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題名 同儕效果對醫師處方行為之影響—以精神分裂症為例
Is doctor`s prescribing behavior affected by peer effect? Evidence from Schizophrenia treatment.
作者 龔芳玉
Kung, Fangyu
貢獻者 連賢明
龔芳玉
Kung, Fangyu
關鍵詞 同儕效果
處方行為
精神分裂症
peer effect
prescribing behavior
schizophrenia
日期 2007
上傳時間 18-Sep-2009 11:01:02 (UTC+8)
摘要 本文透過健保資料精神疾病歸人檔,擷取1997~2004年門診中之精神分裂症患者,針對其中701位精神科專科醫師對患者的精神分裂症一、二代藥物之處方行為進行研究。迴歸結果顯示醫師性別對處方選擇沒有特別的影響,同儕效果在相當程度上對醫師產生蠻大的改變。藥價調整前,教學醫院的醫師會受到周遭醫師開藥行為影響,其受影響程度大於非教學醫院。藥價調整後,教學醫院醫師幾乎不受同儕影響,相對的,非教學醫院比起藥價變動前,更易受到同僚行為而改變其行為。不過大體而言當周遭醫師容易開新藥(舊藥)時,醫師本身也會較容易開第二代(第一代)藥物。
參考文獻 英文部分
Arcidiacono and Nicholson S. (2005), “Peer effects in medical school”, Journal of Public Economics, 89 (2) :327–350.
Bates, Andree, & Edwin, Bailey, (2003), “ Marketing to win market share-The role of doctor sentiment and benchmarking”, International Journal of Medical Marketing, 3(2): 145-152.
Bayer, P., Pintoff, R., and Pozen, D. (2004), “Building criminal capital behind bars: Social learning in juvenile corrections”, Economic Growth Center Paper, No. 864, Yale University.
Bordley, W.C., Chelminski, A., Margolis, P.A., Kraus, R., Szilagyi, P.G.., Vann, J.J. (2000), “The effect of audit and feedback on immunization delivery: A systematic review “, American Journal of Preventive Medicine, 18(4) : 343-350.
Coleman, J.S., Campbell, E.Q., Hobson, C., McPartland, J., Mood, A., Weinfield, F.D., York, R.(1966),《Equality of educational opportunity》Government Printing Office, Washington, DC.
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.(1995), American Psychiatric Association, Washington, D.C.
Epple, D., Romano, R.(1998), “Competition between private and public schools, vouchers, and peer group effects”, American Economic Review, 88:33–62.
Fidler, H., Lockyer, J.M., Toews J., Violato, C. (1999), “Changing physicians’ practices: The effect of individual feedback”, Academic Medicine,74:702-714.
Gaviria, A., and Raphael, S. (2001), “School-based peer effects and juvenile behavior”, Review of Economics and Statistics, 83:257–268.
Goodpastor, W. A., & Montoya, I. D.(1996), “ Motivating physician behavior change: social influence versus financial contingencies”, International Journal of Health Care Quality Assurance, 9(6): 4-9.
Hillman, A.L, Ripley, K., Goldfard, N., Nuamah, I., Weiner, J., Lusk, E. (1998) , “Physician financial incentives and feedback:Failure to increase cancer screening in Medicaid managed care”, American Journal of Public Health, 88:1699-1701.
Kang, C.(2007), “Classroom peer effects and academic achievement: Quasi-randomization evidence from South Korea” , Journal of Urban Economics, 61:458-495.
LeBaron, C.W, Chaney, M., Baughman, A.L. et al. (1997), “Impact of measurement and feedback on vaccination coverage in public clinics” , JAMA, 277:631 - 635.
Mathie, A.Z.(1997), “Doctors and change”, Journal of Management in Medicine, 11(6): 342-356.
Mano-Negrin, R., & Mittman, B. (2001), “Theorising the social within physician decision making”, Journal of Management in Medicine, 15(4):259-266.
McEwan, P.J. (2003), “Peer effect on student achievement: Evidence from
Chile”, Economics of Education Review, 22:131-141.
Nechyba, T.J.(2000), “ Mobility, targeting, and private-school vouchers.” American Economic Review,90:130– 146
Reilly, J., McIntosh, J., Currie, K.(2002), “Changing surgical practice through feedback of performance data”, Journal of advanced Nursing, 38:607-614.
Schaffner, W., Ray, W. A., Federspiel, C. F., & Miller, W.O.(1983), “Improving antibiotic prescribing in office practice: a controlled trial of three educational methods”, Journal of the American Medical Association, 250(13): 1728-1732.
Stross, J.K., & Bole, G..G..(1980), “ Evaluation of a continuing education program in rheumatoid arthritis”, Arthritis and Rheumatism, 23(7):846-849.
Thompson, R. A., Kirz, H. L., & Gold, R. A.(1983), “Changes in physician behavior and cost savings associated with organizational recommendations on the use of routine chest x-rays and multi channel blood tests”, Preview of Medicine, 12: 385-396.
Weiss, K.B., and Robin, W. (2000) , “Performance measurement through audit, feedback, and profiling as tools for improving clinical care”, Chest, 118:53-58.
Zimmerman, D.(2003), “Peer effects in academic outcomes: evidence from a natural experiment”, The Review of Economics and Statistics, 85 (1):9–23.
中文書目
蕭文主編,Linda Seligman 原著(1995),《心理異常診斷與治療》,台北:五南圖書,頁334-335。
中央健康保險局會計室編著(2005),《全民健康保險統計》,台北:國家書坊,頁218。
周勵志審訂,主婦友社編著,保崎秀夫監修(2005),《精神疾病檢測百科》,台北:三采文化,頁179-183。
林式穀(2005),《精神藥物手冊》,台北:合記,頁34-37。
莊明敏主持(1995),《精神病患醫療服務體系之檢討》,行政院研究發展考核委員會編印,頁7-13。
曾文星、徐靜(1994),《現代精神醫學》,台北:水牛,頁245-248。
張明永主持(2003),《全民健康保險精神分裂症病患用藥型態分析》,行政院衛署九十二年度委託研究計畫,計畫編號DOH92-NH-1025。
中文期刊及論文
Huang et al.(2002), “Reduction of Laboratory Expenditure by Periodic Peer Comparison Feedback to Physicians:Cost-benefit and Durability of Effect”, 臺灣家庭醫學雜誌,12卷,4期,頁168-178。
吳培滋(2006),影響醫學中心醫師開立慢性病連續處方箋之因素探討,長榮大學醫務管理學研究所碩士論文。
林寶鳳(1995),提供藥價及醫師檔案分析資訊對醫師處方行為影響之類實驗性研究,國立陽明大學衛生福利研究所碩士論文。
陳端容、鍾國彪、吳麗竹、曾靜瑤、張金堅(2006),「同儕資訊回饋與內科醫師開立TG檢驗次數之關係:一個探索性研究」,臺灣公共衛生雜誌,25卷,1期,頁26-36。
喻小珠、黃凱琳、王世叡、趙坤郁、陳富滿、黃靜宜(2000),「同儕間藥品處方的回饋對多重用藥的影響,四個月的觀察」,The Changhua Journal of Medicine,6卷,1期,頁37-44。
董旭英、王文玲(2007),「國高中生依附父母、接觸偏差同儕、傳統價值觀念與偏差行爲的關聯性之差異性研究」,犯罪學期刊,10卷,2期,頁29-48。
楊雪華、陳端榮、李蘭、柯姍如(2003),「雙親和同儕團體對高中生吸菸行為的影響」,醫學教育,7卷,2期,頁128-139。
劉育昇、于若蓉(2007),「工作團隊內的同儕效果:台灣房屋仲介經紀人的分析」,經濟論文叢刊,35卷,2期,頁183-212。
描述 碩士
國立政治大學
財政研究所
95255022
96
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0095255022
資料類型 thesis
dc.contributor.advisor 連賢明zh_TW
dc.contributor.author (Authors) 龔芳玉zh_TW
dc.contributor.author (Authors) Kung, Fangyuen_US
dc.creator (作者) 龔芳玉zh_TW
dc.creator (作者) Kung, Fangyuen_US
dc.date (日期) 2007en_US
dc.date.accessioned 18-Sep-2009 11:01:02 (UTC+8)-
dc.date.available 18-Sep-2009 11:01:02 (UTC+8)-
dc.date.issued (上傳時間) 18-Sep-2009 11:01:02 (UTC+8)-
dc.identifier (Other Identifiers) G0095255022en_US
dc.identifier.uri (URI) https://nccur.lib.nccu.edu.tw/handle/140.119/34724-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 財政研究所zh_TW
dc.description (描述) 95255022zh_TW
dc.description (描述) 96zh_TW
dc.description.abstract (摘要) 本文透過健保資料精神疾病歸人檔,擷取1997~2004年門診中之精神分裂症患者,針對其中701位精神科專科醫師對患者的精神分裂症一、二代藥物之處方行為進行研究。迴歸結果顯示醫師性別對處方選擇沒有特別的影響,同儕效果在相當程度上對醫師產生蠻大的改變。藥價調整前,教學醫院的醫師會受到周遭醫師開藥行為影響,其受影響程度大於非教學醫院。藥價調整後,教學醫院醫師幾乎不受同儕影響,相對的,非教學醫院比起藥價變動前,更易受到同僚行為而改變其行為。不過大體而言當周遭醫師容易開新藥(舊藥)時,醫師本身也會較容易開第二代(第一代)藥物。zh_TW
dc.description.tableofcontents 謝 辭...I
摘 要...III
目 錄...IV
圖表目錄...V
第一章 緒論...1
第二章 背景介紹...3
第一節 精神分裂症介紹...3
第二節 精神分裂症用藥介紹...4
第三節 同儕效果文獻回顧 ...6
第三章 研究方法...10
第一節 實證模型...10
第二節 變數說明...11
第四章 資料來源與處理...13
第一節 資料來源...13
第二節 串檔說明及串檔結果...14
第三節 選取樣本及清檔...15
第四節 樣本整理...17
第五章 實證結果...20
第一節 敘述統計...20
第二節 迴歸結果...27
第六章 結論與建議 ...32
附錄 未處理同齡醫師所產生的誤差...34
參考文獻...40
zh_TW
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dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0095255022en_US
dc.subject (關鍵詞) 同儕效果zh_TW
dc.subject (關鍵詞) 處方行為zh_TW
dc.subject (關鍵詞) 精神分裂症zh_TW
dc.subject (關鍵詞) peer effecten_US
dc.subject (關鍵詞) prescribing behavioren_US
dc.subject (關鍵詞) schizophreniaen_US
dc.title (題名) 同儕效果對醫師處方行為之影響—以精神分裂症為例zh_TW
dc.title (題名) Is doctor`s prescribing behavior affected by peer effect? Evidence from Schizophrenia treatment.en_US
dc.type (資料類型) thesisen
dc.relation.reference (參考文獻) 英文部分zh_TW
dc.relation.reference (參考文獻) Arcidiacono and Nicholson S. (2005), “Peer effects in medical school”, Journal of Public Economics, 89 (2) :327–350.zh_TW
dc.relation.reference (參考文獻) Bates, Andree, & Edwin, Bailey, (2003), “ Marketing to win market share-The role of doctor sentiment and benchmarking”, International Journal of Medical Marketing, 3(2): 145-152.zh_TW
dc.relation.reference (參考文獻) Bayer, P., Pintoff, R., and Pozen, D. (2004), “Building criminal capital behind bars: Social learning in juvenile corrections”, Economic Growth Center Paper, No. 864, Yale University.zh_TW
dc.relation.reference (參考文獻) Bordley, W.C., Chelminski, A., Margolis, P.A., Kraus, R., Szilagyi, P.G.., Vann, J.J. (2000), “The effect of audit and feedback on immunization delivery: A systematic review “, American Journal of Preventive Medicine, 18(4) : 343-350.zh_TW
dc.relation.reference (參考文獻) Coleman, J.S., Campbell, E.Q., Hobson, C., McPartland, J., Mood, A., Weinfield, F.D., York, R.(1966),《Equality of educational opportunity》Government Printing Office, Washington, DC.zh_TW
dc.relation.reference (參考文獻) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.(1995), American Psychiatric Association, Washington, D.C.zh_TW
dc.relation.reference (參考文獻) Epple, D., Romano, R.(1998), “Competition between private and public schools, vouchers, and peer group effects”, American Economic Review, 88:33–62.zh_TW
dc.relation.reference (參考文獻) Fidler, H., Lockyer, J.M., Toews J., Violato, C. (1999), “Changing physicians’ practices: The effect of individual feedback”, Academic Medicine,74:702-714.zh_TW
dc.relation.reference (參考文獻) Gaviria, A., and Raphael, S. (2001), “School-based peer effects and juvenile behavior”, Review of Economics and Statistics, 83:257–268.zh_TW
dc.relation.reference (參考文獻) Goodpastor, W. A., & Montoya, I. D.(1996), “ Motivating physician behavior change: social influence versus financial contingencies”, International Journal of Health Care Quality Assurance, 9(6): 4-9.zh_TW
dc.relation.reference (參考文獻) Hillman, A.L, Ripley, K., Goldfard, N., Nuamah, I., Weiner, J., Lusk, E. (1998) , “Physician financial incentives and feedback:Failure to increase cancer screening in Medicaid managed care”, American Journal of Public Health, 88:1699-1701.zh_TW
dc.relation.reference (參考文獻) Kang, C.(2007), “Classroom peer effects and academic achievement: Quasi-randomization evidence from South Korea” , Journal of Urban Economics, 61:458-495.zh_TW
dc.relation.reference (參考文獻) LeBaron, C.W, Chaney, M., Baughman, A.L. et al. (1997), “Impact of measurement and feedback on vaccination coverage in public clinics” , JAMA, 277:631 - 635.zh_TW
dc.relation.reference (參考文獻) Mathie, A.Z.(1997), “Doctors and change”, Journal of Management in Medicine, 11(6): 342-356.zh_TW
dc.relation.reference (參考文獻) Mano-Negrin, R., & Mittman, B. (2001), “Theorising the social within physician decision making”, Journal of Management in Medicine, 15(4):259-266.zh_TW
dc.relation.reference (參考文獻) McEwan, P.J. (2003), “Peer effect on student achievement: Evidence fromzh_TW
dc.relation.reference (參考文獻) Chile”, Economics of Education Review, 22:131-141.zh_TW
dc.relation.reference (參考文獻) Nechyba, T.J.(2000), “ Mobility, targeting, and private-school vouchers.” American Economic Review,90:130– 146zh_TW
dc.relation.reference (參考文獻) Reilly, J., McIntosh, J., Currie, K.(2002), “Changing surgical practice through feedback of performance data”, Journal of advanced Nursing, 38:607-614.zh_TW
dc.relation.reference (參考文獻) Schaffner, W., Ray, W. A., Federspiel, C. F., & Miller, W.O.(1983), “Improving antibiotic prescribing in office practice: a controlled trial of three educational methods”, Journal of the American Medical Association, 250(13): 1728-1732.zh_TW
dc.relation.reference (參考文獻) Stross, J.K., & Bole, G..G..(1980), “ Evaluation of a continuing education program in rheumatoid arthritis”, Arthritis and Rheumatism, 23(7):846-849.zh_TW
dc.relation.reference (參考文獻) Thompson, R. A., Kirz, H. L., & Gold, R. A.(1983), “Changes in physician behavior and cost savings associated with organizational recommendations on the use of routine chest x-rays and multi channel blood tests”, Preview of Medicine, 12: 385-396.zh_TW
dc.relation.reference (參考文獻) Weiss, K.B., and Robin, W. (2000) , “Performance measurement through audit, feedback, and profiling as tools for improving clinical care”, Chest, 118:53-58.zh_TW
dc.relation.reference (參考文獻) Zimmerman, D.(2003), “Peer effects in academic outcomes: evidence from a natural experiment”, The Review of Economics and Statistics, 85 (1):9–23.zh_TW
dc.relation.reference (參考文獻) 中文書目zh_TW
dc.relation.reference (參考文獻) 蕭文主編,Linda Seligman 原著(1995),《心理異常診斷與治療》,台北:五南圖書,頁334-335。zh_TW
dc.relation.reference (參考文獻) 中央健康保險局會計室編著(2005),《全民健康保險統計》,台北:國家書坊,頁218。zh_TW
dc.relation.reference (參考文獻) 周勵志審訂,主婦友社編著,保崎秀夫監修(2005),《精神疾病檢測百科》,台北:三采文化,頁179-183。zh_TW
dc.relation.reference (參考文獻) 林式穀(2005),《精神藥物手冊》,台北:合記,頁34-37。zh_TW
dc.relation.reference (參考文獻) 莊明敏主持(1995),《精神病患醫療服務體系之檢討》,行政院研究發展考核委員會編印,頁7-13。zh_TW
dc.relation.reference (參考文獻) 曾文星、徐靜(1994),《現代精神醫學》,台北:水牛,頁245-248。zh_TW
dc.relation.reference (參考文獻) 張明永主持(2003),《全民健康保險精神分裂症病患用藥型態分析》,行政院衛署九十二年度委託研究計畫,計畫編號DOH92-NH-1025。zh_TW
dc.relation.reference (參考文獻) 中文期刊及論文zh_TW
dc.relation.reference (參考文獻) Huang et al.(2002), “Reduction of Laboratory Expenditure by Periodic Peer Comparison Feedback to Physicians:Cost-benefit and Durability of Effect”, 臺灣家庭醫學雜誌,12卷,4期,頁168-178。zh_TW
dc.relation.reference (參考文獻) 吳培滋(2006),影響醫學中心醫師開立慢性病連續處方箋之因素探討,長榮大學醫務管理學研究所碩士論文。zh_TW
dc.relation.reference (參考文獻) 林寶鳳(1995),提供藥價及醫師檔案分析資訊對醫師處方行為影響之類實驗性研究,國立陽明大學衛生福利研究所碩士論文。zh_TW
dc.relation.reference (參考文獻) 陳端容、鍾國彪、吳麗竹、曾靜瑤、張金堅(2006),「同儕資訊回饋與內科醫師開立TG檢驗次數之關係:一個探索性研究」,臺灣公共衛生雜誌,25卷,1期,頁26-36。zh_TW
dc.relation.reference (參考文獻) 喻小珠、黃凱琳、王世叡、趙坤郁、陳富滿、黃靜宜(2000),「同儕間藥品處方的回饋對多重用藥的影響,四個月的觀察」,The Changhua Journal of Medicine,6卷,1期,頁37-44。zh_TW
dc.relation.reference (參考文獻) 董旭英、王文玲(2007),「國高中生依附父母、接觸偏差同儕、傳統價值觀念與偏差行爲的關聯性之差異性研究」,犯罪學期刊,10卷,2期,頁29-48。zh_TW
dc.relation.reference (參考文獻) 楊雪華、陳端榮、李蘭、柯姍如(2003),「雙親和同儕團體對高中生吸菸行為的影響」,醫學教育,7卷,2期,頁128-139。zh_TW
dc.relation.reference (參考文獻) 劉育昇、于若蓉(2007),「工作團隊內的同儕效果:台灣房屋仲介經紀人的分析」,經濟論文叢刊,35卷,2期,頁183-212。zh_TW