| 摘要: | 目的：台灣就醫便利民眾習慣在各醫院間遊走或是小病直接到大醫院就醫，導致醫院門急診壅塞且醫療資源浪費情形。為鼓勵民眾小病至當地診所就醫，合理運用醫療資源，實施各層級醫院部分負擔採固定金額收取，若轉診則不加重部分負擔之設計，但成效並未顯著。本研究將以民眾端角度藉由社會行銷理論與行動可能性概念，採用社會行銷理論中民眾在轉診行為中所需付出之「成本」的概念，以及影響民眾在現行就醫場所就醫行動的利益及障礙因素，對其影響接受轉診之行為意願可能性進行探討。
方法：本研究以便利取樣方式選取中部某家醫學中心為取樣場所，且為內科就醫之所有民眾，發放438份問卷。收集個案人口學特性、行動線索的接觸、行動利益、行動障礙等資料，探討個案對接受分級醫療轉診行為意願之影響因素。採用SPSS 18.0統計套裝軟體進行資料分析。
結果：顯示「行動線索資訊性」對於「接受轉診行為意願」有顯著正向影響，民眾獲取轉診資訊的來源管道越多元、認知幫助性越高，「轉診利益」對「接受轉診行為意願」也有顯著正向影響，顯示民眾若認知轉診行為可以帶來的好處越高，則更願意去接受轉診。特別若是提供距離近且便利的就醫時間及檢查、就醫付出金額較低，其接受轉診的行為意願就越高。「轉診障礙」對「接受轉診行為意願」則有負向影響，「基層醫療院所設備儀器不足」、「門診時間少就醫不便利」、「擔心造成疾病治療的延誤」為主要障礙。
結論與建議：本研究結果顯示，民眾獲取轉診資訊的來源管道越多元、認知幫助性越高；以多元管道及淺顯易懂模式介紹「分級醫療、聰明就醫」、「厝邊好醫師」、部分負擔低等轉診利益，宣導基層醫療院所提升其醫療品質，加強民眾對基層醫療品質的信心，減低其對轉診行為的就醫障礙，對於分級醫療有更大助益。而提供便利的就醫時間及檢查、就醫付出金額較低，其接受轉診的行為意願就越高。基層醫療院所強化醫療品質，建立良好制度及口碑品牌，透過與大型醫療機構聯盟、合作，讓民眾感受接受轉診後，仍有順暢、即時之轉診模式。
建議下列4點可作為未來分級醫療轉診制度之政策參考。
1.宣導策略：衛生主管機關可朝向增加知名專業的代言意見領袖，透過多元的宣傳媒體及管道宣導分級醫療轉診制度。
2.提高基層診所於假日、夜間、連續假期之服務量能。
3.增強醫療機構代檢的服務系統，制定優良轉診整合系統，提升民眾對基層醫療院所的信心，提高以實際行動支持及配合轉診
4.針對特定族群加強宣導，如協助年長族群協助轉診至就醫過程交通便利且鄰近住家之基層院所、以及透過癌症病友分享宣導等。
Purpose: Medical care is convenient in Taiwan. People are used to having their medical care from one clinic to another or going to a hospital for a trivial symptom. It causes unavailability of the emergency room for those who need and wasting medical resources. In order to encoring the dwellers to having their medical care in local clinics and using medical resources in proper, a certain fee of grading medical care among hospitals is mostly required. It is also designed for referral patients not to be over-charged; its effect, however, is not significant. In this study, the concept of the action possibility and the social marketing theory is gathered from people’s perspectives. The idea of “cost” in referral system under social marketing theory is adopted, and the impediment factors of medical care in current medical locations affecting people’s benefit are discussed. Above which, the possibilities of the willingness in referral system under affection is analyzed.
Approaches: the sample subjects in this study are selected randomly from the patients of the division of general medicine in a medical center in central Taiwan. Through 438 questionnaires, the information including the features of singular cases, the connections of action possibilities, the action benefits and action impediments is collected. The factors of accepting referral system under grading medical care for singular subjects are mainly discussed. The data are analyzed with SPSS statistic software.
Outcomes: The analysis shows “action-led information” having a significant affection toward “the willingness accepting referral system”. The more sources of referral system people acquire, the higher possibility of recognition they accept. It also reveals a positive affection in “referral benefits” toward “the willingness accepting referral system”. The more benefits people receive from referral, the more agreement of referral are permitted. In particular either the medical care nearby with flexible timetable and regular check-up offered or in a lower medical fee leads to higher willingness accepting referral system for people. “Action impediments” has a negative affection toward “the willingness accepting referral system”. The major inavalaiblities are “a lack of medical facilities in local hospitals”, “inelastic medical timetable” and “causing delay treatment”.
Conclusions and suggestions: The outcomes of this research shows that the more referral informational resources people get, the higher recognition they have. In a pattern of the multiple introduction with simple slogans like “Grading medical care, Brilliant medical care!” or “A neighboring doctors!”, low fee for referral, advocating primary care institutions to improving their qualities of medical treatments, strengthening people’s trust toward the qualities of medical treatments in primary care institutions. Also to decrease the referral barriers in order to promote grading medical care. However, offering medical care nearby with flexible timetable and regular check-up and lower medical fee result in higher willingness toward the acceptation of referral of the public. The reformed qualities of treatments in primary care institutions, rebuilt systems and brands as well as allied and cooperating with larger medical institutions are acceptable for those who referral. It is a fluent pattern of referral system in people’s viewpoints.
The four points listed below are for the reference toward the policy of future grading medical care.
1. Campaign stratagems: Public Healthy Bureau may hire or consult professional medical authorities and advocate grading medical care under referral system via diverse media or methods.
2. Enhancing the efficiency of primary care clinics’ services during holidays, night shifts and series national holidays.
3. Strengthening the service systems of medical institutions, forming a qualified referral system, increasing people’s faith toward primary care institutions, and rising the actural actions supporting referral.
4. Advocating the concepts to certain groups, like the elders, to square their medical care in initial medical institutions in the neighborhood under referral system, as well as advocating via sharing stories from cancer patients etc. |
