政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/52134
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    Please use this identifier to cite or link to this item: https://nccur.lib.nccu.edu.tw/handle/140.119/52134


    Title: 市場競爭，醫療選擇，和醫療品質---以透析治療為例
    Other Titles: Market Competition, Treatment Choice and Treatment Quality--- Evidence from Dialysis Treatment
    Authors: 連賢明
    Contributors: 行政院國家科學委員會
    國立政治大學財政系
    Keywords: 經濟學;醫療品質;透析治療
    Date: 2010
    Issue Date: 2011-11-16 15:11:26 (UTC+8)
    Abstract: 近年來末期腎臟病治療（俗稱洗腎）的健保費用逐年攀高。為了降低逐年攀升的洗腎治療費用，健保局於2006 和2007 年，採取一系列政策鼓勵腹膜透析治療。但即使如此，台灣洗腎病患使用腹膜透析比例仍相當低，再健保局大力推廣後，腹膜透析比例也僅從2006 的7.5％上升至2007 的8.5％，絕大多數還是採用血液透析，顯示台灣洗腎病患對腹膜透析的接受程度有限。本計畫的主要目的在於瞭解為何台灣腹膜透析使用比例如此低。一個可能是兩種透析方式存在療效上的差異。現有文獻普遍認為這兩種透析治療療效大致相同，但這些研究是以病患選擇後結果做比較。由於腹膜透析病患需自行在家進行透析治療，有可能在個人健康狀態上較血液透析病為佳。因此，在第一年計畫，我們採工具變數法（instrumental variable estimation, IV）來探求這兩種透析方法對洗腎病患在存活時間和工作就業的影響。另一個解釋則來自醫療供給者的差異。在 2008 年，台灣有517 院所提供血液透析，卻只有99 家提供腹膜透析，即使是在競爭激烈的都會區，願意提供腹膜透析院所仍相當有限。也就是說，市場競爭不見得會增加病患醫療選擇。在第二年計畫，我們預計討論市場競爭對醫療選擇影響。我們計畫使用Kessler and McClellan（2000）所設計的競爭指標，來分析市場競爭對醫療選擇影響。
    In recent years, dialysis treatment has become one of the fast-growing expenditure components in national health insurance. To contain the rising expenditure of dialysis treatment, Bureau of National Health Insurance (BNHI) has initiated a series of policies to encourage end-stage renal disease (ESRD) patients to adopt Peritoneal dialysis (PD). Despite that, the rate of HD within ESRD patients continues to be in the low ends among developed countries, rising only slightly from 7.5％ in 2006 to 8.5％ in 2007, while the vast majority of ESRD patients still choose hemodialysis (HD). This demonstrates that ESRD patients in Taiwan have limited supports for HD. The purpose of this proposal is to understand why the take-up rate of HD is so low in Taiwan. One explanation is that HD and PD have different treatment effects. Although many researches have argued that the survival of HD and PD patients are approximately the same, those findings are based on the observations of patients who choose various treatment methods. Given that HD patients conduct the HD at homes, it seems plausible to expect HD patients might have better health status. Thus, we use the instrument variable method to sort out the effect of these two methods on the survival and employment of ESRD patients. Another explanation is that the difference comes from health providers. In 2008, there are 517 clinics or hospitals provide HD services, while only 99 provide PD services. Even in the ubran area, there are only very few suppliers willing to provide PD services; that is, market competition does not seem to lead to more treatment choices. In the second year project, we plan to use the competition index developed by Kessler and McClellan（2000） to analyze the effect of market competition on the treatment choices.
    Relation: 基礎研究
    學術補助
    研究期間:9908~ 10007
    研究經費:976仟元
    Source URI: http://grbsearch.stpi.narl.org.tw/GRB/result.jsp?id=1686378&plan_no=NSC99-2410-H004-052-MY2&plan_year=99&projkey=PF9906-1434&target=plan&highStr=*&check=0&pnchDesc=%E5%B8%82%E5%A0%B4%E7%AB%B6%E7%88%AD%EF%BC%8C%E9%86%AB%E7%99%82%E9%81%B8%E6%93%87%EF%BC%8C%E5%92%8C%E9%86%AB%E7%99%82%E5%93%81%E8%B3%AA---%E4%BB%A5%E9%80%8F%E6%9E%90%E6%B2%BB%E7%99%82%E7%82%BA%E4%BE%8B
    Data Type: report
    Appears in Collections:[Department of Public Finance] NSC Projects

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