探討.....................................9
第一節 供給誘導需求（Supply-Induced Demand; SID）...9
第二節 付費意願（Willingness to Pay; WTP）..........33
第三章 研究設計與方法...............................41
第一節 研究假設.....................................41
第二節 資料來源.....................................45
第三節 個人健康狀態之衡量（SF-36）..................48
第四節 付費意願之衡量...............................50
第五節 分析方法.....................................53
第四章 研究結果與探討...............................59
第一節 研究資料特性.................................59
第二節 相關性統計...................................65
第三節 推論性分析...................................68
第四節 複迴歸分析...................................74
第五章 討論.........................................78
第一節 研究結果探討.................................78
第二節 研究方法探討.................................82
第三節 研究限制探討.................................83
第六章 結論與建議...................................85
第一節 結論.........................................85
第二節 建議.........................................85
參考文獻..............................................87
中文部分............................................87
英文部分............................................92

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