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http://ir.cmu.edu.tw/ir/handle/310903500/11192
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| 題名: | 民眾至基層診所就醫意願與開業醫師對醫療服務自我評價之研究 |
| 作者: | 蔡文正(Tsai,Wen-Chen);阮金祥;龔佩珍(Kung, Pei-Tseng) |
| 貢獻者: | 公共衛生學院醫務管理學系 |
| 日期: | 2002-06-30 |
| 上傳時間: | 2009-09-01 15:06:57 (UTC+8) |
| 摘要: | 在全民健保開辦之後，民眾就醫僅需支付少許部分負擔，大大減輕了民眾就醫的財務障礙，加上民眾也普遍認為高層級醫療院所的醫術可能較佳，反而紛紛湧向大型醫院求診。就需求面而言，不少民眾不分大小病一律前往高層級醫療院所求診因而造成無謂的浪費。根據中央健保局的統計（民國89年），醫學中心與區域醫院每件門診平均費用約為1,349與 1,161元，而基層院所約為410元，兩者相差達三倍之多。事實上，根據過去研究發現一般人健康上的問題有百分之八、九十是受過基本醫療訓練與教育的醫師能處理的小症狀，卻因民眾崇尚大醫院的心態而過度浪費醫療資源，並未能將資源真正的用於需要者身上。因此本研究將同時從需求面探討民眾至基層診所就診之意願與從供給面探討開業醫師對本身執行醫療服務的自我評價。本研究將以台中縣市之西、中、牙醫為研究對象，在研究樣本的選取上，將依衛生署八十八年底醫院評鑑統計資料之分級分為醫學中心、區域醫院、地區醫院、診所四個層級進行探訪，並至醫療院所實地隨機抽取就醫民眾，由於病患之就醫層級別有異，故樣本抽樣方式採分層抽樣（Stratified sampling），共1500份。在開業醫師的選取上則以中央健保局88年12月底之醫療特約機構檔案中，台中縣市所有加入健保特約之西、中、牙醫診所共約2393家為對象，隨機抽取500家之開業醫師，分別西、中、牙醫診所依實際數目之比例各為250、100、150家，進行實地問卷訪問。在民眾選擇基層醫療院所就診意願部分，參考Aday＆Andersen（1975）第二階段健康行為模式，設計結構式問卷，以民眾個人特性、醫療服務利用情形、民眾選擇就醫因素等來探討民眾選擇基層診所就診意願，並以羅吉斯迴歸〈Logistic Regression〉控制其他自變項的特性來分析哪些因素會顯著影響民眾選擇至基層診所就診。在開業醫師對本身執行醫療業務自我評價與影響因素方面，以開業醫師之個人特性、執業診所特質及醫療相關因素與認知探討其對本身執行醫療業務自我評價，並以複迴歸〈Multiple Regression〉控制其他自變項的特性來分析哪些因素會影響其自我評價。最後進一步比較民眾選擇基層診所就診意願重要因素與開業醫師對本身執行醫療業務自我評價優勢因素，並以t-test檢定兩組重要因素是否有顯著差異。同時比較不同執業科別間對民眾選擇基層診所就診意願與開業醫師對本身執行醫療業務自我評價之差異。本研究之目的在於瞭解民眾選擇至基層診所之就診意願與影響因素及開業醫師對本身執行醫療業務之評價與影響因素，最後探討如何提升基層醫療服務品質及增加民眾選擇至基層診所就診意願之建議，以提供制訂衛生及健保相關制度之參考。
After the National Health Insurance (NHI) program has been implemented in Taiwan, patients only need to pay a few of copayments when they visit the physicians. This policy has greatly reduced peoples？H？H financial barrier. This situation causes to waste a lot of medical care resources. In fact, according to the previous study, over 80 percent of health problems with no serious symptoms can be cured by the physicians who have basic medical education and trainings. The medical resources are over wasted because patients prefer to go to larger hospitals. So, this study will probe into this issue from two views. This study will include western medicine, traditional Chinese medicine, and dentistry and focus on Taichung county and Taichung city . According to the hospital evaluation by Department of Health in 1999, the hospitals can be separated into four levels, which were medical center, regional hospital, divisional hospital, and clinic. This study will be based on these four levels and conduct the research sampling for patients. Because the patients may be different in the different level of hospitals, the stratified sampling will be used. The sample size will be 1500. In the clinic physician sampling, this study will be based on the files (NHI- contracted clinics in December, 1999) that included all of the contracted clinics in Taichung county and Taichung city. There are total 2393 clinic physicians and 500 of them will be randomly selected to be the sample and be asked for answering the questionnaire. The sample of clinic physicians will consist of 250 western medicine clinics, 100 Chinese medicine clinics, and 150 dental clinics according to the ratio of these three kinds of clinics in Taichung area. In the analysis of peoples？H？H willingness to visit the clinic physician, the Aday？H？Hs and Andersen？H？Hs second stage of health behavior model will be applied to design the structural questionnaire. Some factors such as patient？H？Hs characteristics, health service utilization, and the factors of patient？H？Hs choices for physician services will be included to examine people？H？Hs willingness to visit clinic physicians. Logistic regression will be used to analyze what factors will significantly affect peoples？H？H willingness to go to the clinic, after controlling the other independent variables. On the other hand, some factors such as the characteristics of physicians and of clinics, and perception of medical care ability and perception for NHI program will influence clinic physician？H？Hs self-evaluation for medical care. Multiple regression will be applied to analyze the self-evaluation of clinic physician for their health services. In addition, this study will compare the important factors that are related to people？H？Hs willingness to visit clinic physicians and that influence physician？H？Hs self-evaluation for health services. The t-test will be used to examine whether the factors are significantly different between patients and physicians. This study will also explore the impact of different kinds of medical services such as western medicine, Chinese medicine, and dental care on patient？H？Hs willingness to visit clinic physicians and on clinic physician？H？Hs self-evaluation for their health services. The main purpose of this study is not only to understand peoples？H？H willingness to visit clinic physicians and the relative factors, but also to investigate the physicians？H？H self-evaluation for their health services and the relative factors. This study will give the recommendation of how to promote the health service quality of clinics and of how to increase peoples？H？H willingness to visit clinic physicians. The results of this study can be applied for government to improve the related health policy in Taiwan. |
| 顯示於類別: | [醫務管理學系暨碩士班] 研究計畫
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