| 研究生: |
高譽萍 Yu-ping Kao |
|---|---|
| 論文名稱: |
醫療支出與生命價值之實證研究—以台灣肝癌病患為例 The Empirical Relationship between Medical Spending and The value of Life-the Case of liver cancer patients in Taiwan |
| 指導教授: |
劉錦龍
Jin-long Liu 蔡偉德 Wei-der Tsai |
| 口試委員: | |
| 學位類別: |
碩士 Master |
| 系所名稱: |
管理學院 - 產業經濟研究所 Graduate Institute of Industrial Economics |
| 畢業學年度: | 99 |
| 語文別: | 中文 |
| 論文頁數: | 80 |
| 中文關鍵詞: | 生命價值 、生命年價值 、醫療費用 、存活分析 |
| 外文關鍵詞: | medical spending, survival analysis, value of a life-year, value of life |
| 相關次數: | 點閱:12 下載:0 |
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本研究主要是以台灣肝癌病患為研究對象,使用全民健保資料庫2000年承保抽樣歸人檔,分別從醫院及病患的角度進行探討。首先,從醫院的角度觀察醫院的醫療支出與死亡率之間的關係,並估算出生命價值,其次,從病患的角度觀察病患的醫療支出與存活天數之間的關係,並估算出病患的生命年價值。
本研究的分析方法,從醫院的角度,採用橫斷面資料以及長期追蹤資料,分別使用兩階段最小平方法、隨機效果以及固定效果進行分析;從病患的角度,則是使用存活分析中的Cox比例危險模型以及參數模型中的Log-logistic、Log-normal和Gamma三種分配的加速失敗模型進行估計,並利用估計出的邊際效果估算病患的生命年價值。
研究結果顯示,從醫院的角度,醫院病患死亡率與醫院的醫療費用呈顯著負相關,肝癌病患的生命價值約為2千5百萬到3億9千萬元;從病患的角度,個人存活天數與醫療費用呈顯著正相關,存活天數也會隨年齡的增加而減少。本研究估算從1997-2006年間,肝癌病患每年的存活收益價值為283-363萬元,餘命價值約為824-1,058萬元,而生命年價值為275-353萬元。
To estimate the value of lives by virtue of medical spending, the liver cancer patients in Taiwan were taken as subjects on this study. The data used in this paper were taken from the National Health Insurance Bureau claims data during 1996 till 2007. The analyses were performed both in hospital’s approach and the patients’ approach. First, an analysis between hospital expenses and hospital mortality was held, from which the value of life was estimated. Then, the value of a life-year was derived from another analysis between patients’ spending and patients’ survival time.
In the hospital’s approach , cross section data and panel data were taken , and underwent 2SLS, random effect and fixed effect respectively for regression. In the patients’ approach, the survival analysis with Cox proportional hazard model was held, as well as 3 parametric models including log-logistic, log-normal, and Gamma distributions. From which, the marginal effect was derived and the value of a life-year estimated.
As the results shown, the hospital expenses and hospital mortality are negatively related. And the value of life for the liver cancer patients ranges from 25 millions to 390 millions NTD. In the patients’ approach, patient’s spending and patient’s survival time are positively related, and the survival time decreases with age. In this study, annual value of survival gains in 1997-2006 is 2.8-3.6 millions NTD, lifetime value of survival gains is 8.2-11 millions NTD, that implied value of a life year is 2.8-3.5 millions NTD.
網站
行政院衛生署:http://www.doh.gov.tw/CHT2006/index_populace.aspx
英文書
1.Kleinbaum, David G. and Klein, Mitchel, Survival analysis A self-learning text, second edition, New York, 2005. P.266-268 & P.463-508
2.Rabe-Hesketh, Sophia and Everitt, Brian, A Handbook of Statistical Analyses using Stata, fourth edition, Boca Raton, 2007. P.149-167
中文書
1.林建甫,存活分析,一版,雙葉書廊,台灣,民國九十七年。
英文文獻
1.Cutler, David M., Allison B. Rosen, and Sandeep Vijan. 2006. “The Value of Medical Spending in the United States, 1960 –2000.” The New England Journal of Medicine, 355: 920-927.
2.Felder, Stefan, Markus Meier, and Horst Schmitt. 2000. “Health Care Expenditure in the Last Months of Life.” Journal of Health Economies19: 679-695.
3.Goebbels, Adrienne F. G., and Andre J. H. A. Ament. 2008. “Estimating the Implicit Value of Statistical Life Based on Public Interventions Implemented in The Netherlands.” International Journal of Technology Assessment in Health Care, 24(4): 495-501.
4.Hall, Robert E., and Charles I. Jones. 2007. “The Value of Life and the Rise in Health Spending.” The Quarterly Journal of Economics: 39-72.
5.Hammitt, James K. 2000.“Valuing Mortality Risk: Theory and Practice.” Environmental Science & Technology, 34(8): 1396-1400.
6.Hammitt, James K. 2007. “Valuing Changes in Mortality Risk: Lives Saved Versus Life Years Saved.”Review of Environment Economics and Policy, 1(2): 228-240.
7.Keeler, Emmett B. 2001“The Value of Remaining Lifetime is Close to Estimated Values of Life.” Journal of Health Economics 20: 141-143.
8.Lakdawallac, Darius N., Eric C. Suna, Anupam B. Jenab, Carolina M. Reyesd, Dana P. Goldmanc, and Tomas J. Philipsone. 2010. “An Economic Evaluation of the War on Cancer.” Journal of Health Economics, 29: 333-346.
9.Murphy, Kevin M., and Robert H. Topel. 2005. “Black-White Differences in the Economic Value of Improving Health.” Perspectives in Biology and Medicine, 48(1): S176-S194.
10.Murphy, Kevin M., and Robert H. Topel. 2006. “The Value of Health and Longevity.” Journal of Political Economy, 114(51): 871-904.
11.Rosen, Sherwin. 1988“The Value of Changes in Life Expectancy.” Journal of Risk and Uncertainty, 1: 285-304.
中文文獻
1.連賢明,「如何使用健保資料進行研究」,經濟論文叢刊36(1): 115-143,國立台灣大學經濟學系,2008。
2.賴亦晨,「醫院權屬別與醫療結果的關聯性—以台灣的肝癌病患為例」,國立中央大學產業經濟研究所碩士論文,2010。