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題名 不同權屬別醫院之績效研究: 分量迴歸之應用
作者 周東慶
貢獻者 林馨怡
周東慶
關鍵詞 醫院權屬別
醫院績效
內生性問題
工具變數分量迴歸
日期 2008
上傳時間 14-九月-2009 13:30:34 (UTC+8)
摘要 本文透過 Chernozhukov and Hansen (2005,2006) 的工具變數分量迴歸模型(IVQR)探討台灣醫院權屬別對於醫院績效的影響。
     相較於簡單線性迴歸模型,
     透過工具變數分量迴歸方法不僅能夠完整描繪醫院績效的條件分配,
     亦能修正以傳統分量迴歸方法估計造成估計結果不具一致性的問題。
     本文實證結果發現醫院權屬別對於醫院績效具有不對稱影響效果,
     且 1999 年入院病患與 2000 年入院病患稍有差異。
     
     醫療費用方面, 就 1999 年入院病患而言,
     在住院醫療費用上,
     對於醫療費用較高的族群,公立醫院病患會低於私人醫院病患。
     在一年總醫療費用上,
     對於醫療費用較低的族群, 公立醫院病患會高於私人醫院病患;
     對於醫療費用較高的族群, 非營利財團法人醫院病患會高於私人醫院病患。
     就 2000 年入院病患而言,
     在住院醫療費用與一年總醫療費用上,
     無論醫療費用較高或較低的族群, 公立醫院病患皆會高於私人醫院病患;
     非營利財團法人醫院病患則大多在較高費用族群時才會高於私人醫院病患。
     醫療品質方面, 就 1999 年與 2000 年入院病患而言,
     對於存活天數較短的族群,
     非營利財團法人醫院與公立醫院病患的出院後存活天數皆高於私人醫院病患;
     對於存活天數較長的族群,非營利財團法人醫院與私人醫院病患間或公立醫院與私人醫院病患間, 出院後存活天數上均不存在顯著差別。
     總體來說, 醫院權屬別對於醫院績效的影響效果隨著分量不同而有所差異,
     這也提醒相關政府單位在查核院所績效時需特別注意,尤其在申報費用上, 是否某些族群較易出現浮報或爛報費用等現象, 造成不必要的醫療資源耗用。
參考文獻 邱惠雀 (1995), 地區醫院人力資源配置與營運績效之相關研究, 國立陽明大學醫務管理研究所碩士論文.
張巧忻 (2005), 醫院權屬別與主要癌症照護結果、醫療費用之相關分析, 國立台北護理學院醫護管理研究所碩士論文.
張樂心 (2003), 不同權屬別醫院之經濟行為研究, 國立台灣大學公共衛生學院衛生政策與管理研究所博士論文.
張樂心、鄭守夏、楊銘欽、江東亮 (2004), 醫院權屬別與醫療收費, 臺灣公共衛生雜誌,23卷2期,第130-140頁.
陳佩妮、鄭守夏、鐘國彪、王林美園 (1997), 台灣地區醫療品質指標適用性之探討, 中華衛誌,16期第2卷,第133-142頁.
曾淑卿、郭倉義 (2002), 台灣醫療照護品質指標之應用:以急診轉院率為例, 品質月刊,38卷9期,第64-68頁.
葉憶婷 (2007), 股市價量關係: 工具變數分量迴歸方法的應用, 國立政治大學經濟學研究所碩士論文.
Abadie, A., J. D. Angrist, and G. W. Imbens (2002), Instrumental Variables Estimates of the Effect of Subsidized Training on the Quantiles of Trainee Earnings,
Econometrica, 79, 91-117.
Amemiya, T. (1982), Two Stage Least Absolute Deviations Estimators, Econometrica, 50, 689-711.
Arrow, K. J. (1963), Uncertainty and the Welfare Economics of Medical Care, American Economic Review, 53(5), 941-973.
Becker, E. R. anf F. A. Sloan (1985), Hospital Ownership and Performance, Economic Inquiry, 23, 21-36.
Buchinsky, M. (1994), Changes in the U.S. Wage Structure 1963-1987: Application of Quantile Regression, Econometrica, 62, 405-458.
Buchinsky, M. (1998), Recent Advances in Quantile Regression: A Practical Guide for Empirical Research, Journal of Human Resources, 33, 88-126.
Chernozhukov, V. and C. Hansen (2005), An IV Model of Quantile and Treatment Effects, Econometrica, 73, 245-261.
Chernozhukov, V. and C. Hansen (2006), Instrumental Quantile Regression Inference for Structural and Treatment Effect Models, Journal of Econometrics, 132, 491-525.
Chernozhukov, V. and C. Hansen (2008), Instrumental Variable Quantile Regression: A Robust Inference Approach, Journal of Econometrics, 142, 379-398.
Chesher, A. D. (2003), Identification in Nonseparable Models, Econometrica, 71, 1405-1441.
Cooper, G. S., C. A. Sirio, A. J. Rotondi, L. B. Shepardson, and G. E. Rosenthal (1999), Are Readmissions to the Intensive Care Unit a Useful Measure of Hospital Performance? Medical Care, 37(4), 399-408.
Deber, R. B. (2002), Delivering Health Care Services: Public, Not-for-Profit, or Private? University of Toronto.
Goldstein, L. B., G. P. Samsa, D. B. Matchar, and R. D. Horner (2004), Charlson Index Comorbidity Adjustment for Ischemic Stroke Outcome Studies, Stroke, 35, 1941-1945.
Gowrisankaran, G. and R. J. Town (1999), Estimating the Quality of Care in Hospitals Using Instrumental Variables,
Journal of Health Economics, 18, 747-767.
Hong, H. and E. Tamer (2003), Inference in Censored Models with Endogenous Regressors, Econometrica, 71, 905-932.
Imbens, G. W. and W. K. Newey (2003), Identification and Estimation of Triangular Simultaneous Equations Models Without Additivity, MIT working paper.
Institute of Medicine (1986), For-Profit Enterprise in Health Care, National Academy Press, Washington.
Jensen P. H., E. Webster, and J. Witt (2009), Hospital Type and Patient Outcomes: An Empirical Examination Using Readmission and Mortality Records, Health Economics, 10, 1002.
Johantgen, M. E., R. M. Coffey, D. R. Harris, H. Levy, and J. J. Clinton (1995), Treating Early-Stage Breast Cancer: Hospital Characteristics Associated with Breast-Conserving Surgery, American Journal of Public Health, 85, 1432-1434.
Koenker, R. and G. Bassett (1978), Regression Quantile, Econometrica, 46, 33-50.
Lee S. (2007), Endogeneity in Quantile Regression Models: A Control Function Approach, Journal of Econometrics, 141, 1131-1158.
Lien, H. M., S. Y. Chou, and J. T. Liu (2008), Hospital Ownership and Performance: Evidence from Stroke and Cardiac Treatment in Taiwan, Journal of Health Economics, 27(5), 1208-1223.
Lin, H., S. Xirasagar, and S. Kao (2004), Association of Hospital Ownership with Patient Transfers to Outpatient Care Under a Prospective Payment System in Taiwan, Health Policy, 69(1), 11-19.
Mark, B. A. (1984), Investor-Owned and Not-for-Profit Hospitals : A Comparison, Nursing Economics, 1, 240-245
Manning, D. L. (1997), Investing in the Twenty-First Century Hospital, Health Affairs, 16(2), 108-111.
McClellan, M., B. J. McNeil, and J. P. Newhouse (1994), Does More Intensive Treatment of Acute Myocardial Infarction Reduce Mortality? Journal of the American Medical Association, 270, 1832-1836.
McClellan, M. and D. Staiger (2000), Comparing Hospital Quality at For-Profit and Not-for-Profit Hospitals, In: Cutler, D.M.(Ed.), The Changing Hospital Industry:Comparing Not-for-Profit and For-Profit Institution, University of Chicago Press, Chicago, 93-112.
Nazmi Sari (2002), Is Hospital Competition Socially Wasteful? Health Economics, 11, 571-584.
Newey, W. K., J. Powell, and F. Vella (1999), Nonparametric Estimation of Triangular Simultaneous Equations Models, Econometrica, 67, 565-603.
Newhouse, J. P. (1970), Toward a Theory of Nonprofit Institutions, American Economic Review, 60, 64-74.
Powell, J. (1983), The Asymptotic Normality of Two-Stage Least Absolute Deviations Estimators, Econometrica, 51, 1569-1576.
Powell, J. (1984), Least Absolute Deviations Estimation for the Censored Regression Model, Journal of Econometrics, 25, 303-325.
Powell, J. (1986), Censored Regression Quantiles, Journal of Econometrics, 32, 143-155.
Powell, J. (2002), Lecture Notes on Quantile Regression, Department of Economics, UC Berkeley.
Robert, L. K. (1997), Understanding Health Care Outcomes Research, Aspen Publications, Gaithersburg, MD.
Robinson, J. C. and H. S. Luft (1985), The Impact of Hospital Market Structure on Patient Volume, Average Length of Stay, and the Cost of Care, Journal of Health Economics, 4, 333-356.
Shen, Y. C. (2002), The Effect of Hospital Ownership Choice on Patient Outcomes after Treatment for Acute Myocardial Infarction, Journal of Health Economics, 21(5), 901-922.
Sloan, F. A. (2000), Not-for-Profit Ownership and Hospital Behavior, In: Culyer, Newhouse (Eds.), Handbook of Health Economics, North Holland.
Sloan, F. A., G. A. Picone, D. H. Taylor, and S. Y. Chou (2001), Hospital Ownership and Cost and Quality of Care: Is There a Dime`s Worth of Difference? Journal of Health Economics, 20, 1-21.
描述 碩士
國立政治大學
經濟研究所
96258004
97
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0096258004
資料類型 thesis
dc.contributor.advisor 林馨怡zh_TW
dc.contributor.author (作者) 周東慶zh_TW
dc.creator (作者) 周東慶zh_TW
dc.date (日期) 2008en_US
dc.date.accessioned 14-九月-2009 13:30:34 (UTC+8)-
dc.date.available 14-九月-2009 13:30:34 (UTC+8)-
dc.date.issued (上傳時間) 14-九月-2009 13:30:34 (UTC+8)-
dc.identifier (其他 識別碼) G0096258004en_US
dc.identifier.uri (URI) https://nccur.lib.nccu.edu.tw/handle/140.119/32252-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 經濟研究所zh_TW
dc.description (描述) 96258004zh_TW
dc.description (描述) 97zh_TW
dc.description.abstract (摘要) 本文透過 Chernozhukov and Hansen (2005,2006) 的工具變數分量迴歸模型(IVQR)探討台灣醫院權屬別對於醫院績效的影響。
     相較於簡單線性迴歸模型,
     透過工具變數分量迴歸方法不僅能夠完整描繪醫院績效的條件分配,
     亦能修正以傳統分量迴歸方法估計造成估計結果不具一致性的問題。
     本文實證結果發現醫院權屬別對於醫院績效具有不對稱影響效果,
     且 1999 年入院病患與 2000 年入院病患稍有差異。
     
     醫療費用方面, 就 1999 年入院病患而言,
     在住院醫療費用上,
     對於醫療費用較高的族群,公立醫院病患會低於私人醫院病患。
     在一年總醫療費用上,
     對於醫療費用較低的族群, 公立醫院病患會高於私人醫院病患;
     對於醫療費用較高的族群, 非營利財團法人醫院病患會高於私人醫院病患。
     就 2000 年入院病患而言,
     在住院醫療費用與一年總醫療費用上,
     無論醫療費用較高或較低的族群, 公立醫院病患皆會高於私人醫院病患;
     非營利財團法人醫院病患則大多在較高費用族群時才會高於私人醫院病患。
     醫療品質方面, 就 1999 年與 2000 年入院病患而言,
     對於存活天數較短的族群,
     非營利財團法人醫院與公立醫院病患的出院後存活天數皆高於私人醫院病患;
     對於存活天數較長的族群,非營利財團法人醫院與私人醫院病患間或公立醫院與私人醫院病患間, 出院後存活天數上均不存在顯著差別。
     總體來說, 醫院權屬別對於醫院績效的影響效果隨著分量不同而有所差異,
     這也提醒相關政府單位在查核院所績效時需特別注意,尤其在申報費用上, 是否某些族群較易出現浮報或爛報費用等現象, 造成不必要的醫療資源耗用。
zh_TW
dc.description.tableofcontents 1.前言 1
     2.文獻回顧 4
      2.1醫院權屬別之定義............4
      2.2醫院權屬別與醫院績效表現.....6
     3.分量迴歸模型與內生性問題 11
      3.1分量迴歸模型.............. 11
      3.2分量迴歸模型與內生性問題....16
     4.實證模型 23
     5.實證分析 26
      5.1資料.....................26
      5.2住院醫療費用...............31
      5.3一年總醫療費用..............35
      5.4病患出院後存活天數..........38
      5.5歸納結果...................42
     6.結論 45
     參考文獻 46
     附錄 50
zh_TW
dc.language.iso en_US-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0096258004en_US
dc.subject (關鍵詞) 醫院權屬別zh_TW
dc.subject (關鍵詞) 醫院績效zh_TW
dc.subject (關鍵詞) 內生性問題zh_TW
dc.subject (關鍵詞) 工具變數分量迴歸zh_TW
dc.title (題名) 不同權屬別醫院之績效研究: 分量迴歸之應用zh_TW
dc.type (資料類型) thesisen
dc.relation.reference (參考文獻) 邱惠雀 (1995), 地區醫院人力資源配置與營運績效之相關研究, 國立陽明大學醫務管理研究所碩士論文.zh_TW
dc.relation.reference (參考文獻) 張巧忻 (2005), 醫院權屬別與主要癌症照護結果、醫療費用之相關分析, 國立台北護理學院醫護管理研究所碩士論文.zh_TW
dc.relation.reference (參考文獻) 張樂心 (2003), 不同權屬別醫院之經濟行為研究, 國立台灣大學公共衛生學院衛生政策與管理研究所博士論文.zh_TW
dc.relation.reference (參考文獻) 張樂心、鄭守夏、楊銘欽、江東亮 (2004), 醫院權屬別與醫療收費, 臺灣公共衛生雜誌,23卷2期,第130-140頁.zh_TW
dc.relation.reference (參考文獻) 陳佩妮、鄭守夏、鐘國彪、王林美園 (1997), 台灣地區醫療品質指標適用性之探討, 中華衛誌,16期第2卷,第133-142頁.zh_TW
dc.relation.reference (參考文獻) 曾淑卿、郭倉義 (2002), 台灣醫療照護品質指標之應用:以急診轉院率為例, 品質月刊,38卷9期,第64-68頁.zh_TW
dc.relation.reference (參考文獻) 葉憶婷 (2007), 股市價量關係: 工具變數分量迴歸方法的應用, 國立政治大學經濟學研究所碩士論文.zh_TW
dc.relation.reference (參考文獻) Abadie, A., J. D. Angrist, and G. W. Imbens (2002), Instrumental Variables Estimates of the Effect of Subsidized Training on the Quantiles of Trainee Earnings,zh_TW
dc.relation.reference (參考文獻) Econometrica, 79, 91-117.zh_TW
dc.relation.reference (參考文獻) Amemiya, T. (1982), Two Stage Least Absolute Deviations Estimators, Econometrica, 50, 689-711.zh_TW
dc.relation.reference (參考文獻) Arrow, K. J. (1963), Uncertainty and the Welfare Economics of Medical Care, American Economic Review, 53(5), 941-973.zh_TW
dc.relation.reference (參考文獻) Becker, E. R. anf F. A. Sloan (1985), Hospital Ownership and Performance, Economic Inquiry, 23, 21-36.zh_TW
dc.relation.reference (參考文獻) Buchinsky, M. (1994), Changes in the U.S. Wage Structure 1963-1987: Application of Quantile Regression, Econometrica, 62, 405-458.zh_TW
dc.relation.reference (參考文獻) Buchinsky, M. (1998), Recent Advances in Quantile Regression: A Practical Guide for Empirical Research, Journal of Human Resources, 33, 88-126.zh_TW
dc.relation.reference (參考文獻) Chernozhukov, V. and C. Hansen (2005), An IV Model of Quantile and Treatment Effects, Econometrica, 73, 245-261.zh_TW
dc.relation.reference (參考文獻) Chernozhukov, V. and C. Hansen (2006), Instrumental Quantile Regression Inference for Structural and Treatment Effect Models, Journal of Econometrics, 132, 491-525.zh_TW
dc.relation.reference (參考文獻) Chernozhukov, V. and C. Hansen (2008), Instrumental Variable Quantile Regression: A Robust Inference Approach, Journal of Econometrics, 142, 379-398.zh_TW
dc.relation.reference (參考文獻) Chesher, A. D. (2003), Identification in Nonseparable Models, Econometrica, 71, 1405-1441.zh_TW
dc.relation.reference (參考文獻) Cooper, G. S., C. A. Sirio, A. J. Rotondi, L. B. Shepardson, and G. E. Rosenthal (1999), Are Readmissions to the Intensive Care Unit a Useful Measure of Hospital Performance? Medical Care, 37(4), 399-408.zh_TW
dc.relation.reference (參考文獻) Deber, R. B. (2002), Delivering Health Care Services: Public, Not-for-Profit, or Private? University of Toronto.zh_TW
dc.relation.reference (參考文獻) Goldstein, L. B., G. P. Samsa, D. B. Matchar, and R. D. Horner (2004), Charlson Index Comorbidity Adjustment for Ischemic Stroke Outcome Studies, Stroke, 35, 1941-1945.zh_TW
dc.relation.reference (參考文獻) Gowrisankaran, G. and R. J. Town (1999), Estimating the Quality of Care in Hospitals Using Instrumental Variables,zh_TW
dc.relation.reference (參考文獻) Journal of Health Economics, 18, 747-767.zh_TW
dc.relation.reference (參考文獻) Hong, H. and E. Tamer (2003), Inference in Censored Models with Endogenous Regressors, Econometrica, 71, 905-932.zh_TW
dc.relation.reference (參考文獻) Imbens, G. W. and W. K. Newey (2003), Identification and Estimation of Triangular Simultaneous Equations Models Without Additivity, MIT working paper.zh_TW
dc.relation.reference (參考文獻) Institute of Medicine (1986), For-Profit Enterprise in Health Care, National Academy Press, Washington.zh_TW
dc.relation.reference (參考文獻) Jensen P. H., E. Webster, and J. Witt (2009), Hospital Type and Patient Outcomes: An Empirical Examination Using Readmission and Mortality Records, Health Economics, 10, 1002.zh_TW
dc.relation.reference (參考文獻) Johantgen, M. E., R. M. Coffey, D. R. Harris, H. Levy, and J. J. Clinton (1995), Treating Early-Stage Breast Cancer: Hospital Characteristics Associated with Breast-Conserving Surgery, American Journal of Public Health, 85, 1432-1434.zh_TW
dc.relation.reference (參考文獻) Koenker, R. and G. Bassett (1978), Regression Quantile, Econometrica, 46, 33-50.zh_TW
dc.relation.reference (參考文獻) Lee S. (2007), Endogeneity in Quantile Regression Models: A Control Function Approach, Journal of Econometrics, 141, 1131-1158.zh_TW
dc.relation.reference (參考文獻) Lien, H. M., S. Y. Chou, and J. T. Liu (2008), Hospital Ownership and Performance: Evidence from Stroke and Cardiac Treatment in Taiwan, Journal of Health Economics, 27(5), 1208-1223.zh_TW
dc.relation.reference (參考文獻) Lin, H., S. Xirasagar, and S. Kao (2004), Association of Hospital Ownership with Patient Transfers to Outpatient Care Under a Prospective Payment System in Taiwan, Health Policy, 69(1), 11-19.zh_TW
dc.relation.reference (參考文獻) Mark, B. A. (1984), Investor-Owned and Not-for-Profit Hospitals : A Comparison, Nursing Economics, 1, 240-245zh_TW
dc.relation.reference (參考文獻) Manning, D. L. (1997), Investing in the Twenty-First Century Hospital, Health Affairs, 16(2), 108-111.zh_TW
dc.relation.reference (參考文獻) McClellan, M., B. J. McNeil, and J. P. Newhouse (1994), Does More Intensive Treatment of Acute Myocardial Infarction Reduce Mortality? Journal of the American Medical Association, 270, 1832-1836.zh_TW
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