不同層級醫院的形象知覺與就醫選擇月暈效應之研究

A Study of the Halo Fffect in Different Levels of Hospitals’ Images and Choices

張志鴻(Chih-Hong Chang)

指導教授 ： 曾信超

共同指導教授 ： 陳彩鳳

長榮大學/管理學院/經營管理研究所(博)/碩士(2008年)

https://doi.org/10.6833/CJCU.2008.00120

摘要

為了因應台灣醫療市場的重大改變及激烈的競爭，醫院的經營者均重視醫療行銷，醫院形象及服務滿意度的調查，以期提昇醫院的競爭力。另一方面，政府也委由民間機構自2006年起全面施行新制醫院評鑑，期望提昇醫療品質，並將民眾就醫行為導向：大病大醫院看，小病小醫院看。儘管如此，為何大部份的民眾仍往大醫院就醫？醫學中心依然門庭若市，一床難求？國內在這方面的研究，多半是對消費者滿意度及就醫選擇因素之分析較多；但對於月暈效應如何影響民眾的醫院形象知覺與就醫選擇則較缺乏。
所謂月暈效應是指:人們在做判斷時，可能受限於對客體的整體或特殊顯著的部分或人們本身屬性的影響，而得出偏高或偏低的一種感受結果傾向，這種感受傾向又影響了人們對客體各別屬性的評價，造成判斷與真實情形有距離的現象，可說是一種判斷上的偏誤。本研究以高屏地區民眾為研究對象，探討月暈效應對民眾就醫選擇之影響。本研究自2007年10月至12月，共收集有效樣本243份，並採用敘述性統計分析、相關分析、共變數分析及ANOVA分析等研究方法對月暈效應進行相關的探討。最後我們也以結構方程式模型（SEM）來驗證，本研究架構各構念間的關係。本研究共歸納出以下幾點結論：
1.雖然不同層級醫院的重要屬性與非重要屬性，在月暈效應程度的測量上沒有差異，但受訪者對不同層級醫院是有不同的期待。
2.不同的測量方法──A卷(高月暈效應法)、B卷(低月暈效應法)，在月暈效應程度的測量上並無顯著差異。
3.就醫次數增加可以增加受訪者對醫院的熟悉度，進而降低對醫院之月暈效應程度，這結果在地區醫院可以得到驗證，但是在醫學中心及區域醫院則不顯著。
4.在受訪者屬性方面，我們發現高學歷者（大學以上），及高家庭收入者（平均月收入80,000元以上）對於醫學中心有明顯的月暈效應。
5.在三個層級醫院建構的SEM整體模式中，只有醫學中心在受訪者就醫選擇上具有月暈效應，而區域醫院及地區醫院的模式則不具月暈效應。
另外，依據本研究結論，我們得到下列具管理意涵之建議：
1.受訪者並不重視醫院之收費，而且高家庭收入者對於醫學中心有明顯的月暈效應，因此健保局希望藉由調高到醫學中心的部份負擔，落實雙向轉診制度，是無法達成目的；反而過高的部份負擔將造成經濟弱勢者的就醫障礙。
2.受訪者對不同層級的醫院有不同面相的期待；然而新制醫院評鑑完全以醫學中心為出發點，要求各層級醫院要在500多項評鑑要求下，接受一致的檢驗，這不但抹煞了各層級醫院應負的不同責任外，也使小醫院經營陷入困境。
3.各層級醫院的經營者必須了解自家醫院在民眾心目中有何優勢?如醫學中心必須提供病人先進完善的檢查與診療；地區醫院必須提供方便、快捷的就醫環境等。進而將此優勢屬性強化，形成月暈效應吸引病患就醫；另一方面，病患重視之屬性即使是自家醫院做不到，也必須透過與更高層級醫院之策略聯盟來加以補救。
4.本研究發現受訪者對各層級醫院的醫師都有著良好醫德、醫術及好名聲、好的服務態度的期待。身為醫師必須認真去滿足病人上述的要求，建立良好醫病關係才不會被淘汰。

關鍵字

月暈效應 ； 醫院形象 ； 醫療行銷

並列摘要

In response to fierce competition and major changes in the medical market, hospital operators must pay attention to healthcare marketing and customer satisfaction to raise hospital competitiveness. Meanwhile, in order to upgrade the quality of medical care and avoid a waste of medical resources, the government not only has stepped up its new system of hospital evaluation but also has launched its referral system to promote the concept of “treating a major disease at a large hospital and a minor disease at a small clinic” since 2006. However, large hospitals, especially medical centers, are still overcrowded, to the extent that no ward beds are readily available for an in-patient therapy. Studies related to this problem in Taiwan have mostly focused on customer satisfaction and medical options. There are fewer studies on the Halo effect and the public perception and choice of hospitals.
The halo effect refers to a perceptual tendency as a result of a higher or lower evaluation under the influence of an overall impression or particular outstanding traits of the object. The perception of these outstanding traits will affect how people evaluate the individual traits of the object and result in a discrepancy between the reality and the judgment. The halo effect is thus a kind of judgmental bias. This study used the residents in both Kaohsiung and Pingtung areas as the subjects to explore the influence of the Halo effect on hospital-going choices. A questionnaire survey was conducted during the period of October to December, 2007 with a collection of 243 valid samples. The data was analyzed by means of descriptive statistics, correlation analysis, analysis of covariance, and analysis of variance to determine the factors of the Halo effect. Finally, a structural equation model was employed to measure the applicability of the theoretic model developed in this study. This study has come up with the following findings:

1. Hospitals of different levels have different attributes, although there are no significant differences in the measurement of the Halo effect between important and unimportant attributes.
2. The two methods measuring the Halo effect in questionnaire A and questionnaire B failed to result in significant differences in the measurement of the effect.
3. The increasing frequency of visits for a patient will increase his/her familiarity with a district hospital and reduce the Halo effect. The same result cannot be found with medical centers and regional hospitals.
4. In terms of personal attributes, a significant Halo effect can be found with the subject who have a higher educational background (college and above) and a greater family income (an average of more than NT$80,000 per month) with regard to the choice of medical centers for care.
5. In the perception and choice of a hospital for a medical service, the structural equation model verifies a significant Halo effect for medical centers while it fails to verify any Halo effect for regional and district hospitals.

Meanwhile, according to the conclusions of this study, the suggestions are summarized as follows:
1. The respondents are not concerned over medical fees and a significant halo effect can be found with higher income families with regard to the choice of medical centers for healthcare. Henceforth, the Bureau of National Health Insurance, which is expected to implement its two-way referral system by raising the copayment for medical services at medical centers, will find it difficult to carry out the system. Consequently, the higher copayment will become an obstacle for the financially disadvantaged receiving healthcare at medical centers.
2. The respondents have different expectations for hospitals at different levels. However, the new hospital evaluation system has been established with more than 500 items for assessment for the scale of a medical center. It will not only disregard the responsibilities of hospitals at all levels, but also cause operating difficulties for small-scale hospitals.
3. Hospitals on all levels should be aware of their own attributes and advantages from the perspective of the public. For instance, a medical center must provide patients with advanced and comprehensive examinations and treatments, while a regional hospital should offer patients a convenient and speedy healthcare environment. A hospital should focus on its key attributes and advantages to strengthen the halo effect in order to attract patients. If a hospital fails to offer the service its patients expect, it must seek an appropriate alliance with another hospital to address this inadequacy.
4. The respondents expect doctors at hospitals of all levels to have good medical ethics, good medical skills, good reputation, and good service attitude. A doctor should work to live up to these expectations and establish good doctor-patient relationship.

並列關鍵字

Halo Effect ； Hospital Image ； Healthcare Marketing

參考文獻

2.王乃弘(1999)。民眾就醫選擇之研究－分析層級程序法之應用。中華衛誌，18(2)，138-151。

17.候毓昌、黃文鴻(1999)。中醫醫院門診病人選擇醫院之考慮因素及就醫滿意度之研究-以台中市七家醫院為例。中華衛誌，18(1)，34-42。

14.張櫻淳、黃文鴻、蘇喜(1998)。醫院形象定位之研究---以台北市六家醫學中心的家醫科民眾為例。中華衛誌，17(2)，111-124。

5.林進財、周瑛琪、郭亭玉(2001)，一般民眾對醫院行銷公關認知之研究，醫護科技學刊，3(4)，350-357

23.曾倫崇(1999)，從行銷觀點談門診顧客就診考慮因素-以台南地區為例。醫護科技學刊，1(1)，59-74。