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研究生:李佳蔚
研究生(外文):Chia-wei Lee
論文名稱:市場競爭對就醫選擇機會的影響-以血液透析治療為例
論文名稱(外文):Impacts of Market Competition on Opportunities of Choices of Health Care Providers-Evidence from Hemodialysis Treatment
指導教授:許績天許績天引用關係
指導教授(外文):Jitian Sheu
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
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:2007
畢業學年度:95
語文別:中文
論文頁數:79
中文關鍵詞:市場競爭賀芬達指數透析就醫選擇機會
外文關鍵詞:market competitionHerfindahl-Hirschman Indexdialysisopportunities of choices of health care providers
相關次數:
  • 被引用被引用:4
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  • 收藏至我的研究室書目清單書目收藏:4
近幾年來臺灣透析治療的發生及盛行率居高不下,透析人數也逐年攀升,而透析醫療供給不論就腎臟專科醫師數以及透析病床數而言皆有不斷成長的趨勢,當醫療供給增加,民眾(病患)就醫選擇越高。本研究擬以透析醫療院所家數為衡量病患的就醫選擇,探討市場競爭是否會對醫療供給產生變化,進而提高民眾的就醫選擇機會。
本研究以全國各鄉鎮市區(不包含離島地區)共359個鄉鎮區域劃分市場的範圍,以賀芬達指數作為競爭的衡量,使用1996 到2003年健保資料中重大傷病檔的門診資料,分析透析醫療市場的供給情形,並且設立實證模型,估計在給定的需求和供給之下,不同市場競爭的狀態以及市場之間競爭的改變對供給者數目的影響。
研究結果顯示,以賀芬達指標作為競爭指標時,其估計係數為負,表示市場競爭程度增加,則透析醫療院所的家數越多;進一步將市場競爭程度區分為四等分,其結果發現,位於高度競爭的市場,透析醫療院所家數增加最多;最後探討市場之間競爭程度改變的結果,當市場之間的競爭程度變化為增加時,則該醫療院所的家數數目較多。綜合上述研究結果,市場的競爭越激烈,醫療提供者增加,而病患的就醫選擇機會提高。
In recent years, with the prevalence of dialysis therapies and the soaring number of dialysis patients in Taiwan, there is an increasing demand in the number of either nephrologists or dialysis sickbeds. The more the number of the health care supply is provided, the more the patients’ opportunities of choices of health care providers are raised. This study uses the number of dialysis health care organizations as a measurement to assess patients’ opportunities of choices of health care providers, and then discusses that whether or not the market competition will have an influence on the health care market supply.
The scale of this research encompasses all 359 cities and townships in Taiwan (off-shore islands excluded). We used the Herfindahl-Hirschman Index to measure the degree of competition, and used the out-patient data files of the serious diseases cases from National Health Insurance during 1999 to 2003 to analyze the supply in medical market. We also set up empirical models to measure the factors that have an influence on the number of health care providers under the given market supply and demand, and those factors are the status of different market competition and changes in competition between markets.
The result indicated that the estimated coefficient was negative, when we used Herfindahl-Hirschman Index as the competition indicator. This negative coefficient implied that the more competitive the market is, the more the dialysis centers there will be. Furthermore, we divided the degree of market competitiveness into four scales ranging from the highest to the lowest; the result showed that the number of the dialysis health care organizations rises the most in the highest competitive market scale. As the degree of competitiveness between markets rises, the number of the dialysis health care organizations also increases. To sum up, the more competitive the market is, and the more the number of the health care providers, the more the patients’ opportunities of choices of health care providers.
目錄
指導教授推薦書……………………………………………………….
口試委員會審定書…………………………………………………….
授權書………………………………………………………………….
誌謝…………………………………………………………………….iii
中文摘要………………………………………………………………. iv
英文摘要………………………………………………………………. v
目錄…………………………………………………………………… vi
圖表目錄………………………………………………………………viii
第一章 緒論………………………………………………………… 1
第一節 研究背景與動機…………………………………… 1
第二節 研究目的…………………………………………… 8
第二章 文獻探討…………………………………………………… 9
第一節 市場的概念和界定………………………………… 9
第二節 競爭程度的衡量……………………………………13
第三節 醫療機構的競爭行為………………………………17
第四節 競爭及其他因素對就醫選擇機會的影響…………22
第五節 文獻總結……………………………………………25
第三章 研究方法……………………………………………………27
第一節 實證模型…………………………………………. 27
第二節 研究變項說明…………………………………….. 32
第三節 樣本說明與資料來源…………………………….. 36
第四節 資料處理步驟…………………………………….. 39
第四章 研究結果……………………………………………………41
第一節 描述性統計分析………………………………….41
第二節 實證結果………………………………………….52
第五章 結論與建議………………………………………………... 67
第一節 研究限制………………………………………. 67
第二節 結論與討論…………………………………….. 69
第三節 建議與未來研究方向………………………….. 72
參考文獻………………………………………………………………73
附錄…………………………………………………………………....78


圖表目錄
圖1-1-1 臺灣地區歷年醫院診所家數變動………………………… 2
圖1-1-2 歷年透析治療病床成長趨勢……………………………… 3
圖1-1-3 歷年腎臟專科醫師數……………………………………… 4
圖1-1-4 歷年透析病患之盛行率與發生率成長趨勢……………… 5
圖1-1-5 歷年血液透析與腹膜透析人數成長趨勢………………… 5
圖1-1-6 歷年透析總人數成長趨勢………………………………… 6
圖3-1-1 資料庫建構圖………………………………………………37
表4-1-1 歷年血液透析治療院所層級別分佈………………………46
表4-1-2 歷年血液透析治療院所權屬別分佈………………………46
表4-1-3 不同競爭程度之透析市場個數……………………………47
表4-1-4 不同競爭程度之透析醫療院所平均家數…………………47
表4-1-5 描述性統計表(1996-2003) …………………………………48
表4-1-6 不同競爭程度的描述性統計表(1996-2003) ………………49
表4-1-7 歷年市場醫療院所數的平均人口分布……………………50
表4-2-1 透析醫療市場供給之迴歸分析結果………………………62
表4-2-2 透析醫療市場供給之Tobit迴歸分析結果……………… 63
表4-2-3 透析醫療市場供給之迴歸分析結果………………………64
表4-2-4 透析醫療市場供給之Tobit迴歸分析結果……………… 65
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