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論文名稱 Title |
制度評量的計量分析:台灣結核病論質計酬專案的效果評估 Evaluating the Quality Payment Program in Taiwan for Treating Tuberculosis |
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系所名稱 Department |
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畢業學年期 Year, semester |
語文別 Language |
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學位類別 Degree |
頁數 Number of pages |
57 |
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研究生 Author |
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指導教授 Advisor |
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召集委員 Convenor |
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口試委員 Advisory Committee |
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口試日期 Date of Exam |
2007-07-05 |
繳交日期 Date of Submission |
2007-07-22 |
關鍵字 Keywords |
完治率、平均實驗效果、配對估計、論質計酬、結核病、制度評量 matching estimator, quality payment, average treatment effect |
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統計 Statistics |
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中文摘要 |
「論質計酬制」是現在世界各國正逐漸推行的健保給付制度, 其主要精神為依據醫療品質來給付醫事服務提供者, 藉由適當的財務誘因, 鼓勵醫生給予病人更妥善的照護。本研究選取台灣目前的五個論質計酬試辦計畫中的結核病計畫進行制度評量。我們利用疾管局提供的94年結核病資料庫和健保局提供的試辦計畫名單, 並採用Abadie and Imbens (2006) 的計量方法: 最近鄰域配對估計式(nearest neighbor matching estimator) 來估計不同醫院層級和權屬加入試辦計畫後, 完治率是否顯著提高。我們衡量完治率的指標包括:「所有結核病通報病例完治的比例」以及「痰培養陽性病患完治的比例」。不管用哪一種指標, 診所皆是完治率顯著提高最多的層級。而控制在層級底下公私立醫院比較的話, 私立醫院效果比公立醫院大(區域醫院這一層級例外)。總體而言, 實施此一制度可使結核病完治率顯著提高10%以上。 |
Abstract |
none |
目次 Table of Contents |
1 前言 1 2 結核病的背景與健保制度 3 2.1 結核病簡介 3 2.2 健保有關結核病的專案 4 2.3 論質計酬支付制度 5 3 簡介平均實驗效果 (Average Treatment Effect) 8 3.1 Rubin’s Model 8 3.2 樣本選擇偏誤 (Selection Biases) 10 3.3 認定與估計 12 3.3.1 迴歸 13 3.3.2 配對 (Matching) 15 3.3.3 比較最小平方與配對估計法 18 3.3.4 Propensity Score 的作用 19 4 配對估計法 21 5 實證分析 24 5.1 資料處理 24 5.2 變數 25 5.3 模型 32 5.4 實證結果 33 5.5 成本效益分析 40 6 結論 41 |
參考文獻 References |
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