健康照護產業市場特性、資源耗用 與結果之關係研究——環境動態機制觀點

Study on Relationship among Health Care Market Characteristics and Resource Utilization with Outcome –View of Environment Dynamic Mechanism

李顯章(HSIEN-CHANG LI)

指導教授 ： 呂鴻德

中原大學/商學院/管理研究所/博士(2008年)

https://doi.org/10.6840/cycu200900639

摘要

健康照護產業過去數年在已開發中國家面對內外環境持續的改變及國際經濟的波 動，迫使此產業採取流程再造等策略因應。但涉及資源重配置的醫護流程再造可能對最 後的醫療健康產出有明顯的影響。本研究目的即利用「市場結構--流程--產出結果」模 型對上述情形以國家層級為基礎進行模型間的關係變化分析。同時因考量外在環境的影 響，加入國民教育年數與國民總收入兩因子，進行環境動態機制下「健康市場結構-照 護支出-健康產出」之實證研究。 本研究搜集2001 至2005 年間經濟合作暨發展組織會員國之數據集，以panel data 對橫斷面與縱斷面併行分析各國間因文化、制度或醫護行為習慣不同而不同，但不隨時 間改變的相互關係及各國因時間點不同，但不隨國家別而改變的關係又如何變化。結果 發現除科技進步外，各市場結構特徵之變化與醫療照護支出有顯著相關，但國家固定效 果下，僅醫事人員及醫師與醫療支出顯著相關；即在各國間會因各國不同之文化或制度 背景致使市場特徵的改變不明顯地造成醫療照護支出之改變。而時間效果下，除護理人 員數及科技進步兩變數外，市場特徵對醫療照護支出又回復高顯著性相關；即在時序 上，各因素會隨時間不同而有顯著影響。而在健康照護支出對國民預期壽命上，不論何 種固定效果，均呈顯著相關。又，本研究係假設教育水準越高，越注重健康致健康照護 支出越高，且預期壽命越長的國家其國民教育年數越多下，藉由國民預期教育年數來檢 定國民人均健康照護支出與國民預期壽命前後期之動態關係，實證結果均顯著。再則， 以國家總收入作為外在經濟環境變化與醫護支出的關係研究，顯現高度正向相關，且其 在以國家別或時序別的固定效果下亦全部顯現高度正相關。

關鍵字

市場特性 ； S-P-O 模型 ； 資源耗用 ； 環境動態機制

並列摘要

Health care industry in developing countries has faced intensive change during the past
few years. The industry has responded to these stresses of worldwide economic volatility by
adopting a variety of theories for health care management, including procedure-reengineering
and resource disposition adjustments (replacing expensive health care procedure with less
expensive ones). These changes of process decision of manageable strategy may have a
significant influence on the final outcome of health. The objective of this study is to
investigate the direct effects of health care underlying a changing environment on process
decisions, and the effects of process decisions on national health outcomes. Furthermore,
when the market structure was experiencing incremental changes in different countries or
during different time period, health care system would like to change their resource allocation
related to program of process. Consequently, these changes impacted the national health
outcome. The dynamic aspect of education and national income were put into consideration in
this study.
A panel design from 2001 to 2005 of OECD was employed in this study. Six databases
were merged together for the final analysis. The country-effects models suggest that the health
care industry in a country experiencing infrastructural changes makes the relationship
insignificant, but the time-effects models demonstrate their coefficients have a strong
significant relationship as the original models. Also, panel analyses provide mixed support for
a significant relationship among health care expenditure, health outcome, school year
expectancy, and national income. The results suggest that increasing changes of school year
expectancy and national income over time were sufficient to impact health care expenditure.
And a dynamic effect may exist: better health care services based on the demand of
well-educated population. This happening triggered the changes of process. The change in
health care process would influence the entire national health outcome, and then this outcome
increases education level. Generally, the empirical results in this study are reasonable.

並列關鍵字

market characteristics ； S-P-O model ； environment dynamic mechanism. ； resource utilization

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