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研究生:林佳嬑
研究生(外文):Chia-Yi Lin
論文名稱:台灣家庭醫療保險需求之探討-以分量迴歸分析
論文名稱(外文):Exploring Household Health Insurance Demand in Taiwan-Evidence from Quantile Regression
指導教授:劉亞明劉亞明引用關係
指導教授(外文):Liu Ya-Ming
學位類別:碩士
校院名稱:國立成功大學
系所名稱:經濟學系碩博士班
學門:社會及行為科學學門
學類:經濟學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:110
中文關鍵詞:差異中之差異方法分量迴歸兩部模型商業性健康保險全民健保
外文關鍵詞:difference-in-differenceNational health insurancequantile regressiontwo-part modelprivate health insurance
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本研究主要目的為藉由分量迴歸(quantile regression)方法衡量在原已擁有商業性健康保險情況下,不同特徵變數對家戶單位購買商業性健康保險需求之影響,並透過差異中之差異方法(difference-in-difference)以檢視全民健保制度實施後,對家戶單位購買商業性健康保險需求行為之改變;此外,亦利用Logistic及OLS兩部模型方法衡量家戶單位購買商業性健康保險機率及數量之影響。

以1993年至1997年行政院主計處家庭收支調查報告為研究資料,實證結果發現於各保險支出分量中,全民健保與商業性健康保險兩者皆呈互補關係,並且家戶單位商業性健康保險支出在中間及較高(q0.5、q0.75)之分量,其補充性效果愈強。在購買商業性健康保險機率方面,戶長為女性、年齡愈大、教育程度愈高以及任職於公部門者,相對購買機率較高。此外,家戶單位所得愈高、家庭規模愈大、家中所得收入人口數愈少、0-19歲與20-64歲占家庭人口比例愈大及居住於都市、城鎮之家戶,對於購買健康保險機率呈顯著正相關。在不同商業性健康保險支出分量方面,地區變數、戶長之社經變數以及家庭特徵變數對於家戶單位商業性健康保險購買決策影響皆扮演重要之角色,是以往傳統普通最小平方迴歸分析觀察不到之現象。

全民健保制度實施之淨效果方面,可發現在不同保險支出分量中,戶長及配偶部門別組合、所得層級、戶長年齡層以及戶長與配偶之教育程度對於家戶單位購買商業性健康保險行為亦有不同程度之影響。本研究結果可提供予我國商業保險市場作為參考之資訊,未來健康保險在保險市場中仍有其發展空間,以及消費者之保單內容設計亦可朝向全民健保之補充性方向發展。
The purpose of this research is to use quantile regression model to examine the demand for private health insurance of those households with private health insurance and employ difference-in-difference specification to assess the quantile treatment effects of National Health Insurance (NHI) on private health insurance market. This study also used a two-part model to explore the factors that likely influenced the probability and amount of private health insurance purchased by households.

Data used in this research is from “Survey of Family Income and Expenditures” (SFIE) of 1993 to 1997. Empirical results show that the relationship between the implementation of NHI and the purchase of private health insurance is complementary, and household health insurance expenditures in middle and higher quantile(q0.5、q0.75) demonstrate more significantly complementary relationship. Household with head being female, elder, obtaining higher education level, working in public sector, higher household income, larger household size, fewer total earner, higher ratio of age0-19 and age20-64, living in urban and suburban would have larger probability to purchase private health insurance. The variables with respect to regional characteristics, household head socioeconomic status and family composition are also important factors in different expenditure quantiles of private health insurance, which likely provided various results that are different from OLS analysis.

In the sub-analysis over the distribution of covariates the results show the heterogeneous feature of the demand of private health insurance in various head-spouse sectoral combination groups, income quintile groups, head age groups, and head and spouse education groups. This study likely implied that the implementation of NHI might provide business opportunity in private health insurance market. Thus private health insurance company could propose the health insurance schemes to supplement the deficiency of NHI in the future.
第一章 緒論..............................................1
第一節 研究背景........................................1
第二節 研究動機與目的..................................4
第三節 研究流程........................................9
第二章 文獻回顧.........................................10
第三章 健康保險之現況分析...............................18
第一節 全民健康保險之現況分析.........................18
第二節 商業性健康保險之現況分析.......................21
第四章 研究方法.........................................25
第一節 研究工具.......................................25
第二節 研究架構.......................................31
第三節 研究資料來源...................................33
第四節 變數說明及假設.................................36
第五章 實證結果與分析...................................48
第一節 非條件差異中之差異分析.........................48
第二節 Logistic及OLS迴歸分析..........................52
第三節 分量迴歸分析...................................56
第六章 結論與建議.......................................97
第一節 結論...........................................97
第二節 建議..........................................101
參考文獻...............................................102
附錄...................................................106
一、中文部分
1. 中央健保局 (2006),「全民健康保險統計」,中央健康保險局。
2. 何宗祐 (2001),「當前我國商業性健康保險問題之探討」,逢甲
大學保險研究所碩士論文。
3. 何艷宏 (1995) 「在全民健保制度下對商業性互補醫療險最適需
求的決定模式」,《保險專刊》,42,頁119-137。
4. 何艷宏 (1996) 「在全民健康保險制度下民眾對互補醫療險需求
的模擬分析研究」,《保險專刊》,43,頁166-176。
5. 洪乙禎、譚令蒂、謝啟端 (2005) 「補充性健康保險與全民健保
搭配的影響效果分析」,《經濟論文》,33(4),頁433-465。
6. 洪小喬 (2003),《私人健康保險購買的決定因素-全民健保前後
比較》。台北大學財政學研究所碩士論文。
7. 耿紹勛,許燕菁 (2006)「全民健保實施對家計消費影響之實證研
究」,第八屆全國實證經濟學論文研討會。
8. 陳欽賢、劉彩卿、林建仁 (2005) 「家庭所得與自付醫療費用之
財務負擔分析」,《台灣銀行季刊》,56(2),頁200-229。
9. 陳雲中 (1992) 「論全民健康保險與商業性健康保險之互補關
係」,《保險專刊》,30,頁6-22。
10.傅立葉 (1995) 「福利國家公/私部門的互動:台灣私人保與社會
保險關係的初步探討」,《中國社會學刊》,18,頁117-152。
11.楊立維 (2007) 《全民健保制度下部份負擔調整與醫療需求之關
係》。成功大學高階管理碩士在職專班碩文。
12.劉耀福 (1997),《全民健康保險與商業性健康保險互補性認知之
研究》。逢甲大學保險研究所碩士論文。
13.劉彩卿、陳欽賢、黃瑞春 (2002) 「政府對全民健保保險費補助
之分析」,《財稅研究》,34(3),頁100-115。
14.劉彩卿、陳欽賢、洪小喬 (2004) 「全民健保實施對商業健康保
險購買決策的影響」,《財稅研究》,36(2),頁71-94。
15.劉耀福 (1997),《全民健康保險與商業性健康保險互補性認知之
研究》。逢甲大學保險研究所碩士論文。
16.蔡隸亞 (2006),《台灣全民健保對個人健康保險購買行為之影
響-以金融保險從業人員為例》。台北:政治大學行政管理碩士論
文。
17.賴本隊 (2005),「淺談健康險的經營」,《壽險季刊》,138,
頁24-40。

二、西文部分:
1. Asenso-Okyere,W.Kwadwo, Isaac Osei-Akoto, Adote Anum and
Ernest N. Appiah (1997) “Willingness to pay fo health
insurance in a developing economy. A pilot study of the
informal sector of Ghana using contingent valuation”
Health Policy, 42, 223-237.
2. Cameron, A.C, P. K. Trivedi, Frank Milne and J. Piggott
(1988) “ A Microeconomertic Model of the Demand for
Health Care and Health Insurance in Australia”Review of
Economic Studies, LV, 85-106.
3. Cheng,Shou-Hsia and Tung-Liang Chiang (1997). “The
Effect of Universal Health Insurance on Health Care
Utilization in Taiwan” Journal of then American Medical
Association, 278(2)
4. Chou, Shin-Yi ,Jin-Tan Liu and James K. Hammitt (2004).
“Nation Health Insurance and Technology Adoption:
Evidence From Taiwan” Contemporary Economic Policy, 22
(1), 26-38.
5. Chou, Shin-Yi ,Jin-Tan Liu and James K. Hammitt (2003).
“National Health Insurance and precautionary saving:
evidence from Taiwan” Journal of Public Economics, 87,
1873-1894.
6. Chu,Tu-Bin ,Tsai-Ching Liu, Chin-Shyan Chen , Yi-Wen
Tsai and Wen-Ta Chiu (2005). “Household out-of-pocket
medical expenditures and national health insurance in
Taiwan: income and regional inequality” BMC Health
Services Research, 5(60), 1-1
7. Cutler ,David M. and Jonathan Gruber (1996) “Does
public insurance crowd out private insurance?” The
Quarterly Journal of Economics,111(2),391-430.
8. Fukuda,Kosei (2007) “An empirical analysis of us and
Japanese health insurance using age-period-cohort
decomposition” Health Economics, 16, 475-489.
9. Gruber ,Jonathan and Kosali Simon (2008) “Crowd-Out
Years Later: Have Recent Public Insurance Expansions
Crowded Out Private Health Insurance?” Journal of
Health Economics, 27(2),201-242.
10. Hopkins ,Sandra and Michael P. Kidd (1996) “The
determinants of the demand for private health insurance
under Medicare” Applied Economics, 1623-1632.
11. Koc ,Cagatay (2004) “The effects of uncertainty on the
demand for health insurance” The Journal of Risk and
Insurance, 71(1), 41-61.
12. Koenker ,Roger and Kevin F. Hallock (2001) “Quantile
Regression” Journal of Economic Perspectives, 15(4),
143-156.
13. Kuan Chung-Ming(2007)”An Introduction to Quantile
Regression”working paper, 1-20.
14. Kuan Chung-Ming and Chen Chinen-Liang(2007) “Quantile
Treatmenet effects of National Health Insurance on
Household Precautionary Saving:Evidence from a Regime
Switch in Taiwan” working paper, 1-40.
15. Lee,Jonq-Ying, Mark G. Brown, James L. Seale and Jr.
(1994).“Model Choice in Consumer Analysis: Taiwan,
1970-89”American Agricultural Economics Association,
76, 504-512.
16. Liu ,Tsai-Ching and Chin-Shyan Chen (2002) “An
analysis of private health insurance purchasing
decisions with national health insurance in Taiwan”
Social Science & Medicine, 55, 755-774.
17. Liu, Tsai-Ching, Shin-Yi Chou and James K. Hammitt
(2006) “Health Isurance and Households’ Precautionary
Behavior:An Unusual Natural Experiment” Econlit, 4(4),
395-421.
18. Lo,Sasso Anthony T. and Thomas C. Buchmueller (2004)
“The effect of the state children’s health insurance
program on health insurance coverage” Journal of
Health Economics , 23, 1059-1082.
19. Lu ,Jui-Fen Rachel and William C. Hsiao (2003). “Does
Universal Health Insurance Make Health Care
Unaffordable? Lessons From Taiwan” Health Affrics, 22
(3),77-88.
20. Manning ,Willard G. and M. Susan Marquis (1996)
“Health insurance: the tradeoff between risk polling
and moral hazard” Journal of Health Economics, 15, 609-
639.
21. Parry ,Ian W.H. (2005). “Comparing the welfare effects
of public and private health care subsidies in the
United Kingdom” Journal of Health Economics, 24, 1191-
1209.
22. Propper ,Carol (2000). “The demand for private health
care in the UK” Journal of Health Economics, 19, 855-
876.
23. Rhine ,Sherrie L. W. and Ying Chu Ng (1998) “The
effect of employment status on private health insurance
coverage: 1977 and 1987” Health Economics, 7, 63-79.
24. Showers, Vince E. and Joyce A. Shotick (1994), “The
Effects of Household Characteristics on Demand for
insurance: A Tobit Analysis” The Journal of Risk and
Insurance, 61(3), 492-502.

三、參考網站:
1.中央健康保險局
http://www.nhi.gov.tw/

2.SunnyNet商學網站保險網
http://www.sunny.org.tw/ins
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