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研究生:陳柏亨
研究生(外文):Po Heng Chen
論文名稱:專科診所設立因素之探討-以婦產科診所為例
論文名稱(外文):An Empirical Analysis on Factors of Affecting Establishment of Obstetrics and Gynecology Clinics
指導教授:許績天許績天引用關係
指導教授(外文):J. T. 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:2008
畢業學年度:96
論文頁數:50
中文關鍵詞:關聯性婦產科小兒科診所設立
外文關鍵詞:associationobstetricspediatricsestablishment of clinics
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近年來研究醫療提供者的相關討論越來越多,但對於醫療服務提供者的市場進入行為少有研究進行探討;因我們僅能藉觀察到地區有新機構的設立,來瞭解醫療提供者進入市場的行為,所以我們可以藉由探討醫療機構設立因素來瞭解此行為。而關於影響醫療機構設立因素之研究,先前研究多從醫師選擇的角度切入討論,並未針對不同科別間的相互影響進行瞭解與探討。因此,本研究擬以小兒科家數與婦產科專科診所之設立機率來探討婦產科與小兒科之間的關聯性。
本研究資料分析部分,市場範圍是用全國各鄉鎮市區(不含離島)共351個鄉鎮區域來劃分,並利用1999-2003年全民健康保險資料庫中的醫事機構基本資料檔及醫事機構診療明細檔,分別以機構及鄉鎮為觀察單位,藉由Ordered Probit及Probit迴歸模型來估計婦產科診所設立機率與小兒科家數之間的關聯性。
研究結果發現(1)鄉鎮區域範圍外的小兒科專科診所數越多時,其婦產科在該區域內設立之可能性越高,兩者存在高關聯性;(2)鄉村地區及規模小於5萬人的鄉鎮,婦產科設立與小兒科專科數關聯性較高。
Recently, there is a dramatic amount of researches on behavior of health care providers, but unfortunately little of them focus on their entry behavior. While we can only describe the entry behavior by investigating the new established organization in an area, we can probe the behavior into discussing factors of affecting establishment of organization. Moreover, most of previous studies use the viewpoint of doctors to discuss the factors of the establishment of medical organizations. Few studies aim at the relationship of each specialty. Henceforth, this study focuses on the number of existing pediatric clinics and the probability of establishment of an obstetric clinic to discuss the association between these two specialties.
The market of this study is defined by administrative townships, and encompassed all of 351 townships in Taiwan (excluding off-shore areas). We use Registry For Contracted Medical Facilities (HOSB) and Registry For Contracted Specialty Services (DETA) from National Health Insurance Research Database (NHIRD) of 1999-2003. We used two observational units for analysis-townships and clinics. The Ordered Probit and Probit model are performed for estimating the relationship between the two specialties.
Our major findings are as follows: (i)When there are more pediatric clinics in a given town, the probability of establishment of an obstetric clinic is significantly higher. This provides evidence of strong association between these two specialties. (ii)The association between these two specialties is more significant for towns located in rural areas and the towns with population less than fifty thousand.
目錄
指導教授推薦書…...............................................................................
口試委員會審定書…...............................................................................
授權書...............................................................................iii
誌謝...............................................................................…iv
中文摘要...............................................................................……v
英文摘要...............................................................................….vi
目錄................................................................................vii
圖表目錄…................................................................................ix
第一章 前言…...............................................................................…..1
第二章 文獻探討.. ....................................................................................5
第三章 研究方法…...........................................................................…..10
第四章 研究資料與樣本說明.................................................................13
第一節 資料來源…..................................................................13
第二節 資料處理流程…................................................................13
第三節 研究變項說明及資料來源…............................................15
第四節 樣本說明............................................................................19
第五章 實證估計結果............................................................................24
第一節 婦產科專科診所設立與小兒科診所之關聯-以鄉鎮
為觀察單位…….............................................................24
第二節 婦產科專科診所設立與小兒科診所之關聯-以機構
為觀察單位.....................................................................27
第三節 都市化與婦產科及小兒科關聯之估計結果....................30
第四節 市場規模與婦產科及小兒科關聯之估計結果................33
第五節 小結…................................................................................36
第六章 結論與討論….............................................................................38
參考文獻…...............................................................................................41
圖表目錄
圖一 歷年小兒科及婦產科專科機構數量變化.....................................21
表一 文獻彙整表…...................................................................................7
表二 醫師執業地點選擇之影響因素彙整表...........................................9
表三 各縣市歷年婦產科專科新設立數........................................22
表四 變項資料描述統計表.........................................................23
表五 婦產科專科診所設立與小兒科診所之關聯分析表-以鄉鎮為
觀察單位 .......................................................................................26
表六 婦產科專科診所設立與小兒科診所之關聯分析表-以機構為
觀察單位 .......................................................................................29
表七 都市化與婦產科及小兒科關聯估計結果.....................................32
表八 市場規模與婦產科及小兒科關聯估計結果.................................35
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