市場競爭對西醫基層醫師執業收入的影響

The Impect of Market Competition on Primary Western Physician`s Practice Incomes

劉巧菁(Chiao-Ching Liu)

指導教授 ： 林恆慶

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2006年)

摘要

「站在好地頭，勝過好拳頭」，道盡了商店生存的要件，意味著地段良好與否，乃成為商店經營好壞的關鍵；診所如同商店一樣是立地產業，開業醫師幾乎提供相同的醫療產品、價格，故開業地點的良好與否、競爭對手的多寡，攸關診所業務的好壞，間接影響醫師的荷包。 目的：本研究欲了解各專科別西醫基層醫療服務市場的集中程度情形，並探討市場競爭對西醫基層各專科醫師執業收入的影響。 方法：以2002年行政院衛生署醫政處醫師收入資料檔的案件為對象(n=9323)，並排除75歲以上（n=420）及執業未滿一年之醫師（n=1203）共計7700個研究樣本，本研究乃以行政地理疆界法，將台灣按行政區域劃分，共計23縣市(排除連江縣及金門縣)，以各縣市各專科別醫師之門診服務人次做為衡量市場競爭的指標，分析西醫基層醫師執業收入情形，並探討市場競爭程度、醫師特質、醫療資源分布、地區特性對西醫基層醫師執業收入的影響。 結果： 影響西醫基層醫師執業收入之因素包含市場競爭情形、醫師性別、年齡、執業科別、執業型態、每萬人口西醫師數、每萬人口急性病床數、人口密度、老年人口比、平均家戶所得、四歲以下孩童比、女性人口數、都市化程度等變項。 結論與建議：本研究結果顯示西醫基層醫師門診執業收入受門診賀芬達指數(市場競爭程度)、年齡、性別、執業科別、執業型態、每萬人口急性病床數、女性人口數、縣市別、都市化程度等變項影響；在控制其他變項之後，門診賀芬達指數愈高(市場競爭程度低)，西醫基層醫師執業收入愈豐；另家庭醫學科、一般科、內科此一專科別市場競爭程度最劇，以復健科專科別之市場競爭情形最緩。依據研究結果對醫療政策方面提出以下建議：(1)縮小部分縣市專科別之醫療可近性；(2)醫療資訊市場宜透明化；(3)支付標準的重新思考；(4)思考部份負擔制度的合理性。

關鍵字

賀芬達指標 ； 市場競爭 ； 醫師執業收入

並列摘要

As an old saying that “out of sight, out of mind,” the main factor of keeping business is the determined right practice location. Since requiring similar production of medicine and prices for managing a clinic, there is no much different for primary physician to earning living but a marketing chosen, such as nice location. Therefore, this study primarily is to examine the effects on marketing management for primary physician’s practice Incomes. Purpose: The purpose of this study is to investigate the distribution of primary care physician service market and to determine the level of the effects on market competition for the master income of primary care physician. Method: The research data is conducted by analysis among the condition of primary western physician’s practice incomes, and to evaluate the influence on levels of market competition, characteristics of physician, display of medicinal recourses, and difference of region which is based on geopolitical boundary area in Taiwan and divided into 23 counties and cities (no including Matsu County and Kinmen County). Except the objects of primary physicians whose age above 75 and service less than one year, the data of the objects in this study are based on the cases from the Department of Health, Executive Yuon in 2002. Result：The variables of influence on western primary care physiciants’ income are Herfindahl-Hirschman Index, age, sexuality, specialist and mode of physicians’ practice, hospital size, population density, elder population, average of house income, under 4-year-old ratio, female population, urbanization, etc. Conclusion and recommendations： The significant results in this research are that (1) the variables of primary physicians’ incomes are impacted on Herfindahl-Hirschman Index, age, sexuality, subjects and mode of physicians’ practice, hospital size, female population, levels of regions, urbanization, etc. (2) the higher Herfindahl-Hirschman Index of the visiting persons of out-patient is, the more primary physicians’ incomes. According to the results, five suggestions are recommended as following: (1) to narrow the accessibility of medical care in Specialists, (2) to transparence the medical information market, (3) to rethink the standard of payment, (4) to rationalize copayment system.

並列關鍵字

HHI ； market competition ； physician’s practice incomes

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