牙醫師執業行為之經濟分析;The Economics Analyses of Dentist Practice Patterns

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题名:	牙醫師執業行為之經濟分析;The Economics Analyses of Dentist Practice Patterns
作者:	林宜靜;Lin,I-Ching
贡献者:	產業經濟研究所
关键词:	根管治療;流動地點執業;牙醫總額支付點值;群醫執業;group practic;root canal treatment;mobile practicing dentists;global budget
日期:	2012-12-03
上传时间:	2013-01-29 14:43:20 (UTC+8)
出版者:	國立中央大學
摘要:	牙科屬於基礎醫療照護專科，在維護國民健康方面扮演重要角色。然而，牙醫師執業型態以及牙醫診所之醫師組成型態與醫療結果之關聯性如何？牙醫總額支付制度對牙醫師執業的區位選擇是否有影響？本論文將以「牙醫師執業行為之經濟分析」為主軸，採用國家衛生研究院健保資料庫，分別以牙齒根管治療結果及醫師執業地點異動情形，進行探究三個相關之議題。研究結果分述如下：議題一，研究焦點在牙醫群醫執業的醫療結果是否優於獨立執業型態？以病患牙位為觀察單位，設定order probit 模型分析診所執業型態與根管治療結果之關聯性，實證結果顯示在群醫診所接受根管治療的牙齒持續保存良好之機率高於獨立執業診所，而且此效果隨著群醫診所之規模而遞增。究其原因，乃群醫執業藉由合作學習、專業分工及發揮規模經濟效益等優勢，而提升醫療結果。議題二，根據第一個議題群醫執業之醫療結果，將群醫診所之型態分為三種，研究焦點在探討醫師固定地點執業型診所、醫師流動地點執業型診所及混合型診所等三種型態之醫師的醫療結果是否存在差異？以牙醫師為觀察單位，設定診所固定效果的最小平方估計法，實證結果顯示：混合型之醫師兼具固定地點執業型醫師的品牌聲譽效應與流動地點執業型醫師的知識外溢效果，使得根管治療的牙齒保存良好機率較高。議題三，由於群體執業之醫師未必固定在單ㄧ診所看診，在人力可自由流動的市場，瞭解醫師區位選擇的決策因素，有助於解決醫療人力不均的問題，因此本議題焦點在分析總額支付點值是否影響牙醫師之區位選擇？根據牙醫師執業的區域特性來分析造成牙醫師變更執業地點的誘因。實證結果顯示，牙醫師會因為支付點值較高而留在原地區執業，而支付點值越高的地區(醫療資源相對貧乏區)越能吸引31至40歲的牙醫師遷入。剛畢業的牙醫師首次區位選擇傾向在支付點值成長率高的地區，因此，牙醫總額支付制度對平衡牙醫師人力分布有正向效果。Dental care definitely plays an essential role in maintaining general health. By employing the data extracted from the National Health Insurance Database, this study empirically examined the correlation between dentist practice and quality of dental care which is measured by the outcome of root canal treatment. Furthermore, this paper assesses the influence of dental global budgets on dentists’ location choices. The objective of this dissertation concerns three issues relating to dentist practice patterns.In first issue, this study empirically investigated whether dentists practicing in group tend to have better performance than that of the solo counterparts. Order probit model showed that success rate of root canal treatment is significantly increasing with the group size. The better performance of dentist group practice may result from the effect of peer learning, peer competition, economies of scale and labor division within a workplace. In the second issue of this study, we divided dental clinics into three types: (1) clinic with all mobile practicing dentists; (2) clinic with all immobile practicing dentists; and (3) clinic is mixed, containing both mobile and immobile practicing dentists (“mixed type” hereafter). Based on a physician-level data, this study investigates the treatment outcome disparity among different types of clinics via employing ordinal least squares with clinic fixed effects. Our results found that dentists of the mixed type were likely to have better performance. This improvement could be attributed to brand name and knowledge spillovers effect.In the third issues, we investigate the effects of dental global budget on dentists relocated their practices. Markets with high point value of dental global budget did increase the probability of staying in the original markets for dentists. Dentists who aged 31-40 and relocated their practices were most likely to switch to a county where the point value was higher than their original markets. Further, higher growth rates of point value did affect the choice of initial practice location by new dentists. Hence, the result reveals that dental global budgeting could improve the equality of medical resources distribution.
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