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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鄭守夏 | |
dc.contributor.author | Chi-Chen Chen | en |
dc.contributor.author | 陳啟禎 | zh_TW |
dc.date.accessioned | 2021-06-08T04:47:51Z | - |
dc.date.copyright | 2009-09-16 | |
dc.date.issued | 2009 | |
dc.date.submitted | 2009-07-29 | |
dc.identifier.citation | 參考文獻
中文文獻 行政院經建會:台灣地區綜合開發計畫。台北:行政院經建會,1978。 行政院衛生署:醫療保健計畫-籌建醫療網計畫。台北:行政院衛生署,1986。 行政院衛生署:醫療服務機構現況及醫療服務量統計摘要,1994。URL: http:// www. doh. gov. tw/statistic/醫療服務量/83.htm 。 行政院衛生署:醫療服務機構現況及醫療服務量統計摘要,2007。URL: http://www.doh.gov. tw/statistic/醫療服務量/96.htm。 李靜玟、吳肖琪(2005)。市場競爭及其他因素對精神科急性住院病患醫療利用之影響。台灣公共衛生雜誌,24(4),296-305。 陳珮青、楊銘欽、江東亮、鄭守夏(2003)。病人跨區住院與醫療區資源分佈之探討。台灣公共衛生雜誌,22(1),27-32. 劉容華、江東亮(2001)。台灣小型醫院新設與歇業之影響。中華公共衛生雜誌,20(1),27-33。 張清溪等(2000)。經濟學-理論與實際(二版)。台北:雙葉書廊,2000。 蔡偉德、李一鑫(2002)。醫院非價格性競爭與市場結構:醫院購置高科技醫療儀器之實證研究。經濟論文,30(1),57-78。 盧瑞芬、謝啟瑞(2003)。台灣醫院產業的市場結構與發展趨勢分析。經濟論文叢刊,31(1),107-53。 謝慧欣、鄭守夏、丁志音(2000)。住院病患對選擇醫療資訊的需求:初步調查發現。中華公共衛生雜誌,19(6),437-445。 羅萱(2005)。醫院引進及擴張新醫療科技之影響因素與結果。台灣公共衛生雜誌,24(5),385-393. 英文文獻 Aiken, L. K., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. The Journal of the American Medical Association, 288(16), 1987-1993. Allen, R., & Gerlter, P. J. (1991). Regulation and the provision of quality to heterogeneous consumers. Journal of Regulatory Economics, 3(4), 361-375. Allen, R. (1992). Policy implications of recent hospital competition studies. Journal of Health economics, 11(3), 347-351. Bain, J. (1956). Barries to new competition. Cambridge: Harvard University Press. Bain, J. S. (1951). Relation of profit rate to industry concentration: American manufacturing, 1936-1940. Quarterly Journal of Economics, 65(3), 293-324. Baker, L. C. (2001). Measuring competition in health care markets. Health Service Research, 36(1 Pt2):223-251. Baldwin, J. R., & Gorecki, P. K. (1991). Firm entry and exit in the Canadian manufacturing sector. Canadian Journal of Economics, 24(2), 300-323. Baron, R. M., & Kenny, D. A. (1986). The moderator-meditor variable distinction in social psychological research: conceptual, strategic, and statistical considerations, Journal of Personality and Social Psychology, 51(6), 1173-1182. Becker, G. S. (1965). Theory of the allocation of time. Economic Journal, 75(299), 493-517. Blegen, M. A., Goode, C. J., & Reed, L. (1998). Nursing staffing and patient outcome. Nursing Research, 47(1), 43-50. Bollen, K. A. (1989). Structural equations with latent variables. New York: Wiley. Bolton, L. B., Aydin, C. E., & Donaldson, N. (2003). Nurse staffing and patient perceptions of nursing care. Journal of Nursing Administration, 33(11), 607-614. Bound, J., Jaeger, D. A., & Baker, R. M. (1995). Problems with instrumental variables estimation when the correlation between the instruments and the endogenous explanatory variable is weak. Journal of American Statistical Association, 90(430), 443-450. Bradley, E. H., Herrin, J., & Elbel B. (2006). Hospital quality for Acute Myocardial Infarction: correlation among process measures and relationship with short-term mortality. Journal of the American Medical Association, 296(1), 72-78. Castle, N. G., Brown, J., Hepner, K. A., & Hays, R. D. (2005). Review of the literature on survey instruments used to collect data on hospital patients' perceptions of care. Health Services Research, 40(6 Pt 2), 1996-2017. Charlson, M. E., Pompei, P., Ales, K. L., & McKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Disease, 40(5), 373-383. Cho, S. H., Ketefian, S., Barkauskas, V. H., & Smith, D. G. (2003). The effects of nurse staffing on adverse events, morbidity, mortality, and medical cost. Nursing Research, 52(2), 71-79. Cruz, L., & Moreira, M. (2005). On the validity of econometric techniques with weak instruments: inference on retuns to education using compulsory school attendance laws. Journal of Human Resources, 40(2), 393-410. Cheng, S. J., Wei, Y. J., & Chang, H. J. (2006). Quality competition among hospitals: the effects of perceived quality and perceived expensiveness on health care consumers. American Journal of Medical Quality, 21(1), 68-75. Consumer Assessment of Healthcare Providers and Systems: Survey instruments. URL: https://www.cahps.ahrq.gov/content/products/Prod_Intro.asp?p=102&s=2. Currie, V., Harvey, G., West, E., McKenna, H., & Keeney, S. (2005). Relationship between quality of care, staffing level, skill mix and nurse autonomy: literature review. Journal of Advanced Nursing, 51(1), 73-82. Deily, M. E., Mckay, N.L., & Domer, F. H. (2000). Exit and inefficiency- the effects of ownership type. Journal of Human Resources, 35(4), 734-747. Demstz, H. (1973). Industry structure, market rivalry and public policy. Journal of Law and Economics, 16(1), 1-10. D’Hoore, W., Bouckaert, A., Tilquin, C. (1996). Practical considerations on the use of the Charlson Comorbidity Index with administrative data bases. Journal of Clinical Epidemiology, 49(12), 1429-1433. Donabedian, A. (1988). The quality of care: How can it be assessed? The Journal of the American Medical Association, 260(12), 1743-1748. Dorfman, R., & Steiner, P. (1954). Optimal advertising and optimal quality. American Economic Review, 44(5), 826-836. Dranove, D., & Satterthwaite, M. A. (1992). Monopolistic competition when price and quality are imperfectly observable. RAND Journal of Economics, 23(4), 518-534. Dranove, D., Shanley, M., & Simon, C. (1992). Is hospital competition wasteful? Rand of Journal of Economics, 23(2), 247-262. Dranove, D., & Satterthwaite, M. A. (2000). Handbook of Health Economics. North Holland: Elsevier Science. Dubois, R. W., Rogers, W. H., Moxley, J. H., Draper, D., & Brook, R. H. (1987). Hospital inpatient mortality. It is a predictor of quality? The New England Journal of Medicine, 317(26), 1674-1680. Dunn, T., Roberts, M., & Samuelson, L. (1988). Patterns of firm entry and exit in U.S. Manufacturing Industries. Rand Journal of Economics, 19(4), 495-515. Efron, B., & Tibshirani, R. (1993). An Introduction to the Bootstrap. New York: Chapman & Hall. Elixhauser, A., Steiner, C., Harris, R., & Coffey, R.M. (1998). Comorbidity measures for use with administrative data. Medical Care, 36(1), 8-27. Elzinga, K.G., & Hogarty, T. F. (1973). The problem of geographic market delineation in anti-merger suits. The Antitrust Bulletin, 18, 45-81. Elzinga, K.G., & Hogarty, T. F. (1978). The product of geographic market delineation revisited. The Antitrust Bulletin, 23, 1-18. Enthoven, A. C., & van de Ven, W. P. P. M. (2007). Going Dutch-Managed- competition health insurance in Netherlands. The New England Journal of Medicine, 357(24), 2421-2423. Escarce, J. J., Jain, A. K., & Rogowski, J. (2006). Hospital competition, managed care, and mortality after hospitalization for medical conditions: evidence from three states. Medical Care Research and Review, 63(6), 112S-140S. Finkelstein, B.S., Singh, J., & Silvers, J.,B. (1998). Patient and hospital characteristics associated with patient assessments of hospital obstetrical care. Medical Care, 36(8 suppl), AS68-AS78. Folland, S., Goodman, A.C., & Stano, M. (2007). The economics of health and health care. Upper Saddle River, NJ : Pearson Prentice Hall. Frech, H. E., & Mobley, L. R. (2000). Efficiency, growth and concentration: an empirical analysis of hospital markets. Economic Inquiry, 38(3), 369-384. Garnick, D. W., Luft, H. S., Robinson, J. C., & Tetreault, J. (1987). Appropriate measures of hospital market areas. Health Service Research ,22(1), 69-89. Gaynor, M., & Vogt, W. B. (2003). Competition among hospitals. RAND Journal of Economics, 34(4), 764-785. Gaynor, M. (1994). Issue in the industrial organization of the market for physician services. Journal of Economics & Management Strategy, 3(1), 211-255. Gaynor, M. (2006). What do we know about competition and quality in health care market? NBER working paper. Goody, B. (1993). Defining rural hospital markets. Health Service Research, 28(2), 183-200. Gowrisankaran, G., & Town, R. J. (2003). Competition, payers, and hospital quality. Health Services Research, 38(6), 1403-1421. Gresenz, C. R., Rogowski, J., & Escarce, J. J. (2004). Updated variable-radius measures of hospital competition. Health Services Research, 39(2), 417-430. Gujarati, D. N. (2003). Basic Econometrics. North America: McGraw Hill. Held, P. J., & Pauly, M. V. (1983). Competition and efficiency in the end stage renal disease program. Journal of Health Economics, 2(2), 95-118. Hibbard, J. H., Jewett, J. J., Legnini, M. W., & Tusler, M. (1997). Choosing a health plan: do large employers use the data? Health Affairs, 16(6), 172-180. Horn, S. D., Sharkey, P. D., & Buckle, J. M.(1991). The relationship between severity of illness and hospital length of stay and mortality. Medical Care, 29(4), 305-317. Jenkinson, C., Coulter, A., Bruster, S., Richards, N., & Chandola, T. (2002). Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Quality & Safety in Health Care, 11(4), 335-339. Joskow, P. (1980). The effects of competition and regulation on hospital bed supply and the reservation quality of the hospital. Bell Journal of Economics, 11(2), 421-447. Keeler, E. B., Melnick, G., & Zwanziger, J. (1999). The changing effects of competition on non-profit and for-profit hospital pricing behavior. Journal of Health Economics, 18(1), 69-86. Kessler, D. P., & Geppert, J. J. (2005). The effects of competition on variation in the quality and cost of medical care. Journal of Economics and Management Strategy, 14(3), 575-589. Kessler, D. P., & McClellan, M. B. (2000). Is hospital competition socially wasteful? The Quarterly Journal of Economics, 115(2), 577-615. Kim, H. K., Fay, M. P., Feuer, E. J., & Midthune, D. N. (2000). Permutation tests for Joinpoint regression with applications to cancer rates. Statistics in Medicine, 19(3), 335-351. Kranton, R. E. (2003). Competition and the incentive to produce high quality. Economica, 70(279), 385-404. Landsburg, S. E. (2005). Price theory and application. United States: Thomson /South -Western. Lanksbear, A. J., Sheldon, T. A., & Maynard, A. (2005). Nurse staffing and healthcare outcomes. A systematic review of the international research evidence. Advances in Nursing Science, 28(2), 163-174. Lien, H. M., Chou, S. Y., & Liu, J. T. (2009). The role of hospital competition on treatment expenditure and outcome: evidence from stroke and cardiac treatment in Taiwan. Economic Inquiry (in press). Lindrooth, R. C., Lo Sasso, A. T., & Bazzoli, G. J. (2003). The effect of urban hospital closure on markets. Journal of Health Economics, 22(5), 691-712. Lichtig, L. K., Knauf, R. A., & Milholland, D. K. (1999). Some impacts of nursing on acute care hospital outcomes. Journal of Nursing Administration, 29(2), 25-33. Liu, Y. M., & Kinsey, J. (2005). The effect of competition on the practice of outpatient services for diabetes patients at different levels of hospital in Taiwan. Applied Economics, 37(12), 1411-1422. Liu, H., & Phelps, C. E. (2008). Nonprice competition and quality of care in managed care: the New York SCHIP market. Health Services Research, 43(3), 971-987. Luft, H.S., Robinson. J. C., Garnick, D. W., Maerki, S. C., & McPhee, S. J. (1986). The role of specialized clinical services in competition among hospitals. Inquiry, 23(1), 83-94. Luft, H. S. &Hunt, S. S., & Maerki, S. C. (1987). The volume-outcome relationship: practice-makes-perfect or selective-referral patterns? Health Service Research, 22(2), 157-182. Lynk, W. J. (1995). Nonprofit hospital mergers and the exercise of market power. Journal of Law and Economics, 38(2), 437-461. Magovern, J. A., Sakert, T., & Magovern, G. J. (1996). A model that predicts morbidity and mortality after coronary artery bypass graft surgery. Journal of the American College of Cardiolog, 28(5), 1147-1153. Mark, B. A., Salyer, J., & Wan, T. T. (2003). Professional nursing practice. Impact on organizational and patient outcome. Journal of Nursing Administration, 33(4), 224-234. Marshall, G. N., Morales, L. S., Elliott, M., & Spritzer, K. (2001). Confirmatory factor analysis of the consumer assessment of health plans study (CAHPS) 1.0 core survey. Psychological Assessment, 13(2), 216-229. Meltzer, D., Chung, J., & Basu, A. (2002). Does competition under Medicare prospective payment selectively reduce expenditures on high-cost patients? RAND Journal of Economics, 33(3), 447-68. McGillis, Hall. L., Doran, D., & Pink, G. H. (2004). Nurse staffing models, nursing hours and patient safety outcomes. Journal of Nursing Administration, 34(1), 41-45. McNulty, P. (1967). A Note on the history of perfect competition. Journal of Political Economy , 75(4), 395-399. McNulty, P. (1968). Economic theory and the meaning of the competition. Quarterly Journal of Economics, 82(4), 639-656. Mitchell, D. H., Swift, G., & Gilbert, G. L. (1999). Surgical wound infection surveillance: the importance of infections that develop after hospital discharge. The Australian and New Zealand Journal of Surgery, 69(2), 117-120. Mitchell, P. H., & Shortell, S. M. (1997). Adverse outcomes and variations in organization of care delivery. Medical Care, 35(11), NS19-NS32. Moore, K., Lynn, M., McMillen, B.J., & Evans, S. (1999). Implementation of the ANA report care. Journal of Nursing Administration, 29(6), 48-54. Morrisey, M. A., Sloan, F. A., & Valvona, J. (1989). Defining geographic markets for hospital care. Law and Contemporary Problems, 51(2), 165-194. Mukamel, D. B., Zwanziger, J., & Bamezai, A. (2002). Hospital competition , resource allocation and quality o of care. BMC Health Services Research, 2(1), 1-10. Mukamel, D. B., Zwanziger, J., & Tomaszewski, K. J. (2001). HMO penetration, competition , and risk-adjusted hospital mortality. Health Services Research, 36(6), 1019-1035. Needleman, J., Buerhaus, P., Mattke, S., & Stewart, M. (2002). Nurse-staffing levels and the quality of care in hospitals. The New England of Medicine, 346(22), 1715-1722. Newhouse, J. P. (1970). A model of physician pricing. Southern Economic Journal, 37(2), 174-183. Noether, M. (1988). Competition among hospitals. Journal of Health Economics, 7(3), 259-84. Nunnally, J. (1978). Psychometric Theory. New York: McGraw-Hill. Pauly, M. V. (2004). Competition in medical services and the quality of care: concepts and history. International Journal of Health Care Finance and Economics, 4(2), 113-130. Pepall, L., Richards, D. J., & Norman, G. (2005). Industrial Organization: Contemporary Theory and Practice. Canada: Thomson Corporation. Pérez, A., Dennis, R. J., Gil, J. F., Rondón, M. A., & López, A. (2002) Use of the mean, hot deck and multiple imputation techniques to predict outcome in intensive care unit patients in Colombia. Statistics in Medicine, 21(24), 3885-3896. Perloff, J. M., Karp, L. S., & Golan, A. (2007). Estimating market power and strategies. New York: Cambridge University Press. Picker Institute: Surveys and feeback. URL: http://www.pickereurope.org/page.php?id=66. Picone, G. A., Sloan, F. A., Chou, S. Y., & Taylor, D. H. (2003). Does higher hospital cost imply higher quality of care? The Review of Economics and Statistics, 85(1), 51-62. Pope, G. C. (1989). Hospital nonprice competition and medicare reimbursement policy. Journal of Health Economics, 8(2), 147-172. Propper, C., Burgess, S., & Green, K. (2004). Does competition between hospitals improve the quality of care? Journal of Public Economics, 88(7-8), 1247-1272. Robinson, J. C., & Luft, H. S. (1985). The impact of hospital market structure on patient volume, average length of stay and the cost of care. Journal of Health Economics, 4(4), 333-356. Robinson, J. C., & Luft, H. S. (1987). Competition and the cost of the hospital care, 1972-1987. Journal of American Medical Association, 257(23), 3241-3245. Rogowski, J., Jain, A. K., & Escarce, J. J.(2007). Hospital competition, managed care and mortality after hospitalization for medical conditions in California. Health Services Research, 42(2), 682-705. Romano, P. S., & Mutter, R. (2004). The evolving science of quality measurement for hospitals: implications for studies of competition and consolidation. International Journal Health Care Finance and Economics, 4(2), 131-157. Rubin, D. B. (2004) Multiple imputation for nonresponse in surveys. Hoboken, N.J. ; Wiley-Interscience. Santerre, R. E., & Neun, S. P. (1996). Health economics: theories, insights, and industry studies. Mason, Ohio: Thomson/South-Western. Sari, N. (2002). Do competition and managed care improve quality? Health Economics, 11(7), 571-584. Scanlon, D. P., Swaminathan, S., Chernew, M., Bost, J. E., & Shevock, J. (2005). Competition and health plan performance: evidence from health maintenance organization insurance markets. Medical Care, 43(4), 338-346. Scanlon, D. P., Swaminathan, S., Chernew, M., & Lee, W. (2006). Market and plan characteristics related to HMO quality and improvement. Medical Care Research and Review, 63(6 suppl), 56S-89S. Scanlon, D. P., Swaminathan, S., Lee, W., &Chernew, M. (2008). Does competition improve health care quality? Health Services Research, 43(6), 1931-1951. Schmidt, L. A. (2004). Patients’ perceptions of nurse staffing, nursing care, adverse events, and overall satisfaction with the hospital experience. Nursing Economic, 22(6), 295-306. Sephered, W. G. (1997). The economics of Industrial Organization: Analysis, Markets, Polices. New Jersey: Prentice-Hall. Shen, Y. C. (2003). The effect of financial pressure on the quality of care in hospitals. Journal of Health Economics, 22(2), 243-269. Shortell, S. M., & Hughes, E. F. X. (1988). The effects of regulation, competition , and ownership on mortality rates among hospital inpatients. The New England Journal of Medicine, 318(17), 1100-1107. Singleton, R. C. (1986). Industrial organization and antitrust: a survey of alternative perspective. Ohio: Publishing Horizons. Sjetne, I. S., Veenstra, M., & Stavem, K. (2007). The effect of hospital size and teaching status on patient experiences with hospital care: a multilevel analysis. Medical Care, 45(3), 252-258. Sohn, M.W. (2002). A relational approach to measuring competition among hospitals. Health Services Research, 37(2), 457-482. Sovie, M. D., Faan, C., & Jawad, A. F. (2001) Hospital restructuring and its impact on outcomes. Nursing staff regulations are premature. Journal of Nursing Administration, 31(12), 588-600. Stigler, G., & Sherwin, R. (1985). The extent of the market. Journal of Law and Economics, 28(3), 555-585. Stock, J. H., & Watson, M. W. (2007). Introduction to econometrics. Boston : Pearson/Addison Wesley. Suhonen, R., Välimäki, M., Katajisto, J., & Leino-Kilpi, H. (2007). Hospital’s organizational variables and patients’ perceptions of individualized nursing care in Finland. Journal of Nursing Management, 15(2), 197-206. Tomal, A. (1998). The relationship between hospital mortality rates, and hospital, market and patient characteristics. Applied Economics, 30(6), 717-725. Tourangeau, A. E., Giovannetti, P., Tu, J. V., & Wood, M. (2002). Nursing-related determinants of 30-day mortality for hospitalized patients. The Canadian Journal of Nursing Research, 33(4), 71-88. Volpp, K. G., Williams, S. V., & Waldfogel, J. (2003). Market reform in New Jersey and the effect on mortality from acute myocardial infraction. Health Services Research, 38(2), 515-533. Welch, H. G., Miller, M. E., & Welch, W. P. (1994). Physician profiling. An analysis of inpatient practice patterns in Florida and Oregon. The New England Journal of Medicine, 330(9), 607-612. White, L. J. (1972). Quality variation when prices are regulated. Bell Journal of Economics and Management Science, 3(2), 425-436. Wong, H., Zhan, C., & Mutter, R. (2005). Do different measures of hospital competition matter in empirical investigations of hospital behavior? Review of Industrial Organization, 26(1), 61-87. Xirasagar, S., & Lin, H. C.(2004). Cost convergence between public and for-profit hospitals under prospective payment and high competition in Taiwan. Health Service Research ,39(6), 2101-2116. Xirasagar, S., & Lin, H. C. (2006). Effects of payment incentives, hospital ownership and competition on hospitalization decisions for ambulatory surgical procedures. Health Policy , 76(1), 26-37. Yang, K. P. (2003). Relationships between nurse staffing and patient outcomes. Journal of Nursing Research, 11(3), 149-158. Yokoe, D. S., Christiansen, C. L., & Johnson, R. (2001). Epidemiology of and surveillance for postpartum infections. Emergence Infection Diseases, 7(5), 837-841 . Zwanziger, J., Melnick, G. A., & Mann, J. M. (1990). Measures of hospital market structure: a review of the alternatives and a proposed approach. Socioeconomic Planning Science, 24(2), 81-95. Zwanziger, J., & Melnick, G. A. (1988). The effects of hospital competition and the Medicare PPS program on hospital cost behavior in California. Journal of Health Economics, 7(4), 301-320. Zwanziger, J., Mukamel, D. B., & Indridason, I. (2002). Use of resident-origin data to define nursing home market boundaries. Inquiry, 39(1), 56-66. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/23214 | - |
dc.description.abstract | 過去已有許多研究探討市場競爭與廠商行為的議題,但多半著重於市場競爭和醫院成本的關係,甚少探討市場競爭的測量以及市場競爭對於醫療品質的影響。本研究分為下列三個主題:(1)主題一:競爭程度的測量:以台灣的醫療照護市場為例;(2)主題二:檢驗醫院市場競爭程度分別與病患主觀感受品質及傳統客觀品質指標之相關性;(3)主題三:檢驗醫院市場競爭與病患主觀感受品質的相關,是否透過醫院投入之中介機制所影響。
在資料來源方面,主題一:使用衛生署統計室1994年至2007年「醫院服務量檔」;主題二、三:使用2002年及2004年「出院病人調查」資料串連當次住院的健保申報資料。針對不同主題採用不同的分析方式:主題一:描述各學派市場競爭程度,並檢驗歷年間各學派市場競爭程度之變化趨勢的相關性;主題二:採用工具性變項及隨機截距模型,檢驗市場競爭分別與病患主觀感受品質以及傳統客觀品質的相關性;主題三:採用階層式模型和隨機截距模型,檢驗醫院投入是否為市場競爭和病患主觀感受品質之中介因素。 在研究結果方面;主題一:發現不論是採用「結構學派」或「行為學派」之市場競爭程度,皆隨著年代呈現逐年下降的趨勢,且歷年不同學派間市場競爭指標具有中高度的相關性。主題二:發現醫院位於市場競爭程度愈高的地區,醫院病患不論在人際面或技術面所感受到的主觀醫療品質皆較高。然而,醫院面對的市場競爭程度與傳統客觀品質指標(病患出院後30日內的再住院情形)並無顯著相關。主題三:發現市場競爭對於人際面和技術面病患主觀感受品質有不同的影響機制:市場競爭對於病患人際面感受品質具有直接的影響力,換言之市場上存在品質競爭的情形;然而,控制護理人力素質後,醫院面對的市場競爭和病患技術面感受品質的關係減弱。 本研究之結論為:一、若醫院位於愈競爭的區域,出院病患感受品質愈高。二、醫院投入(護理人力素質)為市場競爭和病患技術面感受品質之中介機制。建議政府在制定醫療產業相關政策上,應該要引入市場競爭機制,且醫院評鑑制度應要規範醫院人力之素質。 | zh_TW |
dc.description.abstract | The majority of previous studies on the relationship between market competition and hospital behaviors have focused on the impact of competition on costs. However, the measures of market competition and it effects on health care quality have been rarely discussed. This study comprised three research topics: (1) Measuring market competition using data from Taiwan’s health care market; (2) Examining the relationship between hospital market competition and patient quality of care; and (3) Investigating the mediating effect of hospital input on the relationship between market competition and patient perceived quality of care.
Data for the first research topic came from the “Health care institution survey” and “Hospital services volume survey” from 1994 to 2007. We compared the trend of market competition defined by the Structuralism with that by the Behaviorism. For the second and third research topics, we used the 2002 and 2004 “Discharge patient survey” and national health insurance claim datasets. Instrumental variable and random intercept model were applied to examining the impact of market competition on subjective and traditional objective quality of care measures. Furthermore, hierarchical models and random intercept model were performed to test the mediating effect of hospital input on the association between market competition and patient perceived quality of care. The level of market competition, measured either by Structuralism or Behaviorism, both showed to be decreasing. There was a significant and moderate correlation between the two measures. When hospitals were in a more competitive market, their patients reported better perceived quality of care in terms of interpersonal skills and clinical competence. However, competition level was not significantly associated with traditional quality indicator, the readmission rate after 30 days of discharge. The mechanism linking market competition and quality of interpersonal skills tended to be different from that linking competition and clinical competence. There was a direct effect of market competition on quality of interpersonal skills, while hospital input in nursing professional (skill mix) mediated the association between competition and quality of clinical competence. A more competitive market is associated with better patient perceived quality. Hospital input (e.g. nursing professionalism) mediates the relationship between market competition and patient perceived quality of clinical competence. According to our findings, we suggest that the government should employ competition approach to promote the quality of hospital care and incorporate the quality of hospital staff in the hospital accreditation system. | en |
dc.description.provenance | Made available in DSpace on 2021-06-08T04:47:51Z (GMT). No. of bitstreams: 1 ntu-98-D93845003-1.pdf: 913435 bytes, checksum: b4b680d955dd9402bc86e9ccf08508c7 (MD5) Previous issue date: 2009 | en |
dc.description.tableofcontents | 誌謝 I
摘要 I 英文摘要 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 4 第三節 研究重要性 5 第二章 文獻探討 7 第一節 市場競爭概念的理論 7 第二節 市場競爭和醫療品質的理論 12 第三節 市場競爭和醫療品質實證研究的回顧 21 第四節 市場競爭和醫療品質實證研究中方法學之討論 33 第五節 市場競爭和醫療品質之中介機制 47 第三章 研究方法 54 第一節 市場競爭程度的測量:以台灣醫療市場的競爭為例 55 第二節 市場競爭對病患主觀感受品質和傳統客觀品質的影響 63 第三節 市場競爭、醫院投入與病患主觀感受品質 73 第四章 研究結果 80 第一節 市場競爭程度的測量:以台灣醫療市場的競爭為例 80 第二節 市場競爭對病患主觀感受品質和傳統客觀品質的影響 95 第三節 市場競爭、醫院投入與病患主觀感受品質 120 第五章 討論 131 第一節 市場競爭程度的測量:以台灣醫療市場的競爭為例 131 第二節 市場競爭對病患主觀感受品質和傳統客觀品質的影響 135 第三節 市場競爭、醫院投入與病患主觀感受品質 141 第六章 結論與建議 145 第一節 研究結論 145 第二節 政策意涵 146 第三節 未來研究方向 147 參考文獻 148 中文文獻 148 英文文獻 149 | |
dc.language.iso | zh-TW | |
dc.title | 市場競爭性測量與醫療品質之相關性研究 | zh_TW |
dc.title | Measuring competition and quality of care in healthcare market | en |
dc.type | Thesis | |
dc.date.schoolyear | 97-2 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 吳肖琪,江東亮,湯澡薰,劉亞明 | |
dc.subject.keyword | 醫院,競爭,醫療品質,病患感受品質, | zh_TW |
dc.subject.keyword | hospital,competition,quality of care,patient perception of quality, | en |
dc.relation.page | 158 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2009-07-29 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 衛生政策與管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
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