透析總額制度對腎臟專科醫師執業行為的影響

୯ҥѠ᡼εᏢϦӅፁғᏢଣᙴᕍᐒᄬᆅ౛ࣴز܌!

ᅺγፕЎ!

Graduate Institute of Health Care Organization Administration College of Public Health

National Taiwan University Master Thesis!

!

೸݋ᕴᚐڋࡋჹ๝᠌஑ࣽᙴৣ୺཰Չࣁޑቹៜ The Impacts of Outpatient Dialysis Global Budgets

on Nephrologist Behavior

ࣴزғǺֆ٫ᑉ Chia-Ying Wu

ࡰᏤ௲௤Ǻ஭ᅴ␫ റγ Advisor: Ray-E Chang, Ph.D.

ύ๮҇୯ 97 ԃ 7 Д

July, 2008

ठᖴ

٫ᑉࡐ۩ၮૈ຾ΕѠεᙴᆅ܌Ǵӧ೭ٿԃޑᏢಞၸำύǴܭፐ཰ᏢಞǵፕЎ ኗቪǵೀ٣ᄊࡋϷӕᏢ࣬ೀ΢ǴࣣԖ࣬྽ӭޑԏᕇǴЈύᅈᚶགᖴǶ

གᖴࡰᏤԴৣ஭ᅴ␫റγޑಒЈࡰᏤǴаϷೀ٣ᄊࡋǵᡄᒠ܄ࡘԵޑ૽ግǶ ӕਔགᖴѠε࿶ࣴ܌ᓛܴቼԴৣӧीໆ࿶ᔮБݤᏢ΢ޑࡰᏤǴှเ٫ᑉӧࣴزБ ݤ΢ޑୢᚒǶ੝ձགᖴٿՏα၂ہ঩ፁғ࿿ୋ࿿ߏᎄӺহԴৣаϷύࣴଣ࿶ࣴ܌

ᖴ௴ྷ௲௤ӧԭԆϐύ๏ϒ٫ᑉᝊ຦ޑࡌ᝼ᆶࡰᏤǴ٬ԜጇፕЎ׳ᖿܭֹ᏾Ƕ

ࣴز܌অ཰ය໔Ǵᖴᖴ܌΢᝵഻Դৣǵླྀሎ෕Դৣǵ݅ૈқԴৣǵᗛ୯ುԴ

ৣǵഋᆄ৒Դৣޑ௲ᏤǴаϷঅಞᗬ඘ԴৣǵླྀדؼԴৣǵ᛿ᒬරԴৣǵ໳຾ᑫ Դৣޑᙴᆅ࣬ᜢፐำǴᙦ൤٫ᑉ؃ᏢޑຎഁǴ፯рਠߐࡕǴ׆ఈϝԖᐒ཮ӆӛӚ ՏԴৣፎ੻ᏢಞǶ

ӣ२ٿԃޑࣴزғғࢲǴനϿόΑޑ൩ࢂӕҒӅधޑӳ࠻϶ӵДǹ஭ৎᏢۊ ᑉᑯϷεᏢߏځ҅ޑεΚᔅԆǴ΋ଆѺ࡫ޑӳұՔ఼⃐ǵॕ։ǵγ൸ǴӕৎᏢ׌

ۂλߓ࠰ǵ܃࣓ǵ٫ᐪǵӼඵǹR95 ވ኷იޑ੦৒ǵݒ޼ǵλ޸ǵ໡Ўǵྤ๔ǵKINGǵ λइЬҺǵVICKYǹR94 ޑϘണǵဃറǵΪ৒ǵλስǵλ Bǵ܃๩ǵλқаϷё ངշ௲܃։ǵऍޙᏢۊޑ࣬ϕႴᓰᆶЍ࡭Ǵεৎჹ٫ᑉޑӳǴஒ҉ӸךЈǶ

നख़ाޑࢂाགᖴ΋ޔЍ࡭ךޑݿݿ༰༰ǴᖴᖴգॺޑངǴᡣךૈ໩ճֹԋ Ꮲ཰Ǵ٫ᑉനངݿݿ༰༰ΑǶ੝ձགᖴणݿݿϷण༰༰ჹ٫ᑉޑྣ៝Ǵ٠ගٮຬ

෇ޑՐஎᕉნǴаϷणۊۊޑ዗Јྣ៝ǴӢࣁԖգॺޑᔅշᡣךૈ໩ճ౥཰Ǵӧ Ԝठ΢૱ЈޑགᖴǶ

ֆ٫ᑉ ᙣᇞ 2008.07

ύЎᄔा

଼ߥֽܭ҇୯ 90 ԃ 7 ДჴࡼՋᙴ୷ቫᕴᚐႣᆉڋࡋǴයఈᙖҗႣӃ೛ۓᕴᚐ ႣᆉޑБԄǴ٠ᙖҗӕᏆڋऊߦ຾ӝ౛ᙴᕍ୍ܺሽໆޑගٮǴаԖਏ௓ڋᙴᕍ຤

ҔǶЍбڋࡋޑϟΕϷׯᡂ཮ቹៜᙴᕍගٮޣޑᙴᕍՉࣁǴ຾Զቹៜᙴᕍၗྍ઻

Ҕޑ௃׎ǶԶ೸݋୍ܺឦଯ୍ܺໆϷଯൂሽϐᙴᕍ୍ܺ໨ҞǴЪԋߏזೲǴ٠ܭ ӚᕴᚐႣᆉޑϩଛࢎᄬύ೏ᐱҥጓӈႣᆉǴࡺҁࣴزԑӧ௖૸Ջᙴ୷ቫᕴᚐႣᆉ ڋࡋΠǴߐບ೸݋ᕴᚐჹ୷ቫଣ܌๝᠌஑ࣽᙴৣ୺཰ՉࣁޑቹៜǶ

ҁࣴزࣁ΋Ծฅჴᡍ(natural experiment)Ǵа 1999 ԃ 7 ДԿ 2002 ԃ 6 Д໔Ǵ ڀ๝᠌஑ࣽ୺ྣЪම୺Չ೸݋୍ܺᙴৣࣁࣴزჹຝǴஒа஑ឦܭ୷ቫଣ܌ᙴৣࣁ ჴᡍಔǴӦ୔ᙴଣᙴৣࣁჹྣಔǴ௦Ҕৡ౦ύϐৡ౦ݤᆶ GEE ՗ी଑ᘜኳࠠϐ಍

ीБݤǴၮҔӄ଼҇நߥᓀࣴزၗ਑৤຾Չϩ݋ǴаᙶమՋᙴ୷ቫᕴᚐႣᆉڋࡋ ჹ୷ቫଣ܌๝᠌஑ࣽᙴৣՉࣁޑቹៜǶ

ҁࣴزЬाࣴز่ፕӵΠǺ

(1) Ջᙴ୷ቫᕴᚐႣᆉڋࡋჴࡼ߻Ǵ࣬ၨܭӦ୔ᙴଣǴ୷ቫଣ܌๝᠌஑ࣽᙴৣёૈ

ӸӧႣයЈ౛Ǵග߻ቚуߐບ೸݋୍ܺޑᙴᕍ຤ҔᗺኧЪᡉ๱ԋߏǴᡉҢᕴᚐ ႣයਏᔈዴჴӸӧǶ

(2) ࣬ၨܭӦ୔ᙴଣǴՋᙴ୷ቫᕴᚐႣᆉڋࡋჴࡼࡕǴᕴᚐਏᔈჹ୷ቫບ܌๝᠌஑

ࣽᙴৣ೸݋୍ܺǴԖ҅ӛޑቹៜǴՠόᡉ๱Ǵёૈڙज़ܭࣴز΢ޑज़ڋǴᏤठ คݤዴᇡԜਏᔈǶ

ᆕӝ΢ॊǴҁࣴزࡌ᝼ፁғЬᆅᐒᜢӧཥࡹ฼ჴࡼ߻ࡕǴሡԵໆᙴᕍගٮޣ ჹࡹ฼ϟΕޑႣයЈ౛ǴϷࡹ฼ჴࡼࡕᙴৣՉࣁޑׯᡂǴёႣӃᔕۓᆅ౛฼ౣǴ ঈ٬ዴߥࡹ฼Ҟ኱ԖਏၲԋǴ٠फ़եځдόటـϐԛਏᔈǶ

ᜢᗖӷǺՋᙴ୷ቫᕴᚐႣᆉڋࡋǵߐບ೸݋୍ܺǵᙴৣՉࣁ

Abstract

BackgroundΚNational Health Insurance implemented the global budget for primary

care since July 2001. With expectations of the pre-set amount of budget caps and the

mechanism of peer review to promote the reasonable price of medical services provided,

and effective control medical costs. It is widely accepted that payment will affect how

physicians practice medicine, thereby affecting consumption of medical resources.

Dialysis care is a high-volume, high-priced medical service, and the number of patient

requiring dialysis increase rapidly. Besides, the budget allocation framework of the

provision was an independent budget.

ObjectiveΚThe purpose of this study is to investigate the impacts of outpatient dialysis

global budgets on nephrologist behavior.

MethodsΚThis research is a natural experiment. The study subjects are licensed

nephrologists who had practiced dialysis services from July 1999 to June 2002. Using

National Health Insurance Research database for research, the nephrologists practicing

in clinics are the experimental group, and the nephrologists in district hospitals are the

control group. Adopting the differences-in-differences method and generalized

estimation equation approach, the impacts of outpatient dialysis global budgets on

nephrologist behavior were analyzed.

Findings:

1. Compared to the nephrologists of district hospitals, prior to the implementation of

outpatient dialysis global budgets, the nephrologists of clinics may have anticipations

effect and therefore increase outpatient dialysis services in advance. Medical expenses

also increase significantly.

2. Compared to the nephrologists of district hospitals, after the implementation of

outpatient dialysis global budgets, the global budgets of dialysis services have

positively affected the services provided by nephrologists.

The results suggested that the health administration should develop management

strategies in advance in order to reduce expectation effects and adverse policy effects

before a policy is implemented.

Key word: global budget; dialysis services; physician behavior

Ҟᒵ

α၂ہ঩཮ቩۓਜठᖴ ...I ठᖴ ... II ύЎᄔा ...III ABSTRACT ... IV Ҟᒵ ... VI ߄Ҟᒵ ...VIII კҞᒵ ... IX

ಃ΋ക ᆣፕ ... 1

ಃ΋࿯ ࣴزङඳᆶ୏ᐒ... 1

ಃΒ࿯ ࣴزҞޑ... 4

ಃΒക Ў᝘௖૸ ... 5

ಃ΋࿯ ୯ϣѦ҃ය๝᠌ੰ౜ݩ... 5

ಃΒ࿯ ӄ଼҇நߥᓀ೸݋୍ܺЍбڋࡋϐݮॠ... 10

ಃΟ࿯ Ѝбڋࡋϐ଄୍ᇨӢჹᙴৣՉࣁޑቹៜ... 14

ಃѤ࿯ ᕴᚐႣᆉڋࡋჹᙴৣՉࣁޑቹៜϐჴ᛾ࣴز... 19

ಃϖ࿯ ୯ϣᕴᚐڋࡋჹ೸݋୍ܺϐቹៜ... 22

ಃΟക ࣴزБݤ ... 23

ಃ΋࿯ ࣴز೛ीᆶࣴزࢎᄬ... 23

ಃΒ࿯ ࣴزଷᇥ... 28

ಃΟ࿯ ࣴزᡂ໨... 29

ಃѤ࿯ ࣴز׷਑ᆶၗ਑ೀ౛... 30

ಃϖ࿯ ಍ीБݤ... 33

ಃѤക ࣴز่݀ ... 36

ಃ΋࿯ ๝᠌஑ࣽᙴৣ੝፦... 36

ಃΒ࿯ ๝᠌஑ࣽᙴৣՋᙴߐບ୍ܺϐᖿ༈ϩ݋... 38

ಃΟ࿯ ๝᠌஑ࣽᙴৣՋᙴߐບ୺཰୍ܺϐৡ౦ύޑৡ౦ݤϩ݋... 40

ಃѤ࿯ ๝᠌஑ࣽᙴৣՋᙴߐບ୺཰୍ܺϐ଑ᘜϩ݋... 42

ಃϖ࿯ ࣴز่݀λ่... 46

ಃϖക ૸ፕ ... 47

ಃ΋࿯ ࣴز่݀૸ፕ... 47

ಃΒ࿯ ࣴزज़ڋ... 50

ಃϤക ่ፕᆶࡌ᝼ ... 52

ୖԵЎ᝘ ... 54

ύЎ೽ҽ ... 54

मЎ೽ҽ ... 57

ߕᒵ ... 59

߄Ҟᒵ

߄ 2-1-1 1999-2006 ԃ୯ϣ೸݋ੰΓኧ಍ी߄ ... 6

߄ 2-1-2 1999-2005 ԃऍ୯๝᠌ၗ਑ฦᒵس಍Ӛ୯ ESRD ಍ी ... 7

߄ 2-1-3 ך୯೸݋ᙴᕍ຤Ҕ 2001-2007 ԃ಍ी᏾౛... 8

߄ 2-1-4 ࢱ๝ੰ஻ϐख़ε໾ੰ຤Ҕ 1999-2006 ԃ಍ी... 9

߄ 2-1-5 ୯ϣ೸݋ᙴᕍٮ๏ 1999-2006 ԃ಍ी᏾౛... 9

߄ 3-3-1 ࣴزᡂ໨ϐᏹբࠠۓက... 29

߄ 4-1-1 ჴᡍಔᆶჹྣಔ๝᠌஑ࣽᙴৣϐ୷ҁၗ਑... 37

߄ 4-2-1 ѳ֡؂ՏᙴৣՋᙴߐບ୍ܺᙴᕍ຤Ҕᗺኧ... 39

߄ 4-3-1 ๝᠌஑ࣽᙴৣՋᙴߐບ୺཰୍ܺϐৡ౦ύޑৡ౦ݤϩ݋... 41

߄ 4-4-1 ๝᠌஑ࣽᙴৣՋᙴߐບ୺཰୍ܺϐ଑ᘜϩ݋ˇᕴᚐႣයਏᔈ... 44

߄ 4-4-2 ๝᠌஑ࣽᙴৣՋᙴߐບ୺཰୍ܺϐ଑ᘜϩ݋ˇᕴᚐਏᔈ... 45

߄ 4-5-1 Ӛය໔ϐৡ౦ύޑৡ౦... 46

კҞᒵ

კ 3-1-1 ࣴز೛ी... 25

კ 3-1-2 ࣴزࢎᄬ... 27

კ 3-4-1 ๝᠌஑ࣽᙴৣኬҁᒧڗࢬำ... 32

კ 3-5-1 ࣴزය໔Ӛਏᔈϩ݋კ... 34

კ 4-2-1 ๝᠌஑ࣽᙴৣ೸݋୍ܺᙴᕍ຤Ҕᗺኧ... 39

ಃ΋ക ᆣፕ

ҁകӅϩࣁٿ࿯Ǵಃ΋࿯ϟಏࣴزङඳᆶ୏ᐒǹಃΒ࿯ࣁҁࣴزϐࣴزҞޑǶ

ಃ΋࿯ ࣴزङඳᆶ୏ᐒ

ᙴᕍ຤ҔޑଯᅍࢂШࣚӚ୯܌य़ᖏޑᜤᚒǴ઱઱௢୏࣬ᜢࡹ฼׆ఈૈှ،Ԝ ᜤᚒǴԶவٮ๏य़๱ЋԋࣁёаԖਏ௓ڋᙴᕍޑ٬Ҕᆶ຤ҔޑԋߏޑБԄϐ΋Ƕ ך୯Ԗ᠘ܭϦമၭߥਔය௦ፕໆीၿЍбڋࡋǴᙴᕍ຤Ҕޑ࡚ೲԋߏǴ೷ԋ଄୍

ᝄख़ᖝཞǴӄ଼҇நߥᓀೕჄਔǴջஒჴࡼᕴᚐЍбڋࡋયΕೕჄख़ᗺǴ٠ܭӄ

଼҇நߥᓀݤಃ 47 చԿಃ 49 చǵಃ 54 చܴЎೕۓǶӄ଼҇ߥ໒ᒤ߃යЍбБԄ Ьा௦Չፕໆीၿ(fee for service)Ǵᙴᕍ୍ܺගٮޣલЮϩᏼ଄୍॥ᓀϷ࿯ऊᙴᕍ

ၗྍޑᇨӢǴ٬ளᙴᕍ຤Ҕόᘐ΢ᅍǴܭ҇୯ 87 ԃ໒ۈр౜ԏЍόѳᑽ௃׎Ǵࣁ Αှ،Ԝ΋ୢᚒǴ଼ߥֽ೴؁٩ӄ଼҇நߥᓀݤೕۓ௢ՉᕴᚐЍбڋࡋǴයఈᙖ җႣӃ೛ۓᕴᚐޑБԄǴԖਏ௓ڋ຤ҔޑଯᅍǶԾ 1998 ԃ 7 Д२ӃჴࡼУᙴߐ ບᕴᚐǴϐࡕഌុܭ 2000 ԃ 7 ДჴࡼύᙴߐບᕴᚐǴ2001 ԃ 7 ДჴࡼՋᙴ୷ቫᕴ ᚐǴ2002 ԃ 7 ДჴࡼᙴଣᕴᚐǴԿԜǴᙴᕍ຤ҔЍбςදၹڙډᕴᚐႣᆉᆅ౛(ӄ

଼҇நߥᓀᙴᕍ຤Ҕڐۓہ঩཮Ǵ2005)Ƕ

ᙴᕍ୍ܺၸำύǴᙴৣࣁӚᅿᙴᕍྣៈϷݯᕍБݤޑЬा،฼ޣǴჹᙴᕍၗ

ྍϷ຤ҔԖࡐεޑቹៜǶԶᕴᚐЍбڋࡋջаڐ୘ႣᆉБԄٰЇᏤᙴᕍ୍ܺޑග ٮǴаڐۓᙴᕍЍрᕴᚐ،ۓߥᓀ଄୍ᝢ௛ǴᙖԜӝ౛௓ڋᙴᕍ຤ҔǴ٠ᙖҗӕ Ꮖڋऊߦ຾ᙴᕍ୍ܺሽໆޑӝ౛ගٮǶԜѦǴך୯ჴࡼᕴᚐЍбڋࡋҞޑۘхࡴ

೸ၸ໣ᡏڐ୘ှ،б຤ޣᆶٮ๏ޣճ੻ፂँǴගܹ஑཰ԾЬ៾Ǵ٠ஒࠔ፦Ϸ҇౲

଼நયΕᕴᚐڐ୘ϦԄǴයаᏤ҅ᙴᕍՉࣁ฻฻(ӄ଼҇நߥᓀᙴᕍ຤Ҕڐۓہ঩

཮Ǵ2003)ǶҗԜёޕǴჴࡼᕴᚐЍбڋࡋЬाаׯᡂ࿶ᔮᇨӢޑБԄ຾Զቹៜٮ

๏य़ᙴᕍගٮՉࣁǴҞޑନΑԖਏ௓ڋᙴᕍ຤ҔԋߏѦǴటЇᏤᙴৣՉࣁ׳ᖿӝ

౛ϯǶӢԜǴᕕှᕴᚐЍбڋࡋޑϟΕჹᙴৣՉࣁ܌೷ԋޑቹៜ൩ᡉள࣬྽ख़ाǶ

ӧჴࡼᕴᚐႣᆉڋࡋޑӚ೽ߐύǴߐບ೸݋୍ܺவ 90 ԃ 7 ДՋᙴ୷ቫᕴᚐ໒ ۈǴςᐱҥࣁ΋ൂᐱλᕴᚐǹӧೕჄᙴଣᕴᚐਔǴҭஒ೸݋୍ܺुࣁ੝ձႣᆉϐ

΋Ǵ٠ܭ 92 ԃ 1 Д໒ۈӄय़௢୏ߐບ೸݋ᐱҥᕴᚐǴӚԾவᙴଣᕴᚐ೸݋୍ܺᆶ Ջᙴ୷ቫࢱ๝೽ߐႣᆉӝٳࣁൂ΋ᕴᚐǴҗᙴଣቫભϷ୷ቫଣ܌Ӆӕᒤ౛᏾ӝ܄

ᙴᕍྣៈ୍ܺǶԶሡाۓයௗڙ೸݋୍ܺޑੰΓǴܭ 2006 ԃऊ 5 ࿤ 2 ίΓǴэ܌

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ᄬύ೏ᐱҥ૸ፕ٠ጓӈႣᆉǴᡉҢόፕӧᙴᕍྣៈ܈଼ߥ଄୍ࣣ׎ԋख़ाޑϦӅ ፁғ᝼ᚒǶ

ԶᕴᚐႣᆉڋࡋΠǴᙴᕍճҔ௓ڋޑԋ݀ό΋Ǵՠܭ౛ፕኳࠠ௢Ꮴ΢Ǵ่݀

ӭࣁᙴৣ཮௦ڗᝡݾ฼ౣǴቚу܌ගٮޑ୍ܺǴଓ؃ঁΓനεճዎ(Benstetter and Wambach, 2006ǹFan, Chen, and Kan, 1998ǹഋ෕፣ǵቅறঙǵ݅ࡌϘǵԙη⊭ǵ ߋЎၲǴ2003ǹ೚ᅺ޹ǵླྀ໡࣓Ǵ2007)ǴЪ୯ϣԖᜢУᙴᕴᚐǴᡉҢᙴৣ཮ᒧ᏷

ቚу୍ܺໆǵගଯ؂ԛ࣮ບݯᕍஏࡋϷҙൔߎᚐǴ܈ᒧ᏷๏бߎᚐၨଯϷԖճё კޑ୍ܺ໨Ҟ(ᄃℱ๤Ǵ2000ǹᖴችृǴ2003ǹՖྻǵ໳଻൏Ǵ2005)ǶՋᙴ୷ቫᕴ ᚐڋࡋჹບ܌ܭ೸݋୍ܺޑቹៜǴ஭੻၈کᄃֻৱ(2002)ϷЦذᑯ(2002)ࣴز่݀

ࡰрǴບ܌೸݋୍ܺᕴҙൔᗺኧϷҹኧࣣࣁ΢ϲǴՠவບ܌فࡋٰຑ՗ᙴৣՉࣁ ٠όֹ᏾Ǵёૈӵ൹ᒸᕉ(2003)ࣴز่݀΋ኬǴᕴᚐࡕ೽ҽ೸݋ບ܌ӧΓΚᆶ೛ഢ

΢Ԗᘉεೕኳޑᖿ༈ǴࢂӢࣁᙴৣኧޑቚуԶቚуບ܌ᕴҙൔᗺኧǴЪځቚуচ ӢҭёૈࣁځѬӢન೷ԋԶߚՋᙴ୷ቫᕴᚐڋࡋǴᔈϒа௨ନǶ

ԜѦǴЍбڋࡋჴࡼჹᙴৣ܌஥ٰޑႣයЈ౛ቹៜҭ࣬྽ख़ाǴHenke ฻Γ (1994)߄Ңቺ୯ᕴᚐჴࡼ߃යǴӧ೛ۓᕴᚐᚐࡋਔǴࣁᗉխჴࡼ߻΋ԃᙴৣ٣Ӄቚ уځ୍ܺໆǴ٬ځीᆉ୷ྗԃϐᚐࡋᡂӭǴࡺаჴࡼ߻ٿԃࣁځᚐࡋ೛ۓ୷ྗԃǶ

Ջᙴ୷ቫᕴᚐϐ߻܌ჴࡼޑУᙴᕴᚐϷύᙴᕴᚐǴځीᆉཥԃࡋᕴᚐᚐࡋϐ୷ྗ

ԃࣁ߻΋ԃǴԶך୯ፁғ࿿Ӄܭ 88 ԃ 9 ДԋҥȨՋᙴ୷ቫߐບᕴᚐЍбڋࡋࣴ᝼

λಔȩǴՋᙴ୷ቫᕴᚐࣴ᝼Бਢ೛ۓ୷ྗԃҭࣁ߻΋ԃǴ๝᠌஑ࣽᙴৣࢂցԖႣය Ј౛Զග߻ϸᔈǴׯᡂځᙴৣՉࣁǴҭࢂ࣬྽ख़ाޑ᝼ᚒǶ

೸݋୍ܺࢂߏයǵፄᚇϷଯ຤ҔǴឦଯ୍ܺໆЪଯൂሽϐᙴᕍ୍ܺ໨ҞǴЪ ӧך୯ӚᕴᚐႣᆉޑϩଛࢎᄬύǴߐບ೸݋୍ܺ೏ᐱҥ૸ፕ٠ጓӈႣᆉǴᡉҢ೸

݋୍ܺ܌઻Ҕޑᙴᕍ຤ҔӧᕴᚐႣᆉύתᄽ࣬྽ख़ाޑفՅǶԶ୯ϣҞ߻௖૸Ջ ᙴ୷ቫᕴᚐჹ೸݋୍ܺޑቹៜǴЬाаࣴزჹ೸݋ੰΓᙴᕍճҔޑቹៜǴԶٮ๏

य़ޑ௖૸߾аບ܌ࣁࣴزჹຝǴ٠ߚவᙴৣفࡋ๱ЋǴځࣴز่݀٠ค௨ନځд ёૈቹៜӢનǴᜤаᙶమࢂցࣁՋᙴ୷ቫᕴᚐޑቹៜǴࡺҁࣴزஒ௖૸Ջᙴ୷ቫ ᕴᚐࡕჹ୷ቫଣ܌๝᠌஑ࣽᙴৣՉࣁ܌೷ԋޑቹៜǴϷჴࡼ߻ᙴৣࢂցڀႣයЈ

౛Զග߻ϸᔈǴׯᡂځᙴৣՉࣁǴ٠೛࿼ځჹྣಔаᙶమՋᙴ୷ቫᕴᚐ܌஥ٰޑ ਏᔈǶ

ಃΒ࿯ ࣴزҞޑ

଼ߥֽයఈᙖҗႣӃ೛ۓᕴᚐႣᆉޑБԄǴԖਏ௓ڋ຤ҔޑଯᅍǶ೚ӭЎ᝘

ࡰрߥᓀЍбڋࡋޑϟΕϷׯᡂ཮ቹៜᙴᕍගٮޣޑᙴᕍՉࣁǴ຾Զቹៜᙴᕍၗ

ྍ઻Ҕޑ௃׎ǴӢԜዴϪΑှЍбڋࡋӵՖቹៜᙴৣՉࣁࢂ࣬྽ख़ाޑǶࡺҁࣴ

زа 1999 ԃԿ 2002 ԃ໔ೱុѤԃڀ๝᠌஑ࣽ୺ྣЪ୺Չ೸݋ݯᕍϐ୷ቫບ܌๝

᠌஑ࣽᙴৣǴϷځჹྣಔϐ๝᠌஑ࣽᙴৣǴᢀჸך୯ܭ 2001 ԃ 7 ДჴࡼՋᙴ୷ቫ ᕴᚐ߻ࡕᙴৣՉࣁޑ௃׎Ǵය೚а଺ࣁ҂ٰ࣬ᜢࡹ฼ڋुϐୖԵǶҁࣴزЬाޑ

ࣴزҞޑӵΠǺ

΋ǵʳ Αှ 1999 ԃ 7 ДԿ 2002 ԃ 6 Д໔ೱុΟԃڀ๝᠌஑ࣽ୺ྣЪ୺Չ೸

݋ݯᕍϐ๝᠌஑ࣽᙴৣϐߐບ೸݋୍ܺ୺཰௃׎Ƕ

Βǵʳ ௖૸ӧՋᙴ୷ቫᕴᚐڋࡋჴࡼ߻Ǵ୷ቫບ܌ϐ๝᠌஑ࣽᙴৣࢂցӸӧ ႣයЈ౛Ǵග߻ׯᡂځ୺཰ՉࣁǶ

Οǵʳ ௖૸Ջᙴ୷ቫᕴᚐڋࡋჹ୷ቫບ܌๝᠌஑ࣽᙴৣ୺཰ՉࣁޑቹៜǶ

ಃΒക Ў᝘௖૸

ҁകЬा௖૸᏾౛୯ϣ೸݋౜ݩаϷՋᙴ୷ቫᕴᚐڋࡋჹᙴৣՉࣁޑቹៜϐ

࣬ᜢЎ᝘Ǵϩࣁϖλ࿯Ǻಃ΋࿯ϟಏ୯ϣѦ҃ය๝᠌ੰ౜ݩǹಃΒ࿯߾ᇥܴӄ҇

଼நߥᓀ೸݋୍ܺЍбڋࡋϐݮॠǹಃΟ࿯ࣁЍбڋࡋϐ଄୍ᇨӢჹᙴৣՉࣁޑ ቹៜǹಃѤ࿯ࣁᕴᚐႣᆉڋࡋჹᙴৣՉࣁޑቹៜϐჴ᛾ࣴزǹಃϖ࿯߾ࣁ୯ϣᕴ ᚐڋࡋჹ೸݋୍ܺϐቹៜǶ

ಃ΋࿯ ୯ϣѦ҃ය๝᠌ੰ౜ݩ

΋ǵ҃ය๝᠌ੰ(End-Stage Renal Disease , ESRD)

Γᡏ๝᠌ޑфૈନΑ௨ݧ؂Вيᡏ܌ౢғޑ֖ේቲނѦǴۘԖჹНҽǵႝှ

፦ᆶለᡵޑѳᑽǵआՈౚғԋન(Erythropoietin, EOP)ᆶᆢғન D ޑᇙ೷ǵՈᓸፓ

࿯Ϸ಻ᅟᆾжᖴ฻фૈǶȨ๝૰ᆃȩࣁ๝᠌фૈեΠޑᕴᆀǴΞϩࣁ࡚܄ᆶᄌ܄๝

૰ᆃǶ࡚܄๝૰ᆃࢂࡰอය໔๝фૈِೲൾϯǴځচӢࡐӭǴதวғܭՐଣၸำ ύǴЪၨԖࡠൺޑᐒ཮ǹԶᄌ܄๝૰ᆃ(Chronic Kidney Disease , CKD)ࣁόё଍ǵ ᅌ຾܄ൾϯޑǴځੰӢӭࣁᑗֿੰǵଯՈᓸǵ๝ํౚ๝ݹ܌ЇଆǴऍ୯๝᠌୷ߎ

཮ჹ๝фૈ౦தၲ 3 ঁД܈а΢ޣۓကࣁᄌ܄๝ੰǴ٠а๝ํౚၸᘠೲ౗

(Glomerular Filtration Rate)ஒੰำϩϖයǴԶനࡕ΋යջࣁ҃ය๝᠌੯ੰ(End-Stage Renal Disease , ESRD)Ǵ߫ᆀȨֿࢥੱȩǴԜਔ๝фૈཱུࡋ૰ଏǴቹៜӄيౢғቶݱ

ੱރ (ጰߞֻǵഋ଼ѳǴ2002)ǴԜᜪੰ஻ӧ୯ϣ࿶๝᠌஑ࣽᙴৣቩࢗᇡۓࡕջϒ วܫख़ε໾ੰьǶ

ӧݯᕍБय़Ǵҗܭᄌ܄๝૰ᆃޑੰำࢂ೴؁ว৖ޑǴӢԜόӕ໘ࢤԖόӕޑ ݯᕍচ߾Ƕӧ҂ၲ҃ය๝૰ᆃਔǴ௦ՉЍ࡭܄ᕍݤǴӵ໯१௓ڋǵϣࣽᛰނݯᕍ

฻ǹऩ຾Ε҃ය๝૰ᆃЪϣࣽᛰނݯᕍคਏਔǴ߾Ѹ໪௦Չ๝᠌ඹжݤ(Renal replacement therapy, RRT)аᆢ࡭ғڮǴх֖Ոన೸݋(Henodialysis, HD ;߫ᆀࢱ

๝)ǵဎጢ೸݋(Peritoneal dialysis, PD ;߫ᆀࢱغη)܈๝᠌౽෌Ǵځݯᕍࢂߏයǵፄ ᚇϷଯ຤Ҕޑၸำ((Mallick and Gokal 1999ǹጰߞֻǵഋ଼ѳǴ2002)Ƕ

Βǵวғ౗Ϸ౰Չ౗

Ѡ᡼߈ԃٰ೸݋ੰΓև౜࡭ុቚуޑᖿ༈ǴЪวғ౗Ϸ౰Չ౗ۚଯόΠ(߄ 2-1-1)Ƕऍ୯๝᠌ၗ਑ฦᒵس಍ȐUSRDSȑ2005 Կ 2007 ԃൔ֋ᡉҢ(߄ 2-1-2)ǴШ

ࣚӚ୯҃ය๝ੰวғ౗؂ԃ࡭ុ΢ϲǴځύѠ᡼Ծ 2000 ԃаٰ҃යᄌ܄๝૰ᆃ (ESRD)วғ౗΋ޔଯۚШࣚಃ΋ǴԶ౰Չ౗ӧ 2000 ԃϐ߻໻ԛܭВҁ௨ӜಃΒǴ Ծ 2001 ԃ໒ۈ߾௨ӜШࣚಃ΋ (USRDS, 2006, 2007, 2008)Ƕ

߄ 2-1-1 1999-2006 ԃ୯ϣ೸݋ੰΓኧ಍ी߄ ԃҽ ߐບ೸݋

ੰΓኧ ԋߏ౗ Ոన೸݋ ဎጢ೸݋

ख़ε໾ੰ

ьሦ᛾ኧ ԋߏ౗

1999 … … … … 31,405 … 2000 … … … … 36,984 17.76%

2001 … … … … 38,465 4.00%

2002 42,465 … … … 44,916 16.77%

2003 45,766 7.77% 92.98% 7.02% 49,824 10.93%

2004 48,978 7.02% 92.73% 7.27% 48,200 …*

2005 52,601 7.40% 92.60% 7.40% 50,022 3.78%

2006 55,388 5.30% 92.24% 7.76% 52,081 4.12%

ၗ਑ٰྍǺ93-96 ԃӄ଼҇நߥᓀᕴᚐЍбڋࡋڐ୘ୖԵࡰ኱ाំǵ88-95 ԃ଼ߥ಍ीၗ਑

ຏǺᄌ܄ੰ๝૰ᆃख़ε໾ੰьኧࣁԃۭԖਏሦ᛾ኧǴԋߏ౗߯ᆶ߻΋ԃӕය࣬КၨǶ

Ȩ*ȩǺ଼ߥᕴᚐЍбڋࡋڐ୘ୖԵࡰ኱ाំ߄ҢǴ߯Ӣ଼ߥֽᙴᕍᆅ౛཰୍ܭ 93 ԃ 8 Д 25 В໒ ۈׯࣁಃΒжᙴᕍၗૻس಍Ǵ಍ी਱Ԅǵϣ৒ϷीᆉБԄᡂ׳Ǵ93 ԃ 12 Дჴሞሦ᛾ኧၨ߻΋ԃ ෧Ͽ஭ 1,625Ǵՠவၗ਑ኧᏵٰ࣮ᔈࣁ 1,624Ƕ

߄ 2-1-2 1999-2005 ԃऍ୯๝᠌ၗ਑ฦᒵس಍Ӛ୯ ESRD ಍ी

Ѡ᡼ Вҁ ऍ୯ Ѡ᡼ Вҁ ऍ୯

ԃࡋ วғ౗ (؂ԭ࿤Γα) ౰Չ౗ (؂ԭ࿤Γα) 1999 306 231 320 1,401 1,443 1,312 2000 353 242 324 1,526 1,616 1,378 2001 368 251 334 1,644 1,640 1,403 2002 395 256 338 1,792 1,726 1,451 2003 407 262 342 1,872 1,797 1,496 2004 405 267 346 1,902 1,857 1,540 2005 404 … 351 1,830 … 1,585

ၗ਑ٰྍǺ The United States Renal Data System Annual Data Report 2005-2007 ԃ

Οǵ೸݋ੰ஻Γα੝፦

୯ϣௗڙ೸݋ޑੰΓ҃යᄌ܄๝૰ᆃวੰচӢа๝ౚํ๝ݹ(38.95%)ǵᑗֿੰ

(28.22%)ǵ๝໔፦๝ݹ(7.19%)ϷଯՈᓸ(3.62%)ࣁനӭ(Ѡ᡼๝᠌ᙴᏢ཮Ǵ2006)Ƕӧ Ѡ᡼೸݋୍ܺύǴᐕԃٰаՈన೸݋ࣁЬǴऊ՞᏾ঁ೸݋୍ܺ 92%(߄ 2-1-1)Ƕߐ ບ೸݋ᕴᚐ஑཰ᙴᕍ୍ܺࠔ፦ൔ֋ᡉҢǴܭ 94 ԃԿ 96 ԃಃ 2 ۑޑՈన೸݋ੰΓ ѳ֡ԃសऊ 60 ྃǴЪԃសεܭ 65 ྃޣऊ՞ 41%ǴԶဎጢ೸݋ੰΓѳ֡ԃសऊ 50

ྃǴځԃសεܭ 65 ྃޣऊ՞ 18% (ύѧ଼நߥᓀֽǴ2008b)Ǵё௢՗೸݋ੰΓа

᏾ᡏԃសаԴԃΓα՞εӭኧǶऍ୯ԴԃΓα౰Չ౗؂ԃቚу 5~8%ǴᡉҢ೸݋஻

ޣԖԴԃϯϐ௃׎(Reikes, 2000)ǶԜѦǴEggers(2000)߄ҢӚ୯೸݋ੰΓޑԴΓϷ ᝄख़ӝٳੱ஻ޣǴ੝ձࢂᑗֿੰੰ஻ޑуΕ٬ள᏾ᡏޑ೸݋ΓαεࣁቚуǶ

Ѥǵ೸݋ੰ஻ᙴᕍ຤Ҕ

ך୯᏾ᡏ೸݋ᙴᕍ຤Ҕόᘐଯᅍ(߄ 2-1-3)Ǵऊ՞᏾ᡏᙴᕍ຤Ҕ 6%Ǵՠࢂ೸݋

ੰΓѝ՞൩ᙴΓαޑ 0.2%ǴќѦ൩ࢱ๝ੰ஻ܭख़ε໾ੰ຤Ҕޑ಍ीǴӢࣁ຤Ҕ఼

ᇂᄌ܄๝᠌ੰ࣬ᜢݯᕍ຤ҔǴନ೸݋຤ҔѦǴᗋԖځдߚ೸݋ߐບǵ࡚ບϷՐଣǴ

ࡺځᙴᕍ຤Ҕ՞᏾ᡏᙴᕍ຤Ҕऊ 7%(߄ 2-1-4)ǴᡉҢϿኧޑ೸݋ੰΓ٬Ҕ࣬྽εК ٯޑ଼ߥႣᆉǴځ՞᏾ᡏᙴᕍ຤ҔКٯ೴ԃቚуǶ

Զऍ୯ޑ҃ය๝᠌ੰ(ESRD)຤Ҕҭ೴ԃ΢ϲǴ1999 ԃԿ 2004 ԃ໔ԋߏΑ 57%ǴЪ՞ऍ୯ Medicare ᕴЍр 6.7%Ǵ҃ය๝᠌ੰੰΓѝ՞ऍ୯Γαޑ 0.03%(Foley and Collins, 2007)ǴҭᡉҢϿኧੰΓ٬Ҕ࣬྽εКٯޑᙴᕍ຤ҔǶЪ᏾౛୯ϣѦ࣬

ᜢЎ᝘ࡕว౜Ǵ҃ය๝᠌ੰੰΓӭኧڀӝٳੱǴҭԖԴԃϯ௃׎Ǵ٬ள೸݋ੰ஻

ޑᙴᕍ຤Ҕ׳ଯǴځύаᑗֿੰǵЈՈᆅ੯ੰӝٳੱϷԃសᡉ๱ቹៜᙴᕍ຤Ҕ(Lee et al., 2002; Salonen, Reina, Oksa, Sintonen, and Pasternack, 2003; Sesso et al., 2007;

St Peter, Khan, Ebben, Pereira, and Collins, 2004; ஭ᅸҏǵ໳ۘדǵЛಹ໥Ǵ2000; ᎄ

ਁ׊ǵߠֻரǵᒲቼЎǴ2005)Ƕ

߄ 2-1-3 ך୯೸݋ᙴᕍ຤Ҕ 2001-2007 ԃ಍ी᏾౛

ᙴᕍ຤ҔЍр ᙴᕍ୍ܺճҔ

ԃж ຤ҔЍр

(ԭ࿤ϡ) ԋߏ౗ эᕴЍр ԭϩК

຤Ҕᗺኧ

(ԭ࿤ᗺ) ԋߏ౗ ൩ᙴ౗

2001 … … … 19732 … … 2002 19,663 … 5.46% 21455 8.73% … 2003 22,444 14.14% 5.97% 23,371 8.93% 0.21%

2004 24,240 8.00% 6.19% 24,984 6.90% 0.22%

2005 25,985 7.20% 6.39% 26,544 6.24% 0.24%

2006 27,721 6.68% 6.56% 28,181 6.17% 0.25%

2007 28,521 2.89% 6.44% … … …

ၗ਑ٰྍǺ93-96 ԃӄ଼҇நߥᓀᕴᚐЍбڋࡋڐ୘ୖԵࡰ኱ाំ

ຏǺ൩ᙴ౗ࣁ྽ԃ࣮ບΓԛᘜЊࡕ൩ᙴΓኧ/4 ۑۑύ(2ǵ5ǵ8ǵ12 Д)ߥᓀჹຝΓኧ֡ኧ

߄ 2-1-4 ࢱ๝ੰ஻ϐख़ε໾ੰ຤Ҕ 1999-2006 ԃ಍ी

ԃж ߐՐບᕴᗺኧ ՞ᕴख़ε໾ੰ຤Ҕ ՞ᕴ຤Ҕ

1999 18,183,053,825 33.91% 6.24%

2000 20,151,600,257 33.69% 6.79%

2001 22,325,235,377 33.34% 7.17%

2002 24,501,723,791 31.82% 7.21%

2003 26,574,755,534 30.91% 7.52%

2004 28,919,881,243 27.49% 7.10%

2005 30,665,877,042 27.65% 7.30%

2006 32,701,447,250 28.48% 7.72%

ၗ਑ٰྍǺ88-95 ԃፁ࿿ӄ଼҇நߥᓀ಍ी

ϖǵ୯ϣ೸݋ᙴᕍٮ๏௃׎

คፕࢂ೸݋ݯᕍੰ׉ǵ๝᠌஑ࣽᙴৣ܈୺Չ೸݋ݯᕍᙴৣࣣԖԋߏޑᖿ༈(߄ 2-1-5)Ƕ๝᠌஑ࣽᙴৣϷ୺Չ೸݋ݯᕍᙴৣኧӷόӕǴࢂӢࣁ୯ϣ٠ؒԖฯ܄ೕۓ

໻ૈȨ๝᠌஑ࣽᙴৣȩωૈ୼୺Չࢱ๝ϐᙴᕍ཰୍ǴӢԜ཮Ԗߚ๝᠌஑ࣽᙴৣ୺

Չ೸݋୍ܺǴՠፁғ࿿Ԗჹᙴᕍບ܌வ٣Ոన೸݋཰୍ೕጄ؂ 15 ஭Ոన೸݋ݯᕍ

׉ᔈԖᙴৣ΋Γа΢ǴЪځύᔈԖΒϩϐ΋а΢ڀԖҁ࿿ᇡۓϐՈన೸݋஑ࣽᙴ

ৣၗ਱ϷځдೕጄǴаߥምੰΓᙴᕍࠔ፦(ߕᒵ 1)Ƕ

߄ 2-1-5 ୯ϣ೸݋ᙴᕍٮ๏ 1999-2006 ԃ಍ी᏾౛

! ԃж ೸݋ݯᕍੰ׉ኧ ԋߏ౗ ҙൔᙴৣኧ ԋߏ౗ ๝᠌஑ࣽ

ᙴৣኧ ԋߏ౗

1999 6,922 … … … 551 …

2000 7,531 8.80% … … 600 8.89%

2001 8,465 12.40% … … 658 9.67%

2002 9,305 9.92% 815 … 697 5.93%

2003 10,226 9.90% 864 6.01% 746 7.03%

2004 11,059 8.15% 943 9.14% 799 7.10%

2005 12,061 9.06% 988 4.77% 848 6.13%

2006 12,594 4.42% 1,071 8.40% … …

ၗ਑ٰྍǺѠ᡼๝᠌ᙴᏢ཮ǵ93-96 ԃӄ଼҇நߥᓀᕴᚐЍбڋࡋڐ୘ୖԵࡰ኱ाំǵ 88-95ԃ଼ߥ಍ीၗ਑

ಃΒ࿯ ӄ଼҇நߥᓀ೸݋୍ܺЍбڋࡋϐݮॠ

΋ǵ೸݋୍ܺЍб኱ྗݮॠ

ߐບ೸݋୍ܺύЬाϩࣁՈన೸݋ᆶဎጢ೸݋Ǵ଼ߥ໒ᒤаٰࣣ௦ՉۓᚐЍ бБԄǴԾ҇୯ 84 ԃ 3 Д 1 ВଆǴൂԛՈన೸݋ޑЍбᗺኧࣁ 4,000 ᗺǴϣ֖מ

ೌ຤ǵᔠᡍ຤ǵᛰᏊ຤ǵ΋૓׷਑຤ǵ੝ਸ׷਑຤ǴԶ੝ਸᛰᏊ຤(֖ EPO)Ϸ๝܄

೦ՈϐᒡՈ຤ќѦҙൔǶ҇୯ 85 ԃ 7 Д 1 ВǴൂԛՈన೸݋ޑЍбᗺኧׯࣁ 4,100 ᗺǴԶ੝ਸᛰᏊ຤(֖ EPO)Ϸ๝܄೦ՈϐᒡՈ຤߾΋ଆх֖ܭ 4,100 ᗺϣ(ഋӆਕǴ 2006)Ƕ

ӄ଼҇நߥᓀᙴᕍ຤Ҕϣࣽቩࢗݙཀ٣໨ԖȨֿࢥੱ࣬ᜢݯᕍ (хࡴᙁൂགߵ

ᛰ) ϷᔠࢗᔈхࡴܭՈన೸݋຤ҔϣǶȩϐೕጄ(ύѧ଼நߥᓀֽ 2006)Ǵ٠ܭ҇

୯ 93 ԃ 6 Дࢱ๝ᙴᕍ୍ܺࠔ፦ගϲीฝύගډǴځ܌ᆀ࣬ᜢݯᕍϷᔠࢗϐϣ৒ۓ ကϝό୼ܴዴǴᔈୖԵӚϩ୔ቩࢗᙴৣϐࡌ᝼ܭЍб኱ྗύܴुϣ֖ܭߐບࢱ๝

຤Ҕϐ໨ҞǶԜѦǴЍб኱ྗೕጄՈన೸݋௦ۓᚐЍбǴோӵԖ੝ਸੰٯளਡჴ ҙൔǴӧࢱ๝ᙴᕍ୍ܺࠔ፦ගϲीฝύǴࣚۓՈన೸݋໨Ҟϣ֖຤ҔϐጄൎǴᇥ

ܴۘԖ࣬ᜢӝٳੱ܈ᄌ܄ੰϐᔠࢗǵݯᕍ຤ҔதԖќਡჴҙൔϐ௃׎Ǵхࡴ(1)ط фૈ౦தϐ BǵC ࠠطݹ஥চǵطฯϯޣǴۓයଓᙫϐط᠌ຬॣݢǵAFP ᔠࢗǹ (2)ᛰࠔ੝׷೽ϩхࡴ CAPD ϐ೸݋నǵफ़Ոિᛰނǵαܺफ़Ոᑗᛰ܈ݙ৔ી৞

નǵ੝ਸϐगውᅬ܈ΜΒࡰဉውᅬҔᛰǵЈࡓό᏾܈߷ރ୏ેЈ᠌ੰҔᛰǵߚ๝

܄೦Ոϐ࡚܄рՈϐᒡՈݯᕍ຤Ƕ

வ҇୯ 93 ԃ 5 Д 31 ВଆǴׯ٩Ӛߥᓀᙴ٣୍ܺᐒᄬ؂Дҙൔߐບ೸݋ΓԛǴ Ѝбᗺኧሀ෧ӵΠǴ؂Дҙൔໆλܭ 500 ޣǴൂԛՈన೸݋Ѝбᗺኧࣁ 4,100ǹ؂

Дҙൔໆӧ 501~1,000 ޣǴൂԛՈన೸݋Ѝбᗺኧࣁ 4,050ǹ؂Дҙൔໆӧ 1,001~1,500ޣǴൂԛՈన೸݋Ѝбᗺኧࣁ 4,000ǹ؂Дҙൔໆӧ 1,501~2,000 ޣǴ

ൂԛՈన೸݋Ѝбᗺኧࣁ 3,950ǹ؂Дҙൔໆӧ 2,001~2,500 ޣǴൂԛՈన೸݋Ѝ

бᗺኧࣁ 3,900ǹ؂Дҙൔໆӧ 2,501~3,000 ޣǴൂԛՈన೸݋Ѝбᗺኧࣁ 3,850ǹ

؂Дҙൔໆεܭ 3,000 ޣǴൂԛՈన೸݋Ѝбᗺኧࣁ 3,800Ƕ

ӧဎጢ೸݋Бय़ǴΨࢂ௦ۓᚐЍбБԄǴ҇୯ 84 ԃ 3 Д 1 ВଆǴൂԛဎጢ೸

݋ޑЍбᗺኧࣁ 6,940 ᗺǴЍбϣ৒аДࣁൂՏǴ؂ԛЍб΋ঁДޑ࣬ᜢ຤ҔǴх

ࡴᙴៈΓ঩຤(nursing care)ǵ੝ਸ׷਑຤(special material)ǵ؂Дᙴ׷੃઻ࠔ(monthly consumption)Ϸᔠࢗ຤(monthly laboratory fee)Ǵ஻ޣऩύ೼ଶЗݯᕍΕଣǴࡪКٯ Ԍନ҂ݯᕍϺኧ຤Ҕ(ύѧ଼நߥᓀֽ, 2008a)Ƕ٠வ҇୯ 94 ԃ 1 Д 1 ВّϞǴЍ бᗺኧׯࣁ 8,675 ᗺǴځ܌ϣ֖໨ҞؒԖׯᡂǶ

Βǵ೸݋ߐບ࣬ᜢᕴᚐЍбڋࡋ

җܭᙴᕍ຤Ҕόᘐ΢ϲǴӄ଼҇ߥߥᓀࣁၲ௓ڋ຤ҔԋߏϐҞޑǴ௦Ҕӭᅿ

׭ڋٮ๏ᆶሡ؃ޑ௛ࡼǴӧሡ؃य़௦Չ೽ϩॄᏼڋࡋǴԶӧٮ๏य़߾ᅌ຾ޑჴࡼ

Ӛ೽ߐϐȨᕴᚐЍбڋࡋȩٰᆅ౛଼ߥᙴᕍ຤ҔޑЍрǴߐບ೸݋୍ܺҭόૈ࿼

ܭځѦǴԾ 90 ԃ 7 ДՋᙴ୷ቫᕴᚐ໒ۈςᐱҥࣁ΋ൂᐱλᕴᚐǴډ 92 ԃ 1 Дӄ य़௢୏ߐບ೸݋ᐱҥᕴᚐǴҗᙴଣቫભϷ୷ቫບ܌Ӆӕᒤ౛᏾ӝ܄ᙴᕍྣៈܺ

୍ǴаΠࣁߐບ೸݋࣬ᜢᕴᚐڋࡋޑ၁ಒϟಏǶ

(΋) Ջᙴ୷ቫᕴᚐ

ᕴᚐЍбڋࡋനӃቹៜߐບ೸݋୍ܺޑࢂՋᙴ୷ቫᕴᚐЍбڋࡋǴፁғ࿿Ӄ ܭ 88 ԃ 9 ДԋҥȨՋᙴ୷ቫߐບᕴᚐЍбڋࡋࣴ᝼λಔȩǴᐕ࿶ 13 ԛ཮᝼Ǵֹԋ

ࣴ᝼БਢǴܭ 90 ԃ 2 Д 21 ВҬбӄ଼҇நߥᓀᙴᕍ຤Ҕڐۓہ঩཮຾Չڐ୘Ƕ

ӄ଼҇நߥᓀᙴᕍ຤Ҕڐۓہ঩཮ܭ 90 ԃ 4 Д 27 Вֹԋڐۓϣ৒Ǵځಃ΋

යՋᙴ୷ቫᕴᚐܭ 90 ԃ 7 ДԿ 91 ԃ 12 ДǴӝी 1 ԃъǴ؂Γᙴᕍ๏б຤Ҕၨ୷

ྗԃԋߏ 3.727%Ƕӧ୷යԃޑ೛ۓ΢Ǵচࣴ᝼Бਢࡌ᝼௦ჴࡼ߻΋ԃ(Չࡹଣፁғ

࿿Ǵ2001)Ǵ࿶ڐۓࡕׯࣁ 88 ԃ 7 ДԿ 89 ԃ 12 ДǴ୔ϩࣁΟঁъԃ(88 ԃ 7 ДԿ 88ԃ 12 Дǵ89 ԃ 1 ДԿ 89 ԃ 6 Дǵ89 ԃ 7 ДԿ 89 ԃ 12 Д)Ǵ࿶ѳ֡ीᆉࡕள ډ୷යԃ؂Γᙴᕍ๏б຤ҔǶ

ӧᕴᚐᚐࡋϩଛ΢Ǵ೸݋୍ܺܭᕴᚐϩଛКٯǴ٩ځӧ 89 ԃ 7 ДԿ 89 ԃ 12 Дය໔ᆶ΋૓ߐບ୍ܺޑ຤ҔКॶ 1:12.535 ϩଛߎᚐǴЪ௦Ѝр΢ज़ڋǴᗺॶᒿ

୍ܺໆޑӭჲੌ୏ǴόӈΕӦ୔ᕴᚐϩଛǴځ܌՞К౗ࣁՋᙴ୷ቫᕴᚐύޑ 6.064%Ǵёຎࣁ΋ᐱҥλᕴᚐǶԶځдߐບ୍ܺ٩ӚϩֽߥᓀჹຝΓኧϩଛǴࣣ

௦Ѝр΢ज़ڋǴନᛰ຤Ϸᛰ٣୍ܺ຤а΋ᗺ΋ϡᗺႣӃԌନǴځᎩᗺॶࣣᒿ୍ܺ

ໆޑӭჲԶੌ୏Ƕ

(Β) ᙴଣᕴᚐ

ፁғ࿿ܭ 89 ԃ 8 ДԋҥȨᙴଣᕴᚐЍбڋࡋࣴ᝼λಔȩ຾ՉೕჄǴᐕ࿶ 17 ԛ

཮᝼Ǵֹԋࣴ᝼БਢǴܭ 91 ԃ 2 Д 25 ВҬбӄ଼҇நߥᓀᙴᕍ຤Ҕڐۓہ঩཮

ڐ᝼Ǵ٠ܭ 91 ԃ 4 Д 26 ВֹԋڐۓǴڐۓϣ৒Եໆᙴଣ೽ߐ࣬ၨځд೽ߐፄᚇǴ ࣁᗉխཥڋࡋޑჴࡼǴჹᙴଣፂᔐၸε܈࣬ᜢიᡏӢᔈόϷǴ௦аȨᙁൂ΢ၡǴ ᅌ຾ׯॠȩϐᆒઓǴࡺಃ΋໘ࢤӃ௦ՉЍр΢ज़ڋႣᆉচ߾ǴځᎩڋࡋኩόᡂ୏

ӃՉ΢ၡǶ

ಃ΋යᙴଣᕴᚐܭ 91 ԃ 7 ДԿ 12 ДǴӝीъԃǴ؂Γᙴᕍ๏б຤ҔၨΐΜ ԃӕයԋߏ 4%Ǵ٠ό௦Ӧ୔ᕴᚐϩଛБԄǶځᕴᚐ఼ᇂጄൎҭх֖ߐບ೸݋ܺ

୍ǴځচҁೕჄߐບ೸݋୍ܺࣁϩ୔੝ձႣᆉǴЪ௦ՉЍр΢ज़ڋǴࣁӢᔈȨᙁ

ൂ΢ၡǴᅌ຾ׯॠȩϐᆒઓǴӧಃ΋໘ࢤ٠҂ќѦᐱҥ୔ϩᚐࡋ(Չࡹଣፁғ࿿Ǵ 2002)Ƕ

(Ο) ߐບ೸݋ᐱҥᕴᚐ

Ԗ᠘ܭӕੰӕၿϐচ߾Ǵ٠ᗉխੰΓϷᙴৣܭ୷ቫບ܌Ϸᙴଣٿ೽ߐϐ໔ࢬ

୏Զ೷ԋ଄୍॥ᓀϐୢᚒǴԾ 2003 ԃ 1 Д໒ۈჴࡼߐບ೸݋ᐱҥᕴᚐǴќुҥ΋

΢ज़ڋᕴᚐǴӚԾவᙴଣᕴᚐ೸݋୍ܺᆶՋᙴ୷ቫࢱ๝೽ߐႣᆉӝٳࣁൂ΋ᕴ ᚐǴЪό௦ՉӦ୔ᕴᚐϩଛǴӅӕᒤ౛᏾ӝ܄ᙴᕍྣៈ୍ܺǶ

ಃΟ࿯ Ѝбڋࡋϐ଄୍ᇨӢჹᙴৣՉࣁޑቹៜ

Ԑය҂ԖಃΟб຤ޣϟΕ଼நྣៈਔǴᙴৣගٮᙴᕍ୍ܺࡕǴҗੰ஻ޔௗб

๏ᙴৣᙴᕍ຤ҔǴՠӧಃΟб຤ޣϟΕΠǴ҇౲ᛦҬิ܈ߥᓀ຤Ǵܭ٬Ҕᙴᕍܺ

୍ࡕҗಃΟб຤ޣб຤๏ᙴᕍගٮޣǴԜб຤ޑ኱ྗϷ୷ྗջᆀϐࣁȨЍбڋ ࡋȩǶಃΟб຤ޣதࣁΑ࿯࣪຤Ҕ܈ගଯᙴᕍࠔ፦ԶׯᡂЍбБԄǴόӕޑЍбڋ ࡋஒቹៜᙴᕍٮ๏ޣϐᙴᕍ୺཰Չࣁ(ླྀדؼ฻ΓǴ2008)Ƕ

Զ܌ᒏޑᙴৣՉࣁ(Physician Behavior)ǴਥᏵՉࡹଣፁғ࿿఼ញǴᙴৣݤಃΒ ΜΖచ܌ᆀᙴᕍ཰୍ϐՉࣁǴ߯ࡰаݯᕍǵᕖ҅܈ႣٛΓᡏ੯ੰǵ໾্ǵූલࣁ ҞޑǴ܌ࣁޑບჸǵບᘐϷݯᕍǹ܈୷ܭບჸǵບᘐ่݀ǴаݯᕍࣁҞޑǴ܌ࣁ ޑೀБǵҔᛰǵࡼೌ܈ೀ࿼฻Չࣁޑӄ೽܈΋೽ޑǴ֡ឦϐǶҁࣴزஒа΢ᙴᕍ

཰୍ϐՉࣁ಍ᆀࣁᙴৣ୺཰ՉࣁǴᙁᆀᙴৣՉࣁǶ

Rodwin(2004)ࡰр྽ᙴৣࢂڀԖԾճ୏ᐒਔǴѸ໪λЈᅱ௓дॺޑՉࣁ٠Ъा

ᆒྗޑፓ᏾ځᇨӢǶ೚ӭ࣬ᜢЎ᝘ࡰрǴᙴᕍߥᓀЍбڋࡋϷځѬ଄୍ᇨӢޑϟ ΕϷׯᡂǴό໻ׯᡂ҇౲ޑ൩ᙴኳԄǴΨቹៜᙴᕍٮ๏ޣޑᙴᕍՉࣁϷ୍ܺࠔ፦

(Chaix-Couturier, Durand-Zaleski, Jolly, and Durieux, 2000; Reschovsky, Hadley, and Landon, 2006; Rice, 1997; Shen et al., 2004)ǶӧЍбڋࡋύǴ΋૓தـҔٰբࣁᙴ

ৣЍб೛ीޑԖፕໆीၿǵፕΓीၿᆶᕴᚐЍбڋࡋǴаΠஒჹ೭٤ЍбБԄޑ

଄୍ᇨӢჹᙴৣՉࣁቹៜǴаϷቹៜᙶమЍбڋࡋჹᙴৣՉࣁϐӢηբ૸ፕǶ

(΋) ፕໆीၿ

٩ಃΟб຤ޣ๏бޑᙴᕍ୍ܺ໨ҞǴ೴໨ुۓЍб኱ྗǴᙴᕍගٮޣ൩ჴሞ ගٮ୍ܺǴ೴໨٩Ѝб኱ྗҙൔ຤ҔǶԜڋࡋϐΠ཮ౢғΟᅿቹៜǴ1.ᙴᕍගٮޣ

৒ܰၸࡋගٮᙴᕍ୍ܺǹ2.ගଯ؂໨୍ܺሽ਱ǹ3.લЮ௓ڋԋҁޑᇨӢǴӢࣁಃΟ б຤ޣ๏ᙴᕍගٮޣޑ኱ྗǴࢂаჴሞวғޑԋҁࣁ୷ᘵ(ᐽྷ޹ǵᖴ௴ྷǴ2004ȑǶ

Rice(1997)ӣ៝ᙴৣЍбڋࡋޑቹៜǴว౜ԐයЎ᝘ Medicare ፕໆीၿЍбڋࡋޑ ׯᡂǴӭኧ཮ቚуځ୍ܺໆϷځஏࡋǹၨ߈යޑЎ᝘ࣴز่݀ӳᚯୖъǴ೽ҽᡉ Ңᙴৣ཮ቚуԖճёკޑ୍ܺ໨ҞǵڗжচҁޑݯᕍБݤ܈ቚуدΓߥᓀޑ୍ܺ

ໆǶԶך୯മߥҘΌЧ߄ჴࡼࡕǴࣴزว౜྽೸ၸЍбڋࡋफ़ե؂ҹҙൔߎᚐਔǴ ᙴৣࣁΑᆢ࡭ԏΕНྗǴ໼ӛܭቚуҙൔҹኧ(೾ߞඵǵླྀדؼǴ1994)Ƕ

(Β)ፕΓीၿ

߯ࡰߥᓀΓଞჹ΋ۓጄൎޑ୍ܺ٩ᏵߥᓀჹຝϐΓኧϷځ൩ᙴሡाႣӃЍб

΋฽ڰۓߎᚐ๏܍хޑᙴᕍගٮޣǴܭ΋੝ۓය໔ϣගٮߥᓀჹຝӧࠨऊጄൎϣ

܌ሡޑᙴᕍ୍ܺǶҗܭԜڋࡋᆶᙴᕍ୍ܺගٮໆคᜢǴёගٮமਗ਼࿶ᔮᇨӢǴߦ

٬ᙴᕍගٮޣගٮၨԖਏ౗ϐ୍ܺǶᐽྷ޹کᖴ௴ྷ(2000)ࡰрӧԜڋࡋΠǴᙴᕍ ගٮޣதԖٿᅿӢᔈϸᔈǴ΋ࣁ॥ᓀᑔᒧǴջᙴᕍගٮޣ཮ᒧ᏷ե॥ᓀޑߥᓀჹ ຝǴаफ़եᙴᕍ଄୍॥ᓀǴቚуճዎǹΒࢂᙴᕍගٮόىǴᗉխᡣੰ஻ௗڙࠨऊ ጄൎϣܳ຦ޑݯᕍکᔠᡍǶChaix-Couturier ฻Γ( 2000) ӣ៝࣬ᜢЎ᝘ว౜Ǵᆶፕ ໆीၿ࣬КǴҺՖޑ Funding holder ϷፕΓीၿڋࡋΠǴᙴᕍගٮޣ཮෧Ͽ 0-24%

ೀБໆǴՐଣВ׳Πफ़߈ 80%ǶShen ฻Γ(2004)ࣴزว౜ፕΓीၿЍбڋࡋΠޑ ᙴৣܭഘӛӭ໒ܳ຦ᛰǵᔠᡍϷஒੰΓᙯບޑКٯᡉ๱ϿܭፕໆीၿޑᙴৣǴԶ ӧ"bother scores"(໼ӛϿҔᙴᕍၗྍ)Ǵ໒ܳ຦ᛰǵᔠᡍǵஒੰΓᙯບϷ౽෌Ј᠌΢

ࣣКፕໆीၿޑᙴৣᡉ๱ଯǶ

(Ο)ᕴᚐႣᆉڋࡋ

ᕴᚐႣᆉڋࡋ߯ࡰಃΟб຤ޣᆶᙴᕍٮ๏ޣǴ൩੝ۓጄൎޑᙴᕍ୍ܺǴႣӃ аڐ୘БԄǴुۓ҂ٰ΋ࢤය໔Ȑ೯தࣁ΋ԃȑϣᙴᕍ୍ܺᕴЍрȐႣᆉᕴᚐȑǴ

аၿб၀୍ܺ೽ߐӧ၀ය໔ϣ܌ගٮޑᙴᕍ୍ܺ຤ҔǴᙖа௓ڋᙴᕍ຤ҔܭႣᆉ ϣǶӧᕴᚐႣᆉڋࡋჹᙴৣՉࣁޑቹៜ೽ҽǴBenstetter ک Wambach (2006)аኳࠠ

௢ᏤޑБԄࣴزᙴৣӧᕴᚐႣᆉڋࡋΠගٮ୍ܺኧໆϸᔈǴ٠ϩ݋ᙴᕍሽ਱ჹፕ ໆीၿ(fee-for-service)ϷᕴᚐႣᆉڋࡋޑቹៜǶբޣᇡࣁፕໆीၿࣁ΋ሽ਱س಍Ǵ ᙴৣਏҔཱུεϯх֖೤ჾሽॶ(monetary costs)ϷոΚԋҁ(effort costs)Ǵ྽୍ܺሽ਱

ଯਔǴᙴৣ཮٬ᜐሞԏΕ฻ܭᜐሞԋҁǴځхࡴոΚԋҁǹሽ਱եਔǴᙴৣ཮۹

ౣոΚԋҁǴոΚπբаᗉխԖ଄୍ӒᐒǶ

ԶᕴᚐႣᆉڋࡋࣁ΋ᗺॶس಍Ǵ࣬ჹܭሽ਱س಍ǴӸӧ΋ڐ୘ୢᚒǴ֡ᑽᗺ ڗ ، ܭ ᕴ ᚐ ޑ ε λ Ǵ ྽ ᕴ ᚐ ᚐ ࡋ ε ਔ Ǵ ᙴ ৣ Չ ࣁ ӵ ӕ ճ ዎ ཱུ ε ޣ (profit maximizers )ǹᕴᚐᚐࡋեਔǴԖ΋೽ҽᙴৣ཮ଏрѱ൑Ǵќ΋೽ҽ߾཮ոΚπբ аᗉխ଄୍ӒᐒǶԶᕴᚐᚐࡋϟܭύ໔ਔǴ܌Ԗޑᙴৣ೿཮ոΚπբǴؒԖΓ཮

ଏрѱ൑ǴՠԜ΋֡ᑽᗺࢂόᛙۓޑǴբޣஒаᖻֽၯᔍ(Cournot game)૸ፕϐǶ

ᙴৣӧय़ჹϟܭύ໔ᚐࡋϐᕴᚐਔǴځ฼ౣӵӕᖻֽၯᔍǴᙴৣ཮Ⴃෳځд ᙴৣޑՉࣁٰ،ۓԾρޑ୍ܺໆӭჲǴ཮Ԗٿᅿ௃׎Ǵ΋ࣁڐ୘ջεৎόፂໆǴ ߥ࡭ၨଯᗺॶǹΒࣁؒԖڐ୘εৎፂໆǴᗺॶࡐեǶவჴ᛾ၗ਑ٰ࣮Ǵቺ୯ᙴৣ

ᒧ᏷ஒ୍ܺໆനεϯǴӧ 1993 ԃᕴᚐჴࡼࡕߐບቚу 1.9%ǴځдԏΕቚу 4.9%Ǵ ЬाࣁدΓߥᓀ(FFS)ǴᕴԏΕቚу 2.5%Ǵՠځԋҁࠅቚу 8.9%ǴЪԋҁ՞ԏΕ Кٯቚу 6.3%ǴࣦᎩ෧Ͽ 6%ǶBenstetter ฻Γᇡࣁቺ୯ᙴৣᒧ᏷ፂໆࢂё೏౛ှ

ޑǴӢࣁऩᙴৣགྷᆢ࡭ଯᗺॶԶ٬୍ܺໆᡂϿǴՠځдᙴৣࠅፂໆǴஒ٬ளᙴৣ

य़ᖏ଄୍ӒᐒǶฅԶǴऩᙴৣ᝺ளᗺॶ཮ࡐեԶቚу୍ܺໆǴջ٬നࡕᗺॶࢂଯ ޑǴԏΕ཮׳ӭǴЪૈዴߥό཮य़ᖏ଄୍ӒᐒǶ

ځ౛ፕኳࠠ௢Ꮴ่݀ᡉҢǴӧሽ਱س಍ύᙴᕍሽ਱ଯਔǴᙴৣՉࣁӵӕճዎ

ཱུεޣǹ྽ᙴᕍሽ਱եਔǴᙴৣஒᇨวሡ؃аၲځҞ኱ԏΕǴѝӧЯ೤ჾሽॶǴ ոΚπբቚу୍ܺໆаᗉխԖ଄୍ӒᐒǴӵӕ satisficers ΋ኬǴ୼Ҕ൩ӳǶԶᕴᚐ

ϐΠǴኳࠠ௢ፕᙴৣ໔ڐ୘Ѩ௳Ǵᙴৣ࡭ុոΚπբ(the treadmill effect)Ǵ٬ᙴᕍ

୍ܺໆၲനεϯǹЪ྽ᗺॶࡐեਔǴᙴৣ཮ቚуᙴᕍ୍ܺໆǴԖ΋೽ҽᙴৣ཮ଏ рѱ൑(Benstetter and Wambach, 2006)Ƕ

୯ϣ Fan ฻Γ(1998)а Nash ౛ፕ௢ᏤǴӧ΢ज़ڋϷҞ኱ڋᕴᚐႣᆉڋࡋΠᙴ

ৣՉࣁޑቹៜǴளޕ྽΢ज़ڋϷҞ኱ڋޑЍр΋ኬਔǴ΢ज़ڋޑᙴᕍ୍ܺໆ཮К Ҟ኱ڋӭǶ٠ᇶаᙴᏢଣᏢғ௃ნୢเჴᡍǴځ่݀ᆶય೚֡ᑽ࣬՟ǴӧҞ኱ڋ ਔǴᆶ౛ፕ௢Ꮴ่݀࣬಄Ǵᙴৣ཮ଓ؃ঁΓനεճዎǹԶӧ΢ज़ڋਔǴჴᡍ่݀

ᆶᝡݾኳԄ௢Ꮴ่݀࣬಄ǴԶᆶӝբኳԄ߾ό಄ӝǴᙴৣဂύԖΓࠇ଒Ǵᒧ᏷ቚ у୍ܺໆǴԶߚаനϿԋҁౢрளډၨଯޑᗺॶϷճዎǶᡉҢᙴৣόፕӧᝡݾ܈

ࢂӝբኳԄΠǴ೿཮௦ڗᝡݾ฼ౣǴቚу܌ගٮޑ୍ܺǴଓ؃ঁΓനεճዎǴ٬

ளᗺॶΠफ़ճዎ෧Ͽ(Fan, Chen, and Kan, 1998)Ƕ

ഋ෕፣฻Γ(2003)Ϸ೚ᅺ޹฻Γ(2007)ࣴز่݀ᡉҢǴᙴଣӧԵໆҁيޑճ੻

ΠǴᒧ᏷ଯ୍ܺໆࢂᓬ༈฼ౣǴЬाࢂӢࣁᏼЈᝡݾჹЋόଛӝǴԾρᒧ᏷եܺ

୍ໆϸԶᆾڙཞѨǶഋᝬܿ(2004)߾ᇡࣁόӕЍбڋࡋჹᙴৣ୺཰Չࣁޑቹៜᆶᙴ

ৣගٮᙴᕍ୍ܺޑԋҁ่ᄬԖᜢǶᕴᚐႣᆉჴࡼࡕǴऩᙴᕍ୍ܺᜐሞԋҁሀቚਔǴ ᙴৣՉࣁׯᡂόεǹऩᙴᕍ୍ܺᜐሞԋҁࣁڰۓਔǴᙴৣՉࣁᡂளᝄᙣ(ഋ෕፣ǵ ቅறঙǵ݅ࡌϘǵԙη⊭ǵߋЎၲǴ2003ǹ೚ᅺ޹ǵླྀ໡࣓Ǵ2007)Ƕ

(Ѥ)ቹៜᙶమЍбڋࡋჹᙴৣՉࣁϐӢη

Hellinger(1996)ࡰрၸѐࣴز଄୍ᇨӢჹᙴৣՉࣁޑቹៜϐ่݀όܴዴǴࢂҗ ܭځࣴزၗ਑ወӧޑୃᇤǴх֖ᙴৣᒧ᏷ǵੰΓᒧ᏷Ϸคݤ೏ෳໆޑߥᓀीჄ੝

፦ǴࡺࣁΑᐱҥ଄୍ᇨӢჹᙴৣՉࣁޑቹៜǴ௓ڋᙴৣǵੰΓǵ଼நीჄϷѱ൑

ޑ੝܄ࢂԖѸाޑǶChaix-Couturier ฻Γ(2000)ӣ៝࣬ᜢЎ᝘Ǵ᏾౛ёૈ཮υᘋࣴ

ز଄୍ᇨӢჹᙴৣՉࣁޑቹៜϐӢηǴхࡴᙴৣԃសǵ૽ግǵ஑ࣽǵ୺཰ӦᗺϷ

ࠠᄊǵၸѐޑਡ෧௃׎ǵ੯ੰᜪࠠϷᝄख़ࡋǵߥᓀϦљޑᜪࠠǶԜѦǴ೚ӭЎ᝘

Ψ௓ڋᙴৣ੝፦ǵ୺཰੝፦ǵӦ୔੝፦ǵѱ൑੝፦аਏ҅ЍбڋࡋჹᙴৣՉࣁޑ ቹៜ( Shen, Andersen et al. 2004; Reschovsky, Hadley et al. 2006)Ƕ

୯ϣУᙴᕴᚐޑࣴزҭࡰрǴόӕ଼ߥϩֽձϷࠤໂձ໔ǴУᙴບ܌ϐᕴߎ ᚐǵኧໆǵϷሽ਱ৡ౦ᡂε(ᄃℱ๤Ǵ2000)ǹόӕԃសձޑᙴৣӧУᙴᕴᚐႣᆉڋ ࡋჴࡼ߻ࡕޑҙൔኧໆԖόӕᡂϯ(ᖴችृǴ2003)Ƕӧፕੰٯीၿڋࡋ΢Ǵჹܭԃ

ၗၨభᙴৣКԃၗၨߏޑᙴৣӧݯᕍલՈ܄Ј᠌ੰ،฼΢ၨԖᡉ๱ϐቹៜ(஭ᐋ

඾ǵูྷᓪǵᒲቼЎǴ2004)ǶԜѦǴҭԖࣴزࡰрУᙴৣΓαКቚу཮Ꮴठ؂ԛ

࣮ບѳ֡ҙൔߎᚐ΢ϲǴՠ൯ࡋ࣬྽λ(ଭё৒ǵᎄӺহǵڬᑉࡹǴ2002)Ƕ

ӧᙴৣჹջஒჴࡼޑЍбڋࡋౢғႣයЈ౛೽ҽǴHenke ฻Γ(1994)ӣ៝ቺ୯ ᕴᚐ࣬ᜢЎ᝘Ǵ߄Ңቺ୯ܭ 1993 ԃჴࡼ GSG ׯॠБਢǴځЍр௦΢ज़ڋǴᙖҗ ӕਔ௓ڋᙴᕍ୍ܺϷᛰࠔޑໆᆶሽǴаှ،࡭ុ΢ᅍޑᙴᕍЍрǶӧ೛ۓ 1993 ԃ ЍрႣᆉԋߏǴࢂа 1991 ԃࣁځ୷ྗԃǴаڗжа 1992 ԃࣁ୷ྗਔǴаᗉխᙴ

ৣёૈӧ 1992 ԃቚуځ୍ܺໆаᘉεځ୷ྗॶǶ

୯ϣֆਔ௘(2004)ࣴزว౜Ǵܭ 90 ԃ 1 Дᙴଣߐບӝ౛ໆჴࡼ߻΋ԃౢғႣ යਏᔈǴځᙴଣߐບໆޑԋߏೲࡋКϐ߻׳זǴբޣᇡࣁ୯ϣᙴଣߐບӝ౛ໆԾ

҇୯ 88 ԃ 12 Д໒ۈ૸ፕঅुǴीᆉϦԄхࡴ߻΋ԃޑ୍ܺໆǵੰ׉ኧᆶᙴৣኧǴ ж߄߻΋ԃߐບໆຫӭǴΠ΋ԃࡋޑߐບӝ౛ໆΓԛຫӭǶԶႣයਏᔈޑౢғǴ

٬ளߐບӝ౛ໆۘ҂ޕၰჴࡼਏ݀ǴϸԶӃ೷ԋᙴଣזೲቚуߐບໆǶ

ᆕӝа΢୯ϣѦࣴزᙴৣՉࣁЎ᝘ᡉҢǴऩाຑ՗ЍбڋࡋჹᙴৣՉࣁޑቹ ៜǴ߾Ѹ໪௓ڋᙴৣ੝፦ǵੰΓ੝፦ǵѱ൑܈Ӧ୔੝፦ǴаϷᙶమځႣයЈ౛܌

ౢғޑӢᔈՉࣁǴа௖૸੿҅ЍбڋࡋჹᙴৣՉࣁ܌஥ٰޑਏᔈǶ

ಃѤ࿯ ᕴᚐႣᆉڋࡋჹᙴৣՉࣁޑቹៜϐჴ᛾ࣴز

ҁ࿯ஒϩࣁٿ೽ҽ௖૸ᕴᚐႣᆉڋࡋ࣬ᜢჴ᛾Ў᝘Ǵಃ΋೽ҽࣁ୯ѦЎ᝘ǹ ӧಃΒ೽ҽ߾ࣁУᙴᕴᚐϷՋᙴ୷ቫᕴᚐჹ΋૓ᙴᕍ୍ܺޑቹៜǶ

΋ǵ୯ѦᕴᚐႣᆉჹᙴৣՉࣁޑቹៜϐჴ᛾Ў᝘

Hurley฻Γ(1997)௦ҔϦӅ଄ၗ਑ϩ݋ࢎᄬϐঁਢϩ݋ݤǴау৾εٿঁ࣪ҽ ࣁٯǴࣴز่݀ว౜ӧᕴᚐႣᆉڋࡋΠǴᙴৣ཮ڙځдӭኧᙴৣޑቹៜǴԶӅӕ ޑቚу܈෧Ͽᙴᕍ୍ܺǶځύǴAlberta ࣪ޑᕴᚐႣᆉਏ݀Ԗؼӳޑ຤Ҕ௓ڋǴԶ Nova Scotia࣪ࠅԖܴᡉޑຬᚐᙴᕍճҔ౜ຝǶHurley ฻Γᇡࣁٿ࣪ৡ౦ࢂٰԾܭ Nova Scotiaᕴᚐ΢ज़ڋޑ࿶ᔮᓸΚၨ Alberta εǴӧڐ୘ᕴᚐࡹ฼ਔǴAlberta ࣪ӧ

ࡹ۬ᆶᙴᕍڐ཮(Alberta medical association ,AMA)໔Ԗၨӳޑڐ୘ᜢ߯ǴЪ AMA ᆅ౛ᕴᚐϐΠᙴᕍЍрޑБԄҭၨ٫Ƕ

ځ܌ࡰޑ࿶ᔮᓸΚԖٿঁǴ΋ࣁ Nova Scotia ࣪ޑѳ֡ᙴᕍ຤եܭ Alberta ࣪Ǵ Ъ Nova Scotia ࣪ޑᙴৣΓαКϷځԋߏ౗೿ଯܭ Alberta ࣪ǴΒࣁ Nova Scotia ӧ २ٿԃޑႣᆉ٠ؒԖԋߏǴԶ Alberta ࣪߾ԖቚуǴNova Scotia ࣪ϐࡕޑᕴᚐԋߏ

౗ҭեܭ Alberta ࣪Ǵа΢ᡉҢ Nova Scotia ࣪ᙴৣޑ࿶ᔮᓸΚዴჴၨ Alberta ࣪ε (Hurley, Lomas, and Goldsmith, 1997)Ƕ

Henke฻Γ(1994)Ўകύࡰрቺ୯ᛰࠔჴࡼᕴᚐ܌࣪ΠޑЍрǴΞ޸຤ӧځд ඹж୍ܺ΢Ǵ೭ࢂҗܭບ܌ᙴৣעੰΓᙯບԿؒԖჴࡼᕴᚐ΢ज़ڋޑ஑ࣽᙴৣ܈

ᙴଣޑ௃׎ቚӭǴЀځࢂሡाଯҔᛰԋҁޑੰΓǶ

Leonard ฻Γ(2003)Кၨ༫Ӧճϐ case-based Ϸу৾εϐᕴᚐႣᆉڋࡋٿᅿό ӕၗߎࡹ฼ჹՐଣੰΓޑቹៜ่݀ว౜Ǵ༫ӦճޑՐଣВᡉ๱ߏܭу৾εǴԜѦǴ ٿ୯ޑΕଣВϷрଣВ٠όࢂѳ֡ϩණܭ΋ຼǴԶࢂ໣ύܭࢃය΋ϷࢃයϖǶᙴ ଣ཮ᗉխੰ஻ӧڬ҃рଣǴӢࣁຼ҃લЮΓΚǴ܌аੰ஻рଣόࢂࢃය΋൩ࢂࢃ

ය ϖ Ǵ ځ ύ у ৾ ε җ ܭ ଄ ୍ ᓸ Κ Ǵ Ԝ ౜ ຝ ᡉ ๱ ܴ ᡉ (Leonard, Rauner, Schaffhauser-Linzatti, and Yap, 2003)Ƕ

Βǵ୯ϣᕴᚐჴჹᙴৣՉࣁޑቹៜϐჴ᛾Ў᝘

୯ϣԖᜢᕴᚐޑࣴزаУᙴᕴᚐࣁЬǴᄃℱ๤(2000)аᖻֽ౛ፕ௖૸Уᙴᕴᚐ ޑჴࡼࢂցӢࣁอයϣᙴৣคݤၲԋӅᒉǴԶаᝡݾኳԄቚуځ୍ܺǴࣴز่݀

ว౜Уᙴບ܌ϐᕴߎᚐǵኧໆǵϷሽ਱֡ᡉ๱΢ϲǴځύҙൔኧໆԋߏλܭሽ਱

ԋߏǴբޣࡰрёૈࢂӢࣁУᙴບ܌ၨό৒ܰബ೷ੰΓໆǴ܌аӧ؂ԛບᕍਔӭ

଺܈ᒧ᏷๏бߎᚐၨଯϐ໨ҞǴ٬ሽ਱ϐԋߏଯܭኧໆϐԋߏǶ

ᖴችृ(2003)ҭว౜ӧУᙴᕴᚐڋࡋࡕǴУᙴৣᕴҙൔҹኧ෧ϿǴᕴҙൔᗺኧ ቚуǴԶӧჴࡼ߻ࡕЍбᗺኧፓଯޑ 11 ঁ໨ҞύǴԖ 6 ໨ҙൔኧໆቚуǴӧ࣬ӕ ᜪձޑ୍ܺ໨ҞύǴУᙴৣ཮໼ӛᒧ᏷๏бᗺኧၨଯǵޗ཮΢ࢬՉޑݯᕍ॥਱ǵ

॥ᓀၨեЪᜤࡋόଯޑ໨ҞǴऩУᙴৣჹҞ߻πբໆ܈ߎᒲൔၿόᅈཀਔǴ཮໼

ӛଓ؃ቚуᙴᕍ୍ܺໆǶ

ՖྻϷ໳଻൏(2005)Ǵӧଷ೛Уᙴৣଓ؃܌ளനεϯΠǴ௦୔Տቫԛڗӛа 291

ঁໂᙼѱ୔ࣁࣴزჹຝǴ௖૸УᙴᕴᚐႣᆉڋࡋࡕǴУᙴৣӧ୍ܺໆϷሽ਱΢ޑ ϸᔈǴࣴز่݀ᡉҢУᙴৣ཮ଓ؃܌ளനεϯǴ཮Ԗቚу୍ܺໆ܈ගଯ؂ҹҙൔ ߎᚐޑᙴᕍՉࣁǴЀځࢂሽ਱ޑ΢ϲǶԶླྀণሎ฻Γ( 2001)аୢڔፓࢗ௖૸Уࣽᕴ ᚐႣᆉڋࡋჹܭѠчѱУᙴৣՉࣁׯᡂޑቹៜǴჹУᙴৣޑԏΕϷ୍ܺໆคܴᡉ ቹៜǴჹܭᙴᕍࠔ፦Ϸᙴੰᜢ߯ёૈԖշ੻Ƕ

ԶӧՋᙴ୷ቫᕴᚐڋࡋჹ᏾ᡏ୷ቫᙴᕍ୍ܺቹៜ΢Ǵ஭੻၈کᄃֻৱ(2002)

ࣴزࡰрᕴᚐڋࡋჴࡼࡕъԃǴ࣬ၨܭ߻ԃӕයǴч೽Ӧ୔Ջᙴ୷ቫບ܌ҙፎᕴ ҹኧᡉ๱Πफ़ǴൂՏሽ਱ᡉ๱ቚуǴԶႣٛߥ଼Ϸᄌ܄ੰ฻Ⴔᓰ೽ߐҙፎҹኧک

ᗺኧᡉ๱ቚуǴ΢ज़ڋ೽ߐ(΋૓ߐ࡚ບ)ҙፎҹኧϷᗺኧᡉ๱෧ϿǶЦذᑯ(2002)

ࣴزύǴՋᙴ୷ቫᕴᚐჴࡼࡕъԃǴ࣬ၨܭ߻ԃӕයǴଯࡀϩֽ୷ቫບ܌ҙፎᕴ ҹኧΠफ़ǴൂՏሽ਱ቚуǴࣣόᡉ๱ǶεठٰᇥՋᙴ୷ቫᕴᚐڋࡋჹ᏾ᡏ୷ቫᙴ ᕍ୍ܺቹៜǴӚϩֽ୷ቫບ܌ѳ֡ᕴҙൔҹኧΠफ़Ǵՠځѳ֡ሽ਱ϲଯǶ

ಃϖ࿯ ୯ϣᕴᚐڋࡋჹ೸݋୍ܺϐቹៜ

வ୯ϣჹՋᙴ୷ቫᕴᚐڋࡋჹܭ೸݋୍ܺቹៜϐࣴزǴёϩࣁሡ؃य़Ϸٮ๏

य़Ǵӧሡ؃य़೽ҽǴа௖૸Ջᙴ୷ቫᕴᚐڋࡋჹߏයௗڙ೸݋୍ܺϐੰΓ᏾ᡏᙴ ᕍၗྍճҔޑቹៜǶಷඁ⋙(2004)ࣴزࡰрଯࡀϩֽੰ஻Ԗၠቫભ൩ᙴ௃׎Ǵ؂Γ ߚ೸݋ߐບճҔϷ؂ΓՐଣѳ֡຤ҔᗺኧӧՋᙴ୷ቫᕴᚐڋࡋჴࡼࡕᡉ๱ቚуǶ Ц࢙Ў(2005)ࣴزว౜೸݋ੰ஻ᙴଣߚ೸݋ߐບճҔԛኧቚуǴ୷ቫບ܌ߚ೸݋ߐ ບճҔԛኧΠफ़Ǵ୷ቫບ܌೸݋ߐບΓԛቚу൯ࡋεܭځдቫભᙴᕍບ܌ǴԶ೸

݋ੰ஻؂ԛߚ೸݋ߐບ຤Ҕᗺኧ߾ᡉ๱෧ϿǴ؂ΓՐଣѳ֡຤Ҕᗺኧᡉ๱ቚуǶ

ӧٮ๏य़೽ҽǴࣴزጄൎӭࣁ᏾ᡏՋᙴ୷ቫ୍ܺ໨ҞǴ೸݋୍ܺѝࢂځࣴز

่݀ޑ΋λ೽ҽǴ٠ค੝ձଞჹ೸݋೽ҽуа૸ፕǴՠவځ่݀ኧᏵёа࣮рځ อයჹӚϩֽ୷ቫບ܌೸݋୍ܺϐᙴᕍ຤ҔޑᡂϯǶ஭੻၈کᄃֻৱ(2002)ач೽

Ӧ୔Ջᙴບ܌ࣁࣴزჹຝǴࣴز่݀ว౜Ջᙴ୷ቫᕴᚐڋࡋჴࡼࡕǴ୷ቫບ܌ѳ

֡೸݋ҙൔ຤ҔϷҹኧࣣ΢ϲǶЦذᑯ(2002)߾аଯࡀϩֽՋᙴບ܌ࣁࣴزჹຝǴ ځ่݀ҭว౜Ջᙴ୷ቫᕴᚐڋࡋჴࡼࡕǴ୷ቫບ܌ѳ֡೸݋ҙൔ຤ҔϷҹኧࣣ΢

ϲǶҞ߻໻Ԗ൹ᒸᕉ(2003)ϐࣴز߯ଞჹՋᙴ୷ቫᕴᚐڋࡋჹ೸݋ບ܌ޑቹៜǴࣴ

زଯࡀϩֽ 13 ৎ೸݋ບ܌ޑ௃׎Ǵࣴز่݀ᡉҢᕴᚐࡕ೸݋ບ܌ӧΓΚᆶ೛ഢ΢

Ԗᘉεೕኳޑᖿ༈Ǵ᏾ᡏ୍ܺໆϷځ՞೸݋ѱ൑К౗ࣣࣁቚуǶ

ᆕᢀ΢ॊǴՋᙴ୷ቫᕴᚐڋࡋჹᙴᕍගٮޣܭ೸݋୍ܺޑቹៜǴவບ܌ޑ೸

݋ᕴҙൔᗺኧٰຑ՗ᙴৣՉࣁ٠όֹ᏾ǴځᕴҙൔᗺኧϷҹኧޑ΢ϲǴёૈӵ൹

ᒸᕉ(2003)ࣴز่݀΋ኬǴᕴᚐࡕ೽ҽ೸݋ບ܌ӧΓΚᆶ೛ഢ΢Ԗᘉεೕኳޑᖿ

༈ǴࢂӢࣁᙴৣኧޑቚуԶቚуບ܌ᕴҙൔᗺኧǴЪځቚуচӢҭёૈࣁځѬӢ ન೷ԋԶߚՋᙴ୷ቫᕴᚐڋࡋǴࡺҁࣴزஒଞჹ୷ቫບ܌๝᠌஑ࣽᙴৣ௖૸Ջᙴ

୷ቫᕴᚐڋࡋჹᙴৣՉࣁޑቹៜǴ٠уΕჹྣಔаᙶమځՉࣁޑׯᡂࢂցٰԾܭ ᕴᚐڋࡋޑϟΕǶ

ಃΟക ࣴزБݤ

ҁകϩࣁϖλ࿯Ǵಃ΋࿯ඔॊҁࣴز೛ीᆶࣴزࢎᄬǹಃΒ࿯ගрҁࣴزଷ ᇥǹಃΟ࿯ӈрࣴزᡂ໨ϐᏹբࠠۓကǹಃѤ࿯ᇥܴࣴز׷਑ᆶၗ਑ೀ౛Бݤǹ

ಃϖ࿯ࣁҁࣴز܌٬Ҕϐ಍ीϩ݋БݤǶ

ಃ΋࿯ ࣴز೛ीᆶࣴزࢎᄬ

΋ǵࣴز೛ी

ҁࣴزԑӧ௖૸ЍбڋࡋޑׯᡂǴჹᙴৣՉࣁԖคቹៜǴࡺճҔ҇୯ 90 ԃ 7 Дಃ΋යՋᙴ୷ቫᕴᚐႣᆉЍбڋࡋஒ೸݋Ⴃᆉൂᐱ೛ҥޑჴࡼǴᢀჸӕ΋ဂ๝

᠌஑ࣽᙴৣӧჴࡼՋᙴ୷ቫᕴᚐ߻ࡕᙴৣՉࣁԖคׯᡂǴឦܭ΋Ծฅჴᡍ(natural experiment)ǴЪࣁڰۓኬҁख़ፄෳໆ(Panel survey)ϐࣴز೛ीǶ

(΋) ࣴزਔ໔

ך୯ፁғࡹ฼௢୏ၨᓎᕷǴటᢀჸൂ΋ࡹ฼ځၨߏਔ໔ޑቹៜǴ৮ᜤаᙶమ ځঁձޑਏᔈǶԜѦǴᙴᕍၗྍ઻Ҕҭӕਔڙډሡ؃य़ޑቹៜǴӵ҇౲ᙴᕍճҔ ϐۑ࿯܄ਏᔈϷ೽ϩॄᏼፓ᏾฻࣬ᜢӢનǴаϷᙴᕍගٮޣёૈԖႣයЈ౛Ǵࣁ Ӣᔈࡹ฼ޑϟΕǴග߻ϸᔈځᙴᕍՉࣁǶҗܭՋᙴ୷ቫ೸݋୍ܺܭ҇୯ 90 ԃ 7 Д Ջᙴ୷ቫᕴᚐჴࡼଆǴջᐱҥܭځдᙴᕍ୍ܺԾԋᕴᚐǴࡺҁࣴزࣁᗉխځдࡹ

฼ǵۑ࿯܄ਏᔈቹៜϷ௖૸ᙴᕍගٮޣёૈග߻ϸᔈϐՉࣁǴࣴزਔ໔ጄൎ೛ۓ 88ԃ 7 ДԿ 91 ԃ 6 ДǴځ٠ߚஒӕԃ 1 ДԿ 12 Дၗ਑ຎࣁ΋ԃǴԶаࢌԃࡋ 7 ДԿࡕ΋ԃࡋ 6 Дࣁ΋ԃයǴӆಒϩࣁჴࡼ߻ٿԃ(88/7~89/6Ǵಃ΋ය)ǵჴࡼ߻΋

ԃ(89/7~ 90/6ǴಃΒය)Ϸჴࡼࡕ΋ԃ(90/7~91/6ǴಃΟය)Ƕ

ҁࣴزਔ໔ጄൎϣ٠คፓ᏾೽ϩॄᏼ฻ӧอයϣىаቹៜ҇౲ᙴᕍճҔޑख़ εӢનǴࡺଷ೛ࣴزය໔ϣሡ؃य़ϐᙴᕍՉࣁคځдቹៜӢનǴऩ୷ቫບ܌ߐບ

೸݋୍ܺගٮԖ܌ᡂϯǴځቹៜᔈٰԾܭՋᙴ୷ቫᕴᚐჴࡼࡕᙴᕍ୍ܺගٮޣՉ ࣁޑׯᡂǶ

(Β) ࣴزБݤ

ࣁ຾΋؁ᙶమՋᙴ୷ቫᕴᚐჴࡼჹՋᙴ୷ቫບ܌๝᠌஑ࣽᙴৣϐගٮߐບ೸

݋୍ܺՉࣁޑቹៜǴҁࣴزҭஒ௦٣߻٣ࡕჹྣಔКၨࣴزݤ(pretest-post-test control group design)Ǵᗉխ໻ଞჹൂ΋ಔኬҁ຾Չϩ݋ਔǴѝૈ࣮ډόӕਔයϐ๊

ჹޑᡂϯǴԶ࣮όрόӕဂᡏ໔ޑ࣬ჹৡ౦Ǵคݤளډࡹ฼੿҅஥ٰޑቹៜǴࡺ

ҁࣴزஒࣴزჹຝϩࣁԖคჴࡼՋᙴ୷ቫᕴᚐϐ๝᠌஑ࣽᙴৣٿಔ຾ՉϐǶ

ࣴز΢ჹܭჹྣಔޑा؃Ǵ੝܄ᔈᅰёૈᆶჴᡍಔ࣬՟Ǵ٠Ъӧࣴزය໔ϣ ჹྣಔᔈคځдख़εࡹ฼ϟΕǶҗܭ 90 ԃ 1 Д܌ჴࡼޑᙴଣߐບӝ౛ໆ໻Ӧ୔ᙴ ଣόჴࡼǴЪځᙴଣ੝܄ҭၨᙴᏢύЈϷ୔ୱᙴଣ׳ௗ߈ܭ୷ቫບ܌ǴӢԜǴӦ

୔ᙴଣࣁҁࣴزၨ፾྽ϐჹྣಔǶ٠Եቾ๝᠌஑ࣽ୺཰ӦᗺӭᡂǴԶ຾΋؁୔ϩ ࣁჴࡼՋᙴ୷ቫᕴᚐޑჴᡍಔņ஑ឦ୷ቫບ܌ϐ๝᠌஑ࣽᙴৣǴᆶόჴࡼՋᙴ୷ቫ ᕴᚐޑჹྣಔņ஑ឦӦ୔ᙴଣϐ๝᠌஑ࣽᙴৣǶ

ࣁ௨ନჴᡍಔᆶჹྣಔڙډԾฅᖿ༈ϐቹៜϷࣁᆒዴᢀჸԜࡹ฼܌஥ٰޑ੿

҅ਏᔈǴҁࣴزஒ٬Ҕৡ౦ύϐৡ౦ޑ಍ीБݤ(difference-in-difference, DID)Ǵό

໻ϩձᢀჸჴᡍಔᆶჹྣಔࡹ฼ϟΕ߻ࡕৡ౦Ǵӆ຾΋؁ஒٿಔ߻ࡕৡ౦࣬෧Ǵ ෧ѐځѬӅӕԋߏਏᔈࡕǴளډৡ౦ύৡ౦ॶǴջࣁՋᙴ୷ቫᕴᚐჴࡼჹᙴᕍܺ

୍ගٮޣޑቹៜǶ

ځύճҔಃΒය(89/7~ 90/6)ᆶಃ΋ය(88/7~89/6)໔Ǵ๝᠌஑ࣽᙴৣ୺཰௃׎ϐ ᡂϯǴ௖૸ᙴᕍගٮޣࢂցග߻Ӣᔈࡹ฼ޑϟΕǴԶග߻ϸᔈځᙴᕍՉࣁϐႣය ਏᔈǹҗܭჹྣಔӦ୔ᙴଣᒿࡕܭ 91 ԃ 7 ДჴࡼᙴଣᕴᚐǴҁࣴزҭଷ೛ځᆶ୷ ቫບ܌΋ኬǴܭჴࡼᕴᚐ߻཮Ԗ࣬ӕޑႣයЈ౛Ǵ٠ග߻ϸᔈځᙴᕍՉࣁǴЪٿ ಔϐᕴᚐႣයਏᔈ࣬ӕǶӧԜଷ೛ΠǴ੿҅ޑᕴᚐਏᔈ໪ճҔಃΟය(90/7~ 91/6) ᆶಃ΋ය(88/7~89/6)໔Ǵ๝᠌஑ࣽᙴৣ୺཰௃׎ޑᡂϯǴ௖૸ӧჴࡼՋᙴ୷ቫᕴᚐ ࡕᙴৣՉࣁޑቹៜϐᕴᚐਏᔈǶࣴز೛ीӵკ 3-1-1 ܌ҢǺ

ჴᡍಔǺ୷ቫບ܌

ಃ΋ය (88/7~89/6) ಃΒය (89/7~90/6) ಃΟය (90/7~91/6)

88/7 89/1 89/7 90/1 90/7 91/1 91/7

(ϟΕӢη)

(ځѬӅӕԋߏ 1 + Ⴃයਏᔈ) (ځѬӅӕԋߏ 1 + Ⴃයਏᔈ) + (ځѬӅӕԋߏ 2 + ᕴᚐਏᔈ) ჹྣಔǺӦ୔ᙴଣ

88/7 89/1 89/7 90/1 90/7 91/1 91/7

(คϟΕӢη)

(ځѬӅӕԋߏ 1 ) (ځѬӅӕԋߏ 1) + (ځѬӅӕԋߏ 2 + Ⴃයਏᔈ) კ 3-1-1 ࣴز೛ी

90/7 Ջᙴ୷ቫᕴᚐ

91/7 ᙴଣᕴᚐ

(Ο) ࣴزჹຝ

ҁࣴزஒࣴزჹຝϩࣁ୷ቫບ܌ϷӦ୔ᙴଣϐ๝᠌஑ࣽᙴৣǴӢԵໆ๝᠌஑

ࣽ୺཰ӦᗺӭᡂǴࡺ௨ନࣴزය໔ϣځ୍ܺᙴଣቫભԖᡂ୏ޣǶԜѦǴவЎ᝘ύ ว౜ѱ൑੝܄ҭ཮ቹៜᙴৣՉࣁǴऩӧҁࣴزය໔ϣᙴৣ୺཰Ӧᗺᡂ୏ࡕǴځ୺

཰௃׎ऩԖ܌ׯᡂǴஒᜤа୔ϩࢂࡹ฼ޑቹៜ܈ࢂ܌ೀόӕѱ൑ޑׯᡂǴࡺҁࣴ

ز܌ᒧڗϐࣴزჹຝǴࣁ஑ឦܭࢌ΋଼ߥϩֽϐ୷ቫບ܌܈Ӧ୔ᙴଣޑ๝᠌஑ࣽ

ᙴৣǶ

(Ѥ) ࣴزጄൎ

ҁࣴزҞޑࣁຑ՗Ջᙴ୷ቫᕴᚐჴࡼჹ୷ቫບ܌ϐ๝᠌஑ࣽᙴৣޑቹៜǴӢ ԜǴ٩ᡂ໨ࣁᙴৣ୺཰୍ܺ௃׎Ǵځ܌୺཰୍ܺϣ৒Ǵߐບ೽ҽх֖΋૓ߐǵ࡚

ບਢҹϷߐບ೸݋୍ܺਢҹǴځύߐບ೸݋୍ܺࣁ๝᠌஑ࣽᙴৣЬा୍ܺ໨Ҟǹ ӧՐଣ୍ܺޑ೽ҽǴҁࣴزЬाࣴزჹຝϐ୷ቫ๝᠌஑ࣽᙴৣǴ໻΋Տᙴৣܭಃ

΋ය(88/7~89/6)໔ϣԖ΋฽Րଣ୍ܺ૶ᒵǴࡺҁࣴزஒόჹՐଣ୍ܺ຾Չϩ݋Ǵѝ ଞჹ๝᠌஑ࣽᙴৣϐ܌Ԗߐບ೸݋୍ܺ຾Չϩ݋Ƕ

Βǵࣴزࢎᄬ

ҁࣴزࣁ௖૸Ջᙴ୷ቫᕴᚐჴࡼჹᙴᕍ୍ܺගٮޣޑቹៜǴаჴࡼՋᙴ୷ቫ ᕴᚐޑჴᡍಔᆶόჴࡼՋᙴ୷ቫᕴᚐޑჹྣಔ࣬ၨޑБԄ຾ՉǴ٠Եቾᙴৣǵѱ

൑ǵӦ୔੝፦ҭ཮ቹៜᙴৣՉࣁǴӢԜஒځӈࣁ௓ڋᡂ໨Ƕҁࣴزࢎᄬӵკ 3-1-2

܌ҢǶ

კ 3-1-2 ࣴزࢎᄬ

୷ቫບ܌ / ჴࡼ߻΋ԃ ߐບ೸݋୍ܺ

ϐᙴᕍ຤Ҕᗺኧ Ӧ୔ᙴଣ ߐບ೸݋୍ܺ

ϐᙴᕍ຤Ҕᗺኧ

୷ቫບ܌ / ჴࡼಃ΋ԃ ߐບ೸݋୍ܺ

ϐᙴᕍ຤Ҕᗺኧ Ӧ୔ᙴଣ ߐບ೸݋୍ܺ

ϐᙴᕍ຤Ҕᗺኧ

୷ቫບ܌ / ჴࡼ߻ٿԃ ߐບ೸݋୍ܺ

ϐ ᙴᕍ຤Ҕᗺኧ

Ӧ୔ᙴଣ ߐບ೸݋୍ܺ

ϐ ᙴᕍ຤Ҕᗺኧ

Ջᙴ୷ቫᕴᚐ Ѝбڋࡋ ႣයЈ౛

(Ⴃයਏᔈ)

Ջᙴ୷ቫᕴᚐ Ѝбڋࡋ (ᕴᚐਏᔈ)

௓ڋᡂ໨

ᙴৣ੝፦Ǻ

܄ձ ǵԃស ѱ൑੝፦Ǻ

؂Տᙴৣ୍ܺ೸݋ੰΓӭჲ

ಃΒ࿯ ࣴزଷᇥ

ҁࣴزЬाӧ௖૸Ջᙴ୷ቫᕴᚐჴࡼჹ୷ቫບ܌ϐ๝᠌஑ࣽᙴৣᙴᕍՉࣁޑ ቹៜǴவЎ᝘ٰύளޕǴᕴᚐႣᆉڋࡋΠǴᙴᕍճҔ௓ڋޑԋ݀ό΋Ǵՠܭ౛ፕ ኳࠠ௢Ꮴ΢Ǵ่݀ӭࣁᙴৣ཮௦ڗᝡݾ฼ౣǴቚу܌ගٮޑ୍ܺǴଓ؃ঁΓനε ճዎ(Benstetter and Wambach, 2006; Fan et al., 1998; ೚ᅺ޹ǵླྀ໡࣓Ǵ2007; ഋ෕

፣฻ΓǴ2003; ഋᝬܿǴ2004)ǴЪ୯ϣԖᜢУᙴᕴᚐϷՋᙴ୷ቫᕴᚐࣴزǴᡉҢ ᙴৣ཮ᒧ᏷ቚу୍ܺໆ܈ගଯ؂ҹҙൔߎᚐޑᙴᕍՉࣁౢғ(Ֆྻǵ໳଻൏Ǵ2005;

ᄃℱ๤Ǵ2000; ᖴችृǴ2003)ǹځύᖴችृ(2003)ࣴز߄Ңᙴৣ཮ӭ଺܈ᒧ᏷๏б ߎᚐၨଯϷԖճёკޑ୍ܺ໨ҞǴ٬ሽ਱ϐԋߏଯܭኧໆϐԋߏǶ

ӧࡹ฼ϟΕϐѦǴቹៜᙴৣՉࣁޑӢનۘԖᙴৣ੝፦ǵѱ൑੝፦ǵӦ୔੝፦

(Chaix-Couturier et al., 2000; Hellinger, 1996; Reschovsky et al., 2006; Shen et al., 2004)Ƕ୯ϣࣴزҭᡉҢόӕ଼ߥϩֽձϷࠤໂձ໔ϐৡ౦ᡂε(ᄃℱ๤Ǵ2000)Ǵ ϷόӕԃសձޑᙴৣӧᕴᚐႣᆉڋࡋჴࡼ߻ࡕޑҙൔኧໆԖόӕᡂϯ(ᖴችृǴ 2003)Ƕ

ନΑࡹ฼ჴࡼࡕޑቹៜѦǴځ܌஥ٰޑႣයЈ౛ቹៜҭ࣬྽ख़ाǴHenke ฻Γ (1994)߄Ңቺ୯ᕴᚐჴࡼ߃යǴӧ೛ۓᕴᚐᚐࡋਔǴࣁᗉխჴࡼ߻΋ԃᙴৣ٣Ӄቚ уځ୍ܺໆǴ٬ځीᆉ୷ྗԃϐᚐࡋᡂӭǴࡺаჴࡼ߻ٿԃࣁځᚐࡋ೛ۓ୷ྗԃǴ ୯ϣֆਔ௘(2004)ҭว౜Ǵܭ 90 ԃ 1 Дᙴଣߐບӝ౛ໆჴࡼ߻΋ԃౢғႣයਏᔈǴ

೷ԋᙴଣזೲቚуߐບໆǶԶך୯Ջᙴ୷ቫᕴᚐࣴ᝼Бਢ೛ۓ୷ྗԃࣁ߻΋ԃǴ ٠ؒԖ௨ନёૈႣӃϸᔈϐՉࣁǴӢԜҁࣴزటᡍ᛾ᙴৣࢂցԖႣයЈ౛ග߻ϸ ᔈǴቚуځ୍ܺໆǶ

ᆕӝ߻ॊЎ᝘௖૸ϷࣴزࢎᄬǴҁࣴزϐࣴزଷᇥӵΠǺ

H1. Ջᙴ୷ቫᕴᚐჴࡼ߻΋ԃǴ୷ቫບ܌๝᠌஑ࣽᙴৣϐߐບ೸݋୍ܺᙴᕍ

຤ҔᗺኧቚуǶ

H2. Ջᙴ୷ቫᕴᚐჴࡼࡕ΋ԃǴ୷ቫບ܌๝᠌஑ࣽᙴৣϐߐບ೸݋୍ܺᙴᕍ

຤ҔᗺኧቚуǶ

ಃΟ࿯ ࣴزᡂ໨

ҁࣴزԑӧ௖૸Ջᙴ୷ቫᕴᚐჴࡼჹ๝᠌஑ࣽᙴৣᙴᕍՉࣁޑቹៜǴҁࣴز аߐບ೸݋୍ܺᙴᕍ຤ҔᗺኧǴж߄๝᠌஑ࣽᙴৣ୺཰௃׎ǴаᢀჸՋᙴ୷ቫᕴ ᚐჴࡼჹᙴᕍ୍ܺගٮޣޑቹៜǶନࡹ฼ϟΕϐѦǴቹៜᙴৣՉࣁޑӢનۘԖᙴ

ৣ੝፦ǵੰΓ੝፦ǵᕉნ੝፦(ѱ൑੝፦ǵӦ୔੝፦)Ǵҁࣴزᔈҭ჋၂ϒа௓ڋǶ ҁࣴزࣁଞჹՋᙴ୷ቫᕴᚐΠ೸݋λᕴᚐჹ๝᠌஑ࣽᙴৣᙴᕍՉࣁޑቹៜǴ Զௗڙ೸݋୍ܺϐੰ஻Ǵࣁೕࡓ؂ຼௗڙ೸݋ݯᕍΟԛǴੰΓϐ໔܌ሡ೸݋୍ܺ

ৡ౦όεǴЪ๝᠌஑ࣽᙴৣᙴᕍ୍ܺа೸݋Ьा໨ҞǴӢԜҁࣴز٠คԵቾੰΓ

੝፦ჹ๝᠌஑ࣽᙴৣᙴᕍՉࣁޑቹៜǶԜѦǴڙज़ܭᙴৣኬҁኧϿǴᙴৣܭӦ୔

΢ߚ֡ϬϩѲǴҁࣴز௦ΒϩᜪஒӚ଼ߥϩֽϐ؂Տ೸݋ᙴৣ୍ܺ೸݋ੰΓӭჲ ϩࣁٿಔǴඹжѱ൑ٮሡ੝፦ϷӦ୔੝፦ᡂ໨ǶନԜϐѦǴҁࣴزҭ௓ڋᙴৣ܄

ձϷԃស௦Οԃសಔϩᜪϐᡂ໨Ƕ߄ 3-3-1 ࣁҁࣴزࣴزᡂ໨ϐᏹբࠠۓကϷឦ܄Ƕ

߄ 3-3-1 ࣴزᡂ໨ϐᏹբࠠۓက

ᡂ໨Ӝᆀ ᏹբࠠۓက ឦ܄

ᙴৣՉࣁ ߐບ೸݋୍ܺ

ϐᙴᕍ຤Ҕᗺኧ

ঁձᙴৣϐ྽යՋᙴߐບǴਢҹϩᜪࣁȨ05ȩϐҙ ፎߎᚐу೽ҽॄᏼ

ೱុ

௓ڋᡂ໨

ᙴৣ܄ձ ت܄Ϸζ܄ ᜪձ

ᙴৣԃស 39 ྃаΠǵ40~49 ྃǵ50 ྃа΢ ᜪձ

؂Տᙴৣ୍ܺੰΓК Ӛ଼ߥϩֽϣ؂Տ೸݋ᙴৣ୍ܺ೸݋ੰΓኧК

=྽යම٬Ҕၸ೸݋୍ܺϐੰ஻

ϐᙴৣ

྽යම୺Չၸ೸݋୍ܺ

ځॶࣁ 49 аΠࣁեǴ50 а΢ࣁଯ

ᜪձ

ಃѤ࿯ ࣴز׷਑ᆶၗ਑ೀ౛

΋ǵၗ਑ٰྍ

ҁࣴزࣁԛભၗ਑ϩ݋ǴճҔӄ଼҇நߥᓀၗ਑৤ 1999 ԃԿ 2002 ԃϐߐບ

ೀБϷݯᕍܴಒᔞȐCDȑǵߐບೀБᙴзܴಒᔞȐOOȑǵ஑ࣽᙴৣ᛾ਜЬᔞ(DOC)ǵ ᙴ٣Γ঩୷ҁၗ਑ᔞ(PER)Ϸᙴ٣ᐒᄬ୷ҁၗ਑ᔞ(HOSB)຾Չϩ݋Ƕ

(΋) ߐບೀБϷݯᕍܴಒᔞȐCDȑǺҔаڗளࣴزჹຝϐᙴৣжဦǵՋᙴߐບ ҙൔߎᚐǵ೽ҽॄᏼǵ຤ҔԃДǵҙൔᜪձǵᙴ٣ᐒᄬжዸǵҙൔВයǵ ਢҹϩᜪǵࢬНဦ฻Ƕ

(Β) ߐບೀБᙴзܴಒᔞȐOOȑǺҔаڗளᙴৣ୍ܺගٮϣ৒ϐᙴзжዸǵᙴ зᜪձϷ຤ҔԃДǵҙൔᜪձǵᙴ٣ᐒᄬжዸǵҙൔВයǵਢҹϩᜪǵࢬ Нဦ฻Ƕ

(Ο) ஑ࣽᙴৣ᛾ਜЬᔞ(DOC)ǺҔаڗளᙴৣϐ஑ࣽᙴৣࣽձǵ᛾ਜғਏଆВ ϷғਏّВǶ

(Ѥ) ᙴ٣Γ঩୷ҁၗ਑ᔞ(PER)ǺҔаڗளᙴৣϐрғВයϷ܄ձǶ

(ϖ) ᙴ٣ᐒᄬ୷ҁၗ਑ᔞ(HOSB)ǺҔаڗளᙴৣ୍ܺᐒᄬϐ੝ऊᜪձϷᑜѱ

୔ዸǶ

Βǵࣴزჹຝϐᒧڗ

ҁࣴزа଼ߥҙൔၗ਑Ϸ஑ࣽᙴৣ᛾ਜЬᔞٰࣚۓࣴزჹຝǴᑔᒧр 1999 ԃ Կ 2002 ԃ໔؂ԃೱុ୺Չ೸݋୍ܺϐ๝᠌஑ࣽᙴৣǴࣁҁࣴزᢀჸ௼ဂǶၗ਑ೀ

౛ၸำ(კ 3-4-1)Ǵ२Ӄפр 1999 ԃԿ 2002 ԃ໔ම࿶୺Չၸ 05 ਢҹՈన೸݋Ϸဎ ጢ೸݋ޑ๝᠌஑ࣽᙴৣǴᙖҗ OO ᔞύਢҹϩᜪࣁ 05 ЪᙴзжዸࣁՈన೸݋

Ȩ58001CȩǵȨ58019Cȩ~Ȩ58025CȩǴаϷဎጢ೸݋Ȩ58002CȩǵȨ58011AȩǵȨ58011Bȩǵ Ȩ58011CȩǵȨ58017AȩǵȨ58017BȩǵȨ58017CȩޑੰΓύࡷрځᙴৣжဦӅ 1126 ՏǹಃΒ؁ᡯǴᆶ஑ࣽᙴৣ᛾ਜЬᔞՍᔞǴ಄ӝ஑ࣽᙴৣࣽձࣁ๝᠌஑ࣽϐᙴৣ

жዸ 676 ՏǹಃΟ؁ᡯǴᆶᙴ٣Γ঩୷ҁၗ਑ᔞՍᔞǴନѐ܄ձϷғВԖᇤϐၗ

਑ࡕᎩ 661 ՏǹಃѤ؁ᡯǴவ 661 Տᙴৣޑ܌Ԗ೸݋୍ܺύǴᑔᒧೱុѤԃԖ๝

᠌஑ࣽ୺ྣЪೱុѤԃම࿶୺Չၸ 05 ਢҹϐ๝᠌஑ࣽᙴৣӅ 430 ՏǴࣁҁࣴزᢀ ჸϐ҆ဂᡏǶ

җܭڙज़ܭ୯ৎፁғࣴزଣޑӄ଼҇நߥᓀࣴزၗ਑৤੝ਸሡ؃ҙፎǴჹҙ ፎၗ਑৒ໆελԖ܌ೕጄǴࡺ୯ፁଣ໻ගٮᒿᐒܜኬ 60%ϐࣴز҆ဂᡏǴ܌ளܜ ኬኬҁӅ 258 ՏǴ࿶፾ӝࡋᔠۓኬҁϐᙴৣ܄ձǵԃសϷ୺཰܌ឦϩֽϩѲ௃׎

ᆶ҆ဂᡏคᡉ๱ৡ౦ǴᡉҢҁࣴزኬҁϩѲىаж߄҆ဂᡏǶ

ҁࣴزԑӧ௖૸Ջᙴ୷ቫᕴᚐჹ୷ቫ๝஑ࣽᙴৣՉࣁޑቹៜǴࣁᙶమՋᙴ୷ ቫᕴᚐޑቹៜǴஒࣴزჹຝ୔ϩࣁჴᡍಔᆶჹྣಔǴ٠Եቾ๝᠌஑ࣽᙴৣ୺཰Ӧ ᗺӭᡂǴӢԜ٩ځ୺཰ᐒᄬ੝ऊቫભբ୔ϩǴࡺᒧрኬҁܭ 88/7-89/6ǵ89/7-90/6 Ϸ 90/7-91/6 ߻ࡕΟයǴځ୍ܺᐒᄬ੝ऊձࣁӕ΋ቫભϷӕ΋଼ߥϩֽϐ๝᠌஑ࣽ

ᙴৣǴаКၨ୷ቫ๝஑ࣽᙴৣᆶӦ୔ᙴଣޑৡ౦Ƕനࡕளډ୷ቫ 48 ՏǵӦ୔ᙴଣ 42Տ๝᠌஑ࣽᙴৣǴӅ 90 ՏࣁҁࣴزϐࣴزჹຝǶ

Οǵᙴৣҙൔ຤Ҕၗ਑ϐڗள

җߐບೀБϷݯᕍܴಒᔞȐCDȑᒧڗࣴزኬҁ 90 Տᙴৣ 1999 ԃ 7 ДԿ 2002 ԃ 6 Д໔܌Ԗߐບ೸݋ҙൔਢҹǴᙴৣ྽ය೸݋୍ܺᙴᕍ຤ҔᗺኧǴឦՋᙴߐບ ਢҹΠǴਢҹϩᜪࣁ 05 ޣǴа೽ҽॄᏼ(PART_AMT)Ϸҙፎߎᚐ(T_APPL_AMT) ӝीϐǶ

ѤǵӚ଼ߥϩֽᙴৣ୍ܺੰΓКϐڗள

а ୯ ፁ ଣ ග ٮ ҁ ࣴ ز ම ୺ Չ ೸ ݋ ܺ ୍ ϐ ᙴ ৣ ܜ ኬ Ҕ ϐ ᔞ ਢ Ǵ ڗ ள ӄ ୯ 1999-2002ԃ໔ම࿶ම୺Չ೸݋୍ܺϐᙴৣжဦǴϷځ୺Չ೸݋୍ܺ຤ҔԃДکᙴ ٣ᐒᄬжဦǴளаڗளֹ᏾Ӛ଼ߥϩֽϐ೸݋୍ܺᙴৣኧǶ

೸݋ੰ஻߾аҁࣴز܌ܜኬϐ 258 ՏᙴৣǴ྽යම࿶୍ܺޑ೸݋ੰΓǴᘏڗ చҹࣁ OO ᔞύਢҹϩᜪࣁ 05 ЪᙴзжዸࣁՈన೸݋Ȩ58001CȩǵȨ58019Cȩ~

Ȩ58025CȩǴаϷဎጢ೸݋Ȩ58002CȩǵȨ58011AȩǵȨ58011BȩǵȨ58011CȩǵȨ58017Aȩǵ Ȩ58017BȩǵȨ58017CȩੰΓ຾ՉᘜЊǴ٠ࡪځᆶऍ୯๝᠌ၗ਑ฦᒵس಍ȐUSRDSȑ

2005 ԃൔ֋܌ϦѲ 1999-2002 ԃѠ᡼೸݋౰Չ౗ϐК౗Ǵ՗ीӚය໔Ϥε଼ߥϩ

ֽϣϐ೸݋ੰΓኧǴ຾ԶаڗளӚ଼ߥϩֽᙴৣ୍ܺੰΓКǶ

კ 3-4-1 ๝᠌஑ࣽᙴৣኬҁᒧڗࢬำ 1999/1-2002/12

ම୺Չ 05 ਢҹϐᙴৣ 1126 Տ

ࡷр๝᠌஑ࣽᙴৣ 676 Տ

ࡷрೱុѤԃԖ๝᠌஑ࣽ୺ྣ

ϐ๝᠌஑ࣽᙴৣ 486 Տ

ၗ਑ନᒱࡕᎩ 661 Տ๝᠌஑ࣽᙴৣ

ᒿᐒܜр 60%಄ӝ΢ॊచҹ ϐ๝᠌஑ࣽᙴৣ 258 Տ ᑔрೱុѤԃම࿶୺Չၸ 05 ਢҹ

ϐ๝᠌஑ࣽᙴৣ 430 Տ

1999/7-2002/6

คᡂ୏୍ܺቫભϷ଼ߥϩֽޣ Ӧ୔ᙴଣǺ42 Տ ୷ቫଣ܌Ǻ48 Տ

ࣁҁࣴزϐࣴزჹຝ

ಃϖ࿯ ಍ीБݤ

ҁࣴز٬Ҕ SAS ঺း೬ᡏ 9.1 ހϷ SPSS13.0 ހ຾Չၗ਑ϩ݋Ǵ಍ीБݤхࡴǺ

΋ǵඔॊ܄಍ी

(΋) ࣴزჹຝᙴৣঁΓ੝፦Ǻ܄ձǵԃសǵᙴৣ୺཰Ӧᗺ܌ឦϐ଼ߥϩֽ฻

ϩթ௃׎Ƕ

(Β) Ջᙴ୷ቫᕴᚐჴࡼ߻ࡕǴࣴزჹຝߐບ೸݋୍ܺϐᙴᕍ຤Ҕᗺኧϩթ௃

׎Ƕ

Βǵ௢ፕ܄಍ी

(΋)ৡ౦ύϐৡ౦ݤ

Ҕаຑ՗Ջᙴ୷ቫᕴᚐϟΕǴჹՋᙴ୷ቫບ܌๝᠌஑ࣽᙴৣޑቹៜǶ܌ᒏޑ ৡ౦ύϐৡ౦БݤǴ߯ࡰϩձीᆉჴᡍಔᆶჹྣಔӧࡹ฼(٣ҹ)ϟΕ߻ࡕৡຯࡕǴ ӆ຾΋؁ஒჴᡍಔᆶჹྣಔޑ߻ࡕৡຯ࣬෧Ǵளډځৡ౦ύϐৡ౦ॶǴа௨ନځ ѬυᘋӢનቹៜǴၨૈᆒዴीᆉࡹ฼(٣ҹ)ϟΕ܌ठׯᡂቚ෧ϐ੿҅ਏ݀Ƕ

ҁࣴزஒࣴزჹຝϩࣁჴࡼՋᙴ୷ቫᕴᚐޑჴᡍಔņ஑ឦ୷ቫບ܌ϐ๝᠌஑

ࣽᙴৣǹᆶόჴࡼՋᙴ୷ቫᕴᚐޑჹྣಔņ஑ឦӦ୔ᙴଣϐ๝᠌஑ࣽᙴৣǶϩձ௖

૸ᙴᕍගٮޣࢂցჹࡹ฼ޑϟΕԖႣයЈ౛ǴԶග߻ϸᔈځᙴᕍՉࣁϐႣයਏ ᔈǴаϷ௖૸ӧჴࡼՋᙴ୷ቫᕴᚐࡕᙴৣՉࣁޑቹៜϐᕴᚐਏᔈ(კ 3-5-1)Ƕ

ၮҔৡ౦ύϐৡ౦ݤǴଷ೛ჴᡍಔᆶჹྣಔନΑࡹ฼ϟΕჴᡍಔѦǴځдቹ ៜ܈ԾฅԋߏӢηࣣ࣬ӕǴӢԜҁࣴزճҔಃΒය(89/7~ 90/6)ᆶಃ΋ය(88/7~ 89/6) ໔Ǵჴᡍಔٿයৡ౦( B1 - B2)ᆶჹྣಔٿයৡ౦( B1’- B2’)࣬෧Ǵҭ฻ܭளډৡ౦ ύޑৡ౦( B1 - B2 ) - ( B1’- B2’)ǴջࣁᕴᚐႣයਏᔈǶ

ᕴᚐਏᔈ೽ҽǴՠჹྣಔӦ୔ᙴଣஒܭ 91 ԃ 7 ДჴࡼᙴଣᕴᚐǴҁࣴزଷ೛

ځᆶ୷ቫଣ΋ኬܭჴࡼᕴᚐ߻཮Ԗ࣬ӕޑႣයЈ౛Ǵග߻ϸᔈځᙴᕍՉࣁǴЪٿ ಔϐᕴᚐႣයਏᔈ࣬ӕǴӧԜଷ೛ΠǴ੿҅ޑᕴᚐਏᔈ໪ճҔಃΟය(90/7~ 91/6) ᆶಃ΋ය(88/7~89/6)໔Ǵჴᡍಔᆶჹྣಔৡ౦ύޑৡ౦ளϐǴջࣁჴᡍಔٿයৡ౦ ( A1ɡB2)ᆶჹྣಔٿයৡ౦( A1’ ɡB2’)࣬෧Ǵҭ฻ܭளډৡ౦ύޑৡ౦( A1ɡB2 )

- ( A1’ɡB2’)ǴԜࣁᕴᚐႣයਏᔈǶ

ჴᡍಔǺ୷ቫບ܌

ಃ΋ය (88/7~89/6) ಃΒය (89/7~90/6) ಃΟය (90/7~91/6)

88/7 89/1 89/7 90/1 90/7 91/1 91/7

B2 B1

(ځѬӅӕԋߏ 1 + Ⴃයਏᔈ)

A1

(ځѬӅӕԋߏ 1 + Ⴃයਏᔈ) + (ځѬӅӕԋߏ 2 + ᕴᚐਏᔈ) ჹྣಔǺӦ୔ᙴଣ

88/7 89/1 89/7 90/1 90/7 91/1 91/7

B2’ B1’

(ځѬӅӕԋߏ 1 )

A1’

(ځѬӅӕԋߏ 1) + (ځѬӅӕԋߏ 2 +Ⴃයਏᔈ)

კ 3-5-1 ࣴزය໔Ӛਏᔈϩ݋კ

91/7 ᙴଣᕴᚐ 90/7

Ջᙴ୷ቫᕴᚐ

(Β) ଑ᘜϩ݋

ࣁ௓ڋёૈቹៜᙴৣՉࣁϐӢનǴҁࣴز຾΋؁٬Ҕቶက՗ीݤ(Generalized estimating equation, GEE)௓ڋӚයձϐ໔ޑ࣬ᜢ܄Ǵа҅ዴ՗ी଑ᘜኳࠠǴ٠௓ڋ ᙴৣ܄ձǵԃសǵ଼ߥϩֽǴаϩ݋ჴᡍಔᆶჹྣಔޑᙴৣՉࣁࢂցԖৡ౦Ǵ଑

ᘜኳԄӵΠ܌ҢǶ

Y1=E₀+E₁Level +E₂Period +E₃Level*Period+E₄gender +E₅age_2 +E₆age_3 +E₇market +İ

Y2=E₀+E₁Level +E₂Period +E₃Level*Period+E₄gender +E₅age_2 +E₆age_3 +E₇market +İ

Y1Ǻж߄ಃ΋ය 88/7~89/6 ᆶಃΒය 89/7~90/6 ϐ໔ޑᙴৣߐບ೸݋ᙴᕍ຤ҔᗺኧǶ Y2Ǻж߄ಃ΋ය 88/7~89/6 ᆶಃΟය 90/7~91/6 ϐ໔ޑᙴৣߐບ೸݋ᙴᕍ຤ҔᗺኧǶ

ᡂ໨ϐཀကǺ

LevelǺж߄ಔձǴ୷ቫບ܌๝᠌஑ࣽᙴৣ(ჴᡍಔ)ࣁ 1ǵ Ӧ୔ᙴଣ๝᠌஑ࣽᙴৣ(ჹྣಔǴୖԵಔ)ࣁ 0Ƕ PeriodǺж߄ය໔Ǵࡕයࣁ 1ǵ߻යࣁ 0(ୖԵಔ)

genderǺж߄ᙴৣ܄ձǴتࣁ 1ǵζࣁ 0(ୖԵಔ)

ageǺж߄ᙴৣԃសǴ39 ྃаΠࣁୖԵಔǹ40 Կ 49 ྃ߾ age_2 ࣁ 1Ǵځдࣁ 0ǹ 50ྃа΢߾ age_3 ࣁ 1Ǵځдࣁ 0Ƕ

marketǺж߄ᙴৣ୺཰Ӧᗺ܌ឦ଼ߥϩֽޑ؂Տᙴৣ୍ܺੰΓКǴ50 Γа΢ࣁ 1ǵ 49ΓаΠࣁ 0(ୖԵಔ)Ƕ

İǺж߄ᇤৡ໨Ƕ

՗ीॶϐཀကǺ E1Ǻࣁಔձ໔ޑৡ౦

E2Ǻࣁಔձ໔ӧ߻ࡕයϐ໔࣬ӕޑৡ౦Ǵջࣁಃ΋చ଑ᘜϐځдӅӕԋߏ 1Ǵᆶ

ಃΒచ଑ᘜϐځдӅӕ 1ǵځдӅӕ 2 ϷႣයਏᔈϐӝǶ

E3Ǻࣁಔձ໔ϐৡ౦ύϐৡ౦Ǵջࣁಃ΋చ଑ᘜϐᕴᚐႣයਏᔈǴᆶಃΒచ଑ᘜ ϐᕴᚐਏᔈǶ

ಃѤക ࣴز่݀

ҁകϩࣁϖλ࿯Ǵಃ΋࿯ඔॊҁࣴز܌ᢀჸϐ๝᠌஑ࣽᙴৣޑ୷ҁ੝܄ǹಃ

Β࿯ аᖿ༈კ຾Չ୷ቫບ܌ϷӦ୔ᙴଣϐ๝᠌஑ࣽᙴৣߐບ೸݋୍ܺᙴᕍ຤Ҕ ᗺኧϐϩ݋ǹಃΟ࿯ ճҔৡ౦ύޑৡ౦Бݤ຾Չ๝᠌஑ࣽᙴৣՉࣁϐৡ౦ύޑৡ ౦ϩ݋ǹಃѤ࿯ࣁ๝᠌஑ࣽᙴৣՉࣁϐ଑ᘜϩ݋Ƕ

ಃ΋࿯ ๝᠌஑ࣽᙴৣ੝፦

ҁࣴزჹຝа଼ߥҙൔၗ਑Ϸ஑ࣽᙴৣ᛾ਜЬᔞٰࣚۓϐǴᒿᐒܜኬ 60%ϐ 2000ԃԿ 2002 ԃ໔Ǵڀ๝᠌஑ࣽ୺ྣЪ୺Չ೸݋୍ܺϐ୷ቫບ܌ϷӦ୔ᙴଣ๝᠌

஑ࣽᙴৣǴ٠Եቾ๝᠌஑ࣽᙴৣ୺཰ӦᗺӭᡂǴ௨ନҁࣴزය໔ 2000 ԃ 7 ДԿ 2002 ԃ 6 Д໔Ǵځ୍ܺቫભϐ੝ऊձᡂ୏ޣǴаϷ଼୍ܺߥϩֽձᡂ୏ޣǴ಄ӝచҹ ޣӅ 90 Տ๝᠌஑ࣽᙴৣǶ߄ 4-1-1 ࣁჴᡍಔᆶჹྣಔ๝᠌஑ࣽᙴৣϐ୷ҁၗ਑Ǵ ჴᡍಔࣁ୷ቫບ܌ǴԖ 48 Տ๝᠌஑ࣽᙴৣǴऊ՞ 53.3 %ǹჹྣಔࣁӦ୔ᙴଣԖ 42 Տ๝᠌஑ࣽᙴৣǴऊ՞ 46.7%Ƕ٠࿶፾ӝࡋᔠۓჴᡍಔᆶჹྣಔϐᙴৣ܄ձϷԃ សǴځϩթ௃׎คၲᡉ๱ৡ౦ǴࡺჴᡍಔᆶӚჹྣಔ໔ࢂڀёКၨ܄ǹԶځ୍ܺ

଼ߥϩֽϩթ௃׎ၲᡉ๱ৡ౦Ǵࡺܭ଑ᘜኳࠠਠ҅ϐǶ

ӧ๝᠌஑ࣽᙴৣϐ੝፦Бय़Ǵ᏾ᡏᙴৣ܄ձаت܄ࣁЬǴ՞ 92.2%Ǵζ܄՞

7.8%ǹԃសБय़Ǵ߯а 2000 ԃ෧ѐࣴزჹຝрғВයϐՋϡԃीᆉǴ᏾ᡏѳ֡ԃ សࣁ 43.4 ྃǴځύа 40 Կ 49 ྃޑᙴৣനӭǴ՞ 44.4%Ǵځԛࣁ 39 ྃаΠǴ՞ 33.3%Ǵ 50 ྃа΢ޣѝ՞ 22.2%Ƕӧ๝᠌஑ࣽᙴৣ୺཰ϐ଼ߥϩֽձύǴаѠчӦ୔ࣁന ӭǴ՞ 28.9%Ǵځд٩ׇࣁࠄ୔ϩֽǵύ୔ϩֽǵଯࡀϩֽǵѠчϩֽǴനϿޑࣁ

ܿ୔ϩֽǴ՞ 3.3%Ƕ

߄ 4-1-1 ჴᡍಔᆶჹྣಔ๝᠌஑ࣽᙴৣϐ୷ҁၗ਑

ჴᡍಔ ჹྣಔ

୷ቫບ܌ Ӧ୔ᙴଣ x²test ӝी

Γኧ % Γኧ % pॶ Γኧ %

ᙴৣኧ 48 53.3% 42 46.7% 90 100%

܄ձ 0

ت 45 93.8% 38 90.5% 83 92.2%

ζ 3 6.3% 4 9.5% 0.38 7 7.8%

ԃស

39ྃаΠ 15 31.3% 15 35.7% 30 33.3%

40 ~ 49ྃ 22 45.8% 18 42.9% 40 44.4%

50ྃа΢ 11 22.9% 9 21.4% 0.82 20 22.2%

଼ߥϩֽ

Ѡчϩֽ 16 33.3% 10 23.8% 26 28.9%

ч୔ϩֽ 2 4.2% 9 21.4% 11 12.2%

ύ୔ϩֽ 7 14.6% 10 23.8% 17 18.9%

ࠄ୔ϩֽ 17 35.4% 4 9.5% 21 23.3%

ଯࡀϩֽ 4 8.3% 8 19.0% 12 13.3%

ܿ୔ϩֽ ! 2 4.2% 1 2.4% <0.001 ! 3 3.3%

ຏǺ௦፾ӝࡋᔠۓჴᡍಔᆶჹྣಔϩѲК౗௃׎Ƕ

ಃΒ࿯ ๝᠌஑ࣽᙴৣՋᙴߐບ୍ܺϐᖿ༈ϩ݋

ҁࣴزය໔ࣁ҇୯ 88 ԃ 7 ДԿ 91 ԃ 6 ДǴϩࣁಃ΋යǴՋᙴ୷ቫᕴᚐჴࡼ

߻ٿԃ(88/7~89/6)ǹಃΒයǴჴࡼ߻΋ԃ(89/7~ 90/6)ǹϷಃΟයǴჴࡼࡕ΋ԃ (90/7~91/6)ǶаΠճҔ߄ 4-2-1 ᆶკ 4-2-1Ǵև౜ჴᡍಔ୷ቫບ܌ϷჹྣಔӦ୔ᙴଣ

๝᠌஑ࣽᙴৣӧࣴزය໔Ǵѳ֡؂Տᙴৣߐບ೸݋୍ܺǶ

ӧߐບ೸݋୍ܺϐᙴᕍ຤Ҕᗺኧ΢(߄ 4-2-1)Ǵ୷ቫບ܌๝᠌஑ࣽᙴৣѳ֡؂

Γಃ΋යࣁ 35,736,377 ᗺǴಃΒයࣁ 40,173,282 ᗺǴಃΟයࣁ 43,164,564 ᗺǶӦ

୔ᙴଣ๝᠌஑ࣽᙴৣѳ֡؂Γಃ΋යࣁ 40,379,673 ᗺǴಃΒයࣁ 40,803,478 ᗺǴ

ಃΟයࣁ 43,186,105 ᗺǶځಃΒයԋߏ౗Ǵ୷ቫບ܌๝᠌஑ࣽᙴৣࣁ 12.42%Ǵᇻ εܭӦ୔ᙴଣᙴৣޑ 1.05%ǹಃΟයԋߏ౗Ǵ୷ቫບ܌๝᠌஑ࣽᙴৣࣁ 7.45%Ǵଯ ܭӦ୔ᙴଣᙴৣޑ 5.84%Ƕ

வკ 4-2-1Ǵёܴᡉ࣮рٿಔΟࢤය໔ޑᡂϯǴӧಃ΋යᆶಃΒය໔Ǵ୷ቫບ

܌๝᠌஑ࣽᙴৣε൯ϲଯǴಃΒයᆶಃΟය໔ǴٿಔԔጕ೿և౜΢ϲǴՠё࣮р

୷ቫບ܌๝᠌஑ࣽᙴৣ΢ϲ൯ࡋౣεܭӦ୔ᙴଣǶ᏾ᡏԶقǴ࣬ၨܭӦ୔ᙴଣᙴ

ৣԔጕǴ୷ቫບ܌๝᠌஑ࣽᙴৣև౜ε൯ࡋޑ΢ϲǴܭಃΟයਔǴ୷ቫບ܌ᙴৣ

൳ЯזၲډᆶӦ୔ᙴଣޑᙴৣ΋ኬޑߐບ೸݋୍ܺᙴᕍ຤ҔᗺኧǴѳ֡؂Γ໻ৡ ຯ 21,541 ᗺǶᡉҢӧߐບ೸݋୍ܺБय़Ǵ࣬ჹܭӦ୔ᙴଣǴ୷ቫບ܌๝᠌஑ࣽᙴ

ৣёૈӧಃΒයр౜ᕴᚐႣයਏᔈǴаϷёૈӧಃΟයวғᕴᚐਏᔈǴቚуځܺ

୍ᙴᕍ຤ҔᗺኧǶ

߄ 4-2-1 ѳ֡؂ՏᙴৣՋᙴߐບ୍ܺᙴᕍ຤Ҕᗺኧ

୷ቫບ܌ (n=48) Ӧ୔ᙴଣ (n=42) ය໔

೸݋୍ܺ ԋߏ౗ ೸݋୍ܺ ԋߏ౗

ಃ΋ය (88/7~89/6) 35,736,377 40,379,673

ಃΒය (89/7~90/6) 40,173,282 12.42% 40,803,478 1.05%

ಃΟය (90/7~91/6) 43,164,564 7.45% 43,186,105 5.84%

ˆ˃˃

ˆˇ˃

ˆˋ˃

ˇ˅˃

ˇˉ˃

รԫཚ รԲཚ รԿཚ

Լᆄរ ^{ഗᐋೃࢬ چ೴᠔ೃ}

კ 4-2-1 ๝᠌஑ࣽᙴৣ೸݋୍ܺᙴᕍ຤Ҕᗺኧ

ಃΟ࿯ ๝᠌஑ࣽᙴৣՋᙴߐບ୺཰୍ܺϐৡ౦ύޑৡ౦ݤϩ݋

ҁ࿯аৡ౦ύޑৡ౦(DID)ݤǴճҔಃ΋යᆶಃΒයᙴৣ଼ߥҙൔၗ਑Ǵीᆉ

୷ቫບ܌๝᠌஑ࣽᙴৣܭՋᙴ୷ቫᕴᚐჴࡼ߻΋ԃޑᕴᚐႣයਏᔈǴϷճҔಃ΋

යᆶಃΟයǴीᆉՋᙴ୷ቫᕴᚐჴࡼࡕ΋ԃޑᕴᚐਏᔈǶ٬Ҕଛჹ T test ᔠۓٿಔ Ӛձ߻ࡕයᡂϯǴϷаٿಔᐱҥኬҁ T test ᔠෳٿಔৡ౦ύޑৡ౦ࢂցᡉ๱όӕǴ

ٰ௖૸Ջᙴ୷ቫᕴᚐჹᙴᕍගٮޣޑቹៜǴа߄ 4-3-1 ߄ҢϐǶ

΋ǵႣයਏᔈ

ӧ߄ 4-3-1 ύǴߐບ೸݋୍ܺᙴᕍ຤ҔᗺኧǴ୷ቫບ܌๝᠌஑ࣽᙴৣѳ֡؂Γ

ಃΒයၨಃ΋යቚу 4,436,905 ᗺǴ኱ྗᇤࣁ 1,334,541 ᗺǴP ॶࣁ 0.002Ǵၲ಍ी

΢ᡉ๱ৡ౦ǶӦ୔ᙴଣ๝᠌஑ࣽᙴৣѳ֡؂ΓಃΒයၨಃ΋යቚу 423,805 ᗺǴ኱

ྗᇤࣁ 1,543,581 ᗺǴP ॶࣁ 0.785Ǵ҂ၲ಍ी΢ᡉ๱ৡ౦Ƕٿಔ߻ࡕයৡ౦࣬෧ी

ᆉளৡ౦ύޑৡ౦ࣁ 4,013,100 ᗺǴ኱ྗᇤࣁ 2,029,716 ᗺǴP ॶࣁ 0.051Ǵ҂ၲ಍

ी΢ᡉ๱ৡ౦ǶᡉҢӦ୔ᙴଣᙴৣٿය୍ܺ٠คᡉ๱ׯᡂǴ୷ቫບ܌ᙴৣ߾Ԗᡉ

๱ቚуǴՠӧ୷ቫບ܌๝᠌஑ࣽᙴৣӧಃΒයਔǴߐບ೸݋ԏΕቚуᆶჹྣಔ࣬

Кคᡉ๱ৡ౦Ƕ

Βǵᕴᚐਏᔈ

୷ቫບ܌๝᠌஑ࣽᙴৣѳ֡؂ΓಃΟයၨಃ΋යቚу 7,428,187 ᗺǴ኱ྗᇤࣁ 2,042,971ᗺǴP ॶࣁ 0.001Ǵၲ಍ी΢ᡉ๱ৡ౦ǶӦ୔ᙴଣ๝᠌஑ࣽᙴৣѳ֡؂Γ

ಃΟයၨಃ΋යቚу 2,806,432 ᗺǴ኱ྗᇤࣁ 2,179,203 ᗺǴP ॶࣁ 0.205Ǵ҂ၲ಍

ी΢ᡉ๱ৡ౦Ƕٿಔ߻ࡕයৡ౦࣬෧ीᆉளৡ౦ύޑৡ౦ࣁ 4,621,755 ᗺǴ኱ྗᇤ ࣁ 2,987,527 ᗺǴP ॶࣁ 0.125Ǵ҂ၲ಍ी΢ᡉ๱ৡ౦ǶᡉҢ୷ቫບ܌ᙴৣٿයߐບ

೸݋୍ܺԖᡉ๱ৡ౦ǴӦ୔ᙴଣᙴৣ٠คᡉ๱ׯᡂǴԶ୷ቫບ܌๝᠌஑ࣽᙴৣӧ

ಃΟයਔǴߐບ೸݋୍ܺᙴᕍ຤Ҕᗺኧቚуᆶჹྣಔ࣬КࡕǴ҂ၲᡉ๱ৡ౦Ƕ