醫療服務市場競爭程度對住院醫療品質之影響—以 急性心肌梗塞為例
良好的競爭應有助於醫院的技術成長及醫療品質改善，並增進病患之福祉。本研究旨在
探討市場競爭程度對急性心肌梗塞住院病患之醫療品質的影響，研究發現盼能對於提昇 醫療品質有所助益。
本研究採用 2000 年至 2005 年的全民健康保險研究資料庫之住院醫療費用清單明細 檔，以 ICD-9-CM 主診斷為 410 之急性心肌梗塞住院病患就醫醫院為研究對象，探討市 場競爭程度、醫院特質、病患組成特質對於急性心肌梗塞住院病患的醫療品質之影響。
本研究以住院期間死亡率、出院後 14 日及 30 日內再住院率做為品質指標，市場競 爭程度則採用賀芬達指數，以 16 個醫療區 ( 不包含外島地區 ) 做為各醫院的市場範圍
，並以住院人日數做為市場佔有率的計算單位。控制變項則包括醫院權屬別、層級別及 服務量，以及該醫院治療之病患的年齡、性別及合併症程度組成比率。在統計方法方面
，本研究以廣義估計方程式分析市場競爭程度對急性心肌梗塞住院病患的醫療品質之影 響。 本研究的重要研究結論如下：
1. 市場競爭程度較低的醫療區，其急性心肌梗塞住院病患之死亡率較低，但再住院率較
高。2. 地區醫院及服務量較低之醫院，其急性心肌梗塞住院病患之死亡率及再住院率較高。
3. 公立醫院的急性心肌梗塞住院病患之死亡率較私立醫院高。
依據本研究之研究發現，茲提出以下幾點建議： ( 一 ) 對醫院：從提升照護品質，
並建立品牌行銷，以吸引病患前來就診。 ( 二 ) 對後續研究者：從臨床資料探究到院前 已死亡的病患，其延遲就醫的原因為何，以及疾病表現型態等議題。
Competitions can be stimulants for hospitals to have their medical techniques grown more ma ture and improve quality of healthcare. This research was focused on the medical quality amon g acute myocardial infarction(AMI) inpatients in relation to the market competition.
Using the files of inpatient expenditures by admissions and registry for contracted medical faci lities from the National Health Insurance Research Database(NHIRD) during 2000-2005, this research identified AMI inpatients by a principal diagnosis (ICD-9-CM codes 410). This study discussed the influence of the market competition, hospital characteristics and patient characte ristics on AMI inpatients’ medical quality.
The quality indicators were consisted of in-hospital mortality, readmission within 14 days and readmission within 30 days. The definition of hospital market was the 16 medical regions in T aiwan area. This study used the Herfindahl-Hirschman Index (HHI) to measure competitions a mong hospitals. Control variables included hospital characteristics(ownership, accreditation le vels and service volumes) and patient characteristics(age, sex and complications). Cochran-Ar mitage trend test and Generalized Estimating Equation were employed to analyze the relations hip between the market competition and AMI inpatients’ medical quality.
The research results were summed up as follows:
1.The lower competition area had lower mortality rate and higher readmission rate.
2.Community hospitals and lower volumes hospitals have higher mortality rate and higher rea dmission rate.
3.Public hospitals’ mortality rate was higher than private hospitals.
