本研究主要探討影響台灣基層醫療機構存活的關鍵因素，研究對象為台灣22個縣市的基層醫療機構（包含西醫、牙醫與中醫診所），研究期間自1998年至2012年，資料來源為健保資料庫及中華民國統計資訊網。判定診所是否存活的依據為診所與健保局保持合約的狀態，診所在研究期間保持與健保局為簽約狀態，判定為存活，反之則退出市場。本研究利用Cox Proportional Hazard (PH) Model 與 Kaplan-Meier survival curve 進行實證模型的分析。
實證結果顯示，影響診所存活的內部因素有醫療總點數、醫生數、醫技人員數。醫療總點數與解約率有顯著負相關，代表診所賺取的點數越多，越不容易與健保局解約。人力資源方面，醫生數與解約率呈現正相關，聘請越多的醫生將導致規模不經濟的情況發生，但多聘僱醫技人員可以增加診所的存活率。在外部因素方面，人口密度、老化指數與解約率呈現顯著負相關，與歐美文獻的結論相反，因為全民健康保險降低失業人口與老年人口獲取醫療服務的成本，使得設立在高失業率與多老年人口地區的診所能夠有較佳的存活率。而縣市政府對醫療政策相關支出也顯著影響診所的存活，政府提升人民健康水準後將降低人民的醫療服務需求，使得診所的存活率也跟著下降。在同業競爭中，設立在診所多的區域能改善診所存活率，因為住在有著完善醫療服務地區的人民對醫療服務的需求較高，但是醫院及診所之間就有著替代關係存在，將診所設立在醫院附近會降低診所的存活率。

This study mainly investigates the determinants of the closure of clinics, including the Western Medicine, the Dentist and the Chinese Medicine, in Taiwan during the period from 1998 to 2012. To this end we utilize the Cox Proportional Hazard model and Kaplan-Meier survival curve. The empirical results reveal the several key findings as follows. In terms of characteristics of clinics, the total applied points variable has a significantly negative impact on the rate at which the clinics are closed. Receiving larger subsidies from the National Health Insurance Administration (NHIA) can enable clinics to survive longer. As for human resources, hiring more physicians will give rise to diseconomies of scale. However, clinics can hire more medical staff to increase their survival rate. As for characteristics of the environment, population density and the unemployment rate are found to have a significant impact on the closure of clinics. This results are against findings from western countries because NHI reduce cost of medical service for the elderly and unemployed population. Furthermore, government expenditure on health care has a significant negative influence on the closure of clinics. Consequently, it damages the survival of clinics. Finally, clinics surrounded by many other clinics enjoy a lower closure rate than clinics located in areas with fewer clinics. Nevertheless, hospitals are still the main rivals of the clinics.

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