探討病人忠誠度、價值共創行為，以及使用健康照護服務之意圖

Patient Loyalty, Value Co-creation Behavior, and Intention to Use in Healthcare Service Contexts

謝佩珊(Hsieh, Pei Shan)

指導教授 ： 林福仁

國立清華大學/科技管理學院/科技管理研究所/博士(2015年)

https://doi.org/10.6843/NTHU.2015.00302

摘要

在論人計酬支付制度之下，根據被保險人過去兩年的健保醫療支出，訂定當年度的健保支出額度。如果當年度的健保支出低於額度，結餘的經費就成為醫院的盈餘；反之，若醫療支出高於額度，則多出來的費用，照護的醫院要自行吸收。目前在台灣，病人被授予可以自由選擇不同的健康照護提供者。因此，對於實施論人計酬支付制度的醫院而言，如何讓其分配到的病人能忠誠地使用其服務至關重要。本研究探討論人計酬支付制度中的兩大議題：病人忠誠度以及病人和醫院之間的資訊不對稱。
本論文包含三大主題，安排如下：首先，我們以病人忠誠度，病人體驗，服務接觸和病人價值共創行為來解釋所提出來的概念性模型。第二個主題的目的是要解釋病人在健康照護情境下，對於醫院的不同服務接觸所認知的服務品質，以及關於醫院形象的認知，是否會影響他們的價值共創行為。第一和第二個主題的樣本資料來自於台灣北部區域教學醫院（耕莘醫院）之不同門診的病人。第三個主題則以情境為基礎的實驗法，調查病人在知道醫院實施論人計酬制度，以及他們歸屬於該醫院照護的病人時，使用該醫院服務的意圖。
本論文研究發現病人在不同的服務接觸點會因其公民行為之不同有不同的忠誠度表現；同時，在所獲得的價值與對醫院的信任在不同的服務接觸點也會影響病人共創價值的行為。在醫病資訊不對稱的情況下，從情境的實驗的結果得知醫院主動發出論文計酬支付制度以及健康照顧服務的資訊，對於病人就診意願有顯著的影響。從研究結果，健康服務提供者如醫院可以配置服務資源在不同的服務接觸點以獲得更好的病人忠誠度與共創價值的行為表現。發布病人為中心的健康照顧資訊（如: e-health）與機構服務資訊（如: 論人計酬支付制度），可以增進病人就診的意願。因此，本研究的發現除了在學術的理論上有所增進外，對於健康服務的實務上，也有具體的參考價值。然而，本研究的結果僅在某一段時間內中所獲得的資料，未來可以發展病人行為模式的縱貫性研究。

關鍵字

病人忠誠度 ； 價值共創 ； 病人體驗 ； 服務接觸

並列摘要

Patient loyalty is crucial within a capitation payment scheme, especially when patients are granted freedom to choose among alternative providers, e.g., in Taiwan. A service provider can take the part of the amount paid as profit if the patient uses few services, and has to absorb the excessive expenses if the patient consumes services the cost exceeding the reserved. As a result, the success of the capitation payment scheme needs to tackle two major issues patient loyalty and the information asymmetry between patients and the hospital.
This dissertation includes three main themes organized as follows. First, we explain the proposed conceptual model along with relevant research pertaining to patient loyalty, patient experience, service encounter and patient co-creation behavior. The aim of the second theme is to justify the role played by each encounter of perceived service quality and hospital image in the explanation of co-creation behavior in the context of the healthcare services offered by a hospital. We collected data about patients of different clinics in a regional hospital (Cardinal Tien Hospital: CTH) in northern Taiwan for the first and second theme. Finally, in the third theme, through the scenario-based survey method, we investigate patients’ revisit intention to a hospital after they know about their affiliation with the specified hospital via the capitation system.
This research discovered that patients’ experiences in different healthcare service encounters with different patient citizenship behaviors affect the loyalty to the corresponding service providers (e.g., hospitals). Patients’ perceived value and trust from different service encounters also affects their value co-creation behaviors. From the scenario-based survery, we identified that siganaling instittuionalized service information and the patient-centered care service information policy significantly affect patients’ intention to use the service provided by the healthcare service provider comparing with signialing no or either one information item. The results imply that a healthcare service provider such as a hospitial can allocate resources for different service encounters in order to maintain patients’ loyalty and value co-creation behaviors. The provision of the information in institutationlized service (e.g., capitation payment scheme) and the patient-centered service (e.g., e-healthcare service) could increase patients’ intention to use the services provided the healthcare service provider. In summary, this research contributes not only to the academic literature but also to the managerial implications to healthcare service. However, the findings of this study are obtained only in a snapshot of a time flow. There is a need for longitudinal studies to develop patient behavior model in future.

並列關鍵字

Patient loyalty ； value co-creation ； patient experience ； service encounter

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