臺灣博碩士論文加值系統

本研究藉由更新中國31省之追蹤資料，探討影響中國政府醫療支出成長的決定性因素。文中由六個層面來探討對於醫療支出成長的影響，分別是所得因素、醫療供給面因素、政府赤字、保險制度、人口結構、醫療水準。此外，實證分析採用固定效果模型與隨機效果模型，以控制各省差異對於醫療支出成長造成影響。
實證上，本文先探討2002年至2010年，影響政府醫療支出成長的決定性因素。接著再分析2007年至2010年，保險制度對於政府醫療支出成長的影響。研究結果發現：（1）所得為重要的決定性因素，與文獻結論相符。（2）保險參與率的提升與人口的增加誘發對於醫療的需求，進而增加政府的醫療支出。（3）老年人口扶養比對於醫療支出影響沒有預期中的顯著。（4）政府赤字與醫療支出為正相關，表示赤字的增加不會抑制政府之醫療支出。（5）死亡率的降低與醫療供給面的改善仰賴政府的力量，故顯著影響政府醫療支出。

This study examines the determinants of the growth of Chinese provincial government health expenditure by updating the panel data of 31 provinces in China. This study uses six levels of variables to examine the impact to the growth of health expenditure, including income factor, medical supply side factor, government deficit, insurance system, population structure, standards of medical care. In addition, this study employs fixed-effect model and random-effect model to control the growth of health expenditure caused by the differences in each province.
Empirically, this study first explores the determinants of the growth of government health expenditure from 2002 to 2010, then analyzes the impact on the growth of government health expenditure caused by the insurance system from 2007 to 2010. The finding show that：（1）Income factor is an important determinant and it corresponds to the conclusion of the literature.（2）A rise in participation rate of insurance and the increase in population induce the demand for medical care.（3）The impact on government health expenditure caused by old-age dependency ratio is not as significant as expected.（4）There is a positive relationship between government deficit and health expenditure, indicating that the increase in the deficit does not decrease the government health care expenditure.（5）The decrease in mortality and the improvement of the medical supply side rely on government's efforts, and therefore, they significantly affect government health expenditure.

第一章 緒論1
第一節 研究動機與目的1
第二節 研究架構與流程6
第二章 文獻回顧8
第一節 醫療支出相關文獻回顧8
第二節 基本社會保險文獻回顧14
第三章 中國社會保障制度發展23
第一節 基本醫療保險制度發展23
第二節 基本醫療保險制度存在的問題28
第四章 研究方法33
第一節 資料來源與變數說明33
第二節 實證模型-追蹤資料分析（PANEL DATA ANALYSIS）43
第三節 實證模型-豪斯曼檢定（HAUSMAN TEST）47
第四節 模型設定48
第五章 實證結果51
第一節 敘述統計51
第二節 醫療支出成長實證分析結果62
第三節 保險制度下的醫療支出67
第四節 整合分析70
第六章 結論與政策建議74
第一節 結論歸納74
第二節 政策建言79
第三節 未來研究方向81
參考文獻82

一、英文文獻
1.Alastair, Gray （2005）,“ Population Ageing and Health Care Expenditure, Ageing Horizons, Issue No. 2, 15–20.
2.Busse , R.（2001）, “ Expenditure on Health Care in the EU: Making Projections for the Future Based on the Past , The European Journal of Health Economics, Vol. 2, No. 4, 158-161.
3.Baltagi, Badi H. and Francesco Moscone（2010）, “ Health Care Expenditure and Income in the OECD Reconsidered: Evidence from Panel Data, IZA Discussion Paper No. 4851.
4.Crinelli , Luca, Massimo Filipprni and Ilaria Mosca（2006）, “ Federalism and Regional Health Care Expenditures：An Empirical Analysis for The Swiss Cantons , Health Economics, Vol. 15, Issue 5, 535 - 541.
5.Chou, Win-Lin（2007）,“Explaining China’s regional health expenditures using LM‐type unit root tests,Journal of Health Economics 26: 682– 698.
6.Dong , Weizhen ( 2003 ) , “ Healthcare-financing Reforms in Transitional Society: A Shanghai Experience , Journal of Health, Population and Nutrition, 223-234.
7.Dreger, Christian and Hans-Eggert Reimers（2005）,“Health Care Expenditures in OECD Countries : A Panel Unit Root and Cointegration Analysis , IZA Discussion Paper No. 1469.
8.Eggleston, Karen（2009）, Prescribing Cultures and Pharmaceutical Policy in the Asia-Pacific, California : Shorenstein APARC, 205-222.
9.Jacobzone , Stephane （2002）, “Ageing and Health Care Costs, Journal for International Relations and Global Trends ,137-156.
10.Liasg , Jersey, Edward Jow-Chisg Tu and Xiasgmng Chen（1986）, “ Population Aging in The People’s Republic of China , Social Science ＆ Medicine, Vol. 23, 1353 - 1362.
11.Mocan, H.Naci, Erdal Tekin, Jeffrey S. Zax ( 2004 ) , “The Demand for Medical Care in Urban China, World Development, Vol. 32, No. 2, 289 - 304.
12.Matteo, Livio Di（2004）, “The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time , Health Policy, 23 - 42.
13.Newhouse , Joseph P.（1977）,“Medical-Care Expenditure：A Cross-National Survey, The Journal of Human Resources, Vol. 12, NO.1, 115 - 125.
14.Pan, Jay and Gordon G. Liu（2011）,“The Determinants of Chinese Provincial Government Health Expenditures：Evidence From 2002 - 2006 data , Health Economics , Vol.21, Issue 7, 757- 777.
15.Seshamania , Meena and Gray Alastair（2004）, “ Ageing and health-care expenditure: the red herring argument revisited , Health Economics , 13: 303 - 314.
16.Taylor, Richard and Glenn Salkeld （1996）, “ Health care expenditure and life expectancy in Australia : How well do we perform? , Australian and New Zealand Journal of Public Health, Vol. 20, NO. 3, 233-240.
17.Ulf-G., Gerdthem（1992）, “Pooling International Health Care Expenditure data, Health Economics, Vol. 1, 1：217-231.
18.Wooldridge , Jeffery M.（2006）, Introductory Econometrics：A Modern Approach, Third Edition, Australia : South-Western.
19.Xu , Ling, Yan Wang, Charles D Collins and Shenglan Tang（2007）, “ Urban health insurance reform and coverage in China using data from National Health Services Surveys in 1998 and 2003 , BMC Health Services Research, Vol. 7, 37 - 50.
20.Yip, Winnie and William C. Hsiao（2008）, “ The Chinese Health System At A Crossroads , Health Affairs, Volume 27, Number 2, 460 - 468.
21.Yu , Baorong , Qingyue Meng, Charles Collins, Rachel Tolhurst, Shenglan Tang, Fei Yan, Lennart Bogg and Xiaoyun Liu（2010）, “How Does the New Cooperative Medical Scheme Influence Health Service Utilization? A Study in Two Provinces in Rural China, BMC Health Services Research, 10:116.
22.Zweifel, Peter, Stefan Felder and Markus Meiers（1999）, “ Ageing of Population and Health Care Expenditure：A Red Herring ? , Health Economics, 8: 485 - 496.

二、中文文獻
1.中國衛生部，http://www.moh.gov.cn/。
2.中國國家統計局，http://www.stats.gov.cn/。
3.中國衛生部(2003-2011)，《中國衛生統計年鑑》。中國協和醫科大學出版社。
4.中國統計局(2003-2011)，《中國統計年鑑》。中國統計出版社。
5.熊吉峰、陳玉萍、丁士軍(2009)，「城鄉醫療統籌中欠發達地區農民面臨的主要矛盾與化解策略」，《農業經濟問題》，2009年第4期，38-42。
6.汪德華、張瓊(2006)，「公共醫療保險與居民醫療負擔-全球視野下的中國全民醫保」，《南京理工大學學報》，NO.6，2008，30-39。
7.董黎明(2009)，「構建中國特色醫療衛生體制的公共財政支持機制」，《熱點聚焦》，2009年第4期，17-20。
8.石宏偉、沈思思(2011)，「統籌我國城鄉居民醫療保險制度的對策研究」，《湖北農業科學》，Vol.50, No.12, Jun., 2011，2589-2592。
9.李秀娟、尚麗岩(2007)，「中國醫療保健支出的城鄉差距與地區差距分析」，《亞洲社會藥學》，2007，2（4），138-142。
10.詹勳旺(2009)，「中國各省分經濟規模對其社會保障支出的影響」，國立政治大學，碩士學位論文。
11.魏眾、B.古斯塔夫森（2005），「中國居民醫療支出不公平性分析」，《經濟研究》，2005年第12期，26 -34。