全民健保醫院總額支付制度對醫藥職業代間傳遞的影響

Abstract

本研究利用行政院主計總處的人力運用調查資料，研究臺灣醫藥職業的代間傳遞，即了解擁有從事醫藥職業父母親的子女，其是否較容易在大學就讀醫藥相關科系。此外，本研究更進一步研究2002年實施的全民健保醫院總額支付制度是否對臺灣的醫藥職業代間傳遞造成影響，因為許多從事醫藥職業者表示總額制度導致他們的工作福利下降，因此這些從事醫藥職業者可能會較不鼓勵自己的子女在未來從事醫藥職業。透過線性機率迴歸模型的結果，發現父母從事醫藥職業的子女就讀醫藥科系的機率顯著高於父母從事非醫藥職業的子女。然而本研究並未發現總額制度有降低醫藥職業代間傳遞程度的現象，推測這可能是因為總額制度並未顯著降低醫藥職業的薪水，因此從事醫藥職業的家長依然鼓勵子女就讀醫藥科系。但分別探究從事醫藥職業的父親與母親對於不同性別子女的影響，則發現若母親從事醫藥職業會降低兒子大學選擇醫藥科系的機率，但對女兒則無此影響，推測這可能是因為在醫療業中女性佔多數的職業受總額制度的負面衝擊較大，因此從事醫藥職業的母親會較不鼓勵子女就讀醫藥科系。但同時可能因為臺灣社會的性別平等意識漸升，家庭願意投資較多教育資源於女兒身上、讓女兒就讀醫藥相關科系，因此在女兒的身上，兩個效果相互抵銷，導致只看到兒子大學選擇醫藥科系的機率下降。

This study uses data of the Manpower Utilization Survey to investigate the intergenerational transmission of medical professions in Taiwan. The study also examines the impacts of the Global Budget System of National Health Insurance implemented from 2002 on the intergenerational transmission of medical professions. The linear probability regression models reveal that the probability of choosing medicine-related majors at university is significantly higher for offspring with at least one parent who works as a medical professional, compared to their counterparts with both parents working in non-medical industries. However, the study finds no evidence that the Global Budget System influences the intergenerational transmission of medical professions. This may be because the Global Budget System does not significantly lower the salaries of medical professionals; therefore, parents working in the medical industry have no incentive to discourage their offspring from pursuing medicine-related majors. Nonetheless, if mother works in medical industry, the probability of her son choosing medicine-related majors decreases. This may suggest that the Global Budget System negatively impacts women more, because women mostly hold positions with lower compensation and power in the medical industry. Consequently, mother working in medical industry may discourage their offspring to pursue medicine-related majors. At the same time, the rising awareness of gender equality in Taiwan may result in families being more willing to invest educational resources in their daughters. The effect of the rising awareness of gender equality and the medical mother effect may offset each other. Hence, we do not find the similar change for daughters.