臺灣博碩士論文加值系統

幾乎所有國家都為醫療費用上漲所苦，財源籌措越來越困難，原因很多，例如：所得增加、平均壽命延長、人口老化、醫療科技的進步、醫療照護供給增加；然而醫療費用增加、人員及醫療設施增加，醫療利用率是否必然增加？醫療利用率增加，國民健康是否隨之增進？
醫療體系的最終目的之一是提升民眾健康(WHO,2000)。影響健康的因素很多，醫療只是其中一項。探討醫療費用支出佔GDP比率相關文獻甚多，但很少探討例如GDP對醫療資源之影響；更少涉及GDP與醫療資源如何影響醫療利用；更缺乏醫療費用、醫療資源與醫療利用對健康之影響。
OECD共有三十個會員國，OECD對相關資料的收集及整理有一致的規範及正確性，台灣雖非會員國，但全民健保的實施及衛生署醫療保健支出統計(National Health expenditure, NHE)也與國際接軌，已達OECD國家的水準，故可一同納入，而從體制面、經濟、人力、設施、醫療利用率等方面與民眾健康，探討其間相關性，並比較實際值與期望值間的差距。
結果發現，公部門健康支出佔總健康支出比率顯著影響醫療支出(Per capita HE及HE佔GDP比率)、醫療資源(每千人口醫師數及病床數)、醫療利用(每千人口出院次數)。
依本研究模式，以OECD國家的資料比較分析之，則台灣相對耗用較少的GDP於健康照護，卻得到更多的醫療服務(住院及門診)，且國民享有較佳的健康水準。

Nearly all countries suffer from the rise of the health expenditure . There are a lot of reasons, for example: the increase of income, the extension of lifespan, the aging of population, the progress of medical science and technology, and the increase of health care service provision. However, with the increase of health expenditure, the personnel and the health facilities, whether the healthcare utilization inevitably increases or not? And whether the national health status improved or not along with the increase of health care utilization?
One of the final goals in the health care system is to promote the populace health (WHO, 2000). There are a lot of factors to influence health, and the medical service is only one of them. The related literature discussing the percentage of health expenditure in GDP are many, but few of them discusses the influence of GDP to health resource, even fewer involves how GDP and the health resources affect the health care utilization, and they are even in lack of the influence of the health expenditure, health resources and health care utilization to the health status.
OECD altogether has 30 member nations. OECD has the consistent standard and accuracy of the related data collection and coordination. Although Taiwan is the non-member nation, the implementation of its National Health Insurance and the statistics of its health disbursement in the Department of Health (National Health expenditure, NHE) also connect to the international rail, and it has reached the OECD nation’s standard. Therefore, Taiwan may count as one of the member nations. We can discuss their correlations and compare their disparity between the actual value and expected value, from the aspects of systems, economics, manpower, facilities, health care utilization and populace health as well.
The result showed that the ratio of the health expenditure in government institutes to the total health expenditure notably influences the medical expenditure (Per capita HE and percentage of HE to GDP), the medical resources (the number of doctors and beds per thousand population), and the health care utilization (the number of patients checking out the hospital per thousand population).
According to this research pattern, compared with the analysis of the OECD countries materials, Taiwan relatively consumes less GDP on health care, but obtains more health care service (hospitalized and outpatient service), and the nation enjoys a better health status.

第一章 緒 論
第一節 前言…………………………………………………1
第二節 研究目的……………………………………………3
第二章 文獻探討
第一節 醫療照護欲達到之目標及影響醫療體系因素……4
第二節 影響醫療費用、醫療資源、醫療利用及民眾健康之因素……………6
第三章 研究方法
第一節 研究架構……………………………………………8
第二節 研究問題假設………………………………………9
第三節 研究材料…………………………………………10
第四章 研究結果
第一節 描述性統計分析…………………………………11
第二節 回歸統計分析…………………………………….3
第三節 台灣實際值與期望值之分析比較……………….31


第五章 結論與討論…………………………………………33
第六章　研究限制及建議
第一節 研究限制………………………………………35
第二節 建議……………………………………………35


參考文獻……………………………………………………………37

1.中華民國衛中華民國衛生統計(93年)
2.全民健康保全民健康保險醫療統計(92年)
3.Anne B. Martin, Lekha S. Whittle, and Katharine R. Levit
Trends in State Health Care Expenditures and Funding: 1980-1998
Health Care Financing Review ; Summer 2001; 22,4; ABI/INFORM Global
4.Cathy Cowan, M.B.A., Aaron Catlin, M.S.M. Cynthia Smith, M.A. and Arthur Sensenig, M.A.
National Health Expenditures, 2002
Health Care Finacing Review; Summer (2004); 25, 4; ABI/INFORM Global p.143
5.Dale A. Rublee and Markus Schneider
International Health Spending: Comparisons With The OECD
HEALTH AFFAIRS | Fall( 1991)
6.Daniel R. Waldo, Sally T. Sonnefeld, Jeffrey A. Lemieux, and David R. McKusick
Health Spending Through 2030: Three Scenarios
HEALTH AFFAIRS | Winter (1991)
7.David PARKIN*
Aggregate Health Care Expenditures AND National Income Is Health Care a Luxury Good?
Alistair McGUIRE* and Brian YULE*
Journal of Health Economics 6 (1987) 109-127. North-Holland
8.D. P. DOESSEL
Technology and health expenditures: a demand approach applied to a process innovation
Applied Economics(1990), 22,1277-1289
9.Elmer V. Bernstam, Dawn M. Shelton, Muhammad Walji, Funda Meric-Bernstam
Instruments to assess the quality of health information on the World Wide Web：what can our patients actually use?
International Journal of Medical Informatics(2005) 74, 13-19
10.Gerard Anderson, Jeremy Hurst, Peter Sotir Hussey, Melissa Jee-Hughes.
Health spending and outcomes：Trends in OECD countries,1960-1998
Health Affairs. Chevy Chase：May/Jun 2000. Vol.19, lss. 3; pg.150, 8 pgs
11.Gerard F. Anderson, Peter S. Hussey, Bianca K. Frogner, and Hugh R. Waters
Health Spending In The United States And The Rest Of The Industrialized World
HEALTH AFFAIRS- Volume 24, Number 4
12.Gerard F. Anderson. Peter S. Hussey, Bianca K. Frogner, and Hugh R.Waters
Health Spending In The United States And The Rest Of The Industrializatized World
Health Affairs volume 24, Number 4, 903-913
13.Joan L. Buchanan, Emmett B. Keeler, Joan E. Rolph, and Martin R. Holmer
Simulating Health Expenditures under Alternative Insurance Plans*
Buchanan, Joan L. ; Keeler, Emmett B.; Rolph, John E.; Holmer, Martin R.
Management Science; Sep(1991); 37, 9; ABI/INFORM Global p.1067
14.John Kyriopoulos – Kyriakos Souliotis
Health Expenditure In the OECD Countries
15.Levit, Katharine R, Lazenby, Helen C, Sivarajan, Lekha.
Health care spending in 1994: Slowest in decades
Health Affairs. Chevy Chase: Summer 1996. Vol.15, lss. 2; pg.130, 15pgs
16.Manfred Huber; Eva Orosz
Health Expenditure Trends in OECD Countries, 1990-2001
Health Care Financing Review; Fall (2003); 25,1; ABI/INFORM Global pg.1
17.Milton I. Roemer
al Health Systems Of The World 1983
chapter four: types of health systems and their determinants
18.OECD Data Base (2003)
19.Paul Hansen, Alan King *
The determinants of health care expenditure: A cointegration approach
Journal of Health ecnomics 15(1996)127-137
20.Randall P. Ellis and Thomas G. McGuire
Supply-Side and Demand-Side Cost Sharing in Health Care
Journal of Economic Perspectives -Volume7,Number4-Fall (1993)135-151
21.Schieber, George J.; Poullier, Jean-Pierre
Overview of International Comparisons of Health Care Expenditures
Health Care Financing Review; 1989;ABI/ INFORM Global 1-7
22.Shahram Heshmat, PhD
The Multiple Determinants of Health
An Overview of Managerial Economics in the Health Care System (2001), Chapter 6, 82-96
23.Simanis, Joseph G.
Health Care Expenditures: International Comparisons, 1970-80
Social Security Bulletin; Oct 1987; 50,10,ABI/INFORM Global 19-24.
24.Statement of John P. Martin
The Experience of OECD Countries In Coping with Rising Health Costs
Economic Committee April 10,2003
25.Stephen Heffler, Shelia Smith, Sean Keehan, M. Kent Clemens, Greg Won, and Mark Zezza
Health Spending Projections For 2002-2012
http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.54v1/DC1

26.Stephen Heffler, Sheila Smith, Sean Keehan, M Kent Clemens, et al.
Health Spending Projections Through 2013
Health Affairs. Chevy Chase：Jan-Jun 2004. pg. W79, 14 pgs
27.Susan G. Haber and Joseph P. Newhouse
Haber, Susan G. ; Newhouse, Joseph P.
Health Care Financing Review;
Fall(1991); 13, 1; ABI/INFORM Global p.111
28.Suzanne K. McCoskey a, Thomas M. Selden b,*
Health Care Expenditures AND GDP: panel data unit root test results
Journal of health Economics 17(1998)369-376
29.The World Health Report 2000:health systems: improving performance
30.Theo Hitiris and John Posnett*
The determinants and effects of health expenditure in developed countries
Journal of Health Economics 11 (1992)173-181. North-Holland
31.Thomas E Getzen
Forecasting Health Expenditures：Short, Medium, and Long(Long) Term
Journal of Health Care Finance; Spring 2000; 26, 3; ABI/ INFORM Global 56-72
32.Uwe E. Reinhardt, Peter S. Hussey, and Gerard F. Anderson(2002)
Cross-National Comparisons Of Health Systems Using OECD Data, 1999.
Trends, May/June , 169-181