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系統識別號 U0002-0307201302151800
中文論文名稱 診斷關聯群、追趕效果與醫療支出
英文論文名稱 Diagnosis Related Groups, Catch-Up Effect and Health Expenditures
校院名稱 淡江大學
系所名稱(中) 產業經濟學系碩士班
系所名稱(英) Department of Industrial Economics
學年度 101
學期 2
出版年 102
研究生中文姓名 黃嘉蕙
研究生英文姓名 Chia-Hui Huang
學號 600540123
學位類別 碩士
語文別 中文
口試日期 2013-06-13
論文頁數 52頁
口試委員 指導教授-胡登淵
委員-陳鎮洲
委員-鄒孟文
中文關鍵字 診斷關聯群  醫療支付制度  醫療支出  追趕效果 
英文關鍵字 Diagnosis Related Groups  Health Payment System  Health Expenditure  Catch-Up Effect 
學科別分類
中文摘要 在醫療經濟學的領域中,醫療支出是相當重要的課題,由於醫療支出不斷的增加,為各國政府帶來沉重的財政壓力,因此如何有效控制醫療支出的成長成為各國政府努力的課題,大多OECD國家藉由診斷關聯群 (DRGs) 制度來控制醫療支付的額度,擬迫使醫院控制自身的醫療成本;反觀文獻中也提及醫療支出的追趕效果,DRGs支付制度的實施是為了壓制醫療支出,追趕效果和DRGs支付制度兩者效果互相角力,因此本文也同時加以討論醫療支出的追趕效果是否會使得起初醫療支出較低的國家追趕上起初醫療支出較高的國家。本文主要使用2010年OECD Health Data,分析29國的資料,樣本期間為1980年至2008年,利用2SLS for panel模型分析診斷關聯群制度、起初醫療支出、國內生產總值成長率、老年人口占總人口成長率以及出生時的預期壽命成長率對總合、公共與私人醫療支出成長率的影響,並使用Laporte and Windmeijer (2005) 提出的模型,用來估計panel data模型之下的二元變數即treatment effect不是固定的,而是會隨著時間變化之效果,在式子中加入脈衝變量,來捕捉診斷關聯群制度實施前後對醫療支出成長率的影響效果。本文的實證結果發現當診斷關聯群制度正式引入國家的醫療系統,當作控制醫療費用的工具時,透過脈衝變量與DRG變量的相互關係得知僅公共醫療支出實施後第二年才會使得成長率減少,但DRGs支付制度長期下並未能有效控制公共醫療支出成長;而本文也發現醫療費用存在著追趕效果,起初醫療支出較低的國家追趕起初醫療支出較高的國家,使得醫療支出成長。 綜合兩者效果,OECD國家醫療支出長期呈現成長的趨勢。
英文摘要 In the field of health economics, how to control for the growth of health expenditure is an important issue. Because of health expenditure continuing to increase during past thirty years in most OECD countries, governments have imposed heavy financial pressure, so how to control for the growth becomes the subject of efforts of many governments in OECD countries. Diagnostic Related Groups to limit the amount of health payments, forcing hospitals to control for their own health care costs. While DRGs payment system was implemented to suppress the health expenditure, catch-up effects, as mentioned in the literature, and the effects of DRGs payment system may conflict each other. The thesis hence also discusses whether the catch-up effects of health expenditure exist. It will examine whether countries with low initial health expenditure catch up with countries with higher initial health expenditure. This thesis mainly uses 2010 OECD Health Data., The data of 29 countries over the period from 1980 to 2008 were analyzed. It uses the 2SLS for panel model for the analysis of the impact of the implementation of DRGs system and the effect of initial health expenditure on the growth rate of health expenditures, including per-capita real total health expenditure, per-capita real public health expenditure and per-capita real private health expenditure while controlling for the GDP growth rate, growth rate of population aged 65 and above and growth rate of life expectancy at birth. It uses Laporte and Windmeijer’s (2005) model, which is capable of estimating the panel data model with binary explanatory variables in which treatment effect is not fixed, changing over time , through adding pulses variables to capture effects prior to and after the implementation of the DRGs system. This study finds that the implementation of diagnosis-related-groups system will make the growth rate of per-catipa real public health care spending be reduced in the second year after the implementation. Nonetheless, the DRGs payment system is not effectively in reducing growth rate of public health spending in the long-run. This thesis also finds that catch-up effect exists. It makes health expenditure grow for those countries with low initial public health expenditure. In consideration of both the DRGS effects and catch-up effects, it rationalizes the long-run growth of the majority of OECD countries.
論文目次 目錄
第一章 緒論 1
第一節 研究動機與目的 1
第二節 支付制度介紹 3
第三節 醫療支出的追趕效果 5
第二章 文獻回顧 7
第三章 資料來源與變數定義 11
第一節 資料來源 11
第二節 變數定義與敘述統計 11
第四章 實證模型設定 16
第一節 實證模型架構 16
第二節 實證模型介紹 16
第五章 實證模型分析 20
第一節 醫療制度的實施對醫療支出成長率的影響 21
第二節 國內生產總值成長率對醫療支出成長率的影響 25
第三節 65歲以上人口占總人口比例成長率對醫療支出成長率的影響 25
第四節 出生時的預期壽命成長率對醫療支出成長率的影響 26
第五節 醫療支出的追趕效果 27
第六節 敏感性分析 28
第六章 結論 33
國內參考文獻 35
國外參考文獻 35
附表 39

圖目錄
圖一、人均醫療支出成長率趨勢 2
圖二、公共醫療支出占政府支出的比例 2
圖三、OECD 29國-fixed effects 實施DRG前後醫療支出成長率走勢圖 23
圖四、OECD 29國-2SLS for panel data實施DRG前後醫療支出成長率走勢圖 23
圖五、OECD 13國-fixed effects實施DRG前後醫療支出成長率走勢圖 24
圖六、OECD 13國2SLS for panel data實施DRG前後醫療支出成長率走勢圖 24

表目錄
表一、DRGs實施年份及定義表 13
表二、其他國家引入DRGs時間 14
表三、變數定義表 14
表四、OECD 29國估計結果 29
表五、OECD 13國的估計結果 30
表六、OECD 29國的估計結果-加入追趕效果 31
表七、OECD 13國的估計結果-加入追趕效果 32

附表目錄
附表 一、OECD 13國的人均實質總醫療支出的敘述統計表 39
附表 二、OECD 16國的人均實質總醫療支出的敘述統計表 39
附表 三、OECD 13國的人均實質公共醫療支出的敘述統計表 40
附表 四、OECD 16國的人均實質公共醫療支出的敘述統計表 40
附表 五、OECD 13國的人均實質私人醫療支出的敘述統計表 41
附表 六、OECD 16國的人均實質私人醫療支出的敘述統計表 41
附表 七、OECD 13國的人均實質國內生產總值的敘述統計表 42
附表 八、OECD 13國的人均實質國內生產總值的敘述統計表 42
附表 九、OECD 13國65歲以上人口占總人口的比例的敘述統計表 43
附表 十、OECD 16國65歲以上人口占總人口的比例的敘述統計表 43
附表 十一、OECD 13國出生時預期壽命的敘述統計表 44
附表 十二、OECD 16國出生時預期壽命的敘述統計表 44
附表 十三、OECD 13國平均住院天數的敘述統計表 45
附表 十四、OECD 16國平均住院天數的敘述統計表 45
附表 十五、OECD 13國人均實質總醫療支出成長率的敘述統計表 46
附表 十六、OECD 16國人均實質總醫療支出成長率的敘述統計表 46
附表 十七、OECD 13國人均實質公共醫療支出成長率的敘述統計表 47
附表 十八、OECD 16國人均實質公共醫療支出成長率的敘述統計表 47
附表 十九、OECD 13國人均實質私人醫療支出成長率的敘述統計表 48
附表 二十、OECD 16國人均實質私人醫療支出成長率的敘述統計表 48
附表 二十一、OECD 13國人均實質國內生產總值成長率的敘述統計表 49
附表 二十二、OECD 13國人均實質國內生產總值成長率的敘述統計表 49
附表 二十三、OECD 13國65歲以上人口占總人口比例成長率的敘述統計表 50
附表 二十四、OECD 13國65歲以上人口占總人口比例成長率的敘述統計表 50
附表 二十五、OECD 13國出生時預期壽命成長率的敘述統計表 51
附表 二十六、OECD 16國出生時預期壽命成長率的敘述統計表 51
附表 二十七、刪除沒有實施診斷關聯群的國家 52


參考文獻 國內參考文獻

1. 邵靄如(2009)。「健康保險」。台灣:華泰文化。
2. 盧瑞芬、謝啟瑞(2000)。「醫療經濟學」。台灣:學富文化。
3. 楊靜利(2009)。「被誤導了?人口老化與醫療費用的關係」。台灣老年學論壇第二期。


國外參考文獻
1. Berki, S. E. "DRGs, incentives, hospitals, and physicians." Health Affairs 4.4 (1985): 70-76.
2. Bac, Catherine, and Yannick Le Pen. "An international comparison of health care expenditure determinants."10th International Conference on Panel Data, Berlin, July 5-6, 2002. No. C5-1. International Conferences on Panel Data, 2002.
3. Baltagi, Badi H., and Francesco Moscone. "Health care expenditure and income in the OECD reconsidered: Evidence from panel data."Economic modeling 27.4 (2010): 804-811.
4. Barros, P. P. "The black box of health care expenditure growth determinants."Health economics 7.6 (1998): 533.
5. Blomqvist, Ake G., and Richard Anthony Lynch Carter. "Is health care really a luxury?." Journal of Health Economics 16.2 (1997): 207-229.
6. Breyer, Friedrich, and Stefan Felder. "Life expectancy and health care expenditures: a new calculation for Germany using the costs of dying."Health policy (Amsterdam, Netherlands) 75.2 (2006): 178.
7. Breyer, Friedrich, Joan Costa-Font, and Stefan Felder. "Ageing, health, and health care." Oxford Review of Economic Policy 26.4 (2010): 674-690.
8. Busse, Reinhard, et al. Diagnosis-related groups in Europe. Open University Press, 2011.
9. Clemente, Jesus, et al. "On the international stability of health care expenditure functions: are government and private functions similar?." Journal of Health Economics 23.3 (2004): 589-613.
10. Cutler, David M., and Louise Sheiner. Demographics and medical care spending: Standard and non-standard effects. No. w6866. National bureau of economic research, 1998.
11. Daviglus, Martha L., et al. "Benefit of a favorable cardiovascular risk-factor profile in middle age with respect to Medicare costs."New England Journal of Medicine 339.16 (1998): 1122-1129.
12. Dormont, Brigitte, Michel Grignon, and Helene Huber. "Health expenditure growth: reassessing the threat of ageing." Health Economics 15.9 (2006): 947-963.
13. Dreger, Christian, and Hans-Eggert Reimers. "Health care expenditures in OECD countries: a panel unit root and cointegration analysis." (2005).
14. France, George, Francesco Taroni, and Andrea Donatini. "The Italian health‐care system." Health economics 14.S1 (2005): S187-S202.
15. Gbesemete, K,P. and Gerdtham, U-G..Determinants of health care expenditure in Africa : a cross-sectional study. World Development,20:303-308,1992.
16. Gerdtham, Ulf-G., and Mickael Lothgren. "On stationarity and cointegration of international health expenditure and GDP." Journal of Health Economics 19.4 (2000): 461-475.
17. Gilardi, Fabrizio, Katharina Fuglister, and Stephane Luyet. "Learning from others the diffusion of hospital financing reforms in oecd countries."Comparative Political Studies 42.4 (2009): 549-573.
18. Hafsteinsdottir, Elin JG, and Luigi Siciliani. "Hospital cost sharing incentives: evidence from Iceland." Empirical Economics 42.2 (2012): 539-561.
19. Hansen, Paul, and Alan King. "The determinants of health care expenditure: a cointegration approach." Journal of Health Economics 15.1 (1996): 127-137.
20. Hausman, Jerry, James H. Stock, and Motohiro Yogo. "Asymptotic properties of the Hahn–Hausman test for weak-instruments." Economics Letters 89.3 (2005): 333-342.
21. Helmut herwartz and Bernd theilen (2010), “The determinants of health-care expenditure: new results from semiparametric estimation” ,Health Economics 964-978.
22. Hitiris, T., and J. Posnett (1992), “The determinants and effects of health expenditure in developed countries”, Journal of Health Economics 11:173–181.
23. Hitiris, Theo. "Health care expenditure and integration in the countries of the European Union." Applied Economics 29.1 (1997): 1-6.
24. Hogan, Christopher, et al. "Medicare beneficiaries’ costs of care in the last year of life."Health Affairs 20.4 (2001): 188-195.
25. Jones, Randall S. Health-care reform in Japan: Controlling costs, improving quality and ensuring equity. No. 739. OECD Publishing, 2009.
26. Kimberly, John Robert, Gerard de Pouvourville, and Thomas A. D'Aunno, eds.The globalization of managerial innovation in health care. London: Cambridge University Press, 2008.
27. Kleiman, E. (1974), “The determinants of national outlay on health”, in: M. Perlman, ed., The Economics of Health and Medical Care. New York : John Wiley & Sons pp.66-81
28. Lago-Penas, Santiago, David Cantarero-Prieto, and Carla Blazquez-Fernandez. "On the relationship between GDP and health care expenditure: A new look."Economic Modelling 32 (2013): 124-129.
29. Laporte, Audrey, and Frank Windmeijer. "Estimation of panel data models with binary indicators when treatment effects are not constant over time."Economics Letters 88.3 (2005): 389-396.
30. Leu, R.E. (1986), “The public-private mix and international health care costs”, in: A.J. Culyer and B. Jonsson, eds., Public and Private Health Services (Basil Blackwell, Oxford).
31. Lubitz, James D., and Gerald F. Riley. "Trends in Medicare payments in the last year of life." New England journal of medicine 328.15 (1993): 1092-1096.
32. Lubitz, James, et al. "Health, life expectancy, and health care spending among the elderly." New England Journal of Medicine 349.11 (2003): 1048-1055.
33. Mathauer, Inke, and Friedrich Wittenbecher. DRG-based payment systems in low-and middle-income countries: Implementation experiences and challenges. World Health Organization, 2012.
34. Meseguer, Covadonga. (2004). What role for learning? The diffusion of privatisation in OECD and Latin American countries. Journal of Public Policy, 24(3), 299-325.
35. Meseguer, Covadonga. (2006). Learning and economic policy choices. European Journal of Political Economy, 22, 156-178.
36. Miraldo, M., Goddard, M., Smith, P. (2006). The Incentive Effects of Payment by Results. York: University of York Centre for Health Economics (CHE Research Paper 19).
37. Narayan, Paresh Kumar. "Do health expenditures ‘catch‐up’? Evidence from OECD countries."Health economics 16.10 (2007): 993-1008.
38. Newhouse, J.P. (1977), “Medical care expenditure: a cross-national survey”, Journal of Human Resources 12:115–125.
39. Newhouse, Joseph P. "Medical care costs: how much welfare loss?." The Journal of Economic Perspectives 6.3 (1992): 3-21.
40. Okunade, Albert A., and Vasudeva NR Murthy. "Technology as a ‘major driver’of health care costs: a cointegration analysis of the Newhouse conjecture."Journal of Health Economics 21.1 (2002): 147-159.
41. Parkin, D., A. McGuire and B. Yule (1987), “Aggregate health expenditures and national income: is health care a luxury good?”, Journal of Health Economics 6:109–127.
42. Quentin, Wilm, et al. "Hospital Payment Based On Diagnosis-Related Groups Differs In Europe And Holds Lessons For The United States." Health Affairs32.4 (2013): 713-723.
43. Riley, Gerald F., and James D. Lubitz. "Long‐Term Trends in Medicare Payments in the Last Year of Life." Health services research 45.2 (2010): 565-576.
44. Schmid, Achim, and Ralf Gotze. "Cross‐national policy learning in health system reform: The case of Diagnosis Related Groups." International Social Security Review 62.4 (2009): 21-40.
45. Shang, Baoping, and Dana Goldman. "Does age or life expectancy better predict health care expenditures?."Health Economics 17.4 (2008): 487-501.
46. Spillman, Brenda C., and James Lubitz. "The effect of longevity on spending for acute and long-term care."New England Journal of Medicine 342.19 (2000): 1409-1415.
47. Werblow, Andreas, Stefan Felder, and Peter Zweifel. "Population ageing and health care expenditure: a school of ‘red herrings’?." Health economics 16.10 (2007): 1109-1126.
48. Wooldridge, Jeffrey M.Econometric Analysis Cross Section Panel. MIT press, 2002.
49. Zweifel, Peter, Stefan Felder, and Markus Meiers. "Ageing of population and health care expenditure: a red herring?." Health economics 8.6 (1999): 485-496.
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