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研究生:黃伯偉
研究生(外文):Po-Wei Huang
論文名稱:市場競爭程度對醫院行為的影響--以昂貴醫療處置採用為例
論文名稱(外文):The Impact of Competition on Hospital Behavior--Evidences from the Adoption of Expensive Procedures
指導教授:湯澡薰湯澡薰引用關係許玫玲許玫玲引用關係
指導教授(外文):Chao-Hsiun TangMei-Ling Sheu
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫務管理學系
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2003
畢業學年度:91
語文別:中文
論文頁數:84
中文關鍵詞:醫院競爭市場結構賀芬達指數昂貴醫療處置採用
外文關鍵詞:hospital competitionmarket structureHerfindahl-Hirschman Indexthe adoption of expensive procedure
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醫療服務市場的特殊性,包括資訊不對稱、保險的介入、不確定性等等,長期以來讓經濟學家認為可能造成醫療服務市場將會脫離一般市場法則,這也是衛生主管機關強力介力醫療服務市場最重要的原因之一。然而若是醫療服務市場雖然具備一些異於一般市場的特性,但卻仍然沒有脫離一般經濟學的法則,也許政府仍可透過自由競爭的結果,讓醫療服務市場的效率提高,進而降低總體的醫療成本。
本研究旨在檢視臺灣醫院服務市場昂貴醫療處置的採用是否與市場競爭程度有關,也就是醫院競相採用醫療儀器及設備,造成無效率的醫療品質(inefficient quality)及總體醫療費用的上漲。初步研究結果發現,競爭程度愈高的地區,醫院採用昂貴醫療儀器或手術的可能性愈高,而平均醫療費用亦越高。
本研究建議未來衛生政策制定時應考量此一因素,在醫院服務產業高度競爭的情況下加強儀器設備的共同使用,並透過制度的改變,以降低無效率的昂貴醫療處置採用。
For a long time, economists think that the health services market won’t accord with the general rules because of the information asymmetry, insurance, and the uncertainty. Also, it’s the main reason of the government intervention. However, if the health services market accords with the general rules, we can promote the efficiency even reduce the total health expenditure through competition without government intervention.
This study examines if the adoption of expensive medical procedures related with the degree of competition in Taiwan, which results in the inefficient quality and the rising health expenditure possibly. The results show that hospitals in more competitive environment tend to adopt the expensive procedure, which also have higher health expenditure.
We suggest that the phenomenon must be considered when the health policy formed in the future. To reduce the inefficiency, the government should promote the share of the medical procedure between hospitals and change the payment system.
誌謝 I
中文摘要 II
英文摘要 III
目錄 IV
表目次 VI
圖目次 IX
第一章 緒論 1
第一節 研究緣起 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 定義市場範圍 4
第二節 衡量競爭程度 7
第三節 競爭程度對醫院行為之影響 11
第四節 國內文獻探討及綜合討論 17
第三章 研究方法 23
第一節 研究設計及概念架構 23
第二節 研究變項及操作型定義 30
第三節 研究假設 34
第四節 資料來源與分析方法 35
第四章 研究結果 38
第一節 描述性統計分析 38
第二節 賀芬達指數的建立 51
第三節 羅吉斯迴歸分析結果 57
第四節 線性迴歸分析結果 67
第五章 結論與建議 73
第一節 研究限制 73
第二節 結果討論 75
第三節 政策建議 77
參考文獻 78
中文文獻 78
英文文獻 81
中文文獻
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