政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/77277
English  |  正體中文  |  简体中文  |  Post-Print筆數 : 27 |  Items with full text/Total items : 113648/144635 (79%)
Visitors : 51584777      Online Users : 798
RC Version 6.0 © Powered By DSPACE, MIT. Enhanced by NTU Library IR team.
Scope Tips:
  • please add "double quotation mark" for query phrases to get precise results
  • please goto advance search for comprehansive author search
  • Adv. Search
    HomeLoginUploadHelpAboutAdminister Goto mobile version
    Please use this identifier to cite or link to this item: https://nccur.lib.nccu.edu.tw/handle/140.119/77277


    Title: 兒童醫療補助對醫療資源利用不均之影響
    The Impact of Children Subsidy Program on the Access and Utilization of Health Care among Young Children
    Authors: 程千慈
    Cheng, Chien Tzu
    Contributors: 連賢明
    Lien, Hsien Ming
    程千慈
    Cheng, Chien Tzu
    Keywords: 兒童醫療補助計畫
    醫療資源可近性
    部份負擔
    RDD
    children subsidy program
    accessibility
    co-payment
    RDD
    Date: 2015
    Issue Date: 2015-08-03 13:37:29 (UTC+8)
    Abstract: 為了「減輕家庭負擔,使3歲以下兒童獲得適切的健康照顧,促進其身心正常發展」,內政部兒童局自2002年起實施「三歲以下兒童醫療補助計畫」,並且已有研究證實此政策確實有效以免除部分負擔的方式降低兒童就醫門檻,增加兒童的醫療利用。然而,在我國面臨醫療資源分布不均與貧富差距逐漸擴大的同時,政策效果的分配是否公平有待商榷。由於兒童一旦滿三歲即不再受政策補助,本研究使用2004年至2009年健保資料庫中就醫年紀滿三歲前後二十週的兒童為樣本,依其居住地區與在固定居住地區下依其家庭所得條件分組,觀察各組兒童滿三歲前後醫療利用的變化並比較組間差別,使用RDD (regression discontinuity design) 分析政策在兒童滿三歲時造成的斷點是否顯著。
    實證結果顯示,在依居住地區分組下,兒童滿三歲不受補助後,西醫門診以醫療資源不足區醫療利用的下降最為顯著;西醫急診以醫療資源過剩區醫療利用下降最為顯著,而不論西醫門診或西醫急診,皆以醫療資源不足區的價格彈性最大,其中西醫門診與急診間的替代關係對估計結果有一定的影響。在固定居住地區下依家庭所得條件分組下,各居住地區均以低所得組受政策效果較顯著,醫療資源不足區的低所得組以西醫門診政策效果最為顯著;過剩區的低所得組則以西醫急診政策效果最為顯著。兩種分組依據下的結果均顯示,醫療資源分布不均造成的低落醫療可近性無法以兒童醫療補助計畫消弭。
    Reference: 英文參考文獻
    Aday, L. A. and R. M. Andersen (1974), “Framework for the study of access to medical care,” Health Services Research, 9(3), 208-220.
    Anderson, M., C. Dobkin, and T. Gross (2010), The effect of health insurance coverage on the use of medical services, National Bureau of Economic Research.
    Angrist, J. D. and V. Lavy (1997), Using Maimonides` rule to estimate the effect of class size on student achievement, National Bureau of Economic Research.
    Bambas, A. and J. A. Casas (2001), “Assessing equity in health: conceptual criteria,” Pan American Health Organization, editor. Equity and health. Views from the Pan American Sanitary Bureau. Washington DC: Pan American Health Organization, 12-21.
    Biggs, B., L. King, S. Basu and D. Stuckler (2010), “Is wealthier always healthier? The impact of national income level, inequality, and poverty on public health in Latin America,” Social science & medicine, 71(2), 266-273.
    Bodenheimer, T. S. (1970). “Patterns of American ambulatory care,” Inquiry, 26-37.
    Card, D., C. Dobkin and N. Maestas (2007), Does Medicare save lives?, National Bureau of Economic Research.
    Carlisle, D. M. and B. D. Leake (1998), “Differences in the Effect of Patients` Socioeconomic Status on the Use of Invasive Cardiovascular Procedures Across Health Insurance Categories,” American Journal of Public Health, 88, 1089-1092.
    Casas, J. A., J. N. Dachs and A. Bambas (2001), “Health disparities in Latin America and the Caribbean: the role of social and economic determinants,” Equity and health, 8, 22-49.
    Case, A., A. Fertig and C. Paxson (2004), “The lasting impact of childhood health and circumstance,” Journal of Health Economics, 24, 365-389.
    Cutler, D. M. and R. J. Zeckhauser (2000), “The anatomy of health insurance,” Handbook of health economics, 1, 563-643.
    Deaton, A. (2001), Health, inequality, and economic development, National bureau of economic research.
    Donabedian, A. (1973), Aspects of medicalcare administration: specifying requirements for health care, Cambridge: Harvard University Press.
    Eberhardt, M. S. and E. R. Pamuk (2004), “The importance of place of residence: examining health in rural and nonrural areas,” American Journal of Public Health, 94(10), 1682-1686.
    Fossett, J. W., J. D. Perloff, P. R. Kletke, and J. A. Peterson (1992), “Medicaid and access to child health care in Chicago,” Journal of Health Politics, Policy and Law, 17(2), 273-298.
    Freeborn, D. K. and M. R. Greenlick (1973), “Evaluation of the performance of ambulatory care systems: Research requirements and opportunities,” Medical Care, 68-75.
    Lee, D. S. (2008), “Randomized experiments from non-random selection in US House elections,” Journal of Econometrics, 142(2), 675-697.
    Manning, W. G., J. P. Newhouse, N. Duan, E. B. Keeler and A. Leibowitz (1987), “Health insurance and the demand for medical care: evidence from a randomized experiment,” The American economic review, 251-277.
    Marmot, M. and R. G. Wilkinson (1999), Social Determinants of Health, Oxford: Oxford University Press.
    Oliver, A. and E. Mossialos (2004), “Equity of access to health care: outlining the foundations for action,” Journal of epidemiology and community health, 58(8), 655-658.
    Pritchett, L. and L. H. Summers (1996), “Wealthier is healthier,” Journal of Human resources, 841-868.
    Sherwin, R. P. (1983), “What is an adverse health effect?,” Environmental health perspectives, 52, 177.
    Van Doorslaer, E., C. Masseria and X. Koolman (2006), “Inequalities in access to medical care by income in developed countries,” Canadian medical association journal, 174(2), 177-183.
    Wagstaff, A. (2001), “Poverty, equity, and health: Some research findings,” Pan American Health Organization. Equity and health: Views from the Pan American Sanitary Bureau. Washington DC: PAHO, 56-60.
    Whitehead, M. (1992), “The Concepts and Principles of Equity and Health,” International Journal of Health Services, 22, 429-445.
    Wilkinson, R. G. and K. E. Pickett (2006), “Income inequality and population health: a review and explanation of the evidence,” Social science & medicine, 62(7), 1768-1784.
    Newhouse, J. P., W. G. Manning, C. N. Morris, L. L. Orr, N. Duan, E. B. Keeler, A. Leibowitz, K. H. Marqui, M. S. Marquis, C. E. Phelps, and R. H. Brook (1981), “Some interim results from a controlled trial of cost sharing in health insurance,” New England Journal of Medicine, 305(25), 1501–1507.

    中文參考文獻
    吳依凡 (2004),《醫療資源可近性對個人醫療利用的影響-台灣地區的實證研究》,國立中央大學產業經濟研究所碩士論文。
    吳宛蕙、楊長興 (2007),「全民健保對健康差距之影響-以平均餘命為測量」,《臺灣公共衛生雜誌》,26(3),196-207。
    呂鴻基 (1999),「三十五年來台灣兒童的健康水平」,《臺灣醫學》,3(5),505-514。
    李仁輝 (2007),《經濟成長與國民死亡率之關聯-台灣地區之實證研究》,國立中央大學產業經濟研究所碩士在職專班學位論文。
    李昭琴、盧瑞芬 (2013),「台灣兒童之健康平等及醫療照護利用公平性探討」,《臺灣公共衛生雜誌》,32(5),449-461。
    林主恩 (2002) ,《全民健保的實施對醫療資源分佈影響之空間統計分析》,國立台灣大學經濟研究所碩士論文。
    林淑敏 (2004),《醫療資源與國人健康的關聯》,國立中央大學產業經濟研究所碩士論文。
    紀慧珊 (2011),《兒童醫療補助計畫是否改善弱勢兒童醫療利用的可近性?》,國立中央大學產業經濟研究所碩士論文。
    孫樹根、劉俊賢 (2006),「從台灣城鄉嬰幼兒死亡率差異探討社會不公平問題」,《農業推廣學報》,(21),33-58。
    許君強、林澤余、沈希哲、張嘉莉與湯澡薰 (2006),「醫療補貼政策對醫療利用之影響-以臺北市兒童醫療補助計畫為例」《北市醫學雜誌》,3(3),268-287。
    陳宗梧 (2009),《偏遠地區民眾之醫療照顧政策成效分析》,國立政治大學財政學研究所碩士論文。
    陳昕 (2007) ,《利用健保部分負擔調漲估算醫院門診價格彈性:一個自然實驗法的觀察分析》,國立臺灣大學衛生政策與管理研究所學位論文。
    陳欽賢,朱子斌與劉彩卿 (2006),「全民健康保險制度下兒童預防保健服務之利用」,《醫務管理期刊》,7(1),107-122。
    湯澡薰、郭乃文與葉壽山 (1999),「台灣醫療資源使用之公平性探討」,《醫護科技學刊》,1(1),43-58。
    黃郁雯 (2005),《台灣地區嬰兒死亡率城鄉差異變化趨勢探討》,高雄醫學大學公共衛生學研究所碩士論文。
    黃耀庭 (2005),《從死亡原因看所得對健康的影響》,國立臺灣大學經濟學研究所學位論文。
    楊順宇 (2011),《家戶所得相對剝奪與健保醫療利用關聯分析–Yitzhaki 指數應用》,國立臺北大學財政學系學位論文。
    趙思越 (2015),《成年人社會經濟地位與健康的關係:臺灣地區的實證研究》,國立中央大學產業經濟研究所碩士在職專班學位論文。
    蔡偉德、陳芝嘉、余清祥 (2014) ,「老人醫療利用的價格效果-以921震災的自然實驗為例」,《經濟論文》,42(4),599-645。
    韓幸紋、連賢明 (2008a),「降低部分負擔對幼兒醫療利用的影響:以北市兒童補助計畫為例」,《經濟論文叢刊》,36(4),589-623。
    韓幸紋、連賢明 (2008b),「利用「分量迴歸」分析部分負擔對兒童醫療利用的影響」,台灣社會福利學會2008年年會暨「新世紀社會保障制度的建構與創新:跨時變遷與跨國比較」國際學術研討會。
    Description: 碩士
    國立政治大學
    財政研究所
    102255008
    Source URI: http://thesis.lib.nccu.edu.tw/record/#G0102255008
    Data Type: thesis
    Appears in Collections:[Department of Public Finance] Theses

    Files in This Item:

    File SizeFormat
    500801.pdf1985KbAdobe PDF2201View/Open


    All items in 政大典藏 are protected by copyright, with all rights reserved.


    社群 sharing

    著作權政策宣告 Copyright Announcement
    1.本網站之數位內容為國立政治大學所收錄之機構典藏,無償提供學術研究與公眾教育等公益性使用,惟仍請適度,合理使用本網站之內容,以尊重著作權人之權益。商業上之利用,則請先取得著作權人之授權。
    The digital content of this website is part of National Chengchi University Institutional Repository. It provides free access to academic research and public education for non-commercial use. Please utilize it in a proper and reasonable manner and respect the rights of copyright owners. For commercial use, please obtain authorization from the copyright owner in advance.

    2.本網站之製作,已盡力防止侵害著作權人之權益,如仍發現本網站之數位內容有侵害著作權人權益情事者,請權利人通知本網站維護人員(nccur@nccu.edu.tw),維護人員將立即採取移除該數位著作等補救措施。
    NCCU Institutional Repository is made to protect the interests of copyright owners. If you believe that any material on the website infringes copyright, please contact our staff(nccur@nccu.edu.tw). We will remove the work from the repository and investigate your claim.
    DSpace Software Copyright © 2002-2004  MIT &  Hewlett-Packard  /   Enhanced by   NTU Library IR team Copyright ©   - Feedback