市場競爭性測量與醫療品質之相關性研究

陳啟禎

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市場競爭性測量與醫療品質之相關性研究

Measuring competition and quality of care in healthcare market

陳啟禎 , Ph.D　　Advisor：鄭守夏　　

繁體中文

醫院；競爭；醫療品質；病患感受品質； hospital ； competition ； quality of care ； patient perception of quality

Abstract │ Reference (152) │ Altmetrics

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The majority of previous studies on the relationship between market competition and hospital behaviors have focused on the impact of competition on costs. However, the measures of market competition and it effects on health care quality have been rarely discussed. This study comprised three research topics: (1) Measuring market competition using data from Taiwan’s health care market; (2) Examining the relationship between hospital market competition and patient quality of care; and (3) Investigating the mediating effect of hospital input on the relationship between market competition and patient perceived quality of care.

Data for the first research topic came from the “Health care institution survey” and “Hospital services volume survey” from 1994 to 2007. We compared the trend of market competition defined by the Structuralism with that by the Behaviorism. For the second and third research topics, we used the 2002 and 2004 “Discharge patient survey” and national health insurance claim datasets. Instrumental variable and random intercept model were applied to examining the impact of market competition on subjective and traditional objective quality of care measures. Furthermore, hierarchical models and random intercept model were performed to test the mediating effect of hospital input on the association between market competition and patient perceived quality of care.

The level of market competition, measured either by Structuralism or Behaviorism, both showed to be decreasing. There was a significant and moderate correlation between the two measures. When hospitals were in a more competitive market, their patients reported better perceived quality of care in terms of interpersonal skills and clinical competence. However, competition level was not significantly associated with traditional quality indicator, the readmission rate after 30 days of discharge. The mechanism linking market competition and quality of interpersonal skills tended to be different from that linking competition and clinical competence. There was a direct effect of market competition on quality of interpersonal skills, while hospital input in nursing professional (skill mix) mediated the association between competition and quality of clinical competence.

A more competitive market is associated with better patient perceived quality. Hospital input (e.g. nursing professionalism) mediates the relationship between market competition and patient perceived quality of clinical competence. According to our findings, we suggest that the government should employ competition approach to promote the quality of hospital care and incorporate the quality of hospital staff in the hospital accreditation system.

Reference ( 152 ) 〈TOP〉

李靜玟、吳肖琪(2005)。市場競爭及其他因素對精神科急性住院病患醫療利用之影響。台灣公共衛生雜誌，24(4)，296-305。
連結：
陳珮青、楊銘欽、江東亮、鄭守夏(2003)。病人跨區住院與醫療區資源分佈之探討。台灣公共衛生雜誌，22(1)，27-32.
連結：
劉容華、江東亮(2001)。台灣小型醫院新設與歇業之影響。中華公共衛生雜誌，20(1)，27-33。
連結：
蔡偉德、李一鑫(2002)。醫院非價格性競爭與市場結構：醫院購置高科技醫療儀器之實證研究。經濟論文，30(1)，57-78。
連結：
盧瑞芬、謝啟瑞(2003)。台灣醫院產業的市場結構與發展趨勢分析。經濟論文叢刊，31(1)，107-53。
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