基層衛生保健單位角色定位與競爭模式研究－以中部某縣衛生所為例

Role positioning and competitive situation analysis of public health center－An example of mid-Taiwan county

祝年豐(Nain-Feng Chu)

指導教授 ： 任立中

國立臺灣大學/管理學院/高階公共管理組/碩士(2008年)

https://doi.org/10.6342/NTU.2008.10435

摘要

衛生所曾是台灣地區衛生醫療保健最重要的基層單位，然而隨著社會經濟發展，時空變化及醫療資源的充足，衛生所在基層醫療保健所扮演的角色也面臨著不同的挑戰。在都會區由於醫療資源的充沛，衛生所在醫療服務的角色已不復以往，然而在保健防疫及衛生教育及健康促進上仍扮演相當角色。相較於都會區，偏遠離島地區衛生所在醫療保健上的角色就更凸顯其功能性及重要性。然而因為基層醫療機構愈來愈多，其與衛生所之角色與功能也許應有不同特性。因此，在離外島及偏遠地區衛生所的角色地位及競爭分析仍值得加以研究探討，以期使衛生所能發揮其最大功能。
　　本研究是以中部某縣六家衛生所進行研究分析，調查該地區民眾對當地衛生所使用情形、角色定位及競爭態勢分析。經立意取樣，本研究於2008年5月，選取每天前10位於該六家衛生所接受服務個案為受訪者，各所收集120位受訪者為研究個案。個案以自填方式回答一結構式問答，內容包括基本資料及人格特質、受訪者衛生所使用情形及對衛生所服務滿意度等資料。本研究除分析不同受訪者基本特性及探討衛生所使用情形及滿意度狀況，並進行不同醫療機構間各項服務屬性競爭態勢分析及知覺定位圖分析，同時亦比較分析衛生所在各項服務屬性競爭態勢分析及知覺定位分析。
本研究共收集720位個案（其中男性278位約38.6%，女性442位約61.4%），平均每月去衛生所的頻率以少於1次有321位約44.6%。去衛生所的目的，以一般門診的55.1%為最多，在服務態度、醫療費用、省時、地點方便、服務內容及服務安全感等認為重要及非常重要的均達八成以上。其中服務較安心及有安全感最高約為93.5%。
全部受訪者對不同醫療機構的競爭態勢分析及知覺定位分析中，衛生所在費用低及地點方便均佔優勢，而在省時間、服務完整、態度親切及安全感上則為弱勢。衛生所距理想點的距離為最近，另中醫診所、西醫診所及藥局為同一競爭群的醫療機構，而醫院則位於較單獨的位置。在不同性別、年齡、收入或教育程度受訪者均有類似結果。各衛生所受訪者中，仍覺得各衛生所與理想點較接近，但各衛生所的優勢點卻不盡相同，以沙鹿鎮及大安鄉衛生所受訪者為例，衛生所在各項屬性上均較其他醫療機構為佳，但只有費用低屬性為優勢點，其他屬性仍為弱勢點。外埔鄉衛生所受訪者則認為衛生所在費用低、省時間及地點方便等屬性均為優勢點，其他則為弱勢點。此外，地點方便不但在衛生所為優勢點，在西醫診所及藥局亦同為優勢點。在六家衛生所的比較分析中，梧棲鎮衛生所在各項屬性上均較其他衛生所為佳，其次為清水鎮衛生所。大安鄉、沙鹿鎮及大甲鎮衛生所為屬性較相似的衛生所，外埔鄉衛生所在服務完整及安全感等屬性較為弱勢。
由本研究結果可以發現，在使用衛生所的受訪者，約一半以上喜歡或非常喜歡衛生所，前往衛生所目的仍以接受一般門診服務為主。約八成以上受訪者對衛生所提供的服務內容及醫護人員的專業均認為滿意或非常滿意。雖然衛生所與其他醫療機構比較具理想點較近，但只有費用低或地點方便等屬性具優勢，其他服務完整、態度親切及安全感等屬性仍為弱勢，有待加強與改善。不同衛生所間各項屬性的比較發現各家衛生所在優、弱勢屬性亦不相同，整體而言，以梧棲鎮衛生所為較佳，清水鎮衛生所居次，其他四家衛生所則為相類似群體。
本研究為以競爭態勢分析及知覺定位圖分析來比較衛生所與基層保健機構的競爭分析，此不但可提供中部某縣六家衛生所其服務滿意及需加強改善之分析。同時，亦可藉由此模式將衛生所與其他醫療機構進行比較分析，以瞭解其競爭之優弱勢，以到改善服務內容及追求卓越目標。

關鍵字

基層衛生保健單位 ； 角色定位 ； 競爭態勢分析 ； 知覺定位圖

並列摘要

Public health center (PHC) was ever an important health care and disease prevention primary institue in Taiwan. However as the social-economic developed and medical resources growth, PHC faced many different challenges. In comparison with the urban area, the function, role and competition of PHC in rural area became more and more important.
We selected six public health centers in mid-Taiwan county to evaluate their function, utilization and positioning. Furthermore we compared PHCs with other primary health care institues to examine the competition analysis. After purposive sampling, we enrolled the first 10 subjects who received services in each PHC (total 6 PHCs), on the first 2 weeks of May, 2008. Self-reported structure questionnaire included general characteristics, utilization, and satisfactions of PHC services were recoded. Competitive situation analysis was conducted to evaluate the performance on different health care institutes.
Totally 720 subjects (278 male, 38.6%, 442 female, 61.4%) were included, 321 utilized the PHC less than≦1 per month (55.2%). For the purpose of visiting PHC, about 55.1% subjects were seeking for general outpatient services. More than 80% subjects considered service attitude, medical expense, time consumption, location convenience, service content and safety were important or very important criteria for PHC services. Among these criteria, the most important factor for the primary health care institute is safety (93.5%).
In competitive situation and perception of positioning analyses, the advantages of PHC were low expense and location convenience. The related disadvantages for PHC were time consumption, service in complete, attitude unfriendly and unsafety. But the PHC still had the nearest distance to the ideal point among these health care institutes. Chinese medicine clinic, western medicine clinic and pharmacy were with the same competitive group in the perception map; however, the hospital was in the separate group. Similar results were found in different gender, age, average income or education level subjects.
The advantages for each PHC were varying, for example, Shalu and Da-an Township PHC, both had better service criteria scores than other medical care institutes, but only with the advantage of low expense. In Waipu Township PHC, low expenses, less time consumption and location convenience were advantages. In addition, location convenience was not only the advantage for public health center, but also for medical clinic and pharmacy. In comparison of these PHCs, Wuci Township PHC had better performances in all service criteria, the following was Cingshuei Township PHC. Da-an, Shalu and Da-jia Township PHCs had similar service criteria scores, but the Waipu Township PHC had the characteristics of service incomplete and unsafety.
Our study used competitive situation analysis and perception of positioning analysis to evaluate the health care satisfiction, performance and competition among different medical care institutes (including PHC) in Taiwan. These results may help us to make better decision, about improving service content, role positioning and primere goal of public health center on primary medical care in the future.

並列關鍵字

Public health center ； Utilization ； Role positioning ； Competitive situation analysis ； Perception of positioning analysis

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