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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 | Yun Chia Tzeng | en |
dc.contributor.author | 曾芸家 | zh_TW |
dc.date.accessioned | 2021-06-15T04:05:07Z | - |
dc.date.available | 2010-03-12 | |
dc.date.copyright | 2010-03-12 | |
dc.date.issued | 2010 | |
dc.date.submitted | 2010-02-09 | |
dc.identifier.citation | Andersen (1995 ). Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav, 36(1), 1-10.
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/45116 | - |
dc.description.abstract | 研究背景:每個人一生中總會經驗過扭傷腳踝或肩頸背痛而有醫療的需求。目前國內缺乏關於肌肉骨骼系統損傷醫療利用情形的研究。過去多篇文獻驗證中、西醫之關係,但結論不一致,且多數為問卷調查,非採用自然試驗方法。本研究利用健保局在民國88年8月引入中西醫復健療程造成的”價格變動”,創造出自然試驗的契機,以交叉價格彈性驗證中西醫復健療程之替代互補關係。目的:1.探討影響肌肉骨骼系統損傷患者選擇中、西醫療利用型態(只用西醫、只用中醫與中西合用)的因素。2.驗證中、西醫復健療程(傷科、針灸與物理治療)間是否存在替代互補關係。方法:肌肉骨骼系統損傷醫療利用型態研究,是利用健保資料庫2007年一百萬人抽樣歸人檔,以multinomial logistic regression分析不同醫療利用型態人口特質的差異。中、西醫復健療程之替代互補驗證利用健保資料庫1998~1999年一百萬抽樣歸人檔共5組20萬人,採panel data自然實驗設計研究,並以一階差分模型進行統計分析。結果:1.醫療利用型態只用西醫占61%,只用中醫21%,中西合用占18%。比起65歲以上只用西醫者,年紀越小越容易只用中醫;但25~64歲比較容易中西合用。比起男性只用西醫,女性比較容易只求診中醫與中西合用。有慢性病比起只用西醫者,不較不會只用中醫,但是比較會中西合用。重大傷病者比起只用西醫,比較不會只用中醫或中西合用。比起需部分負擔者只用西醫,不需部分負擔者較容易只求診中醫或中西合用。比起每萬人口中醫師數低者只用西醫,每萬人口中醫師數越高,越容易只用中醫或中西合用。2. 價格彈性物理治療為-0.16,傷科為-0.20,針灸療程數量對物理治療價格的交叉價格彈性在控制每萬人口復健專科醫師數與每萬人口中醫師數後為0.043,即物理治療價格上漲10%,針灸使用量增加0.4%;針灸療程數量對傷科價格的交叉價格彈性在控制每萬人口中醫師數後為0.092,即傷科價格上漲10%,針灸使用量增加0.92%。討論:影響民眾因肌肉骨骼系統損傷就醫,只用中醫與中西合用的因素包括年紀較輕、女性、慢性病、不需部分負擔與當地中醫師資源的多者。本研究估算的價格彈性在國內外計算醫療服務的價格彈性值(-0.17~-0.22)內。交叉價格彈性結果,推翻兩者為互補關係的研究假說。本研究在區分出肌肉骨骼損傷疾病後,得到的彈性係數(0.02)雖然較李氏(-0.005)稍大,但是依然遠小於0.1而可視為無彈性,傾向解釋兩者間為獨立商品。依然沒有發現中西醫療間有替代互補關係的證據。 | zh_TW |
dc.description.abstract | Background: Everybody in the life must have the experience of ankle sprain or back pain and have the need to seek the medicine help. There had far been relatively little research into the area of the medical utilization pattern of musculoskeletal damage Several researches investigated the relationship between Chinese and Western medicine, but the conclusion were not in concert and the data collect through interview by questionnaire, not through natural experiment. The study used price difference of Chinese and Western medicine rehabilitation treatment program since in August, 1999 when the NHI copayment policy was to take effect to estimate the cross-price elasticity to examine the relationship of Chinese and Western medicine rehabilitation treatment programs. Purpose: 1.Investigate the factor that influence the medical utilization pattern (Western medicine only, Chinese medicine only and both) between Chinese and West medicine.2.Examine if the Chinese and West rehabilitation programs (traumatiology manipulative therapy, acupuncture and physical therapy) existed the substitute and complementary relationship. Method: 1. Used 2007 data one set of the longitudinal health insurance database (LHID2005) , and multinomial logistic regression was introduced. 2. Used 5 set data of 1998~1999 of the LHID2005 with natural experiment study design, and first-difference statistical method is introduced.
Result: Among the musculoskeletal damage medical utilization, 61% used Western medicine only,21% used Chinese medicine only and 18% used both. The younger tended to use Chinese medicine only and the 25~64 y/o tended to use both then the people older then 65y/o who used Western medicine only., Female tended to use Chinese medicine only or both then Male who used Western medicine only. No copayments were needed people tended to use Chinese medicine only or use both then the people who needed. 2. The price elasticity of physical therapy was -0.16, traumatiology manipulative therapy is -0.20. The cross-price of acupuncture to physical therapy price was 0.043, controlling the rehabilitation and Chinese doctors per ten thousand people. The cross-price of acupuncture to traumatiology manipulative therapy was 0.092, controlling Chinese doctors per ten thousand people. Conclusion: The factor influence people used Chinese medicine or both was the younger, female, no copayment needed and with more sufficient Chinese medicine manpower resources. The price elasticity estimated in the study was in the range of the medical price elasticity estimated by other researches. The result of the cross-price elasticity demolished the hypothesis. There was still no substitute or complementary relationship found between the Chinese and West medicine even we separate the disease type. | en |
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dc.description.tableofcontents | 口試委員會審定書……………………………………………………………… i
誌謝………………………………………………………………………………. ii 中文摘要………………………………………………………………………… i ii 英文摘要…………………………………………………………………………. v 第一章 緒論………………………………………………………………….. 1 第一節、研究背景與動機………………………………………………… 1 第二節、研究重要性………………………………………………….… 3 第三節、研究目的 ……………………………………………………… 4 第二章 文獻探討……………………………………………………….. 5 第一部分、基礎理論整理 第一節、Andersen model醫療服務利用行為模式…………………….. 6 第二節、經濟學觀點的醫療服務市場…………………………………… 10 第三節、傷科、針灸與物理治療之簡介與比較……………………….. 17 第二部份、文獻回顧 第一節、國內中醫與西醫使用的研究............................................................. 24 第二節、國內中、西醫療的替代互補研究……………………………….… 29 第三節、國外互補性替代療法(CAM)的研究……………………………… 31 第四節、運用交叉價格彈性推估替代互補關係之文獻探討……………. 35 第三章 研究方法 第一節、影響民眾選擇中西醫療利用型態的因素………………………. 42 第二節、驗證復健療程間替代和互補的關係………………………….… ..50 第四章 結果 第一節、影響民眾選擇中西醫療利用型態的因素……………………….. 59 第二節、驗證復健療程間替代和互補的關係…………………………….. 71 第五章 討論…………………………………………………………………….. 78 參考文獻………………………………………………………………………… 83 附錄……………………………………………………………………………… 87 圖目錄: 圖2.1.1:Andersen第一階段醫療服務利用行為模式(1960s)………… 8 圖2.1.2第四階段醫療服務利用行為模式(1995)……………………… 9 圖3.1.1主題一、影響民眾選擇中西醫療利用型態的因素…………… 42 圖3.1.2、資料處理流程 (影響民眾選擇中西療利用型態因素)………46 圖3.2.1案件選取:所有使用者與兩年都使用者的關係……………… 51 圖3.2.2 資料處理流程(復健療程替代互補關係驗證)…………………53 圖4.1.1 肌骨損傷就醫科別比例…………………………………………61 圖4.1.2 肌肉骨骼損傷平均每人每年看診次數…………………………61 圖4.1.3 肌肉骨骼損傷患者,平均每年看診次數………………………61 圖4.1.4肌肉骨骼系統損傷,醫療利用型態求診人數百分比………… 63.. 圖4.1.5 肌肉骨骼系統損傷,醫療利用型態平均門診次數……………63 圖4.1.7年齡別、醫療利用型態平均門診次數………………………… 64 圖4.2.1 肌骨損傷就醫人數與復健人數…………………………………72 圖4.2.2各復健療程使用人數變化……………………………………… 72 圖4.2.3 各復健療程使用次數變化………………………………………72 圖4.2.4 研究對象所有使用者與兩年都用者的關係……………………73 表目錄: 表2.1.1醫療服務利用行為模式的可變程度(Andersen, 1995)…………… 8 表2.2.1需求彈性(需求數量對價格或所得變動的反應程度)……………… 13 表2.2.2 替代品與互補品的定義與解釋………………………………………15 表2.3.1物理治療與針灸推拿的比較………………………………………… 21 表2.3.2傷科(推拿整復)、針灸、物理治療學制與法規之比較…………… 22 表2.4.1 交叉價格彈性估計方法—以兩篇利用panel data之文獻整理… 37 表2.4.2計算交叉價格彈性(cross-price elasticity)文獻之整理……… 38 表.3.1.1 選取範圍ICD9_CM編碼與中文診斷名稱………………………… 44 表.3.3.1研究變項與操作型定義………………………………………………48 表3.2.1替代互補研究 產品組合…………………………………………… 50 表3.2.2 肌肉骨骼損傷,各醫院層級使用人數比例…………………………52 表3.2.3 復健療程替代互補驗證的 變項操作型定義……………………… 56 表3.2.4估計價格彈性與交叉彈性的轉換方式………………………………58 表4.1.1肌肉骨骼系統損傷,科別醫療利用比例……………………………60 表4.1.2 區分醫療利用型態人數百分比………………………………………63 表4.1.3三種醫療利用型態之multinomial logistic model分析結果……67 表4.2.1研究個案人口學變項敘述統計量…………………………………… 74 表4.2.2 物理治療的價格彈性與對針灸的交叉價格彈性……………………76 表4.2.3 傷科的價格彈性與對針灸的交叉價格彈性…………………………77 | |
dc.language.iso | zh-TW | |
dc.title | 中西醫療替代互補關係之研究---以肌肉骨骼系統損傷為例 | zh_TW |
dc.title | Study of the substitute and complementary relationship of Chinese and Western medince | en |
dc.type | Thesis | |
dc.date.schoolyear | 98-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 曹昭懿,湯澡薰 | |
dc.subject.keyword | 交叉價格彈性,肌肉骨骼損傷,中西醫醫療利用,健保資料庫,一階差分模型, | zh_TW |
dc.subject.keyword | cross-price elasticity,musculoskeletal damage,utilization of Chinese and Western medicine,NHI research database,First-difference model, | en |
dc.relation.page | 112 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2010-02-09 | |
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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