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系統識別號 U0026-2407201717121000
論文名稱(中文) 主治醫師性別對病患住院死亡率與再住院率之影響-以內科為例
論文名稱(英文) The Effect of Physician Gender on Mortality and Readmission Rates - Evidence from Internal Medicine
校院名稱 成功大學
系所名稱(中) 經濟學系
系所名稱(英) Department of Economics
學年度 105
學期 2
出版年 106
研究生(中文) 彭亦寗
研究生(英文) Yi-Ning Peng
學號 U56041044
學位類別 碩士
語文別 中文
論文頁數 78頁
口試委員 指導教授-劉亞明
口試委員-區俊傑
口試委員-李妙純
口試委員-沈秀祝
中文關鍵字 全民健康保險  傾向分數配對法  粗化精確配對法  健保資料庫 
英文關鍵字 National Health Insurance  Propensity Score Matching  Coarsened Exact Matching  National Health Insurance Research Database 
學科別分類
中文摘要 性別相關議題為近幾十年來備受重視的議題之一,就醫療領域而言,近年來臺灣整體醫療環境與人力結構急速改變,男、女性醫學系畢業生與男、女性醫師人數比例的變化情形,以及男、女性醫師執行醫療行為和醫療照護結果之差異等,皆為影響醫療教育、醫療照護品質與未來發展之重要課題。

本研究係以全民健康保險研究資料庫2000 年、2005 年以及2010 年三次的百萬人承保抽樣歸人檔中,其2008 年至2012 年之「內科」住院申報資料進行分析,並運用傾向分數配對(Propensity Score Matching, PSM)與粗化精確配對(Coarsened Exact Matching, CEM)兩種匹配方法篩選住院案件樣本,使得男、女性醫師治療之病患的個人特徵及健康條件較為平衡,再使用Probit 模型做為分析工具,探討主治醫師性別對病患住院死亡率與再住院率之影響。

實證研究結果發現:(1)在以PSM 及CEM 兩種匹配方式篩選出之案件樣本中,女性醫師治療之病患較男性醫師治療之病患均有較低的入院後30 天內在院死亡率。(2)在PSM 匹配方式篩選出之案件樣本中,女性醫師治療之病患較男性醫師治療之病患有較低的出院後30 天內再住院率;而就PSM 匹配方式篩選出之案件樣本,醫師性別與病患之出院後30 天內再住院率並無顯著關係。

結論:綜合文獻與實證結果,女性醫師相較於男性醫師提供更好的醫療照護品質及醫療照護結果,因此若未來在醫療教育與訓練上,更加以重視醫事人員之性別議題,並予以改善,或許是能促進醫療品質之提升。
英文摘要 Studies have found differences in practice patterns between male and female physicians. Physician gender has been viewed as a possible source of variation in medical practices. This paper discusses whether patient outcomes (30-day mortality and readmission rates) differ between patients treated by male or female physicians.

The data were obtained from the National Health Insurance (NHI) Research Database. We analyzed a sample of patient hospitalized with a medical condition and treated by internists from January 1, 2008, to December 31, 2012. To avoid potential sample selection problems, we used the propensity score matching (PSM) and coarsened exact matching (CEM). Then, patient characteristics were similar between those treated by female physicians v.s. those treated by male physicians and finally investigate the effect of physician gender on mortality and readmission rates by probit regression model.

The empirical results found that patients who receive care from female internists have lower 30-day mortality and readmission rates than do patients cared for by male internists, after accounting for patient, hospital and physician characteristics.

Because the numbers and percentage of female physicians are increased during these years, physician gender has become an important issue recently. To improve physician development and the quality of care, medical education needs to focus on gender specific training in the various specialties.
論文目次 第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究方法與架構 4
第二章 文獻回顧 5
第一節 國內外醫師勞動市場概況 5
第二節 男、女性醫師之醫療行為風格差異相關文獻 7
第三節 醫師性別對醫療照護結果影響之相關文獻 10
第三章 資料來源與處理 12
第一節 資料來源 12
第二節 資料處理 14
第四章 研究方法及模型設定 18
第一節 傾向分數配對(Propensity Score Matching, PSM) 18
第二節 粗化精確配對(Coarsened Exact Matching, CEM) 22
第三節 實證模型設定 23
第四節 變數說明 25
第五章 實證結果與分析 31
第一節 敘述統計 31
第二節 實證結果與分析 41
第六章 結論與建議 69
第一節 結論 69
第二節 討論 72
第三節 建議與研究限制 73
參考文獻 74
附錄 78
參考文獻 一、中文部份
1. 中華民國醫師公會全聯會 (2012),「中華民國台灣地區執業醫師、醫療機構統計」,中華民國醫師公會全聯會編印。
2. 高美英、呂碧鴻、李明濱、王維典 (2000),「醫學生的專科偏好與相關因素探討」,《醫學教育》,4(1),頁23-37。
3. 高美英、陳秀蓉、呂碧鴻 (2009),「醫學生以病人為中心之醫療態度的演變」,《醫學教育》,13(4),頁275-286。
4. 連賢明 (2008),「如何使用健保資料進行經濟研究」,《經濟論文叢刊》, 36(1),頁115-143。
5. 陳皎眉 (2000),「性別差異與性別角色」,《高中職教師兩性平等教工作坊研習教材》,頁58-62。
6. 陳潤秋、郭乃文、陳韋君(2011),《醫師性別與醫療行為相關趨勢之探討(第2 年)研究成果報告》。
7. 黃曉令、李克怡 (2003),「台灣女醫師人力分佈之初探性研究」,《台灣醫界》,46(6),頁41-43。
8. 楊明仁、蔡瑞熊 (1999),「某醫學院學生之專科選擇及其相關因素」,《醫學教育》 ,3(2),頁147-154。
9. 劉彩卿、陳欽腎、鄭雅靜 (2004),「全民健保制度下影響醫學系學生選擇醫療科別之因素分析」,《醫務管理期刊》,5(4),頁473-494。

二、西文部份
1. Butter I. (1985). Sex and status: Hierarchy in the health workforce. Washington: American Public Health Association.
2. Allen, D. I. (1989). “Women in medical specialty societies:An update.” JAMA, 262(24), pp.3439-3443.
3. Austin, P. C., & Mamdani, M. M. (2006). “A comparison of propensity score methods: a case ‐ study estimating the effectiveness of post ‐ AMI statin use.” Statistics in medicine, 25(12), pp.2084-2106.
4. Baumhäkel, M., Müller, U., & Böhm, M. (2009). “Influence of gender of physicians and patients on guideline‐recommended treatment of chronic heart failure in a crosssectional study.” European journal of heart failure, 11(3), pp.299-303.
5. Bertakis, K. D. (2009). “The influence of gender on the doctor–patient interaction.” Patient education and counseling, 76(3), pp.356-360.
6. Bertakis, K. D., Franks, P., & Azari, R. (2002). “Effects of physician gender on patient satisfaction.” Journal of the American Medical Women's Association (1972), 58(2), pp.69-75.
7. Berthold, H. K., Gouni‐Berthold, I., Bestehorn, K. P., Böhm, M., & Krone, W. (2008). “Physician gender is associated with the quality of type 2 diabetes care.” Journal of internal medicine, 264(4), pp.340-350.
8. Blackwell, M., Iacus, S., King, G., & Porro, G. (2009). “CEM: Coarsened exact matching in Stata.” Stata Journal, 9(4), pp.524-546.
9. Dahrouge, S., Hogg, W., Younger, J., Muggah, E., Russell, G., & Glazier, R. H. (2016). “Primary care physician panel size and quality of care: a population-based study in Ontario, Canada.” The Annals of Family Medicine, 14(1), pp.26-33.
10. Frank, E., & Harvey, L. K. (1996). “Prevention advice rates of women and men physicians.” Archives of family medicine, 5(4), pp.215-220.
11. Franks, P., & Bertakis, K. D. (2003). “Physician gender, patient gender, and primary care.” Journal of women's health, 12(1), pp.73-80.
12. Gjerberg, E. (2001). “Medical women—towards full integration? An analysis of the specialty choices made by two cohorts of Norwegian doctors.” Social Science &
Medicine, 52(3), pp.331-343.
13. Iacus, S. M., King, G., & Porro, G. (2011). “Multivariate matching methods that are monotonic imbalance bounding.” Journal of the American Statistical
Association, 106(493), pp.345-361.
14. Iacus, S., King, G., & Porro, G. (2008). Matching for Causal Inference without Balance Checking (No. unimi-1073). Universitá degli Studi di Milano.
15. Jefferson, L., Bloor, K., Birks, Y., Hewitt, C., & Bland, M. (2013). “Effect of physicians’ gender on communication and consultation length: a systematic review and metaanalysis.” Journal of health services research & policy, 18(4), pp.242-248.
16. Jerant, A., Bertakis, K. D., Fenton, J. J., & Franks, P. (2013). “Gender of physician as the usual source of care and patient health care utilization and mortality.” The Journal of the American Board of Family Medicine, 26(2), pp.138-148.
17. Kaplan, S. H., Gandek, B., Greenfield, S., Rogers, W., & Ware, J. E. (1995). “Patient and visit characteristics related to physicians' participatory decision-making style: Results from the Medical Outcomes Study.” Medical care, pp.1176-1187.
18. Kim, C., McEwen, L. N., Gerzoff, R. B., Marrero, D. G., Mangione, C. M., Selby, J. V., & Herman, W. H. (2005). “Is physician gender associated with the quality of diabetes care?” Diabetes care, 28(7), pp.1594-1598.
19. Lurie, N., Slater, J., McGovern, P., Ekstrum, J., Quam, L., & Margolis, K. (1993). “Preventive Care for Women--Does the Sex of the Physician Matter?” New England
Journal of Medicine, 329(7), pp.478-482.
20. Maccoby, E. E. & Jacklin, C. N. (1974). “The psychology of sex differences. Stanford, CA: Stanford University Press.”
21. Martin, S. C., Arnold, R. M., & Parker, R. M. (1988). “Gender and medical socialization.” Journal of Health and Social Behavior, pp.333-343.
22. Parkerton, P. H., Wagner, E. H., Smith, D. G., & Straley, H. L. (2003). “Effect of Parttime Practice on Patient Outcomes.” Journal of general internal medicine, 18(9), pp.717-724.
23. Rosenbaum, P. R., & Rubin, D. B. (1983). “The central role of the propensity score in observational studies for causal effects.” Biometrika, pp.41-55.
24. Roter, D. L., Hall, J. A., & Aoki, Y. (2002). “Physician gender effects in medical communication: a meta-analytic review.” Jama, 288(6), pp.756-764.
25. Tsugawa, Y., Jena, A. B., Figueroa, J. F., Orav, E. J., Blumenthal, D. M., & Jha, A. K. (2017). “Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians.” JAMA internal medicine, 177(2), pp.206-213.
26. Uhlenberg, P., & Cooney, T. M. (1990). “Male and female physicians: family and career comparisons.” Social Science & Medicine, 30(3), pp.373-378.
27. Woodward, C. A., & Hurley, J. (1995). “Comparison of activity level and service intensity of male and female physicians in five fields of medicine in Ontario.” CMAJ: Canadian Medical Association Journal, 153(8), pp.1097.
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