請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/85117完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 郭年真(Raymond N. Kuo) | |
| dc.contributor.author | Yi-Wen Chang | en |
| dc.contributor.author | 張逸雯 | zh_TW |
| dc.date.accessioned | 2023-03-19T22:44:43Z | - |
| dc.date.copyright | 2022-10-03 | |
| dc.date.issued | 2022 | |
| dc.date.submitted | 2022-08-11 | |
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(2020). 從人口老化及薪資停滯角度探討全民健保財務及保費負擔世代分配問題. 臺灣經濟預測與政策, 51(1), 57-110. 連賢明. (2011). 如何使用健保資料推估社經變數. 人文及社會科學集刊, 23(3), 371-398. 陳再晉, 鐘珮純, 陳冠文, & 蕭允強. (2020). 植入性醫材登錄監視制度與病人權益保障. 台灣公共衛生雜誌, 39(3), 235-239. 陳思潔, 陳楚杰, 謝明娟, & 胡文萍. (2022). 臺灣地區民眾白內障門急診就診率之趨勢研究. 醫務管理期刊, 23(1), 80-101. 陳瑞杰, & 林金龍. (2009). 全民健保特殊材料納入部分給付之評估模式研究. 台北市: 行政院衛生署 黃鈞奕. (2015). 探討社經地位對血管支架置入病人支架選擇及預後情形之影響 國立陽明大學]. 台北市. 黃鈞奕, 陳慧珊, 張嘉恬, & 吳肖琪. (2015). 探討社經地位對血管支架置入病患死亡風險之影響. 台灣公共衛生雜誌, 34(1), 37-49. 黃歆景. (2010). 不同材質人工髖關節對全人工髖關節置換術醫療利用之影響. 楊涵妃, & 文羽苹. (2007). 台灣西醫基層診所聯合執業的變化: 1998 年與 2003 年. 台灣公共衛生雜誌, 26(2), 161-168. 楊智堯. (2012). 全民健保制度下影響病人選擇傳統或塗藥支架因素之研究 國立成功大學]. 台南市. 盧雪玉, 陳昌文, & 劉榮宏. (1988). 門診白內障摘除併人工水晶體植入手術. 中華民國眼科醫學會雜誌, 27(1), 89-94. 賴辛癸, & 藍忠孚. (1993). 差額負擔: 公平, 效率與醫療品質間之衝突. 中華民國公共衛生學會雜誌, 12(2), 107-120. 韓幸紋, & 連賢明. (2010). 加倍自然產支付能否降低剖腹產比例？. 台灣公共衛生雜誌, 29(3), 218-227. 職業安全衛生署. (2015). 職業性白內障認定參考指引. 台北市: 職業安全衛生署 | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/85117 | - |
| dc.description.abstract | 研究背景：我國的高價植入性醫療特殊材料除健保全額給付品項，針對材質精進或增加附加功能的品項適用自付差額制，人工水晶體為其中適用較早且用量最大者。過往研究可見不同都市化地區與不同層級醫療機構的自付差額使用佔率存在顯著差異。若能了解病人選用不同自付額的人工水晶體與醫療機構之關係，則可進一步探討此制度潛在的機構財務誘因或病人可負擔性。 研究目的：藉由次級資料分析以了解醫療機構特性與病人選用不同差額人工水晶體之相關性，並檢視當醫師轉換至不同特性的機構執業時，病人選用與機構特性的相關是否改變，以期增進對自付差額制度實務運作的認識。 研究方法：本研究為橫斷性研究，資料來源為全民健保資料庫，以2016年至2019年首次於門診接受水晶體置換的病人為研究對象，以階層式羅吉斯迴歸模型進行分析，探討在控制病人人口學特性、社經特性、共病狀態與醫師特性後，醫療機構特性對病人選用不同差額類別的人工水晶體之影響。 研究結果：就醫機構層級越高、所在地所得程度越低，病人選用中、高差額人工水晶體的傾向越低，權屬別則未達統計顯著意義。當醫師至不同層級的機構執業時，醫院較診所病人選用中差額相對低差額類別的可能較高（醫學中心OR=0.620、區域醫院OR=0.657、地區醫院OR=0.776），選用高差額相對低差額類別的可能亦然（醫學中心OR=0.178、區域醫院OR=0.282、地區醫院OR=0.369）。 結論：本研究發現就醫機構層級、所在地所得程度與病人選用不同差額人工水晶體存在相關性。因此建議政府強化公開各家院所在各種功能類別的使用率與價格資訊，讓民眾就醫時增加對特材需自付差額的敏感度，則可視自身經濟能力，就治療的期待與醫師進行更務實的討論。 | zh_TW |
| dc.description.abstract | Background: A large number of medical implants are fully covered by the national health insurance in Taiwan ; however, advanced medical implants that are made from better materials or boast additional functions fall into a balanced-billing system, among which intraocular lens (IOL) are the most common. Previous studies have shown that there are significant differences in the use of balance-billed medical devices in different urbanized areas and different accreditation levels of healthcare providers. The financial incentives that healthcare providers potentially face and the affordability for patients in choosing appropriate implants can be further explored by understanding the association between providers' characteristics and patient choice on IOL with different co-payments. Objective: Through secondary data analysis, this research aimed to explore whether the relationship between patient choice and providers' characteristics changed depending on the accreditation level of the institution in which physicians practiced. A better understanding of this relationship provides new insights into how a balanced-billing system works in practice. Methods: The data sources used in this study were from the National Health Insurance Research Database (NHIRD) and included patients who first underwent outpatient cataract surgery between 2016 and 2019. The hierarchical logistic regression model was used to examine the effects of the characteristics of physicians and providers on patients' selection of IOL with different co-payments after controlling for patient age, sex, socioeconomic status, and comorbidities. Results: The higher the accreditation level and the lower the area income level of the provider were, the lower the likelihood of patients choosing IOLs with medium and high co-payments. The ownership of the provider was not significant. When physicians switched to different accreditation levels of practice, patients at medical centers (OR=0.620), metropolitan hospitals (OR=0.657), and community hospitals (OR=0.776) had a higher likelihood of choosing medium versus low co-payment items; similarly, patients at medical centers (OR=0.178), metropolitan hospitals (OR=0.282), and community hospitals (OR=0.369) were also more likely to choose high versus low co-payment items. Conclusions: Patients' choice on IOLs with medium and high co-payments was associated with a higher accreditation level and lower area income level of a provider. As the co-payment of the IOL increased, the patients' preference for IOL varied more between hospitals and clinics. Therefore, policies for improving the accessibility and affordability of appropriate IOL for patients should take into account the information already available to the public, such as utilization and price comparisons among providers. | en |
| dc.description.provenance | Made available in DSpace on 2023-03-19T22:44:43Z (GMT). No. of bitstreams: 1 U0001-0408202216263000.pdf: 5290268 bytes, checksum: 9c46862b4b37d244f44b01460a118c1a (MD5) Previous issue date: 2022 | en |
| dc.description.tableofcontents | 誌 謝 I 摘 要 II ABSTRACT III 目 錄 V 圖目錄 VII 表目錄 VIII 第壹章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的 3 第三節 研究重要性 4 第貳章 文獻回顧 5 第一節 健保自付差額制度 5 第二節 特殊功能人工水晶體 9 第三節 治療選擇差異的理論架構 13 第四節 醫療服務提供者的治療選擇差異 17 第五節 影響特材選用因素之實證研究 21 第六節 文獻回顧小結 25 第參章 研究設計與方法 26 第一節 研究設計與架構 26 第二節 研究假說 28 第三節 研究對象 28 第四節 資料來源與處理流程 29 第五節 研究變項與操作型定義 34 第六節 統計分析方法 39 第肆章 研究結果 41 第一節 使用人工水晶體個案基本特性比較 41 第二節 病人選用不同差額人工水晶體之影響因子 48 第三節 就醫機構層級之分層分析 56 第四節 跨層級執業醫師治療個案基本特性比較 76 第五節 醫師轉換執業機構層級對病人選用之影響 83 第六節 跨層級執業醫師在各類人工水晶體的使用佔率 90 第七節 研究結果小節 94 第伍章 討論 96 第一節 研究假說驗證 96 第二節 研究結果討論 97 第三節 研究限制 106 第陸章 結論與建議 109 第一節 結論 109 第二節 建議 110 參考文獻 112 附錄 123 附錄一、特殊功能人工水晶體品項表 123 附件二、不同差額人工水晶體分類原則 129 附件三、改變完整提供機構定義之多變項分析 130 | |
| dc.language.iso | zh-TW | |
| dc.subject | 治療選擇差異 | zh_TW |
| dc.subject | 自付差額 | zh_TW |
| dc.subject | 人工水晶體 | zh_TW |
| dc.subject | 醫療機構特性 | zh_TW |
| dc.subject | intraocular lens | en |
| dc.subject | healthcare providers’ characteristics | en |
| dc.subject | medical practice variation | en |
| dc.subject | balance-billing | en |
| dc.title | 探討醫療機構特性與病人選用不同差額人工水晶體之相關性 | zh_TW |
| dc.title | The Association between Healthcare Providers’ Characteristics and Patients’ Choice on Intraocular Lens with Different Co-payment | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 110-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 連賢明(Hsien-Ming Lien),蔡淑鈴(Shu-Ling Tsai) | |
| dc.subject.keyword | 自付差額,人工水晶體,醫療機構特性,治療選擇差異, | zh_TW |
| dc.subject.keyword | balance-billing,intraocular lens,healthcare providers’ characteristics,medical practice variation, | en |
| dc.relation.page | 138 | |
| dc.identifier.doi | 10.6342/NTU202202064 | |
| dc.rights.note | 同意授權(限校園內公開) | |
| dc.date.accepted | 2022-08-11 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| dc.date.embargo-lift | 2024-08-12 | - |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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