臺灣博碩士論文加值系統

本研究是以1995年至1999年等五年為觀察的時間，將臺灣地區所有牙醫師作為研究母群體。利用行政院衛生署與中央健康保險局提供之資料進行分析，來瞭解牙醫師人力因素與社經因素、人口因素、市場競爭因素、環境因素之相關性。重要的研究結果如下：
1.臺灣地區每十萬人口牙醫師數最高縣市（臺北市）與最低縣市（嘉義縣）的差距，於1999年縮小至相差6.7倍，澎湖縣亦不再如1990年代敬陪末座。人口密度、大專以上學歷民眾百分比、家戶平均年收入等因素，對於每十萬人口牙醫師數而言，具有顯著的正相關。中區縣市（臺中縣市、南投縣、彰化縣）與臺北區縣市（臺北縣市、基隆市、宜蘭縣）的每十萬人口牙醫師數有顯著差異，前者高於後者。賀芬達指標對於每十萬人口牙醫師數的時間變化趨勢有顯著影響力。
2.賀芬達指標對於牙醫師移出率而言，具有顯著的正相關。南區縣市（臺南縣市、嘉義縣市、雲林縣）與臺北區縣市（臺北縣市、基隆市、宜蘭縣）的牙醫師移出率有顯著差異，前者低於後者。實施牙科總額預算制度之後與實施之前的牙醫師移出率有顯著差異，實施之後低於實施之前。
3.65歲以上人口百分比、人口成長率等因素，對於牙醫師移入率而言，具有顯著的正相關。14歲以下人口百分比對於牙醫師移入率而言，具有顯著的負相關。 1996年與1995年的牙醫師移入率有顯著差異，1996年高於1995年。 地理分區與賀芬達指標對於牙醫師移入率的時間變化趨勢有顯著的影響力。
4.賀芬達指標、人口成長率等因素，對於牙醫師成長率而言，具有顯著的正相關。 家戶對於醫療照護之平均年支出、人口密度、14歲以下人口百分比等因素，對於牙醫師成長率而言，具有顯著的負相關。 賀芬達指標對於牙醫師成長率的時間變化趨勢有顯著的影響力。

In this research, all dentists in Taiwan were considered as the study population, and the 5-year study period was between 1995 and 1999. Meanwhile, the data obtained from the Department of Health and the Central Health Insurance Bureau was conducted to analysis in order to realize the relationship between the factors of dental manpower and the factors of socio-economic, population, market competition, and environment.
Important findings include:
1.The difference in the amounts of dentists owned by per 100,000 population decreased as time went by and reached 6.7 times between the most highly concentrated area, Taipei City, and the sparsest one, Chia-Yi County, in 1999. Density of population, percentage of population with college degree, and per capita income, were positively associated with the amounts of dentists owned by per 100,000 population. Dentists concentrated more highly in Middle Taiwan than in Taipei region. Herfindahl — Hirschman Indexes showed significant influence on the trends of the amounts of dentists owned by per 100,000 population.
2.Herfindahl — Hirschman Indexes demonstrated positive association with dentists’ moving-out rates. The rates were lower in South Taiwan than in Taipei region. Nevertheless, dentists’ moving-out rates decreased after the application of global budget compared with the period prior to that.
3.Dentists’ moving-in rates were positively associated with percentage of population older than 65 and growth rates of population, while they were negatively associated with percentage of population younger than 14. In addition, dentists’ moving-in rates increased in 1996 compared with the ones in 1995. Surprisingly, Herfindahl — Hirschman Indexes had significant influence on the trends of dentists’ moving-in rates, while regional bureaus showed significant difference among the trends of dentists’ moving-in rates.
4.There were positive associations between growth rates of dentists and Herfindahl — Hirschman Indexes as well as growth rates of population. On the other hand, growth rates of dentists were negatively associated with per capita expenditure for health care service, density of population, and percentage of population younger than 14. Meanwhile, Herfindahl — Hirschman Indexes showed significant influence on the trends of growth rates of dentists.

指導教授推薦書
口試委員會審定書
授權書……………………………………………………………………………. -iii-
誌謝……………………………………………………………………………… -v-
中文摘要…………………………………………………………………………. -vii-
英文摘要………………………………………………………………………… -ix-
第一章 緒論
1.1 緣起…………………………………………………………………… 1
1.2 研究目的……………………………………………………………… 2
第二章 文獻探討
2.1醫療人力流動研究方法理論………………………………………… 3
2.2 國內牙醫師人力供給與分佈情形…………………………………… 8
2.3 國外牙醫師人力變化現象…………………………………………… 9
2.4 臺灣地區實施全民健保與
試辦牙科總額預算制度之沿革……………………………………… 11
第三章 研究材料與方法
3.1 研究架構……………………………………………………………… 16
3.2 變項之操作型定義…………………………………………………… 18
3.3 研究假設……………………………………………………………… 27
3.4 研究設計……………………………………………………………… 30
3.5 資料來源……………………………………………………………… 31
3.6 分析工具與方法……………………………………………………… 32
第四章 研究結果
4.1 變項基本特質分析…………………………………………………… 34
4.2 橫斷面研究之牙醫師人力變化相關性……………………………… 42
4.3 縱斷面研究之牙醫師人力變化相關性……………………………… 49
第五章 討論
5.1 方法學的討論………………………………………………………… 60
5.2 研究結果的討論……………………………………………………… 62
5.3 研究限制……………………………………………………………… 75
第六章 結論與建議
6.1結論…………………………………………………………………… 77
6.2建議…………………………………………………………………… 79
參考文獻………………………………………………………………………… 81

1. Baker T.D., Perlman M. Health manpower in a developing economy: Taiwan, a case study in planning. Baltimore, the Johns Hopkins Press 1967:203.
2. Gober P., Gordon R. Intraurban physician location: a case study of Phoenix. Social Science & Medicine 1980;14D:407-417.
3 .Tanaka T. et al. Methodological approaches on medical care planning from the viewpoint of geographic allocation model: a case study on South Tama district. Social Science & Medicine 1981;15D:83-91.
4. Gesler W.M., Meade M.S. Locational and population factors in health care-seeking behavior in Savannah, Georgia. Health Services Research 1988;23:443-462.
5. Cromley E., Shannon G.W. Locating ambulatory medical care facilities for the elderly. Health Services Research 1986;21:499-514.
6. McConnel, C.E. Distributional change in physician manpower. United States, 1963-1980. American Journal of Public Health 1986 ;76:638-642.
7. Langwell, K.M. Career paths of first-year resident physicians: a seven-year study. Journal of Medical Education 1980 ;55:897-905.
8. Giddens, A. The constitution of society. University of California Press 1984, Berkeley.
9. Baer, L.D. et al. The wineglass model: tracking the locational histories of health professionals. Social Science & Medicine 2000 Feburary;50:317-329.
10. 藍忠孚等人. Studies on health manpower supply in Taiwan, II. Current situation of dentists, 1972. Journal of Formosan Medical Association. 1974 December;73(12):715-722.
11. 江東亮. 牙醫師人力供給. 全民健康保險研究計畫專案小組, 全民健康保險制度規劃技術報告. 臺北: 行政院經濟建設委員會, 1990.
12. 江東亮. 臺灣地區公元二千年牙醫師人力的供給與地理分布推計. 中華醫誌1992;50:153-160.
13. Bourne D.E. Medical manpower in South Africa ─ emigration during 1975-1981 of doctors qualifying after 1955. South African Medical Journal. 1983 September 17;64(12):447-448.
14. Evans J.R. Health manpower: issues and goals in Canada. Bulletin of Pan America Health Organization. 1974;8(4):302-310.
15. Moore R. Dental education in Sweden: cultural perspective, structure, and issues. Journal of American Dental Association. 1985 May;110(5):692-696.
16. Crawford A.N. The future provision of specialist oral surgery and orthodontic services. British Dental Journal. 1994 August 20;177(4):143-145.
17. Journal of Clinical Orthodontics. Results of JCO issues survey. Journal of Clinical Orthodontics. 1990 April;24(4):225-228.
18. Waldman H.B. Variation and distribution of periodontists: 1982-1991. Journal of Periodontology. 1993 November;64(11):1079-1084.
19. Waldman H.B. Planning for the manpower needs for the next generation of periodontal patients. Journal of Periodontology. 1995 July;66(7):599-604.
20. Mann J. et al. Dental underemployment: a study of uncontrolled dental manpower immigration. International Dental Journal 1993 August;43(4):317-322.
21. Waldman H.B. Selecting a practice location: factors that periodontists may consider. Journal of Periodontology. 1999 January;70(1):95-99.
22. 楊漢湶等人. 牙醫總額支付制度試辦計劃草案. 中華民國行政院衛生署, 1997 November.
23. 藍素禎. 全民健保的新契機 ─ 總額預算制度. 醫望電子報1998 July 8th。 Http://www.south.nsysu.edu.tw/
24. 臺灣省牙醫師公會. 檢討總額預算，各分區提報告. 臺灣牙醫1999. March 10th. 第16期， 第3版.
25. 林志聰. 牙醫總額預算建言. 臺灣牙醫. 1999 March 10th. 第16期, 第三版.