| 摘要: | 中文摘要 為提升山地離島偏遠地區醫療可近性，健保局自民國八十八年起陸續在全國各山地離島地區實施「全民健康保險山地離島地區醫療給付效益提昇計畫（以下簡稱IDS計畫）」，目前全國48個山地離島鄉均已納入計畫實施範圍，然而根據過去相關文獻顯示在醫療提供的方式與服務內容項目上，仍無法完全符合當地民眾的需求，造成民眾的鄉外就醫率仍然偏高。因此，本研究目的在於運用服務內容缺口模式，以瞭解參與醫療給付效益提升計畫之醫療院所(供給者)與民眾(消費者)對服務內容項目的認知以及兩者間是否有差異存在。 本研究為一橫斷面研究，樣本包含全國加入IDS計畫之醫療機構與信義鄉十八歲以上的居民。醫療機構方面以普查方式進行問卷發放，而民眾部分則以分層隨機抽樣方式抽出2034位民眾為研究樣本，並以公共衛生護士進行結構式問卷訪視以取得資料，之後再利用次數分配、平均數、標準差、卡方檢定、T檢定與變異數分析等統計方法進行問卷資料之描述性分析與缺口檢定。 本研究主要研究結果如下： 1. 在轉診後送服務上存在醫療機構方面的服務內容缺口，即未提供服務的醫療機構所認為的重要性大於有提供的醫療機構。 2. 在民眾方面並未出現服務內容的缺口，大致上民眾在服務項目重要程度與滿意度的認知上呈現正相關。 3. 信義鄉民眾與當地加入IDS計畫之醫療機構在醫療服務項目的重要程度認知上存在醫療提供者與消費者的服務內容缺口。兩者在重要程度的認知上，差異最大的前五項為：心臟內科、骨科、復健科、腎臟科、腸胃科與志工之訓練。 4. 信義鄉民眾與當地加入IDS計畫之醫療機構在應加強與協助的醫療服務項目的認知上存在醫療提供者與消費者的服務內容缺口。兩者差異最大的前五項（排除專科門診）為夜間及假日緊急醫療照護、骨科、復健科、腎臟科、胸腔科與轉診後送服務。 研究結果得知信義鄉民眾對於IDS計畫所提供的服務其滿意度很高，未來在服務項目的設計與資源的投入上應考量民眾所重視與需求的項目，以提高鄉內就醫率。 關鍵字：山地離島、醫療給付效益提升計畫、服務內容缺口模式; Abstract In order to improve accessibility of medical and health services at those mountainous, islet and outlying districts, the Bureau of National Health Insurance (NHI) has implemented “The National Health Insurance Project of Integrated Delivery Systems in Mountainous and Islet Districts (IDS)” in 1999. Presently, all of the forty-eight Mountainous and Islet Districts was involved. However the interrelated literatures indicated there was not good enough for the resident of the Mountainous and Islet Districts at the method and contents of medical service that was the cause of the high rate of doctor consultation outside of the village. Therefore, the purpose of this study is using the contents of service gaps model to understand the medical providers currently participating in “The National Health Insurance Project of Integrated Delivery Systems in Mountainous and Islet Districts” (providers) and resident’s (consumers) perception for the contents of service and whether there are difference or not. This research is a cross-sectional study. The sample involve all of the medical providers currently participating in the IDS project and the resident of the Hsin-yi Township who above eighteen years old. We sent the questionnaire to all of the medical providers currently participating in the IDS project and sampling 2034 residents which given a visit by nurse. After sampling, use Frequency Distribution Analysis, Mean, standard deviation, t-Test, ANOVA to determine the descriptive analysis and test the gap. Major findings of this study are: 1. there is a content of service gap of the medical providers in the medical transfer service, to wit, the importance of the medical transfer service of the providers don’t provide it are greater than the providers that provider the transfer service. 2. There is not a content of service gap of the resident; roughly, the importance of the medical service items of the resident is positively related to the satisfaction. 3. There is the content of service gap exist between the resident and the medical providers currently participating in the IDS project of the Hsin-yi Township in the perception for the importance of medical service items. The gaps of the top five of the perception for the importance of medical service items are the department of cardiac, orthopedics, rehabilitation, nephrology, gastrointestinal medical service and volunteer social workers training. 4. There is the content of service gap exist between the resident and the medical providers currently participating in the IDS project of the Hsin-yi Township in the perception for the need improved or helped of medical service items. The gaps of the top five of the need improved or helped of medical service items (besides the faculty outpatient service) are the department of the night and holiday emergent medical care, orthopedics, rehabilitation, nephrology, thoracic surgery and the medical transfer service. From the result of this study, the resident of the Hsin-yi Township express their great satisfaction at the medical service items of the IDS project. In the future, |
