臺灣博碩士論文加值系統

臺灣全民健保於2002年全面實施總額預算支付制度，其宗旨是藉由分配地區預算的方式，將較多預算分配給醫療需求較多或醫療需求未被滿足的地區，以此改善偏鄉地區醫療資源分配不均的問題。因此本論文欲探討在總額支付制度下，點值是否為醫師選擇執業地區的決策因素。本文使用2006-2011年健保資料庫資料，探討該期間內的執業和開業醫師的區位選擇是否受到總額預算支付制度下浮動的點值之影響。首先採用多項式Logit 模型（Multinomial Logit Model）比較不同醫師個人屬性對於執業區位選擇的影響。由於醫師的區位選擇可能受到地區平均每人所得、總人口數等因素的影響，因此本文再透過條件Logit機率模型（Conditional Logit Model）加以探討各區的地區特性對於醫師區位選擇的影響。最後，使用混合Logit模型（Mixed Logit Model）同時探討醫師特徵及地區特徵對於醫師執業區位選擇的影響。實證結果發現，總額支付點值並非是影響西醫基層醫師區位選擇的重要因素；但是影響牙醫師區位選擇的重要決策因素之一。其次，西醫基層和牙醫師皆偏好選擇到平均整體服務量較高之分區執業。實證結果也顯示，地區的醫療需求與經濟水準，包含人口密度、平均家戶所得，與租賃及權利金，也是西醫師和牙醫師區位選擇之重要因素。

Taiwan’s National Health Insurance implemented a global budget system since 1999. The policy intends to improve the uneven distribution of medical resources by focusing more on the areas with higher medical or unmet medical needs. Therefore, this paper is going to discuss whether the point value is a crucial component for physicians to choose a practice location under the global budget system. This paper uses the data from the National Health Insurance database from 2006 to 2011. The floating point value is the key to determine the physician’s practice location choice under the global budget system during the period. Firstly, this paper adopts the multinomial logit model to analyze the choice of practice location on different physicians' characteristics between age, gender, and experience. Because the location selection of physicians may be affected by factors such as the average income per person in the area or the total population, I used the conditional logit model to discuss the influence of different regional characteristics on the location selection of physicians. Finally, I used the mixed logit model to discuss the choice of physician practice locations with the physicians’ characteristics and market characteristics. The empirical results indicate that the point value is not an important factor for primary care physician’s practice location choices, but it is important for dentists, however, both of them prefer to choose the area with large overall quantity of service. The empirical results also show that market characteristics are important factors for physicians when choosing location, including population density, average household income, and the amount of lease and royalties.

謝辭 i
摘要 ii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 論文架構 2
第二章 文獻回顧 3
第三章 臺灣總額支付制度 5
第四章 資料 11
第一節 資料來源與整理 11
第二節 變數說明與敘述統計 15
第五章 實證模型 19
第六章 實證結果 25
第七章 結論與建議 36
參考文獻 38

一、中文部分
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黃昱瞳、楊長興與薛亞聖（2002），「全民健保實施牙醫總額預算制度對醫療資源分布的影響評估」，台灣公共衛生雜誌，21卷6期，403-410。
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二、英文部分
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三、網站部分
內政部戶政司人口統計。取自
　　https://www.ris.gov.tw/app/portal/346
所得稅申報核定統計專冊資料。取自
　　https://www.fia.gov.tw/
衛生福利部中央健康保險署。取自
　　https://www.nhi.gov.tw/