為了探討醫療院所競爭對自付差額醫療器材利用與價格之影響，本文使用2015 年至 2020 年全民健康保險資料庫，篩選出首次使用整組人工髖節以及首次使用人工水晶體之病患和醫療院所資料進行實證分析。首先，本研究使用羅吉斯迴歸模型，探討醫療院所競爭對病患使用自付差額醫療器材之影響；第二部份，使用廣義線性迴歸模型，分析醫療院所競爭對醫療院所自付差額醫療器材使用率之影響；最後，使用固定效果迴歸模型，研究醫療院所競爭對自付差額醫療器材收費價格之影響。
經實證結果顯示，醫療院所市場競爭程度與醫療院所規模對自付差額醫療器材之利用皆有正顯著之影響。若按醫院權屬別來看，財團法人醫院有較高的自付差額醫療器材利用。此外，本研究在比較兩種不同醫療器材的實證結果後，發現自付差額人工水晶體的需求彈性比人工髖關節高，且集團醫院亦會提升自付差額人工水晶體之利用。最後，本研究在固定各項醫療器材之平均價格差異性後，發現當醫療院所競爭程度越高，自付差額醫療器材之收費價格會越低，儘管在統計上不顯著，但綜合上述得以證實我國自付差額醫療器材市場存在某種程度之醫療競武（品質競爭）現象。

To investigate the impact of competition among hospitals on the utilization and pricing of out-of-pocket medical devices, this study utilized the National Health Insurance database from 2015 to 2020. This study selected patients’ and hospitals data specifically focused on patients undergoing primary total artificial hip joints and artificial intraocular lenses. Firstly, we used a logistic regression model to examine the influence of hospital competition on patients' utilization of out-of-pocket medical devices. Secondly, we used a generalized linear regression model to analyze the impact of hospital competition on the utilization rate of out-of-pocket medical devices within hospitals. Lastly, a fixed-effect regression model was employed to investigate the influence of hospital competition on the pricing of out-of-pocket medical devices.
According to empirical evidence, hospital competition and size significantly affect the utilization of out-of-pocket medical devices. According to the ownership type of
hospitals, nonprofit hospitals have a higher utilization of out-of-pocket medical devices. In addition, this study found that the demand elasticity for out-of-pocket artificial
intraocular lenses is higher than for artificial hip joints. Moreover, group hospitals also increase the utilization of out-of-pocket artificial lenses. Additionally, we observed that higher competition among hospitals tends to lower prices for out-of-pocket medical devices, even though not statistically significant. In summary, this study confirms the presence of a certain level of quality competition in our country's market of out-ofpocket medical devices.

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三、其他部份
1. 衛生福利部統計處網站，醫事機構服務量調查：
https://dep.mohw.gov.tw/DOS/lp-5099-113.html
2. 衛生福利部統計處網站，國民醫療保健支出統計表：
https://reurl.cc/Y8rkdO