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    Title: 診斷關聯群、追趕效果與醫療支出
    Other Titles: Diagnosis related groups, catch-up effect and health expenditures
    Authors: 黃嘉蕙;Huang, Chia-Hui
    Contributors: 淡江大學產業經濟學系碩士班
    胡登淵;Hu, Teng-Yuan
    Keywords: 診斷關聯群;醫療支付制度;醫療支出;追趕效果;Diagnosis Related Groups;Health Payment System;health expenditure;Catch-Up Effect
    Date: 2013
    Issue Date: 2014-01-23 13:34:15 (UTC+8)
    Abstract: 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。
    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.
    Appears in Collections:[產業經濟學系暨研究所] 學位論文

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