臺灣長期存在健康不平等的現象，而這現象可能是地區或醫療市場的需求面與供給面因素所造成。因此，本研究旨在分析因為地區或醫療市場的需求面與供給面因素所造成的地域性的健康不平等，並以鄉鎮別的乳癌病患做為研究對象。本研究使用 1999 年、2000 年、2006 年、2013 年的需求面與供給面資料進行實證研究，藉由衛生福利部國民健康署的癌症登記線上互動系統篩選出所需年份的鄉鎮別乳癌死亡率與乳癌發生率當作被解釋變數。本研究考量鄉鎮之間有互相影響的效果存在，因此將使用空間模型解決因空間所產生的偏誤。

本研究的實證發現，乳癌死亡率長期而言不存在空間聚集的現象，在需求面因素有老年人口比率與人口密度為正向顯著相關，說明老年人口比率愈高或人口密度愈高的鄉鎮其乳癌死亡率愈高，供給面因素僅有大型醫院的虛擬變數為正向顯著相關，說明有大型醫院的鄉鎮其乳癌發生率愈高。而乳癌發生率長期存在空間聚集的現象，需求面因素有家戶所得與人口密度為正向顯著相關，說明家戶所得愈高或人口密度愈高的鄉鎮其乳癌發生率愈高，供給面因素有每萬人口醫生數與大型醫院的虛擬變數為正向顯著相關，說明醫生數愈多或有大型醫院的鄉鎮其乳癌發生率愈高。本研究從以上實證結果推論臺灣長期而言存在地域性的健康不平等。

There is health inequality in Taiwan over a long period of time because of the demand factors and supply factors. Therefore, This study want to analyze health inequality
caused by them. The research subjects are breast cancer patients. We use the demands factors, supply side factors, the breast cancer death rate and the rate of occurrence of breast cancer in towns in 1999, 2000, 2006 and 2010. We consider that there is an effect between towns so that we use spatial models to solve spatial bias.

The result is that there isn't spatial clustering on the breast cancer death rate. On the demand variables, the rate of elderly population and the population density have a significantly positive correlation to breast cancer death rate. On the supply variables, only the dummy variable of large-scaled hospitals has a significantly positive correlation to breast cancer death rate. On the other hand, there is spatial clustering on
the rate of occurrence of breast cancer. On the demand variables, the household income and the population density have a significantly positive correlation to the rate of occurrence of breast cancer. On the supply variables, the doctors per ten thousands population and the dummy variable of large-scaled hospitals have a significantly
positive correlation to the rate of occurrence of breast cancer. According to the results, we can infer that the geographic health inequality exist in Taiwan over a long period of time.

中文文獻
1.吳依凡(2004)，「醫療資源可近性對個人醫療利用的影響-台灣地區的實證研究」，國立中央大學產業經濟所碩士論文。

2林淑敏(2004)，「醫療資源與國人健康的關聯」，國立中央大學產業經濟所碩士論文。

3孫樹根、劉俊賢(2006)，「從台灣城鄉嬰幼兒死亡率差異探討社會不公平問題」，<<農業推廣學報>>，23，33-58。

4.胡立諄、賴進貴(2006) 「臺灣女性癌症的空間分析」，<<臺灣地理資訊學刊>>，4， 39-55。

5.洪乾巽(2010)，「交通建設對台灣失業率之影響-空間計量模型之應用」，中國文化大學社會科學院經濟學系碩士論文。

6.周孟嫻、紀玉臨、謝雨生(2010)，「臺灣自殺率具空間群聚嗎?模仿效應或結構效應」，<<人口學刊>>，41，1-65。

7.呂宗學、陳端容、將東亮(2015)，「釐清健康不平等相關名詞」，<<臺灣公共衛生雜誌>>，34(2)，115-118。

英文文獻
1. Anselin, L. 1995.“Local Indicators of Spatial Association LISA.＂Geographical Analysis, 27(2): 94-115.

2. Anselin, L., and Florax, R.J. 1995.“Small sample properties of tests for spatial dependence in regression models: Some further results.＂New directions in spatial econometrics, 21-74.

3. Anselin, L. 1988. Spatial econometrics: methods and models (Vol. 4). Springer Science & Business Media.

4. Anselin, L. 2001.“Spatial econometrics.＂A companion to theoretical econometrics, 310-330.

5. Arcury, T. A., Gesler, W. M., Preisser, J. S., Sherman, J., Spencer, J., and Perin, J. 2005.“The effects of geography and spatial behavior on health care utilization among the residents of a rural region.＂Health services research, 40(1), 135-156.

6. Braveman, P., and Gruskin, S. 2003.“Defining equity in health.”Journal of epidemiology and community health, 57(4), 254-258.

7. Baltagi, B. H., and Moscone, F. 2010. “Health care expenditure and income in the OECD reconsidered: Evidence from panel data.＂Economic Modelling, 27(4), 804-811.

8. Cliff, A.D., and Ord, J.K. 1981. Spatial processes: models and applications (Vol. 44). London: Pion.

9. Currie, J., and Reagan, P. B. 2003.“Distance to hospital and children's use of preventive care: is being closer better, and for whom?”Economic Inquiry,41(3), 378-391.

10. Cawley, J. 2004.“The impact of obesity on wages.＂Journal of Human resources, 39(2), 451-474.

11. Cracolici, M. F., Cuffaro, M., and Nijkamp, P. 2007.“Geographical distribution of unemployment: An analysis of provincial differences in Italy. ＂Growth and Change, 38(4), 649-670.

12. Clegg, L.X., Reichman, M.E., Miller, B.A., Hankey, B.F., Singh, G.K., Lin, Y. D., ... and Bernstein, L. 2009.“Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality Study.＂Cancer causes & control, 20(4), 417-435.

13. Comber, A. J., Brunsdon, C., and Radburn, R. 2011.“A spatial analysis of variations in health access: linking geography, socio-economic status and access perceptions.＂International journal of health geographics, 10(1), 1.

14. Freund, C. L., & Weinhold, D. 2004.“The effect of the Internet on international trade.” Journal of international economics, 62(1), 171-189.

15. Humphries, K. H., and Van Doorslaer, E. 2000.“Income-related health inequality in Canada.”Social science & medicine, 50(5), 663-671.

16. Hjortsberg, C. 2003.“Why do the sick not utilise health care? The case of Zambia.＂Health economics, 12(9), 755-770.

17. Hassapidou, M., Papadopoulou, S. K., Frossinis, A., Kaklamanos, I., and Tzotzas, T. 2009. Sociodemographic,“ethnic and dietary factors associated with childhood obesity in Thessaloniki, Northern Greece.＂Hormones, 8(1), 53-59.

18. Kopetsch, T., and Schmitz, H. 2014.“Regional variation in the utilisation of ambulatory services in Germany.＂Health economics, 23(12), 1481-1492.

19. LeSage, J. P. 2008.“An introduction to spatial econometrics.＂Revue d'économie industrielle, (123), 19-44.

20. Mu, R. 2014.“Regional Disparities In Self‐Reported Health: Evidence From Chinese Older Adults.＂Health economics, 23(5), 529-549.

21. Owens, G. 2008.“Gender differences in health care expenditures, resource utilization, and quality of care.＂ Journal of Managed Care Pharmacy, 14(3), 2-6.

22. Ramírez, M. T., & Loboguerrero, A. M. (2002).“Spatial dependence and economic growth: Evidence from a panel of countries.＂Borradores de Economia Working Paper, (206).

23. Sacker, A., Firth, D., Fitzpatrick, R., Lynch, K., and Bartley, M. 2000.“Comparing health inequality in men and women: prospective study of mortality 1986-96.＂BMJ, 320(7245), 1303-1307.

24. Singh, G.K., Williams, S.D., Siahpush, M., and Mulhollen, A. 2012.“Socioeconomic, rural-urban, and racial inequalities in US cancer mortality: Part I-All cancers and lung cancer and Part II-Colorectal, prostate, breast, and cervical cancers.”Journal of cancer epidemiology, 2011.

25. Singh, G. K., Azuine, R. E., and Siahpush, M. 2015.“Global inequalities in cervical cancer incidence and mortality are linked to deprivation, low socioeconomic status, and human development.”International Journal of MCH and AIDS (IJMA), 1(1), 17-30.

26. Vieira, V. M., Webster, T. F., Weinberg, J. M., and Aschengrau, A. 2008. “Spatial-temporal analysis of breastcancer in upper Cape Cod, Massachusetts.”International Journal of Health Geographics, 7(1), 1.

27. Walker, R., Moran, E., and Anselin, L. 2000. “Deforestation and cattle ranching in the Brazilian Amazon: external capital and household processes.”World development, 28(4), 683-699.

28. Woods, L. M., Rachet, B., and Coleman, M. P. 2006.“Origins of socio-economic inequalities in cancer survival: a review.”Annals of Oncology, 17(1), 5-19.

29. Wen, C. P., Tsai, S. P., and Chung, W. S. I. 2008.“A 10-year experience with universal health insurance in Taiwan: measuring changes in health and health disparity. ”Annals of internal medicine, 148(4), 258-267.