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題名 醫師採用創新產品之影響因素-以採用心臟支架之情境為例
The decision determinants of physician’s innovation adoption - a empirical study of coronary stent diffusion in Taiwan
作者 孫玉齡
貢獻者 許牧彥
孫玉齡
關鍵詞 多世代產品
創新擴散
採用決策
Multi-generations Product
Diffusion of Innovation
Adoption
日期 2011
上傳時間 30-Oct-2012 14:21:29 (UTC+8)
摘要 本研究在探討醫師採用不同世代產品行為受到醫院背景、個人因素及病患之影響，以全民健康保險資料庫進行大樣本迴歸分析，分析自中央健康保險局納入給付後醫師採用心臟支架的情形，並對醫師首次採用時間早晚進行研究分析。本研究以兩世代產品採用差異發掘創新擴散各階段醫師採用心臟支架的影響變數，並分為醫院-醫師-病患三個層次來做整體考量。實證結果顯示，從醫療院所的層級或權屬看來，醫院層級對醫師採用早晚無顯著影響，而私立醫院的醫師較早採用第二代產品。另外，在醫師個人特質方面，年齡越大的醫師越早採用產品，資深醫師會較晚採用第一代產品，而女性醫師也會較晚採用第一代產品。從病患影響的角度來看，醫師所遇到的病人願意自付比例高者，採用時間越早。而兩世代採用時間早晚也具相關性，越早採用第一代產品，也會越早採用第二代產品。
The purpose of this research is to investigate the decision determinants of physician’s innovation adoption of multi-generations products. Based on the National Health Insurance database, this study focuses on analyzing the physician’s adoption time on coronary stent to verify the hypothetical determinants from hospital - physician - patient levels. The empirical results show that the academic level is not associated with physician’s innovation adoption time. Physician in private hospital is likely to adopt the second generation product earlier. In addition, physician’s personal characteristics- age, work experience and gender also have significant impacts upon physician’s adoption time. Elder physician will be early adopters of innovation products, and senior or female physician will be the late adopters of first-generation products. As to the influence of patients, if the physician’s patients are more willing to pay, the physician will adopt product earlier. Besides, the two generations have positive correlation, the earlier adopter in first-generation products will also adopt second-generation product earlier.
第壹章 緒論1
     第一節 研究背景與動機1
     第二節 研究目的與研究問題3
     第貳章 文獻探討4
     第一節 醫療產品的創新擴散4
     第二節 多世代產品採用16
     第三節 心血管支架發展與擴散20
     第參章 研究方法26
     第一節 研究架構26
     第二節 研究假說28
     第三節 資料來源30
     第四節 研究變數32
     第五節 統計方法36
     第肆章 結果與分析37
     第一節 樣本結構之敘述性統計37
     第二節 相關係數分析47
     第三節 迴歸分析結果49
     第伍章 結論與建議65
     第一節 假設驗證與結論65
     第二節 綜合討論72
     第三節 研究限制74
     第四節 研究貢獻與建議75
     參考文獻77
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     Austin, D., Oldroyd, K. G., Holmes, D. R., Jr., Rihal, C. S., Galbraith, P. D., Ghali, W. A., . . . Pell, J. P. (2009). Drug-eluting stents: a study of international practice. Am Heart J, 158(4), 576-584.
     Bass, F. M. (1969). A New Product Growth for Model Consumer Durables. Management Science, 15(5), 215-227.
     Bass, P. I., & Bass, F. M. (2001). Diffusion of technology generations: A model of Adoption and Repeat Sales.
     Burke, M. A., Fournier, G. M., & Prasad, K. (2007). The Diffusion of a Medical Innovation: Is Success in the Stars? Southern Economic Journal, 73(3), 588-603.
     Cappellaro, G., Ghislandi, S., & Anessi-Pessina, E. (2011). Diffusion of medical technology: the role of financing. Health Policy, 100(1), 51-59.
     Chanda, U., & Bardhan, A. K. (2008). Modelling innovation and imitation sales of products with multiple technological generations. The Journal of High Technology Management Research, 18(2), 173-190.
     Chatterji, A. K., Fabrizio, K. R., Mitchell, W., & Schulman, K. A. (2008). Physician-industry cooperation in the medical device industry. Health Aff (Millwood), 27(6), 1532-1543.
     Coleman, J. S., Katz, E., Menzel, H., & Columbia University. Bureau of Applied Social, R. (1966). Medical innovation; a diffusion study. Indianapolis: Bobbs-Merrill Co.
     Decker, D., Wheeler, G. E., Johnson, J., & Parsons, R. J. (2001). Effect of organizational change on the individual employee. Health Care Manag (Frederick), 19(4), 1-12.
     Epstein, A. J., Polsky, D., Yang, F., Yang, L., & Groeneveld, P. W. (2011). Coronary Revascularization Trends in the United States, 2001-2008. JAMA: The Journal of the American Medical Association, 305(17), 1769-1776.
     Fisher, J. C., & Pry, R. H. (1971). A simple substitution model of technological change. Technological Forecasting and Social Change, 3, 75-88.
     Gaglia, M. A., Jr, Torguson, R., Xue, Z., Gonzalez, M. A., Collins, S. D., Ben-Dor, I., . . . Waksman, R. (2010). Insurance Type Influences the Use of Drug-Eluting Stents. J Am Coll Cardiol Intv, 3(7), 773-779.
     Gompertz, B. (1825). On the Nature of the Function Expressive of the Law of Human Mortality, and on a New Mode of Determining the Value of Life Contingencies. Philosophical Transactions of the Royal Society of London, 115, 513-583.
     Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly, 82(4), 581-629.
     Hashimoto, H., Noguchi, H., Heidenreich, P., Saynina, O., Moreland, A., Miyazaki, S., . . . Ikegami, N. (2006). The diffusion of medical technology, local conditions, and technology re-invention: a comparative case study on coronary stenting. Health Policy, 79(2-3), 221-230.
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     Norton, J. A., & Bass, F. M. (1987). A Diffusion Theory Model of Adoption and Substitution for Successive Generations of High-Technology Products. Management Science, 33(9), 1069-1086.
     Pae, J. H., & Lehmann, D. R. (2003). Multigeneration innovation diffusion: The impact of intergeneration time. Journal of the Academy of Marketing Science, 31(1), 36-45.
     Park, K. W., Kang, S.-H., Chung, W.-Y., Lee, H.-Y., Park, J.-S., Kang, H.-J., . . . Kim, H.-S. (2010). "Real World` Comparison of Drug-Eluting Stents vs Bare Metal Stents in the Treatment of Unselected Patients With Acute ST-Segment Elevation Myocardial Infarction. Circulation Journal, 74(6), 1111-1120.
     Qian, F., Hannan, E. L., Glance, L. G., Phelps, C. E., Ling, F. S., & Veazie, P. J. (2011). Coronary stent use in New York State in the drug-eluting stent era. J Eval Clin Pract.
     Rai, L. P. (1999). Appropriate models for technology substitution. Journal of Scientific & Industrial Research, 58(1), 14-18.
     Rao, S. V., Shaw, R. E., Brindis, R. G., Klein, L. W., Weintraub, W. S., Krone, R. J., & Peterson, E. D. (2006). Patterns and outcomes of drug-eluting coronary stent use in clinical practice. American Heart Journal, 152(2), 321-326.
     Robertson, T. S. (1967). The Process of Innovation and the Diffusion of Innovation. The Journal of Marketing, 31(1).
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     Roter, D., Lipkin, M., & Korsgaard, A. (1991). Sex Differences in Patients` and Physicians` Communication during Primary Care Medical Visits. Medical Care, 29(11), 1083-1093.
     Roter, D. L., Hall, J. A., & Aoki, Y. (2002). Physician Gender Effects in Medical Communication. JAMA: The Journal of the American Medical Association, 288(6), 756-764.
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     Shimony, A., Zahger, D., Ilia, R., Shalev, A., & Cafri, C. (2010). Impact of the community`s socioeconomic status on characteristics and outcomes of patients undergoing percutaneous coronary intervention. International journal of cardiology, 144(3), 379-382.
     Sorenson, C., & Kanavos, P. (2011). Medical technology procurement in Europe: a cross-country comparison of current practice and policy. Health Policy, 100(1), 43-50.
     Speece, M. W., & Maclachlan, D. L. (1992). Forecasting Fluid Milk Package Type with a Multigeneration New Product Diffusion-Model. Ieee Transactions on Engineering Management, 39(2), 169-175.
     Tung, R., Kaul, S., Diamond, G. A., & Shah, P. K. (2006). Narrative Review: Drug-Eluting Stents for the Management of Restenosis: A Critical Appraisal of the Evidence. Annals of Internal Medicine, 144(12), 913-919.
     Velasco, E., Espelage, W., Faber, M., Noll, I., Ziegelmann, A., Krause, G., & Eckmanns, T. (2011). A national cross-sectional study on socio-behavioural factors that influence physicians` decisions to begin antimicrobial therapy. Infection, 39(4), 289-297.
     Wen, Y.-W., Huang, W.-F., Lee, Y.-C., Kuo, K., Tsai, C.-R., & Tsai, Y.-W. (2011). Diffusion patterns of new anti-diabetic drugs into hospitals in Taiwan: the case of Thiazolidinediones for diabetes. BMC Health Services Research, 11(1), 21.
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描述 碩士
國立政治大學
科技管理研究所
98359012
100
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0098359012
資料類型 thesis
dc.contributor.advisor 許牧彥zh_TW
dc.contributor.author (Authors) 孫玉齡zh_TW
dc.creator (作者) 孫玉齡zh_TW
dc.date (日期) 2011en_US
dc.date.accessioned 30-Oct-2012 14:21:29 (UTC+8)-
dc.date.available 30-Oct-2012 14:21:29 (UTC+8)-
dc.date.issued (上傳時間) 30-Oct-2012 14:21:29 (UTC+8)-
dc.identifier (Other Identifiers) G0098359012en_US
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/54914-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 科技管理研究所zh_TW
dc.description (描述) 98359012zh_TW
dc.description (描述) 100zh_TW
dc.description.abstract (摘要) 本研究在探討醫師採用不同世代產品行為受到醫院背景、個人因素及病患之影響，以全民健康保險資料庫進行大樣本迴歸分析，分析自中央健康保險局納入給付後醫師採用心臟支架的情形，並對醫師首次採用時間早晚進行研究分析。本研究以兩世代產品採用差異發掘創新擴散各階段醫師採用心臟支架的影響變數，並分為醫院-醫師-病患三個層次來做整體考量。實證結果顯示，從醫療院所的層級或權屬看來，醫院層級對醫師採用早晚無顯著影響，而私立醫院的醫師較早採用第二代產品。另外，在醫師個人特質方面，年齡越大的醫師越早採用產品，資深醫師會較晚採用第一代產品，而女性醫師也會較晚採用第一代產品。從病患影響的角度來看，醫師所遇到的病人願意自付比例高者，採用時間越早。而兩世代採用時間早晚也具相關性，越早採用第一代產品，也會越早採用第二代產品。zh_TW
dc.description.abstract (摘要) The purpose of this research is to investigate the decision determinants of physician’s innovation adoption of multi-generations products. Based on the National Health Insurance database, this study focuses on analyzing the physician’s adoption time on coronary stent to verify the hypothetical determinants from hospital - physician - patient levels. The empirical results show that the academic level is not associated with physician’s innovation adoption time. Physician in private hospital is likely to adopt the second generation product earlier. In addition, physician’s personal characteristics- age, work experience and gender also have significant impacts upon physician’s adoption time. Elder physician will be early adopters of innovation products, and senior or female physician will be the late adopters of first-generation products. As to the influence of patients, if the physician’s patients are more willing to pay, the physician will adopt product earlier. Besides, the two generations have positive correlation, the earlier adopter in first-generation products will also adopt second-generation product earlier.en_US
dc.description.abstract (摘要) 第壹章 緒論1
     第一節 研究背景與動機1
     第二節 研究目的與研究問題3
     第貳章 文獻探討4
     第一節 醫療產品的創新擴散4
     第二節 多世代產品採用16
     第三節 心血管支架發展與擴散20
     第參章 研究方法26
     第一節 研究架構26
     第二節 研究假說28
     第三節 資料來源30
     第四節 研究變數32
     第五節 統計方法36
     第肆章 結果與分析37
     第一節 樣本結構之敘述性統計37
     第二節 相關係數分析47
     第三節 迴歸分析結果49
     第伍章 結論與建議65
     第一節 假設驗證與結論65
     第二節 綜合討論72
     第三節 研究限制74
     第四節 研究貢獻與建議75
     參考文獻77		-
dc.description.tableofcontents 第壹章 緒論1
      第一節 研究背景與動機1
      第二節 研究目的與研究問題3
     第貳章 文獻探討4
      第一節 醫療產品的創新擴散4
      第二節 多世代產品採用16
      第三節 心血管支架發展與擴散20
     第參章 研究方法26
      第一節 研究架構26
      第二節 研究假說28
      第三節 資料來源30
      第四節 研究變數32
      第五節 統計方法36
     第肆章 結果與分析37
      第一節 樣本結構之敘述性統計37
      第二節 相關係數分析47
      第三節 迴歸分析結果49
     第伍章 結論與建議65
      第一節 假設驗證與結論65
      第二節 綜合討論72
      第三節 研究限制74
      第四節 研究貢獻與建議75
     參考文獻77		zh_TW
dc.language.iso en_US-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0098359012en_US
dc.subject (關鍵詞) 多世代產品zh_TW
dc.subject (關鍵詞) 創新擴散zh_TW
dc.subject (關鍵詞) 採用決策zh_TW
dc.subject (關鍵詞) Multi-generations Producten_US
dc.subject (關鍵詞) Diffusion of Innovationen_US
dc.subject (關鍵詞) Adoptionen_US
dc.title (題名) 醫師採用創新產品之影響因素-以採用心臟支架之情境為例zh_TW
dc.title (題名) The decision determinants of physician’s innovation adoption - a empirical study of coronary stent diffusion in Taiwanen_US
dc.type (資料類型) thesisen
dc.relation.reference (參考文獻) Ajrouch, K. J., Blandon, A. Y., & Antonucci, T. C. (2005). Social networks among men and women: The effects of age and socioeconomic status. Journals of Gerontology Series B-Psychological Sciences and Social Sciences, 60(6), S311-S317.
     Austin, D., Oldroyd, K. G., Holmes, D. R., Jr., Rihal, C. S., Galbraith, P. D., Ghali, W. A., . . . Pell, J. P. (2009). Drug-eluting stents: a study of international practice. Am Heart J, 158(4), 576-584.
     Bass, F. M. (1969). A New Product Growth for Model Consumer Durables. Management Science, 15(5), 215-227.
     Bass, P. I., & Bass, F. M. (2001). Diffusion of technology generations: A model of Adoption and Repeat Sales.
     Burke, M. A., Fournier, G. M., & Prasad, K. (2007). The Diffusion of a Medical Innovation: Is Success in the Stars? Southern Economic Journal, 73(3), 588-603.
     Cappellaro, G., Ghislandi, S., & Anessi-Pessina, E. (2011). Diffusion of medical technology: the role of financing. Health Policy, 100(1), 51-59.
     Chanda, U., & Bardhan, A. K. (2008). Modelling innovation and imitation sales of products with multiple technological generations. The Journal of High Technology Management Research, 18(2), 173-190.
     Chatterji, A. K., Fabrizio, K. R., Mitchell, W., & Schulman, K. A. (2008). Physician-industry cooperation in the medical device industry. Health Aff (Millwood), 27(6), 1532-1543.
     Coleman, J. S., Katz, E., Menzel, H., & Columbia University. Bureau of Applied Social, R. (1966). Medical innovation; a diffusion study. Indianapolis: Bobbs-Merrill Co.
     Decker, D., Wheeler, G. E., Johnson, J., & Parsons, R. J. (2001). Effect of organizational change on the individual employee. Health Care Manag (Frederick), 19(4), 1-12.
     Epstein, A. J., Polsky, D., Yang, F., Yang, L., & Groeneveld, P. W. (2011). Coronary Revascularization Trends in the United States, 2001-2008. JAMA: The Journal of the American Medical Association, 305(17), 1769-1776.
     Fisher, J. C., & Pry, R. H. (1971). A simple substitution model of technological change. Technological Forecasting and Social Change, 3, 75-88.
     Gaglia, M. A., Jr, Torguson, R., Xue, Z., Gonzalez, M. A., Collins, S. D., Ben-Dor, I., . . . Waksman, R. (2010). Insurance Type Influences the Use of Drug-Eluting Stents. J Am Coll Cardiol Intv, 3(7), 773-779.
     Gompertz, B. (1825). On the Nature of the Function Expressive of the Law of Human Mortality, and on a New Mode of Determining the Value of Life Contingencies. Philosophical Transactions of the Royal Society of London, 115, 513-583.
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