就醫價格彈性與品質彈性之比較; The quality and own-price elasticites of the demand

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Title:	就醫價格彈性與品質彈性之比較;The quality and own-price elasticites of the demand
Authors:	曾宏棋
Contributors:	中國醫藥大學醫務管理研究所
Keywords:	價格彈性;品質彈性;門診用藥天數;兩階段最小平方法;Price Elasticity;Quality Elasticity;Visit-Days;Two-Stage Least Square
Date:	1993
Issue Date:	2009-12-24 10:55:07 (UTC+8)
Abstract:	醫療市場競爭行為究竟是「價格競爭」或「品質競爭」？品質競爭與價格競爭是醫療體系關注的議題，其實務面的原因是在健康保險的介入下，醫療院所往往透過醫療軍備競賽進行品質競爭，其結果是造成醫療費用的上漲，而且因為品質競爭所造成的醫療費用上漲，往往無法透過敬其他價格競爭的機制獲得改善，這個現象就引發學理面有趣的研究議題，而且有部分議題在學理探討上尚未完整。許多醫療院所因應較低市場集中度的方式，不是降低價格，而是提高品質。如果醫療院所考量如何增加服務量或顧客的方法中，提高品質的成本比降低價格的成本要低的話，則在利潤最大化的前提下，以提高品質來吸引病人就是理性的行為。換句話說，就單位醫療費用而言，需求的「品質彈性」(quality elasticity of demand) 如果大於價格彈性的話，供給者增加品質的行為會比降低價格更來的更有利可圖。醫療消費者對價格不敏感的原因，可能是因為健康保險的介入，也可能是因為醫療品質會主導消費者的效用函數，所以品質彈性與價格彈性的比較對醫療體系而言是相當有意義的。本文擬由另一個全新的角度來研究：（1）西醫門診利用在本研究中將以兩種單位來呈現，第一個單位是門診次數或人次（Patient Visits），第二個單位是門診人日或門診用藥天數（Visit days）（2）計算民眾的醫療需求價格彈性與品質彈性，透過彈性值的計算來推論民眾對於醫療品質的敏感程度是否大於醫療價格。本研究母群體為中央健保局中區分局轄區內四縣市(台中市、台中縣、彰化縣、南投縣)之保險對象。為了取得研究所需之樣本保險對象，以「抽取率與抽樣單位大小成比率」方法對這四縣市的保險對象抽戶，再以戶內選樣方式抽取1500位保險對象為研究樣本，並且以面訪進行資料蒐集。研究分析則採用計量經濟學對於聯立方程組模型（Simultaneous Equations Models）之聯立性檢定（Hausman test）觀察變項間的內生問題，藉以判斷是否以兩階段最小平方法（Two-stage least square；2SLS）求解。研究結果顯示，在控制了人口學特徵與健康狀態等相關變項後，醫療利用情形與醫療價格為負相關，門診用藥天數醫療價格彈性值為 -0.228；醫療利用情形與醫療品質為顯著正相關，門診用藥天數品質彈性為0.312、門診次數品質彈性為0.405。民眾就醫的品質彈性高於醫療價格，也就是說民眾醫療選擇行為，認為醫療院所的聲譽與口碑遠比醫療價格重要。以此研究結果提出政策建議之擬定方向不應只以價格管制為限，同時須對供給面予以控制，才能有效率的節制醫療費用的支出。; Price versus Quality competition in health sector? The relation between ‘quality elasticity’ and ‘price elasticity’ may be particularly likely in the health sector if consumers are not very sensitive to price because of extensive insurance coverage. Quality competition is often associated with higher investment in high-technology equipment Providers respond to lower concentration not by dropping price, but by increasing quality. Within a profit-maximising framework, this strategy would be rational if it costs the provider less to gain additional customer by increasing quality than by reducing price. In other words if, per unit of expenditure, ‘quality elasticity of demand’ is higher than price elasticity of demand, it will be more profitable for the provider to increase quality than to reduce price. Consumers are not very sensitive to price because of extensive insurance coverage and/or because quality dominates in their utility functions. It is meaningful to compare with quality elasticity and price elasticity in hospital market. This study uses the concept include:（1） Medical service utilization units will select ‘Patient-Visits’ and/or ‘Visit-Days’（2）At the same time, calculate the ‘price elasticity’ and ‘quality elasticity’ . A national sample of 1500 general insured were interview from the population in Taichung city, Taichung country, Chunghua country and Nantou country of Bureau of National Health Insurance in Taiwan. The probability proportion to size（PPS）sampling method was used. Data was analyzed by simultaneous equations models, and Hausman’s specification test was applied to test the endogenity. Study results show that after controlling demography, health status and other relative variables, outpatient’s medical service utilization and medical price are negative relationship, price elasticity of Visit-days for outpatient care is -0.228. Beside, the relationship between medical service utilization and quality is positive, quality elasticity of Visit-days is 0.312, and quality elasticity of Patient-visits is 0.405. Patient’s quality elasticity of demand is higher than price elasticity of demand that means if patients produce health service demand, they would visit hospital with good reputation and public praise. The policy implication of the study result is that cost containment policy should not confine to price control only. The supply of physician should also be one of the important strategies.
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