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請使用永久網址來引用或連結此文件:
http://ir.cmu.edu.tw/ir/handle/310903500/24015
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| 題名: | 民眾選擇自費就醫因素之探討-以台中縣市為例;Factors Associated with Patients''s Choice between NHI-contracted Clinics and non-NHI-contracted Clinics |
| 作者: | 邱聖豪;Sheng-Hao Chiu |
| 貢獻者: | 中國醫藥學院醫務管理研究所 |
| 關鍵詞: | 自費就醫;非全民健保特約診所;就醫選擇;out-of-pocket payment;non-NHI-contracted clinics;choice behavior |
| 日期: | 1999 |
| 上傳時間: | 2009-12-02 14:16:04 (UTC+8) |
| 摘要: | 全民健保自民國八十四年三月一日實施至今，幾乎全民納保，加上醫療院所特約率高達九成以上，全民健保對民眾的就醫選擇權又幾乎沒有限制，除偏遠山地、離島地區外，全民健保已提供給民眾一個擁有充足醫療資源、高度醫療可近性及充分就醫選擇權的醫療環境，為何仍有民眾願意選擇至非健保特約醫療院所自費就醫？ 本文的研究目的在於探討民眾選擇至非健保特約診所自費就醫之主要原因；比較民眾在選擇自費就醫場所時及選擇健保特約診所時，各個就醫場所選擇之影響因素的重要性有何不同；並從民眾之個人基本資料、就醫背景、就醫場所選擇之影響因素中找出顯著影響民眾選擇自費就醫的因素。 本研究以台中縣市為取樣地區，針對健保特約及非健保特約之中、西醫診所各抽樣10家診所，共40家診所，以結構式問卷進行訪談病患，每家診所25份，共1,000份，問卷實際回收848份。其中有386位當次自費就醫者、462位當次使用健保卡就醫者；550位為曾經自費就醫者，298位為從未自費就醫者。 以敘述性統計、t檢定、卡方檢定與羅吉斯迴歸〈Logistic Regression〉來分析本研究之各種問題。研究結果發現，醫術及名氣仍舊是民眾選擇自費就醫之主要原因。在就醫場所選擇之影響因素方面，經t-test檢定，發現當民眾選擇自費時，會較重視醫師的醫術及名氣、自付額的高低；當民眾選擇使用健保卡就醫時，會較重視服務態度良好、儀器設備新穎、等候時間長短、交通時間長短。在當次自費/從未自費的羅吉斯迴歸模式中，對健保的滿意度、慢性疾病、心臟系統疾病、婦科疾病、復健、骨傷、交通時間長短、醫師的醫術及名氣、自付額的高低、儀器設備新穎、宗教信仰、居住地區為顯著影響因素〈p<0.05〉，其中對健保的滿意度等級越高，越不容易選擇自費就醫；慢性疾病患者較急性疾病患者易選擇自費就醫；心臟系統疾病患者、婦科疾病患者較非該科疾病患者易選擇自費就醫；復健病患、骨傷病患較非該科病患不易選擇自費就醫；越重視交通時間長短者、越重視自付額的高低者及越重視儀器設備新穎者，越不易選擇自費就醫；越重視醫師的醫術及名氣者，越容易選擇自費就醫；信仰佛、道教者較無宗教信仰者易選擇自費就醫；居住在非市區者較居住在市區者易選擇自費就醫。; In Taiwan, the government introduced National Health Insurance ( NHI ) to cover all citizens in 1995. This study examines the factors that influence patients’ choice between NHI-contracted clinics and non-NHI-contracted clinics. It was planned to sample 25 patients in each clinics ( 40 clinics, 10 Chinese medicine NHI-contracted clinics, 10 Chinese medicine non-NHI-contracted clinics, 10 Western medicine NHI-contracted clinics, 10 Western medicine non-NHI-contracted clinics ). A total of 848 patients were interviewed in Taichung area. Of 848 patients, 386 were non-NHI-contracted clinics’ patients, 462 were NHI-contracted clinics’ patients. Logistic regression was conducted to examine the factors associated with patients’ choice between non-NHI-contracted clinics and NHI-contracted clinics. Major results from the analyses revealed that physician’s competence was the major reason that caused patients to choose non-NHI-contracted clinics. Comparisons of mean ratings for non-NHI-contracted and NHI-contracted clinics showed that patients had a tendency to rate physician’s competence and out-of-pocket payment more important on non-NHI-contracted clinics than NHI-contracted clinics. Besides, patients had a tendency to rate courteous employees, modern equipment, waiting time, travel time more important on NHI-contracted clinics than non-NHI-contracted clinics. Based on logistic regression analysis, it was found that patients with higher satisfaction of NHI favored non-NHI-contracted clinics; patients who had some chronic illness would like to choose non-NHI-contracted clinics than with acute problems; patients with cardiovascular system diseases, gynecology diseases tended to choose non-NHI-contracted clinics than with other diseases; patients with rehabilitation diseases, orthopedic diseases tended to choose NHI-contracted clinics than with other diseases; patients who rated higher importance on travel time, out-of-pocket payment, modern equipment were more likely to choose NHI-contracted clinics; patients who rated higher importance on physician’s competence were more likely to choose non-NHI-contracted clinics; patients who had a religion in Buddhism or Taoism tended to choose non-NHI-contracted clinics than without religion; rural residing patients were more likely to choose non-NHI-contracted clinics than urban residing patients. |
| 顯示於類別: | [醫務管理學系暨碩士班] 博碩士論文
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