Econometric Studies on Demand and Supply for Health and Long Term Care Services

本研究的目的是：一是考察医疗服务的消费者（需求方）和提供者（供给方）在政策改革下的行为变化，即老年共同支付率的提高或老年共同支付方案从固定比例改为比例比例，或老年财政支持减少共同支付；二是考察计算机密集型计量经济学方法，即bootstrap，分位数回归，非参数回归，将应用于实证研究与reseputo（保险索赔从诊所或医院到保险公司）数据集。2002年，笔者利用障碍负二项（NB）模型、零膨胀NB模型、分位数回归和非参数回归模型，对参保人70岁前和70岁后两个时期的牙齿重建数据集和重建数据进行了分析。2003年，笔者利用市级财政数据对参保企业的成本函数进行了估算，验证了中央财政支持越多，成本效率越低的假设。我还利用基于家庭的汇总数据库数据调查了家庭成员中谁在医疗服务上花了多少钱，发现家庭成员分担健康风险，但只有家属承担由头部疾病引起的收入风险。2003年，我研究了当前以家庭为基础的保费是否对单个家庭非常不利，如果是的话，如何使其合理化。我还研究了在老年医疗保健系统引入比例共付后，医院雇用的医生如何改变他们的治疗强度。

The objectives of this research are, first, to examine how consumers (demand side) and providers (supply side) of medical services would change their behaviors corresponding to the policy reforms, namely, increase of copayment rate or change of copayment scheme for the elderly from fixed to proportional copayment, or to financial support for the elderly to reduce copayment, and second, to see how the computer-intensive econometric methods, namely, bootstrap, quantile regression nonparametric regression, are to be applied for empirical researches with a reseputo (insurance claim from a clinic or hospital to a insurer) data set. In 2002, I analyzed a dental reseputo data set and a reseputos of the insured for two periods of before-seventy and of after-seventy years with hurdle negative binomial (NB) model, zero-inflated NB model, quantile regression and nonparametric regression models. In 2003, I estimated a cost function of the insurers of the National Health Insurance based on municipalities with their financial data to check the hypothesis that the more the financial support comes from the central government the less the cost-efficiency is. I also investigate who spends how much for medical services among family members with family-based aggregated reseputo data and find that family members share health risk but only dependents bear income risk caused by head's illness. In 2003, I study whether or not the current family-based premium is substantially disadvantageous for a single household and if so how it is to be rationalized. I also examine how physicians employed in hospitals change their treatment intensities after proportional copayment is introduced for the elderly health care system.