⺰  ᢥ⾗Ḯ㈩ಽᯏ⢻ߣߒߡߩ೙ᐲ࡮ⷙ೙㧦ࠊ߇࿖ක≮೙ᐲߩ⚻ᷣಽᨆ*⍮ ㊁ ື ᦶ**㧔ጟጊᄢቇᄢቇ㒮␠ળᢥൻ⑼ቇ⎇ⓥ⑼ᢎ᝼㧕 ᧄⓂߩ⋡⊛ߪ㧘ක≮೙ᐲࠍ⾗Ḯ㈩ಽᯏ⢻ߩ઀⚵ߺߩ 1 ߟߣ⠨߃ߚߣ߈㧘ࠊ߇࿖ߩ⃻ⴕ೙ᐲ߇ߤߩࠃ߁ߥ
⾗Ḯ㈩ಽ਄ߩᓎഀࠍᨐߚߒߡ޿ࠆߩ߆ࠍ⠨ኤߔࠆߎߣߢ޽ࠆ‫ߚ߹ޕ‬㧘ක≮೙ᐲࠍᏒ႐ߦઍࠊࠆ㕖Ꮢ႐⊛⾗Ḯ㈩ಽߩ઀⚵ߺߣ޿߁ⷞὐ߆ࠄ⠨ኤߒߚߣ߈㧘ࠊ߇࿖ߩක≮೙ᐲᡷ㕟ߦ߅ߌࠆ೙ᐲ⸳⸘ߦ㓙ߒߡߘߩ᡽╷⺰⊛⺖㗴ࠍ᣿ࠄ߆ߦߔࠆߎߣ߽⋡⊛ߩ 1 ߟߢ޽ࠆ‫ޕ‬ ක≮ࠨ࡯ࡆࠬಽ㊁ߢߪක≮೙ᐲࠍㅢߓߡ⾗Ḯ㈩ಽ߇ⴕࠊࠇࠆߎߣ߆ࠄ㧘ක≮೙ᐲࠍ᭴ᚑߔࠆ᭽‫ߥޘ‬೙ᐲ߿ⷙ೙߇㕖Ꮢ႐⊛⾗Ḯ㈩ಽߩᣇᴺߣߒߡᯏ⢻ߒߡ޿ࠆ 1)‫ߡߞ߇ߚߒޕ‬㧘ߘࠇࠄߩ೙ᐲ߿ⷙ೙ߦ઻߁⚻ᷣ⊛฽ᗧࠍಽᨆߔࠆߎߣߪක≮೙ᐲౝߦ߅ߌࠆ⾗Ḯ㈩ಽࠍ᣿ࠄ߆ߦߔࠆߩߺߥࠄߕ㧘ᒰ⹥ක≮೙ᐲߦଐሽߒߚ
ᖚ⠪ߣකᏧߩା㗬㑐ଥߩᒻᚑ࡮⛽ᜬߦ߽⽸₂ߔࠆ‫ߒ߆ߒޕ‬㧘ක≮೙ᐲࠍ᭴ᚑߔࠆ೙ᐲ߿ⷙ೙ߦߪ᭽‫߽ߥޘ‬ߩ߇ሽ࿷ߒߡ޿ࠆߎߣ߆ࠄ㧘ක≮೙ᐲࠍㅢߓߚ⾗Ḯ㈩ಽᯏ⢻ߪታ㓙ߦߪⶄว⊛ߥᓇ㗀ࠍ߽ߚࠄߒߡ޿ࠆ‫ޕ‬
ᧄⓂߢߪࠊ߇࿖ක≮೙ᐲߩߥ߆ߢ߽ၮゲߣߥࠆ౏⊛଻㒾೙ᐲߣ⸻≮ႎ㈽೙ᐲࠍขࠅ਄ߍ㧘ߘߩ⾗Ḯ㈩ಽ਄
ߦ߅ߌࠆ⚻ᷣ⊛฽ᗧࠍታ⸽ℂ⺰⊛஥㕙߆ࠄᬌ⸛ߔࠆ‫ޕ‬ ක≮ಽ㊁ߢߪᣣᧄߩߺߥࠄߕฦ࿖ߣ߽ߦ㧘ක≮ࠨ࡯ࡆࠬᏒ႐ߩ㔛⛎ਔࠨࠗ࠼ߦ߅޿ߡߪ᭽‫ߥޘ‬᡽ᐭⷙ೙߇ሽ࿷ߒߡ޿ࠆ‫ߩߎޕ‬ක≮ࠨ࡯ࡆࠬಽ㊁ߦ߅ߌࠆ᡽ᐭ੺౉ߩ⚻ᷣ⊛ᩮ᜚ߦߪ޿ߊߟ߆ߩℂ↱߇ᜰ៰ߐࠇߡ
޿ࠇࠆ 2)‫߫߃ߣߚޕ‬ක≮ࠨ࡯ࡆࠬߩಽ㊁ߢߪ౏ⴐⴡ↢߿ᗵᨴ∝ߥߤߦ␜ߐࠇࠆࠃ߁ߥᄖㇱᕈ߿㧘ᖚ⠪ߣකᏧ㑆ߦ߅ߌࠆᖱႎߩ㕖ኻ⒓ᕈ߇ሽ࿷ߒߡ޿ࠆ‫ޕ‬߹ߚක≮଻㒾ߩಽ㊁ߢߪ∔∛߇୘ੱ࡟ࡌ࡞ߢߪ੍᷹ߢ߈ߕ㧘ߘߩක≮ᡰ಴߽㜞㗵ߣߥࠆน⢻ᕈ߇޽ࠆ‫ߦࠢࠬ࡝ߩߘޕ‬ኻಣߔࠆᣇᴺߣߒߡ᳃㑆଻㒾ࠍㅢߓߚᏒ႐ࠍ೑↪
ߔࠆᣇᴺ߇޽ࠆ߽ߩߩ㧘⃻ታߦߪᖱႎߩ㕖ኻ⒓ᕈ߆ࠄࡕ࡜࡞ࡂࠩ࡯࠼߿ㅒㆬᛯߣ޿ߞߚ໧㗴߇↢ߓࠆߚ߼㧘∔∛ߦ઻߁࡝ࠬࠢ߇᳃㑆଻㒾Ꮢ႐ࠍㅢߓߡߪㆡಾߦኻಣߐࠇߥ޿‫ߡߒߘޕ‬㧘Ꮢ႐ߦછߖߚߣ߈ߦߪක≮ࠨ࡯ࡆࠬߩࠕࠢ࠮ࠬߩ౏ᐔᕈ߇៊ߥࠊࠇࠆߣ޿߁໧㗴߇޽ࠆ‫ߥ߁ࠃߩߎޕ‬ℂ↱߆ࠄක≮ಽ㊁ߢߪ㔛⛎ਔࠨࠗ࠼ߦኻߒߡ᭽‫ⷙ⊛౏ߥޘ‬೙߇ታᣉߐࠇߡ޿ࠆ‫ޕ‬ ක≮ಽ㊁ߦ߅ߌࠆ౏⊛ⷙ೙ߩሽ࿷ߪฦ࿖ߦ౒ㅢߒߚ߽ߩߢ޽ࠆ‫ⷙߩߘߒ߆ߒޕ‬೙ߩ࿷ࠅᣇ߿ᣇᴺߪฦ࿖
ߢ⋧㆑ߒ㧘ߒߚ߇ߞߡක≮೙ᐲࠍㅢߓߚ⾗Ḯ㈩ಽ߽⇣ߥߞߡߊࠆ‫߫߃ߣߚޕ‬ฦ࿖ߩක≮଻㒾೙ᐲߦߟ޿ߡ
ߘߩ⽷Ḯ߆ࠄ࿖༡ࠪࠬ࠹ࡓ㧘␠ળ଻㒾ࠪࠬ࠹ࡓ㧘᳃㑆଻㒾ࠪࠬ࠹ࡓߣ޿߁ಽ㘃߇ⴕࠊࠇߡ޿ࠆ߇ 3)㧘ߘࠇ* ᧄ⎇ⓥߩᚑᨐߩ৻ㇱߪᢥㇱ⑼ቇ⋭⑼ቇ⎇ⓥ⾌⵬ഥ㊄߆ࠄߩ⽷᡽⊛េഥࠍฃߌߡ޿ࠆ‫ޕ‬** 1984 ᐕ᧲੩ㇺ┙ᄢቇᄢቇ㒮␠ળ⑼ቇ⎇ⓥ⑼ඳ჻⺖⒟න૏ขᓧਛㅌ㧘หᐕ᧲੩ㇺ┙ᄢቇ⚻ᷣቇㇱഥᚻ㧘ߘߩᓟ㧘᧲੩ቇ⧓ᄢቇ⻠Ꮷ࡮ഥᢎ᝼㧘┙๮㙚ᄢቇ⚻ᷣቇㇱᢎ᝼㧘ጟጊᄢቇ⚻ᷣቇㇱᢎ᝼ࠍ⚻ߡ 2006 ᐕࠃࠅ⃻⡯‫ޕ‬ᚲዻቇળߪᣣᧄ⚻ᷣቇળ,ᣣᧄ NPO ቇળ‫ޕ‬ਥⷐ⺰ᢥߪ‘The Present
and Future National Medical Expenditure in Japan’㧔౒⪺㧕‫⚻ޡ‬ᷣಽᨆ‫ޢ‬152㧘1997 ᐕ‫ޕ‬1) ೙ᐲ߿ⷙ೙㧘ߘߒߡᴺߪ‫ޟ‬Ꮢ႐‫ࠆߥ⇣ߪߣޠ‬ᣇᴺߢ⾗Ḯ㈩ಽᯏ⢻ߩᓎഀࠍᨐߚߒߡ޿ࠆ‫ߥ߁ࠃߩߎޕ‬㕖Ꮢ႐⊛⾗Ḯ㈩ಽᣇᑼߣߒߡᧄⓂߢߪක≮ಽ㊁ߩ೙ᐲ࡮ⷙ೙ࠍขࠅ਄ߍߡ޿ࠆ‫ޕ‬೙ᐲߩ⚻ᷣቇ㧔ᣂ೙ᐲ⚻ᷣቇ New Institutional Economics㧕ߦߟ޿ߡߪ North㧔1990㧕, Alston,Eggertsson, and North㧔1996㧕ࠍෳᾖ‫ޕ‬ᣂ೙ᐲ⚻ᷣቇߩߥ߆ߢ߽ property rights㧔ᚲ᦭ᮭ㧕ౝኈߩᓇ㗀ߦ⌕⋡ߒߡ⚻ᷣਥ૕ߩⴕേಽᨆࠍℂ⺰⊛ߦ⠨ኤߔࠆ property rights ℂ⺰ߦߟ޿ߡߪᵈ 18㧕ࠍෳᾖ‫ޕ‬2) ߚߣ߃߫ක≮⚻ᷣቇߩవ㚟⊛⺰ᢥߣߥࠆ Arrow㧔1963㧕㧘ߐࠄߦߘߩᩮ᜚ߦଥࠊࠆ੹ᣣ⊛ᗧ๧ࠍ⠨ኤߒߚ Hammer㧔2003㧕ࠍ߽ෳᾖ‫ޕ‬3) OECD㧔1987㧕
㧔1994㧕ࠍෳᾖ‫ޕ‬㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕

ߪหᤨߦ㧘ᶖ⾌⠪㧔ᖚ⠪㧕ߩⷰὐ߆ࠄක≮ࠨ࡯ࡆࠬ೑↪ߦ઻߁ഀᒰ㧔rationing㧕ࡔࠞ࠾࠭ࡓߩၮᧄ⊛ߥ⋧㆑ࠍ␜ໂߒߡ޿ࠆ‫ߚ߹ޕ‬㧘ห৻ಽ㘃ߩක≮଻㒾೙ᐲߦ⹥ᒰߒߡ޿ߡ߽ක≮ឭଏࠪࠬ࠹ࡓ߇⋧㆑ߔࠇ߫㧘ක≮ࠨ࡯ࡆࠬ೑↪ߦ઻ߞߡᯏ⢻ߔࠆഀᒰᣇᑼ߽⋧㆑ߔࠆ‫߫߃ߣߚޕ‬ක≮ឭଏࠪࠬ࠹ࡓ߇౏⊛޽ࠆ޿ߪ⑳⊛ක≮ᯏ㑐߆ࠄ᭴ᚑߐࠇࠆߩ߆㧘޽ࠆ޿ߪਔ⠪ߩ૬ሽߢ޽ࠆߩ߆╬ߦࠃߞߡ㧘ᖚ⠪߇⋥㕙ߔࠆ࿾ၞߩක≮ଏ⛎
᧦ઙߪ⋧㆑ߒߡߊࠆ 4)‫⋧ߩߎޕ‬㆑ߪ㧘ߚߣ߃␠ળ଻㒾ࠪࠬ࠹ࡓߢᖚ⠪ߩ⽶ᜂଔᩰ߇ૐߊߡ߽㧘࿾ၞߦ߅ߌ
ࠆක≮ࠨ࡯ࡆࠬ೑↪ߩ࿷ࠅᣇߦᄢ߈ߥᏅ⇣ࠍ↢ߓߐߖࠆḮᴰߩ 1 ߟߣߥࠆ‫ޕ‬ ᧄⓂߩಽᨆኻ⽎ߢ޽ࠆᣣᧄߩක≮೙ᐲߪ଻㒾೙ᐲߢ⸒߃߫␠ળ଻㒾ࠪࠬ࠹ࡓߦዻߒ㧘ోߡߩੱ߇૗ࠄ߆
ߩ଻㒾ߦࠃߞߡࠞࡃ࡯ߐࠇ㧘ක≮ࠨ࡯ࡆࠬߩᖚ⠪⽶ᜂߪේೣߣߒߡߘߩ⾌↪ߩ 3 ഀߩ㊄㗵㧔ᶖ⾌⠪ଔᩰ㧕ߣߥࠆ‫ߡߞ߇ߚߒޕ‬㧘ᶖ⾌⠪ߣ↢↥⠪ߩଔᩰߪਵ㔌ߒ㧘ㅢᏱߩ‫ޟ‬Ꮢ႐‫ߡ޿߅ߦޠ‬ᯏ⢻ߔࠆ㔛⛎⺞ᢛߪଔᩰߦࠃߞߡߪⴕࠊࠇߕ㧘ක≮೙ᐲౝߦሽ࿷ߔࠆⷙ೙߿೙ᐲࠍㅢߓߡ૞↪ߔࠆ‫⺞ߩߎޕ‬ᢛ߇ߤߩࠃ߁ߥࡔࠞ࠾
࠭ࡓࠍㅢߓߡⴕࠊࠇࠆߩ߆ࠍ㧘ࠊ߇࿖ක≮೙ᐲߩ߽ߣߢਥⷐߥᓎഀࠍᨐߚߒߡ߈ߚ೙ᐲ࡮ⷙ೙ࠍขࠅ਄ߍ
ߡᬌ⸛ߔࠆ‫ ╙ޕ‬1 ▵ߢߪ㔛ⷐࠨࠗ࠼ߩⷙ೙ߢ޽ࠆක≮଻㒾೙ᐲࠍਛᔃߣߒߡᖚ⠪ߩฃ⸻ߦ઻߁ታ⾰ࠦࠬ࠻ߣක≮ࠨ࡯ࡆࠬ೑↪ߦ㑐ߔࠆ⺞ᢛᚻᲑߦߟ޿ߡ⠨ኤߔࠆ‫ ╙ޕ‬2 ▵ߢߪᖚ⠪ߩฃ⸻ߦ઻߁ታ⾰ࠦࠬ࠻ࠍⷙቯ
ߔࠆଏ⛎᧦ઙߦߟ޿ߡᬌ⸛ߔࠆ߽ߩߢ㧘ߘߩਛᔃߪක≮ᯏ㑐ߩⴕേߦ⋥ធ⊛ߥᓇ㗀ࠍਈ߃ࠆ⸻≮ႎ㈽೙ᐲ
ࠍขࠅᛒ߁‫ ╙ޕ‬3 ▵ߢߪ㧘⃻ⴕߩ⸻≮ႎ㈽೙ᐲ߇੹ᣣߩ⪺ߒ޿ⅣႺ᧦ઙߩᄌൻߩ߽ߣߢਛ࡮㐳ᦼ⊛ߦߤߩࠃ߁ߥ໧㗴ࠍᛴ߃ߡ޿ࠆߩ߆ࠍᬌ⸛ߔࠆ‫ߪࠇߎޕ‬ක≮᡽╷⊛ⷰὐ߆ࠄක≮೙ᐲߩ⸳⸘ߢߣߊߦ⇐ᗧߒߥߌࠇ߫ߥࠄߥ޿੐㗄ߢ޽ࠆ‫ޕ‬╙㧝▵ ක≮଻㒾೙ᐲߣฃ⸻ࠦࠬ࠻ ࠊ߇࿖ߩක≮ಽ㊁ߢ߽㔛⛎ਔࠨࠗ࠼ߦ߅ߌࠆⷙ೙߇ሽ࿷ߒ㧘ߘࠇࠄߩⷙ೙ࠍㅢߓߡක≮ࠨ࡯ࡆࠬߩ㔛⛎
߇⺞ᢛߐࠇࠆ઀⚵ߺߣߥࠆ‫ߥ߁ࠃߩߎޕ‬㕖Ꮢ႐⊛⾗Ḯ㈩ಽߩᣇᴺߪଔᩰࡔࠞ࠾࠭ࡓߦࠃࠆ⾗Ḯ㈩ಽߣߪ⇣ߥࠅ㧘㔛⛎ਔࠨࠗ࠼ߩⷙ೙ߩ࿷ࠅᣇߦࠃߞߡ⾗Ḯ㈩ಽ߇ᄢ߈ߊᓇ㗀ߐࠇࠆ‫ߟ߆ޕ‬㧘ⷙ೙ߩ⚿ᨐߣߒߡᥧ㤩⊛ߥࠦࠬ࠻㧔hidden costs㧕߇↢ߓ㧘ߎࠇߦࠃߞߡᗧ࿑ߖߑࠆ⽶ᜂ߇ᗧ࿑ߖߑࠆਥ૕ߦ⺖ߐࠇࠆ႐ว߽޽
ࠆ‫ߪߢ▵ᧄޕ‬㔛ⷐࠨࠗ࠼ߦ߅ߌࠆⷙ೙ߦὶὐࠍ⛉ࠅ㧘ߘߩⷙ೙ߦࠃߞߡߤߩࠃ߁ߥࠦࠬ࠻߇↢ߓࠆߩ߆㧘ߘߒߡߘࠇ߇ฃ⸻ߦߤߩࠃ߁ߥᓇ㗀ࠍਈ߃ࠆߩ߆ࠍᬌ⸛ߔࠆ‫ޕ‬

1.1. ౏⊛ක≮଻㒾ߣฃ⸻ ᶖ⾌⠪㧔ᖚ⠪㧕ߩක≮ࠨ࡯ࡆࠬ㔛ⷐߦᓇ㗀ࠍਈ߃ࠆⷙ೙ߩߥ߆ߢ߽㊀ⷐߥ߽ߩߣߒߡ౏⊛ක≮଻㒾೙ᐲ߇ᜰ៰ߢ߈ࠆߛࠈ߁‫ߩߎޕ‬೙ᐲߪࠊ߇࿖ߩ଻㒾⸻≮ߩౝኈߣ▸࿐㧘ߘߒߡ⥄Ꮖ⽶ᜂ㗵ࠍቯ߼ࠆ߽ߩߣߥߞ
ߡ޿ࠆ‫଻ޕ‬㒾⸻≮ߩ▸࿐ࠍ⿥߃ࠆක≮ߦߟ޿ߡߪ଻㒾⛎ઃ߇ⴕࠊࠇߕ㧘߹ߚ଻㒾⸻≮ߣ଻㒾ᄖ⸻≮ߩ૬↪
ߦߟ޿ߡߪේೣߣߒߡ㧘ߘߩ଻㒾⛎ઃಽ߽฽߼ߡో㗵߇ᖚ⠪⥄Ꮖ⽶ᜂߣߥࠆ઀⚵ߺߣߥߞߡ޿ࠆ‫ޕ‬ᓟ⠪߇ᷙว⸻≮ߩ⑌ᱛߣ⸒ࠊࠇߡ޿ࠆ߇㧘ߘߩ⼏⺰ߪᦨㄭߩᡷ㕟ࠍ〯߹߃ߡᰴ▵એ㒠ߢⴕ߁‫ޕ‬એਅߢߪ౏⊛ක≮଻㒾೙ᐲࠍਛᔃߣߒߡฃ⸻ߦ઻߁೙ᐲ⊛ߥ೙⚂᧦ઙߦߟ޿ߡ⺑᣿ߒࠃ߁‫ޕ‬ ࠊ߇࿖ߢߪ⊝଻㒾೙ᐲ߇ 1961 ᐕߦታ⃻ߐࠇ㧘ోߡߩ࿖᳃ߪ৻ㇱߩ⥄Ꮖ⽶ᜂߢో࿖ߤߎߦ߅޿ߡ߽ක≮ࠨ࡯ࡆࠬࠍฃߌࠄࠇࠆߎߣߦߥߞߚ 5)‫ޕ‬ᖚ⠪ߩ⥄Ꮖ⽶ᜂ㗵ߪ 2005 ᐕ㧘ⵍ଻㒾⠪ᧄੱ߿ߘߩኅᣖߦ᜔ࠊࠄ
ߕේೣߣߒߡ 3 ഀ⽶ᜂߣߥߞߡ޿ࠆ‫ߒߛߚޕ‬㧘㜞㗵≮㙃⾌೙ᐲ߇ណ↪ߐࠇ㧘ߘߩ⥄Ꮖ⽶ᜂ㒢ᐲ㗵߇⸳ቯߐ4) ߎߩࠃ߁ߥක≮ᯏ㑐ߩᚲ᦭ᒻᘒߩઁߦ㧘಴᧪㜞ᛄ޿㧘✚੍▚㗵ᣇᑼ㧘ੱ㗡ᛄ޿ᣇᑼ㧘ቯ㗵ᛄ޿ᣇᑼߥߤߩᡰᛄ޿ᣇᑼߦࠃߞߡක≮ᯏ㑐ߩଔᩰ⺃࿃ᯏ⢻߇⇣ߥࠆߎߣ߆ࠄ㧘ߘࠇߦᔕߓߡක≮ߩଏ⛎᧦ઙ߽⋧㆑ߒߡߊࠆ‫ޕ‬5) ࠊ߇࿖ߩක≮଻㒾೙ᐲߦ㑐ߔࠆ⹦⚦ߪศේ࡮๺↰㧔1999㧕ࠍෳᾖ‫ޕ‬㧙㧙

⾗Ḯ㈩ಽᯏ⢻ߣߒߡߩ೙ᐲ࡮ⷙ೙

ࠇߡ޿ࠆ‫ߚ߹ޕ‬㜞㦂⠪ක≮ߦߟ޿ߡߪ⠧ੱ଻ஜ೙ᐲ߇ 1983 ᐕߦഃ⸳ߐࠇ㧘⥄Ꮖ⽶ᜂ㗵ߪࠃࠅૐ޿߽ߩߣ
ߥߞߡ޿ࠆ‫ޕ‬⠧ੱක≮ฃ⛎⾗ᩰ⠪ߪᒰೋ㧘70 ᱦએ਄ߩ⠪෸߮ 65 ᱦએ਄ 70 ᱦᧂḩߩኢߚ߈ࠅ╬ߩ⁁ᘒߦ޽ࠆ⠪ߢ޽ߞߚ߇㧘2002 ᐕࠃࠅߘߩኻ⽎ᐕ㦂߇ 75 ᱦએ਄ߦᒁ߈਄ߍࠄࠇ㧘߹ߚ⠧ੱක≮ฃ⛎⠪ߩ⥄Ꮖ⽶ᜂ㗵߽ 2005 ᐕߢ 1 ഀ⽶ᜂ㧘৻ቯએ਄ߩᚲᓧ⠪ߪ 2 ഀ⽶ᜂߣߥߞߡ޿ࠆ 6)‫⊛౏ߥ߁ࠃߩߎޕ‬ක≮଻㒾೙ᐲߩሽ࿷ߦࠃߞߡ㧘ᖚ⠪ߪ↢↥⠪ଔᩰ㧔⸻≮ႎ㈽㗵㧕ߦᲧߴߡૐ޿ᶖ⾌⠪ଔᩰ㧔⥄Ꮖ⽶ᜂ㗵㧕ࠍᡰᛄ߁ߎߣ
ߦࠃߞߡක≮ࠨ࡯ࡆࠬࠍฃߌࠆߎߣ߇ߢ߈ࠆ 7)‫ޕ‬ㅢᏱߩᏒ႐ߢขᒁߐࠇࠆ⽷߿ࠨ࡯ࡆࠬߦ߅޿ߡߪᏒ႐ଔ
ᩰߦࠃߞߡᒰ⹥⽷ߩഀᒰ㧔rationing㧕߇ⴕࠊࠇࠆ߇㧘ක≮ࠨ࡯ࡆࠬߩ႐วߪ৻ㇱߩଔᩰ⽶ᜂ߇ᖚ⠪ߦ⺖ߖࠄࠇࠆߩߺߣߥࠆ‫ߩߘޕ‬ᗧ๧ߢߪක≮ࠨ࡯ࡆࠬߩ㔛ⷐ߇ߘߩଏ⛎⢻ജࠍ⿥߃ࠆ⁁ᴫߢߪ⥄Ꮖ⽶ᜂ㗵ߣ޿߁ଔᩰએᄖߩഀᒰᚻᲑ߇᳞߼ࠄࠇࠆߎߣߦߥࠆ‫ޕ‬ ߐࠄߦ㧘ࠊ߇࿖ߢߪක≮ᯏ㑐ㆬᛯߦߟ޿ߡ⋥ធ⊛ߥⷙ೙߇ሽ࿷ߖߕ㧘ᖚ⠪ߪ⥄ಽߢ⥄↱ߦක≮ᯏ㑐ࠍㆬ߱ߎߣ߇น⢻ߢ޽ࠆ‫ޕ‬ක≮ᯏ㑐ㆬᛯߩ⥄↱ߦߟ޿ߡߪ㧘⧷࿖㧘ࠬࠞࡦ࠺ࠖ࠽ࡧࠖࠕ⻉࿖㧘☨࿖ߩ HMO ߥߤߢ⷗ࠄࠇࠆࠃ߁ߥࠥ࡯࠻ࠠ࡯ࡇࡦࠣ೙ᐲ㧔gatekeeping system㧕ߪࠊ߇࿖ߦߪሽ࿷ߒߥ޿‫⧷߫߃ߣߚޕ‬࿖ߦ߅޿ߡߪࡊ࡜ࠗࡑ࡝࡯ࠤࠕࠍᜂ߁৻⥸ක㧔general practitioners㧕߇ࠥ࡯࠻ࠠ࡯ࡄ࡯㧔gatekeeper㧕ߣߒߡᯏ⢻ߒߡ߅ࠅ㧘ᖚ⠪߇ኾ㐷ක㧔specialists㧕ߩක≮ࠨ࡯ࡆࠬࠍฃߌࠆߦߪ৻⥸කߩ⚫੺߇ᔅⷐߣߐ
ࠇࠆ઀⚵ߺߣߥߞߡ޿ࠆ‫ߩߎޕ‬೙ᐲߩ೑ὐߣߒߡߪ㧘ᖚ⠪ߦࠃࠆਇᔅⷐߥක≮ㆬᛯ߇੐೨ߦ⏕⹺ߢ߈ࠆߎ
ߣ߆ࠄක≮⾌ᛥ೙ߦߥࠆߎߣ㧘ߐࠄߦ㜞ᰴක≮ߩ⾗Ḯ㈩ಽߦߟ޿ߡߪᖱႎࠍ᦭ߔࠆ৻⥸කߦࠃߞߡⴕࠊࠇ
ࠆߎߣ߆ࠄߘߩല₸⊛ߥឭଏ߇น⢻ߣߥࠆߥߤ߇ᜰ៰ߐࠇߡ޿ࠆ 8)‫ઁޕ‬ᣇ㧘ࠊ߇࿖ߢߪᖚ⠪߇⋥ធߦ㜞ᰴක≮ࠍឭଏߔࠆක≮ᯏ㑐ࠍ߽ฃ⸻น⢻ߣߥࠆ઀⚵ߺߢ޽ࠆߎߣ߆ࠄ㧘ᷙ㔀⃻⽎ࠍㅢߓߡ㜞ᰴක≮ߩ⾗Ḯ㈩ಽߦ߅ߌࠆല₸ᕈࠍ៊ߥ߁໧㗴߇ሽ࿷ߒߡ޿ࠆ 9)‫ޕ‬

1.2. ฃ⸻ࠦࠬ࠻ߣഀᒰ ࠊ߇࿖ߩฃ⸻ߦ઻߁೙ᐲ⊛ᨒ⚵ߺߩ߽ߣߢ㧘ߤߩࠃ߁ߥࠦࠬ࠻߇ᖚ⠪ߦ⺖ߖࠄࠇߡ޿ࠆߩߛࠈ߁߆‫ߎޕ‬ߩฃ⸻ߦ઻߁ታ⾰ࠦࠬ࠻ߪක≮ࠨ࡯ࡆࠬ㔛ⷐࠍⷙቯߔࠆਥⷐߥⷐ࿃ߩ 1 ߟߢ޽ࠆߣ⠨߃ࠄࠇࠆ‫ߞ߇ߚߒޕ‬ߡ㧘ߚߣ߃⥄Ꮖ⽶ᜂ㗵ߣ޿߁ᢱ㊄ଔᩰ㧔money price㧕߇ૐߊߡ߽㧘ߘࠇࠍ฽߼ߚታ⾰ࠦࠬ࠻㧔ߟ߹ࠅ full
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ታ⾰⊛ߦᯏ⢻ߒߡ޿ࠆߣ⸒߃ࠆ 10)‫ޕ‬એਅߢߪ⃻ⴕ೙ᐲߩ߽ߣߢᶖ⾌⠪㧔ᖚ⠪㧕߇ߤߩࠃ߁ߥࠦࠬ࠻ߦ⋥㕙ߔࠆߩ߆㧘ߘߒߡ㧘ߘࠇ߇ߤߩࠃ߁ߥ᧦ઙߦⷙቯߐࠇࠆߩ߆ࠍ೙ᐲ⊛஥㕙߆ࠄᬌ⸛ߔࠆ‫ޕ‬ ߹ߕ౏⊛ක≮଻㒾೙ᐲߢ⸳ቯߐࠇࠆᖚ⠪ߩ⥄Ꮖ⽶ᜂ㗵㧔ᶖ⾌⠪ଔᩰ㧕߇޽ࠆ‫⽶ߩߎޕ‬ᜂߪᖚ⠪ߦߣߞߡ᣿␜⊛ߥ money price ߢ㧘ㄭᐕߢߪ㜞㦂ൻߩㅴዷߦࠃࠆ⽷᡽⁁ᴫߩᖡൻߦ઻ߞߡჇട௑ะߦ޽ࠆ‫⃻ޕ‬࿷ߢߪᣢㅀߒߚࠃ߁ߦ 3 ഀߩ⥄Ꮖ⽶ᜂ߇⸳ቯߐࠇߡ޿ࠆ߇㧘ታ㓙ߦߪᖚ⠪ߦߣߞߡฃ⸻ߦ઻߁ࠦࠬ࠻ߪߎࠇߦ
㒢ቯߐࠇߥ޿‫ޕ‬ක≮ߩ႐วߦߪએਅߦ⺑᣿ߔࠆࠃ߁ߥᥧ㤩⊛ߥࠦࠬ࠻㧔hidden costs㧕߇↢ߓߡ޿ࠆ‫ߘޕ‬
ߩℂ↱ߪ೨ዊ▵ߢ⺑᣿ߒߚ઀⚵ߺߦ޽ࠆ‫ޕ‬ක≮ಽ㊁ߢߪ㔛⛎ਔࠨࠗ࠼ߦⷙ೙߇ታᣉߐࠇ㧘ㅢᏱߩଔᩰࡔࠞ
࠾࠭ࡓߦࠃߞߡ㔛⛎߇⺞ᢛߐࠇࠆࠃ߁ߥᏒ႐ဳߩ⾗Ḯ㈩ಽᣇᴺ߇ᯏ⢻ߒߡ޿ߥ޿‫ࠅ߹ߟޕ‬㧘㔛ⷐ⠪㧘↢↥6) 㜞㦂⠪ߩᖚ⠪⽶ᜂߦ㑐ߒߡߪ 2005 ᐕ㧘ේೣ 1 ഀ⽶ᜂߣߥߞߡ޿ࠆ߇㧘⃻ᓎਗߺᚲᓧ⠪㧔⺖⒢ᚲᓧ 145 ਁ౞㧘ᮡḰႎ㈽᦬㗵 28 ਁ౞⋧ᒰએ਄㧕ߩ㜞㦂⠪ߪ 2 ഀ⽶ᜂߢ㧘ߘߩ⥄Ꮖ⽶ᜂ㒢ᐲ㗵߽㜞ߊߥࠆ‫ߚ߹ޕ‬㧘૑᳃⒢㕖⺖⒢਎Ꮺߣߥࠆૐᚲᓧ⠪ߦߟ޿ߡߪߘߩ⽶ᜂ㗵ߪ⇣ߥࠆ‫ޕ‬ෘ↢ഭ௛⋭㧔2005c㧕ߢߪ㧘೨ᦼ㧔65 ᱦએ਄ 74 ᱦ㧕߅ࠃ߮ᓟᦼ㧔75 ᱦએ਄㧕ߣ޿߁ᐕ㦂඙ಽߩ߽ߣߢ㜞㦂⠪ߩᖚ⠪⽶ᜂߦ㑐ߔࠆ᩺߇␜ߐࠇߡ޿ࠆ‫ޕ‬7) ߘߩᏅ㗵ߪ଻㒾ᢱߣ౏⊛⽶ᜂߢ㧘࿖᳃ක≮⾌ో૕ߢߺࠆߣ㧘ߘࠇߙࠇߩഀวߪ 23%㧘52%ߣߥࠆ‫ޕ‬8) ৻⥸කߦࠃࠆࠥ࡯࠻ࠠ࡯ࡇࡦࠣ೙ᐲߦߟ޿ߡߪ Scott㧔2000㧕,ߘߒߡ Brekke, Nuscheler and Straume㧔2005㧕ࠍෳᾖ‫ޕ‬9) ߚߛߒ㧘ࠊ߇࿖ߢߪ 1996 ᐕߩ⸻≮ႎ㈽ᡷቯߦ߅޿ߡ 200 ∛ᐥએ਄ߩ∛㒮ߪ⚫੺⁁ࠍᜬߚߥ޿ᖚ⠪ߦኻߒߡ㜞޿ೋ⸻ᢱ߇⸳ቯߢ߈ࠆࠃ߁ߦ
ߥߞߡ޿ࠆ‫ޕ‬10) ᧄᢥߩએਅߢ⺑᣿ߔࠆᓙߜᤨ㑆ࠦࠬ࠻ࠍ฽߼ߚ full price ߿ money price ߇ක≮ࠨ࡯ࡆࠬ㔛ⷐߦਈ߃ࠆᓇ㗀ߦߟ޿ߡߪ⍮㊁
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ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕

⠪ߘࠇߙࠇ߇⋥㕙ߔࠆ౏⊛ଔᩰߪਵ㔌ߒߡ߅ࠅ㧘㔛⛎ߩ⺞ᢛᯏ⢻ࠍᨐߚߔଔᩰߣߪ⇣ߥࠆ‫ߡߞ߇ߚߒޕ‬㧘ਔࠨࠗ࠼ߩਥ૕ߪߘࠇߙࠇߩ‫⊛౏ޟ‬ଔᩰ‫ߦޠ‬෻ᔕߔࠆ߽ߩߩ㧘ߘߩ㔛⛎⺞ᢛߪ⇣ߥࠆᣇᴺߢⴕࠊࠇࠆ‫ޕ‬㔛ⷐࠨࠗ࠼ߦߟ޿ߡߚߣ߃߫ࠥ࡯࠻ࠠ࡯ࡄ࡯ߥߤߦࠃࠆഀᒰᣇᑼ߇ታᣉߐࠇߡ޿ߥ޿ࠊ߇࿖ߢߪ㧘⿥ㆊ㔛ⷐߩ⁁ᴫߩ߽ߣߢߪએਅߢ⺑᣿ߔࠆᥧ㤩⊛ߥࠦࠬ࠻߇ᖚ⠪㧔ᶖ⾌⠪㧕ߦ⺖ߖࠄࠇ㧘㔛ⷐ߇৻ቯߩଏ⛎⢻ജߦ⺞ᢛߐࠇࠆ઀⚵ߺߣߥߞߡ޿ࠆ‫ޕ‬ ߢߪߤߩࠃ߁ߥᥧ㤩⊛ߥࠦࠬ࠻߇ᖚ⠪ߦ⺖ߖࠄࠇࠆߩ߆‫⥄ޕ‬Ꮖ⽶ᜂએᄖߩᖚ⠪ߦ⺖ߖࠄࠇࠆࠦࠬ࠻ߩ߁
ߜ㊀ⷐߥ߽ߩߣߒߡක≮ᯏ㑐ߦ߅ߌࠆᓙߜᤨ㑆㧔waiting time㧕ߦ઻߁ࠦࠬ࠻߇޽ࠆ‫ߪࠇߘޕ‬ฃ⸻ߦ㓙ߒߡᓙߜᤨ㑆߇ᔅⷐߣߥࠆ߇㧘ߎߩࠃ߁ߥࠨ࡯ࡆࠬ೑↪ࠍᓙߟߚ߼ߩⴕ೉㧔queues㧕ࠦࠬ࠻߇޽ࠆ‫ࠦߩߎޕ‬ࠬ࠻߇㜞޿ߩߢ޽ࠇ߫㧘ක≮ࠨ࡯ࡆࠬߩ೑↪ߦ㓙ߒߡᓙߜᤨ㑆ߦࠃࠆഀᒰࡔࠞ࠾࠭ࡓ߇ᯏ⢻ߒߡ޿ࠆߣ⸒
߃ࠆ‫ߚ߹ޕ‬㧘ක≮ࠨ࡯ࡆࠬ೑↪ߦ㓙ߒߡߪක≮ᯏ㑐ߢߩⴕ೉ߦࠃࠆᓙߜᤨ㑆߇⾌߿ߐࠇࠆߩߺߥࠄߕ㧘ᒰ⹥ක≮ᯏ㑐߹ߢߩࠦࠬ࠻߇ሽ࿷ߔࠆ‫ౕޕ‬૕⊛ߦߪ⥄ቛ߆ࠄක≮ᯏ㑐߹ߢߩᤨ㑆ߣߘߩ੤ㅢ⾌↪ߢ޽ࠆ‫ߎޕ‬ߩක≮ᯏ㑐߹ߢߩࠕࠢ࠮ࠬࠦࠬ࠻ߪ㧘ᖚ⠪ߩ૑߻࿾ၞ߇ߤߩࠃ߁ߥක≮ࠨ࡯ࡆࠬߩଏ⛎⢻ജߦ޽ࠆߩ߆ߣ
޿߁ଏ⛎஥ߩ᧦ઙߦଐሽߒߡ޿ࠆ‫߇࠻ࠬࠦߩࠄࠇߎޕ‬ታ㓙ߦ⺖ߖࠄࠇࠆߎߣߦࠃߞߡ㔛ⷐ߇⺞ᢛߐࠇࠆ‫ޕ‬ߚߣ߃߫⥄Ꮖ⽶ᜂ㗵ߩ money price ߇࠯ࡠ౞㧔ߟ߹ࠅήᢱ㧕ߦߥߞߡ⿥ㆊ㔛ⷐ߇↢ߓߚߣߔࠆߣ 11)㧘ᖚ⠪ߩჇടߪᓙߜᤨ㑆ࠍჇᄢߐߖ㧘ߘࠇ߇৻ቯߩᖚ⠪ߦฃ⸻ߩᛥ೙ࠍ߽ߚࠄߔߎߣߦߥࠆ 12)‫ߥ߁ࠃߩߎޕ‬ᥧ㤩⊛ߥࠦࠬ࠻ࠍㅢߓߚ㔛ⷐ⺞ᢛ߇ᯏ⢻ߔࠆߩߪ㧘ߚߣ߃߫ࠥ࡯࠻ࠠ࡯ࡄ࡯ߥߤߦࠃࠆഀᒰᣇᑼ߇೙ᐲߣߒߡ
ⴕࠊࠇߡ߅ࠄߕ㧘ࡈ࡝࡯ࠕࠢ࠮ࠬ߇ណ↪ߐࠇߡ޿ࠆߎߣߦ⿠࿃ߒߡ޿ࠆ‫ޕ‬ ߹ߚ㧘ක≮ࠨ࡯ࡆࠬߩ߁ߜᬌᩏ㧘౉㒮߿ᚻⴚߥߤߩࠨ࡯ࡆࠬࠍฃߌࠆ႐ว㧘ᢇᕆක≮ࠍ㒰ߌ߫㧘৻ቯߩᓙᯏᦼ㑆߇޽ࠆߩ߇᥉ㅢߢ޽ࠆ‫߫߃ߣߚޕ‬ㆬᛯ⊛ᚻⴚ㧔selective surgery㧕ߦ߅޿ߡᓙᯏ࡝ࠬ࠻㧔waiting
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ࠬࠍฃߌࠆᓙᯏᦼ㑆߇ዋߥ޿ߎߣߪ㧘∛ᐥᢙ߇ᄙߊሽ࿷ߒ㧘߆ߟ㧘ᬌᩏᯏེ╬߇ᄙߊ଻᦭ߐࠇߡ޿ࠆߣ޿
߁ࠊ߇࿖ߩක≮ଏ⛎᧦ઙߩ․ᓽߦଐሽߒߡ޿ࠆ 14)‫ߒ߆ߒޕ‬㧘ߚߣ߃౉㒮߿ᚻⴚߩᓙᯏᦼ㑆߇⍴޿ߣߒߡ߽㧘ක≮ࠬ࠲࠶ࡈߣ޿߁ੱ⊛⾗Ḯߦߟ޿ߡߪઁ࿖ߦᲧߴߡዋߥߊߥࠆߣ޿߁․ᓽ߇޽ࠆߎߣ߆ࠄ㧘ᖚ⠪ߪੱ⊛⾗Ḯߩᛩ౉߇ዋߥߊߥࠆක≮ࠨ࡯ࡆࠬࠍฃߌߡ޿ࠆߎߣࠍᗧ๧ߒࠃ߁‫ࠅ߹ߟޕ‬㧘ᓙᯏᦼ㑆ߦࠃࠆ⺞ᢛߢߪߥߊ㧘ੱ⊛⾗Ḯᛩ౉ࠍㅢߓߚ⺞ᢛ߇ⴕࠊࠇߡ޿ࠆߎߣߦߥࠆ‫ޕ‬ ᖚ⠪ߩක≮ࠨ࡯ࡆࠬฃ⸻ߦ઻߁ታ⾰ࠦࠬ࠻㧔full price㧕ߪ⥄Ꮖ⽶ᜂᢱ㊄㧔money price㧕ߩߺߥࠄߕ㧘ฃ⸻ߩߚ߼ߦ߆߆ࠆᓙߜᤨ㑆ࠦࠬ࠻߿㧘ᒰ⹥ක≮ᯏ㑐߹ߢߩᤨ㑆߿੤ㅢ⾌↪╬ࠍ฽߼ߚࠕࠢ࠮ࠬࠦࠬ࠻㧘ߐࠄߦߪᬌᩏ㧘౉㒮߿ᚻⴚ╬ߩߚ߼ߩᓙᯏᦼ㑆ߦ઻߁ࠦࠬ࠻ߥߤࠍ฽߼ߚ߽ߩߣߥࠆ‫ߩߎޕ‬ታ⾰ࠦࠬ࠻ߪක≮ߩଏ⛎᧦ઙߦଐሽߔࠆߎߣ߆ࠄ㧘ᖚ⠪ߩ⽶ᜂߔࠆࠦࠬ࠻߇ߘߩዬ૑ߔࠆ࿾ၞߩ᧦ઙߦࠃߞߡᏀฝߐࠇ
11) ࠊ߇࿖ߢߪ 1972 ᐕߦ⠧ੱක≮ήᢱൻ᡽╷߇ዉ౉ߐࠇ㧘⠧ੱක≮ߦ㑐ߔࠆ⥄Ꮖ⽶ᜂ߇࠯ࡠߣߥߞߚ‫⚿ߩߎޕ‬ᨐ㧘㜞㦂⠪ߩක≮㔛ⷐ߇ᄢ߈ߊ
Ⴧടߒߚ‫ߪࠇߘޕ‬ଏ⛎᧦ઙࠍ৻ቯߣߔࠇ߫㧘ᥧ㤩⊛ࠦࠬ࠻㧔ᓙߜᤨ㑆ࠦࠬ࠻㧕߇Ⴧᄢߒ㧘ߘࠇ߇ක≮ࠨ࡯ࡆࠬ೑↪ߩഀᒰᚻᲑߣߒߡߩᓎഀࠍ
ᄢ߈ߊߒߡ޿ࠆ‫ޕ‬12) ᔅߕߒ߽ߎߩࠃ߁ߥᖚ⠪ᢙߩᷫዋࠍㅢߓߥߊߡ߽㧘ߚߣ߃߫⸻ኤᤨ㑆ߩᷫዋ㧔ߟ߹ࠅක≮ࠨ࡯ࡆࠬߩ⾰⊛ૐਅ㧕ࠍㅢߓߡ⺞ᢛ߇ⴕࠊࠇࠆߎ
ߣ߽⃻ታߦߪ޽ࠆߛࠈ߁‫ޕ‬13) Siciliani and Hurst(2003),OECD(2004)ࠍෳᾖ‫⧷ޕ‬࿖ߢߪߒ߫ߒ߫ waiting list ߩ໧㗴߇ᄢ߈ߥ᡽ᴦ⊛໧㗴ߣߒߡᜰ៰ߐࠇߡ޿ࠆ‫ޕ‬14) OECD(2005)ߦࠃࠇ߫㧘ජੱᒰߚࠅ∛ᐥᢙ㧔2003 ᐕ࠺࡯࠲㧕ߢߪᣣᧄ߇ 14.3 ߢ৻⇟ᄙߊ㧘ᰴߦ࠴ࠚࠦ౒๺࿖ 8.8㧘࠼ࠗ࠷ 8.7 ߣ⛯߈㧘⧷࿖
߇ 4.2㧘☨࿖߇ 3.3 ߢ޽ࠆ‫ߚ߹ޕ‬㧘⊖ਁੱᒰߚࠅ CT ࠬࠠࡖ࠽࡯ᢙ㧔2002 ᐕ࠺࡯࠲㧕ߢߪᣣᧄ߇ 92.6 ߢ৻⇟ᄙߊ㧘ᰴ߇㖧࿖ߩ 30.9 ߢ㧘☨࿖߇
13.1㧘ߜߥߺߦ⧷࿖߇ 5.8㧔2001 ᐕ࠺࡯࠲㧕ߣߥࠆ‫౉ޕ‬㒮ᦼ㑆㧔2003 ᐕ࠺࡯࠲㧕ߦߟ޿ߡߪᣣᧄ߇ 36.4 ߢ৻⇟㐳ߊ㧘ᰴߦ㖧࿖ 13.5㧘ࡈ࡜ࡦࠬ 13.4 ߣ⛯ߊ㧘⧷࿖ߪ 7.6㧘☨࿖߇ 6.5 ߢ޽ࠆ‫ޕ‬㧙㧙

⾗Ḯ㈩ಽᯏ⢻ߣߒߡߩ೙ᐲ࡮ⷙ೙

ࠆߎߣߦߥࠆ‫߇ࠊޕ‬࿖ߩଏ⛎ࠪࠬ࠹ࡓߢߪ⥄↱㐿ᬺක೙ࠍၮᧄߣߒ㧘ߘࠇࠍ⵬ቢߔࠆࠃ߁ߦ౏⊛ᯏ㑐߇ሽ࿷ߔࠆ߽ߩߩ㧘࿾ၞߦ߅ߌࠆක≮ߩଏ⛎᧦ઙߪක≮ᯏ㑐ᢙ㧘∛ᐥᢙ㧘ߘߒߡឭଏߐࠇࠆක≮ߩ㗔ၞ╬ߩὐߦ߅޿ߡ࿾ၞᩰᏅ߇↢ߓߡ޿ࠆ 15)‫ߩߘޕ‬ᗧ๧ߢߪታ⾰ࠦࠬ࠻ߦࠃࠆഀᒰᯏ⢻߇૞↪ߔࠆ⒟ᐲ߇࿾ၞߦࠃߞ
ߡ⇣ߥߞߡߊࠆߎߣߦߥࠆ‫ޕ‬╙㧞▵ ⸻≮ႎ㈽೙ᐲߣଏ⛎ࠪࠬ࠹ࡓ ೨▵ߢߪଏ⛎஥ߩ↢↥⢻ജ╬ࠍᚲਈߣߒߡ㧘⃻ⴕߩක≮଻㒾೙ᐲߩ߽ߣߢᖚ⠪߇ߤߩࠃ߁ߥ⾗Ḯ㈩ಽߩ
⺞ᢛࠍฃߌࠆߩ߆ࠍี๧ߒߚ‫⚿ߩߘޕ‬ᨐߣߒߡ㧘ᖚ⠪ߩฃߌขࠆක≮ࠨ࡯ࡆࠬߪᖚ⠪ߩዬ૑࿾ၞߦ߅ߌࠆ
ක≮ᯏ㑐ߩ↢↥⢻ജ߿࠲ࠗࡊߥߤ㧘ߘߩଏ⛎᧦ઙߦᏀฝߐࠇࠆ․ᓽࠍ᦭ߒߡ޿ߚ‫ߩߘߪߢ▵ᧄޕ‬ଏ⛎ࠪࠬ࠹ࡓࠍⷙቯߔࠆ⻉ⷙ೙ߩ߁ߜ㧘ක≮ᯏ㑐ߩⴕേߦᄢ߈ߥᓇ㗀ࠍ෸߷ߔ⸻≮ႎ㈽೙ᐲࠍขࠅ਄ߍࠆ 16)‫≮⸻ޕ‬
ႎ㈽ߪක≮ࠨ࡯ࡆࠬߩ↢↥⠪ଔᩰߣߒߡක≮ᯏ㑐ߩଔᩰ⺃࿃ᯏ⢻ࠍ᦭ߒ㧘ଏ⛎஥ߩ⾗Ḯ㈩ಽ᳿ቯߦᓇ㗀ࠍ෸߷ߔ‫ߡߞ߇ߚߒޕ‬㧘⸻≮ႎ㈽ߩ࿷ࠅᣇ߇ଏ⛎᧦ઙߩᓇ㗀ࠍㅢߓߡ೨▵ߢ᣿ࠄ߆ߦߒߚක≮ࠨ࡯ࡆࠬߩታ
⾰ࠦࠬ࠻ߩᄢ߈ߐࠍⷙቯߒߡ޿ࠆ‫ޕ‬એਅߢߪ㧘⸻≮ႎ㈽߇ක≮ᯏ㑐ߩㆬᛯⴕേࠍㅢߓߡߘߩଏ⛎᧦ઙߩᒻᚑߦߤߩࠃ߁ߥ㑐ଥࠍᜬߟߩ߆㧘߹ߚ㧘⃻ⴕߩ⸻≮ႎ㈽೙ᐲ߇ߤߩࠃ߁ߥ․ᓽ߅ࠃ߮໧㗴ὐࠍ᦭ߒߡ޿ࠆ
ߩ߆ࠍ᣿ࠄ߆ߦߔࠆ‫ޕ‬

2.1. ⸻≮ႎ㈽ߣක≮ᯏ㑐ߩⴕേ ⸻≮ႎ㈽೙ᐲߪක≮ࠨ࡯ࡆࠬߦ㑐ߔࠆ↢↥⠪ଔᩰⷙ೙ߩ৻⒳ߣߥࠆ߇㧘ㅢᏱߩଔᩰⷙ೙ߣߪᰴߩὐߢ⇣ߥࠆ‫ⷙޕ‬೙ኻ⽎߇ක≮ࠨ࡯ࡆࠬߩ႐ว㧘↥಴‛㧔ࠕ࠙࠻ࡊ࠶࠻㧕ߘߩ߽ߩߣ⸒߁ࠃࠅ߻ߒࠈ㧘ක≮ࠨ࡯ࡆࠬࠍ↢↥ߔࠆߚ߼ߩᛩ౉ⷐ⚛ߦㄭ޿߽ߩߣߥߞߡ޿ࠆ‫⸻߫߃ߣߚޕ‬ኤ㧘ᬌᩏ㧘ᛩ⮎㧘ᚻⴚߥߤߩ⸻≮ⴕὑ߇ଔᩰઃߌߩኻ⽎ߣߥߞߡ޿ࠆ‫ޕ‬ଔᩰኻ⽎ߩᢙߪ⸻≮ⴕὑߩ႐วߦߪᢙජ⒳㘃ߢ㧘⮎೷ߢߪ 1 ਁຠ⋡એ਄ߦ⥋ࠆ 17)‫ߩߎޕ‬ଔᩰ⴫߇⸻≮ႎ㈽ὐᢙ⴫ߢ㧘⮎೷ߦߟ޿ߡߪ೎ㅜ㧘⮎ଔၮḰὐᢙ⴫ߣ๭߫ࠇࠆ‫ޕ‬ታ㓙ߩ⸳ቯߢߪὐᢙᣇᑼ߇ߣࠄࠇ㧘1 ὐ߇ 10 ౞ߣߥࠆ‫ޕ‬ක≮ࠨ࡯ࡆࠬߦኻߔࠆක≮ᯏ㑐߳ߩᡰᛄ޿㗵ߪߘߩឭଏߐ
ࠇߚฦ⒳ߩ⸻≮ⴕὑߦઃߐࠇߚὐᢙࠍⓍ▚ߒߚ㊄㗵ߢ޽ࠅ㧘ㅢᏱ㧘ߘߩ 3 ഀߩ㊄㗵߇ᖚ⠪⽶ᜂಽߢ㧘ᱷࠅߪ଻㒾⠪߆ࠄ⛎ઃߐࠇࠆ‫ޕ‬ ৻⥸ߦ㧘ଔᩰߪ⚻ᷣਥ૕ߦኻߒߡⴕേߩ⺃࿃ᯏ⢻ࠍ᦭ߒߡ޿ࠆ‫ޕ‬ක≮ಽ㊁ߦ߅޿ߡ߽ଔᩰ⺃࿃ᯏ⢻ߪ૞↪ߔࠆߢ޽ࠈ߁‫ޕ‬ක≮ᯏ㑐ߪේೣߣߒߡ㧘ක≮ࠨ࡯ࡆࠬឭଏߦ઻߁෼౉ߦࠃߞߡߘߩ⾌↪߇⾔ࠊࠇࠆណ▚ᕈ߇ⷐ⺧ߐࠇࠆ߆ࠄߢ޽ࠆ‫ߒߛߚޕ‬㧘ක≮ᯏ㑐ߦ߽ߘߩ㐿⸳⠪ߦߪ᭽‫߇ߩ߽ߥޘ‬ሽ࿷ߒ㧘ߘߩណ▚ᕈߩⷐ⺧߽ᒰ⹥ᯏ㑐ߦ⺖ߖࠄࠇߚ೙ᐲ⊛೙⚂ߦࠃߞߡ⇣ߥࠆ‫߫߃ߣߚޕ‬ෘ↢ഭ௛⋭ߩᄢಽ㘃ߦࠃࠇ߫㧘࿖㧘౏⊛ක≮ᯏ㑐㧔ㇺ㆏ᐭ⋵ߣᏒ↸᧛㧘߅ࠃ߮ᣣ⿒㧘ᷣ↢ળ㧘ෘ↢ㅪߥߤࠍ฽߻㧕㧘␠ળ଻㒾㑐ଥ࿅૕㧔ో࿖␠ળ଻
㒾දળㅪวળ㧘ஜᐽ଻㒾⚵ว෸߮ߘߩㅪวળ㧘౒ᷣ⚵ว෸߮ߘߩㅪวળߥߤ㧕㧘ක≮ᴺੱ㧘୘ੱ㧘ߘߩઁ㧔౏
⋉ᴺੱ㧘ቇᩞᴺੱ㧘ߘߩઁߩᴺੱߥߤ㧕ߥߤ㧘㐿⸳⠪ߩ⇣ߥࠆᯏ㑐߇ሽ࿷ߔࠆ‫⊛౏ޕ‬ක≮ᯏ㑐ߦᲧߴߡߣ
ߊߦක≮ᴺੱߣ୘ੱߩ⑳⊛ක≮ᯏ㑐ߢߪ㧘ߘߩਥߥ෼౉ߪ౏⊛⵬ഥ㊄߿ነઃ㊄ߥߤߢߪߥߊ㧘ක≮ࠨ࡯ࡆࠬឭଏߦ઻߁කᬺ෼౉ߣߥࠆ‫ߩߘޕ‬ᗧ๧ߢߪ㧘ක≮ᯏ㑐ߩ㐿⸳⠪ߩ⋧㆑ߦࠃߞߡ㧘ක≮ᯏ㑐ߩㆬᛯⴕേ߽

15) ᦺᣣᣂ⡞㧔2006 ᐕ 1 ᦬ 18 ᣣ㧕ߦࠃࠆߣ㧘ක≮ଏ⛎ߩ࿾ၞ㑆ᩰᏅߦᄢ߈ߥ஍ࠅ߇޽ࠆߚ߼㧘᡽ᐭߪක≮ᴺࠍᡷᱜߒߡ㐿ᬺߩ⾗ᩰⷐઙߦ㧘ㆊ⇹࿾߿කᏧਇ⿷ߣߥࠆ⸻≮⑼߳ߩᓥ੐ࠍታᣉߔࠆᣇ㊎ࠍ࿕߼ߡ޿ࠆ‫ޕ‬16) ᧄⓂߢߪࠊ߇࿖ߢၮᧄ⊛ߦ೑↪ߐࠇߡ޿ࠆ಴᧪㜞ᛄ޿ᣇᑼࠍขࠅ਄ߍ㧘ߘߩᨒ⚵ߺࠍන⚐ൻߒߡ⠨ኤߔࠆ‫߅ߥޕ‬㧘☨࿖ߩ DRG/PPS ߩࠃ߁ߥᡰᛄ޿ᣇᑼߪᧄⓂߣߪ⇣ߥࠆᨒ⚵ߺߣߥࠆ‫ޕ‬17) ␠ળ଻㒾⎇ⓥᚲ㧔2004㧕㧘ߓ߶߁㧔2005㧕ࠍෳᾖ‫ޕ‬㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕

⇣ߥߞߡߊࠆߣ⠨߃ࠄࠇࠆ 18)‫ޕ‬ታ㓙㧘ࠊ߇࿖ߩ⃻ⴕߩ⥄↱㐿ᬺක೙ߣ㕖༡೑ᕈ೙⚂ߩ߽ߣߢ㧘⑳⊛ක≮ᯏ㑐߇㊄㌛⊛ߥଢ⋉ㅊ᳞ߣ޿߁ὐߦ߅޿ߡᒝߊᓇ㗀ߐࠇࠆ․ᓽࠍ߽ߟ 19)‫ޕ‬ ᭽‫ߥޘ‬㐿⸳⠪ߩක≮ᯏ㑐߇૬ሽߔࠆࠪࠬ࠹ࡓߩ߽ߣߢߪ㧘⸻≮ႎ㈽ߩ߽ߟଔᩰ⺃࿃ᯏ⢻ߪ㐿⸳⠪㑆ߢ⋧㆑ߒߡߊࠆ‫⊛⑳ߦߊߣޕ‬ක≮ᯏ㑐ߪ౏⊛ᯏ㑐ߦᲧߴߡណ▚ᕈࠍ⠨ᘦߒߚක≮ࠨ࡯ࡆࠬߩឭଏࠍㆬᛯߔࠆߎ
ߣߦߥࠆ 20)‫↱⥄ߪࠇߘޕ‬㐿ᬺක೙ߩ߽ߣߢ㧘ක≮ࠨ࡯ࡆࠬᏒ႐ߦ߅ߌࠆ⑳⊛ᯏ㑐ߩሽ⛯ߦ㑐ࠊࠆߎߣ߆ࠄ
ߢ޽ࠆ‫ߡߞ߇ߚߒޕ‬㧘┙࿾ߔࠆ႐ᚲ߿ߘߩឭଏߔࠆක≮ࠨ࡯ࡆࠬߩ⒳㘃߿ౝኈ߇⃻ⴕߩ⸻≮ႎ㈽૕♽ߦᾖࠄߒߡㆬᛯߐࠇࠆߎߣߦߥࠆ‫⊛⑳ߥ߁ࠃߩߎޕ‬ක≮ᯏ㑐ߩㆬᛯⴕേߩ⚿ᨐߣߒߡࠢ࡝࡯ࡓࠬࠠࡒࡦࠣ⃻⽎߇↢ߓ㧘౏⑳ක≮ᯏ㑐㑆ߦ߅ߌࠆᏒ႐᭴ㅧ⊛․ᓽߩ⋧㆑߇ᒻᚑߐࠇࠆ 21)‫ߚ߹ߪࠇߘޕ‬㧘ฦ࿾ၞߦ߅ߌࠆක
≮ଏ⛎᧦ઙߩ⋧㆑ࠍ߽↢߻߽ߩߣߥࠆ‫ߦߊߣޕ‬㜞㦂⠪౉㒮ක≮ߦߟ޿ߡߪ⑳⊛ක≮ᯏ㑐߇ᜂߞߡ޿ࠆᓎഀ
߇ᄢ߈ߊ㧘ߘߩ∛ᐥᢙߩ࿾ၞ⊛ᩰᏅ߇੺⼔଻㒾೙ᐲᚑ┙೨ߦ߅޿ߡ㜞㦂⠪౉㒮ක≮⾌ߩᩰᏅࠍ↢߻㊀ⷐߥ
㧕ⷐ࿃ߣߥߞߡ޿ࠆ 22)‫ߪࠇߎޕ‬ක≮ߣ੺⼔ߩႺ⇇⊛㗔ၞߦ߅ߌࠆ㐳ᦼ౉㒮ᖚ⠪㧔޿ࠊࠁࠆ‫␠ޟ‬ળ⊛౉㒮‫ޠ‬ߦ㑐ㅪߒߚ໧㗴ߢ޽ࠆ߇㧘੺⼔଻㒾೙ᐲᚑ┙ᓟߦ߅޿ߡ߽≮㙃∛ᐥ߇ක≮ဳ∛ᐥߣ੺⼔ဳ∛ᐥߦಽ߆ࠇߟ
ߟ߽㧘౉㒮⠪߇ਔ⠪㑆ߢᷙ࿷ߒߡ޿ࠆ 23)‫ޕ‬ ⷐ⚂ߔࠆߣ㧘⸻≮ႎ㈽ߪߘߩ㐿⸳⠪೎ක≮ᯏ㑐߳ߩᓇ㗀ࠍㅢߓߡ࿾ၞ㑆ߩଏ⛎᧦ઙࠍⷙቯߔࠆߎߣߦߥ
ࠅ㧘ߘࠇ߇೨▵ߢ⺑᣿ߒߚක≮ࠨ࡯ࡆࠬฃ⸻ߦ઻߁ታ⾰ࠦࠬ࠻ߩᄢ߈ߐߦᓇ㗀ࠍ෸߷ߔߎߣߦߥࠆ‫߹ߟޕ‬ࠅଏ⛎᧦ઙߩ⋧㆑ߪ㧘ᖚ⠪ߩක≮ᯏ㑐ㆬᛯߩ⥄↱ⵙ㊂߇ᄢ߈޿೙ᐲߩ߽ߣߢ㧘࿾ၞߦ߅ߌࠆฃ⸻ߩᥧ㤩⊛ߥࠦࠬ࠻ߩᄢ߈ߐࠍⷙቯߒߡ޿ࠆ‫߇࠻ࠬࠦߩߎޕ‬೨▵ߢ⺑᣿ߒߚක≮ࠨ࡯ࡆࠬ೑↪ߩഀᒰᚻᲑߣߒߡ㊀ⷐߥᓎഀࠍᜂߞߡ޿ࠆ 24)‫ޕ‬

2.2. ⸻≮ႎ㈽೙ᐲߩ․ᓽߣ໧㗴ὐ ߢߪ಴᧪㜞ᛄ޿ᣇᑼߦၮߠ޿ߚ⃻ⴕߩ⸻≮ႎ㈽೙ᐲ߇ߤߩࠃ߁ߥ․ᓽߣ໧㗴ࠍ᦭ߒߡ޿ࠆߩ߆ࠍ⾗Ḯ㈩ಽ਄ߩⷰὐ߆ࠄᬌ⸛ߒࠃ߁‫ޕ‬ᒰ⹥೙ᐲߩၮᧄ⊛․ᓽߪㄭᐕߩක≮ࠍขࠅᏎߊᕆỗߥⅣႺ᧦ઙߩᄌൻߩ߽ߣ
ߢ㧘ක≮⾗Ḯߩ⾗Ḯ㈩ಽߦ߅ߌࠆല₸ᕈࠍ৻ጀૐਅߐߖࠆ߽ߩߣߥࠆߣ⠨߃ࠄࠇࠆ‫ޕ‬એਅߢߪ⸻≮ႎ㈽ⷙ
೙ߦߟ޿ߡ 3 ߟߩਥⷐߥ⺰ὐࠍขࠅ਄ߍߡᬌ⸛ߔࠆ‫ޕ‬ ╙৻ߦ㧘⸻≮ႎ㈽ߪක≮ࠨ࡯ࡆࠬߩ౏⊛ଔᩰߢ޽ࠆߎߣ߆ࠄ↢↥⠪ߦߣߞߡᚲᓧಽ㈩ߦଥࠊࠆ㊀ⷐߥⷙ
೙ߩ 1 ߟߢ޽ࠆߣ޿߁․ᓽ߇޽ࠆ‫≮⸻ߩߘޕ‬ႎ㈽ߩ᳿ቯߪ೑ኂ㑐ଥ⠪ࠍ฽߼ߚᆔຬ߆ࠄ᭴ᚑߐࠇࠆਛᄩ␠
ળක≮ද⼏ળ㧔ਛකද㧕ߦࠃߞߡⴕࠊࠇߡ޿ࠆ‫ⷙߥ߁ࠃߩߎޕ‬೙ߦߟ޿ߡߪ৻⥸ߦ㧘ⷙ೙ߦ઻߁Ḱ࡟ࡦ࠻߇⊒↢ߔࠆߎߣ߆ࠄߘࠇࠍ᳞߼ࠆ೑⋉࿅૕ߩ࡟ࡦ࠻ࠪ࡯ࠠࡦࠣᵴേ߇᡽ᴦㆊ⒟ߢዷ㐿ߐࠇࠆ௑ะ߇޽ࠆ‫ޕ‬㡍↰㧔1995㧕ߪࠊ߇࿖ߩක≮ಽ㊁ߦ߅ߌࠆ೑⋉࿅૕ߣߒߡᣣᧄකᏧળߦ⌕⋡ߒ㧘ᣣක࠾ࡘ࡯ࠬߣ޿߁⾗ᢱࠍㅢߓߡߘߩ⻉ᵴേࠍᢙ㊂ታ⸽⊛ߦ⸃᣿ߒߡ޿ࠆ‫⎇ߩߘޕ‬ⓥ⚿ᨐ߆ࠄ㧘ᣣᧄකᏧળߩᵴേ߇೑⋉࿅૕ߣߒߎߩࠃ߁ߥ property rights ߩ⋧㆑ߦࠃߞߡᒰ⹥ᯏ㑐ߩ⚻ᷣ⊛ⴕേ߇ᓇ㗀ߐࠇࠆ‫ޕ‬ߎߩ⚻ᷣℂ⺰ߦߟ޿ߡߪ Alchian㧔1965㧕
, Demsetz㧔1966㧕,
㧔1967㧕, Alchian and Demsetz㧔1972㧕, Furubotn and Pejovich㧔1972㧕, Cheung㧔1974㧕, Barzel㧔1997㧕ߥߤࠍෳᾖ‫ޕ‬19) ࠊ߇࿖ߩක≮ᯏ㑐ߪක≮ࠨ࡯ࡆࠬឭଏߦ㓙ߒߡක≮ᴺ╙㧣᧦ߩ㕖༡೑ᕈⷙቯߩㆡ↪ࠍฃߌࠆ‫⊛⑳ߚ߹ޕ‬ක≮ᯏ㑐ߪหᴺ╙ 54 ᧦ߦࠃࠅක≮ߢᓧߚ೾૛㊄ߩಽ㈩߇⑌ᱛߐࠇߡ޿ࠆ‫ߒ߆ߒޕ‬㧘ߎߩ㕖༡೑ᕈ೙⚂ߪ⃻ⴕߩ␠࿅ක≮ᴺੱ೙ᐲߩ߽ߣߢ಴⾗⠪ߦ೾૛㊄ߩᱷ૛⺧᳞ᮭࠍᔅߕߒ
߽ឃ㒰ߔࠆ߽ߩߢߪߥ޿‫ߪߡ޿ߟߦ⚦⹦ߩߘޕ‬⍮㊁㧔2004㧕ࠍ㧘߹ߚ㕖༡೑⚵❱ߢ޽ࠆක≮ᯏ㑐ߩ⋡⊛ߣⴕേߦߟ޿ߡߪ⍮㊁㧔1988㧕ࠍෳᾖ‫ޕ‬20) ⑳⊛ක≮ᯏ㑐ߩࠪࠚࠕߦߟ޿ߡߪ㧘ක≮ᴺੱߣ୘ੱߩ∛㒮߇ᣉ⸳ᢙߢ 71㧑㧘∛ᐥᢙߢ 55㧑ࠍභ߼ࠆ‫≮⸻ޕ‬ᚲߦߟ޿ߡߪᄢඨ߇⑳⊛ක≮ᯏ㑐ߢ޽ࠆ‫ޕ‬21) ⍮㊁㧔1995㧕
㧔2003㧕ࠍෳᾖ‫ޕ‬22) ⍮㊁㧔2003a㧕㧔2005㧕
㧘⍮㊁࡮᧖㊁㧔2004㧕ࠍෳᾖ‫ޕ‬23) ߚߣ߃߫ක≮⚻ᷣ⎇ⓥᯏ᭴㧔2001㧕ࠍෳᾖ‫ޕ‬᡽ᐭߪ 2005 ᐕ 12 ᦬㧘੺⼔ဳ≮㙃∛ᐥࠍ 2012 ᐕᐲߦోᑄߔࠆᣇ㊎ߣหᤨߦ㧘ක≮ဳ≮㙃∛ᐥߦߟ޿ߡ߽⸻≮ႎ㈽਄ߢ౉㒮ᖚ⠪ߩක≮ᔅⷐᐲߦᔕߓߚႎ㈽⸳ቯࠍ᳿߼ߡ޿ࠆ‫ޕ‬24) ක≮ࠍ฽߼ߡ‫ߣ↥↢ߪߢޠࠬࡆ࡯ࠨޟ‬ᶖ⾌ߩหᤨᕈ߇ሽ࿷ߒ㧘ߘߩᶖ⾌ߪᶖ⾌⠪ߣ↢↥⠪߇ᤨ㑆ߣ႐ᚲߣ޿߁ᰴరߢ৻⥌ߒߡߪߓ߼ߡⴕࠊ
ࠇࠆ‫ߩࠬࡆ࡯ࠨߥ߁ࠃߩߎޕ‬೙⚂ߪᖱႎㅢାᛛⴚ(IT)ߩ⊒ዷߦࠃߞߡシᷫߐࠇࠆ߇㧘ᰴ▵ߢߪߎߩ IT ൻߩଢ⋉ࠍታ⃻ߐߖࠆߚ߼ߦߪߤߩࠃ߁
ߥ೙ᐲ⊛઀⚵ߺ߇ක≮ಽ㊁ߢⴕࠊࠇࠆߎߣ߇ᰳ߆ߖߥ޿߆ࠍี๧ߒߡ޿ࠆ‫ޕ‬
18)㧙㧙

⾗Ḯ㈩ಽᯏ⢻ߣߒߡߩ೙ᐲ࡮ⷙ೙

ߡߩᓎഀࠍᨐߚߒߡ޿ࠆߎߣ߇␜ໂߐࠇࠆ‫ᧄޕ‬Ⓜߩ⸻≮ႎ㈽ⷙ೙ߣߩ㑐ଥߦߟ޿ߡ⸒߃߫㧘⃻ⴕߩ⸻≮ႎ㈽૕♽߇㐿ᬺකࠍ฽߼ߚ᳃㑆∛㒮ߦ᦭೑ߦ㧘ઁᣇ㧘ⷙᮨߩᲧセ⊛ߦᄢ߈ߥ౏⊛∛㒮ߦਇ೑ߦߥࠆߣ޿߁․ᓽ߇ᡰᜬߐࠇࠆߛࠈ߁ 25)‫ߪࠇߘޕ‬ᣣᧄකᏧળߩਛᩭߣߥࠆળຬ߇㐿ᬺක߿᳃㑆∛㒮ߣ޿߁ਛዊⷙᮨߩක≮ᯏ㑐ߦዻߔࠆකᏧߢ޽ࠆߎߣ㧘ߘߒߡ⸻≮ႎ㈽߇ߘࠇࠄߩකᬺ෼౉㧔߅ࠃ߮ᚲᓧ㧕ߦኒធߦ㑐ଥߒߡ޿ࠆ
ߎߣ߇⢛᥊ߦ޽ࠆ 26)‫ߡߞ߇ߚߒޕ‬㧘⃻ⴕߩ⸻≮ႎ㈽૕♽߇ߘߩⷙ೙ㆊ⒟ࠍㅢߓߡ᡽ᴦ⊛ߥࡃࠗࠕࠬࠍ෻ᤋ
ߔࠆ․ᓽࠍ᦭ߒߡ޿ࠆ‫ޕ‬ ╙ੑߦ㧘⃻ⴕߩ⸻≮ႎ㈽ὐᢙ⸳ቯߦߟ޿ߡߪᰴߩࠃ߁ߥขᒁ⾌↪ߩ੺࿷߇໧㗴ࠍឭ⿠ߔࠆ‫ޕ‬ታ㓙ߩ⸻≮
ႎ㈽⸳ቯߩ⸻≮ⴕὑߪోߡߩ଻㒾ක≮ᯏ㑐ߦㆡ↪น⢻ߣ޿߁ὐ߆ࠄ㧘ขᒁ਄ߦ߅޿ߡขࠅᛒ޿ኈᤃߥᜰᮡ
ߣߥࠆ௑ะࠍ߽ߟ 27)‫ࠅ߹ߟޕ‬㧘ක≮ࠨ࡯ࡆࠬ↢↥ߦነਈߔࠆ᭽‫ߥޘ‬ක≮ⴕὑߦߪߘߩᕈ⾰਄㧘᷹ቯ߅ࠃ߮
⋙ⷞ⾌↪ߦᄢ߈ߥ⋧㆑߇ሽ࿷ߔࠆߎߣ߆ࠄ㧘ߘߩߥ߆ߢ߽ታ㓙਄ߦ߅޿ߡኈᤃߦ᷹ቯน⢻ߢ㧘߆ߟ⋙ⷞน⢻ߥኻ⽎߇ណ↪ߐࠇࠆ‫ߥ߁ࠃߩߎޕ‬ขᒁ⾌↪ࠍ⠨ᘦߒߚߣ߈㧘⮎೷߿⸻ᢿⵝ⟎ߦ㑐ࠊࠆࡕࡁߦᲧߴߡකᏧ
߿⋴⼔Ꮷߥߤߩࠨ࡯ࡆࠬߢߪࠃࠅන⚐ߥᜰᮡ߇ណ↪ߐࠇࠆ௑ะࠍ␜ߔ‫⚿ߩߘޕ‬ᨐ㧘ឭଏߐࠇߚࠨ࡯ࡆࠬߩ
ຠ⾰╬ߩౝኈ߇೙ᐲߣߒߡㆡᱜߦ⚻ᷣ⊛⹏ଔߐࠇ㔍޿ߎߣߦߥࠆ 28)‫≮⸻ߩߘߦࠄߐޕ‬ႎ㈽ኻ⽎ߩᢙߪ⃻࿷㧘⸻≮ⴕὑߢ૗ජ⒳㘃㧘⮎೷ߦߟ޿ߡߪ 1 ਁ⒳㘃એ਄ߩຠ⋡ߦߥࠆ‫≮⸻ߥ߁ࠃߩߎޕ‬ႎ㈽ኻ⽎ߩ⸳ቯߣߘߩ
ᢙࠍ⠨߃ࠆߣ㧘⚿ᨐߣߒߡ㧘⃻ⴕߩ⸻≮ႎ㈽૕♽߇৻ቯߩ∔ᖚߦኻߒߡߘߩᦨㆡߥ⸻ᢿ࡮ᴦ≮ࠨ࡯ࡆࠬߩ
⚻ᷣ⊛⹏ଔઃߌߦኻᔕߔࠆߣߪ㒢ࠄߥ޿ߛࠈ߁‫ޕ‬ ᦨᓟߦ㧘
⃻ⴕߩ⸻≮ႎ㈽೙ᐲߪ⸻≮ႎ㈽ὐᢙ⴫ࠍㅢߓߡ଻㒾ㆡ↪ߣߥࠆක≮ߩ▸࿐ࠍⷙቯߔࠆߎߣ߆ࠄ㧘ක≮ᯏ㑐ߩㆬᛯⴕേ߇ᄢ߈ߥ೙⚂ࠍฃߌࠆ‫ߪࠇߎޕ‬ᰴ▵ߢᬌ⸛ߔࠆࠃ߁ߦක≮ಽ㊁ߩᛛⴚ⊛ㅴዷ߇⪺ߒ޿
੹ᣣߩⅣႺ᧦ઙߩ߽ߣߢ㧘ᰴߩࠃ߁ߥਛ࡮㐳ᦼ⊛ߥല₸ᕈࠍ៊ߥ߁ߣ޿߁໧㗴ࠍឭ⿠ߔࠆ‫≮⸻ߩⴕ⃻ޕ‬ႎ㈽⴫ߪ଻㒾ㆡ↪ߐࠇࠆ୘‫ⴕ≮⸻ߩޘ‬ὑߦߟ޿ߡߘߩଔᩰ㧔ὐᢙ㧕ࠍ␜ߒߚ߽ߩߢ㧘ߎߩ⴫߇ၮḰߣߥߞߡ଻㒾⸻≮ߩᡰᛄ޿߇ක≮ᯏ㑐ߦⴕࠊࠇࠆ‫ߡߞ߇ߚߒޕ‬㧘ක≮ᯏ㑐ߪ଻㒾⸻≮ߩᡰᛄ޿ࠍฃߌࠆߦߪ⸻≮ႎ㈽⴫ߩ▸࿐ߢක≮ឭଏࠍⴕ߁ߎߣ߇᧦ઙߣߥࠆ‫଻ߦ߁ࠃߩߎޕ‬㒾ㆡ↪ߩ⸻≮ⴕὑ߇෩ኒߦ೙㒢ࠍฃߌࠆ‫ޕ‬ߘߒߡ଻㒾⸻≮ߣ଻㒾ᄖ⸻≮ߩ૬↪߇ⴕࠊࠇߚߣ߈ߪේೣߣߒߡ㧘଻㒾⛎ઃಽ߽฽߼ߡో㗵߇ᖚ⠪ߩ⥄Ꮖ⽶ᜂߣߥࠆ઀⚵ߺߢ޽ࠆ‫ࠅ߹ߟޕ‬㧘ᷙว⸻≮ߩ⑌ᱛ߇ណ↪ߐࠇࠆ 29)‫ⷙߩߎޕ‬೙ᣇᴺߪක≮ᯏ㑐ߦኻߒߡᛩ
౉‛ㆬᛯߣ↢↥ᣇᴺࠍ෩ኒߦ㒢ቯߔࠆ⚿ᨐߣߥࠅ 30)㧘੹ᣣߩක≮ࠍขࠅᏎߊⅣႺ᧦ઙߩᄌൻ߳ߩኻᔕࠍଦ
ߔ⺃࿃߇೙ᐲ⊛ߦᏗ⭯ߣߥࠆ‫ߪࠇߎޕ‬ක≮ಽ㊁ߦ߅޿ߡᖱႎㅢାᛛⴚ㧔IT㧕ߩᕲᕺࠍౝㇱൻߔࠆὐߦ߅޿
ߡ㓚ኂߣߥࠅ㧘ਛ࡮㐳ᦼ⊛ߥⷰὐ߆ࠄᒰ⹥ಽ㊁ߩല₸ᕈ߇៊ߥࠊࠇࠆߎߣߦߥࠆ‫ߩߎޕ‬ᣂߚߥᛛⴚዉ౉ߦ
㑐ߔࠆ໧㗴ߪᰴ▵ߢ㧘⃻ⴕߩ․ቯ≮㙃⾌೙ᐲ߿ߘߩᦨㄭߩᡷ㕟ࠍ〯߹߃ߡ⹦⚦ߦᬌ⸛ߔࠆ‫ޕ‬╙㧟▵ ⅣႺ᧦ઙߩᄌൻߣ೙ᐲ࡮ⷙ೙
೨▵ߢ⸻≮ႎ㈽೙ᐲߩ⾗Ḯ㈩ಽ਄ߩᓎഀߦߟ޿ߡ⸅ࠇߚ߇㧘ߘࠇࠍ⵬ቢߔࠆ೙ᐲ⊛઀⚵ߺ߇ሽ࿷ߔࠆ‫ޕ‬25)

㡍↰㧔1995㧕ߩઁߦ㧘ߚߣ߃߫ᣣᧄߩ⸻≮ႎ㈽᡽╷ߦߟ޿ߡ⠨ኤߒߚ㜞ᧁ㧔2005㧕ࠍෳᾖ‫ޕ‬කᏧળߩᓇ㗀ߪਛකදߩ᭴ᚑߦ߽෻ᤋߐࠇ㧘ਛකදߩ⸻≮஥ᆔຬ 5 ฬ߇ᣣᧄකᏧળߩផ⮈ߣ޿߁ᣇᴺ߇ߣࠄࠇߡ޿ࠆ‫ߛߚޕ‬ᐔᚑ 11 ᐕࠃࠅ㧘ߘߩ㧝ฬߦోᣣᧄ∛㒮දળߩ㑐ଥ⠪߇ផ⮈ߐࠇࠆߎߣߦߥߞߚ㧔ෘ↢ഭ௛⋭㧔2005a㧕㧕‫ߥ߁ࠃߩߎޕ‬ᓇ㗀ߩ⚿ᨐߣߒߡ㧘ᄢ߈ߥ∛㒮ߩ⚻༡⁁ᴫࠍ෻ᤋߔࠆࠃ߁ߥ⸻≮ႎ㈽ߩ᳿ቯ߇㔍ߒߊ㧘ⷙᮨߩᄢ߈ߥ∛㒮ߩ⚻༡߇෩ߒߊߥࠆߛࠈ߁‫ޕ‬කᏧળߩᓇ㗀ജࠍ฽߼ߡᣣᧄߩක≮᡽╷ࠍ㡍↰
㧔2001㧕ߪ౏౒⚻ᷣቇ⊛஥㕙߆ࠄ⠨ኤߒߡ޿ࠆ‫ޕ‬27) ⹦⚦ߪ⍮㊁㧔2003b㧕ࠍෳᾖ‫ޕ‬28) ߎࠇߪᖱႎ⾌↪ߦ㑐ㅪߒߡ߅ࠅ㧘ᦨㄭߦ߅ߌࠆක≮ᖱႎߩ೙ᐲ⊛೙⚂ߩ✭๺߿ᖱႎ⾌↪ߩૐਅࠍଦߔ IT ൻߥߤߦࠃߞߡᓇ㗀ߐࠇࠆ‫ޕ‬29) ߚߛߒ㧘ᓟㅀߔࠆࠃ߁ߥ․ቯ≮㙃⾌೙ᐲ߇ሽ࿷ߒ㧘৻ቯߩ଻㒾ᄖ⸻≮ߦߟ޿ߡߪ૬↪߇น⢻ߣߥࠆ‫ ߦࠄߐޕ‬2005 ᐕߢߪߘߩ․ቯ≮㙃⾌೙ᐲߩᡷ㕟߇ታᣉߐࠇ㧘૬↪ߩน⢻ᕈ߇᜛ᄢߒߡ޿ࠆ‫ޕ‬30) ৻⥸ߦ㧘⵾ຠߩ቟ోᕈߩߚ߼ߦⷙᩰࠍⷙ೙ߔࠆᚻᲑߣߒߡߪ‫ޟ‬ᕈ⢻ၮḰ‫઀ޟߣޠ‬᭽ၮḰ‫ⷙࠆࠃߦޠ‬೙ᣇᴺ߇޽ࠆ߇㧘⸻≮ႎ㈽ⷙ೙ߪ޽ߚ߆
߽‫઀ޟ‬᭽ၮḰ‫ⷙޠ‬೙ߦ⹥ᒰߔࠆ߽ߩߣߥࠆߛࠈ߁‫ޕ‬
26)

㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕

ߘࠇ߇․ቯ≮㙃⾌೙ᐲߢ㧘ᣂߚߥᛛⴚ߿ᖚ⠪࠾࡯࠭ߦኻᔕߔࠆᯏ⢻ࠍ᦭ߒߡ޿ࠆ߇㧘ㄭᐕߩ⪺ߒ޿ⅣႺ᧦
ઙߩᄌൻߩ߽ߣߢߘߩᯏ⢻߇චಽߦߪ௛߆ߥ޿ߣ޿߁໧㗴߇ᜰ៰ߐࠇࠆ‫ⷙߪࠇߘޕ‬೙ᡷ㕟࡮᳃㑆㐿᡼ផㅴળ⼏ߣෘ↢ഭ௛⋭ߩ㑆ߦ߅ߌࠆ‫ޟ‬ᷙว⸻≮‫ޠ‬໧㗴ߩ⼏⺰ߦ߽෻ᤋߐࠇߡ޿ࠆ߇㧘⃻ⴕߩ․ቯ≮㙃⾌೙ᐲߩ߽ߣߢᣂߚߥක≮ᛛⴚ߿ක⮎ຠ߇ㆡᱜߦ೑↪ߢ߈㧘߹ߚᖚ⠪ߩᣂߚߥ࠾࡯࠭߇ㆡಾߦḩߚߐࠇࠆ߆ߣ޿߁
ὐߢ޽ࠆ‫․ߪߢ▵ᧄޕ‬ቯ≮㙃⾌೙ᐲࠍ฽߼ߚ⃻ⴕߩ⸻≮ႎ㈽೙ᐲߩ߽ߣߢ㧘ᣂߚߥᛛⴚ╬߇ක≮ಽ㊁ߦዉ
౉ߐࠇࠆࡔࠞ࠾࠭ࡓߩ໧㗴ὐࠍ⠨ኤߔࠆ‫ߦߊߣߪࠇߘޕ‬ක≮ಽ㊁ߩᛛⴚ㧔ߚߣ߃߫ᣂߚߥᴦ≮ᣇᴺ㧘ක≮ᯏེ޽ࠆ޿ߪක⮎ຠߥߤ㧕ࠃࠅ߻ߒࠈ㧘ක≮ࠨ࡯ࡆࠬߩ↢↥߿ឭଏᣇᴺߥߤߩᐢ޿▸࿐ߦᓇ㗀ࠍ෸߷ߔᖱ
ႎㅢାᛛⴚ㧔IT㧕ൻߩዉ౉ߦଥࠊࠆߎߣߢ޽ࠆ‫ޕ‬

3.1. ․ቯ≮㙃⾌೙ᐲߣᷙว⸻≮໧㗴 ৻⥸ߦ㧘ㅢᏱߩ⽷߿ࠨ࡯ࡆࠬಽ㊁ߩ႐ว㧘⾗Ḯ㈩ಽᯏ⢻ߪᏒ႐ࠍㅢߓߚଔᩰࡔࠞ࠾࠭ࡓߦࠃߞߡߥߐࠇ
ࠆ‫ޕ‬ᣂߚߥᛛⴚߩዉ౉ߦߟ޿ߡ߽㧘ᒰ⹥ᛛⴚ߇⾌↪߅ࠃ߮ຠ⾰ࠍ⠨ᘦߒߚᏒ႐ߩ࠴ࠚ࠶ࠢࠍㅢߓߡዉ౉ߩ
นุ߇್ቯߐࠇࠆ‫ߩߘޕ‬ᗧ๧ߢ‫ޟ‬Ꮢ႐‫ߪޠ‬ᣂߚߥᛛⴚዉ౉ࠍ߽฽߼ߚ⾗Ḯ㈩ಽߩᯏ⢻ࠍ⥄േ⊛ߦⴕ߁઀⚵ߺߢ޽ࠆ‫ߒ߆ߒޕ‬㧘ක≮ಽ㊁ߩ႐วߦߪᣢߦ⺑᣿ߒߚࠃ߁ߦ㧘⾗Ḯ㈩ಽᯏ⢻ߪ‫ޟ‬Ꮢ႐‫ߊߥߪߢޠ‬㧘೙ᐲ࡮ⷙ೙ࠍㅢߓߡⴕࠊࠇࠆ‫ߡߞ߇ߚߒޕ‬㧘ߘࠇࠄ೙ᐲ࡮ⷙ೙ߐࠄߦߪ᡽ᐭ੺౉ߩ࿷ࠅᣇ߇ᣂߚߥⅣႺ᧦ઙߩᄌ
ൻߦኻߔࠆ⾗Ḯ㈩ಽᯏ⢻ߩᚑᨐࠍᏀฝߔࠆ‫ޕ‬એਅߢߪ⸻≮ႎ㈽೙ᐲߩᯏ⢻ࠍ⏕⹺ߒߡ㧘ߘࠇࠍ⵬ቢߔࠆ⃻ⴕߩ․ቯ≮㙃⾌೙ᐲߩ․ᓽߣ໧㗴ࠍᬌ⸛ߒࠃ߁‫ޕ‬ ⸻≮ႎ㈽ߪ೨▵ߢ᣿ࠄ߆ߦߒߚࠃ߁ߦ㧘⾗Ḯ㈩ಽᯏ⢻ߩᓎഀߣߒߡ㊀ⷐߥ߽ߩߢ޽ߞߚ‫≮⸻ߩⴕ⃻ޕ‬ႎ㈽೙ᐲߩ߽ߣߢ଻㒾ㆡ↪ߣߥࠆ⸻≮ߩ▸࿐߇ᜰቯߐࠇ㧘ක≮ᯏ㑐ߪߎߩ▸࿐ߦ߅޿ߡ଻㒾⛎ઃኻ⽎ߣߥࠆක≮ࠨ࡯ࡆࠬߩឭଏࠍⴕ߁ 31)‫଻ߒ߽ޕ‬㒾⸻≮ߣ଻㒾ᄖ⸻≮ߩ૬↪߇ⴕࠊࠇߚߣ߈ߪේೣߣߒߡ㧘଻㒾⛎ઃಽ߽฽߼ߡో㗵߇ᖚ⠪ߩ⥄Ꮖ⽶ᜂߣߥࠆ઀⚵ߺߢ޽ߞߚ‫ࠅ߹ߟޕ‬㧘ᷙว⸻≮ߩ⑌ᱛ߇ⴕࠊࠇߡ޿ࠆ‫଻ޕ‬㒾⸻≮ߩ▸࿐ࠍ⏕ቯߔࠆߩ߇ෘ↢ഭ௛⋭ߩਛᄩ␠ળක≮ද⼏ળ㧔ਛකද㧕ߢ޽ࠆ‫ޕ‬ਛකදߪ㓒ᐕᲤߦ⸻≮ႎ㈽ᡷቯࠍⴕ߁߇㧘ߘࠇߪหᤨߦ଻㒾⸻≮ߩ▸࿐ߣ⷗⋥ߒࠍ߽฽߻᳿ቯࠍߔࠆ‫ޕ‬ᣂߚߥක≮ᛛⴚ߿ක⮎ຠߪߎߩਛකදߩክ⼏࡮᳿ቯࠍ⚻ߚᓟ㧘଻㒾⸻≮ߩኻ⽎ߣߒߡ⸻≮ႎ㈽ὐᢙ⴫߿⮎ଔၮḰ⴫ߦ෼タߐࠇࠆߎߣ
ߦߥࠆ‫ޕ‬ ଻㒾⸻≮ߩ઀⚵ߺߦߪ㧘੹ᣣߩⅣႺ᧦ઙߩ⪺ߒ޿ᄌൻߩ߽ߣߢߘߩᄌൻߦኻᔕߒߚක≮ࠨ࡯ࡆࠬߩឭଏ
߇㔍ߒߊߥࠆ⁁ᴫ߇޽ࠆ‫ޕ‬ᣂߚߥක≮ᛛⴚ߿ක⮎ຠ㐿⊒ߩㅴዷ߿ᖚ⠪ߩᣂߚߥ࠾࡯࠭ߩᄌൻߥߤ㧘੹ᣣߩ
ⅣႺ᧦ઙߩᕆỗߥᄌൻߩ߽ߣߢߪ㧘ߘࠇࠄ߳ߩኻᔕ߇೙ᐲ⊛ߦㆃࠇࠍ઻߁ߎߣߦߥࠆ‫ߩߎޕ‬ኻᔕᣇ╷ߣߒߡߪ⃻࿷㧘଻㒾⸻≮ߣ଻㒾ᄖ⸻≮ߩ૬↪߇৻ቯߩၮḰߢ⹺߼ࠄࠇࠆ․ቯ≮㙃⾌೙ᐲ߇޽ࠆ‫ߩߘޕ‬૬↪߇น⢻ߣߥࠆ଻㒾ᄖ⸻≮ߩౝኈߦߟ޿ߡߪ㧘㜞ᐲవㅴක≮ߣㆬቯක≮ࠍኻ⽎ߣߒߡਛකද߇⹺߼ߚ߽ߩߣߥࠆ
઀⚵ߺߢ޽ࠆ‫․ޕ‬ቯ≮㙃⾌೙ᐲߪᣂߚߥක≮ᛛⴚ߿ᖚ⠪ߩ༵ᅢ㧔೑ଢᕈ߿ࠕࡔ࠾࠹ࠖߥߤ㧕ߩᄌൻߥߤ㧘ක≮ಽ㊁ࠍขࠅᏎߊⅣႺᄌൻߦኻߒߡ⺞ᢛࠍⴕ߁ᯏ⢻ࠍ߽ߞߡ޿ࠆ‫ޕ‬೨⠪ߩ㜞ᐲవㅴක≮ߢߪ㧘ߚߣ߃߫
1992 ᐕߦᜰቯߐࠇ 98 ᐕߦ଻㒾ㆡ↪ߣߥߞߚ↢૕⢄⒖ᬀ㧘޽ࠆ޿ߪ఺∉≮ᴺߩ৻⒳ߢ 97 ᐕߦᜰቯߐࠇߚ
߇଻㒾ㆡ↪ߣߥߞߡ޿ߥ޿ᵴᕈൻ⥄Ꮖ࡝ࡦࡄ⃿⒖౉≮ᴺߥߤ߇޽ࠅ㧘߹ߚᓟ⠪ߩㆬቯක≮ߩߥ߆ߦߪ㧘ߚߣ߃߫Ꮕ㗵ࡌ࠶࠼㧘ᴦ㛎⮎㧘㐳ᦼ౉㒮ක≮ߥߤ߇ߘߩኻ⽎ߣߒߡ฽߹ࠇࠆ‫ޕ‬ ․ቯ≮㙃⾌೙ᐲߦߟ޿ߡߪ㧘ⷙ೙ᡷ㕟࡮᳃㑆㐿᡼ផㅴળ⼏ߣෘ↢ഭ௛⋭ߩ㑆ߦ߅ߌࠆ‫ޟ‬ᷙว⸻≮‫ޠ‬໧㗴ߩ⼏⺰ߢ߽ᜰ៰ߐࠇߚ߇㧘ᒰ⹥೙ᐲߩ߽ߣߢᣂߚߥක≮ᛛⴚߩዉ౉߿ᣂߚߥᖚ⠪࠾࡯࠭ߩల⿷߇ㆡಾߦⴕ

31)

ᧄⓂߢߪ଻㒾ක≮ᯏ㑐ࠍኻ⽎ߣߒߡ޿ࠆ‫ޕ‬㧙㧙

⾗Ḯ㈩ಽᯏ⢻ߣߒߡߩ೙ᐲ࡮ⷙ೙

ࠊࠇࠆߩ߆ߣ޿߁໧㗴߇޽ࠆ‫․ߩⴕ⃻ߪࠇߘޕ‬ቯ≮㙃⾌೙ᐲߩ߽ߣߢߪ߈ࠊ߼ߡ㒢ቯߐࠇߚක≮ࠨ࡯ࡆࠬ߇ߘߩኻ⽎ߣߥߞߡ޿ࠆߦㆊ߉ߥ޿߆ࠄߢ޽ࠆ‫ߚ߹ޕ‬㧘ㆇ༡਄ߩ໧㗴ߦଥࠊࠆ߽ߩߣߒߡਛකදߩ᭴ᚑ߿
ᯏ⢻࡮ᓎഀࠍ฽߼ߚ࿷ࠅᣇߦߟ޿ߡਇㅘ᣿ߐ߿ਇ᣿⏕ߐ߇ሽ࿷ߒߡ޿ࠆ߆ࠄߢ޽ࠆ 32)‫ߩߘޕ‬ᗧ๧ߢߪᷙว
⸻≮⑌ᱛߩ߽ߣߢ㧘⃻ⴕߩ․ቯ≮㙃⾌೙ᐲ߇චಽߦ⾗Ḯ㈩ಽᯏ⢻ࠍᨐߚߒߡ޿ࠆߩ߆ߣ޿߁໧㗴߇ᱷࠆ 33)‫ޕ‬⚿ዪ㧘ෘ↢ഭ௛⋭ߪᖚ⠪࠾࡯࠭ߩᄙ᭽ൻ߿ක≮ᛛⴚߩ㜞ᐲൻࠍ〯߹߃ߡ㧘ᖚ⠪ߩㆬᛯߦࠃࠆࠨ࡯ࡆࠬߩ᜛
ల߇᳞߼ࠄࠇߡ޿ࠆߎߣࠍ㊀ⷞߒ㧘⃻ⴕߩ․ቯ≮㙃⾌೙ᐲࠍᑄᱛߒߡᣂߚߥᨒ⚵ߺࠍឭ␜ߒߡ޿ࠆ 34)‫ޕ‬

3.2. ක≮ಽ㊁ߩ IT ൻߣක≮᡽╷ ․ቯ≮㙃⾌೙ᐲߦଥࠊࠆᷙว⸻≮໧㗴ߪ⾗Ḯ㈩ಽ਄ߩⷰὐߩߺߥࠄߕ㧘౏⊛଻㒾ක≮೙ᐲߩၮᧄߦ㑐ࠊࠆᚲᓧಽ㈩਄ߩⷰὐ߆ࠄ߽ᬌ⸛ߔࠆߎߣ߇ᰳ߆ߖߥ޿ߛࠈ߁‫ᧄߒ߆ߒޕ‬Ⓜߢߪ߅߽ߦ೨⠪ߩ⾗Ḯ㈩ಽ਄ߩ
ⷰὐ߆ࠄ㧘․ቯ≮㙃⾌೙ᐲߦઍࠊࠆᣂߚߥ೙ᐲߦߟ޿ߡ⸅ࠇ㧘ߎࠇࠍ฽߼ߡ⃻ⴕߩ⸻≮ႎ㈽೙ᐲߦ߅ߌࠆ
⺞ᢛᯏ⢻ߩ໧㗴ࠍ⠨ኤߔࠆ‫ޕ‬ ᷙว⸻≮໧㗴ߦߟ޿ߡߪ 2004 ᐕ㧘ෘ↢ഭ௛⋭ߪߘߩၮᧄ⊛⠨߃ᣇߣߒߡ㧘଻㒾ᄖ⽶ᜂߩ࿷ࠅᣇࠍᩮᧄ
⊛ߦ⷗⋥ߒ㧘ᖚ⠪ߩಾታߥⷐᦸߦ⊛⏕ߦኻᔕߔࠆߣߒߡ㧘ᣧᕆߦኻಣߔߴ߈᡽╷ࠍឭ␜ߒߡ޿ࠆ 35)‫ߩߘޕ‬ឭ␜ߐࠇߚኻᔕ╷㧔࿖ౝᧂᛚ⹺⮎㧘ක≮ᛛⴚ߅ࠃ߮೙㒢࿁ᢙࠍ⿥߃ࠆක≮ⴕὑߦଥࠊࠆ᡽╷㧕ߩ޿ߊߟ߆
ߦߟ޿ߡߪߘߩᓟ㧘⃻ⴕߩ․ቯ≮㙃⾌೙ᐲߦ߅ߌࠆㆬቯක≮ߣߒߡ⹺߼ࠄࠇࠆߦ⥋ߞߡ޿ࠆ‫․ߒ߆ߒޕ‬ቯ≮㙃⾌೙ᐲߦߟ޿ߡߪߘࠇࠍᑄᱛߒ㧘એਅߩࠃ߁ߥ᩺߇ឭ␜ߐࠇߚ 36)‫ޕ‬ෘ↢ഭ௛⋭ߪ዁᧪⊛ߥ଻㒾ዉ౉ߩߚ߼ߩ⹏ଔࠍⴕ߁߽ߩߢ޽ࠆ߆ߤ߁߆ߣ޿߁ⷰὐ߆ࠄ⃻ⴕߩ․ቯ≮㙃⾌೙ᐲࠍᑄᱛߒ㧘ᔅߕߒ߽㜞ᐲߢߪߥ޿వㅴᛛⴚ߿㧘࿖ౝᧂᛚ⹺⮎㧘೙㒢࿁ᢙࠍ⿥߃ࠆක≮ⴕὑ߽฽߼ߡ㧘ᣂߚߥ઀⚵ߺߣߒߡ‫଻ޟ‬㒾ዉ౉ᬌ⸛ක≮㧔઒⒓㧕‫ޠ‬㧔଻㒾ዉ౉ߩߚ߼ߩ⹏ଔࠍⴕ߁߽ߩ㧕ߣ‫ޟ‬ᖚ⠪ㆬᛯหᗧක≮㧔઒⒓㧕‫ޠ‬㧔଻㒾ዉ౉ࠍ೨ឭߣ
ߒߥ޿߽ߩ㧕ߣߦౣ᭴ᚑߔࠆߎߣࠍឭ␜ߒߡ޿ࠆ‫ޕ‬ ߎߩᡷ㕟᩺ࠍㅢߓߡ㧘ᧄⓂߢ໧㗴ߣߔࠆⅣႺᄌൻߦኻߔࠆ⾗Ḯ㈩ಽߩ⺞ᢛߪᓥ᧪ࠃࠅ߽᣿⍎ߢㄦㅦߦⴕ
ࠊࠇࠆߛࠈ߁‫ߒ߆ߒޕ‬㧘ଏ⛎஥ߩ⾗Ḯ㈩ಽ⺞ᢛߪၮᧄ⊛ߦ⸻≮ႎ㈽೙ᐲࠍㅢߓߡⴕࠊࠇࠆ‫ࠅ߹ߟޕ‬೨▵ߢ᣿ࠄ߆ߦߒߚࠃ߁ߦ㧘⸻≮ႎ㈽೙ᐲߦ߅ߌࠆⷙ೙ߩ࿷ࠅᣇ߿ߘߩଔᩰ૕♽ߩ໧㗴߇ଐὼߣߒߡක≮ಽ㊁ߦ߅ߌࠆ⾗Ḯ㈩ಽᯏ⢻ߦ৻ቯߩ೙⚂ࠍ⺖ߒߡ޿ߚ‫ߦߊߣޕ‬ක≮ಽ㊁ߦ߅ߌࠆ෩ߒ޿ᛩ౉ⷙ೙ߪᣂߚߥක≮ᛛⴚ߿ක⮎ຠ╬ߩዉ౉ߦኻߒߡᛥ೙⊛ߦ૞↪ߔࠆ‫ޕ‬‫ޟ‬ਛකදߩ࿷ࠅᣇߦ㑐ߔࠆ᦭⼂⠪ળ⼏‫⺆↪ߚࠇߐ↪૶ߢޠ‬ࠍ୫ࠅߡ⴫⃻ߔࠇ߫ 37)㧘଻㒾ㆡ↪ߣߐࠇࠆ୘‫ⴕ≮⸻ߩޘ‬ὑߩ౏⊛ଔᩰࠍቯ߼ࠆ‫ޟ‬ଔᩰ⴫‫ߣޠ‬㧘଻㒾ㆡ↪ߣߔࠆ⸻≮ⴕὑߩ▸࿐ࠍቯ߼ࠆ‫ޟ‬ຠ⋡⴫‫ߦޠ‬ଥࠊࠆ․ᓽ߇⾗Ḯ㈩ಽࠍⷙቯߒߡ޿ࠆ‫ߡߞ߇ߚߒޕ‬㧘ᣂߚߥᛛⴚߩዉ౉ߣߘߩ᥉෸ߪ‫ޟ‬ຠ⋡⴫‫ޟߣޠ‬ଔᩰ⴫‫ߦޠ‬ଐሽߔࠆ‫ߩߎޕ‬᳿ቯ߇ࠊ߇࿖ߢߪਛකදߣ޿߁ 1 ߟߩ೙ᐲ࡮ⷙ೙㧔ߟ߹ࠅ㕖Ꮢ႐⊛⾗Ḯ㈩ಽᣇᴺ㧕ࠍㅢߓߡⴕࠊࠇࠆ‫ޕ‬ਛකද߇ᜂ߁ᯏ⢻߇ㆡᱜߦ௛߆ߥ޿႐ว㧘ක≮ಽ㊁ߦ߅ߌࠆ⾗Ḯ㈩ಽߩല₸ᕈ߇៊ߥࠊࠇࠆߎߣߦߥࠆ‫ޕ‬32) ෘ↢ഭ௛⋭㧔2005a㧕ߢߪ㧘⸻≮ႎ㈽ᡷቯߦଥࠊࠆၮᧄ⊛ߥක≮᡽╷ߩክ⼏ߪઁߩ⻁໧ᯏ㑐ߢⴕ޿㧘ਛකදߢክ⼏ߔࠆߴ߈੐㗄ߦߟ޿ߡߪ
୘‫ⴕ≮⸻ߩޘ‬ὑߦߟ޿ߡߩ଻㒾ㆡ↪ߩนุ߿㧘ౕ૕⊛ߥ⸻≮ႎ㈽ὐᢙߩ⸳ቯߥߤࠍਛᔃߦߔߴ߈ߎߣ߇ឭ⸒ߐࠇߡ޿ࠆ‫ߥ߁ࠃߩߎޕ‬ਛකදߩᡷ㕟ᬌ⸛ߩ⢛᥊ߦߪ㧘⸻≮ႎ㈽ᡷቯ߇ᤨߣߒߡ᡽ᴦ⊛⸃᳿ߦᆔߨࠄࠇࠆߎߣ㧘ᦨㄭߢߪ⸻≮ႎ㈽ᡷቯࠍᎼࠆ⿅෼⾔੐ઙ߇⊒↢ߒߡ޿ࠆߎߣߥ
ߤ߽޽ࠆߛࠈ߁‫ޕ‬ᐔᚑ 18 ᐕᐲ⸻≮ႎ㈽ᡷቯߢߪ㧘ౝ㑑߇ᡷቯ₸ࠍ᳿ቯߒ㧘␠ળ଻㓚ክ⼏ળߩක≮଻㒾ㇱળ࡮ක≮ㇱળ߇⸻≮ႎ㈽ᡷቯߩၮᧄᣇ
㊎ࠍቯ߼㧘ਛකදߪߎߩၮᧄᣇ㊎ߦၮߠ޿ߡౕ૕⊛ߥὐᢙࠍ⸳ቯߔࠆߎߣߦߥߞߚ‫ޕ‬33) ᷙว⸻≮໧㗴ߦ㑐ߔࠆ⚻ᷣℂ⺰⊛⎇ⓥߢߪᷙว⸻≮⑌ᱛ೙ᐲߩ⚻ᷣಽᨆࠍⴕߞߚᨋ࡮Ⴧ↰㧔2003㧕㧘߹ߚ⾗Ḯߩല₸ᕈߩߺߥࠄߕ౏ᐔᕈࠍ
᣿␜⊛ߦขࠅᛒߞߚ㥲⮮࡮㡍↰㧔2003㧕ࠍෳᾖ‫ޕ‬34) ෘ↢ഭ௛⋭㧔2005b㧕㧔2005c㧕ࠍෳᾖ‫ޕ‬35) ෘ↢ഭ௛⋭㧔2004㧕ࠍෳᾖ‫ޕ‬36) ෘ↢ഭ௛⋭㧔2004㧕
㧔2005b㧕㧔2005c㧕ࠍෳᾖ‫ޕ‬37) ෘ↢ഭ௛⋭㧔2005a㧕ࠍෳᾖ‫ޕ‬㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕

 ੹ᣣߩᖱႎㅢାᛛⴚ㧔IT㧕ߩㅴዷߪ␠ળߩ⚻ᷣ᭴ㅧߩᄌൻࠍଦߒߡ޿ࠆ߇㧘⾗Ḯ㈩ಽ߇㕖Ꮢ႐⊛ߥᣇᴺߢⴕࠊࠇߡ޿ࠆಽ㊁ߢߪ᡽╷ࠍㅢߓߡታᣉߔࠆᔅⷐ߇޽ࠆ‫ޕ‬ක≮߽ߘߩࠃ߁ߥಽ㊁ߩ 1 ߟߢ޽ࠆ 38)‫ޕ‬ක≮ಽ㊁ߩ IT ൻߪ࡟࠮ࡊ࠻ߩ㔚▚ಣℂൻ߿ࠞ࡞࠹ߩ㔚ሶൻߩߺߥࠄߕ㧘ᰴߩࠃ߁ߥක≮ࠨ࡯ࡆࠬߩឭଏߩ࿷
ࠅᣇࠍ߽฽߼ߚല₸ൻߩน⢻ᕈࠍឭଏߔࠆ‫ߪࠇߘޕ‬ක≮ࠨ࡯ࡆࠬߩᣂߚߥឭଏᣇᴺ߿ឭଏ⚵❱߿㧘ߘࠇߦଥࠊࠆක≮ᖱႎߩᣂߚߥឭଏ߿ᵴ↪ߥߤࠍน⢻ߣߒ㧘ߘߩㆡᔕ㗔ၞߪᐢ▸࿐ߦ෸ࠎߢ޿ࠆ 39)‫ߚ߹ޕ‬㧘ߎࠇߦࠃߞߡක≮᡽╷ߩᣇᴺ㧘ߐࠄߦߪ᡽ᐭߩᓎഀ߽ᄌൻߖߑࠆࠍᓧߥ޿‫ߥ߁ࠃߩߎޕ‬ක≮ಽ㊁ߩ IT ൻࠍ⠨ᘦߒߚߣ߈㧘ߘࠇࠄߩᛛⴚ㕟ᣂࠍዉ౉ߔࠆ⚻ᷣ⊛⺃࿃ࠪࠬ࠹ࡓ߇⃻ⴕ೙ᐲߩ߽ߣߢߪᏗ⭯ߣߥߞߡ޿ࠆ‫ޕ‬㕖Ꮢ႐⊛⺞ᢛࠍⴕߞߡ޿ࠆක≮ಽ㊁ߢߪ᡽╷⊛ߦ೙ᐲ࡮ⷙ೙ࠍㅢߓߡߘߩ⚻ᷣ⊛⺃࿃ࠍౝㇱൻߔࠆߎߣ߇
ᰳ߆ߖߥ޿߇㧘IT 㕟๮ߩᕆㅦߥㅴዷߩߚ߼ߦ㧘ߘࠇ߇⃻ⴕ೙ᐲߩ᦭ߔࠆ⚻ᷣ⊛฽ᗧࠍ〯߹߃ߡචಽߦߪᬌ
⸛ߐࠇߡ޿ߥ޿߆ࠄߢ޽ࠆ‫ޕ‬ ක≮ಽ㊁ߩ IT ൻߪᖚ⠪ߩฃߌขࠆක≮ࠨ࡯ࡆࠬߩຠ⾰ࠍะ਄ߐߖࠆ߁߃ߢ㧘߹ߚක≮ࠨ࡯ࡆࠬឭଏߩ
ല₸ൻߦߣߞߡ߽ᰳ߆ߖߥ޿ᣇ╷ߢ޽ࠆ‫ ߫߃ߣߚޕ‬Institute of Medicine㧔2001㧕ߢߪ㧘IT ൻࠍၮ␆ߣߒ
ߚක≮ឭଏࠪࠬ࠹ࡓߩ᭴▽߇ਛ࡮㐳ᦼ⊛ⷰὐ߆ࠄක≮ࠨ࡯ࡆࠬߩ⾰⊛ะ਄߅ࠃ߮ല₸ᕈࠍ଻⸽ߔࠆ߁߃ߢ
㊀ⷐߢ޽ࠆߣ޿߁⹺⼂ߩ߽ߣߢ㧘᡽ᐭߦࠃࠆ଻ஜක≮ᖱႎࠗࡦࡈ࡜ߩᢛ஻ࠍឭ⸒ߒߚ‫ߥ߁ࠃߩߘޕ‬ක≮ឭଏࠪࠬ࠹ࡓ߇୘‫ߩޘ‬ᖚ⠪ߦ⑳⊛ଢ⋉ࠍ߽ߚࠄߔߩߺߥࠄߕ㧘ߘߩឭଏߐࠇࠆක≮ߦߟ޿ߡੱ‫ߦޘ‬቟ో߿଻⸽ࠍਈ߃ࠆߣ޿߁౏౒⽷⊛ᕈ⾰ࠍ߽ߟ␠ળ⊛ଢ⋉ࠍ߽↢ߓߐߖࠆ߆ࠄߢ޽ࠆ‫ߡߞ߇ߚߒޕ‬㧘IT ߦଥࠊࠆᛛ
ⴚ㕟ᣂࠍක≮ಽ㊁ߦዉ౉ߔࠆࡔࠞ࠾࠭ࡓߩ᭴▽ߢߪ㧘ࠊ߇࿖ක≮ಽ㊁ߩ೙ᐲ࡮ⷙ೙ߩ߽ߟ⾗Ḯ㈩ಽ਄ߩᓎ
ഀࠍ〯߹߃ߚ⚻ᷣቇ⊛⼏⺰߇ᰳ߆ߖߥ޿‫ޕ‬38) ᣣᧄߢ߽ e-Japan ᚢ⇛ߢᣣᧄߩ e-Health ᡽╷߇ዷ㐿ߐࠇߡ޿ࠆ‫ޕ‬᡽ᐭߪ㔚ሶࠞ࡞࠹࡮࡟࠮ࡊ࠻㔚▚ൻߥߤߩක≮ߩ IT ൻࠍផㅴߒ㧘ߘߩ⋡ᮡߣ㆐ᚑᐕࠍ⸳ቯߒߥ߇ࠄᡰេᣇ╷ࠍ⻠ߓߡ޿ࠆ‫ޕ‬ෘ↢ഭ௛⋭㧔2001㧕ࠍෳᾖ‫ޕ‬39) ߚߣ߃߫ᖱႎឭଏߦߟ޿ߡߪ㔚ሶࠞ࡞࠹ࠪࠬ࠹ࡓ㧘࡟࠮ࡊ࠻㔚▚ಣℂࠪࠬ࠹ࡓ㧘⾰ߩะ਄ߦߟ޿ߡߪ‫ޟ‬ᩮ᜚ߦၮߠߊක≮‫ޠ‬
㧔EBM㧕
㧘㔚ሶࠞ
࡞࠹ࠪࠬ࠹ࡓ㧘㆙㓒⸻≮ᡰេ㧘ല₸ൻߦߟ޿ߡߪ㔚ሶࠞ࡞࠹ࠪࠬ࠹ࡓ㧘ࠝ࡯࠳࡝ࡦࠣࠪࠬ࠹ࡓ㧘࡟࠮ࡊ࠻㔚▚ಣℂࠪࠬ࠹ࡓ㧘‛ᵹ▤ℂࠪࠬ࠹ࡓ㧘ߘߒߡ቟ోኻ╷ߦߟ޿ߡߪࠝ࡯࠳࡝ࡦࠣࠪࠬ࠹ࡓ߇ IT ࠍᵴ↪ߒߚᚻᲑߣߒߡᜰ៰ߐࠇߡ޿ࠆ㧔ෘ↢ഭ௛⋭㧔2001㧕߅ࠃ߮଻ஜක≮ᖱႎࠪࠬ࠹ࡓᬌ⸛ળߩ⼏⺰ࠍෳᾖ㧕‫ ߥ߁ࠃߩߎޕ‬IT ࠍᵴ↪ߔࠆ⁁ᴫߩ߽ߣߢߪ㧘ක≮ឭଏߩᣇᴺ߿⚵❱߽ᄌൻߖߑࠆࠍᓧߕ㧘ߒߚ߇ߞߡߘߩක≮೙ᐲߩ࿷ࠅᣇ߇໧ࠊࠇߡ޿ࠆ‫ᧄޕ‬Ⓜߢߪ߅߽ߦ⸻≮ႎ㈽೙ᐲߩ࿷ࠅᣇߦὶὐࠍ⛉ߞߡᬌ⸛ߒߡ޿ࠆ‫ޕ‬㧙㧙ෳ⠨ᢥ₂ක≮⚻ᷣ⎇ⓥᯏ᭴ 2001 ‫≮ޟ‬㙃ဳ∛ᐥ⟲ߦ߅ߌࠆᖚ⠪ߩታᘒ╬ߦ㑐ߔࠆ⺞ᩏ‫ޠ‬㧔ႎ๔ᦠ㧕ᐔᚑ 13 ᐕ 3 ᦬.
ෘ↢ഭ௛⋭ 2001 ‫଻ޟ‬ஜක≮ᖱႎಽ㊁ߩᖱႎൻߦ߻ߌߡߩࠣ࡜ࡦ࠼࠺ࠩࠗࡦ‫ޠ‬㧔଻ஜක≮ᖱႎࠪࠬ࠹ࡓᬌ
⸛ળ㧕ෘ↢ഭ௛⋭ 2004 ‫ޟࠆࠁࠊ޿ޟ‬ᷙว⸻≮‫ޠ‬໧㗴ߦߟ޿ߡ‫ޠ‬ᐔᚑ 16 ᐕ 12 ᦬ 15 ᣣ.
̆̆̆̆̆ 2005a ‫ޟ‬ਛᄩ␠ળ଻㒾ක≮ද⼏ળߩᣂߚߥ಴⊒ߩߚ߼ߦ‫ޠ‬㧔‫ޟ‬ਛකදߩ࿷ࠅᣇߦ㑐ߔࠆ᦭⼂⠪ળ⼏‫ޠ‬ႎ๔ᦠ㧕ᐔᚑ 17 ᐕ 7 ᦬ 20 ᣣ̆̆̆̆̆ 2005b ‫≮⸻ޟ‬ႎ㈽૕♽ߩ⷗⋥ߒߦߟ޿ߡ‫ޠ‬̆̆̆̆̆ 2005c ‫ޟ‬ක≮೙ᐲ᭴ㅧᡷ㕟⹜᩺‫ޠ‬ᐔᚑ 17 ᐕ 10 ᦬ 19 ᣣ.
㥲⮮⵨⟤࡮㡍↰ᔘᒾ㧔2003㧕‫ޟ‬ᷙว⸻≮ࠍ߼ߋࠆ৻⠨ኤ㧦ല₸ᕈߣ౏ᐔᕈߦߟ޿ߡ‫ޡޠ‬ක≮ߣ␠ળ‫ޢ‬
Vol.13,No.2,2003 ᐕ pp.153-168.
␠ળ଻㒾⎇ⓥᚲ 2004 ‫ޡ‬ක⑼⸻≮ႎ㈽ὐᢙ⴫‫␠ޢ‬ળ଻㒾⎇ⓥᚲ
ߓ߶߁ 2005 ‫⮎ޡ‬ଔၮḰὐᢙᣧ⷗⴫‫߁߶ߓޢ‬㜞ᧁ቟㓶 2005 ‫߇ࠊޟ‬࿖ߩ⸻≮ႎ㈽᡽╷ߩዷ㐿ߣ੹ᣣ⊛⺖㗴㧙ᛛⴚ⹏ଔߣක≮⾌㈩ಽߩࠫ࡟ࡦࡑ㧙‫ޠ‬㧔㆙⮮ਭᄦ࡮ᳰ਄⋥Ꮘ ✬⪺‫ޡ‬ක≮଻㒾࡮⸻≮ႎ㈽೙ᐲ‫ޢ‬ഹ⨲ᦠᚱ㧕, pp.93-122.
⍮㊁ືᦶ 1988 ‫߇ࠊޟ‬࿖ߦ߅ߌࠆ౏⑳ਔ∛㒮ߩⴕേ㧦੍஻⊛⠨ኤ‫ޠ‬‫␠ޡ‬ળ⑼ቇ‫ ╙ޢ‬40 㓸㧘pp.23-36.
̆̆̆̆ 1994 ‫ߣ࠻ࠬࠦࡓࠗ࠲ޟ‬ฃ⸻ⴕേ㧦ࠊ߇࿖ߦ߅ߌࠆක≮ᯏ㑐ㆬᛯߩ⠨ኤ‫ޡޠ‬ක≮ߣ␠ળ‫ޢ‬
vol.4,no.1,pp.1-25.
̆̆̆̆ 1995 ‫߇ࠊޟ‬࿖ක≮ᯏ㑐ߩ᭴ㅧ⊛․ᓽߣⴕേ‫(ޠ‬㡍↰ᔘᒾ✬‫ޡ‬ᣣᧄߩක≮⚻ᷣ‫᧲ޢ‬ᵗ⚻ᷣᣂႎ␠),pp.103-127.
̆̆̆̆ 2003a ‫ޟ‬㜞㦂⠪౉㒮ක≮⾌ߩㇺ㆏ᐭ⋵೎ᩰᏅߣߘߩ᳿ቯⷐ࿃‫ޡޠ‬ක≮ߣ␠ળ‫ޢ‬vol.13, no.1,
pp.1-15.
̆̆̆̆ 2003b ‫ޟ‬㜞㦂⠪ක≮⾌,⸻≮ႎ㈽೙ᐲ߅ࠃ߮⑳⊛ක≮ᯏ㑐‫ޠ‬‫ޡ‬ળ⸘ᬌᩏ⎇ⓥ‫ ╙ޢ‬28 ภ㧘pp.217-232.
̆̆̆̆ 2004 ‫ޟ‬㕖༡೑ᕈ೙⚂ߣ⸻≮ႎ㈽ⷙ೙㧦ක≮ࠨ࡯ࡆࠬߩ೙ᐲ⚻ᷣಽᨆ‫ޠ‬‫ޡ‬ක≮ߣ␠ળ‫ޢ‬vol.14, no.3,
pp.51-68.
̆̆̆̆ 2005 ‫ޟ‬㜞㦂⠪ක≮⾌ߩᩰᏅ,౏⑳ක≮ᯏ㑐ߩ૬ሽ,߅ࠃ߮౏⊛ⷙ೙‫ޠ‬㧔↰ㄭᩕᴦ࡮૒⮮ਥశ✬‫ޡ‬ක≮ߣ੺⼔ߩ਎ઍ㑆ᩰᏅ‫᧲ޢ‬ᵗ⚻ᷣᣂႎ␠㧕,pp.77-96.
⍮㊁ືᦶ࡮᧖㊁⺈ 2004 ‫ޟ‬㜞㦂⠪ක≮⾌ߩᩰᏅߣߘߩ⚻ᷣ⊛฽ᗧ‫ޠ‬ጟጊᄢቇ⚻ᷣቇળ㔀⹹ 36 2 , pp.15-34.
㡍↰ᔘᒾ 1995 ‫ޟ‬ᣣᧄකᏧળߩⴕേ̆‫ޡ‬ᣣක࠾ࡘ࡯ࠬ‫ޢ‬25 ᐕߩಽᨆ‫ޠ‬㧔㡍↰ᔘᒾ✬‫ޡ‬ᣣᧄߩක≮⚻ᷣ‫ޢ‬᧲ᵗ⚻ᷣᣂႎ␠㧕, pp.151-167.
̆̆̆̆ 2001 ,‫ޟ‬ᣣᧄߩක≮᡽╷̆౏౒⚻ᷣቇ⊛஥㕙‫ޠ‬‫⚻ޡ‬ᷣ⎇ⓥ‫ޢ‬vol.52, no.3, pp.205-219.
ᨋⴕᚑ࡮Ⴧ↰⃍⦟ 2003 ‫ޟ‬ᷙว⸻≮⑌ᱛ೙ᐲߦ㑐ߔࠆ⚻ᷣℂ⺰⊛⠨ኤ‫ޡޠ‬ක≮ߣ␠ળ‫ޢ‬vol.13,no.3,
pp.73-85.
ศේൎ࡮๺↰ஜੑ 1999 ‫ޡ‬ᣣᧄක≮଻㒾೙ᐲผ‫᧲ޢ‬ᵗ⚻ᷣᣂႎ␠
Alchian,A.A. 1965 , "Some Economics of Property Rights," Il Politico 30, no.4, pp816-829. Reprinted
in Alchian,A.A., Economic Forces at Work, Liberty Press, 1977.
Alchian,A.A. and H. Demsetz 1972 , "Production, Information Costs, and Economic Organization,"

American Economic Review 62, December, pp.777-795.
Alston,L.J., T.Eggertsson and D.C.North

1996 , Empirical Studies in Institutional Change,㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕

Cambridge University Press.
Arrow,K.J. 1963 , "Uncertainty and the Welfare Economics of Medical Care," American Economic

Review 53 5 , pp.941-973.
Barzel,Y 1997 , Economic Analysis of Property Right, second edition, Cambridge University Press.
(ਤᴛ቟ᴦ ⸶‫↥⽷ޡ‬ᮭ࡮ᚲ᦭ᮭߩ⚻ᷣಽᨆ‫⊕ޢ‬᩶ᦠᚱ 2003 ᐕ)
Brekke,K.R., R.Nuscheler and O.R.Straume 2005 , "Gatekeeping in Health Care," CESinf Working

Paper No.1552, September, 2005.
Cheung,S.N.S 1974 , "A Theory of Price Control", Journal of law and economics, vol.17, no.1,
pp.53-72.
Demsetz,H. 1966 , "Some Aspects of Property Rights ", Journal of Law and Economics 9, October,
pp.61-70.
Demsetz,H. 1967 , "Toward a Theory of Property Rights ", American Economic Review 57, no.2,
pp.347-373.
Furubotn,G.E.and S.Pejovich 1972 , "Property Rights and Economic Theory: A Survey of Recent
Literature," Journal of Economic Literature 10, pp.1137-1162.
Hammer,P.J.,ed. 2003 , Uncertain Times: Kenneth Arrow and the Changing Economics of HealthCare, Duke University Press.
Institute of Medicine 2001 , Crossing the Quality Chasm:a New Health System for the 21st Century,
National Academey Press.
North,D.C. 1990 , Institutions, Institutional Changes and Economic Performance, Cambridge
University Press. ┻ਅ౏ⷞ ⸶‫ޡ‬೙ᐲ࡮೙ᐲᄌൻ࡮⚻ᷣᚑᨐ‫ᤩޢ‬ᵗᦠᚱ 1994 ᐕOECD 1987 , Financing and Delivering Health Care: A Comparative Analysis of OECD Countries,
Paris: OECD.
̆̆ 1994 , The Reform of Health Care Systems: A Review of Seventeen OECD Countries, Paris:OECD.
̆̆ 2004 ,The OECD Health Project :Towards High-Performing Health Systems, Paris:OECD.
̆̆ 2005 , OECD Health Data 2005, Paris:OECD.
Scott,A. 2000 , "Economics of General Practice," in Culyer,A.J. and J.P.Newhouse eds. , Handbookof Health Economics,Vol.1B., North-Holland, Amsterdam, pp.1175-1200.
Siciliani,L. and J.Hurst 2003 , Explaining Waiting Times Variations for Elective Surgery AcrossOECD Countries, OECD Health Working Papers㧙㧙