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題名:失業與醫療利用
書刊名:臺灣公共衛生雜誌
作者:蔡淑鈴藍忠孚李丞華周穎政
作者(外文):Tsai, Shu-lingLan, Chung-fuLee, Cheng-huaChou, Yiing-jenq
出版日期:2004
卷期:23:5
頁次:頁365-376
主題關鍵詞:失業每人年醫療利用差異中之差異法廣義估計方程式臺灣UnemploymentMedical utilizationDifference in difference methodDDGeneralized estimation equationGEETaiwan
原始連結:連回原系統網址new window
相關次數:
  • 被引用次數被引用次數:期刊(3) 博士論文(1) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:3
  • 共同引用共同引用:0
  • 點閱點閱:43
     目標:過去之研究顯示失業與醫療利用之關係同時存在健康效應(health effect)與所得效應(income effect),但迄今尚無定論,在臺灣迄今亦無失業與醫療利用相關之實証研究。本研究之目的在了解臺灣在全民健康保險制度下,失業對醫療利用上之影響,並針對特定疾病醫療利用之影響加以分析。方法:本研究為有對照組之實驗設計,定義之失業為2001年非志願性失業者共92,562人為研究對象,並選取同時期之在職者共92,443人為對照組,觀察期間為每人失業前後各一人年,以差異中之差異法(difference in difference method)與廣義估計方程式(Generalized Estimation Equation )測量。結果:研究結果顯示失業後一年西醫整體門診醫療利用變化呈下降情形,主要受呼吸道感染之醫療利用下降之影響;精神疾病之醫療利用有明顯上升之情形;另三種心血管疾病之醫療利用則在失業後無明顯影響。結論:失業對醫療利用之影響,在不同疾病上確有可能受所得降低與健康衝擊之不同程度之影響。本研究只檢驗失業對醫療利用之短期(一年)影響,至長期影響尚待後續之追蹤與監測。
     Objective: Previous research has shown that exposure to unemployment could have health effect and income effect on medical care utilization. This study examines total and five disease-specific medical care utilizations before and after exposure to involuntary unemployment under the National Health Insurance Program in Taiwan. Methods: An experimental study with control group and fixed effect model were used. Two groups of people were observed from 1999 to 2002: (1) the involuntary unemployment group (n=92,562), and (2) the control group (n=92,443). The unit of observation was person-year. In order to obtain more precise estimates and control for possible confounders, the difference-in-difference (DD) method and generalized estimation equation (GEE) approach were conducted. Results: Decrease in both ambulatory and inpatient services utilizations were observed after unemployment. In terms of disease-specific utilization, 3 important findings are identified: (1) a decrease in the ambulatory utilization for respiratory diseases has been detected after unemployment; (2) no significant change in utilization for three cardiovascular diseases has been found after unemployment; (3) an increase in utilization has been identified for mental diseases after unemployment. Conclusion: A decrease in income and health effects of unemployment on medical care utilization vary among the types of diseases. One limitation in the study that we only examined the short-term (one year) effects of unemployment on medical care utilization, so it is important in the future to further investigate the possible long-term effects of unemployment on utilization.
期刊論文
1.Jin, R. L.、Shah, C. P.、Svoboda, T. J.(1995)。The Impact of Unemployment on Health: A Review of the Evidence。Canadian Medical Association Journal,153,529-540。  new window
2.Hamilton, V. H.、Merrigan, P.、Dufresne, E.(1997)。Down and out: Estimating the relationship between mental health and unemployment。Health Econ,6,397-406。  new window
3.Ruhm, C. J.(2000)。Are recession good for your health?。Q J Econ,115,617-650。  new window
4.Ruhm, Christopher J.(2003)。Good Times Make You Sick。Journal of Health Economics,22(4),637-658。  new window
5.Yang, B. M.、Prescott, N.、Bae, E. Y.(2001)。The impact of economic crisis on health-care consumption in Korea。Health Policy Plan,16,372-385。  new window
6.Crouchley, R.、Davies, R. B.(1999)。A Comparison of Population Average and Random-effect Models for the Analysis of Longitudinal Count Data with Base-line Information。Journal of the Royal Statistical Society, Series A: Statistics in Society,162(3),331-347。  new window
7.Novo, M.、Hammarström, A.、Janlert, U.(2001)。Do high level unemployment influence the health of those who are not unemployed? A gendered comparison of young men and women during boom and recession。Soc Sci Med,53,293-303。  new window
研究報告
1.Ruhm, C. J.(2003)。Healthy living in hard times。沒有紀錄。  new window
圖書
1.彭百崇(2000)。勞動經濟學。勞動經濟學。臺中。  延伸查詢new window
2.Jonathan, G.(2000)。Health Insurance and the Labor Market。Handbook of Health Economics, Vol. 1A。Amsterdam, Netherlands。  new window
3.中華經濟研究院(2002)。臺灣經濟預測2002年。臺灣經濟預測2002年。臺北。  延伸查詢new window
其他
1.行政院主計處(2001)。臺灣地區人力資源統計月報,臺北。  延伸查詢new window
 
 
 
 
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