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研究生： 卓采筠
Tsai-Yun Cho
論文名稱： 影響台灣洗腎透析診所營運績效之變動因子
Factors and Determinants of the Operational Performance of Dialysis Clinics in Taiwan
指導教授： 張順教
Shun-Chiao Chang
口試委員: 張順教
Shun-Chiao Chang
張光第
Guang-Di Chang
賴法才
Fav-Tsoin Lai
學位類別： 碩士
Master
系所名稱： 管理學院 - 企業管理系
Department of Business Administration
論文出版年： 2018
畢業學年度： 106
語文別： 英文
論文頁數： 68
中文關鍵詞： 縱橫資料迴歸模型 、洗腎透析診所營運績效 、血液透析 、總額支付制度
外文關鍵詞： Panel data regression model, Performance of dialysis clinic, Hemodialysis, Global Budget system
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    • 本研究以縱橫資料迴歸模型為應用，探討影響台灣洗腎透析診所營運績效之關鍵因素，而評估營運績效的指標為診所獲得之健保點數總額。研究資料採用 1998 年至 2012 年來自健保資料庫、衛生福利部統計處及中華民國統計資訊網的 縱橫資料。同時，本研究採用 BP-LM Test、Hausman Test 及 Over-Identification Test of Hausman Taylor Model (HTM) 選取最合適的實證模型。
    實證結果顯示，診所內部相關之因素，包含醫師數量、藥師數量、技術醫療 人員數量及血液透析治療件數，皆對洗腎透析診所的總點數有正向的影響。外部政策及環境相關因素方面，實施總額支付制度及老化指數亦對洗腎透析診所之總點數有正向影響，而失業率與政府健康醫療支出則對診所的總點數有負面的影響。
    基於上述實證結果，本研究建議洗腎透析診所增加醫療相關人員的數量。此外，雖本研究的實證結果指出血液透析治療能為診所帶來可觀的總點數，但近年來，政府積極推廣腹膜透析，因此，仍須提醒洗腎透析業者需權衡血液透析治療與腹膜透析治療之醫療服務，時時留意政策動向，才能在競爭激烈的醫療環境中保有獲利。

    The study aims to explore the determinants affecting the operational performance of dialysis clinics in Taiwan by utilizing a panel regression model. The evaluation of the performance is based on the point system established by the NHIA. The study collected data dating from 1998 to 2012 from the NHIRD, Ministry of Health and Welfare and National Statistics, and utilized the BP-LM test, the Hausman test, and the Hausman-Taylor Over-identification test to select the optimal empirical model.
    The empirical results show that the internal factors, which are the numbers of physicians, dispensing doctors, technical medical personnel, and hemodialysis treatment, have positive impacts on the performance of dialysis clinics. On the other hand, two of the four external factors, namely the implementation of Global Budget system and the aging index, also have positive impacts on the performance of dialysis clinics, whereas the other two factors, the unemployment rate and government health expenditure, have negative impacts.
    Based on the empirical results, the present study suggests that the dialysis clinics recruit more medical personnel to increase the total points. In addition, although the hemodialysis treatment can bring in a greater number of points, it is recommended that the clinics carefully weigh the advantages and disadvantages of both peritoneal dialysis and hemodialysis, since peritoneal dialysis is now being promoted by the NHIA.

    摘要................................................................................................................................ I Abstract ......................................................................................................................... II 誌謝..............................................................................................................................III Contents ...................................................................................................................... IV List of Tables ................................................................................................................V List of Figures ............................................................................................................. VI Chapter 1 Introduction ...................................................................................................1 1.1 Background and Motivation ............................................................................1 1.2 Research Objectives and Purpose ....................................................................6 1.3 Research Framework .......................................................................................7 Chapter 2 Literature Review ..........................................................................................9 2.1 The Measurement of Dialysis Clinic Performance ..........................................9 2.2 The Determinants of Dialysis Clinic Performance ........................................11 Chapter 3 Methodology ...............................................................................................21 3.1 Sample Description........................................................................................21 3.2 Description of Variables ................................................................................22 3.3 Empirical Model ............................................................................................35 3.4 Methods of Empirical Model Selection .........................................................36 Chapter 4 Empirical Findings and Analysis ................................................................41 4.1 Testing for Multicollinearity..........................................................................41 4.2 Empirical Model Selection ............................................................................46 4.3 Empirical Findings.........................................................................................48 Chapter 5 Conclusions and Suggestions ......................................................................55 5.1 Conclusions....................................................................................................55 5.2 Suggestions ....................................................................................................57 References....................................................................................................................60

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