- 學位論文
家戶所得相對剝奪與健保醫療利用關聯分析–Yitzhaki指數應用
Relative Deprivation and Medical Care Utilization–an Application of Yitzhaki Index
摘要
臺灣近年所得分配呈現惡化趨勢，根據行政院主計處的資料，近二十年吉尼係數與所得差距倍數增長幅度分別約為11%及22%。在社會比較的機制下，個人可能會因所得差異引發負面心裡感受，使得健康惡化進而增加健保醫療利用。本研究主要目的為探討臺灣是否因為所得分配惡化引起的相對剝奪感而增加健保醫療利用。此外，檢測菸酒及檳榔是否為相對剝奪感與健保醫療利用間的中介因子。 本研究應用Yitzhaki (1979)的相對剝奪感指數，探討其對健保給付與家戶門診自付費用的影響，採用合併橫斷面資料加以分析，民國88–95年「臺灣地區家庭收支調查」。同時考量潛在內生性偏誤的問題，分析方法採用兩階段最小平方法，並做內生性檢定。 迴歸分析結果顯示，相對剝奪感對家戶平均每人健保給付及門診自付費用的影響，呈現正向顯著關係。即家戶會因為所得差異引發的負面心理，增加家戶平均每人健保醫療利用。此外，研究結果顯示在相對剝奪感與健保醫療利用之間，菸草及檳榔消費具有部分中介效果。 由於相對剝奪感指數與健保醫療利用有關，同時，相對剝奪感反應家戶間的所得差異，較高的相對剝奪感指數伴隨著較大的所得差距或較高的所得不均度。所以，為促進國民身心健康及福祉，應更重視改善所得分配的政策。藉由強化所得分配政策以平抑國民相對剝奪感，同時亦可有效減輕健保財務壓力。
關鍵字
醫療利用 相對剝奪感 所得不均並列摘要
The trend of income distribution in Taiwan has been deteriorating during the past two decades. According to statistics, the Gini coefficient and the difference in household income between top 20% to lowest 20% were both found increased. The magnitude was 11% and 22%, respectively. Based on social comparison mechanism, people with lower income or life quality may feel upset or oppressive and then could cause the feeling of “relative deprivation”. Under the relative deprivation, they may be more likely to get sick and result in more medical expenditures. The objective of this paper was to examine whether there is an association between relative deprivation and medical expenditures. The use of tobacco, wine and betel nut were also included in the analysis to control their impacts on relative deprivation, i.e. examining the impact of the mediator. The Yitzhaki’s index was applied to quantify the relative deprivation. Medical expenditures were grouped into two parts: NHI (National Health Insurance) coverage and out-of-pocket. Data were selected from 1999-2006 Survey of Family Income and Expenditure, which is a pooled cross-section data. To avoid the potential endogenous bias, the two stage least squares and Wu–Hausman test were adopted. The result showed that relative deprivation has a positive significant effect on both types of medical expenditures. This indicated that people who have higher relative deprivation tended to have more expenditures no matter whether it is out-of–pocket or not. Besides, the impacts of tobacco, wine and betel nut use were shown to be significant. But we do not have strong evidence for a dominant mediator. Due to the significant impact of relative deprivation, the authority needs to pay more attention on income redistribution policy to reduce the gap of income level and relative deprivation. By doing this, NHI financial crisis may be also improved.