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    Please use this identifier to cite or link to this item: https://nccur.lib.nccu.edu.tw/handle/140.119/157501


    Title: 傷殘保險與道德風險：子宮切除手術為例
    Disability Insurance and Moral Hazard: Hysterectomy in Taiwan
    Authors: 連賢明
    Contributors: 財政系
    Date: 2018-06
    Issue Date: 2025-06-23 13:21:48 (UTC+8)
    Abstract: 道德風險，亦即病人消費過多或甚至不需要的醫療服務，一直是醫療保險中焦點。雖說道德風險相關實證研究不少，但很少研究能證明這些「額外」醫療服務對病人造成傷害。在這兩年研究計畫中，我們探討一個台灣所特有的生育傷殘補助。目前不論是公保、勞保、或農保，被保險婦女若在45 歲前實施（1）子宮切除手術（2）兩側卵巢切除手術（3）卵巢放射性治療，均可領取這個生育傷殘補助；補助金額約略為投保薪資的6 個月。這生育傷殘補助提供一個財務誘因，使婦女在面對醫療不確定情況下，選擇在45 歲前進行切除子宮手術。在計畫的第一年，我們擬利用 2000-2014 年健保住院資料，選擇年紀40-50 歲婦女樣本，採「差異中差異」估計法，來比較有生育傷殘補助婦女和沒有補助婦女的子宮切除比例是否不同。這比例差異可協助我們推估生育傷殘補助增加多少「額外」子宮切除。在計畫的第二年，我們擬區分這「額外」的子宮切除手術，是否有來自醫師方面的誘發。我們計畫使用曾子宮切除婦女樣本，以請領生育傷殘補助的45 歲年紀為基準，採間斷迴歸估計法，比較醫師所實施的手術類別差異（是否採複雜的腹腔鏡子宮切除法）在45 歲前後有差距。另外，我們也比較這些手術類別差異和醫院權屬類別（公私立）或所在市場競爭狀況相關性。
    One of the major concerns in health insurance is moral hazard---patients consume too much unnecessary and even harmful medical treatment. While there are studies indicating that patients consuming too much treatment, there is only little evidence showing additional treatments are harmful to patients. This proposal aims to study a unique and special provision of Taiwanese disability programs on reproduction impairment. In Taiwan, a women covered through major social insurances (Labor insurance, Government employee insurance, and Farmer insurance) could claim disability benefits if she is under the age of 45 and becomes sterile due to i) hysterectomy (the removal of the uterus), ii) oophorectomy (the removal of both ovaries), or iii) radiation therapy. The disability benefits provide women an incentive, in face of treatment uncertainty, to undergo hysterectomy surgery before the age of 45. The first aim of this project is to quantity the size of unnecessary hysterectomy as a result of disability programs on reproduction impairment. With the help of 2000-2014 Taiwan National Health Insurance Data, we select women aged between 40 and 50 years old, and employ the Difference-in-Difference estimation method to compare the incidence rate of hysterectomy of women with disability benefits with that of those without such benefits. In the second aim, we check whether additional hysterectomy surgeries are related to the prescribing behaviors of health providers. We use the sample of women underwent hysterectomy between 2000-2014, and employ the regression discontinuity method to compare the likelihood of laparoscopy hysterectomy around the age of 45--- the eligibility of reproduction disability benefit. In addition, we examine whether such the difference is associated with the type of health providers or the competitiveness of hospital market.
    Relation: 科技部, MOST105-2410-H004-004, 105.08-106.07
    Data Type: report
    Appears in Collections:[財政學系] 國科會研究計畫

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