總統立委選舉競爭程度對民眾醫療使用之影響：以2012年總統立委大選為例

Abstract

隨著時代進步、經濟發展以及文化交流之下，已有愈來愈多國家轉型成民主體制國家，這些民主體制國家的選舉活動往往成為世界矚目之焦點。同樣是民主國家的臺灣，已舉辦許多不同規模之選舉。在激烈的選舉過後，許多民眾會出現躁鬱、情緒不穩以及腸胃不適等選舉症候群症狀。而回顧過去之研究，選舉競爭之議題大多聚焦在選舉對於整體國民長期健康水準之影響，鮮少文獻在探討選舉競爭對於短期個人醫療使用之影響。因此本研究目的即在分析此短期大選效果，並嘗試量化分析選舉競爭程度對於民眾醫療使用之影響。 本文利用臺灣國家衛生研究院全民健保資料庫「2005年承保抽樣歸人檔」中，其樣本在2011年與2012年之醫療使用資料，並串聯2012年總統立委選舉資料以及各鄉鎮醫療機構資料，以13歲至60歲的民眾做為研究對象，利用Difference-in-Differences以及Flexible Difference-in-Differences法進行實證分析，探討不同選舉階段以及不同選舉期間大選對於民眾醫療使用的影響。此外，本研究更利用不同選舉競爭程度變數，進一步探討選舉競爭程度對於民眾的醫療使用之影響。 研究結果顯示，首先，在不同階段選舉的部分，在未控制選舉競爭變數的情況下，無論是總門診次數還是各項就醫科別次數，競選期間效果將顯著降低民眾的門診醫療使用次數，大選效果將顯著增加民眾的門診醫療使用次數。而在控制不同選舉競爭變數後，分析結果發現，隨著選舉競爭程度的增加，民眾的就醫情況增加更為明顯。其次，在不同選舉期間的部分，在未控制選舉競爭變數的情況下，無論是總門診次數還是各項就醫科別次數，大選效果仍然顯著增加民眾的門診醫療是用次數，不同的是，選舉期間效果在選前一週時，是呈現正向之影響，表示選前一週民眾的門診醫療使用情況已明顯增加。在控制選舉競爭變數後，分析結果顯示，隨著選舉競爭程度的增加，民眾的門診醫療使用情況增加更為明顯。整體而言，選舉競爭確實會增加民眾之醫療使用。

Owing to the economic growth, more and more developed countries are now having their political systems toward democracies. In a democratic political system, electoral campaign has been a policy tool. Taiwan is not one of the exceptions and there are a number of different scale elections held. It has been documented that voters may become depressed, anxious and stomach upset etc after the election period. To date, most empirical studies that examine the relationship between human health and political economy focus on political competition and cross-country difference in health. Not much evidence has been provided on the relationship between political competition and medical utilization of voters. The purpose of this study is to investigate the extent to which electoral competition may affect medical utilization of voters using a case study in Taiwan. Using a unique dataset which compiling the National Health Insurance Profile and the Presidential and Legislative Election Data in 2011 and 2012, we estimate a Difference-in-Differences model to investigate how the medical utilization of voters may change over the election period. Several interesting findings can be summaries. Firstly, estimation results indicate that the campaign effect significantly reduces voters' outpatient visits and election effect remarkably increases outpatient visits of voters. On the other hand, after controlling the electoral competition variable, the utilization of outpatient services increases even more significantly with the higher electoral competition. Secondly, the election effect still raises the utilization of outpatient services in both circumstances of all departments or separate department without controlling the electoral competitive variable in different electoral intervals. However, the campaign effect is positively-related to the number of outpatient visits a week before election period, which suggests that there is a significant increase on the utilization of outpatient services a week prior to election. In addition, results also show that the use of outpatient services of voters is highly positively related to the electoral competition. Overall, electoral competition does raise the utilization of medical resources.