本研究旨在探討影響血液透析患者使用醫療級SEBS透析導管願付價格的重要因子。研究採用問卷調查，探討血液透析患者對於SEBS透析產品的基本覺知、對相關議題的理解、健康信念與願付價格。健康信念方面，是參考Janz and Becker (1984) 的健康信念模式，探討感知易感性、感知嚴重性、感知益處和感知障礙對願付價格的影響。
結果顯示，血液透析患者對醫療級SEBS透析產品相關的覺知甚高。他們聽過聚氯乙烯(PVC)、塑化劑（DEHP）和環境荷爾蒙的比例分別高達97%、97%和82%，即使對醫療級橡膠（SEBS）較陌生，但聽過的比例也有74%。在健康信念方面，「感知使用醫療級SEBS透析產品益處」和「感知使用醫療級SEBS透析產品障礙」對願付價格有統計上顯著的影響：感到的益處愈多，愈願意付費改用SEBS透析導管；感到的障礙愈多則不願意付費改用。而性別、教育程度、洗腎病齡和每月平均可支配所得對上述四項健康信念也有部分顯著影響。例如每月平均可支配所得在80,000以上者，他們的感知障礙顯著低於40,000~54,999元者。
在願付價格的價格水準方面，受測者中有85%的人願意為醫療級SEBS透析導管支付25元以上，願支付50元以上者亦高達64%，且男性、每月平均可支配所得80,000以上者願付價格較高。本研究根據這些發現，對政府及SEBS透析產品業者提供了若干實務建議。

This study aimed to explore the important factors that affect the willingness to pay for medical-grade SEBS dialysis catheters in hemodialysis patients. The study used a survey to explore hemodialysis patients' basic awareness of SEBS dialysis products, their understanding of related issues, their health beliefs, and their willingness to pay. In terms of health beliefs, the model of Janz and Becker (1984) was used to explore the impact of perceived susceptibility, perceived severity, perceived benefits and perceived barriers on patients' willingness to pay for SEBS catheters.
Results showed that hemodialysis patients had a high level of awareness regarding medical-grade SEBS dialysis products. Ninety-seven percent of them had heard of polyvinyl chloride (PVC) and plasticizer (DEHP), and 82% of them had heard of environmental hormones. Even though they were relatively unfamiliar with medical grade rubber (SEBS), 74% of them had heard of it. In terms of health beliefs, perceived benefits of using medical-grade SEBS dialysis products and perceived barriers to using medical-grade SEBS dialysis products had statistically significant impacts on willingness to pay: the more benefits people perceived, the more willing they were to pay to switch to SEBS catheters; the more barriers people perceive, the less willing they were to pay to switch. Gender, education level, years of dialysis and average monthly disposable income also had some significant impacts on the above four health beliefs. For example, those with an average monthly disposable income of more than NTD 80,000 had significantly lower perceived barriers than those with an average monthly disposable income between NTD 40,000 and 54,999.
As for willingness to pay, 85% of the respondents were willing to pay more than NTD 25 for medical-grade SEBS dialysis catheters, and 64% were willing to pay more than NTD 50. Men and those with an average monthly disposable income of more than NTD 80,000 were willing to pay a higher price. Based on these findings, this study gives several recommendations for the government and SEBS dialysis product industry.

目錄
論文審定書 i
謝辭 ii
摘要 iii
Abstract iv
目錄 v
圖次 vii
表次 viii
第一章　緒論 1
第一節　研究背景與動機 1
第二節　研究目的 4
第二章 文獻探討 5
第二節　全球醫療器材DEHP的政策 10
第三節　健康信念模型 13
第四節　願付價格影響因素 14
第五節　條件評估法理論與應用 16
第三章　研究方法 19
第一節　研究架構 19
第二節　研究方法與步驟 20
第三節　研究對象 21
第四節　研究工具 22
第五節　資料處理與分析 24
第六節　預試問卷發放與結果 25
第七節　預試問卷分析結果 27
第八節　正式問卷修正與實施 39
第四章　正式問卷之分析 43
第一節　基本資料分析 43
第二節　基本覺知與對相關議題的理解 44
第三節　信度分析 49
第四節　背景變項與健康信念因素之關係 49
第五節　血液透析患者願付價格調查 55
第六節　健康信念因素對血液透析患者願付價格之影響 57
第五章　結論與建議 60
第一節　結果與討論 60
第二節　實務建議 68
第三節　後續研究建議 69
參考文獻 71
附錄一　血液透析患者使用醫療級SEBS透析產品之願付價格問卷 80
附錄二　血液透析患者使用醫療級SEBS導管意願調查正式問卷 84

參考文獻
一、中文文獻
于健、李盈寬（2020）。艋舺龍山寺遊憩效益與遊客之體驗價值評估之研究。觀光與休閒管理期刊，8(1)，1-16。
孔方正、張倩華、陳柔吟、陳宜群（2010）。環保旅館消費者市場區隔及願付價格之研究。運動健康與休閒學刊，(16)，59-70。
王玫（2017）。珍惜醫療資源談「部分負擔制度」，https://jhu.ilshb.gov.tw/index.php?catid=12&cid=1&id=269&action=view
世界醫師會赫爾辛基宣言（2013）。全球醫療衛生專欄。https://www.fyh.mohw.gov.tw/?aid=53&pid=69&page_name=detail&iid=193
台北榮民總醫院臨床毒藥物資訊中心（2011）。塑化劑DEHP參考資料 (醫療衛生人員版)。tcpa.taiwan-pharma.org.tw/sites/default/files/doc/0729-1-1_0.pdf
台灣合成橡膠股份有限公司（2023）。醫療級SEBS在聚烯烴改質的應用。https://www.tsrc.com.tw/tw/products-services/medical-solution/
行政院衛生署（2011）。高鄰苯二甲酸二(2-乙基己基)酯(DEHP)暴露風險之聚氯乙烯(PVC)材質醫療器材相關標示規定。100.05.23.署授食字第1001603415號公告。
呂佳慧、陳育孜、王聖瑋、張淑涵、黃守潔、曾素香、王德原（2022）。市售聚氯乙烯(PVC)材質醫療器材中鄰苯二甲酸二(2-乙基己基)酯(DEHP)之品質監測。食品藥物研究年報，3，125-134。
呂佳慧等（2022）。市售聚氯乙烯(PVC)材質醫療器材中鄰苯二甲酸二(2-乙基己基)酯(DEHP)之品質監測。食品藥物研究年報，13，125-134。
李丞華、周穎政（2002)。全民健保 1999 年部分負擔新制之五大效應評估。行政院衛生署九十年委託研究計劃。
李育慶（2011）。塑化劑暴露與健康危害。血管醫學防治季刊，7，24-27。
林佳慧、賀惠玲、林亞璇（2017）。綠色旅館之願付價格分析：以日月潭風景區為例。觀光休閒學報，23（1），67-99。
邱皓政（2009）。量化研究與統計分析：SPSS中文視窗版資料分析範例解析。五南圖書。
邱皖聆、張靜貞、許家勝、林詠萱（2020）。極端氣候早期預警的願付價值估計－以心血管疾病為例。應用經濟論叢，(107)，1-35。
徐永堂、胡連順、蔡佳璋、曾令軍、賴俊夫（2019）。人工腎臟與透析膜-歷史進展、物理化學結構與性能評估。新編實用血液淨化手冊。
健康世界編輯部（2019）。減少塑化劑暴露能防範心血管危害！健康世界，510，20-21。
郭依婷、李佳駿、宋俊明（2019）。透析治療：觀念演變及進展。內科學誌，30（2），86-95。
陳妙佩、陳建文、丁梅燕、張光世、毛鴻忠、蕭善良、林耀信、李建德、黃友利、趙浩然（2013）。雙酚A與鄰苯二甲酸二酯（環境荷爾蒙）對透析患者的影響。腎臟與透析，25(3)，251-254。
陳建文、賴麗英、廖淑芬、楊恩智、蕭善良（2010）。再忙也不能遺漏的透析前準備工作一模擬透析一讓透析安全多一道保障。腎臟與透析，22（2），141-145。
陳偉立、施李碧玉、陳立奇（2012）。塑化劑對醫藥品影響及致癌機轉之探討。臺灣臨床藥學雜誌，20（4），315-327。
陳興保（2018）。暴露塑化劑鄰苯二甲酸二(2-乙基己基)酯對大腸直腸癌之影響【國立高雄第一科技大學】。臺灣碩博士論文知識加值系統。https://hdl.handle.net/11296/4kvpun
曾令軍、蔡佳璋、王惠芳、盧惠敏、徐永堂、徐世平(2019)。人工腎臟製造新進展。腎臟與透析，31(2)，88-93. doi:10.6340/kd.201906_31(2).0010
黃芳銘（2007）。結構方程模式：理論與應用。五南圖書。
黃程煜（2018）。我國民眾對環境荷爾蒙之理解與避險之願付價格研究【國立 臺灣師範大學】。臺灣碩博士論文知識加值系統。https://hdl.handle.net/11296/d46gb5
董志明、郭孟軒、陳佳欣、黃戊田（2012）。應用條件評估法評估台南市一級古蹟之遊憩效益。嘉南學報（人文類），(38)，457-468。
潘資伊、盧子涵、林靜敏、林卉姍（2023）。降低透析機警報聲發生率之專案。秀傳醫學雜誌，1-25。
蔡孟芸、曾偉君、闕雅文（2022）。提升自行車共享系統之使用與支付意願之價格機制與政策設計－以新竹市You Bike為例。農業經濟叢刊，28（2），1-43。
衛生福利部（2021）。特定醫療器材之標籤、說明書或包裝應加註警語及注意事項。衛授食字第1101604586號公告。
衛生福利部中央健康保險署（2023）。全民健康保險重大傷病證明實際有效領證統計表，衛生福利部中央健康保險署-重要統計資料。https://www.nhi.gov.tw/ch/cp-5031-7696a-3027-1.html
衛生福利部食品藥物管理署（2011）。公布每日塑化劑耐受量參考值，強化風險評估。藥物食品安全週報，(305)，1-2。
賴意勤、闕雅文（2022）。台灣石虎棲地保育效益之評估－孩子的未來和父母的現在。應用經濟論叢，111，75-120。
SGS（2021）。韓國擴大醫療器材範圍管制塑化劑。https://eecloud.sgs.com/Region_TW/Article.aspx?n=146
TSRC 台橡股份有限公司（2023）。醫療解決方案。https://www.tsrc.com.tw/tw/products-services/medical-solution/


二、英文文獻
Acton, J.P. (1973). Evaluating public progress to save lives: the case of heart attacks. Rand Research Report R-73-02. RAND Corporation, Santa Monica, CA.
Al-Hanawi, M.K.,Al sharqi,O.,& Vaidya, K. (2020). Willingness to pay for improved public health care services in Saudi Arabia:a contingent valuation study among heads of Saudi households. Health Econ Policy Law, 15(1), 72-93.
Banik,R.,Islam, M.S.,Pranta, M.U.R.,Rahman, Q.M.,Rahman, M.,Pardhan, S., Driscoll,Rr.,Hossain,S.,& Sikder,M. T. (2021). Understanding the determinants of COVID-19 vaccination intention and willingness to pay: findings from a population-based survey in Bangladesh. BMC Infectious Diseases,21(892),13-15.
Bonini,M.,Errani,E., Zerbinati, G.,Ferri,E.,& Girotti,S. (2008). Extraction and gas chromatographic evaluation of plasticizers content in food packaging films. Microchemical Journal, 90(1), 31-36. https://doi.org/10.1016/j.microc.2008.03.002
Bourdeaux, D., Yessaad, M., Chennell, P., Larbre, V., Eljezi, T., Bernard, L., Sautou,V., Azaroual, N., Barthel, C., & Decaudin,B.( 2016). Analysis of PVC plasticizers in medical devices and infused solutions by GC-MS. Journal of Pharmaceutical and Biomedical Analysis, 118, 206-213
Boyle, K. J., & Bishop, R. C. (1988). Welfare measurements using contingent valuation: a comparison of techniques. American Journal of Agricultural Economics, 70(1), 20. https://doi.org/10.2307/1241972
Calia, P., & Strazzera,E. (2000). Bias and efficiency of single versus double bound models for contingent valuation studies: a Monte Carlo analysis. Applied Economics, 32(10), 1329-1336. https://doi.org/10.1080/000368400404489
Capela,D.,& Mhaouty-Kodja,S. (2021). Effects of pubertal exposure to low doses of di-(2-ethylexyl) phthalate on reproductive behaviors in male mice. Chemosphere, 263, 128-191.
Carson, R. T.(2000). Contingent valuation: a user’s guide. Environmental Science & Technology, 34(8),1413-1418.
Carson, R. T., & Hanemann, W. M. (2005). Chapter 17 Contingent valuation. In K.-G. Mler & J. R. Vincent (Eds.), Handbook of Environmental Economics (pp. 821-936). Elsevier. https://doi.org/10.1016/s1574-0099(05)02017-6
Casals-Casas, C., & Desvergne,B. (2011). Endocrine disruptors: from endocrine to metabolic disruption. Annual Review of Physiology, 73(1),135-162.
Ciriacy-Wantrup, S.V. (1947). Capital returns from soil-conservation practices. Journal of Farm Economics, 29(4),1181-1196.
Council, N.R. (2009). Phthalates and Cumulative Risk Assessment: The Tasks Ahead. National Academies Press.
Davis, R.K. (1963). The value of outdoor recreation: An economic study of the Maine woods. Harvard University.
Engel, S. M., Villanger, G. D., Nethery, R. C., Thomsen, C., Sakhi, A. K., Drover, Samantha, S.M., Hoppin, J. A., Zeiner, P., Knudsen, G.P., Reichborn-Kjennerud, T., Herring, A. H., & Aase, H. (2018). Prenatal phthalates, maternal thyroid function, and risk of attention-deficit hyperactivity disorder in the Norwegian mother and child cohort. Environmental Health Perspectives, 126(5), 057004. https://doi.org/10.1289/EHP2358.
Erickson,B.E. (2021). FDA urged to reduce phthalates in medical equipment. https://cen.acs.org/biological-chemistry/toxicology/FDA-urged-reduce-phthalates-medical/99/i7
Ganiats, T.G., Carson, R.T., Hamm, R.M., & Cantor, S.B. (2000). Population-based time preferences for future health outcomes. Medical Decision Making, 20 (3), 263-270.
Green, R., Hauser, R., Calafat, A.M., & Weuve, J.(2005). Use of di(2-ethylhexyl) phthalate-containing medical products and urinary levels of mono(2-ethylhexyl) phthalate in neonatal intensive care unit infants. Environmental Health Perspectives,113(9), 1222-5.
Grindler,N.M., Vanderlinden, L., Karthikraj, R., Kannan, K., Teal, S.,Polotsky,A.J.,Powell, T.L., Yang, I.V.,& Jansson, T.(2018). Exposure to phthalate, an endocrine disrupting chemical, alters the first trimester placental methylome and transcriptome in women. Scientific Reports, 8(1), 1-9.
Grootendorst,P.V.,O'Brien,B.J.,& Anderson,G.M.(1997).On becoming 65 in Ontario. Effects of drug plan eligibility on use of prescription medicines. Med Care, 35(4), 386-398.
Hartmann, C., Uhl, M., Weiss, S.,Koch, H.M., Scharf, S.,& König, J. (2015). Human biomonitoring of phthalate exposure in Austrian children and adults and cumulative risk assessment. International Journal of Hygiene and Environmental Health,218(5),489-499.
He, M., Inoue, K.I., Yoshida, S., Tanaka, M., Takano, H., Sun, G., & Ichinose, T. (2013). Effects of airway exposure to di-(2-ethylhexyl) phthalate on allergic rhinitis. Immunopharmacology and Immunotoxicology, 35(3), 390–395. https://doi.org/10.3109/08923973.2013.787432
Heudorf, U., Mersch-Sundermann, V., & Angerer, J. (2007). Phthalates: Toxicology and exposure. International Journal of Hygiene and Environmental Health, 210(5), 623-634. https://doi.org/10.1016/j.ijheh.2007.07.011
Jaeger, R.J. & Rubin, R.J. (1970). Plasticizers from plastic devices: extraction, metabolism and accumulation by biological systems. Science, 170(460),1095-9203.
Jaeger, R.J. & Rubin, R.J. (1972).Migration of a phthalate ester plasticizer from polyvinyl chloride blood bags into stored human blood and its localization in human tissues. The New England Journal of Medicine, 287(22), 1114–1118. https://doi.org/10.1056/Nejm197211302872203
Janz, N. K., & Becker, M. H. (1984). The health belief model: A decade later. Health Education Quarterly, 11(1), 1-47. doi:10.1177/109019818401100101
Johannesson, M.,& Fagerberg, B. (1992). A health economic comparison of diet and drug treatment in obese men with mild hypertension. Journal of Hypertension,10(9), 1063-1070.
Jones-Lee,M.W. (1976). The Value of Life: An Economic Analysis. University of Chicago Press, Chicago.
Jurewicz, J., & Hanke, W. (2011). Exposure to phthalates: Reproductive outcome and children health. A review of epidemiological studies. International Journal of Occupational Medicine and Environmental Health, 24(2). https://doi.org/10.2478/s13382-011-0022-2
Kambia, K., Dine, T., Gressier, B., Dupin-Spriet, T., Luyckx, M., &Brunet,C.(2004). Evaluation of the direct toxicity of trioctyltrimellitate (TOTM),di(2-ethylhexyl) phthalate (DEHP) and their hydrolysis products on isolated rat hepatocytes. International Journal of Artificial Organs, 27(11), 971-978.
Koch, H.M., Bolt, H.M., Preuss, R.,& Angerer, J. (2005). New Metabolites of Di (2-Ethylhexyl) Phthalate (Dehp) in Human Urine and Serum after Single Oral Doses of Deuterium-Labelled Dehp. Archives of Toxicology, 79(7), 367-376.
Le Gall-Ely,M. (2009). Definition, measurement and determinants of the consumer’s willingness to pay:A critical synthesis and avenues for further research. Recherche et Applications En Marketing (English Edition), 24(2), 91-112.https://doi.org/10.1177/205157070902400205
Malarvannan, G.,Onghena, M., Verstraete, S., van Puffelen, E., Jacobs, A.,Vanhorebeek, I., CAT Verbruggen, S., Joosten, K., Van den, B. G., Jorens, P. G.,&Covaci, A. (2018). Phthalate and Alternative Plasticizers in indwelling Medical Devices in Pediatric Intensive Care Units. Journal of Hazardous Materials, 363, 64-72.https://doi.org/10.1016/j.jhazmat.2018.09.087
Martino-Andrade, A. J., &Chahoud, I. (2010). Reproductive toxicity of phthalate esters. Molecular Nutrition & Food Research, 54(1), 148-157. https://doi.org/10.1002/mnfr.200800312
Mazur, H.I., Stennett, D.J., &Egging, P. K. (1989). Extraction of diethylhexylphth-alate from total nutrient solution-containing polyvinyl chloride bags. Journal of Parenteral and Enteral Nutrition, 13(1), 59–62.
Mendiola, J., Meeker, J.D.,Jorgensen, N., Andersson, A.M. Liu, F., Calafat, A. M. Redmon, J.B.,Drobnis, E.Z., Sparks, A.E., Wang, C., Hauser, R.,& Swan. S.H. (2012). Urinary concentrationsof di(2-ethylhexyl) phthalate metabolites and serum reproductive hormones: pooledanalysis of fertile and infertile men. Journal of Andrology, 33(3),488-498.
Mitchell, R.C., &Carson, R.T. (1989). Using Surveys to Value Public Goods: The Contingent Valuation Method. Johns Hopkins University Press.
Mitchell, R. C., &Carson, R.T.(1981).An experiment in determining willingness to to pay for national water quality improvements. Washington: Resources for the Future.National Inventors Hall of Frame(2023). Waldo L. Semon. https://www.invent.org/inductees/waldo-l-semon.
Park, C.B., Kim, G.E., Kim, Y.J., On, J., Park, C.G., Kwon, Y.S.,Pyo, H., Yeom, D.H.,& Cho, S.H.(2020). Reproductive dysfunction linked to alteration of endocrine activities in zebrafish exposed to mono-(2-ethylhexyl) phthalate (MEHP). Environmental Pollution, 265 (Part B), 114362. https://doi.org/10.1016/j.envpol.2020.114362.
Propper, C. (1990). Contingent valuation of time spent on NHS lists. Economic Journal,100(400), 193-199. https://doi.org/10.2307/2234196.
Radke, E. G., Braun, J. M., Meeker, J. D., & Cooper, G. S. (2018). Phthalate exposure and male reproductive outcomes: A systematic review of the human epidemiological evidence. Environment International, 121, 764-793. https://doi.org/10.1016/j.envint.2018.07.029
Rajamoorthy, Y., Radam, A., Taib, N. M., Rahim, K. A., Munusamy, S., Wagner, A. L., Harapan, H. (2019). Willingness to pay for hepatitis B vaccination in Selangor, Malaysia: A cross-sectional household survey. PLOS ONE, 14(4), e0215125. https://doi.org/10.1371/journal.pone.0215125
Randall, A., Ives, B.C., Eastman, C. (1974). Bidding games for the valuation of aesthetic environmental improvements. Journal of Environmental Economics and Management, 1(2), 132-149.
Reardon, G., &Pathak, D.S. (1988). Monetary valuation of benefits of pharmacy services.Topics in Hospital Pharmacy Management, 8(2), 66-75.
Reja,U., Manfreda,K.L., Hlebec,V., &Vehovar,V.(2003). Open-ended vs. close-ended questions in web questionnaires. Developments in Applied Statistics ,19(1),159-77.
Rosenstock, I. M. (2005). Why people use health services. Milbank Quarterly, 83(4), 1–32. https://doi.org/10.1111/j.1468-0009.2005.00425.x. Reprinted from The Milbank Memorial Fund Quarterly, 44(3), Pt. 2, 94–124. (Original work published 1966)
Sampson, J., & de Korte, D. (2011). DEHP-plasticized PVC: relevance to blood services. Transfusion Medicine, 21(2), 73-83. https://doi.org/10.1111/j.1365-3148.2010.01056.x
SCENIHR. (2015). Opinion on the safety of medical devices containing DEHP plasticized PVC or other plasticizers on neonates and other groups possibly at risk.https://op.europa.eu/en/publication-detail/-/publication/1bee9152-0253-11e7-8a35-01aa75ed71a1/language-en.
Steigenberger,C., Flatscher‑Thoeni,M., Siebert,U.,& Leiter,A.M.(2022). Determinants of willingness to pay for health services: a systematic review of contingent valuation studies. The European Journal of Health Economics,23(9),1455-1482.https://doi.org/10.1007/s10198-022-01437-x6.
The European Commission. (2015). Directive (EU) 2015/863. http://data.europa.eu/eli/dir_del/2015/863/oj
Tickner, A. J., Schettler, T., Guidotti, T.,McCally, M., & Rossi, M.(2001). Health risks posed by use of di-2-ethylhexyl phthalate (DEHP) in PVC medical devices: A critical review. American Journal of Industrial Medicine,39(1),100-111.
U.S. FDA. (2002). FDA Public Health Notification:PVC Devices Containing the Plasticizer DEHP. http://accessmedicalusa.com/pdf/fda-dehp-letter.pdf
Vinyl Council Australia(2023). Making PVC Products. https://www.vinyl.org.au/plasticisers-for-flexibility.
Wahl, H. G., Hong, Q., Hildenbrand, S., Risler, T., Luft, D., & Liebich, H. (2004). 4-Heptanone is a metabolite of the plasticizer di(2-ethylhexyl) phthalate (DEHP) in haemodialysis patients. Nephrology Dialysis Transplantation, 19(10), 2576–2583. https://doi.org/10.1093/ndt/gfh425
Wertenbroch,K.,& Skiera,B.(2002).Measringconsumers’willingness to pay at the point of purchase.Journal of Marketing Research,38(2),228-241.
Yang, O., Kim,H.L.,Weon,J.I. & Seo, Y.R.(2015). Endocrine-disrupting chemicals: Review of toxicological mechanisms using molecular pathway analysis. Journal of Cancer Prevention, 20(1),12-24.
Ye,Z., Liu, F., Ma, J., Zhou, Z., Wang, C., & Sun, L. (2021). Comparing the monetary value of a quality-adjusted life year from the payment card and the open-ended format. Cost Effectiveness and Resource Allocation, 19(1), 45-50. https://doi.org/10.1186/s12962-021-00298-0
Zhang, Q., Chen,X.Z., Huang,X., Wang, M., Wu, J. (2019). The association between prenatal exposure tophthalates and cognition and neurobehavioral of children-evidence from birth cohorts.Neurotoxicology, 73,199-212. https://doi.org/10.1016/j.neuro.2019.04.007