- 學位論文
矯正機關收容人選擇公費醫療與自費延醫之影響因素及滿意度之探討－以南部某監獄為例
A Study on Factors Influencing prisoners’ Medical Care Choice between Public Service and Out-of -pocket Service and Satisfaction：A Case of a southern Taiwan prison
摘要
摘 要 目的 本研究旨在分析收容人選擇公費醫療或自費延醫之現況及醫療服務使用滿意度，進而探討影響收容人選擇公費醫療或自費延醫的相關因素。 方法 透過抽樣調查的方式對南部某監所之收容人進行問卷調查，計發放1000份，取得有效樣本825份。利用平均數、百分比及差異性分析，比較收容人選擇公費看診或自費延醫之現況，以複迴歸檢測影響收容人醫療服務滿意度之關鍵因素，另以羅吉斯迴歸探討收容人選用公費醫療或自費延醫之影響因素。 結果 近八成（79.5％，654位）收容人生病或身體不適時選用公費看診。卡方檢定發現「親友探監頻率」、「已入監執行年限」及「每個月使用保管金額度」對公費醫療或自費延醫的選用有顯著差異。就醫滿意度分數較高者為「護理人員服務品質和態度」、「看診時段安排」及「協助預約回診」而「治療效果」、「醫療設備品質」與「醫療費用合理性」則是分數最低的三項。影響整體滿意度的因素有年齡、教育程度、探監頻率、健康狀況、及治療方式。羅吉斯迴歸分析顯示，「無親屬探視」的收容人使用公費醫療的比例是「每周有親人探視」收容人的1.985倍，而「保管金（3001-5000元）」的收容人使用公費醫療的比例是「沒有保管金收入」收容人的0.545倍。 結論 本研究發現監所收容人生病時大多數選擇公費看診，因為若選擇自費延醫，個人必須自行負擔醫療費用，而無親屬探視的收容人因為缺乏金錢上的支援，所以使用公費醫療的比例也比較高。已入監執行年限「10年以上」選擇自費延醫比例較高，原因可能是監所的醫療不敷需求，故選擇自費延醫。就醫時「護理人員服務品質和態度」這個項目，滿意度分數最高，可見在犯罪矯正機關中，收容人對於管理人員、醫護人員等的「態度」較為重視。而「醫療設備品質」與「醫療費用合理性」分數較低，顯示矯正機構無足夠的設備與醫護人力，及收容人生病時無足夠的治療費用，所以如何增加收容人的就醫權益與提升照護品質，是不容忽視的課題。
並列摘要
Abstract Objectives The main purpose of this study was to get a better understanding of prisoners’ medical care choices between public service and out-of-pocket service, and the level of satisfaction with medical service. This study also tried to explore the factors which were associated with prisoners’ medical care choices. Methods A survey research design was used and a convenience sampling approach was adopted with a structured questionnaire, which collected respondents’ demographic characteristics, medical care choices, and satisfaction with medical service in a southern Taiwan prison. 1,000 copies of questionnaires were distributed and 825 returned with a valid response rate of 82.5%. In addition to descriptive analysis, logistic regression modeling was conducted to predict prisoners’ medical care choice. Results Nearly 80% of respondents sought free-of-charge medical service when in need. It was also discovered that medical care choices differed significantly by “frequency of family visiting,” “duration in prison,” and “amount of safekeeping dispensable each month.” Overall, respondents were more satisfied with “nursing staff’s attitude and service quality,” “time scheduling of medical service” and “assistance with next appointment;” to the contrary, “effectiveness of cure,” “quality of medical devices,’ and “reasonableness of service charge” were relatively unsatisfactory. Age, level of education, frequency of family visiting, health status, and medical care choice were significant predictgors of overall satisfaction. Logistic analysis showed that respondents who had no visitors were 1.985 times more likely to use public service over out-of-pocket service than their counterparts. As opposed to prisoners with no safekeeping dispensable each month, those who had an amount between NT$3001-5000 were 0.545 times likely to use use public service over out-of-pocket service. Conclusions The free-of-charge medical service was still the primary choice for most of the prisoners in this study. One reason would be related to its affordability, as was demonstrated by the relatively higher percentage of free-of-charge service use by the prisoners with no family visiting. Those who have been in prison for more than 10 years had a higher possibility of using out-of-pocket service in that the free-of-charge service might not meet their medical care need. Respondents were most satisfied with the “nursing staff’s service quality and attitude,” which to some degree might reflect the fact that prisoners cared a lot about administrators’ and medical staff’s attitudes toward them. The relatively lower scores on “quality of medical devices” and “reasonableness of service charge” might indicate that there is still a shortage of medical devices and healthcare manpower, which deserves a close attention in the future.