本研究旨在探討民國86年至89年零至五歲兒童西醫門診次數與其家庭特性、部分負擔制度變革等的關係，希望藉此分析了解可能影響兒童就醫的各項因素對兒童西醫門診次數之影響；研究資料主要來自中央健康保險局民國86年至89年間之全民健保兒童西醫門診處方及治療明細檔與主計處之家庭收支調查等。
運用Panel data 的 Random effects 模型估計所得出之實證結果顯示： 隨著兒童年齡增長，兒童的就診次數呈現顯著減少狀況；而門診部分負擔對零至二歲兒童就診次數的影響是正向顯著,但對三至五歲為負向不顯著；每萬人西醫師數對兒童西醫就診次數的影響為正向且顯著；其他如父母年齡、母親教育以及母親勞動參與率等並不顯著。
上述結果支持下列假說: 第一、隨著兒童年齡增長，兒童身體逐漸茁壯，而且父母育兒經驗也隨之累積，不會稍有狀況即急忙送醫，因此隨著兒童年齡增長，兒童的就診次數呈現顯著減少狀況; 第二、由於部分負擔金額不高，各縣市部分負擔政策雖存在差異，對兒童就診次數並無顯著抑制效果。

This thesis mainly investigates the relationship between physician visits for children aged from 0 to 5 years old and characteristics of family as well as copayment from 1997 to 2000. It attempts to estimate the effect of every factor that potentially affects physician visits for children. Data mainly come from the fee application form of National Health Insurance Bureau and the Survey of Family Income and Expenditure from 1997 to 2000.
The results obtained from the random effects model using the panel data indicate that children’s demand for physician visits decreases as children gradually grow up. The copayment is positively significant for children aged from 0 to 2 but insignificant for children aged from 3 to 5. The variable for density of physician is also positively significant. Other variables such as parents’ age, mother’s education and rate of mother’s participation in job market are insignificant.
These results are consistent with the following hypotheses. First, children become stronger as they grow up, and, in the meantime, parents’ experience accumulates as their children grow up. Parents do not rush to send their children to hospitals or clinics whenever their children look sick as before. Second, the fact that the copayment policies are not designed uniformly in every area in Taiwan does not indicate that the impact of copayment is negatively significant, which is, at least, partly due to the fact that the amount of copayment is not much.

第一章 緒論………………………………………………………… 1
第一節 前言………………………………………………… … 1
第二節 研究流程…………………………………………………6
第二章 台灣健保制度說明………………………………………… 7
第三章 文獻回顧…………………………………………………… 12
第一節 國內文獻…………………………………………………12
第二節 國外文獻…………………………………………………14
第四章 理論、實證模型…………………………………………… 16
第一節 理論模型…………………………………………………16
第二節 實證模型…………………………………………………19
第五章 資料出處與變數說明……………………………………… 22
第一節 資料整理…………………………………………………22
第二節 變數說明…………………………………………………23
第六章 實證分析…………………………………………………… 27
第一節 實證模型…………………………………………………27
第二節 實證結果…………………………………………………28
第七章 結論………………………………………………………… 40
訪談資料…………………………………………………………………41
參考文獻…………………………………………………………………42
附表………………………………………………………………………45
附錄………………………………………………………………………60

1. 方曉娟 (1992) 「台北市兒童醫療需求的實證研究」 政治大學經濟所碩士論文 .
2. 謝啟瑞 (1994) 「兒童醫療需求的實證分析」 《經濟論文叢刊》 22 (1) ：1-23 .
3. 蘇建榮 (1999) 「全民健康保險制度下門診醫療利用函數之估計」 《保險專刊》 57 ： 81-93 .
4. 劉彩卿、陳欽賢 (2001) 「研析在全民健保制度下影響台北都會區民眾就診之因素」 《經濟研究》 37 (1) ：69-92 .
5. 劉彩卿、吳佩璟 (2001) 「全民健保下病患在各醫療層級間的就醫選擇─台北市小兒科病患為例」 發表於醫務管理期刊2001年6月第2卷第2期 .
6. 鄭志宏 (1999) 父母特性與兒童醫療照顧 淡江大學產業經濟所碩士論文 .
7. 胡登淵、魏崇輝、周稚傑 ( 2002) 「台灣兒童牙科門診需求與部分負擔---1997年-2000年縣市跨年之資料分析」 發表於台灣經濟學會2002年會 .
8. 陳怡沁 (1999) 小兒科專科醫師及家庭醫學科專科醫師對於全民健康保險兒童預防保健服務的認知、態度與執業情形之調查研究 國防醫學院公共衛生學研究所碩士論文 .
9. Buhmann, B., Rainwater, L. Schmaus,G. and Smeeding,T. M. (1988), "Equivalence Scale , Well-being , Inequality , and Poverty : Sensitivity Estimates Across Ten Countries Using The Luxembourg Income Study (LIS) Database ." Review of Income and Wealth , Vol.34(2),：115-142 .
10. Ching, Panfila. (1995), "User fees, demand for children’s health care and sccess across income groups ：the Phillippine case." Soc. Sci.Med Vol.41(1), ：37-46 .
11. Coffey, R. M. (1983), "The Effect of Time Price on the Demand for Medical-Care Services . "Journal of Human Resources, Vol.18, No.3,407-424 .
12. Folland, M. S. , Goodman, A. C. and Stano,M. (1993), "The Economics of Health and Health Care, New York, NY：Macmillan Publishing Company."
13. Gerdtham, Ulf-G, et al. (1999), "The demand for health：results from new measures of health capital." European Journal Economy, Vol.15,：501-521 .
14. Grossman, M. (1972), "On the Concept of Health Capital and the Demand for Health." Journal of Political Economy, Vol.80, : 223-255 .
15. Hausman, Jerry , Hall, Bronwyn H. ,Griliches, Zvi. (1984), "Econometric models for count data an application to the patents-R&D relationships." Econometrica, Vol.52(4), :909-938 .
16. Jacobson, Lena. (2000), "The family as producer of health---an extended Grossman model. " Journal of Health Economics, Vol.19, : 611-637 .
17. Jung, K.T. (1998), "Influence of the imtroduction of a per-visit copayment on health care use and expenditure ： the Korean experience.". The Journal of Risk and Insurance, Vol.65(1), ：33-56 .
18. Tsai-Ching Liu, Chin-Shyan Chen and Li-Mei Chen(2002), "Impact of National Health Insurance on neonatal care use and childhood vaccination in Taiwan. " Health Policy and Planning, Vol.17(4), : 384-392 .
19. Moon-Kee Kong, Hoe-Kyung Lee(1999), "Demand for medical care, consumption and cointegration." Economics Letters, Vol.62,：325-330 .
20. Nocera, Sandra , Zweifel, Peter. (1998), "The demand for health : An Empirical test of the Grossman model using Panel Data. Health, The Medical Profession, and Regulation. Bostion, Dordrecht and London : Kluwer Academic." p x, 261 .
21. Wilcox-Goek,Virginia L. (1985), "Mother''s Education, Health Practices and Children''s Health needs : A Variance Components Model. " The Review of Economics and Statistics, Vol 67,： 706-710 .